bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Infant Milk-Type and Childhood Eating Behaviors on Functional Constipation in Preschool Children
Authors: de Oliveira Marcela Barros Barbosa , Jardim-Botelho Anne , de Morais Mauro Batista , da Cruz Melo Ingrid Ribeiro , Maciel Júlia Franco , Gurgel Ricardo Queiroz 
Published: May 2021

ABSTRACTObjective:To investigate the association between functional constipation, infant feeding in early infancy and eating behavior in preschool children.Methodology:A cross-sectional study was undertaken in public and private schools in the state of Sergipe (Northeast of Brazil). The sample calculation was based on a 25% estimate of constipation prevalence in Brazilian children, resulting in a sample size of 1051 children. Functional constipation was assessed using Rome IV criteria. Eating behavior was assessed using the Children's Eating Behavior Questionnaire. Adjusted odds ratios were estimated using a multivariate model.Results:The prevalence of functional constipation was 23%. After adjusting for water intake, children with food fussiness were >6 times likely to have constipation (odds ratio [OR] = 6.65; 95% confidence interval [CI] 5.19–8.52). Children who were fed with cow's milk in the first 6 months of age were up to 15.2 times more likely to have functional constipation. Bottle feeding at 0–6 months of age increased the risk of functional constipation at preschool age (whole cow's milk: OR = 17.02; 95% CI 7.33–39.51, infant formula: OR = 6.35; 95% CI 3.42–11.79, mixed breastfeeding: OR = 10.83; 95% CI 4.57–25.69).Conclusion:Food fussiness and the use of cow's milk-based feeding bottles at 0–6 months of age were associated with functional constipation in preschool children.
Diagnosing Coeliac Disease During Mass-Screening of General Paediatric Population: Is Biopsy Avoidable?
Authors: Al-Hussaini Abdulrahman , Al-Jurayyan Abdullah , Alharbi Sahar , Bashir Muhammed Salman , Troncone Riccardo 
Published: May 2021

ABSTRACT

Objectives:
Studies evaluating the correlation between tissue transglutaminase immunoglobulin antibody (TGA-IgA) levels and the degree of enteropathy in screening-detected coeliac disease (CD) patients from the general childhood population are scarce. The objectives of our study were to evaluate the correlation between the TGA-IgA titre and the degree of enteropathy and to evaluate whether the no-biopsy approach to diagnose CD in symptomatic patients proposed by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition could be extended to asymptomatic CD patients diagnosed during mass screening studies.

Methods:
The present study is a sub-study of a cross-sectional mass screening study, “Exploring the Iceberg of Coeliacs in Saudi Arabia”, conducted among school-aged children (6–15 years) in 2014–2015. The 93 biopsy-confirmed CD patients constituted the study cohort of the present study (mean age 11.4 ± 2.6 years; 24 males). TGA-IgA titres and endomysial antibodies (EMA) at the time of biopsy and grade of enteropathy were assessed, and human leukocyte antigen DQ 2.2/2.5/8 genotyping was performed.

Results:
Thirty-four patients had TGA-IgA titres >10× upper limit of normal (ULN; 36%); all had villous atrophy with positive EMA and DQ 2.2/2.5/8. The sensitivity and specificity of a TGA-IgA titre >10× ULN in correctly diagnosing CD was 100%. There was a significant positive correlation between the anti-TGA-IgA titre and the severity of enteropathy (P < 0.001). There was no significant difference in the TGA-IgA titre between the asymptomatic and symptomatic CD patients.

Conclusions:
Our results provide evidence that a TGA-IgA titre >10× ULN correlates with villous atrophy in CD patients detected by mass screening.
Public Health Expenditures and Clinical and Social Complexity of Tuberculosis Cases–Alameda County, California, July-December 2017
Authors: Shiau Rita , Holmen Jenna , Chitnis Amit S. 
Published: May 2021

Context:
Alameda County, California, is a high tuberculosis (TB) burden county that reported a TB incidence rate of 8.1 per 100 000 during 2017. It is the only high TB burden California county that does not have a public health–funded TB clinic.

Objective:
To describe TB public health expenditures and clinical and social complexities of TB case-patients.

Design, Setting, and Participants:
Public health surveillance of confirmed and possible TB case-patients reported to Alameda County Public Health Department during July 1, 2017, to December 31, 2017. Social complexity status was categorized for all case-patients using surveillance data; clinical complexity status, either by surveillance definition or by the Charlson Comorbidity Index (CCI), was categorized only for confirmed TB case-patients.

