bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Classification Tree Analysis to Predict the Type of Infection in Preterm Neonates: Proof of Concept Study
Authors: Kurul Şerife , Simons Sinno H. P. , Ramakers Christian R. B. , De Rijke Yolanda B. , Kornelisse René F. , Kroon André A. , Reiss Irwin K. M. , Taal H. Rob 
Published: December 2021

BACKGROUND:
Late-onset neonatal sepsis is a major complication in preterm neonates. Early identification of the type of infection could help to improve therapy and outcome depending on the suspected microorganism by tailoring antibiotic treatment to the individual patient based on the predicted organism. Results of blood cultures may take up to 2 days or may remain negative in case of clinical sepsis. Chemical biomarkers may show different patterns in response to different type of microorganisms.

OBJECTIVE:
The aim of this study was to develop, as a proof of concept, a simple classification tree algorithm using readily available information from biomarkers to show that biomarkers can potentially be used in discriminating in the type of infection in preterm neonates suspected of late-onset neonatal sepsis.

DERIVATION COHORT:
A total of 509 suspected late-onset neonatal sepsis episodes in neonates born before less than 32 weeks of gestation were analyzed. To examine model performance, 70% of the original dataset was randomly selected as a derivation cohort (n = 356; training dataset).

VALIDATION COHORT:
The remaining 30% of the original dataset was used as a validation cohort (n = 153; test dataset).

PREDICTION MODEL:
A classification tree prediction algorithm was applied to predict type of infection (defined as no/Gram-positive/Gram-negative sepsis).

RESULTS:
Suspected late-onset neonatal sepsis episodes were classified as no sepsis (80.8% [n = 411]), Gram-positive sepsis (13.9% [n = 71]), and Gram-negative sepsis (5.3% [n = 27]). When the derived classification tree was applied to the test cohort, the overall accuracy was 87.6% (95% CI, 81.3–92.4; p = 0.008). The classification tree demonstrates that interleukin-6 is the most important differentiating biomarker and C-reactive protein and procalcitonin help to further differentiate.

CONCLUSION:
We have developed and internally validated a simple, clinically relevant model to discriminate patients with different types of infection at moment of onset. Further research is needed to prospectively validate this in a larger population and assess whether adaptive antibiotic regimens are feasible.
Age at menopause in women living with HIV: a systematic review
Authors: Van Ommen Clara E. , King Elizabeth M. , Murray Melanie C. M. 
Published: December 2021

Abstract

Importance:
With improved HIV care, more women living with HIV (WLWH) are aging and entering menopause. Understanding any increased risk conferred by a potentially earlier menopause transition is important for the care of these women.

Objective:
There is conflicting literature regarding the association between HIV and an earlier onset of menopause. We conducted a systematic review to summarize the literature on the association between HIV and age at menopause.

Evidence Review:
A search of Ovid MEDLINE, EMBASE, and Web of Science identified 894 articles. We included cohort studies that assessed age at menopause, primary ovarian insufficiency (POI), or early menopause among WLWH and used the World Health Organization definition of menopause as ≥12 months of amenorrhea.

Findings:
Nine studies were included and eight reported on age at menopause. Across studies, the age at menopause for WLWH fell between 46 and 50 years. Five of seven studies reported that WLWH had an earlier menopausal transition than HIV negative controls/the general population. Six studies reported on the prevalence of POI or early menopause among WLWH, with all studies demonstrating an increased prevalence of both among WLWH.

Conclusions:
Our systematic review summarizes the literature around HIV and age at menopause. Many studies reported a high prevalence of POI and early menopause among WLWH; a factor that may partially account for the observed lower age at menopause. As only one study included biochemical confirmation of menopause, it remains unclear whether individuals with early menopause or POI were truly menopausal or had prolonged amenorrhea due to other causes. Overall, our findings highlight the need for further investigation with studies that include an HIV negative control group and biochemical confirmation of menopause to better understand whether menopause truly is occurring earlier among WLWH.
Effectiveness and Controversy of Convalescent Plasma Therapy for Coronavirus Disease 2019 Patients
Authors: Shu Zhanjun , Wu Peipei , Qian Qianqian , Zhou Li , Du Dandan , Ding Mengxuan , Peng Tao , Fang Ke 
Published: December 2021

