bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Luminal Imaging Probe in the Management of Pediatric Esophageal Disorders
Authors: Courbette Olivier , Deslandres Colette , Drouin Éric , Groleau Véronique , Halac Ugur , Faure Christophe 
Published: October 2021

ABSTRACTBackground:Functional luminal imaging probe (FLIP) measures pressure–geometry relationships of digestive luminal space. When used in esophageal disorders, it provides several luminal parameters that help better understand the pathophysiology. Data about the potential utility of FLIP in pediatrics are scarce and there is no standardized use in children. We aim to describe the use of FLIP in our center, its safety, feasibility, and clinical impact in esophageal disorders in children.Methods:Consecutive FLIP recordings performed at the Centre Hospitalier Universitaire‐Sainte‐Justine, Montréal, Canada between February 2018 and January 2021 were extracted. A chart review was conducted for demographics and medical history. Symptomatology after the procedure was evaluated with validated dysphagia scores.Key Results:Nineteen patients were included (11 girls, median age 16 years, range 3.2–19.6) with achalasia (n = 5), post‐Heller's myotomy dysphagia (n = 3), esophagogastric junction outflow obstruction (n = 3), congenital esophageal stenosis (n = 2); post‐esophageal atresia repair stricture (n = 3), and post‐fundoplication dysphagia (n = 3). There was no significant correlation between integrated relaxation pressure measured with high resolution manometry and distensibility index (DI). The use of FLIP made it possible to differentiate between dysphagia related to an esophageal obstruction (DI < 2.8 mm2/mmHg) and dysphagia without major motility disorder (DI > 2.8 mm2/mmHg) that guided the indication for dilation. FLIP led to a change in management in 47% of the patients. Forty‐seven percent of the patients were symptom free at the time of the evaluation.Conclusions & Inferences:FLIP provides key esophageal luminal values and therefore can play an important role in pediatric esophageal disorders management.
Using Patient Simulation to Promote Best Practices in Fall Prevention and Postfall Assessment in Nursing Homes
Authors: Acosta Daniela J. , Rinfret Amber , Plant Jennifer , Hsu Amy T. 
Published: October 2021

Background:
Fall-related injuries rise with age and are of particular concern for frail populations living in nursing homes.

Local Problem:
The Perley and Rideau Veterans' Health Centre is a large nursing home in Ontario, Canada. In 2019, we conducted internal audits of our Falls Prevention Program and identified notable variations in staff's response to a resident fall.

Interventions:
We developed an in situ patient simulation program of a resident fall.

Methods:
This was a mixed-methods evaluation of participants' perspectives of a simulation-based interprofessional education program for fall prevention.

Results:
Participants indicated high-level support for simulation-based learning, with more than 80% of the participants expressing that they will apply these skills in the future when caring for a resident who falls.

Conclusions:
Our findings indicate that simulation-based training is well received by frontline workers in a nursing home setting and can be conducted as part of a typical shift with minimal disruption to resident care.
A Meta-Analysis of Breastfeeding Effects for Infants With Neonatal Abstinence Syndrome
Authors: Chu Liangliang , McGrath Jacqueline M. , Qiao Jianhong , Brownell Elizabeth , Recto Pamela , Cleveland Lisa M. , Lopez Emme , Gelfond Jonathan , Crawford Allison , McGlothen-Bell Kelly 
Published: October 2021

Background
Neonatal abstinence syndrome (NAS) rates have dramatically increased. Breastfeeding is a nonpharmacological intervention that may be beneficial, reducing NAS symptom severity and thus the need for and duration of pharmacological treatment and length of hospital stay.

Objectives
Conduct meta-analysis to determine whether breastfeeding results in better outcomes for NAS infants. Variables included symptom severity, need for and duration of pharmacological treatment, and length of hospital stay.

Methods
PubMed, Scopus, Embase, and Cochrane Library were searched from 2000 to 2020, and comparative studies examining breastfeeding for NAS infants were extracted. Randomized trials and cohort studies were included. Data were extracted and evaluated with Review Manager Version 5.3. A random-effects model was used to pool discontinuous outcomes using risk ratio and 95% confidence intervals. Continuous outcomes were evaluated by mean differences and 95% confidence intervals.