Main Outcome Measures:
Total public health and per patient expenditures were stratified by insurance status. Cohen's kappa assessed concordance between clinical complexity definitions. All comparisons were conducted using Fisher's exact or Kruskal-Wallis tests.

Results:
Of 81 case-patients reported, 68 (84%) had confirmed TB, 29 (36%) were socially complex, and 15 (19%) were uninsured. Total public health expenditures were $487 194, and 18% of expenditures were in nonlabor domains, 57% of which were for TB treatment, diagnostics, and insurance, with insured patients also incurring such expenditures. Median per patient expenditures were significantly higher for uninsured and government-insured patients than for privately insured patients ($7007 and $5045 vs $3704; P = .03). Among confirmed TB case-patients, 72% were clinically complex by surveillance definition and 53% by the CCI; concordance between definitions was poor (κ = 0.25; 95% confidence interval, 0.03-0.46).

Conclusions:
Total public health expenditures approached $500 000. Most case-patients were clinically complex, and about 20% were uninsured. While expenditures were higher for uninsured case-patients, insured case-patients still incurred TB treatment, diagnostic, and insurance-related expenditures. State and local health departments may be able to use our expenditure estimates by insurance status and description of clinically complex TB case-patients to inform efforts to allocate and secure adequate funding.
Modeling the Transmission of COVID-19: Impact of Mitigation Strategies in Prekindergarten-Grade 12 Public Schools, United States, 2021
Authors: Miller Gabrielle F. , Greening Bradford , Rice Ketra L. , Arifkhanova Aziza , Meltzer Martin I. , Coronado Fátima 
Published: May 2021

Background:
Schools are an integral part of the community; however, congregate settings facilitate transmission of SARS-CoV-2, presenting a challenge to school administrators to provide a safe, in-school environment for students and staff.

Methods:
We adapted the Centers for Disease Control and Prevention's COVIDTracer Advanced tool to model the transmission of SARS-CoV-2 in a school of 596 individuals. We estimate possible reductions in cases and hospitalizations among this population using a scenario-based analysis that accounts for (a) the risk of importation of infection from the community; (b) adherence to key Centers for Disease Control and Prevention–recommended mitigation strategies: mask wearing, cleaning and disinfection, hand hygiene, and social distancing; and (c) the effectiveness of contact tracing interventions at limiting onward transmission.

Results:
Low impact and effectiveness of mitigation strategies (net effectiveness: 27%) result in approximately 40% of exposed staff and students becoming COVID-19 cases. When the net effectiveness of mitigation strategies was 69% or greater, in-school transmission was mostly prevented, yet importation of cases from the surrounding community could result in nearly 20% of the school's population becoming infected within 180 days. The combined effects of mitigation strategies and contact tracing were able to prevent most onward transmission. Hospitalizations were low among children and adults (<0.5% of the school population) across all scenarios examined.

Conclusions:
Based on our model, layering mitigation strategies and contact tracing can limit the number of cases that may occur from transmission in schools. Schools in communities with substantial levels of community spread will need to be more vigilant to ensure adherence of mitigation strategies to minimize transmission. Our results show that for school administrators, teachers, and parents to provide the safest environment, it is important to utilize multiple mitigation strategies and contract tracing that reduce SARS CoV-2 transmission by at least 69%. This will require training, reinforcement, and vigilance to ensure that the highest level of adherence is maintained over the entire school term.
The Impacts of Disclosure and a Proactive Compensation Offer on Chinese Patients’ Actions After Medical Errors
Authors: Gu Xiuzhu , Deng Mingming 
Published: May 2021

Objectives
This study aims to obtain evidence of the impacts of error disclosure and the impacts of a proactive compensation offer on Chinese patients’ actions after medical errors.

Methods
A total of 915 responses were collected from a questionnaire survey. Two fictitious cases (entailed moderate and severe harm) that involved error disclosure were described. One of 5 disclosure and compensation types was randomly provided to each participant. The 5 types were combinations of 3 disclosure types (no disclosure, partial disclosure, and full disclosure) and 2 proactive compensation offer categories (no offer and an offer), with the exception of no disclosure but a proactive compensation offer. The respondents were asked about their willingness to take actions if they were the affected patient.

