bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a Pediatric Admission Booklet Significantly Improves the Comprehensiveness of Admission Documentation: A Quality Improvement Project
Authors: Beverstock Andrew , Lewis Carianne , Bruce David , Barnes James , Kelly Alison 
Published: March 2021

Introduction:
At present, doctors in some tertiary pediatric hospitals across the United Kingdom record admission on blank continuation sheets rather than using a specific admission document. Previous evidence from adult medicine shows that using admission booklets to prompt the admitting doctor improves the thoroughness of admission documentation, but no work has evaluated this in pediatrics.

Methods:
Documentation standards for pediatric admissions were created using national standards. We performed a baseline audit of admissions documented on blank continuation sheets. We included 120 patient admissions across pediatric medicine, pediatric surgery, and pediatric orthopedics (40 from each specialty). We introduced an admission booklet for each specialty, which contained prompts for documenting each aspect of the medical history. We then repeated the audit of 120 additional admissions documented on these booklets.

Results:
On average, across all 3 specialties, there was a 33% increase in the inclusion of items in the documented history after the introduction of an admission booklet. In particular, documentation of medication history improved from 46% to 99%, and documentation of allergies improved from 47% to 93%. These improvements were statistically significant.

Conclusion:
We recommend the use of a pediatric admission booklet as a simple and effective way to improve medical record documentation. The use of these booklets was associated with an increase in the thoroughness of the documentation. As NHS hospitals transition to electronic medical records, they should make use of admission templates that retain the advantages of these paper booklets.
Early Mobilization in the Pediatric Intensive Care Unit: A Quality Improvement Initiative
Authors: Herbsman Jodi M. , D’Agati Michael , Klein Daniella , O’Donnell Siobhan , Corcoran John R. , Folks Tiffany D. , Al-Qaqaa Yasir M. 
Published: March 2021

Introduction:
Mobilizing patients during an intensive care unit admission results in improved clinical and functional outcomes. The goal of this quality improvement project was to increase the percentage of patients in the pediatric intensive care unit (PICU) mobilized early from 62% to 80%. Early mobilization was within 18 hours of admission for nonmechanically ventilated (non-MV) patients and 48 hours for mechanically ventilated (MV) patients.

Methods:
We collected data from September 15, 2015, to December 15, 2016, identified key drivers and barriers, and developed interventions. Interventions included the development of an algorithm to identify patients appropriate for mobilization, management of barriers to mobilization, and education on the benefits of early mobilization. The percentage of PICU patients mobilized early; the percentage of patients with physical therapy, occupational therapy (OT), speech-language pathology (SLP), and activity orders; identified barriers; PICU and hospital length of stay (LOS) and discharge disposition, were compared between the pre- and postintervention groups and the non-MV and MV subgroups. The MV subgroup was too small for statistical testing.

Results:
All measures in the combined postintervention group improved and reached significance (<0.05), except for the percentage of SLP orders and discharged home. Percentage mobilized early increased 25%, activity orders 50%, physical therapist orders 14%, OT orders 11%, SLP orders 7%, and discharged home 6%. Hospital LOS decreased by 35%, and PICU LOS decreased by 34%. All measures in the postintervention, non-MV subgroup improved and reached significance (<0.05).

Conclusions:
This early mobilization program was associated with statistically significant improvements in the rate of early mobilization, activity and therapy orders, and hospital and PICU LOS.
Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed
Authors: Anderson Kim , Kalk Emma , Madlala Hlengiwe P. , Nyemba Dorothy C. , Jacob Nisha , Slogrove Amy , Smith Mariette , Kroon Max , Harrison Michael C. , Eley Brian S. , Boulle Andrew , Myer Landon , Davies Mary-Ann 
Published: March 2021

Objectives:
Infants who are HIV exposed but uninfected (HEU) compared with HIV unexposed uninfected (HUU) have an increased risk of adverse birth outcomes, morbidity and hospitalization. In the era of universal maternal antiretroviral treatment, there are few insights into patterns of neonatal morbidity specifically.

Design:
A prospective cohort study.

