bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conversion From Continuous Infusion Fentanyl to Continuous Infusion Hydromorphone in the Pediatric Intensive Care Unit
Authors: Harkin Maura , Miller Jamie L. , Lim Sin Yin , Neely Stephen B. , Walsh Christina K. , Johnson Peter N. 
Published: March 2021

Background: Opioid rotations from fentanyl to hydromorphone may reduce opioid/sedative exposure in critically ill children. Objective: The primary objective was to determine the conversion percentage from fentanyl to hydromorphone infusions using equianalgesic conversions (0.1 mg fentanyl = 1.5 mg hydromorphone). Secondary objectives included identification of the median time and hydromorphone rate at stabilization (defined as the first 24-hour period no hydromorphone rates changed, 80% of State Behavioral Scale [SBS] scores between 0 and −1, and <3 hydromorphone boluses administered). Additional outcomes included a comparison of opioid/sedative requirements on the day of conversion versus the three 24-hour periods prior to conversion. Methods: This retrospective study included children <18 years old converted from fentanyl to hydromorphone infusions over 6.3 years. Linear mixed models were used to determine if the mean cumulative opioid/sedative dosing differed from the day of conversion versus three 24-hour periods prior to conversion. Results: A total of 36 children were converted to hydromorphone. The median conversion percentage of hydromorphone was 86% of their fentanyl dose (interquartile range [IQR] = 67-100). The median hydromorphone rate at stabilization was 0.08 mg/kg/h (IQR = 0.05-0.1). Eight (22%) were stabilized on their initial hydromorphone rate; 8 (22%) never achieved stabilization. Patients had a significant decrease in opioid dosing on the day of conversion versus the 24-hour period prior to conversion but no changes in sedative dosing following conversion. Conclusion and Relevance: A median 14% fentanyl dose reduction was noted when transitioning to hydromorphone. Further exploration is needed to determine if opioid rotations with hydromorphone can reduce opioid/sedative exposure.
‘We should have been told what would happen’: Children’s and parents’ procedural knowledge levels and information-seeking behaviours when coming to hospital for a planned procedure
Authors: Bray Lucy , Appleton Victoria , Sharpe Ashley 
Published: March 2021

Children continue to be poorly prepared and informed about clinical procedures, despite increased evidence of the worth of preparation and the availability of information resources. This study used a concurrent mixed-methods approach to explore the information accessed by children and their parents before attending hospital for a procedure. Information was collected separately from 40 children (aged between 8 and 12 years) and their parents using a paper booklet to examine self-reported perceived procedural knowledge and information-seeking behaviours. Data were analysed using descriptive statistics and content analysis techniques. The findings indicate that many children (70%, n = 28) and their parents (65%, n = 26) have low procedural knowledge levels. The majority of children (85%, n = 36) reported not receiving or seeking information about their procedure, despite identifying a desire and preference for more information. This study shows a mismatch between the current provision of procedural information and children and parents’ expectations that information will be provided directly to them by health professionals. In order for this ‘information hole’ to be filled, there needs to be a concerted effort to develop and systematically use meaningful information materials and for children and their parents to have the opportunity to discuss their procedural knowledge with health professionals.
Bacterial Diversity, Antibiotic Resistance, and the Risk of Lower Limb Amputation in Younger and Older Individuals With Diabetic Foot Infection
Authors: Dörr Stefan , Holland-Letz Ann-Kathrin , Weisser Gregor , Chatzitomaris Apostolos , Lobmann Ralf 
Published: March 2021

Introduction A diabetic foot infection (DFI) contributes to high mortality and morbidity in diabetics due to its often rapid progressive and intricately treatable infection. DFIs are usually a polymicrobial infection and characterizing the entire bacterial load is still challenging. Prompt and effective treatment of DFI is nevertheless mandatory to safe limbs and lives. It is therefore crucial to know the local pathogen spectrum and its antibiotic susceptibility. Methods and Material For a 12-month period, we investigated 353 individuals with infected diabetic foot ulcer, their bacterial diversity, and antimicrobial susceptibility at fist-time visit in a Diabetic Foot Care Center in southern Germany. Results Cultures yielded 888 species, most of them gram-positive cocci (primary Staphylococcus aureus). The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriacae. Because the prevalence of multiresistant species was surprisingly low (0.9% of isolated strains), we suggest penicillins with β-lactamase inhibitor in case of gram-positive–dominated infection or piperacillin/tazobactam or rather carbapenems with equal efficacy when gram-negative species are involved.
Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial
Authors: Krakauer John W. , Kitago Tomoko , Goldsmith Jeff , Ahmad Omar , Roy Promit , Stein Joel , Bishop Lauri , Casey Kelly , Valladares Belen , Harran Michelle D. , Cortés Juan Camilo , Forrence Alexander , Xu Jing , DeLuzio Sandra , Held Jeremia P. , Schwarz Anne , Steiner Levke , Widmer Mario , Jordan Kelly , Ludwig Daniel , Moore Meghan , Barbera Marlena , Vora Isha , Stockley Rachel , Celnik Pablo , Zeiler Steven , Branscheidt Meret , Kwakkel Gert , Luft Andreas R. 
Published: March 2021

