bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Education Discharge Support Strategies for Newly Diagnosed Children With Cancer
Authors: Hockenberry Marilyn , Haugen Maureen , Slaven Abigail , Skeens Micah , Patton Lindsey , Montgomery Kathleen , Trimble Katherine , Coyne Kelly , Hancock Donna , Ahmad Amer , Daut Emily , Glover Leslie , Brown Lauren , St Pierre Sherryann , Shay April , Maloney Jacqueline , Burke Michelle , Hatch Daniel , Arthur Megan 
Published: April 2021

BackgroundDischarge education practices vary among institutions and lack a standardized approach for newly diagnosed pediatric oncology patients and their parents.ObjectiveThe purpose of this American Nurses Credentialing Center–supported pediatric multisite trial was to determine the feasibility and effectiveness of 2 nurse-led Parent Education Discharge Support Strategies (PEDSS) for families with a child who is newly diagnosed with cancer.Interventions/MethodsA cluster randomized clinical trial design assigned 16 Magnet-designated sites to a symptom management PEDSS intervention or parent support and coping PEDSS intervention. Outcome measures evaluated at baseline, 1, and 2 months after diagnosis include symptom experiences, parent perceptions of care, unplanned service utilization, and parent evaluation of the PEDSS interventions.ResultsThere were 283 newly diagnosed children and their parent participating in this study. Linear mixed models revealed pain differed over time by the intervention; children in the symptom management group had a greater decrease in pain. Greater nausea and appetite disturbances were experienced by older children in both groups. Fatigue and sleep disturbance showed a significant decrease over time in both groups. The symptom management group reported significantly greater satisfaction with the PEDSS intervention.ConclusionsThis study is among the first to examine the effects of 2 different early-discharge planning strategies for families of a newly diagnosed child with cancer. The evidence supports a standardized discharge education strategy that can be successfully implemented across institutions.Implications for PracticeNurses play a major role in the educational preparation and discharge of newly diagnosed pediatric cancer patients and their families.
Effects of Rehabilitation Program on Quality of Life, Sleep, Rest-Activity Rhythms, Anxiety, and Depression of Patients With Esophageal Cancer
Authors: Chen Hui-Mei , Lin Yi-Yun , Wu Yu-Chung , Huang Chien-Sheng , Hsu Po-Kuei , Chien Ling-I , Lin Yu-Jung , Huang Hsiu-Li 
Published: April 2021

Background
Esophageal cancer patients experience severe symptoms and poor quality of life.

Objective
We examined the effects of a rehabilitation program on quality of life, sleep, rest-activity rhythms, anxiety, and depression of esophageal cancer patients.

Methods
Forty-four patients with esophageal cancer were randomly assigned to an experimental group, which underwent a 12-week brisk walking and diet education program, or a control group, which received standard care. Health-related quality of life, subjective and objective sleep quality, rest-activity rhythms, anxiety, and depression were assessed at baseline and post intervention.

Results
A generalized estimating equation analysis revealed that, after intervention, compared with the control group, the experimental group exhibited significantly improved reflux (P = .022; effect size, 0.32) and marginally improved emotional (P = .069; effect size, 0.27) and social (P = .069; effect size, 0.27) functions; constipation (P = .050; effect size, 0.29), eating difficulty (P = .058; effect size, 0.27), anxiety (P = .050; effect size, 0.29), and total sleep time (P = .068; effect size, 0.39).

Conclusions
The rehabilitation program may improve health-related quality of life and sleep and alleviate anxiety in patients with esophageal cancer.

Implications for Practice
A rehabilitation program comprising exercise and diet education is a feasible and low-cost intervention for improving quality of life of patients with esophageal cancer. Healthcare team members may consider it as a nonpharmacological treatment option for patients.
A Cross-Sectional Study of the Clinical Metrics of Functional Status Tools in Pediatric Critical Illness
Authors: Ong Chengsi , Lee Jan Hau , Yang Liying , Wong Judith J. M. , Leow Melvin K. S. , Puthucheary Zudin A. 
Published: April 2021

OBJECTIVES:
To determine the clinical metrics of functional assessments in pediatric critical illness survivors.

DESIGN:
Cross-sectional observational study.

SETTING:
PICU follow-up clinic.

