bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of preformed foot orthoses in reducing pain in children with juvenile idiopathic arthritis: a multicentre randomized clinical trial
Authors: Fellas Antoni , Singh-Grewal Davinder , Chaitow Jeffrey , Santos Derek , Clapham Matthew , Coda Andrea 
Published: October 2021

Abstract

Objectives
The aim of this study is to investigate the effect of customized preformed foot orthoses on pain, quality of life, swollen and tender lower joints and foot and ankle disability in children with JIA.

Methods
Parallel group design. Children diagnosed with JIA were recruited from the three children’s hospitals in New South Wales, Australia. Participants were randomly assigned to a control group receiving a standard flat innersole (sham) with no corrective modifications. The trial group were prescribed a preformed device that was customized based on biomechanical assessments. Pain was the primary outcome and was followed up to 12 months post intervention. Secondary outcomes include quality of life, foot and ankle disability and swollen and tender joints. A linear mixed model was used to assess the impact of the intervention at each time point.

Results
Sixty-six participants were recruited. Child-reported pain was reduced statistically and clinically significant at 4 weeks and 3 months post intervention in favour of the trial group. Statistical significance was not reached at 6 and 12-month follow-ups. Quality of life and foot and ankle disability were not statistically significant at any follow-up; however, tender midfoot and ankle joints were significantly reduced 6 months post intervention.

Conclusion
Results of this clinical trial indicate customized preformed foot orthoses can be effective in reducing pain and tender joints in children with JIA exhibiting foot and ankle symptoms. Long-term efficacy of foot orthoses remains unclear. Overall, the trial intervention was safe, inexpensive and well tolerated by paediatric patients.

Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR): 12616001082493.
A Call to (Caring) Arms: A Response to The Care Manifesto: The Politics of Interdependence
Authors: Brennan Deborah 
Published: October 2021

Abstract
The Care Manifesto: The Politics of Interdependence calls for the reorganization of personal relationships, communities, economies, and institutions around the principle of care. Arguing that carelessness is endemic to modern societies, the authors offer numerous practical ideas for action and policy to counter this lack of care. The Manifesto has many strengths and is likely to inform, motivate and energise its readers. Given the broad ambition of the authors, it is disappointing however that they barely glance beyond Europe, the UK and the USA. In taking such a narrow perspective, they miss whole worlds of scholarship, analysis and practical examples. The lack of acknowledgment of feminist social policy is another remarkable omission. Despite its limits, The Care Manifesto conveys a profound sense of urgency about the economic, social, and ecological perils facing the world while suggesting constructive and practical alternatives so that readers are not left feeling pessimistic and powerless. It calls for a new politics based around care and a new ideal of citizenship that recognises multiple sites ranging from the personal to the planetary.
Assessing and Promoting Independence in Young Adults with Autism Spectrum Disorder
Authors: Cheak-Zamora Nancy , Tait Andrew , Coleman Ann 
Published: October 2021

ABSTRACT:

Objective:
Quality of life, independence, and employment outcomes are poor for young adults with autism spectrum disorder (YA-ASD). This study explored the desires and experiences of YA-ASD as they transition into adulthood.

Methods:
Fifteen YA-ASD, age 18 to 25 years, were recruited from autism spectrum disorder centers, participant registries, and social media advertising. Interested individuals completed a survey and individual interview. Semistructured interview guides included questions about transition experiences, current independence, and future goals. Interview transcripts were analyzed using thematic analysis.

Results:
The desire of young adults with autism spectrum disorder for independence was shown within 4 themes. YA-ASD described their vision of adulthood along with their need for improved skills in driving, living independently, and decision-making.

Conclusion:
The findings indicate YA-ASD desire to be independent but lack the specific support services to get there.
Effects of coronavirus disease-2019 on voice: our experience of laryngeal complications following mechanical ventilation in severe coronavirus disease-2019 pneumonitis and review of current literature
Authors: Watson Natalie A. , Karagama Yakubu , Burnay Victoria , Boztepe Selda , Warner Susan , Chevretton Elfy B. 
Published: October 2021

Purpose of review
Dysphonia has been described as a major symptom of coronavirus disease-2019 (COVID-19). A literature review examining this topic was undertaken and is presented here, combined with insights from our experience in managing patients with laryngeal complications following mechanical ventilation for severe COVID-19 pneumonitis.