Results
The generalized ordinal logit regression model showed that error disclosure did not increase the likelihood of the patients taking action, such as changing physicians, complaining, or filing lawsuits. A proactive compensation offer decreased the patients’ willingness to file lawsuits but had no significant influence on the other action choices. In addition, the patients’ actions were affected by other factors, such as the severity of the error, age, sex, education level, being religious, prior error experience, and health insurance.

Conclusions
We suggest that “disclosure and compensation” programs are developed in China. To ensure their implementation, it is recommended that appropriate training is provided and that the disclosure culture in health care organizations is improved. Furthermore, laws or regulations are required that govern error disclosure and provide support for health care professionals and organizations.
An Initiative to Improve Timely Glucocorticoid Tapering in Vasculitis
Authors: Mendel Arielle , Ennis Daniel , Lake Shirley , Carette Simon , Pagnoux Christian 
Published: May 2021

Background/Objective
High-dose glucocorticoids (GCs) are required in the initial treatment of systemic vasculitis. However, slow or delayed tapering can lead to unnecessary GC exposure and toxicity. In this quality improvement initiative, we aimed to increase appropriate GC tapering among newly referred patients awaiting specialty consultation at a tertiary vasculitis clinic.

Methods
For each patient referred for anti–neutrophil cytoplasm antibody–associated vasculitis (AAV) or large vessel vasculitis (LVV), recommendation-based GC tapering suggestions were faxed to referring physicians. To maximize uptake, the intervention format was modified according to feedback from referring physicians' offices. The proportion of new patients presenting to their first appointment who (1) had started to taper GCs, (2) were taking their target GC dose according to recommendations, (3) experienced a vasculitis flare during tapering were compared before (July 2017–January 2019) and after (February–October 2019) the intervention.

Results
Among 169 consecutive patients referred for AAV or LVV, the proportion who had started to taper GCs by their first visit increased from 84 of 117 (72%) preintervention to 49 of 52 (94%) postintervention (p < 0.01). Mean daily prednisone dose at first visit decreased from 29.9 (SD, 18) mg to 21.7 (SD, 14) mg (p < 0.01). However, the proportion who were ultimately taking “target” GC doses at their first visit did not significantly increase (72% vs. 77%). Disease flares during tapering were similar before and after the intervention (9% vs. 12%).

Conclusions
Patients with AAV and LVV had increased GC tapering and lower GC doses at first visit following a preappointment intervention. Further strategies are needed to improve timely GC tapering in vasculitis.
Fully Integrated Quantitative Multiparametric Analysis of Non–Small Cell Lung Cancer at 3-T PET/MRI
Authors: Besson Florent L. , Fernandez Brice , Faure Sylvain , Mercier Olaf , Seferian Andrei , Mussot Sacha , Levy Antonin , Parent Florence , Bulifon Sophie , Jais Xavier , Montani David , Mitilian Delphine , Fadel Elie , Planchard David , Ghigna-Bellinzoni Maria-Rosa , Comtat Claude , Lebon Vincent , Durand Emmanuel 
Published: May 2021

Introduction
The aim of this study was to study the feasibility of a fully integrated multiparametric imaging framework to characterize non–small cell lung cancer (NSCLC) at 3-T PET/MRI.

Patients and Methods
An 18F-FDG PET/MRI multiparametric imaging framework was developed and prospectively applied to 11 biopsy-proven NSCLC patients. For each tumor, 12 parametric maps were generated, including PET full kinetic modeling, apparent diffusion coefficient, T1/T2 relaxation times, and DCE full kinetic modeling. Gaussian mixture model-based clustering was applied at the whole data set level to define supervoxels of similar multidimensional PET/MRI behaviors. Taking the multidimensional voxel behaviors as input and the supervoxel class as output, machine learning procedure was finally trained and validated voxelwise to reveal the dominant PET/MRI characteristics of these supervoxels at the whole data set and individual tumor levels.

Results
The Gaussian mixture model-based clustering clustering applied at the whole data set level (17,316 voxels) found 3 main multidimensional behaviors underpinned by the 12 PET/MRI quantitative parameters. Four dominant PET/MRI parameters of clinical relevance (PET: k2, k3 and DCE: ve, vp) predicted the overall supervoxel behavior with 97% of accuracy (SD, 0.7; 10-fold cross-validation). At the individual tumor level, these dimensionality-reduced supervoxel maps showed mean discrepancy of 16.7% compared with the original ones.