Abstract
Since the coronavirus disease 2019 (COVID-19) began to spread, it remains pandemic worldwide. The European Medicines Agency's human medicines committee and Food and Drug Administration have only granted a conditional marketing authorization for remdesivir to treat COVID-19. It is essential to apply other valuable treatments. Convalescent plasma (CP), donated by persons who have recovered from COVID-19, is the cellular component of blood that contains specific antibodies. Therefore, to determine the feasibility of CP for COVID-19, the effectiveness and controversy are discussed in depth here. It is suggested that CP plays a certain role in the treatment of COVID-19. As a treatment, it may have its own indications and contraindications, which need to be further discussed. Meanwhile, it is critical to establish a standard procedure for treatment from CP collection, preservation, transport, to transfusion, and conduct some large sample randomized controlled trials to confirm the transfusion dosage, appropriate time, frequency, and actively prevent adverse outcomes that may occur.
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists
Authors: Khouja Tumader , Zhou Jifang , Gellad Walid F. , Mitsantisuk Kannop , Hubbard Colin C. , Yan Connie H. , Sharp Lisa K. , Calip Gregory S. , Evans Charlesnika T. , Suda Katie J. 
Published: December 2021

Abstract
Although nonsteroidal anti inflammatory drugs are superior to opioids in dental pain management, opioids are still prescribed for dental pain in the United States. Little is known about the serious adverse outcomes of short-acting opioids within the context of dental prescribing. The objective of this study was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with a dental visit and corresponding opioid prescription (index) from 2011 to 2018 within a nationwide commercial claims database was conducted. Opioid overprescribing was defined as >120 morphine milligram equivalents per Centers for Disease Control and Prevention guidelines. Generalized estimating equation models were used to assess adverse outcomes (emergency department visits, hospitalizations, newly diagnosed substance use disorder, naloxone administration, or death within 30 days from index) and POU (≥1 prescription 4-90 days postindex). Predicted probabilities are reported. Of 633,387 visits, 2.6% experienced an adverse outcome and 16.6% had POU. Adverse outcome risk was not different whether opioids were overprescribed or within recommendations (predicted probability 9.0%, confidence interval [CI]: 8.0%-10.2% vs 9.1%, CI: 8.1-10.3), but POU was higher when opioids were overprescribed (predicted probability 27.4%, CI: 26.1%-28.8% vs 25.2%, CI: 24.0%-26.5%). Visits associated with mild pain and those with substance use disorders had the highest risk of both outcomes. Findings from this study demonstrate that dental prescribing of opioids was associated with adverse outcomes and POU, even when prescriptions were concordant with guidelines. Additional efforts are required to improve analgesic prescribing in dentistry, especially in groups at high risk of opioid-related adverse outcomes.
Long-term prescription opioid users' risk for new-onset depression increases with frequency of use
Authors: Scherrer Jeffrey F. , Salas Joanne , Miller-Matero Lisa R. , Sullivan Mark D. , Ballantyne Jane C. , Debar Lynn , Grucza Richard A. , Lustman Patrick J. , Ahmedani Brian 
Published: December 2021

Abstract
Long-term opioid therapy (LTOT) is associated with increased risk for depression. It is not known if the frequency of opioid use during LTOT is associated with new-onset depression. We used Optum's de-identified Integrated Claims-Clinical dataset (2010-2018) to create a cohort of 5146 patients, 18 to 80 years of age, with an encounter or claims in the year before new LTOT. New LTOT was defined by >90-day opioid use after remaining opioid free for 6 months. Opioid use frequency during the first 90 days of LTOT was categorized into occasional use (<50% days covered), intermittent use (50% to <80% days covered), frequent use (80% to <90% days covered), and daily use (≥90% days covered). Propensity scores and inverse probability of exposure weighting controlled for confounding in models estimating risk for new-onset depression. Patients were on average 54.5 (SD ± 13.6) years of age, 55.7% were female, 72.5% were White, and 9.5% were African American. After controlling for confounding, daily users (hazard ratio = 1.40; 95% confidence interval: 1.14-1.73) and frequent users (hazard ratio = 1.34; 95% confidence interval: 1.05-1.71) were significantly more likely to develop new-onset depression compared with occasional users. This association remained after accounting for the contribution of post-index pain diagnoses and opioid use disorder. In LTOT, risk for new depression episodes is up to 40% greater in near-daily users compared with occasional users. Patients could reduce depression risk by avoiding opioid use on as many low pain days as possible. Repeated screening for depression during LTOT is warranted.
Caregiver Quality of Life After Cochlear Implantation in Older Adults
Authors: Aylward Alana , Gordon Steven A. , Murphy-Meyers Morganne , Allen Chelsea McCarty , Patel Neil S. , Gurgel Richard K. 
Published: December 2021

Objective:
To evaluate factors affecting quality of life (QOL) in caregivers of older cochlear implant (CI) recipients.

