bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Premature Infant Pain Profile-Revised (PIPP-R) e-Learning Module
Authors: Campbell-Yeo Marsha , Carrier Leah , Benoit Britney , Kim Theresa , Bueno Mariana , Rao Megha , Riahi Shirine , Stevens Bonnie 
Published: August 2021

Background
Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence.

Purpose:
To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain.

Methods:
Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder.

Results:
Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators.

Implications for Practice:
Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time.

Implications for Research:
Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.
Hip Displacement in MECP2 Disorders: Prevalence and Risk Factors
Authors: Kanashvili Bidzina , Rogers Kenneth J. , Shrader Michael Wade , Miller Freeman , Dabney Kirk W. , Howard Jason J. 
Published: August 2021

Background:
Methyl-CpG binding protein 2 (MECP2) disorders, including Rett syndrome and MECP2 duplication syndrome, are typified by profound intellectual disability, spasticity, and decline in gross motor function. Unlike scoliosis, linked to disease severity, little has been reported regarding the hip. The aim of this study was to report the prevalence and risk factors of hip displacement (HD) in MECP2 disorders.

Methods:
This was a retrospective, comparative study. Children with a genetically confirmed MECP2 disorder were included. The primary outcome measure was the prevalence of HD (migration percentage>30%). Secondary outcomes included age at HD onset, ambulatory status, presence of clinically relevant scoliosis, genetic severity, presence of seizures, and associated comorbidities. Analysis of proportions of categorical variables was performed using χ2 testing (P=0.05).

Results:
Fifty-six patients (54 Rett syndrome and 2 MECP2 duplication syndrome), diagnosed at 6.6 (SD: 4.7) years, met the inclusion criteria. The prevalence of HD was 36% [onset, 7.7 (SD: 3.8) y]. Risk factors for HD were nonwalker status (P=0.04), scoliosis (P=0.001), and refractory epilepsy (P=0.04).

Conclusions:
The prevalence of HD in MECP2 disorders is comparable to cerebral palsy, associated with proxy measures of disease severity. These results can be used to develop hip surveillance programs for MECP2 disorders, allowing for timely management.

Level of Evidence:
Level III.
Efficacy of Antibiotics in Supracondylar Fractures
Authors: Bhatt Etasha , Ridley Taylor J. , Kruckeberg Bradley , Quanbeck Zachary , Quanbeck Deborah S. , Schiffern Alison 
Published: August 2021

Background:
Controversy exists surrounding antibiotic use in the setting of pediatric supracondylar humerus fractures treated with closed reduction and percutaneous Kirschner wire (K-wire) fixation. While the reported incidence of infection in the literature is low, surgeons frequently administer preoperative antibiotics. The purpose of this study was to retrospectively review preoperative antibiotic use and incidence of infection in children with supracondylar humerus fractures treated with closed reduction and K-wire fixation. It was hypothesized that antibiotic administration will not affect the incidence of infection following this procedure.

Methods:
We performed a retrospective review of 1053 patients with supracondylar humerus fractures treated with closed reduction and K-wire fixation at 3 institutions between 2006 and 2016. Patient demographics, antibiotic administration and follow-up data were reviewed in 905 patients.

Results:
Of 905 patients, 755 patients received preoperative antibiotics and 150 patients did not. The incidence of infection was 2.5% (n=22) in the group that received preoperative antibiotics and 2.0% in the group that did not receive antibiotics with an overall incidence of infection of 2.4%. The difference between groups did not reach significance (P>0.5). The majority of infections were treated with oral antibiotics with or without early pin removal. Four patients, all in the preoperative antibiotic group, required surgical debridement and intravenous antibiotics.

Conclusions:
Retrospective review of the incidence of infection in closed reduction and percutaneous pinning of supracondylar humerus fractures found no difference between patients who received preoperative antibiotics and those who did not receive preoperative antibiotics.