PATIENTS:
Forty-four PICU survivors 6–12 months post PICU stay, and 52 healthy controls 0–18 years old.

INTERVENTIONS:
Nil.

MEASUREMENTS AND MAIN RESULTS:
Function was assessed using the Pediatric Quality of Life Inventory 4.0 generic scales and infant scales, the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test, and the Functional Status Scale. Muscle strength was assessed by hand grip strength in children greater than or equal to 6 years. Clinical metrics assessed included floor and ceiling effects, known-group, and convergent validity. Floor and ceiling effects were present if the participants achieving the worst or best scores exceeded 15%, respectively. Known-group validity was assessed by comparing scores between those with and without complex chronic conditions and abnormal versus good baseline function. Convergent validity was assessed using partial correlation between two tools. Functional Status Scale and Pediatric Quality of Life Inventory physical domain scores showed significant ceiling effects in PICU survivors (69.2% and 15.4%, respectively, achieved the highest possible score). Functional scores were not significantly different between children with or without complex chronic conditions or children with good versus abnormal baseline function. In healthy children, Pediatric Quality of Life Inventory physical correlated moderately with hand grip strength (partial r = 0.66; p < 0.001), whereas Pediatric Quality of Life Inventory psychosocial correlated moderately with Pediatric Evaluation of Disability Inventory–Computer Adaptive Test social/cognitive score (partial r = 0.53; p < 0.001). In PICU survivors, only Pediatric Quality of Life Inventory physical and Pediatric Evaluation of Disability Inventory–Computer Adaptive Test mobility scores were correlated (partial r = 0.55; p < 0.001).

CONCLUSIONS:
PICU functional assessment tools have varying clinical metrics. Considering ceiling effects, Pediatric Evaluation of Disability Inventory–Computer Adaptive Test may be more suitable in survivors than Functional Status Scale. Differences in scores between children with or without complex chronic conditions, and with or without baseline functional impairment, were not observed. Functional assessments likely require a combination of tools to measure the spectrum of pediatric critical illness and recovery.
Pertussis Infants Needing Mechanical Ventilation and Extracorporeal Membrane Oxygenation: Single-Center Retrospective Series in Vietnam
Authors: Tuan Ta Anh , Xoay Tran Dang , Nakajima Noriko , Nakagawa Satoshi , Phuc Phan Huu , Hung Dau Viet , Dung Nguyen Trong , Dong Ngo Tien , Dung Tran Ba , Thuy Phung Thi Bich , Hai Le Thanh , Dien Tran Minh 
Published: April 2021

Objectives:
Pertussis is an infectious disease that causes epidemics and outbreaks and is associated with a high mortality rate, especially in infants, in both developed and developing countries. We aimed to characterize infants with pertussis with respiratory failure and shock and investigated the factors related to mortality.

Design:
A retrospective, observational study conducted between January 2015 and October 2020.

Setting:
This study was conducted at the Vietnam National Children’s Hospital, which is a government hospital that serves as a tertiary care center in Hanoi, Vietnam.

Patients:
Children who fulfilled the following inclusion criteria were included: 1) admitted to the PICU, 2) less than 16 years old, 3) pertussis confirmed by real-time polymerase chain reaction, and 4) treated with mechanical ventilation due to respiratory failure and shock.

Interventions:
None.

Measurement and Main Results:
Seventy-three mechanically ventilated children (40 boys; median age, 56 d), whereas 19 patients received extracorporeal membrane oxygenation support. Twenty-six patients (36%) died including 12 who received extracorporeal membrane oxygenation. Those who received extracorporeal membrane oxygenation support had higher leukocyte counts upon admission and were more frequently diagnosed with pulmonary hypertension and stage 3 acute kidney injury. Compared with survivors, nonsurvivors showed increased heart rates, leukocyte and neutrophil counts, and lower systolic and diastolic blood pressure at admission. Increased Vasoactive-Inotropic Score, stage 3 acute kidney injury, fluid overload, the use of renal replacement therapy, and extracorporeal membrane oxygenation use were prevalent among nonsurvivors.

