bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mapping the current psychology provision for children and young people with juvenile dermatomyositis
Authors: Livermore Polly , Gibson Faith , Mulligan Kathleen , Wedderburn Lucy R , McCann Liza J , Gray Suzanne 
Published: September 2021

AbstractObjectivesJuvenile Dermatomyositis (JDM) is a rare, chronic autoimmune condition of childhood, with known psychosocial implications. In this study, we sought to establish current psychological support for children and young people across the UK with rheumatic conditions, with a specific focus on those with JDM.MethodsElectronic surveys were distributed to the 15 centres that belong to the JDM Research Group in the UK, collecting responses from health-care professionals in the fields of medicine, nursing and psychology.ResultsOne hundred per cent of professionals from medicine and nursing replied from all 15 centres. Of these, 7 (47%) did not have a named psychologist as part of their rheumatology team, despite the majority [13 (87%)] having &gt;200 paediatric rheumatology patients. Of the remaining centres, hospital psychology provision varied considerably. When rating their service, only 3 (8%) of 40 professionals scored their service as five (where one is poor and five is excellent); there were wide discrepancies in these scores. Many challenges were discussed, including limited psychology provision, lack of time and difficulties in offering support across large geographical areas.ConclusionMany of the challenges discussed are applicable to other centres worldwide. Suggestions have been proposed that might help to improve the situation for children and young people with rheumatic conditions, including JDM. Based on these findings, we suggest that rheumatology teams maximize use of these data to advocate and work toward more comprehensive psychology provision and support in their individual centres.
Consumer-based activity trackers in evaluation of physical activity in myositis patients
Authors: Saygin Didem , Rockette-Wagner Bonny , Oddis Chester , Neiman Nicole , Koontz Diane , Moghadam-Kia Siamak , Aggarwal Rohit 
Published: September 2021

Abstract

Objectives
Inflammatory myopathies are characterized by muscle weakness that limits the activities of daily living. Daily step count is an accepted metric of physical activity. Wearable technologies such as Fitbit® enable tracking of daily step counts. We assessed the psychometric properties of Fitbit® and compared the accuracy of Fitbit® step counts to ActiGraph®.

Methods
This was a pilot, proof of concept, prospective observational study with four visits at 0, 1, 3 and 6 months in PM, DM, necrotizing myopathy (NM) or anti-synthetase syndrome (AS) subjects. Six core set measures (manual muscle testing, physician global disease activity, patient global disease activity, and extra-muscular disease activity, HAQ-Disability Index and creatine kinase), three functional tests (six-min walk, timed up-and-go, sit-to-stand tests) and SF-36 physical function-10 (PF10) were collected at each visit. Patients wore waist-worn Fitbit® One and ActiGraph® T3X-BT concurrently for 7 days/month for 6 months.

Results
Twenty-four (10 DM, 8 PM/NM, 6 AS) patients (17 females/7 males; 91% Caucasian) were enrolled. Test-retest reliability of daily steps was strong in 1-month follow-up (ICC 0.89). Daily steps and peak 1-min cadence showed moderate-strong correlations with physician global disease activity, patient global disease activity, HAQ-Disability Index, SF-36 PF10 and all three functional tests. Fitbit® and ActiGraph® step counts demonstrated good agreement and strong correlation (ICC 0.96).

Conclusion
Fitbit® daily steps and peak 1-min cadence are reliable and valid measures of physical activity in a cohort of myositis patients. This pilot data suggests that Fitbit® has a potential for use in clinical practice and trials to monitor physical activity in myositis patients, but larger studies are needed for further validation.
The early impact of the COVID-19 pandemic on mathematical competencies on entry into a UK university
Authors: Hodds Mark 
Published: September 2021

