bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a bedside tool-kit for assessing sensitization in patients with chronic osteoarthritis knee pain or chronic knee pain after total knee replacement
Authors: Sachau Juliane , Otto Jan C. , Kirchhofer Viktoria , Larsen Jesper B. , Kennes Lieven N. , Hüllemann Philipp , Arendt-Nielsen Lars , Baron Ralf 
Published: May 2021

Abstract
Different pathophysiological mechanisms contribute to the pain development in osteoarthritis (OA). Sensitization mechanisms play an important role in the amplification and chronification of pain and may predict the therapeutic outcome. Stratification of patients according to their pain mechanisms could help to target pain therapy. This study aimed at developing an easy-to-use, bedside tool-kit to assess sensitization in patients with chronic painful knee OA or chronic pain after total knee replacement (TKR). In total, 100 patients were examined at the most affected knee and extrasegmentally by the use of 4 standardized quantitative sensory testing parameters reflecting sensitization (mechanical pain threshold, mechanical pain sensitivity, dynamic mechanical allodynia, and pressure pain threshold), a bedside testing battery of equivalent parameters including also temporal summation and conditioned pain modulation, and pain questionnaires. Machine learning techniques were applied to identify an appropriate set of bedside screening tools. Approximately half of the patients showed signs of sensitization (46%). Based on machine learning techniques, a composition of tests consisting of 3 modalities was developed. The most adequate bedside tools to detect sensitization were pressure pain sensitivity (pain intensity at 4 mL pressure using a 10-mL blunted syringe), mechanical pinprick pain sensitivity (pain intensity of a 0.7 mm nylon filament) over the most affected knee, and extrasegmental pressure pain sensitivity (pain threshold). This pilot study presents a first attempt to develop an easy-to-use bedside test to probe sensitization in patients with chronic OA knee pain or chronic pain after TKR. This tool may be used to optimize individualized, mechanism-based pain therapy.
Barriers, facilitators, and resources to opioid deprescribing in primary care: experiences of general practitioners in Australia
Authors: Hamilton Melanie , Mathieson Stephanie , Gnjidic Danijela , Jansen Jesse , Weir Kristie , Shaheed Christina A. , Blyth Fiona , Lin Chung-Wei C. 
Published: May 2021

Abstract
Deprescribing is the systematic process of discontinuing drugs when harms outweigh the benefits. We conducted semistructured telephone interviews with 22 general practitioners (GPs) who had prescribed or deprescribed opioids in patients with chronic noncancer pain within the past 6 months to investigate the barriers and facilitators to deprescribing opioid analgesics in patients with chronic noncancer pain. We also explored GPs' perspectives on the available resources to assist them with opioid deprescribing. Interviews were audio-recorded, transcribed verbatim, and then coded using an iterative process until data saturation reached. The thematic analysis process identified themes, first as concepts, and then refined to overarching themes after the merging of similar subthemes. Themes exploring barriers to deprescribing highlighted the difficulties GPs face while considering patient factors and varying prescribing practices within the confines of the health system. Patient motivation and doctor–patient rapport were central factors to facilitate deprescribing and GPs considered the most important deprescribing resource to be a multidisciplinary network of clinicians to support themselves and their patients. Therefore, although GPs emphasised the importance of deprescribing opioid analgesics, they also expressed many barriers relating to managing complex pain conditions, patient factors, and varying prescribing practices between clinicians. Some of these barriers could be mitigated by GPs having time and resources to educate and build rapport with their patients. This suggests the need for further development of multimodal resources and improved support through the public health system to enable GPs to prioritise patient-centred care.
Processing of trigeminocervical nociceptive afferent input by neuronal circuity in the upper cervical lamina I
Authors: Fernandes Elisabete C. , Carlos-Ferreira José , Luz Liliana L. , Kokai Eva , Meszar Zoltan , Szucs Peter , Safronov Boris V. 
Published: May 2021