Conclusions:
In this study, around one third of mechanically ventilated patients with pertussis died. Those who received extracorporeal membrane oxygenation had higher leukocyte counts, a higher prevalence of pulmonary hypertension, and advanced stages of acute kidney injury. Higher Vasoactive-Inotropic Score and advanced stages of acute kidney injury were associated with a greater risk of mortality.
Cardiopulmonary Bypass–Induced Inflammation and Myocardial Ischemia and Reperfusion Injury Stimulates Accumulation of Soluble MER*
Authors: Becker Amanda C. , Lantz Connor W. , Forbess Joseph M. , Epting Conrad L. , Thorp Edward B. 
Published: April 2021

Objectives:
Soluble MER has emerged as a potential biomarker for delayed resolution of inflammation after myocardial injury and a therapeutic target to reduce cardiac-related morbidity and mortality in adults. The significance of soluble MER in pediatric populations, however, is unclear. We sought to investigate if soluble MER concentrations change in response to myocardial ischemia and reperfusion injury in pediatric patients. In parallel, we also sought to investigate for correlations between the change in soluble MER concentration and specific patient, bypass, and postoperative data.

Design:
We quantified the change in plasma soluble MER concentration post- compared with precardiopulmonary bypass for each patient in a cohort of pediatric patients. Linear regression, correlation coefficients, and t tests were used to compare innate patient characteristics (i.e., sex, age, cyanotic vs acyanotic cardiac lesion), cardiac bypass data (i.e., total cardiac bypass time, total aortic cross-clamp time, perioperative steroid administration), and postcardiac bypass data (total postoperative ventilator days, total postoperative vasoactive medication days, and total postoperative ICU days) with change in soluble MER concentrations.

Setting:
Whole blood samples were obtained intraoperatively at a single tertiary care children’s hospital from April to October 2019.

Subjects:
Our patient cohort included 24 pediatric patients ages ranging from birth to 19 years old with both cyanotic and acyanotic cardiac lesions.

Interventions:
Retrospective analyses of pediatric blood specimens, as well as patient, bypass, and postoperative data, were performed.

Measurements and Main Results:
We observed a statistically significant increase in soluble MER concentration post cardiac bypass in 17 of 24 patients (71%).

Conclusions:
Soluble MER concentrations increase with cardiopulmonary bypass–induced inflammation and myocardial ischemia and reperfusion injury in pediatric patients. The utility of soluble MER as a clinical biomarker to identify pediatric patients at risk for exacerbated postoperative outcomes after bypass-induced myocardial ischemia and reperfusion injury requires further investigation.
Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment
Authors: Rava Marta , Bisbal Otilia , Domínguez-Domínguez Lourdes , Aleman Ma Remedios , Rivero María , Antela Antonio , Estrada Vicente , Ribera Esteban , Muñoz Adolfo , Iribarren José-Antonio , Moreno Santiago , Rubio Rafael , Jarrín Inmaculada 
Published: April 2021

Objectives:
The aim of this study was to examine the impact of late presentation (CD4+ cell count <350 cells/μl or an AIDS-defining event) on effectiveness and safety of initial antiretroviral therapy (ART) and to evaluate whether treatment response depends on first-line ART regimen in late presenters.

Design:
ART-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting triple ART between 2010 and 2018.

Methods:
We used multivariable models to assess differences in viral suppression (viral load <50 copies/ml), immunological response (change in CD4+ cell count, CD4% (>29%) and CD4/CD8 normalization (>0.4 and >1) multiple T-cell marker recovery (MTMR): CD4+ cell count more than 500 cells/μl and CD4% >29% and CD4/CD8 >1), and treatment discontinuation due to adverse events (TDAE) at 48 weeks from ART initiation.

Results:
Out of 8002 participants, 48.7% were late presenters. Of them, 45.8% initiated ART with a NNRTI- (mostly TDF/FTC/EFV), 33.9% with a protease inhibitor (mostly TDF/FTC+boosted DRV) and 20.3% with an INI-based regimen (mostly ABC/3TC/DTG). At 48 weeks, late presenters had similar viral suppression, but worse immunological response, than non-late presenters with no difference on TDAE. Late presenters initiating with NNRTI-based regimens were more likely to achieve viral suppression than those starting with INI-based, due to the higher chance of achieving viral suppression observed with TDF/FTC/RPV compared to ABC/3TC/DTG. Initial treatment with NNRTI or protease inhibitor based showed similar immunological response than the INI-based regimens, which showed lower rates of TDAE than NNRTI- and protease inhibitor based regimens.