Results
Across 11 studies, 6,375 neonates were included in the meta-analysis. Using a random-effects analysis, breastfeeding reduced initiation of pharmacological treatment, reduced duration of pharmacological treatment, and reduced length of stay. No differences were detected for severity of NAS symptoms. Most studies only reported one to two variables of interest. For most studies, these variables were not the primary study outcomes. All studies were found to be of low risk and good quality based on the Cochrane Risk Assessment Tools. Varying breastfeeding definitions limit generalizability.

Discussion
Breastfeeding is associated with decreased initiation and duration of pharmacological treatment and length of stay.
Oxygenation Defects, Ventilatory Ratio, and Mechanical Power During Severe Pediatric Acute Respiratory Distress Syndrome: Longitudinal Time Sequence Analyses in a Single-Center Retrospective Cohort*
Authors: Proulx François , Emeriaud Guillaume , François Tine , Joyal Jean-Sébastien , Nardi Nicolas , Kawaguchi Atsushi , Jouvet Philippe , Sauthier Michaël 
Published: October 2021

OBJECTIVES:
Our understanding of pediatric acute respiratory distress syndrome is based on information from studies reporting intermittent, serial respiratory data. We have analyzed a high-resolution, longitudinal dataset that incorporates measures of hypoxemia severity, metrics of lung mechanics, ventilatory ratio, and mechanical power and examined associations with survival after the onset of pediatric acute respiratory distress syndrome.

DESIGN:
Single-center retrospective cohort, 2013–2018.

SETTING:
Tertiary surgical/medical PICU.

PATIENTS:
Seventy-six cases of severe pediatric acute respiratory distress syndrome, determined according to the Pediatric Acute Lung Injury Consensus Conference criteria.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The high-resolution database included continuous monitoring of ventilatory data (0.03 Hz) for up to 14 days after the diagnosis of pediatric acute respiratory distress syndrome or until extubation or death (n = 26). In the 12,128 hours of data during conventional mechanical ventilation, we used generalized estimating equations to compare groups, accounting for any effect of time. We identified an association between survival and faster rate of improvement in delta pressure (peak inspiratory pressure minus positive end-expiratory pressure; p = 0.028). Nonsurvival was associated with higher daily Pediatric Logistic Organ Dysfunction-2 scores (p = 0.005) and more severe hypoxemia metrics (p = 0.005). Mortality was also associated with the following respiratory/pulmonary metrics (mean difference [95% CI]): positive end-expiratory pressure level (+2.0 cm H2O [0.8–3.2 cm H2O]; p = 0.001), peak inspiratory pressure level (+3.0 cm H2O [0.5–5.5 cm H2O]; p = 0.022), respiratory rate (z scores +2.2 [0.9–3.6]; p = 0.003], ventilatory ratio (+0.41 [0.28–0.55]; p = 0.0001], and mechanical power (+5 Joules/min [1–10 Joules/min]; p = 0.013). Based on generalized linear mixed modeling, mechanical power remained associated with mortality after adjustment for normal respiratory rate, age, and daily Pediatric Logistic Organ Dysfunction-2 score (+3 Joules/breath [1–6 Joules/breath]; p = 0.009).

CONCLUSIONS:
Mortality after severe pediatric acute respiratory distress syndrome is associated with the severity of organ dysfunction, oxygenation defects, and pulmonary metrics including dead space and theoretical mechanical energy load.
Human Factors Analysis of Latent Safety Threats in a Pediatric Critical Care Unit*
Authors: Trbovich Patricia L. , Tomasi Jessica N. , Kolodzey Lauren , Pinkney Sonia J. , Guerguerian Anne-Marie , Hubbert Jackie , Kirsch Roxanne , Laussen Peter C. 
Published: October 2021

OBJECTIVES:
To identify unique latent safety threats spanning routine pediatric critical care activities and categorize them according to their underlying work system factors (i.e., “environment, organization, person, task, tools/technology”) and associated clinician behavior (i.e., “legal”: expected compliance with or “illegal-normal”: deviation from and “illegal-illegal”: disregard for standard policies and protocols).