Abstract
Afferents from the C2 spinal nerve (SN) and trigeminal nerve (TN) innervate neighboring cranial territories, and their convergence on the upper cervical dorsal horn neurons represents neural substrate of pain referral in primary headache disorders. Unfortunately, little is known about trigeminocervical input to the major spinal nociceptive projection area lamina I. Here, we used ex vivo brainstem–cervical cord preparation for the visually guided whole-cell recording from the upper cervical lamina I neurons. We show that 50% of them receive convergent monosynaptic input from both nerves, whereas 35% and 11% of neurons receive specific supply from the C2 SN and TN, respectively. Altogether, 10 distinct patterns of synaptic input from the C2 SN and TN to lamina I neurons could be identified. Although stimulation of both nerves evoked excitatory/inhibitory responses, more numerous pure inhibitory inputs arose from the TN. We show that cervical and trigeminal nociceptors converge on to lamina I projection and inhibitory neurons. Thus, trigeminocervical input in lamina I is processed in both nerve-specific and convergent circuitries. Afferent convergence on to inhibitory interneurons serves as a feedforward mechanism balancing excitatory drive to projection neurons. Disruption of this balance may cause pain in primary headache syndromes.
HIV Incidence Among Women in Sub-Saharan Africa: A Time Trend Analysis of the 2000–2017 Period
Authors: Soto-Ruiz Nelia , Arregui-Azagra Adriana , San Martín-Rodríguez Leticia , Elizalde-Beiras Itsaso , Saralegui-Gainza Amaia , Escalada-Hernández Paula 
Published: May 2021

Abstract
The aim of this study was to use data from the United Nations Global Indicators Database to analyze the trends in the HIV incidence rate among women in sub-Saharan African countries between 2000 and 2017. The HIV incidence rate is defined as the number of new HIV infections per 1,000 uninfected population, aged 15 to 49 years old. Joinpoint regression analysis was applied to identify periods when there were significant changes in the HIV incidence rate. The results show that there was a global decrease trend in the HIV incidence rates among women in sub-Saharan Africa, decreasing in all sub-Saharan African countries, except in Angola, Equatorial Guinea, and Sudan, which have remained the same, and Madagascar, where the overall trend is increasing. The joinpoint regression statistical method offers an in-depth analysis of the incidence of HIV among women in sub-Saharan Africa.
Parent and Physician Report of Discussions About Prognosis for Critically Ill Children*
Authors: Rissman Lauren , Derrington Sabrina , Rychlik Karen , Michelson Kelly N. 
Published: May 2021

Objectives:
Parents value clear communication with PICU clinicians about possible patient and family outcomes (prognostic conversations). We describe PICU parent and attending physician reports and agreement regarding the occurrence of prognostic conversations. We queried parents and physicians about prognostic conversation content, which healthcare providers had prognostic conversations, and whether parents wanted more prognostic information.

Design:
Prospective cross-sectional survey study.

Setting:
University-based 40-bed PICU.

Participants:
Parents and attending physicians of PICU patients with multiple organ dysfunction within 24 hours of PICU admission.

Interventions:
Surveys administered to parents and attending PICU physicians 5–10 days after PICU admission.

Measurements and Main results:
Surveys asked parents and physicians to report the occurrence of prognostic conversations related to PICU length of stay, risk of PICU mortality, and anticipated post-PICU physical, neurologic, and psychologic morbidities for patients and post-PICU psychologic morbidities for parents. Of 101 participants, 87 parents and 83 physicians reported having prognostic conversations. Overall concordance between parents and physicians was fair (Kappa = 0.22). Parents and physicians most commonly reported prognostic conversations about PICU length of stay (67.3% and 63.3%, respectively) and patient post-PICU physical morbidity (n = 48; 48.5% and n = 45; 44.5% respectively). Conversations reported less often by parents and physicians were about patient post-PICU psychologic morbidity (n = 13; 12.9% and n = 20; 19.8%, respectively). Per parent report, bedside nurses and physicians provided most prognostic information. Chaplains (n = 14; 50%) and social workers (n = 17; 60%) were more involved in conversations regarding parent psychologic morbidities. Most commonly, parents requested more information about length of stay and their child’s physical morbidities. Parents less frequently wanted information about their own psychologic morbidities.

Conclusions:
Most parents and physicians report having prognostic conversations, primarily about length of stay and post-ICU physical morbidities. Concordance between parents and physicians is suboptimal. Future studies should evaluate prognostic conversations at other timepoints, how information is delivered, and how these conversations impact the PICU experience.
Comparison of the Demographics and Visit Characteristics of Patients Who Left the Pediatric Emergency Department Without Being Seen With Those Who Were Evaluated in the Emergency Department
Authors: Suastegui Charles , Lozano Juan M. , Maniaci Vincenzo M. , Linares Marc Yves-Rene 
Published: May 2021

Background
We compared those patients who left without being seen (LWBS) with those who stay for evaluation and determined which subsets were more likely to depart prematurely in the largest pediatric population studied to date.