Recent findings
Naunheim et al. reported that patients who are most at risk of needing intubation with COVID-19 disease are those with patient-specific risk factors and these are at an increased risk for subsequent laryngotracheal injury following intubation (1). In our cohort of 105 patients referred with laryngological symptoms postintubation for COVID-19 pneumonitis, 40% presented as urgent reviews, of which almost half had severe postintubation complications requiring surgery. Perceptual voice ratings and patient-reported voice ratings varied widely, but there was no significant change in voice scores postoperatively. The reflux symptom index (RSI) scores did improve significantly (p = 0.0266). The need for surgery was associated with the presence of comorbidities for instance hypertension, diabetes and obesity in our cohort. This is in support of reported association of comorbidity as a risk factor for intubation and subsequent development of postintubation airway complications.

Summary
Dysphonia following COVID-19 infection may have multiple causes. Literature reports demonstrate intubation injury, sensory neuropathy, and postviral neuropathy are associated with voice changes. Our personal experience has confirmed postintubation injury markedly affects glottic function with resultant dysphonia attributable to scar formation, posterior glottic stenosis, granulation and subglottic stenosis. Frequent surgical intervention is required for airway patency and may have short-term further deleterious effects on phonation, although in our cohort this is not statistically significant analysing Grade, Roughness, Breathiness, Asthenia, Strain, Voice Handicap Index-10 or Airway, Voice, Swallow scores. Maximal antireflux medications and advice statistically improved RSI scores postoperatively.
Strain Echocardiography and Myocardial Dysfunction in Critically Ill Children With Multisystem Inflammatory Syndrome Unrecognized by Conventional Echocardiography: A Retrospective Cohort Analysis
Authors: Basu Sonali , Kim Esther J. , Sharron Matthew P. , Austin Ashley , Pollack Murray M. , Harahsheh Ashraf S. , Dham Niti 
Published: October 2021

OBJECTIVES:
Multisystem inflammatory syndrome in children is a newly defined complication of severe acute respiratory syndrome coronavirus 2 infection that can result in cardiogenic shock in the pediatric population. Early detection of cardiac dysfunction is imperative in directing therapy and identifying patients at highest risk for deterioration. This study compares the strengths of conventional and strain echocardiography in identifying cardiac dysfunction in critically ill children with multisystem inflammatory syndrome in children and their association with ICU therapeutic needs and clinical outcomes.

DESIGN:
Retrospective, observational cohort study.

SETTING:
A large, quaternary care PICU.

PATIENTS:
Sixty-five pediatric patients admitted to the PICU with the diagnosis of multisystem inflammatory syndrome in children from March 2020 to March 2021.

INTERVENTIONS:
Global longitudinal strain four chamber was measured retrospectively by strain echocardiography and compared with conventional echocardiography. Cardiac dysfunction was defined by left ventricular ejection fraction less than 55% and global longitudinal strain four chamber greater than or equal to –17.2%. Clinical variables examined included cardiac biomarkers, immune therapies, and ICU interventions and outcomes.

MEASUREMENTS AND MAIN RESULTS:
Twenty-four patients (37%) had abnormal left ventricular ejection fraction and 56 (86%) had abnormal global longitudinal strain four chamber. Between patients with normal and abnormal left ventricular ejection fraction, we failed to identify a difference in cardiac biomarker levels, vasoactive use, respiratory support needs, or ICU length of stay. Global longitudinal strain four chamber was associated with maximum cardiac biomarker levels. Abnormal global longitudinal strain four chamber was associated with greater odds of any vasoactive use (odds ratio, 5.8; 95% CI, 1.3–25.3; z-statistic, 2.3; p = 0.021). The number of days of vasoactive infusion was correlated with global longitudinal strain four chamber (r = 0.400; 95% CI, 2.4–3.9; p < 0.001). Children with abnormal strain had longer ICU length of stay (4.5 d vs 2 d; p = 0.014).

CONCLUSIONS:
Our findings suggest strain echocardiography can detect abnormalities in cardiac function in multisystem inflammatory syndrome in children patients unrecognized by conventional echocardiography. These abnormalities are associated with increased use of intensive care therapies. Evaluation of these patients with strain echocardiography may better identify those with myocardial dysfunction and need for more intensive therapy.
Comparing Incision Choices in Immediate Microvascular Breast Reconstruction after Nipple-Sparing Mastectomy: Unique Considerations to Optimize Outcomes
Authors: Salibian Ara A. , Bekisz Jonathan M. , Frey Jordan D. , Thanik Vishal D. , Levine Jamie P. , Karp Nolan S. , Choi Mihye 
Published: October 2021

Background:
Incision planning is a critical factor in nipple-sparing mastectomy outcomes. Evidence on optimal incision patterns in patients undergoing nipple-sparing mastectomy and immediate microvascular breast reconstruction is lacking in the literature.