Study Design:
Cross-sectional survey.

Setting:
Academic medical center.

Patients:
Adults over age 65 receiving CI between July 13, 2000 and April 3, 2019.

Interventions:
Cochlear implantation.

Main Outcome Measures:
Linear regression models for caregiver QOL measured by Significant Other Scale for Hearing Disability (SOS-HEAR), with independent variables: caregiver role, patient gender, 11 factor modified frailty index (mFI), duration of hearing loss, hearing aid use, age at surgery, time since surgery, change in pure tone average (PTA), processor input type and Nijmegen Cochlear Implant Questionnaire (NCIQ). Correlations between SOS-HEAR and patient speech recognition scores.

Results:
Questionnaires were mailed to all 294 living CI recipients. Seventy-one caregivers completed the questionnaire. Only patient gender and mFi were significant predictors of caregiver QOL on both univariate (p ≤ 0.001, β= −20.26 [95% confidence interval –30.21, –10.3]; 0.005, –0.72 [–1.20, –0.23], respectively) and multivariate (p = 0.005, β = –20.09, –33.05 to –7.13; 0.003, –0.93 [–1.50, –0.37]) analysis, where caregivers of female patients with lower mFI (better health) had better QOL scores. Caregiver QOL was significantly associated with patient's change in PTA and self-reported QOL scores on univariate (p = 0.041, β = 0.52 [0.08, 0.96]; 0.024, –0.27 [–0.52, –0.02]) but not multivariate analysis. Time since CI was significant only on multivariate analysis (0.041, –0.17 [–0.33, –0.01]). Caregiver QOL did not correlate with patient speech recognition scores.

Conclusions:
Higher QOL scores were found among caregivers of healthier, female CI recipients. Patient hearing measurements did not correspond with better caregiver QOL.
Augmented Reality Based Transmodiolar Cochlear Implantation
Authors: Guigou Caroline , Hussain Raabid , Lalande Alain , Bozorg Grayeli Alexis 
Published: December 2021

Hypothesis:
Transmodiolar auditory implantation via the middle ear cavity could be possible using an augmented reality system (ARS).

Background:
There is no clear landmark to indicate the cochlear apex or the modiolar axis. The ARS seems to be a promising tool for transmodiolar implantation by combining information from the preprocedure computed tomography scan (CT-scan) images to the real-time video of the surgical field.

Methods:
Eight human temporal bone resin models were included (five adults and three children). The procedure started by the identification of the modiolar axis on the preprocedure CT-scan followed by a 3D reconstruction of the images. Information on modiolar location and navigational guidance was supplemented to the reconstructed model, which was then registered with the surgical video using a point-based approach. Relative movements between the phantom and the microscope were tracked using image feature-based motion tracking. Based on the information provided via the ARS, the surgeon implanted the electrode-array inside the modiolus after drilling the helicothrema. Postprocedure CT-scan images were acquired to evaluate the registration error and the implantation accuracy.

Results:
The implantation could be conducted in all cases with a 2D registration error of 0.4 ± 0.24 mm. The mean entry point error was 0.6 ± 1.00 mm and the implant angular error 13.5 ± 8.93 degrees (n = 8), compatible with the procedure requirements.

Conclusion:
We developed an image-based ARS to identify the extremities and the axis of the cochlear modiolus on intraprocedure videos. The system yielded submillimetric accuracy for implantation and remained stable throughout the experimental study.
Ten years of interfaculty pain curriculum at the University of Toronto: impact on student learning
Authors: Cioffi Iacopo , Dale Craig M. , Murphy Laura , Langlois Sylvia , Musa Renata , Stevens Bonnie 
Published: December 2021

Abstract

Introduction:
Delivery of interprofessional pain education for prelicensure healthcare professionals is strongly recommended to advance a workforce ready for collaborative practice and to improve the quality and outcomes of pain care.