Abstract
Students from England and Wales had their A-level results in 2020 decided by a ‘triple lock’ system as traditional examinations were cancelled due to the pandemic. Therefore, there was a fear that students were either being unfairly judged ( Arden University 2020) or would enter university with a reduced understanding of concepts leading to an increase in drop-out rates ( Staton, 2020). To measure mathematical ability, diagnostic testing is used at universities. This is now a well-established practice that supports students and their lecturers in discovering areas of mathematical strength and weakness upon entry to a course ( Lawson, 2003; Hodds, Shao, and Lawson, 2020). This article compares the entry competencies of students arriving at one UK university in October 2020 with those who entered in previous years, using the same diagnostic test taken by all students as the method for comparison. Students who received their A levels in the year of entry are also compared to those who entered with A levels from years prior, allowing for a fair comparison of students in 2020 in particular. Furthermore, the abilities of students at different A-level grades are also compared. The results showed that students in 2020 appear not to be disadvantaged by the issues caused by the pandemic. On the contrary, many students outperformed colleagues who had summative assessment prior to 2020.
Dermal Exposure to the Immunomodulatory Antimicrobial Chemical Triclosan Alters the Skin Barrier Integrity and Microbiome in Mice
Authors: Baur Rachel , Gandhi Jasleen , Marshall Nikki B , Lukomska Ewa , Weatherly Lisa M , Shane Hillary L , Hu Gangqing , Anderson Stacey E 
Published: September 2021

AbstractTriclosan is an antimicrobial chemical used in healthcare settings that can be absorbed through the skin. Exposure to triclosan has been positively associated with food and aeroallergy and asthma exacerbation in humans and, although not directly sensitizing, has been demonstrated to augment the allergic response in a mouse model of asthma. The skin barrier and microbiome are thought to play important roles in regulating inflammation and allergy and disruptions may contribute to development of allergic disease. To investigate potential connections of the skin barrier and microbiome with immune responses to triclosan, SKH1 mice were exposed dermally to triclosan (0.5–2%) or vehicle for up to 7 consecutive days. Exposure to 2% triclosan for 5–7 days on the skin was shown to increase transepidermal water loss levels. Seven days of dermal exposure to triclosan decreased filaggrin 2 and keratin 10 expression, but increased filaggrin and keratin 14 protein along with the danger signal S100a8 and interleukin-4. Dermal exposure to triclosan for 7 days also altered the alpha and beta diversity of the skin and gut microbiome. Specifically, dermal triclosan exposure increased the relative abundance of the Firmicutes family, Lachnospiraceae on the skin but decreased the abundance of Firmicutes family, Ruminococcaceae in the gut. Collectively, these results demonstrate that repeated dermal exposure to the antimicrobial chemical triclosan alters the skin barrier integrity and microbiome in mice, suggesting that these changes may contribute to the increase in allergic immune responses following dermal exposure to triclosan.
Stepwise Approach to the Management of Endometriosis-Related Dysmenorrhea
Authors: Bohn Jacqueline A. , Bullard Kimberley A. , Rodriguez Maria I. , Ecker Amanda M. 
Published: September 2021

OBJECTIVE:
To evaluate the cost effectiveness of sequential medical and surgical therapy for the treatment of endometriosis-related dysmenorrhea.

METHODS:
A cost-effectiveness model was created to compare three stepwise medical and surgical treatment strategies compared with immediate surgical management for dysmenorrhea using a health care payor perspective. A theoretical study cohort was derived from the estimated number of reproductive age (18–45) women in the United States with endometriosis-related dysmenorrhea. The treatment strategies modeled were: strategy 1) nonsteroidal antiinflammatory drugs (NSAIDs) followed by surgery; strategy 2) NSAIDs, then short-acting reversible contraceptives or long-acting reversible contraceptives (LARCs) followed by surgery; strategy 3) NSAIDs, then a short-acting reversible contraceptive or LARC, then a LARC or gonadotropin-releasing hormone modulator followed by surgery; strategy 4) proceeding directly to surgery. Probabilities, utilities, and costs were derived from the literature. Outcomes included cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Univariate, bivariate, and multivariate sensitivity analyses were performed.

RESULTS:
In this theoretical cohort of 4,817,894 women with endometriosis-related dysmenorrhea, all medical and surgical treatment strategies were cost effective at a standard willingness-to-pay threshold of $100,000 per QALY gained when compared with surgery alone. Strategy 2 was associated with the lowest cost per QALY gained ($1,155). Requiring a trial of a third medication before surgery would cost an additional $257 million, compared with proceeding to surgery after failing two medical treatments. The probability of improvement with surgery would need to exceed 83% for this to be the preferred first-line approach.