Methods:
A single-institution retrospective review was performed of consecutive patients undergoing nipple-sparing mastectomy and immediate microvascular autologous reconstruction from 2007 to 2019. Outcomes—including major mastectomy flap necrosis, full nipple-areola complex necrosis, and any major ischemic complication of the skin envelope—were compared among incision types. Multivariable logistic regression identified factors associated with major ischemic complication.

Results:
Two hundred seventy-nine reconstructions (163 patients) were identified, primarily using internal mammary recipient vessels (98.9 percent). Vertical incisions were used in 139 cases; inframammary, in 53; lateral radial, in 51; and inverted-T, in 35. Thirty-two cases (11.5 percent) had major mastectomy flap necrosis, 11 (3.9 percent) had full nipple-areola complex necrosis, and 38 (13.6 percent) had any major ischemic complication. Inframammary incisions had higher rates of major ischemic complication (25 percent) than vertical (5.8 percent; p < 0.001) and lateral radial (7.8 percent; p = 0.032) incisions. Inverted-T incisions also had higher rates of major ischemic complication (36.1 percent) than both vertical (p < 0.001) and lateral radial (p = 0.002) incisions. Inframammary incisions (OR, 4.382; p = 0.002), inverted-T incisions (OR, 3.952; p = 0.011), and mastectomy weight (OR, 1.003; p < 0.001) were independently associated with an increased risk of major ischemic complication. Inframammary incisions with major ischemic complication demonstrated significantly higher body mass index, mastectomy weight, and flap weight compared to those without.

Conclusions:
Inframammary and inverted-T incisions are associated with a higher risk of major ischemic skin envelope complications after nipple-sparing mastectomy and immediate microvascular breast reconstruction. Radial incisions can be considered to optimize recipient vessel exposure without compromising perfusion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
From Salvage to Prevention: A Single-Surgeon Experience with Acellular Dermal Matrix and Infection in Prepectoral Breast Reconstruction
Authors: Powers Jeremy M. , Reuter Muñoz Katherine D. , Parkerson Jamie , Nigro Lauren C. , Blanchet Nadia P. 
Published: October 2021

Background:
Increasing amounts of acellular dermal matrix are being used with the adoption of prepectoral breast reconstruction. Postoperative infection remains a challenge in breast reconstruction, and the contribution of acellular dermal matrix type, processing, and sterility assurance level to risk of complications in prepectoral reconstruction is not well studied.

Methods:
The authors performed a retrospective review of patients who underwent immediate prepectoral breast reconstruction from February of 2017 to July of 2020. Because of an increase in the rate of infection, the drain protocol was changed and acellular dermal matrix type was switched from AlloDerm (sterility assurance level, 10−3) to DermACELL (sterility assurance level, 10−6) in January of 2019. Demographic and surgical variables were collected, in addition to details regarding development and management of infection.

Results:
Despite higher rates of direct-to-implant reconstruction and bilateral procedures and increased implant volumes, the rate of infection was significantly lower in patients who received DermACELL instead of AlloDerm [two of 38 (5.3 percent) versus 11 of 41 (26.8 percent); p = 0.014]. Drain duration was slightly longer in the DermACELL group, consistent with the change in drain protocol. Baseline demographic and clinical characteristics remained similar between the two groups.

Conclusions:
With increased reliance on large amounts of acellular dermal matrix for prepectoral breast reconstruction, it directly follows that the properties of acellular dermal matrix with respect to incorporation, sterility, and implant support are that much more important to consider. There have been few studies comparing different types of acellular dermal matrix in prepectoral breast reconstruction, and further research is required to determine the contribution of acellular dermal matrix type and processing techniques to development of postoperative infection.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
New evidence for managing Gram-negative bloodstream infections
Authors: Nutman Amir , Tellapragada Chaitanya , Giske Christian G. , Yahav Dafna 
Published: October 2021

Purpose of review
Gram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI.

Recent findings
New rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened (≤7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined.

Summary
RDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.
Feature-based gating of cortical information transmission
Authors: Ray Sonia Baloni , Kaping Daniel , Treue Stefan 
Published: October 2021

AbstractIn highly developed visual systems, spatial- and feature-based attentional modulation interact to prioritize relevant information and suppress irrelevant details. We investigated the specific role and integration of these two attentional mechanisms in visual cortical area MST of rhesus monkeys. We show that spatial attention acts as a gate for information processing by providing unimpeded high-gain pass-through processing for all sensory information from attended visual locations. Feature-based attentional enhancement does not only show the known dependency on a match between the attended feature and a given cell’s selectivity, but surprisingly is restricted to those features for which a given cell contributes to perception. This necessitates a refinement of the feature-similarity gain model of attention and documents highly optimized attentional gating of sensory information for cortical processing. This gating is shaped by neuronal sensory preferences, behavioral relevance, and the causal link to perception of neurons that process this visual input.
Mouse model and human patient data suggest critical roles for Pten and p53 in suppressing POLE mutant tumor development
Authors: Park Vivian S. , Sun Meijuan J.S. , Frey Wesley D. , Williams Leonard G. , Hodel Karl P. , Strauss Juliet D. , Wellens Sydney J. , Jackson James G. , Pursell Zachary F. 
Published: October 2021