Background Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. Objective To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). Methods A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. Results There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. Conclusions Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
Endoscopic-Assisted Oropharyngectomy for Early Oropharyngeal Cancer in Trismus Patients
Authors: Young Chi-Kuang , Huang Shiang-Fu 
Published: March 2021

Objective: Management of the early-stage oropharyngeal carcinoma in trismus patients underlying with multiple head and neck cancer history is a clinical challenge because minimal invasive surgery such as transoral robotic surgery or transoral laser microsurgery is contraindicated, while open surgery or concurrent chemoradiation (CCRT) wound cause long-term adverse effect. Therefore, we developed a novel endoscopic surgical approach for these patients. Methods: Four patients were enrolled for endoscopic-assisted oropharyngectomy. The oropharyngeal tumor was resected with an adequate margin via a one-surgeon bimanual approach with the aid of a high-resolution videoendoscopic system, scope holder, and designed surgical instruments. The postoperative surgical margin status, trismus status, perioperative complication, average hospital stay, and follow-up period were recorded. Results: The endoscopic-assisted oropharyngectomy was successfully applied in all 4 patients with en bloc tumor excision and adequate free margin status. The mean hospital stay was 6.5 days, and all patients could tolerate oral diet within 2 weeks. There was no perioperative complication noted. No tumor recurrence was identified in patients followed up 2 years after surgery. Conclusion: Endoscopic-assisted oropharyngectomy for patients with trismus and multiple head and neck cancer history is a safe, minimal invasive, and effective treatment choice other than open surgery or CCRT. It provides a safe option for patients with limited mouth opening.
Incorporation of a Poly-ε-Caprolactone Scaffold in a ;Circular Stapled End-To-End Small Intestine Anastomosis Does Not Have Any Adverse Effects Within 30 days: A Study in Piglets
Authors: Schiellerup Nicolai S. , Wismann Joakim , Madsen Gunvor I. , Le Dang Q S. , Qvist Niels , Ellebæk Mark B. 
Published: March 2021

Background . Incorporation of a poly-ε-caprolactone (PCL) scaffold in circular stapled anastomoses has been shown to increase the anastomotic tensile strength on postoperative day (POD) 5 in a pig model. The aim of this study was to investigate the effects of incorporation of a PCL scaffold in a circular stapled end-to-end small intestine anastomosis, with stricture formation and anastomotic histology as primary outcomes in a 30-day observation period. Methods . A total of 15 piglets were included. In each piglet, three circular stapled end-to-end anastomoses were made in the small intestines. Two were interventional and one was a control. On POD 10, 20, or 30, the anastomoses were subjected to in vivo intraluminal contrast study, and the index for anastomotic lumen was calculated. The anastomotic segment was resected and subjected to a tensile strength test and histological examination. Results . At POD 10, the mean ± SD value for anastomotic index was .749 ± .065 in control anastomoses and .637 ± .051 in interventional anastomosis ( P = .0046), at POD 20, .541 ± .150 and .724 ± .07 ( P = .051), and at POD 30, .645 ± .103 and .686 ± .057 ( P = .341), respectively. No significant difference was observed in maximum tensile strength and histology at POD 30. Conclusions . The incorporation of a PCL scaffold in a circular stapled end-to-end small intestine anastomosis does not increase the risk of stricture or impair wound healing after 30 days.
TABADO 2 : une stratégie d’accompagnement au sevrage tabagique des adolescents en milieu scolaire
Authors: Vallata Amandine , Cadeville Marjorie , Kanski Charlotte , Alla François 
Published: March 2021