Methods:
We compared neonatal hospitalizations among infants who were HEU (n = 463) vs. HUU (n = 466) born between 2017 and 2019 to a cohort of pregnant women from a large antenatal clinic in South Africa. We examined maternal and infant factors associated with hospitalization using logistic regression.

Results:
Hospitalization rates were similar between neonates who were HEU and HUU (13 vs. 16%; P = 0.25). Overall, most hospitalizations occurred directly after birth (87%); infection-related causes were identified in 34%. The most common reason for hospitalization unrelated to infection was respiratory distress (25%). Very preterm birth (<32 weeks) (29 vs. 11%; P = 0.01) as well as very low birthweight (<1500 g) (34 vs. 16%; P = 0.02) occurred more frequently among hospitalized neonates who were HEU. Of those hospitalized, risk of intensive care unit (ICU) admission was higher in neonates who were HEU (53%) than HUU (27%) [risk ratio = 2.1; 95% confidence interval (95% CI) 1.3–3.3]. Adjusted for very preterm birth, the risk of ICU admission remained higher among neonates who were HEU (aRR = 1.8; 95% CI 1.1–2.9).

Conclusion:
Neonates who were HEU (vs. HUU) did not have increased all-cause or infection-related hospitalization. However, very preterm birth, very low birthweight and ICU admission were more likely in hospitalized neonates who were HEU, indicating increased severity of neonatal morbidity.
Viral suppression is associated with HIV-antibody level and HIV-1 DNA detectability in early treated children at 2 years of age
Authors: Veldsman Kirsten A. , Laughton Barbara , Janse van Rensburg Anita , Zuidewind Peter , Dobbels Els , Barnabas Shaun , Fry Samantha , Cotton Mark F. , van Zyl Gert U. 
Published: March 2021

Objectives:
Early infant HIV diagnosis and antiretroviral therapy (ART) initiation are now implemented shortly after birth. Maintaining and monitoring ART adherence is difficult and requires frequent visits. We, therefore, investigated whether HIV antibodies and HIV-1 DNA levels are markers of cumulative viremia.

Design:
We conducted a cross sectional investigation at 2 years of age of HIV antibodies and HIV-1 DNA levels in a well characterized cohort of 31 children who started ART shortly after birth.

Methods:
HIV antibodies were measured by a combination of the Abbott ARCHITECT HIV Ag/Ab Combo and Geenius HIV 1/2 supplemental assays; and total HIV-1 DNA quantified using a sensitive quantitative PCR (qPCR) assay targeting the HIV-1 integrase gene.

Results:
Infant post-exposure prophylaxis consisted of zidovudine (AZT) and nevirapine (NPV) (or NVP only, in one child) within 1 day of birth, transitioning, after positive diagnosis, to three-drug ART, at a median [interquartile range (IQR)] of 7 (4–9.5) days. Twelve of 31 children had well suppressed HIV plasma viral loads (HIVVL) and the remainder periods of viremia (HIVVL > 100 copies/ml after 3 months of ART), classified as non-suppressed. At 24 months of age: 11 of 12 (92%) of well suppressed children had undetectable HIV-1 antibodies versus 3 of 19 (16%) non-suppressed children (P < 0.001) and 7 of 12 (58%) well suppressed children had undetectable HIV-1 DNA versus 3 of 19 (16%) non-suppressed children (P = 0.02).

Conclusion:
Considering low assay costs and the high proportion of well suppressed children with undetected antibody levels at 2 years, HIV antibody levels may be a valuable marker of cumulative adherence in children who start treatment shortly after birth and could prompt adherence and viral load investigation.
Clinic and care: associations with adolescent antiretroviral therapy adherence in a prospective cohort in South Africa
Authors: Cluver Lucie , Shenderovich Yulia , Toska Elona , Rudgard William E. , Zhou Siyanai , Orkin Mark , Haghighat Roxanna , Chetty Angelique N. , Kuo Caroline , Armstrong Alice , Sherr Lorraine 
Published: March 2021

Objective:
Adolescent antiretroviral treatment (ART) adherence remains critically low. We lack research testing protective factors across both clinic and care environments.