Conclusions
One-stop-shop PET/MRI multiparametric quantitative analysis of NSCLC is clinically feasible. Both PET and MRI parameters are useful to characterize the behavior of tumors at the supervoxel level. In the era of precision medicine, the full capabilities of PET/MRI would give further insight of the characterization of NSCLC behavior, opening new avenues toward image-based personalized medicine in this field.
A 19-Year Experience With Clavicular Defects
Authors: Lim Kaitlin Ann , Lin Cheng-Hung , Lin Chih-Hung 
Published: May 2021

Background
The clavicle contributes to the stability and functional integrity of the shoulder. Clavicle bone defects are uncommon, and the strategy for their management is variable.

Method
Six patients presented with clavicle bone defects. The causes were as follows: traumatic defects (2 patients), electric injury (1 patient), osteoradionecrosis (2 patients), and nonunion (1 patient). One patient had upper limb palsy for 40 years, and another had posttraumatic shoulder function impairment. A pedicled pectoralis major myocutaneous flap was used for the patient with a dysfunctional limb, and 5 bone flaps (3 free fibular flaps, 1 free iliac flap, and 1 pedicled rib flap) were used for reconstruction in the other patients.

Result
All flaps (2 pedicled flaps and 4 free flaps) were successfully used for wound repair; the pedicled rib flap demonstrated partial marginal necrosis, and the free fibular flap required reexploration for venous kinking. Five functionally impaired upper limbs showed functional improvements postoperatively.

Conclusion
For functionless composite clavicles and soft tissue defects, a soft tissue flap will be required for wound repair. A bone flap, especially a fibular flap, is required for the upper limb to show functional recovery. The variety of flaps will be planned according to the defect size comparison between the bone and soft tissue, and ipsilateral upper limb function, and a proposed algorithm will be discussed.
Jaffe Lichtenstein Type of Polyostotic Skeletal Fibrous Dysplasia With the Involvement of Cranial Bones
Authors: Akkemik Ozlem , Erkus Serkan , Kalenderer Onder , Dündar Nesrin 
Published: May 2021

Abstract
Fibrous dysplasia (FD), a benign fibro-osseous bone tumor commonly involving the craniofacial region, presents a wide spectrum of radiographic patterns. When FD lesions are suspected, various imaging modalities and histopathologic analyses may be required to reach a firm diagnosis. Here, the authors report the case of a 10-year-old male patient presenting with polyostotic type of FD with follow-up data for the next 9 years. The patient showed involvement of cranial bones and bilateral femurs, with skin pigmentation and no endocrine disease, consistent with the diagnosis of Jaffe Lichtenstein disease. The craniofacial radiographic features obtained with computed tomography and cone-beam computerized tomography are documented in this article.
One-step Percutaneous Transhepatic Cholangioscopy Combined With High-frequency Needle-knife Electrotomy in Biliary Strictures After Liver Transplantation
Authors: Tao Haisu , Wang Ping , Sun Beiwang , Zhou Xinghua , Xie Jiafen 
Published: May 2021

Background:
Endoscopic management is the mainstay for biliary strictures after liver transplantation. However, this method is often failed in cases associated with hepatolithiasis or refractory strictures. The aim of this study is to investigate whether 1-step percutaneous transhepatic biliary cholangiography (PTC) combined with high-frequency needle-knife electrotomy can be an alternative method in biliary strictures after liver transplantation that could not be treated by endoscopic management.

Methods:
Clinical data of 14 patients suffering from biliary strictures after liver transplantation from June 2014 to January 2018 were retrospectively analyzed. One-step PTC combined with high-frequency needle-knife electrotomy was used to resolve the strictures.

Results:
One-step PTC was successfully performed in all 14 patients. In 10 of 12 (83.3%) patients with hepatolithiasis, the stones were removed completely. Stricture resolution was detected in 13 of 14 (92.9%) patients at first postoperative choledochoscopy. Three mild adverse events occurred (cholangitis, 2 patients; delayed hemobilia, 1 patient), but were resolved with conservative treatment. The follow-up after supporting catheter removal was 15.7±4.5 months. Only 1 patient (8.3%) had stone recurrence and no stenosis occurred during supporting-catheter-free follow-up.