Methods
We retrospectively extracted data from the electronic medical records of all pediatric patients who visited the emergency department between January 1, 2013, and December 31, 2015. The demographics and visit characteristics were compared between patients who LWBS and those seen by a provider. Bivariate and multivariate analyses were used to determine the odds for premature departure of specific groups within the population.

Results
Of the 271,364 pediatric patients visiting the emergency department during the 3-year study period, 3835 (1.4%) LWBS by a provider. The mean age of those LWBS was younger, and the odds of leaving slightly decreased as the patient's age increased (odds ratio [OR], 0.98). Those triaged as having “nonurgent” medical conditions had a statistically significant increase in odds of premature departure when compared with those with “urgent” medical conditions (OR, 1.16). Patients arriving during the evening and overnight hours had a much greater odds of LWBS (OR, 6.7 and 7.3, respectively).

Conclusions
Our findings demonstrated and confirmed that age, time of arrival, and acuity level upon presentation were predictors of patients leaving before evaluation. This can guide institutions with staffing and flow processes as they attempt to reduce LWBS rates but also raises further questions as to whether these subsets go forward to have worse clinical outcomes after leaving prematurely.
Evaluating Adolescent Substance Use and Suicide in the Pediatric Emergency Department
Authors: Quimby Ernika G. , Brogan Leah , Atte Tita , Diamond Guy , Fein Joel A. 
Published: May 2021

ObjectivesThis study evaluates the relationship between substance use and impairment and current suicidal thoughts or behaviors in adolescent patients screened in a pediatric emergency department (ED).MethodsData were collected between June 2013 and February 2018 from adolescent patients who presented to a single, urban, pediatric ED. Adolescents completed a computerized, self-administered assessment that evaluates depression, suicide, posttraumatic stress, violence, traumatic exposure, bullying, and substance use. Assessments are administered as standard care to all ED patients aged 14 to 18 years. We used binary logistic regression to estimate the odds of reporting current suicidal thoughts or behaviors associated with patient demographics (ie, age, sex, and race), substance use in the past month, and substance-related impairment.ResultsA total of 11,623 adolescent patients (65.4% female and 52.9% African American) completed the assessment. Participants were, on average, 15.7 years old (SD = 1.27). Younger age (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.74–0.84) and substance use impairment (OR, 0.44; 95% CI, 0.33–0.58) decreased the odds of reporting current suicidal thoughts or behaviors, whereas male sex (OR, 1.51; 95% CI, 1.28–1.79) and those with past-month substance use (OR, 1.85; 95% CI, 1.51–2.26) increased the odds.ConclusionsRecent substance use and male sex are associated with a higher likelihood of adolescents reporting current suicidal thoughts or behaviors during an ED visit. Standardized screening during pediatric ED visits may allow for more efficient evaluation of patients in higher-risk groups.
A Regional Intervention to Appoint Pediatric Emergency Care Coordinators in New England Emergency Departments
Authors: Li Joyce , Petrack Emory M. , Boggs Krislyn M. , Auerbach Marc , Foster Ashley A. , Sullivan Ashley F. , Camargo Carlos A. 
Published: May 2021

Objective
The aim of this study was to describe our expansion of a Massachusetts grassroots initiative—to increase the appointment of pediatric emergency care coordinators (PECCs) in emergency departments (EDs)—to all 6 New England states.

Methods
We conducted annual surveys of all EDs in New England from 2015 to 2020 regarding 2014 to 2019, respectively. Data collection included ED characteristics. The intervention from 2018 to 2019 relied on principles of self-organization and collaboration with local stakeholders including state Emergency Medical Services for Children agencies, American College of Emergency Physician state chapters, and Emergency Nursing Association state chapters to help encourage appointment of at least 1 PECC to every ED. Most ED leadership were contacted in person at regional meetings, by e-mail and/or telephone. We reached out to each individual ED to both educate and encourage action.

Results
Survey response rates were greater than 85% in all years. From 2014 to 2016, less than 30% of New England EDs reported a PECC. In 2017, 51% of EDs in New England reported a PECC, whereas in 2019, 91% of New England EDs reported a PECC. All other ED characteristics remained relatively consistent from 2014 to 2019.