Design:
A prospective cohort of adolescents living with HIV (sample n = 969, 55% girls, baseline mean age 13.6) in the Eastern Cape Province in South Africa were interviewed at baseline and 18-month follow-up (2014–2015, 2015–2016). We traced all adolescents ever initiated on treatment in 52 government health facilities (90% uptake, 93% 18-month retention, 1.2% mortality).

Methods:
Clinical records were collected; standardized questionnaires were administered by trained data collectors in adolescents’ language of choice. Probit within-between regressions and average adjusted probability calculations were used to examine associations of caregiving and clinic factors with adherence, controlling for household structure, socioeconomic and HIV factors.

Results:
Past-week ART adherence was 66% (baseline), 65% (follow-up), validated against viral load in subsample. Within-individual changes in three factors were associated with improved adherence: no physical and emotional violence (12.1 percentage points increase in adjusted probability of adherence, P < 0.001), improvement in perceived healthcare confidentiality (7.1 percentage points, P < 0.04) and shorter travel time to the clinic (13.7 percentage points, P < 0.02). In combination, improvement in violence prevention, travel time and confidentiality were associated with 81% probability of ART adherence, compared with 47% with a worsening in all three.

Conclusion:
Adolescents living with HIV need to be safe at home and feel safe from stigma in an accessible clinic. This will require active collaboration between health and child protection systems, and utilization of effective violence prevention interventions.
Perinatally acquired HIV infection is associated with abnormal blood mitochondrial function during childhood/adolescence
Authors: Jao Jennifer , Jacobson Denise L. , Russell Jonathan S. , Wang Jiajia , Yu Wendy , Gojanovich Greg S. , Siminski Sue , Hyzy Laurie , Geffner Mitchell E. , Gerschenson Mariana 
Published: March 2021

Objective:
We assessed differences in mitochondrial function between youth living with perinatal HIV (YPHIV) and youth perinatally HIV-exposed but uninfected (YPHEU).

Design:
Cross-sectional analysis.

Methods:
We measured lactate and pyruvate values, as well as mitochondrial Complex I and Complex IV activity in peripheral blood mononuclear cells. Logistic or linear regression models were fit, as appropriate, to assess the association between PHIV status and each mitochondrial parameter, adjusted for confounders. We introduced interaction terms to assess effect modification of PHIV status on the relationship between anthropometric factors and each mitochondrial parameter. Among YPHIV, similar regression models were fit to assess the relationship between HIV-associated factors and each mitochondrial outcome.

Results:
A total of 243 YPHIV and 118 YPHEU were compared. On average, YPHIV had higher lactate/pyruvate ratio (β: 7.511, 95% confidence interval [95% CI]: 0.402, 14.620) and Complex IV activity (β: 0.037, 95% CI: 0.002, 0.072) compared to YPHEU, adjusted for confounders. Among YPHIV, body mass index Z score (BMIZ) and Complex I activity were inversely associated, whereas, among YPHEU, there was a positive association (β for interaction: −0.048, P = 0.003). Among YPHIV, current (β: −0.789, 95% CI: −1.174, −0.404) and nadir CD4+% (β: −0.605, 95% CI: −1.086, −0.125) were inversely associated with lactate/pyruvate ratio; higher current (4.491, 95% CI: 0.754, 8.229) and peak (7.978, 95% CI: 1.499, 14.457) HIV RNA levels were positively associated with lactate/pyruvate ratio in adjusted models.

Conclusions:
Mitochondrial function and substrate utilization appear perturbed in YPHIV compared to YPHEU. Increasing immunosuppression and viremia are associated with mitochondrial dysfunction among YPHIV.
Ecdysone coordinates plastic growth with robust pattern in the developing wing
Authors: Alves André Nogueira , Oliveira Marisa Mateus , Koyama Takashi , Shingleton Alexander , Mirth Christen 
Published: March 2021