La consommation de tabac est une des premières causes de mortalité évitable au niveau mondial. La dépendance au tabac s’observe dès l’adolescence. En complément des actions visant à prévenir l’entrée des jeunes dans le tabagisme, il est donc nécessaire de développer des stratégies spécifiques pour les adolescents déjà fumeurs. Un programme d’accompagnement au sevrage tabagique pour adolescents, TABADO, a montré son efficacité lors d’un essai contrôlé mené dans des centres de formation des apprentis en 2007/2009. En 2018, l’Institut national du cancer a souhaité généraliser TABADO au niveau national et l’étendre aux lycées professionnels. Pour accompagner ce processus de mise à l’échelle, il était essentiel d’élaborer la théorie d’intervention et d’analyser la transférabilité de TABADO en conditions de vie réelle et dans de nouveaux contextes, et de proposer les adaptations correspondantes. Une recherche spécifique a été conduite et détaillée par ailleurs. L’objectif de cette publication pragmatique est de présenter la nouvelle stratégie TABADO 2 aux acteurs et décideurs de santé publique, et le guide afférent développé pour les accompagner dans la mise en œuvre. Une étude de cas multiples ( n = 10) a été menée à partir de la mise en œuvre de TABADO dans trois régions françaises, qui reposait sur des observations, entretiens et séminaires de retour d’expérience. Elle a mis en évidence l’adaptation de l’intervention aux contextes locaux, ainsi que de nouveaux leviers interventionnels mis en œuvre. De plus, les investigations ont montré que pour instaurer un climat favorable à la démarche d’arrêt de la consommation de tabac et soutenir son maintien sur la durée, il était nécessaire d’inscrire TABADO dans une stratégie globale de l’établissement scolaire et de son environnement. Cette démarche a permis de proposer une transformation de l’intervention TABADO en une nouvelle stratégie – TABADO 2 – et de proposer un guide pour accompagner son déploiement national.
Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures
Authors: Hinckel Betina B. , Thomas Dimitri , Vellios Evan E. , Hancock Kyle John , Calcei Jacob G. , Sherman Seth L. , Eliasberg Claire D. , Fernandes Tiago L. , Farr Jack , Lattermann Christian , Gomoll Andreas H. 
Published: March 2021

Objective To create a treatment algorithm for focal grade 3 or 4 cartilage defects of the knee using both classic and novel cartilage restoration techniques. Design A comprehensive review of the literature was performed highlighting classic as well as novel cartilage restoration techniques supported by clinical and/or basic science research and currently being employed by orthopedic surgeons. Results There is a high level of evidence to support the treatment of small to medium size lesions (<2-4 cm2) without subchondral bone involvement with traditional techniques such as marrow stimulation, osteochondral autograft transplant (OAT), or osteochondral allograft transplant (OCA). Newer techniques such as autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate implantation have also been shown to be effective in select studies. If subchondral bone loss is present OAT or OCA should be performed. For large lesions (>4 cm2), OCA or matrix autologous chondrocyte implantation (MACI) may be performed. OCA is preferred over MACI in the setting of subchondral bone involvement while cell-based modalities such as MACI or particulated juvenile allograft cartilage are preferred in the patellofemoral joint. Conclusions Numerous techniques exist for the orthopedic surgeon treating focal cartilage defects of the knee. Treatment strategies should be based on lesion size, lesion location, subchondral bone involvement, and the level of evidence supporting each technique in the literature.
Switching treatments in clinically stable relapsing remitting multiple sclerosis patients planning for pregnancy
Authors: Almouzain Lubna , Stevenson Fiona , Chard Declan , Rahman Nur Abdul , Hamilton Fiona 
Published: March 2021

Background The decision to have children can be complex, particularly for people with multiple sclerosis (MS). A key concern is the use of disease modifying drugs (DMDs) during pregnancy, and how continuing, stopping or switching them may affect the mother and child. In people with active MS, stopping medications puts the mother at risk of relapse and disease rebound. Objectives Review evidence on the effect of different switching strategies in people with stable relapsing remitting MS (RRMS). Methods We searched MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane Library up to March 2020. Only papers in English were included and no other limits were applied. Seven articles were included: four cohorts, two case reports and one randomized controlled trial (RCT). Results Two strategies were found: de-escalating, which was associated with an increased risk of relapses, and switching between first line injectables, with no change in relapse rate observed. Conclusion Evidence on the effect of switching strategy on disease course in stable RRMS patients planning for pregnancy is scarce, but when switching, current evidence suggests the risk of relapses mirrors known medication efficacy.
Factors Associated with Women’s Unwillingness to Decrease Alcohol Intake to Decrease Breast Cancer Risk
Authors: Matin Jenna , Lucia Rachel McFarland , Lal Krustina , Columbus Alyssa , Goodman Deborah , Larsen Kathryn , Ziogas Argyrios , Park Hannah Lui 
Published: March 2021