ABSTRACTMutations in the exonuclease domain of POLE are associated with tumors harboring very high mutation burdens. The mechanisms linking this significant mutation accumulation and tumor development remain poorly understood. Pole+/P286R;Trp53+/− mice showed accelerated cancer mortality compared to Pole+/P286R;Trp53+/+ mice. Cells from Pole+/P286R mice showed increased p53 activation, and subsequent loss of p53 permitted rapid growth, implicating canonical p53 loss of heterozygosity in POLE mutant tumor growth. Somewhat surprisingly, however, p53 status had no effect on tumor mutation burden or single base substitution signatures in POLE mutant tumors from mice or humans. Pten has important roles in maintaining genome stability. We find that PTEN mutations are highly enriched in human POLE mutant tumors, including many in POLE signature contexts. One such signature mutation, PTEN-F341V, was previously shown in a mouse model to specifically decrease nuclear Pten and lead to increased DNA damage. We found tumors in Pole+/P286R mice that spontaneously acquired PtenF341V mutations and were associated with significantly reduced nuclear Pten and elevated DNA damage. Taken together with recent published work, our results support the idea that POLE-mediated hypermutagenesis is necessary, but not entirely sufficient, for tumorigenesis. Disabling surveillance of nuclear DNA damage is a likely sufficient factor.
A curated collection of Klebsiella metabolic models reveals variable substrate usage and gene essentiality
Authors: Hawkey Jane , Vezina Ben , Monk Jonathan M. , Judd Louise M. , Harshegyi Taylor , López-Fernández Sebastián , Rodrigues Carla , Brisse Sylvain , Holt Kathryn E. , Wyres Kelly L. 
Published: October 2021

AbstractThe Klebsiella pneumoniae species complex (KpSC) is a set of seven Klebsiella taxa which are found in a variety of niches, and are an important cause of opportunistic healthcare-associated infections in humans. Due to increasing rates of multi-drug resistance within the KpSC, there is a growing interest in better understanding the biology and metabolism of these organisms to inform novel control strategies. We collated 37 sequenced KpSC isolates isolated from a variety of niches, representing all seven taxa. We generated strain-specific genome scale metabolic models (GEMs) for all 37 isolates and simulated growth phenotypes on 511 distinct carbon, nitrogen, sulphur and phosphorus substrates. Models were curated and their accuracy assessed using matched phenotypic growth data for 94 substrates (median accuracy of 96%). We explored species-specific growth capabilities and examined the impact of all possible single gene deletions on growth in 145 core carbon substrates. These analyses revealed multiple strain-specific differences, within and between species and highlight the importance of selecting a diverse range of strains when exploring KpSC metabolism. This diverse set of highly accurate GEMs could be used to inform novel drug design, enhance genomic analyses, and identify novel virulence and resistance determinants. We envisage that these 37 curated strain-specific GEMs, covering all seven taxa of the KpSC, provide a valuable resource to the Klebsiella research community.
Markerless Video Analysis of Spontaneous Bodily Movements in 4-Month-Old Infants Predicts Autism-like Behavior in 18-Month-Olds
Authors: Doi Hirokazu , Iijima Naoya , Furui Akira , Soh Zu , Shinohara Kazuyuki , Iriguchi Mayuko , Shimatani Koji , Tsuji Toshio 
Published: October 2021

AbstractEarly intervention is now considered the core treatment strategy for autism spectrum disorders (ASD). Thus, it is of significant clinical importance to establish a screening tool for the early detection of ASD in infants. To achieve this goal, in a longitudinal design, we analysed spontaneous bodily movements of 4-month-old infants and assessed their ASD-like behaviours at 18 months of age. Infants at high risk for ASD at 18 months of age exhibited less rhythmic and weaker bodily movement patterns at 4 months of age than low-risk infants. When the observed bodily movement patterns were submitted to a machine learning-based analysis, linear and non-linear classifiers successfully predicted ASD-like behaviour at 18 months of age based on the bodily movement patterns at 4 months of age, at the level acceptable for practical use. This suggests the utility of the proposed method for the early screening of infants at risk for ASD.