AbstractAnimals develop in unpredictable, variable environments. In response to environmental change some aspects of development adjust to generate plastic phenotypes. Other aspects of development, however, are buffered against environmental change to produce robust phenotypes. How organ development is coordinated to accommodate both plastic and robust developmental responses is poorly understood. Here, we demonstrate that the steroid hormone ecdysone coordinates both plasticity of organ size and robustness of organ pattern in the developing wings of the fruit flyDrosophila melanogaster. Using fed and starved larvae that lack prothoracic glands, which synthesise ecdysone, we show that nutrition regulates growth both via ecdysone and via an ecdysone-independent mechanism, while nutrition regulates patterning only via ecdysone. We then demonstrate that growth shows a graded response to ecdysone concentration, while patterning shows a threshold response. Collectively, these data support a model where nutritionally-regulated ecdysone fluctuations confer plasticity by regulating disc growth in response to basal ecdysone levels, and confers robustness by initiating patterning only once ecdysone peaks exceeds a threshold concentration. This could represent a generalizable mechanism through which hormones coordinate plastic growth with robust patterning in the face of environmental change.
The Effects of Pericapsular nerve group (PENG) block on Postoperative Recovery in Elderly Patients with Hip fracture: a study protocol for randomized, parallel controlled, double-blind trial
Authors: Luo Wei , Luo Quehua , Wu Jieting , Liang Jianhui , Wu Huiyi , Ou Yanhua , Li Yuhui , Ma Wuhua 
Published: March 2021

ABSTRACTIntroductionHip fracture is a common and serious emergency in the elderly, it is associated with severe pain, significant postoperative morbidity and mortality. Featuring peripheral nerve block in Enhanced recovery after surgery (ERAS) pathway may have significantly effect on shortening length of hospital stay, decreasing complications and costs, particular in improvement in dynamic pain and reducing the use of opioid. Pericapsular Nerve Group Block(PENG), suggested by Arangoet al, may provide a effective blockade to the articular branches of the anterior hip joint,which innervate the most section of the hip capsule richly, with a potential motor-sparing effect.The purpose of this trail is to investigate whether PENG is effective to enhanced recovery in elderly patients with hip fracture.Methods and analysisThis study will be a single centre,randomized, parallel controlled, double-blind trail. 92 elderly patients scheduled for hip fracture surgery will be divided into two groups randomly to receive ultrasound-guided PENG block or ultrasound-guided femoral nerve(FN) block. The primary outcome will be compare the quality of recovery-15(QoR-15) score at 24h postoperatively between two groups.The secondary outcomes include the strength of quadriceps, the visual analogue scale(VAS) at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilization, the complications.Ethics and disseminationThis study has been approved by the Medical Science Research Ethics Committees of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (Reference K2020-110). The results of this study will be published in peer-reviewed international journals.Trial registration numberChiCTR2100042341.
Show us the Data: Global COVID-19 Wastewater Monitoring Efforts, Equity, and Gaps
Authors: Naughton Colleen C. , Roman Fernando A. , Alvarado Ana Grace F. , Tariqi Arianna Q. , Deeming Matthew A. , Bibby Kyle , Bivins Aaron , Rose Joan B. , Medema Gertjan , Ahmed Warish , Katsivelis Panagis , Allan Vajra , Sinclair Ryan , Zhang Yihan , Kinyua Maureen N. 
Published: March 2021

AbstractA year since the declaration of the global coronavirus disease 2019 (COVID-19) pandemic there were over 110 million cases and 2.5 million deaths. Learning from methods to track community spread of other viruses such as poliovirus, environmental virologists and those in the wastewater based epidemiology (WBE) field quickly adapted their existing methods to detect SARS-CoV-2 RNA in wastewater. Unlike COVID-19 case and mortality data, there was not a global dashboard to track wastewater monitoring of SARS-CoV-2 RNA worldwide. This study provides a one year review of the “COVIDPoops19” global dashboard of universities, sites, and countries monitoring SARS-CoV-2 RNA in wastewater. Methods to assemble the dashboard combined standard literature review, direct submissions, and daily, social media keyword searches. Over 200 universities, 1,000 sites, and 55 countries with 59 dashboards monitor wastewater for SARS-CoV-2 RNA. However, monitoring is primarily in high-income countries (65%) with less access to this valuable tool in low and middle income countries (35%). Data are not widely shared publicly or accessible to researchers to further inform public health actions, perform meta-analysis, better coordinate, and determine equitable distribution of monitoring sites. For WBE to be used to its full potential during COVID-19 and beyond, show us the data.
Lessons learned from the resilience of Chinese hospitals to the COVID-19 pandemic: a scoping review
Authors: Stennett Jack , Hou Renyou , Traverson Lola , Ridde Valéry , Zinszer Kate , Chabrol Fanny 
Published: March 2021