Conclusion:
Despite safety and effectiveness of initial ART in terms of viral suppression, late presenters may not experience complete immunological response. In late presenters, effectiveness and safety depends on both the class and the specific first-line ART regimen.
HIV disease duration, but not active brain infection, predicts cortical amyloid beta deposition
Authors: Morgello Susan , Cortes Etty P. , Gensler Gary , Meloni Gregory , Jacobs Michelle M. , Murray Jacinta , Borukov Valeriy , Crary John F. 
Published: April 2021

Objective:
Abnormal deposition of the antimicrobial peptide amyloid beta (Aβ) is a characteristic of Alzheimer's disease. The objective of this study was to elucidate risk factors for brain Aβ in a cohort enriched for HIV and other neurotropic pathogens.

Design:
Cross-sectional cohort study.

Methods:
We examined autopsy brains of 257 donors with a mean age of 52.8 years; 62% were men; and 194 were HIV+ and 63 HIV−. Hyperphosphorylated tau (p-tau) and Aβ were identified in frontal and temporal regions by immunohistochemistry. APOE genotyping was performed. Clinical and neuropathological predictors for Aβ were identified in univariate analyses, and then tested in multivariate regressions.

Results:
Cortical Aβ was identified in 32% of the sample, and active brain infection in 27%. Increased odds of Aβ were seen with increasing age and having an APOE ε4 allele; for the overall sample, HIV+ status was protective and brain infection was not a predictor. Within the HIV+ population, predictors for Aβ were duration of HIV disease and APOE alleles, but not age. When HIV disease duration and other HIV parameters were introduced into models for the entire sample, HIV disease duration was equivalent to age as a predictor of Aβ.

Conclusion:
We hypothesize that dual aspects of immune suppression and stimulation in HIV, and beneficial survivor effects in older HIV+ individuals, account for HIV+ status decreasing, and HIV duration increasing, odds of Aβ. Importantly, with HIV, disease duration replaces age as an independent risk for Aβ, suggesting HIV-associated accelerated brain senescence.
Antiretroviral therapy administration reduces neuroinflammation without restoring brain-derived neurotrophic factor signaling in alcohol-administered simian immunodeficiency virus-infected macaques
Authors: Maxi John K. , Foret Brittany L. , Amedee Angela M. , McDaniel Lee S. , Nelson Steve , Simon Liz , Edwards Scott , Molina Patricia E. 
Published: April 2021

Objective:
The present study examined interactions between simian immunodeficiency virus (SIV), chronic binge alcohol (CBA), and antiretroviral therapy (ART) on growth factor signaling, neuroinflammatory markers, viral loads (VL), and CD4+ cell counts.

Design:
Adult male rhesus macaques were administered CBA (13–14 g ethanol (EtOH)/kg per week) or sucrose (SUC) 3 months prior to SIVmac251 infection until the study endpoint. At viral setpoint, a subset of CBA/SIV+ and SUC/SIV+ macaques were randomized to receive daily ART (9-[2-Phosphonyl-methoxypropyly]adenine [PMPA] 20 mg/kg, 2’,3’-dideoxy-5-fluoro-3’-thiacytidine (FTC), 30 mg/kg). Frontal cortex (FC) and basal ganglia (BG) were collected for gene and protein expression.

Methods:
Relationships between brain and plasma VL or CD4+ cell counts were determined using linear regression. Effects of SIV, CBA, and ART on markers of neuroinflammation and brain-derived neurotrophic factor (BDNF) signaling were determined by ANOVA and linear regression.

Results:
SIV increased FC and BG neuroinflammatory and glial cell gene expression (CX3CR1, B2M), and reduced FC protein kinase B phosphorylation. CBA decreased FC and BG tropomyosin receptor kinase B (TrkB) phosphorylation, and increased full-length TrkB (TrkB-FL) and SLC1A3 expression in FC and BG, respectively. ART suppressed plasma and brain VL, reduced neuroinflammatory gene expression in FC (IBA1, CX3CR1, and GFAP), and BG (CD74 and CD11ß), and did not restore FC or BG BDNF signaling deficits.