Objectives:
We report a 10-year (2009–2019) longitudinal evaluation of a 20-hour undergraduate Interfaculty Pain Curriculum (IPC) delivered to students in the Faculties of Dentistry, Nursing, Pharmacy, and Medicine (also including the Departments of Physical Therapy, Occupational Therapy and Physician Assistant) at the University of Toronto, Canada. The IPC follows a constructivist approach to facilitate interactive and multifaceted learning.

Methods:
Evaluation methods based on the Kirkpatrick model were used to appraise changes in participating students' pain knowledge and beliefs and their ability to collaboratively develop an interprofessional pain management plan.

Results:
A total of 10,693 students participated over the 10-year study period. The mean annual attendance was 972 students and participation to the program increased significantly over the years. Overall, the IPC was effective in improving students' mean pain knowledge and beliefs scores; however, the mean knowledge score gains were negatively correlated with time, likely related to increased uniprofessional pain education. Although an increasing trend in mean interprofessional pain management plan scores was observed, the scores were not significantly correlated with time.

Conclusions:
The interactive and multifaceted IPC is consistently effective in improving knowledge and beliefs and interprofessional pain management care plan development among participating student cohorts. Future inquiry is required to better understand the mechanisms behind student learning in interprofessional pain education to enhance pain curriculum development and delivery.
The Superior Mesenteric Artery Angle and Abdominal Main Vessel Diameters in Normovolemic Children
Authors: Keçeli Merter 
Published: December 2021

Background
Knowledge of the normal size of important abdominal vessels is important for determination of hydration status and intravascular volume. Knowing the normal value of superior mesenteric artery (SMA) exit angle from the aorta (SMA angle) is necessary for the diagnosis of clinical pathologies caused by SMA compression.

Objectives
The aim of this study was to determine the normal SMA angles and normal diameters of the main abdominal vascular structures of pediatric participants on ultrasonography (USG).

Methods
Between January 2019 and July March 2019, the USG examinations obtained from 210 participants (age range, 1–214 years; mean age, 83.5 [SD, 5.5] months; females 51%, males 49%) with normal abdominal examinations were prospectively evaluated. The participants were divided into 5 groups according to age. Body mass index values of the participants were kept equal.

Results
The diameters of the abdominal vascular structures increased with age, and the statistical differences among the age groups were significant. In all groups, no statistically significant difference was observed between sexes (P > 0.05). The SMA angle was between 17° and 58° (mean, 37.8° [SD, 8.5°]). A statistically significant difference was observed between the age groups in terms of SMA angle (P < 0.05). No statistically difference was found between sexes (P > 0.58–0.912).

Conclusions
In our study, we think that the measurements obtained by USG provide normal values of the diameters of the abdominal main vessels and SMA angle. These values can be used as a reference for interpreting hydration status, vascular diameter assessment, and SMA compression syndromes.
Challenging Management of Plexiform Schwannoma and Plexiform Neurofibroma
Authors: Nicoli Taija K. , Saat Riste , Tarkkanen Jussi , Kinnunen Ilpo , Mäkitie Antti A. , Jero Jussi 
Published: December 2021

Abstract
Plexiform variants of neurofibromas and schwannomas are rare and typically arise in superficial soft tissues in the head and neck region. The treatment of these tumors is challenging and no generally accepted guidelines exist for their optimal management. The purpose of this study was to review the management and longterm prognosis of head and neck plexiform neurofibromas and schwannomas at 2 tertiary care academic hospitals in Finland over a 31-year period. The pathology files were searched for plexiform neurofibromas and schwannomas between the years 1990 and 2020. The case notes were reviewed for full management details. Two plexiform schwannomas and 6 plexiform neurofibromas were identified. Five of the 6 plexiform neurofibromas were managed operatively. All patients with a surgically managed plexiform neurofibroma underwent multiple operations. Sclerotherapy abolished 1 patient's cutaneous plexiform neurofibromas. The management of plexiform neurofibromas and plexiform schwannomas remains challenging. Sclerotherapy may offer a promising management option for cutaneous plexiform neurofibromas.
Scaphoideus titanus Ball feeding behaviour on three grapevine cultivars with different susceptibilities to Flavescence dorée
Authors: Ripamonti Matteo , Maron Federico , Cornara Daniele , Marzachì Cristina , Fereres Alberto , Bosco Domenico 
Published: December 2021