Level of Evidence:
Level III—therapeutic.
Feasibility of Magnetic Resonance Angiography in Patients With Legg-Calvé-Perthes Disease
Authors: Moreno Grangeiro Patricia , Rodrigues João C. , de Angeli Luiz R.A. , Leão Filho Hilton , Montenegro Nei B. , Guarniero Roberto , Dempsey Molly , Kim Harry K.W. 
Published: August 2021

Background:
The etiology of Legg-Calvé-Perthes disease (LCPD) remains unknown; however, interruption of medial circumflex femoral artery (MCFA) supply to the femoral head is the key pathogenic factor. The main purpose of this study is to determine the feasibility of using magnetic resonance angiography (MRA) to evaluate the course of the MCFA in the normal and affected hips of patients with unilateral LCPD.

Methods:
We analyzed 24 patients with unilateral LCPD using a time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS-MRA). The course of the MCFA was divided into 4 segments in the coronal plane and in 3 segments in the axial plane, based on its location with respect to the femoral neck. The visibility of each segment was studied in the normal and affected sides. The segments were defined as not visible when no contrast was seen within the vessel lumen or visible when the lumen was partially or completely visualized with contrast. The statistical analysis was done using the χ2 test.

Results:
TRICKS-MRA provided well-defined images of the first 2 segments of the MCFA on both the normal and affected sides of patients with LCPD (P=1). In half of the patients, the third segment was also visible using TRICKS-MRA on both sides (P=1). The fourth segment of the MCFA, which was the ascending lateral epiphyseal segment, was not visible on either side (P=0.49). No significant difference was found between the normal and affected hips in terms of visibility of the 4 segments of the MCFA using TRICKS-MRA. Anastomosis of the MCFA with the inferior gluteal artery was found in 3 hips (2 hips with LCPD and 1 normal hip).

Conclusions:
TRICKS-MRA provides well-defined images of the arterial supply to the proximal femoral epiphysis in children with LCPD, presenting a noninvasive and radiation-free alternative to conventional angiography. However, the TRICKS-MRA method used did not allow visualization of the ascending lateral epiphyseal segment of MCFA in the affected and the contralateral normal side. We believe that further advancement of this noninvasive imaging technique may open new opportunities for research aimed at evaluating the vascular supply of the femoral head in children.

Level of Evidence:
Level IV—case-control study.
Viral, inflammatory, and reservoir characteristics of posttreatment controllers
Authors: McMahon James , Lewin Sharon R. , Rasmussen Thomas A. 
Published: August 2021

Purpose of review
To provide an overview of studies to date that have identified posttreatment controllers (PTCs) and to explore current evidence around clinical characteristics, immune effector function, and inflammatory and viral reservoir characteristics that may underlie the control mechanism.

Recent findings
PTCs are broadly defined as individuals capable of maintaining control of HIV replication after cessation of antiretroviral therapy (ART). While starting ART early after HIV infection is associated with PTC, genetic disposition or CD8+ T-cell function do not appear to explain this phenomenon, but these features have not been exhaustively analyzed in PTCs. A lower frequency of latently infected cells prior to stopping ART has been associated with achieving PTC, including a lower level of intact HIV DNA, but more studies are needed to map the genetic location, epigenetic characteristics, and tissue distribution of the intact HIV reservoir in PTCs.

Summary
Current studies are small and heterogeneous and there is a significant need to agree on a uniform definition of PTC. Many aspects of PTC are still unexplored including whether specific features of genetic disposition, immune effector functions, and/or viral reservoir characteristics play a role in PTC. A large multisite international cohort study could aide in providing the important insights needed to fully understand PTC.
Sense of Stress and Posttraumatic Growth in Mothers of Children with Cystic Fibrosis—The Moderating Role of Resilience
Authors: Byra Stanisława , Zubrzycka Renata , Wójtowicz Paweł 
Published: August 2021

ABSTRACT:

Objective:
The aim of this study was to examine the moderating role of resilience in the relationship between sense of stress and posttraumatic growth (PTG) in mothers of children with cystic fibrosis (CF).