Conclusions:
Results show ART-mediated reduction in VL and neuroinflammatory gene expression, irrespective of CBA administration. ART did not attenuate SIV- and CBA-mediated BDNF signaling deficits, suggesting these deficits, despite effective neuroinflammation suppression, may explain CBA- and SIV-associated neurocognitive deficits. Therapeutics targeting growth factor signaling may be important adjuvants in treating HIV-associated neurocognitive decline.
Prevalence and association with birth outcomes of low vitamin D levels among pregnant women living with HIV
Authors: Bergløv Anne , Moseholm Ellen , Katzenstein Terese L. , Johansen Isik S. , Storgaard Merete , Pedersen Gitte , Weis Nina 
Published: April 2021

Objectives:
To evaluate the prevalence of low vitamin D levels among well treated pregnant women living with HIV (WLWH) on combination antiretroviral therapy in Denmark, to identify risk factors of low vitamin D levels, and to assess the association between vitamin D status and birth outcomes.

Design:
Nationwide cohort study.

Methods:
All WLWH in Denmark giving birth from 2000 to 2018 with a vitamin D measurement during pregnancy were identified. Risk factors for low vitamin D (deficiency or insufficiency) were assessed using log-binomial regression models, both univariate and adjusted for maternal and HIV factors. The association between vitamin D status and birth outcomes was assessed using linear regression models for continuous outcomes and log-binomial models for binary outcomes.

Results:
Among 208 WLWH, the prevalence of vitamin D deficiency was 13%, insufficiency 34%, and sufficiency 53%. Being of African origin (RR 2.68, P = 0.01), Asian origin (RR 3.38, P = < 0.01), or having HIV RNA levels more than 50 copies/ml (RR 1.43, P = 0.04) was associated with an increased risk of low vitamin D level. WLWH with vitamin D deficiency had an increased risk of preterm birth (RR 2.66, P = 0.03) and giving birth to small for gestational age (SGA) children (RR 6.83, P = 0.02) compared with WLWH with sufficient vitamin D level.

Conclusion:
Low vitamin D level was prevalent among well treated pregnant WLWH in Denmark, especially among women of African or Asian origin, and women with detectable viral loads. Vitamin D deficiency was associated with an increased risk of preterm birth and SGA.
Image Quality and Detection of Small Focal Liver Lesions in Diffusion-Weighted Imaging
Authors: Saake Marc , Seuß Hannes , Riexinger Andreas , Bickelhaupt Sebastian , Hammon Matthias , Uder Michael , Laun Frederik B. 
Published: April 2021

Objectives
The aim of this study was to compare intraindividual diffusion-weighted imaging (DWI) of the liver acquired with free breathing (FB) versus navigator triggering (NT) for assessing small focal liver lesions (FLLs) in noncirrhotic patients.

Materials and Methods
Patients with known or suspected multiple FLLs were prospectively included, and spin-echo echo-planar DWI with NT and FB acquisition was performed (b-values, 50 and 800 s/mm2 [b50 and b800]). NT and FB DWI sequences with similar acquisitions times were used. Liver and lesion signal-to-noise ratios were measured at b800. The DWI scans were analyzed independently by 2 readers. Liver edge delineation, presence of stair-step artifacts, vessel sharpness, severity of cardiac motion artifacts, overall image quality, and lesion conspicuity were rated with 5-point Likert scales. Small and large FLLs (ie, <1 cm or ≥1 cm) were rated separately for lesion conspicuity. The FLL detectability was estimated by comparing the number of lesions visible with FB to those visible with NT.

Results
Forty-three patients were included in the study. The FB acquisition performed better in terms of severity of cardiac motion artifacts. The NT performed better in terms of liver edge delineation and vessel sharpness. Little difference was found for stair-step artifact, overall image quality, and conspicuity of large FLL, whereas the conspicuity of small FLL was better for NT. For small FLL, both readers found more lesions with NT in 11 cases at b800. For large FLL, this effect was much less pronounced (1 case at b800 reported by 1 of the readers). The mean liver and lesion signal-to-noise ratios were 16.8/41.5 and 19.8/38.4 for NT/FB, respectively.

Conclusions
Small FLL detection is better with NT. Large FLL detection by FB and NT is similarly good. We conclude that NT should be used.