bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Prevalence of Celiac Disease Among Danish Adolescents
Authors: Crawley Caecilie , Sander Stine Dydensborg , Nohr Ellen Aagaard , Lillevang Søren Thue , Andersen Anne‐Marie Nybo , Murray Joseph , Husby Steffen 
Published: July 2021

ABSTRACTObjectives:The objective of this study was to establish an unselected cohort of Danish adolescents and estimate the prevalence of undiagnosed celiac disease (CeD).Methods:The Glutenfunen cohort participants were recruited from an unselected subsample of the Danish National Birth Cohort, defined as participants living in the Island of Funen, Denmark. We invited all 7431 eligible participants in the age range of 15 to 21 years to a clinical visit. CeD diagnosis was based on screening with IgA transglutaminase antibodies (TG2‐IgA) and if positive, was followed by duodenal biopsies compatible with CeD (Marsh 2–3). We calculated the prevalence of CeD in the Glutenfunen cohort as the number of CeD cases diagnosed before and during the study divided by the number of participants in the Glutenfunen cohort.Results:We included 1266 participants in the Glutenfunen cohort (17%, 1266/7431). 1.1% (14 of 1266 participants) had CeD diagnosed before entering the cohort and based on the Danish National Patient Register, 0.2% of the nonparticipants (14 of 6165) had a diagnosis of CeD. In total, 2.6% (33 participants) had TG2 IgA above the upper limit of normal. Nineteen participants had duodenal biopsies compatible with CeD. The prevalence of CeD in the Glutenfunen cohort was 2.6% [(14 + 19)/1266].Conclusions:Our study suggests that CeD is much more common than expected among Danish adolescents, comparable to other European countries, and that the majority were asymptomatic or oligosymptomatic and were only found because of the screening procedure.
Can Temperament and Character Traits Be Used in the Diagnostic Differentiation of Children With ADHD?
Authors: Ucuz Ilknur , Uzun Cicek Ayla , Cansel Neslihan , Kilic Bahar , Colak Cemil , Percinel Yazici Ipek , Kilic Fatma , Kucukakcali Zeynep 
Published: July 2021

Abstract
In this study, it was aimed to determine the contributions of temperament and character traits to the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Thirty-six patients between the ages of 9 and 14 with a diagnosis of combined type ADHD and 39 healthy children were included in the study. The Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version–Turkish Version and the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form were used to assess hyperactivity/impulsivity and inattentiveness, and comorbid disorders. The Junior Temperament and Character Inventory–Revised form was used to evaluate temperament–character traits. The classification-based association rules (CBARs) method was used for finding rules predicting ADHD accurately. Low persistence and self-directedness scores, and higher disorderliness and fatigability subgroup scores were found in the ADHD group. In CBARs, the separation of children with ADHD from healthy controls could be made with 0.83 accuracy, 0.80 sensitivity, and 0.86 specificity. The results of our study support the view that temperament–character traits can help clinical diagnosis of ADHD.
Nursing Program Admission Barriers in the United States
Authors: Hampton Michelle DeCoux , Dawkins Denise , Rickman Patrick Sheri , O'Leary-Kelley Colleen , Onglengco Raissa , Stobbe Brenna 
Published: July 2021

Background
The percentage of Black registered nurses (RN) is disproportionate to Black residents in the population, particularly in Southern states.

Purpose
This study's purpose was to identify the potential admission barriers for Black students in RN education in the South versus Midwest, Northeast, and West.

Methods
A cross-sectional design was used to compare admission criteria for 1597 accredited associate degree in nursing and bachelor of science in nursing programs by geographic region.

Results
Southern programs required a significantly higher count of academic metric criteria (multiple grade point average, standardized tests) and nonacademic criteria (proof of health insurance, background checks). Southern programs had a significantly lower count of holistic admissions review criteria (references, essays, volunteer work).