CONCLUSION:
All sequential medical and surgical management strategies for endometriosis-related dysmenorrhea were cost effective when compared with surgery alone. A trial of hormonal management after NSAIDs, before proceeding to surgery, may provide cost savings. Delaying surgical management in an individual with pain refractory to more than three medications may decrease quality of life and increase cost.
Insights into origins and specificities of autoantibodies in systemic sclerosis
Authors: Tiniakou Eleni , Crawford Jonathan , Darrah Erika 
Published: September 2021

Purpose of review
Autoantibodies are hallmark findings in systemic sclerosis (SSc), often present prior to disease onset. Clinical diagnosis and prognosis of SSc have long relied on the antitopoisomerase – anticentromere – anti-RNA polymerase antibody trichotomy. However, many more autoantibodies found in SSc are being actively investigated for insights into triggering events, mechanisms of tolerance break, and connections to tissue damage. This review examines recent studies on SSc autoantibodies and the early events that lead to their development.

Recent findings
Recent work has elucidated potential connections between human cytomegalovirus infection, silicone breast implants, and malignancy to SSc autoantibody development. At the level of the dendritic cell:T cell interaction, where tolerance is broken, new studies identified shared motifs in the peptide-binding domains of SSc-associated human leukocyte antigen alleles. Immunological analysis of SSc patient B cells has uncovered several anomalies in the regulatory capacities of SSc naïve and memory B cell populations. Expanding efforts to uncover new SSc autoantibodies revealed anti-CXCL4, anticollagen V, and other autoantibodies as potential players in disease pathogenesis.

Summary
Further research into the role of autoantibodies in SSc development may uncover new mechanism-guided therapeutic targets. In addition, a better understanding of autoantibody associations with SSc disease outcomes will improve clinical care.
Contribution of monocytes and macrophages to the pathogenesis of systemic sclerosis: recent insights and therapeutic implications
Authors: Lescoat Alain , Lecureur Valérie , Varga John 
Published: September 2021

Purpose of review
To discuss recent studies addressing the role of monocytes and macrophages in the pathogenesis of systemic sclerosis (SSc) based on human and mouse models.

Recent findings
Studies indicate that monocyte adhesion could be increased in SSc secondary to an interferon-dependent loss of CD52, and chemotaxis up-regulated through the CCR3/CCL24 pathway. Beyond the conventional M1/M2 paradigm of macrophage subpopulations, new subpopulations of macrophages have been recently described in skin and lung biopsies from SSc patients. Notably, single-cell ribonucleic acid sequencing has provided evidence for SPP1+ lung macrophages or FCGR3A+ skin macrophages in SSc. Impaired pro-resolving capacities of macrophages such as efferocytosis, i.e. the ability to phagocyte apoptotic cells, could also participate in the inflammatory and autoimmune features in SSc.

Summary
Through their potential pro-fibrotic and pro-inflammatory properties, macrophages are at the cross-road of key SSc pathogenic processes and associated manifestations. Investigative drugs targeting macrophage polarization, such as pan-janus kinase inhibitors (tofacitinib or ruxolitinib) impacting both M1 and M2 activations, or Romilkimab inhibiting IL-4 and IL-13, have shown promising results in preclinical models or phase I/II clinical trials in SSc and other fibro-inflammatory disorders. Macrophage-based cellular therapy may also represent an innovative approach for the treatment of SSc, as initial training of macrophages may modulate the severity of fibrotic and autoimmune manifestations of the disease.
A review of ophthalmic manifestations of inflammatory bowel disease and associated treatments
Authors: Janardhana Priya , Al-Kadhi Saad 
Published: September 2021

Purpose of review
To review the ocular manifestations of inflammatory bowel disease (IBD) and the treatments for each of these, including novel therapies and their effects on uveitis. With the advent of newer treatments for ulcerative colitis and Crohn's disease, it is important to investigate whether these therapies have beneficial effects for extraintestinal manifestations (EIM) of IBD, in particular, ocular manifestations.

Recent findings
The newer treatments for IBD, including biologics, such as golimumab (Simponi), certolizumab (Cimzia), vedolizumab (Entyvio), and interleukin (IL) receptor inhibitors, such as ustekinimab (Stelara), could potentially have treatment benefits for patients with uveitis and IBD.