Conclusions
We successfully expanded a Massachusetts grassroots initiative to appoint PECCs to all of New England. Through individual outreach, and using principles of self-organization and creating collaborations with local stakeholders, we were able to increase the prevalence of PECCs in New England EDs from less than 30% to greater than 90%. This framework also led to the creation of a New England–wide PECC network and has fostered ongoing collaboration and communication throughout the region.
Trampoline Injuries in Children and Adolescents
Authors: Hussein Mohammad H. , Toreih Ahmad A. , Attia Abdallah S. , Alrowaili Majed , Fawzy Manal S. , Tatum Danielle , Toraih Eman A. , Kandil Emad , Duchesne Juan , Taghavi Sharven 
Published: May 2021

Objective
As trampoline use grows more popular in the United States, the frequency of injuries continues to climb. We hypothesized that toddlers would be at the highest risk for trampoline injuries requiring hospitalization.

Methods
The National Electronic Injury Surveillance System database was examined for trampoline injuries from 2009 to 2018. Patients were categorized into 3 main age groups: toddlers (<2 years), children (2–12 years), and adolescents (13–18 years). Regression models were used to identify patients at high risk for injury or hospitalization.

Results
There was a total of 800,969 meeting inclusion criteria, with 433,827 (54.2%) occurring at their own homes and 86,372 (18.1%) at the sporting venue. Of the total, 36,789 (4.6%) were admitted to a hospital. Fractures (N = 270,884, 34%), strain/sprain injuries (N = 264,990, 33%), followed by skin contusions/abrasions (N = 115,708, 14%) were the most common diagnoses. The most frequent injury sites were lower and upper extremities accounting for 329,219 (41.1%) and 244,032 (30.5%), whereas 175,645 (21.9%) had head and neck injuries. Musculoskeletal injuries (74%) and concussions (2.6%) were more frequent in adolescents than children (67.6% and 1.6%) and toddlers (56.3% and 1.3%). Internal organ and soft tissue injuries were frequent in toddlers. There were no fatalities reported in the injured patients. Multivariate analysis showed adolescents, female sex, extremity injuries, and musculoskeletal injuries were associated with hospitalization. Injury at a sporting venue was not associated with hospitalization.

Conclusions
Adolescents and girls are at increased risk of trampoline injury, warranting hospitalization. Safety standards may help prevent extremity and musculoskeletal injuries in the pediatric population. Finally, use of trampolines at sporting venues does not appear to be particularly dangerous.
Stopping disease-modifying therapy in relapsing and progressive multiple sclerosis
Authors: Hartung Hans-Peter , Meuth Sven G. , Miller Deborah M. , Comi Giancarlo 
Published: May 2021

Purpose of review
To assess the reasons for considering discontinuation of disease-modifying therapies (DMTs)in patients with multiple sclerosis (MS). Relevant aspects of the natural history, pathology, and immunology are analyzed.

Recent findings
A number of retrospective observational studies in aggregate indicate that stopping DMTs may be attempted in older individuals with stable disease. Prognostic factors have been identified informing about the risk of recurrence of disease activity after DMT discontinuation.

Summary
Several clinical scenarios provide a rationale to stop DMTs in people with MS. Cumulative evidence has been gathered recently allowing us to more precisely weigh the risks against the benefits. This information aids in the decision process.
Histopathological Image Analysis for Oral Squamous Cell Carcinoma classification using concatenated deep learning models
Authors: Amin Ibrar , Zamir Hina , Khan Faisal F. 
Published: May 2021

AbstractOral squamous cell carcinoma (OSCC) is a subset of head and neck squamous cell carcinoma (HNSCC), the 7th most common cancer worldwide, and accounts for more than 90% of oral malignancies. Early detection of OSCC is essential for effective treatment and reducing the mortality rate. However, the gold standard method of microscopy-based histopathological investigation is often challenging, time-consuming and relies on human expertise. Automated analysis of oral biopsy images can aid the histopathologists in performing a rapid and arguably more accurate diagnosis of OSCC. In this study, we present deep learning (DL) based automated classification of 290 normal and 934 cancerous oral histopathological images published by Tabassum et al (Data in Brief, 2020). We utilized transfer learning approach by adapting three pre-trained DL models to OSCC detection. VGG16, InceptionV3, and Resnet50 were fine-tuned individually and then used in concatenation as feature extractors. The concatenated model outperformed the individual models and achieved 96.66% accuracy (95.16% precision, 98.33% recall, and 95.00% specificity) compared to 89.16% (VGG16), 94.16% (InceptionV3) and 90.83% (ResNet50). These results demonstrate that the concatenated model can effectively replace the use of a single DL architecture.
Longer incubation periods of SARS-CoV-2 infection in infants than children
Authors: Leung Char 
Published: May 2021