Conclusion
Approximately 50% of programs used academic metrics exclusively, and most programs using some holistic criteria assigned greatest weight to academic metrics despite evidence that this disadvantages qualified, underrepresented students. Access to RN education must be improved. Recommendations are discussed for transition to holistic admissions review.
Assessment of Visual Function and Performance in Paralympic Judo for Athletes with Vision Impairment
Authors: Krabben Kai , Ravensbergen Rianne H.J.C. , Orth Dominic , Fortin-Guichard Daniel , Savelsbergh Geert J.P. , Mann David L. 
Published: July 2021

SIGNIFICANCE
Paralympic judo currently requires all athletes to compete against each other in one class irrespective of their level of vision impairment (VI). Recent evidence suggests that multiple classes are required to enhance fairness, yet it remains unclear how many classes are necessary and what vision tests should be used to define those classes.

PURPOSE
The aim of this study was to quantify the relationship between vision and performance in judo for individuals with VI. The results were expected to inform the development of evidence-based criteria to structure Paralympic judo competition.

METHODS
The visual function of 53 elite VI judokas was assessed using a test battery that included tests of visual acuity (VA), contrast sensitivity, light sensitivity, depth perception, motion perception, visual search, and central visual field. Performance was assessed by measuring the ratio of fights won across all competitions the participants took part in in the 2 years before and after vision testing. Pearson correlation coefficients and decision tree analyses were used to determine the relationship between vision and performance. Partial correlations were also conducted to determine the unique ability of each measure of visual function to predict judo performance.

RESULTS
Visual acuity was the best predictor of judo performance and remained the only visual function related to performance when controlling for correlations between VA and other visual functions. Decision tree analyses suggested to split athletes into two groups for more legitimate competition, using a cutoff point around 2.6 logMAR. Within each of the two resulting subgroups, no correlations remained between any of the visual functions and performance.

CONCLUSIONS
The results of this study suggest that VI judo competition should be split into separate categories for partially sighted and functionally blind athletes. The inclusion of visual functions in addition to VA does not improve the ability to predict performance in VI judo.
Gastrointestinal manifestations of coronavirus disease 2019
Authors: Joshi Tejas , Ahmed Aijaz , Cholankeril George 
Published: July 2021

Purpose of review
The ubiquitous expression of angiotensin-converting enzyme-2 receptors and its significance as the origin of viral entry have assisted in comprehending the pathophysiology of extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, we focus on the clinical significance of gastrointestinal manifestations.

Recent findings
The global pandemic, a result of the widespread implications of SARS-CoV-2, remains a significant burden to current healthcare systems. Fever, dyspnea, and tussive symptoms have primarily been recognized as the most common presenting signs/symptoms. During the past one year our scope of practice has transcended beyond the management of the respiratory system to incorporate other varying systemic manifestations such as anorexia, nausea, vomiting, diarrhea, and abdominal pain. The outcomes reported by recent studies suggest an association between the presence of gastrointestinal symptoms and important clinical factors such as delay in presentation, disease severity, and mortality.

Summary
We provide a summarization of the most recent in-depth investigations of coronavirus disease 2019 with gastrointestinal manifestations and their conclusions. Although the pathophysiology remains an area of evolving interest, a better understanding of this disease process may allow for early recognition, efficient triage, and improved prognostication for those presenting with gastrointestinal manifestations of SARS-CoV-2.
Current opinion in management of septic shock due to Gram-negative bacteria
Authors: Tabah Alexis , Buetti Niccolò , Barbier François , Timsit Jean-François 
Published: July 2021

Purpose of review
The COVID-19 pandemic has caused multiple challenges to ICUs, including an increased rate of secondary infections, mostly caused by Gram-negative micro-organisms. Worrying trends of resistance acquisition complicate this picture. We provide a review of the latest evidence to guide management of patients with septic shock because of Gram-negative bacteria.