Methods:
This cross-sectional study was conducted in a group of 139 mothers of children with CF. A diagnostic survey with Polish versions of the inventories was used.

Results:
Over half of the mothers (52.89%) reported average and 26.11% high levels of general sense of stress. Mothers also experienced high (37.68%) and average (34.06%) PTG. Generally, mothers of children with CF manifested low general resilience. Sense of stress and PTG were significantly and positively correlated in this group of mothers. Positive correlations were revealed between resilience (total and individual dimensions), total PTG, and 1 dimension of PTG: changes in self-perception. Moreover, resilience was found to correlate with sense of stress. The obtained results indicate that resilience manifested as an optimistic life attitude and the ability to mobilize in difficult situations, and tolerance of failures and treating life as a challenge is a moderator in the relationship between sense of stress and PTG.

Conclusion:
The relationship between sense of stress and PTG in mothers of children with CF depends on the level of resilience.
The Effect of FOXP3+ Regulatory T Cells on Infectious and Inflammatory Diseases
Authors: Bai Yakun , Gao Fang , Li Dan , Ji Suyuan , Zhang Shuijun , Guo Wenzhi , Li Bin 
Published: August 2021

Abstract
CD4+CD25+FOXP3+ regulatory T cells (Tregs) contribute to the maintenance of immune homeostasis and tolerance in the body. The expression levels and functional stability of FOXP3 control the function and plasticity of Tregs. Tregs critically impact infectious diseases, especially by regulating the threshold of immune responses to pathogenic microorganisms. The functional regulatory mechanism and cell-specific surface markers of Tregs in different tissues and inflammatory microenvironments have been investigated in depth, which can provide novel ideas and strategies for immunotherapies targeting infectious diseases.
Does pain modality play a role in the interruptive function of acute visceral compared with somatic pain?
Authors: Kleine-Borgmann Julian , Schmidt Katharina , Scharmach Katrin , Zunhammer Matthias , Elsenbruch Sigrid , Bingel Ulrike , Forkmann Katarina 
Published: August 2021

Abstract
Acute pain captures attentional resources and interferes with ongoing cognitive processes, including memory encoding. Despite broad clinical implications of this interruptive function of pain for the pathophysiology and treatment of chronic pain conditions, existing knowledge exclusively relies on studies using somatic pain models. Visceral pain is highly prevalent and seems to be more salient and threatening, suggesting that the interruptive function of pain may be higher in acute visceral compared with somatic pain. Implementing rectal distensions as a clinically relevant experimental model of visceral pain along with thermal cutaneous pain for the somatic modality, we herein examined the impact of pain modality on visual processing and memory performance in a visual encoding and recognition task and explored the modulatory role of pain-related fear and expectation in 30 healthy participants. Despite careful and dynamically adjusted matching of stimulus intensities to perceived pain unpleasantness over the course of trials, we observed greater impairment of cognition performance for the visceral modality with a medium effect size. Task performance was not modulated by expectations or by pain-related fear. Hence, even at matched unpleasantness levels, acute visceral pain is capable of interfering with memory encoding, and this impact seems to be relatively independent of pain-related cognitions or emotions, at least in healthy individuals. These results likely underestimate the detrimental effect of chronic pain on cognitive performance, which may be particularly pronounced in acute and chronic visceral pain.
Predicting Employee Participation in, and Satisfaction With, Wellness Programs
Authors: Smidt Michelle N. , Jimmieson Nerina L. , Bradley Lisa M. 
Published: August 2021

Objective:
To examine the role of employee, supervisor, and organizational support in the prediction of employee participation in wellness programs.

Methods:
Data were collected at two-time points (T1 and T2) from 194 Australian employees.