AbstractAs the SARS-CoV-2 pandemic has brought huge strain on hospitals worldwide, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic. This paper aims to determine the key findings, recommendations and lessons learned in terms of hospital resilience during the pandemic, as well as the quality and limitations of research in this field at present.We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the CNKI and WHO databases) were used to identify papers meeting the eligibility criteria, from which we selected 59 publications (English: n= 26; Chinese: n= 33). After extracting the data, we present an information synthesis using a resilience framework.We found that much research was rapidly produced in the first half of 2020, describing certain strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene and planning. Our search revealed that considerable attention was focused on interventions related to training, healthcare worker well-being, e-health/ telemedicine, and work organization, while other areas, such as hospital financing, information systems and healthcare infrastructure, were less well represented in the literature.We identified a number of lessons learned regarding how China’s hospitals have maintained resilience when confronted with the SARS-CoV-2 pandemic. However, we also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly-focused research on individual interventions and holistic research that attempted to unite the topics within a resilience framework. Research on Chinese hospitals would benefit from a greater range of analysis in order to draw more nuanced and contextualised lessons from the responses to the crisis.
Pneumonia in patients with rheumatoid arthritis: effect of microbial airway colonization
Authors: Ideguchi Shuhei , Yamamoto Kazuko , Tahara Masahiro , Koga Tomohiro , Ide Shotaro , Hirayama Tatsuro , Takazono Takahiro , Imamura Yoshifumi , Miyazaki Taiga , Sakamoto Noriho , Morimoto Shimpei , Izumikawa Koichi , Yanagihara Katsunori , Ashizawa Kazuto , Aoki Takatoshi , Kawakami Atsushi , Yatera Kazuhiro , Mukae Hiroshi 
Published: March 2021

AbstractRheumatoid arthritis frequently complicates airway diseases and is associated with high rates of pneumonia and mortality. The relationship between microorganisms colonizing the lower respiratory tract and the subsequent incidence of pneumonia in patients with rheumatoid arthritis is unclear. In this study, we aimed to identify microorganisms colonizing the lower respiratory tract in patients with rheumatoid arthritis related to the risk of developing subsequent pneumonia in these patients.A retrospective cohort study was designed to include a total of 121 patients with rheumatoid arthritis (median age, 67 years; women, 78.5%) who underwent bronchoscopy at three hospitals from January 2008 to December 2017. The following information was extracted from their electronic medical records: patient characteristics, microorganisms detected by bronchoscopy, and subsequent incidences of pneumonia. The patients were divided into groups based on the microorganisms isolated from the lower respiratory tract and compared with control subjects. The cumulative incidence of pneumonia was assessed using the Kaplan–Meier method and log-rank test. Risk factors for pneumonia were analyzed using the Cox proportional-hazards analysis.The most frequently isolated microbes from the lower respiratory tract in descending order were Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae. The annual incidence rates of pneumonia per 1000 patients were 100, 62, 132, and 38, in the P. aeruginosa, S. aureus, H. influenzae, and control group, respectively. Patients colonized with P. aeruginosa had a higher frequency of macrolide use and a higher degree of bronchiectasis than patients in the control group. The rate of the subsequent incidence of pneumonia was higher in the P. aeruginosa group (P = 0.038), and P. aeruginosa was an independent risk factor for pneumonia (hazard ratio, 3.504; 95% confidence interval, 1.153–10.330).The colonization of the lower respiratory tract by P. aeruginosa in patients with rheumatoid arthritis was associated with the subsequent incidence of pneumonia.