Recent findings
New laboratory techniques to detect pathogens and specific resistance patterns from the initial culture are available. Those may assist decreasing the time to adequate antimicrobial therapy and avoid unnecessary broad-spectrum antibiotic overuse. New antimicrobials, including β-lactam/β-lactamase inhibitor combinations, such as ceftolozane-tazobactam, imipenem-relebactam or meropenem-vaborbactam and cephalosporins, such as cefiderocol targeted to specific pathogens and resistance patterns are available for use in the clinical setting. Optimization of antibiotic dosing and delivery should follow pharmacokinetic and pharmacodynamic principles and wherever available therapeutic drug monitoring. Management of sepsis has brought capillary refill time back to the spotlight along with more reasoned fluid resuscitation and a moderate approach to timing of dialysis initiation.

Summary
Novel rapid diagnostic tests and antimicrobials specifically targeted to Gram-negative pathogens are available and should be used within the principles of antimicrobial stewardship including de-escalation and short duration of antimicrobial therapy.
Predictors of multidrug resistant Pseudomonas aeruginosa involvement in bloodstream infections
Authors: Herrera Sabina , Bodro Marta , Soriano Alex 
Published: July 2021

Purpose of review
In the last decades, there has been a worldwide worrisome spread of multidrug resistant (MDR) Pseudomonas aeruginosa. Treatment of these infections is challenging, in part due to the lack of therapeutic options, and the importance of prescribing an adequate empirical treatment. Bacteraemia is one of the most severe infections, with mortality rates ranging between 20 and 40%.

Recent findings
It is key to understand which patients are at a higher risk of MDR P. aeruginosa bloodstream infection (BSI) to better direct empirical therapies and improve overall survival. Immunocompromised patients are among the most vulnerable for the worst outcomes. Environmental exposure, integrity of the microbiota, and host immunity are the key determinants for the initial colonization and expansion on mucosal surfaces and potential invasion afterwards by MDR P. aeruginosa.

Summary
Available data suggest that high colonization pressure (settings with high prevalence like intensive care units), disruption of healthy microbiota (prior use of antibiotics, in particular fluoroquinolones), immunosuppression (neutropenia) and breaking natural barriers (venous or urine catheters), are the main risk factors for MDR P. aeruginosa BSI.
The Cough Cold and Fever Clinic: A Model for the Safe Management of Ambulatory Patients With Suspected COVID-19
Authors: Gingras Laura F. , Pelzman Fred N. , Marquez Armyl , Arias Diego , Tung Judy 
Published: July 2021

Background and Objective:
When the coronavirus disease-2019 (COVID-19) pandemic swept through New York City, hospital systems became quickly overwhelmed and ambulatory strategies were needed. We designed and implemented an innovative program called the Cough Cold and Fever (CCF) Clinic to safely triage, evaluate, treat, and follow up patients with symptoms concerning for COVID-19.

Methods:
The CCF Clinic was launched on March 13, 2020, in the ambulatory internal medicine office of New York Presbyterian-Weill Cornell Medicine. Patients with symptoms suspicious for COVID-19 were first triaged via telemedicine to determine necessity of in-person evaluation. Clinic workspaces and workflows were fashioned to minimize risk of viral transmission and to conserve COVID-19 testing supplies and personal protective equipment. Protocols containing the most recent COVID-19 practice guidelines were created, updated regularly, and communicated through twice-daily huddles and as a shareable online document. Discharged patients were followed up for at least 7 days through telemedicine. Patient outcomes, including admission to the emergency department (ED), hospitalization, and death, were tracked to ensure clinical quality.

Results:
We report on the first 620 patients seen at CCF between March 13, 2020, and June 19, 2020. Telemedicine follow-up was achieved for 500 (81%). We tested 347 (56%) patients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with 119 (34%) testing positive. Forty-seven (8%) patients were sent to the ED directly from the CCF Clinic and 42 (89%) of these were admitted. Of the patients discharged home from CCF, 15 (3%) were later admitted to a hospital. Twelve (2%) patients in total died.