Objective: Alcohol intake is a known risk factor for breast cancer. National organizations recommend that women consume no more than one serving of alcohol per day, if at all; however, many women exceed this recommendation, and some are unwilling to decrease consumption. Our study sought to identify factors associated with women’s unwillingness to decrease their alcohol intake to decrease their breast cancer risk. Methods: 942 women in a screening mammography cohort were asked questions about their demographics, personal and family health history, lifestyle factors, and willingness/unwillingness to decrease alcohol intake to decrease their breast cancer risk. Univariate and multivariate analyzes of their responses were performed. Results: 13.2% of women in our cohort indicated they were unwilling to decrease their alcohol intake to reduce their breast cancer risk. After adjusting for potential confounders, women who were 60 years and older were more than twice as unwilling to decrease their alcohol intake compared to their younger counterparts ( P = .0002). Women who had an annual household income of more than $200,000 were 1.75 times more unwilling to decrease their alcohol intake compared to their less affluent counterparts ( P = .033). Unwillingness was not significantly associated with race/ethnicity, education, having a first-degree family member with cancer, health perception, breast cancer risk perception, or BMI. Conclusions: Levels of unwillingness to decrease alcohol intake differed by age and household income. An opportunity is present to potentially decrease breast cancer risk in the community by educating women, especially older and more affluent women, about alcohol as a risk factor for breast cancer and the importance of limiting one’s alcohol intake.
Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients
Authors: Dignam Colette , Brown Margaret , Thompson Campbell H 
Published: March 2021

Not for Cardiopulmonary Resuscitation (No-CPR) orders, or the local equivalent, help prevent futile or unwanted cardiopulmonary resuscitation. The importance of unambiguous and readily available documentation at the time of arrest seems self-evident, as does the need to establish a patient’s treatment preferences prior to any clinical deterioration. Despite this, the frequency and quality of No-CPR orders remains highly variable, while discussions with the patient about their treatment preferences are undervalued, occur late in the disease process, or are overlooked entirely. This review explores the evolution of hospital patient No-CPR/Do Not Resuscitate decisions over the past 60 years. A process based on standardized resuscitation plans has been shown to increase the frequency and clarity of documentation, reduce stigma attached to the documentation of a No-CPR order, and support the delivery of medically appropriate and desired care for the hospital patient.
Thermodynamics Controlled Sharp Transformation from InP to GaP Nanowires via Introducing Trace Amount of Gallium
Authors: Tian Zhenzhen , Yuan Xiaoming , Zhang Ziran , Jia Wuao , Zhou Jian , Huang Han , Meng Jianqiao , He Jun , Du Yong 
Published: March 2021

AbstractGrowth of high-quality III–V nanowires at a low cost for optoelectronic and electronic applications is a long-term pursuit of research. Still, controlled synthesis of III–V nanowires using chemical vapor deposition method is challenge and lack theory guidance. Here, we show the growth of InP and GaP nanowires in a large area with a high density using a vacuum chemical vapor deposition method. It is revealed that high growth temperature is required to avoid oxide formation and increase the crystal purity of InP nanowires. Introduction of a small amount of Ga into the reactor leads to the formation of GaP nanowires instead of ternary InGaP nanowires. Thermodynamic calculation within the calculation of phase diagrams (CALPHAD) approach is applied to explain this novel growth phenomenon. Composition and driving force calculations of the solidification process demonstrate that only 1 at.% of Ga in the catalyst is enough to tune the nanowire formation from InP to GaP, since GaP nucleation shows a much larger driving force. The combined thermodynamic studies together with III–V nanowire growth studies provide an excellent example to guide the nanowire growth.
Shared developmental gait disruptions across two mouse models of neurodevelopmental disorders
Authors: Rahn Rachel M. , Weichselbaum Claire T. , Gutmann David H. , Dougherty Joseph D. , Maloney Susan E. 
Published: March 2021

Abstract
Background
Motor deficits such as abnormal gait are an underappreciated yet characteristic phenotype of many neurodevelopmental disorders (NDDs), including Williams Syndrome (WS) and Neurofibromatosis Type 1 (NF1). Compared to cognitive phenotypes, gait phenotypes are readily and comparably assessed in both humans and model organisms and are controlled by well-defined CNS circuits. Discovery of a common gait phenotype between NDDs might suggest shared cellular and molecular deficits and highlight simple outcome variables to potentially quantify longitudinal treatment efficacy in NDDs.

Methods
We characterized gait using the DigiGait assay in two different murine NDD models: the complete deletion (CD) mouse, which models hemizygous loss of the complete WS locus, and the Nf1+/R681X mouse, which models a NF1 patient-derived heterozygous germline NF1 mutation. Longitudinal data were collected across four developmental time points (postnatal days 21–30) and one early adulthood time point.

Results
Compared to wildtype littermate controls, both models displayed markedly similar spatial, temporal, and postural gait abnormalities during development. Developing CD mice also displayed significant decreases in variability metrics. Multiple gait abnormalities observed across development in the Nf1+/R681X mice persisted into early adulthood, including increased stride length and decreased stride frequency, while developmental abnormalities in the CD model largely resolved by adulthood.

Conclusions
These findings suggest that the subcomponents of gait affected in NDDs show overlap between disorders as well as some disorder-specific features, which may change over the course of development. Our incorporation of spatial, temporal, and postural gait measures also provides a template for gait characterization in other NDD models and a platform to examining circuits or longitudinal therapeutics.