DESIGN:
A prospective observational study with contextual inquiry of clinical activities over a 5-month period.

SETTING:
Two PICUs (i.e., medical-surgical ICU and cardiac ICU) in an urban free-standing quaternary children’s hospital.

SUBJECTS:
Attending physicians and trainees, nurse practitioners, registered nurses, respiratory therapists, dieticians, pharmacists, and patient services assistants were observed.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Conducted 188 hours of observations to prospectively identify unique latent safety threats. Qualitative observational notes were analyzed by human factors experts using a modified framework analysis methodology to summarize latent safety threats and categorize them based on associated clinical activity, predominant work system factor, and clinician behavior. Two hundred twenty-six unique latent safety threats were observed. The latent safety threats were categorized into 13 clinical activities and attributed to work system factors as follows: “organization” (n = 83; 37%), “task” (n = 52; 23%), “tools/technology” (n = 40; 18%), “person” (n = 32; 14%), and “environment” (n = 19; 8%). Twenty-three percent of latent safety threats were identified when staff complied with policies and protocols (i.e., “legal” behavior) and 77% when staff deviated from policies and protocols (i.e., “illegal-normal” behavior). There was no “illegal-illegal” behavior observed.

CONCLUSIONS:
Latent safety threats span various pediatric critical care activities and are attributable to many underlying work system factors. Latent safety threats are present both when staff comply with and deviate from policies and protocols, suggesting that simply reinforcing compliance with existing policies and protocols, the common default intervention imposed by healthcare organizations, will be insufficient to mitigate safety threats. Rather, interventions must be designed to address the underlying work system threats. This human factors informed framework analysis of observational data is a useful approach to identifying and understanding latent safety threats and can be used in other clinical work systems.
Early Functional Status After Surgery for Congenital Heart Disease: A Single-Center Retrospective Study*
Authors: Han Brian , Yang Jeffrey K. , Ling Albee Y. , Ma Michael , Kipps Alaina K. , Shin Andrew Y. , Beshish Asaad G. 
Published: October 2021

OBJECTIVES:
The objective of this study is to investigate the change in functional status in infants, children, and adolescents undergoing congenital heart surgery using the Functional Status Scale.

DESIGN:
A single-center retrospective study.

SETTING:
A 26-bed cardiac ICU in a free-standing university-affiliated tertiary children’s hospital.

PATIENTS:
All patients 0–18 years who underwent congenital heart surgery from January 1, 2014, to December 31, 2017.

INTERVENTIONS:
None.

MEASUREMENTS AND MIN RESULTS:
The primary outcome variable was change in Functional Status Scale scores from admission to discharge. Additionally, two binary outcomes were derived from the primary outcome: new morbidity (change in Functional Status Scale ≥ 3) and unfavorable functional outcome (change in Functional Status Scale ≥ 5); their association with risk factors was assessed using modified Poisson regression. Out of 1,398 eligible surgical encounters, 65 (4.6%) and 15 (1.0%) had evidence of new morbidity and unfavorable functional outcomes, respectively. Higher Surgeons Society of Thoracic and the European Association for Cardio-Thoracic Surgery score, single-ventricle physiology, and longer cardiopulmonary bypass time were associated with new morbidity. Longer hospital length of stay was associated with both new morbidity and unfavorable outcome.

CONCLUSIONS:
This study demonstrates the novel application of the Functional Status Scale on patients undergoing congenital heart surgery. New morbidity was noted in 4.6%, whereas unfavorable outcome in 1%. There was a small change in the total Functional Status Scale score that was largely attributed to changes in the feeding domain. Higher Society of Thoracic and the European Association for Cardio-Thoracic Surgery score, single-ventricle physiology, and longer cardiopulmonary bypass times were associated with new morbidity, whereas longer hospital length of stay was associated with both new morbidity and unfavorable outcome. Further studies with larger sample size will need to be done to confirm our findings and to better ascertain the utility of Functional Status Scale on this patient population.
Postacute/Long COVID in Pediatrics
Authors: Morrow Amanda K. , Ng Rowena , Vargas Gray , Jashar Dasal Tenzin , Henning Ellen , Stinson Nika , Malone Laura A. 
Published: October 2021