AbstractObjectiveA large body of research has described the incubation period of SARS-CoV-2 infection, an important metric for assessing the risk of developing a disease as well as surveillance. While longer incubation periods for elderly have been found, it remains elusive whether this also holds true for infants and children, partly due to the lack of data. The present work clarified the incubation periods of COVID-19 for infants and children.MethodsUsing the data released by the Chinese health authorities and municipal offices, statistical comparisons of clinical features were made between infants (aged below 1 year) and children (aged between 1 and 17 years). An age-varying incubation period distribution period was modeled using maximum likelihood estimation modified for interval censored exposure time and age.DiscussionReported in 56 web pages, a total of 65 cases from 20 provinces dated between January and June 2020, including 18 infants and 47 children, were eligible for inclusion. Infants appeared to bear more severe clinical courses, as demonstrated by the higher prevalence of breathing difficulty as well as nasal congestion. In contrast, fever was less prominent in infants than in children. The incubation period was found to decrease with age, with infants appearing to have longer incubation periods.ConclusionFever remained to be one of the most commonly seen symptoms in infants and children with SARS-CoV-2 infection and have continued to determine the time of symptom onset. While shorter incubation periods should be seen in patients with weaker immune system due to weaker antiviral response that is beneficial for viral growth, the longer incubation period in infants may be due to their weaker febrile response to the virus, leading to prolonged symptom onset.
Anti-SARS-CoV-2 Antibodies Persist for up to 13 Months and Reduce Risk of Reinfection
Authors: Gallais Floriane , Gantner Pierre , Bruel Timothée , Velay Aurelie , Planas Delphine , Wendling Marie-Josée , Bayer Sophie , Solis Morgane , Laugel Elodie , Reix Nathalie , Schneider Anne , Glady Ludovic , Panaget Baptiste , Collongues Nicolas , Partisani Marialuisa , Lessinger Jean-Marc , Fontanet Arnaud , Rey David , Hansmann Yves , Kling-Pillitteri Laurence , Schwartz Olivier , De Sèze Jérome , Meyer Nicolas , Gonzalez Maria , Schmidt-Mutter Catherine , Fafi-Kremer Samira 
Published: May 2021

AbstractAssessment of the kinetics of SARS-CoV-2 antibodies is essential in predicting protection against reinfection and durability of vaccine protection. Here, we longitudinally measured Spike (S) and Nucleocapsid (N)-specific antibodies in 1,309 healthcare workers (HCWs), including 916 COVID-19 negative HCWs and 393 convalescent COVID-19 for up to 422 days post-symptom. From month (M)1 to M7-9 post-infection, SARS-CoV-2 antibodies decreased moderately in convalescent HCWs in a biphasic model, with men showing a slower decay of anti-N (p=0.02), and a faster decay of anti-S (p=0.0008) than women. At M11-13, anti-N dramatically decreased (half-life: 283 days) while anti-S stabilized (half-life: 725 days) at a median of 2.39 log Arbitrary Units (AU)/mL (Interquartile Range (IQR): 2.10 -2.75). Overall, 69 SARS-CoV-2 infections developed in the COVID-19 negative group (incidence of 12.22 per 100 person-years) versus one in the COVID-19 positive group (incidence of 0.40 per 100 person-years), indicating a relative reduction in the incidence of SARS-CoV-2 reinfection of 96.7% (p<0.0001). Correlation with live-virus neutralization assay revealed that variants D614G and B.1.1.7, but not B.1.351, were sensitive to anti-S antibodies at 2.3 log AU/mL, while IgG ≥ 3 log AU/mL neutralized all three variants. After SARS-CoV-2 vaccination, anti-S levels reached at least 3 logs regardless of pre-vaccination IgG levels, type of vaccine, and number of doses. Our study demonstrates a long-term persistence of anti-S IgG antibodies that may protect against reinfection. By significantly increasing cross-neutralizing antibody titers, a single-dose vaccination strengthens protection against escape mutants.