Conclusions:
One-step PTC combined with high-frequency needle-knife electrotomy seems to be a useful for treating biliary strictures after liver transplantation.
Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations
Authors: Shackelford Stacy A. , del Junco Deborah J. , Riesberg Jamie C. , Powell Douglas , Mazuchowski Edward L. , Kotwal Russ S. , Loos Paul E. , Montgomery Harold R. , Remley Michael A. , Gurney Jennifer M. , Keenan Sean 
Published: May 2021

BACKGROUND
Quantification of medical interventions administered during prolonged field care (PFC) is necessary to inform training and planning.

MATERIALS AND METHODS
Retrospective cohort study of Department of Defense Trauma Registry casualties with maximum Abbreviated Injury Scale (MAIS) score of 2 or greater and prehospital records during combat operations 2007 to 2015; US military nonsurvivors were linked to Armed Forces Medical Examiner System data. Medical interventions administered to survivors of 4 hours to 72 hours of PFC and nonsurvivors who died prehospital were compared by frequency-matching on mechanism (explosive, firearm, other), injury type (penetrating, blunt) and injured body regions with MAIS score of 3 or greater. Covariates for adjustment included age, sex, military Service, shock, Glasgow Coma Scale, transport team, MAIS and Injury Severity Score (ISS). Sensitivity analysis focused on US military subgroup with AIS/ISS assigned to nonsurvivors after autopsy.

RESULTS
The total inception cohort included 16,202 casualties (5,269 US military, 10,809 non-US military), 64% Afghanistan, 36% Iraq. Of US military, 734 deaths occurred within 30 days, nearly 90% occurred within 4 hours of injury. There were 3,222 casualties (1,111 US military, 2,111 non-US military) documented for prehospital care and died prehospital (691) or survived 4 hours to 72 hours of PFC (2,531). Twenty-five percent (815/3,222) received advanced airway, 18% (583) ventilatory support, 9% (281) tourniquet. Twenty-three percent (725) received blood transfusions within 24 hours. Of the matched cohort (1,233 survivors, 490 nonsurvivors), differences were observed in care (survivors received more warming, intravenous fluids, sedation, mechanical ventilation, narcotics, antibiotics; nonsurvivors received more intubations, tourniquets, intraosseous fluids, cardiopulmonary resuscitation). Sensitivity analysis focused on US military (732 survivors, 379 nonsurvivors) showed no significant differences in prehospital interventions. Without autopsy information, the ISS of nonsurvivors significantly underestimated injury severity.

CONCLUSION
Tourniquets, blood transfusion, airway, and ventilatory support are frequently required interventions for the seriously injured. Prolonged field care should direct resources, technology, and training to field technology for sustained resuscitation, airway, and breathing support in the austere environment.

LEVEL OF EVIDENCE
Prognostic, Level III
Optimizing surgical stabilization of rib fractures using intraoperative ultrasound localization
Authors: Martin Thomas J. , Cao Jessica , Benoit Eric , Kheirbek Tareq 
Published: May 2021

BACKGROUND
Surgical stabilization of rib fractures (SSRF) significantly improve the outcomes of patients with rib fractures. Ultrasound is a specific modality for localizing rib fractures. We hypothesized that use of perioperative ultrasound localization of fracture sites optimizes surgical approach and clinical outcomes.

METHODS
We performed a retrospective cohort study of adult patients undergoing SSRF and compared those with and without adjunctive perioperative ultrasound fracture localization. Our primary outcome was improved surgical efficiency as measured by incision length and total operative time. Secondary clinical outcomes included numeric pain score on follow-up visit and daily morphine milligram equivalent prescribed within 30 days from discharge.

RESULTS
We performed 49 surgical rib fixations between 2015 and 2020; of which, 13 (26.5%) additionally underwent ultrasound localization (26.5%). There were no significant differences between groups in age, sex, number of ribs repaired, or days till surgery. More patients in the ultrasound group had nonflail chest wall injury (76.9% vs. 27.8%, p = 0.003). Use of perioperative ultrasound was associated with shorter incision length (median, 9 vs. 15.5 cm; p = 0.0001), shorter operative time (median, 120 vs. 174 minutes; p = 0.003), less daily morphine milligram equivalent (25 vs. 68 mg, p = 0.009), and reduced numeric pain score on follow up (median, 4 vs. 7, p = 0.05).

CONCLUSION
Use of perioperative ultrasound localization of rib fractures to optimize surgical approach for SSRF was associated with reduced incision length, operative time, and opioid requirements on patient discharge. We recommend considering routine perioperative localization to improve surgical approach and efficiency during SSRF.

LEVEL OF EVIDENCE
Therapeutic, level IV.