Abstract
The long-term sequelae after SARS-CoV-2 infections in children is unknown. Guidance is needed on helpful models of care for an emerging subset of pediatric patients with postacute/long COVID who continue to experience persistent symptoms after initial COVID-19 diagnosis. Here, we describe a pediatric multidisciplinary post–COVID-19 rehabilitation clinic model as well as a case series of the initial cohort of patients who presented to this clinic. A consecutive sample of nine patients (pediatric patients <21 yrs of age) who presented to our clinic are included. The most common presenting symptoms were fatigue (8 of 9 patients), headaches (6 of 9), difficulty with schoolwork (6 of 8), “brain fog” (4 of 9), and dizziness/lightheadedness (4 of 9). Most patients had decreased scores on self-reported quality-of-life measures compared with healthy controls. In the patients who participated in neuropsychological testing, a subset demonstrated difficulties with sustained auditory attention and divided attention; however, most of these patients had preexisting attention and/or mood concerns. There were also some who self-reported elevated depression and anxiety symptoms. Pediatric patients with postacute/long COVID may present with a variety of physical, cognitive, and mood symptoms. We present a model of care to address these symptoms through a multidisciplinary rehabilitation approach.
Brief Report: Polymorphisms in CAMKK2 may Influence Domain-Specific Neurocognitive Function in HIV+ Indonesians Receiving ART
Authors: Gaff Jessica , Estiasari Riwanti , Diafiri Dinda , Halstrom Samuel , Kamerman Peter , Price Patricia 
Published: October 2021

Background:
Despite effective antiretroviral therapy (ART), milder forms of HIV-associated neurocognitive disorders remain prevalent and are characterized by neuroinflammation, synaptic dysfunction, and neuronal loss.

Methods:
We explore associations between neurocognitive impairment in HIV+ Indonesians and 17 polymorphisms in adjacent genes involved in inflammation and neuronal growth/repair pathways, P2X4R and CAMKK2. HIV+ Indonesians (n = 59) who had received ART for 12 months were assessed to derive Z-scores for the attention, fluency, memory, executive, and motor speed domains relative to local control subjects. These were used to determine total cognitive scores.

Results:
No alleles of P2X4R displayed significant associations with neurocognition in bivariate or multivariable analyses. In CAMKK2, rs2686344 influenced total cognitive scores in bivariate analyses (P = 0.04). Multivariable linear regression modeling independently associated rs2686344 with higher executive function Z-scores (P = 0.05) after adjusting for CD4 T-cell counts (adjusted R2 = 0.103, model P = 0.034), whereas rs1653588 associated with lower and rs1718120 (P = 0.05) with higher fluency Z-scores (P = 0.05) after adjusting for education and log10 HIV RNA copies/mL (adjusted R2 = 0.268, model P = 0.001).

Conclusions:
Polymorphisms in CAMKK2 may influence neurocognitive outcomes in specific domains in HIV+ Indonesians receiving ART for 12 months.
Forecasting HIV-1 Genetic Cluster Growth in Illinois,United States
Authors: Ragonnet-Cronin Manon , Hayford Christina , D'Aquila Richard , Ma Fangchao , Ward Cheryl , Benbow Nanette , Wertheim Joel O. 
Published: October 2021

Background:
HIV intervention activities directed toward both those most likely to transmit and their HIV-negative partners have the potential to substantially disrupt HIV transmission. Using HIV sequence data to construct molecular transmission clusters can reveal individuals whose viruses are connected. The utility of various cluster prioritization schemes measuring cluster growth have been demonstrated using surveillance data in New York City and across the United States, by the Centers for Disease Control and Prevention (CDC).

Methods:
We examined clustering and cluster growth prioritization schemes using Illinois HIV sequence data that include cases from Chicago, a large urban center with high HIV prevalence, to compare their ability to predict future cluster growth.

Results:
We found that past cluster growth was a far better predictor of future cluster growth than cluster membership alone but found no substantive difference between the schemes used by CDC and the relative cluster growth scheme previously used in New York City (NYC). Focusing on individuals selected simultaneously by both the CDC and the NYC schemes did not provide additional improvements.