Results:
Hierarchical binary logistic regressions revealed that higher levels of employee and supervisor support for wellness at T1 each predicted T2 participation, and high supervisor support was more effective when organizational support was high and did not compensate for when organizational support was low. Employees with higher perceptions of T1 poor general health had a lower likelihood of T2 participation, and higher levels of T1 supervisor support was a further deterrent to participation.

Conclusions:
Different sources of support for wellness predict employee attendance at wellness programs and it is important to ensure that supervisor and organizational support are aligned.
Interrater reliability of the assessment of disease activity by gastrointestinal ultrasound in a prospective cohort of patients with inflammatory bowel disease
Authors: Smith Rebecca L. , Taylor Kirstin M. , Friedman Antony B. , Su Heidi Y. , Con Danny , Gibson Peter R. 
Published: August 2021

Objective
Gastrointestinal ultrasound is a radiological investigation for monitoring patients with inflammatory bowel disease. However, the reliability of the findings depends on the reproducibility of results between different operators. Thus, the study aim was to assess the interrater reliability of gastrointestinal ultrasound in individuals with inflammatory bowel disease between gastroenterologists with varying GIUS experience.

Methods
Patients were prospectively recruited at the commencement of a new medical therapy for a baseline assessment, with a second assessment at the end of treatment induction (3 months). Consecutive, blinded ultrasounds were performed by two operators for every test. Gastrointestinal ultrasound examination included assessment of bowel wall thickness, vascularity, wall stratification assessment, mesenteric hyperechogenicity and lymphadenopathy.

Results
Forty-nine patients were recruited (Crohn’s n = 27, ulcerative colitis n = 22) with 35 returning for a repeat assessment at 3 months. At baseline, the intraclass coefficient for bowel wall thickness was near perfect (0.882). By bowel segment, the closest correlation was in the terminal ileum and differences in bowel wall thickness were similar by disease subtype. All other ultrasound indices of disease activity demonstrated substantial to near-perfect agreement with Gwet’s agreement coefficient: vascularity (0.681), wall stratification (0.685), mesenteric hyperechogenicity (0.841) and lymphadenopathy (0.633). Similar findings were seen at 3 months.

Conclusion
There is substantial agreement between operators of varying experience in gastrointestinal ultrasound findings in patients with Crohn’s disease or ulcerative colitis and this is repeatedly demonstrated over time. Thus, a well-trained operator should be sufficient to assess disease activity in patients with inflammatory bowel disease.
Self-reported nonceliac wheat sensitivity in an outpatient digestive endoscopy center: high frequency but insufficient medical approach
Authors: Mansueto Pasquale , Soresi Maurizio , Peralta Sergio , Perricone Simona , La Blasca Francesco , Sichera Roberto , Giambalvo Ornella , Carroccio Antonio 
Published: August 2021

Objective
‘Self-reported wheat sensitivity’ (SRWS) is a self-reported condition caused by wheat ingestion in the absence of celiac disease or wheat allergy. The aim of the study was to investigate the frequency and characteristics of SRWS in outpatients referred for digestive endoscopy.

Methods
The study, performed at the University of Palermo, enrolled 496 outpatients.

Results
Seven individuals (1.4%) had an already established diagnosis of celiac disease. The questionnaire was administered to the other 489 individuals: 98 subjects (20%) were SRWS, the remaining 391 served as controls (i.e. not-SRWS). SRWS patients were younger (P < 0.001), with a higher percentage of females (P = 0.002) than not-SRWS. ‘gastroesophageal reflux disease and ulcer-like dyspepsia’ and ‘chronic unexplained diarrhea’ were more frequently the reasons for the endoscopy study in SRWS than in not-SRWS (P = 0.002, and P = 0.05, respectively). Food allergies/intolerances (P = 0.04), milk allergy/intolerance (P = 0.0001), GERD (P = 0.0001), IBS (0.0001), anxiety (P = 0.005) and depression (P = 0.04) were the previous medical diagnoses reported more frequently in SRWS patients than in not-SRWS. In the SRWS group, 38% of the patients had already undergone previous upper endoscopy and 24% colonoscopy. After these investigations, 58% of SRWS patients received no diagnosis, and the other 42% were informed that they ‘were not suffering from celiac disease or wheat allergy’. Finally, 28.6% SRWS patients had followed a gluten-free diet (GFD), and 71.4% of them referred being asymptomatic on GFD.