AbstractScaphoideus titanus (Ball) is a grapevine-feeder leafhopper, and the most important vector of Flavescence dorée of grapevine (FD), a disease associated with phytoplasmas belonging to ribosomal subgroups 16Sr-V–C and –D. FD is a major constraint to viticulture in several European countries and, so far, its control has relied on roguing of infected plants and insecticide applications against the vector. Detailed knowledge on different levels of the multifaceted phytoplasma-plant-vector relationship is required to envisage and explore more sustainable ways to control the disease spread. In the present work, S. titanus feeding behaviour was described on three grapevine cultivars: Barbera (susceptible to FD), Brachetto, and Moscato (tolerant to FD) using the Electrical Penetration Graph (EPG) technique. Interestingly, no differences were highlighted in the non-phloem feeding phases, thus suggesting that the tested cultivars have no major differences in the biochemical composition or structure of the leaf cuticle, epidermis or mesophyll, that can affect the first feeding activities. On the contrary, the results showed significant differences in leafhopper feeding behaviour in terms of the duration of the phloem feeding phase, longer on Barbera and shorter on Brachetto and Moscato, and of the frequency of interruption-salivation events inside the phloem, higher on Brachetto and Moscato. These findings indicate a possible preference for the Barbera cultivar, a better host for the leafhopper. Scaphoideus titanus feeding behaviour on Barbera correlates with an enhanced FDp transmission efficiency, thus explaining, at least in part, the higher susceptibility of this cultivar to FD. The mechanisms for the possible non-preference for Brachetto and Moscato are discussed, and an antixenosis is hypothesized. We propose that breeding for resistance against FD should take into account both plant traits associated with the response to the phytoplasmas and to the vector.
Clinical Characteristics and Treatment Experience of Individuals with SCN8A Developmental and Epileptic Encephalopathy (SCN8A-DEE): Findings from an Online Caregiver Survey
Authors: Cutts Alison , Savoie Hillary , Hammer Michael F. , Schreiber John , Grayson Celene , Luzon Constanza , Butterfield Noam , Pimstone Simon N. , Aycardi Ernesto , Harden Cynthia , Yonan Chuck , Jen Eric , Nguyen Trung , Carmack Tara , Haubenberger Dietrich 
Published: December 2021

ABSTRACTPurposeSCN8A developmental epileptic encephalopathy (SCN8A-DEE) is a rare and severe genetic epilepsy syndrome characterized by early-onset developmental delay, cognitive impairment, and intractable seizures. Variants in the SCN8A gene are associated with a broad phenotypic spectrum and variable disease severity. A caregiver survey, solicited by the advocacy group The Cute Syndrome Foundation (TCSF), was conducted to gather information on the demographics/disease presentation, seizure history, and treatment of patients with SCN8A-related epilepsies.MethodsA 36-question online survey was developed to obtain de-identified data from caregivers of children with SCN8A-related epilepsy. The survey included questions on genetic diagnosis, disease manifestations/comorbidities, seizure severity/type, current/prior use of antiseizure medicines (ASMs), and best/worst treatments per caregiver perception.ResultsIn total, 116 survey responses (87 USA, 12 Canada, 12 UK, 5 Australia) were included in the quantitative analysis. Generalized tonic/clonic was the most common seizure type at onset and time of survey; absence and partial/focal seizures were also common. Most patients (77%) were currently taking ≥2 ASMs; 50% had previously tried and stopped ≥4 ASMs. Sodium channel blockers (oxcarbazepine, phenytoin, lamotrigine) provided the best subjective seizure control and quality of life.ConclusionThe SCN8A-DEE patient population is heterogeneous and difficult to treat, with high seizure burden and multiple comorbidities. The high proportion of patients who previously tried and stopped ASMs indicates a large unmet treatment need. Further collaboration between families, caregivers, patient advocates, clinicians, researchers, and industry can increase awareness and understanding of SCN8A-related epilepsies, improve clinical trial design, and potentially improve patient outcomes.HIGHLIGHTSThis is the first survey-based study of caregiver experiences in SCN8A-DEECaregivers report a broad range of seizure types and genetic variants in patientsPatients generally suffer from high seizure burden and multiple comorbiditiesResults suggest new treatments and standardized treatment protocols are neededPatient-centered research may improve awareness of SCN8A-DEE and patient outcomes