Conclusion:
The vast majority of patients, over 90%, seen in CCF were discharged home, with only a small percentage (3%) later requiring admission to a hospital. Of the patients sent directly to the ED from CCF, close to 90% were admitted, verifying the accuracy of our triage. Overall mortality was low (2%), especially when compared with mortality rates in New York City during the pandemic peak. Telemedicine was effective in identifying patients in need of in-person evaluation and in tracking and follow-up. Workflows and protocols were adaptable to reflect rapidly changing resources and clinical guidelines. Frequent communication through a diversity of methods was critical. Through these strategies, we were able to create a safe and effective outpatient program for patients with potential COVID-19.
End-to-Trunk Masseteric to Facial Nerve Transfer With Selective Neurectomy for Facial Reanimation
Authors: Leader Brittany , Griffin Garrett R. , Larian Babak , Massry Guy , Nabili Vishad , Slattery William , Azizzadeh Babak 
Published: July 2021

Objective:
To examine functional outcomes following end-to-trunk masseteric to facial nerve transfer in patients with chronic flaccid facial paralysis.

Design:
Retrospective chart review.

Setting:
Tertiary-care private practice setting.

Participants:
Patients with complete unilateral facial paralysis of less than 24 months duration.

Interventions:
Direct end-to-trunk masseteric to facial nerve anastomosis.

Outcome measures:
Outcome measures included time to first movement, development of synkinesis, and an objective assessment of the resting tone and dynamic movement that was achieved.

Results:
Patient age at the time of transfer ranged from 6 to 61. Follow-up ranged from 12 to 24 months. No patients had any perioperative complications. No patient experienced significant mass movement or synkinetic facial movement with chewing. No patient had worsened chewing or swallowing. Patients have not yet recovered significant resting tone. All patients achieved smile activity when biting down with a median (interquartile range) oral commissure excursion of 7.57 mm (5.19–9.94 mm), starting 3 to 5 months after transfer.

Conclusions:
End-to-trunk masseteric to facial nerve transfer is a safe and effective procedure. Patients had rapid reinnervation with good excursion and achieved a natural appearing smile. The rehabilitated smile appears better than that achieved with hypoglossal-facial nerve transfer. The procedure can be performed coincident with cross-facial nerve grafting, and in some cases may produce dynamic facial movement that obviates the need for free muscle transfer.
Examining Risk of Speech-Language Disorders in Children With Cleft Lip
Authors: Deatherage Jill , Bourgeois Tran , O’Brien Meghan , Baylis Adriane L. 
Published: July 2021

Abstract
Although it is well-established that children with cleft palate are at high risk for communication disorders, little is known about the speech-language profiles of children with cleft lip (with or without cleft alveolus), who do not have an overt cleft palate. The purpose of this study was to determine the prevalence of speech-language disorders in a consecutively evaluated group of children with cleft lip, with or without cleft alveolus (CL ± A) from a single cleft lip and palate center in the United States. We also explored the types of speech and language disorders in this cohort and examined the impact of co-occurring syndromes and other diagnoses (eg, submucous cleft palate). Eighty-six children (58 males, 28 females) with CL ± A, evaluated between the ages of 12 and 72 months, were included in the study. Forty children had cleft lip and alveolus; 46 children had isolated cleft lip. We examined the proportion of children with CL ± A who received team care, speech-language evaluations, and audiograms, as well as the number of children with CL ± A diagnosed with a communication disorder. Fifty-three percent (n = 46) of children with CL ± A had received at least 1 speech-language evaluation. Approximately 40% of children with CL ± A who underwent evaluation by a speech-language pathologist were diagnosed with some type of communication disorder. Nine children (21%) with CL ± A displayed an articulation disorder and 12 (27%) presented with a language delay/disorder. Statistical analysis examined the potential impact of comorbid diagnoses such as submucous cleft palate and other congenital anomalies, and results were essentially unchanged. Results of this study are congruent with past reports suggesting children with CL ± A have a higher risk of communication disorders than the general pediatric population. Surgeons should be aware of the growing body of evidence that children with CL ± A benefit from cleft team care, which should include routine speech-language assessments starting at an early age to ensure identification of conditions warranting intervention.
Decreasing Inpatient Opioid Use Following Orthognathic Surgery
Authors: Phillips Sarah J. , Peck Connor J. , Pourtaheri Navid , Reategui Alvaro , Carney Martin , Dinis Jacob , Park Kitae E. , Maniskas Seija , Lopez Joseph , Steinbacher Derek M. 
Published: July 2021