Summary
Ocular manifestations of IBD are important to detect early and treat appropriately. With novel treatments for IBD, it is important to further study whether these therapies have benefits for ocular manifestations of IBD, such as uveitis. Future clinical trials need to be conducted to investigate this.
Congenital Rubella Syndrome Surveillance After Measles Rubella Vaccination Introduction in Yogyakarta, Indonesia
Authors: Herini Elisabeth Siti , Triono Agung , Iskandar Kristy , Prasetyo Ashadi , Nugrahanto Andika Priamas , Gunadi  
Published: September 2021

Background:
Congenital rubella syndrome (CRS) is a fatal disease causing severe congenital defects. Indonesia had the highest CRS cases in the world in 2016 with a commitment to achieve elimination of rubella disease by 2020, through the campaign and introduction of measles rubella (MR) national vaccination program in 2017 and 2018. This study aimed to describe the impact of the national vaccination campaign by conducting surveillance of CRS cases and comparing the incidence of new CRS cases before and after the MR vaccination campaign.

Methods:
From July 2015 to July 2020, we conducted surveillance of CRS in Yogyakarta. Suspected patients underwent complete clinical examinations. Serology was tested for the presence of IgM and IgG antibodies against rubella. Descriptive analysis was used to characterize the demographic and clinical characteristics of the cases before and after the MR vaccination campaign.

Results:
The study involved 229 infants who were suspected for CRS. Laboratory-confirmed cases were found in 47 of them (20.86%). Most of the laboratory-confirmed cases (55.3%) were reported among 1–5 months old infants. Common clinical features among laboratory-confirmed cases included structural heart defects in 43 (91.4%). There was a significant decrease (60.9%) of CRS incidence from 0.39 per 1000 live births in the precampaign era to 0.08 in the postcampaign era (P = 0.00).

Conclusion:
There has been a significant declining number of CRS cases based on pre- and post-MR vaccination campaign in Yogyakarta, Indonesia. An effective surveillance system will help monitor the number of CRS cases.
Finding Children Living With HIV in Low-prevalence Countries
Authors: Hrapcak Susan , Bekele Alemayehu , Ahmed Jelaludin , Ayalew Jemal , Gutreuter Steve , Kumssa Hanna , Antefe Tenagnework , Mengistu Semegnew , Mirkovic Kelsey , Dziuban Eric J. , Ross Christine , Belay Zena , Tilahun Tsegaye , Kassa Desta , Teferi Wondimu 
Published: September 2021

Background:
Limited data in low HIV prevalence settings such as Ethiopia limit policy development and implementation of optimized pediatric testing approaches to close the treatment gap. This study aimed to determine HIV prevalence, testing yield and factors associated with HIV among children at 5 entry points.

Methods:
We conducted a cross-sectional study from May 2017 to March 2018 in 29 public health facilities in Amhara and Addis Ababa regions in Ethiopia. Children 2–14 years were enrolled through 5 entry points. Data were obtained from registers, medical records and interviews with caregivers. HIV prevalence and testing yields were calculated for each entry point. Mixed-effects logistic regression analysis identified factors associated with undiagnosed HIV.

Results:
The study enrolled 2166 children, of whom 94 were HIV positive (40 newly diagnosed). HIV prevalence and testing yield were the highest among children of HIV-positive adults (index testing; 8.2% and 8.2%, respectively) and children presenting to tuberculosis clinics (7.9% and 1.8%) or with severe malnutrition (6.5% and 1.4%). Factors associated with undiagnosed HIV included tuberculosis or index entry point [adjusted odds ratio (aOR), 11.97; 95% CI 5.06–28.36], deceased mother (aOR 4.55; 95% CI 1.30–15.92), recurrent skin problems (aOR 17.71; 95% CI 7.75–40.43), severe malnutrition (aOR 4.56; 95% CI 2.04–10.19) and urban residence (aOR 3.47; 95% CI 1.03–11.66).

Conclusions:
Index testing is a critical strategy for pediatric case finding in Ethiopia. Strategies and resources can prioritize minimizing missed opportunities in implementing universal testing for very sick children (tuberculosis, severe malnutrition) and implementing targeted testing in other entry points through use of factors associated with HIV.
Initiative to Improve Postintubation Sedation in a Pediatric Emergency Department
Authors: Irwin Whitney W. , Berg Kathleen T. , Ruttan Timothy K. , Wilkinson Matthew H. , Iyer Sujit S. 
Published: September 2021

ABSTRACT

Background:
Previous research has shown that appropriate pediatric postintubation sedation (PIS) after rapid sequence intubation only occurs 28% of the time. Factors such as high provider variability, cognitive overload, and errors of omission can delay time to PIS in a paralyzed patient.