Conclusion:
Growth-based prioritization schemes can easily be automated in HIV surveillance tools and can be used by health departments to identify and respond to clusters where HIV transmission may be actively occurring.
Characterization of the Population Affected by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017–2019
Authors: Erly Steven , Khosropour Christine M. , Hajat Anjum , Sharma Monisha , Reuer Jen , Grimm Martha , Kwaiser Kelse , Dombrowski Julia C. 
Published: October 2021

Introduction:
AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State.

Methods:
Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems.

Results:
From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25–34 vs 35–44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months).

Conclusions:
Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.
Tranexamic Acid in Craniosynostosis Surgery: A Systematic Review and Meta-Analysis
Authors: Varidel Alistair , Marucci Damian 
Published: October 2021

Abstract
Blood loss is a potential cause of morbidity and mortality in craniosynostosis surgery. Recent reports have suggested that the use of tranexamic acid (TXA), an antifibrinolytic agent, mitigates this blood loss. A comprehensive systematic review and subsequent meta-analysis was undertaken, with the view to clarify the effectiveness of TXA in reducing blood loss and transfusion requirements in craniosynostosis surgery. Medline and PubMed databases were searched using the preferred reporting items for systematic reviews and meta-analyses technique, and 7003 articles were assessed based on predefined selection criteria. Seven trials were identified, of which 2 were randomized controlled trials and the remainder retrospective cohort studies. All trials were assessed using the Jadad and strengthening the reporting of observational studies in epidemiology scores. The meta-analysis found a clear statistical reduction in blood loss in those patients who received TXA perioperatively, with a combined blood loss reduction of 7.06 ml/kg (95% confidence interval −8.97 to −5.15, P < 0.00001). The blood loss reduction was found to extrapolate to a reduction in perioperative transfusion requirements by 8.47 ml/kg in this cohort (95% confidence interval −10.9 to −6.04, P < 00001). There were no TXA-related adverse outcomes recorded in the 258 patients who received TXA across all trials. The trials included in this meta-analysis were limited by underpowered population sizes and significant heterogeneity in blood loss recording techniques. Further, there was significant heterogeneity amongst operations performed. The current literature appears to support the use of TXA in craniosynostosis surgery, but further high quality randomized controlled trials are indicated, ideally including a subgroup analysis between the operations performed.
Relationship Between Blood Glucose Level and Prevalence and Frequency of Stress Urinary Incontinence in Women
Authors: Ying Youyou , Xu Linlin , Huang Ruofei , Chen Tianxi , Wang Xinghong , Li Ke , Tang Lixia 
Published: October 2021

Objectives
The purpose of this study was to evaluate the relationship between blood glucose level and the prevalence and frequency of stress urinary incontinence (SUI) in women.

Methods
We conducted a cross-sectional study of female participants in the National Health and Nutrition Examination Survey database between 2007 and 2016. Dose-response analysis curves and univariate and multivariate logistic regressions were used to determine the relationship between blood glucose level and the prevalence and frequency of SUI.

Results
A total of 10,771 participants were included in this study, of which 6,466 (60.0%) reported no SUI, 4,305 (31.1%) reported monthly SUI, and 953 (8.8%) reported weekly SUI. We found that the blood glucose levels were higher in the weekly SUI group than in the monthly SUI and no SUI groups. Based on blood glucose levels, participants were divided into 3 groups: ≤86.0 mg/dL group, >86.0 to 98.0 mg/dL group, and >98.0 mg/dL group. Dose-response curves showed a nonlinear positive correlation between blood glucose levels and the prevalence and extent of SUI, and participants in the glucose >98.0 mg/dL group had a 15.2% higher risk (adjusted odds risk, 1.152; 95% confidence interval, 1.027–1.293; P = 0.016) of SUI prevalence and 12.5% higher risk (adjusted odds risk 1.125; 95% confidence interval, 1.009–1.255; P = 0.034) of SUI frequency than participants in the glucose ≤86.0 mg/dL group.

Conclusions
We found that the prevalence and frequency of SUI in women were positively correlated with blood glucose levels, and these findings warrant further study and application to clinical practice to control SUI in women.