Purpose:
Strategies to decrease postoperative opioid use are important for mitigating the immediate and long-term risks associated with their use. We aimed to investigate the impact of perioperative various factors on inpatient opioid needs for patients undergoing orthognathic surgery.

Methods:
This was a retrospective cohort study of all patients who underwent orthognathic surgery performed by the senior author from 2012 to 2018. Patients were grouped into intravenous (IV) acetaminophen and no-IV acetaminophen cohorts. Opioid medications received by patients during hospital stay were converted to mean morphine equivalents (MME) for comparison. Additional factors that influenced opioid consumption, such as transexamic acid (TXA) and postoperative nausea and vomiting (PONV), were identified using univariate analysis. Factors found to have statistical significance were added to a multivariate linear regression model.

Results:
319 patients were included. Those who received IV acetaminophen had lower rates of total opioid use (57.3 versus 74.8 MME; P = 0.002) and postoperative opioid use (24.0 versus 37.7 MME; P < 0.001). Perioperative prothrombotic agents, such as TXA, were associated with lower total and postoperative MME (P = 0.005, P = 0.002). Multivariate regression analysis showed that increased PONV resulted in increased postoperative opioid use, whereas perioperative acetaminophen lowered total and postoperative quantities.

Conclusions:
Perioperative IV acetaminophen is an effective method for decreasing inpatient opioid analgesia after orthognathic surgery. Intravenous TXA and PONV control may provide additional benefit to decreasing inpatient opioid consumption. More research as to the mechanisms and ideal clinical applications for both IV acetaminophen and TXA are warranted.
Endoscopic Pilonidal Sinus Treatment: Rapid Recovery, Satisfactory Success, and High Quality of Life
Authors: Gulcu Baris , Ozturk Ersin 
Published: July 2021

Purpose:
In the treatment of pilonidal sinus disease (PD), endoscopic pilonidal sinus treatment (EPSIT), a skin-sparing minimally invasive technique, has attracted attention as an effective treatment. The aim of this study to evaluate the treatment success, cosmetic outcomes, and the quality of life in the patients who underwent an EPSIT for PD.

Materials and Methods:
The prospectively maintained data of 86 patients who underwent EPSIT for PD were retrospectively analyzed. The primary end-point of this study was complete wound healing, while the secondary end-points were the quality of life and cosmetic outcomes.

Results:
Seventy-two (83.7%) patients were male, and the median age was 28 (16 to 52). The median operative time was 32 (24 to 44) minutes, the median time to return to daily activities was 1 (1 to 4) day, and the median time to return to work was 3 (1 to 11) days. Fifty-two patients (60.4%) required no analgesics. No wound complication was observed. The median follow-up period was 12 (3 to 23) months. The complete wound healing rate was 94.2%, incomplete wound healing rate was 4.6% and the recurrence rate was 1.2%. Treatment failure was observed in 5 of the 6 patients with >3 pits located in the midline. The first-year median Wound evaluation scale score was 0 (0 to 4). The quality of life [physical function, physical role difficulty, pain, general health perception, energy/vitality, social functioning, emotional role, and mental health (P<0.0001)] significantly increased from preoperative levels a month after the EPSIT procedure.

Conclusion:
EPSIT, a minimally invasive treatment modality for the treatment of sacrococcygeal PD, is an effective treatment that does not hamper the daily life of the patients, presents high success rates, and has satisfactory cosmetic outcomes.