Conclusions
Our data showed a high frequency of SRWS in outpatients referred to a digestive endoscopy center and a lack of medical accuracy in identifying a possible gluten-related disease.

Registration
The study was registered on Clinicaltrials.gov (registration number: NCT04154137), accessible at: https://clinicaltrials.gov/ct2/show/NCT04154137?term=non+celiac+wheat&draw=2&rank=1
Histological inflammatory activity can predict endoscopic relapse in patients with ulcerative colitis who have achieved mucosal healing
Authors: González-Partida Irene , Martínez-Lozano Helena , González-Lois Carmen , Peligros Isabel , Sánchez-Yuste Rosario , Salas Isabel , Matallana Virginia , Bighelli Federico , Calvo Marta , Marín-Jiménez Ignacio , Salas Clara , Vera María I. , Menchén Luis , González-Lama Yago 
Published: August 2021

Background & aims
Current therapeutic goals in ulcerative colitis (UC) include clinical and endoscopic remission, named mucosal healing (MH). Despite MH, a proportion of patients suffer a clinical relapse, which has been related to histological inflammation. We aimed to identify which histopathological features or histopathological index cut-off was associated with endoscopic relapse (ER) in UC patients with MH.

Methods
Retrospective analysis of UC patients who underwent surveillance colonoscopy showing complete MH (endoscopic Mayo subscore=0) with random biopsies, and at least one more endoscopy along the follow-up. After a consensus meeting, expert pathologist performed histological assessment according to Simplified Geboes Score (SGS), Nancy Index (NI) and Robarts Histopathological Index (RHI). Other histopathological features were also evaluated. Patients were followed until ER or last endoscopy performed showing persistence of MH.

Results
A total of 95 patients (150 colonoscopies) were included. After mean follow-up of 31.2 months (SD 21.7), 33 patients (34.7%) suffered ER. Neutrophils in lamina propria (OR 2.6; P = 0.037), within the epithelium (OR 2.6; P = 0.03), SGS ≥3.1 (OR 2.6; P = 0.037), NI ≥2 (OR 2.6; P = 0.03) and RHI ≥5 (OR 2.6; P = 0.037) were associated with ER in univariate analysis. In multivariate analysis, eosinophils in the lamina propria (HR 2.5; P = 0.01) and clinical remission<12 months (HR 3.2; P = 0.002) were associated with ER.

Conclusions
Histopathological findings in UC patients who have achieved endoscopic MH may predict ER. Standardized histopathology reports according to the presence of neutrophils, eosinophils or to defined cut-off of validated histopathologic indexes may represent a useful tool to predict ER and should be considered at therapeutic and surveillance decision process.
Skull base osteomyelitis imaging
Authors: Singhal Aparna , Sotoudeh Houman , Chapman Philip R. 
Published: August 2021

Purpose of review
Skull base osteomyelitis (SBO) is a challenging entity to diagnose and treat. The goal of this review is to summarize the imaging findings of SBO and present these in the context of recent studies on imaging of SBO.

Recent findings
This review discusses the clinical presentation, pathophysiology and imaging appearances of SBO. The review further emphasizes the results of latest studies on imaging of SBO, and the role of different modalities in diagnosis and evaluation of disease course and treatment response. Brief discussion on differential diagnoses from an imaging standpoint is also included.

Summary
Various imaging modalities play different and complimentary roles in diagnosis and management of SBO, which are discussed in this review.