Purpose:
To increase the proportion of children receiving timely PIS by 20% within 6 months.

Methods:
A multidisciplinary team identified key drivers and targeted interventions to improve timeliness of PIS. The primary outcome of “sedation in an adequate time frame” was defined as a time to post-Rapid Sequence Intubation sedative administration less than the duration of action of the RSI sedative agent. Secondary outcomes included the proportion of patients receiving any sedation and time to PIS administration.

Results:
Pediatric postintubation sedation in an adequate time was improved from 27.9% of intubated patients to 55.6% after intervention (p = .001). The number of patients receiving any PIS improved from 74% to 94% (p = .006). The median time from RSI to PIS was reduced from 13 to 9 minutes (p < .001). Process control charts showed a reduction in PIS variability and a centerline reduction from 19 to 10 minutes.

Conclusions:
Implementation of an intubation checklist and a multidisciplinary approach improved the rate of adequate pediatric PIS.
Binge Drinking Among Public Sector Food Service Workers in Brazil
Authors: Costa Bruna Vieira de Lima , Assunção Ada Ávila , Santos Jennifer Elaine , da Silva Larissa Andreza França , Ramos Sabrina Alves , Lima Eduardo de Paula 
Published: September 2021

Objective:
To investigate occupational risk factors associated with binge drinking (BD) among public sector food service workers in a Brazilian capital.

Methods:
All workers from the Government-backed Economy Restaurant Program (GbERP) in Belo Horizonte city were evaluated. BD was defined as consumption of five or more doses (male) or four or more doses (female) of alcoholic beverages on a single occasion within 30 days. Occupational psychosocial and physical stressors were the main exposure variables; sociodemographic, health, and lifestyle variables were inserted as potential confounding factors. We performed logistic regression.

Results:
A total of 214 people participated in the study and 30.7% reported BD. Psychosocial (violence and high demands) and ergonomic aspects were associated with the outcome.

Conclusion:
There was a high prevalence of BD among GbERP workers. Actions are necessary to reduce violence and high strain and consequently BD.
Seroprevalence of SARS-CoV-2 Among Firefighters/Paramedics in San Francisco, CA
Authors: Grant Megan , Harrison Robert , Nuñez Arlene , Kurtz Theodore , Phelps Stephanie , Brokaw Jennifer , Shusterman Dennis 
Published: September 2021

Objectives:
Despite having close contact with the general public, members of the San Francisco Fire Department (SFFD) reported relatively few cases of COVID-19 during the first half of 2020. Our objective was to explore evidence for prior undetected infections by conducting a seroprevalence survey, and to document both risk and protective factors for prior COVID-19 infection.

Methods:
This cross-sectional study assessed workplace practices and exposures of SFFD personnel during the first 6 months of 2020 via questionnaire and documented prior COVID-19 infections by serologic antibody testing using an orthogonal testing protocol.

Results:
Of 1231 participating emergency responders, three (0.25%) had confirmed positive COVID-19 antibody results.

Conclusions:
Safe workplace practices, community public health intervention, and low community infection rates appear to have been protective factors for emergency responders in San Francisco during our study period.
The Future of Military Occupational and Environmental Medicine in the Department of Defense
Authors: Krahl Pamela L. , Thomas Richard J. , Gaydos Joel C. , Mallon Timothy M. 
Published: September 2021

Objective:
Transfer of military medical facilities to the Defense Health Agency is transforming the Military Health System. Our objective is to inform this transformation with respect to optimum application of occupational and environmental medicine (OEM) expertise.

Methods:
We defined and analyzed the external influences on military OEM practice using a structured framework to identify key drivers.

Results:
Key drivers are political and economic factors. These may change the size or military/civilian ratio of the specialty. Limited career development pathways should prompt consideration of making OEM a second or combined residency, and military-funded training of civilian physicians may be required. OEM specialist utilization should be reassessed.

Conclusions:
OEM is a highly adaptable specialty defined by the needs of its stakeholders. Comprehensive analysis of external influences can ensure that OEM practice remains in step with changing needs.