bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measures of Lactation Outcomes in Women Delivering Preterm Infants
Authors: Parker Leslie A. , Cacho Nicole , Bendixen Marion M. , Sullivan Sandra , Magãlhaes Marina , Krueger Charlene , Mueller Martina 
Published: February 2021

Background
Mother’s own milk (MOM) is well known to decrease prematurity-related morbidities, yet mothers delivering preterm infants often produce insufficient quantities of milk to provide these benefits. Although a critical need exists for research to support lactation success in this vulnerable population, development and investigation of interventions to increase available MOM for infant consumption requires consistent, valid, and reliable measures of lactation outcomes.

Objectives
The aim of this study was to compare and contrast methods of measuring lactation outcomes in mothers of preterm infants and evaluate their advantages and disadvantages.

Methods
Measures of lactation outcomes were reviewed and synthesized. Insights on best practices and future research directions are provided.

Results
Volume of MOM produced, lactation duration, and time to onset of secretory activation are important measures of lactation success. The most valid and reliable measure of milk production is likely weighing each vial of expressed milk combined with test weighing when infants breastfeed. Measures of lactation duration should include actual days mothers lactated rather than limiting to infant consumption of MOM as a proxy for duration and include not only whether mothers are lactating at infant discharge but whether they are also lactating at other health-relevant time points during hospitalization. Although time to onset of secretory activation is an important lactation outcome, information regarding valid and reliable indicators of onset in women delivering preterm infants is limited, and investigation of such indicators is a research priority. Variables that may affect lactation outcomes, including time to initiation of expression following delivery, duration of expression sessions, expression method, time spent in skin-to-skin care, maternal demographics and comorbidities, as well as maternal intent to lactate, must be considered when researchers investigate lactation outcomes in mothers of very low birth weight infants.

Discussion
Consistent and valid measures of lactation outcomes are required to produce reliable results from which evidence-based practice recommendations can be developed in order to improve lactation success in this vulnerable population.
Limited Utility of Reverse Algorithm Syphilis Testing in HIV Clinic Among Men Who Have Sex With Men
Authors: Dionne-Odom Jodie , Van Der Pol Barbara , Boutwell Alex , Biligowda Niranjan , Schmid Daphne G. , Hook Edward W. 
Published: February 2021

Background
The reverse algorithm for syphilis diagnosis consists of a treponemal antibody screening immunoassay followed by confirmatory nontreponemal antibody testing. It is increasingly used in the United States despite studies suggesting limited cost-effectiveness in high-prevalence groups.

Methods
In this retrospective cross-sectional study, we included men who have sex with men tested with the reverse algorithm in an Alabama HIV clinic between March 2015 and February 2017. Trep-Sure enzyme immunoassay (EIA) was used for the initial screen, followed by reflex nontreponemal reactive rapid plasma reagin (RPR) testing of specimens with positive results. Sociodemographic and clinical data were extracted from the electronic medical record and stratified according to EIA screen positivity. Quantitative EIA antibody index values were collected to assess test performance at various thresholds.

Results
Among 1693 men tested for syphilis with the reverse algorithm in HIV clinic, 808 (48%) had a positive initial EIA screen. A majority (53%) of men with subsequent RPR testing had a nonreactive RPR (EIA+/RPR−), and 19% (19/98) of these EIA+/RPR− samples tested had a negative confirmatory Treponema pallidum particle agglutination testing result. Analysis of quantitative EIA index values using a receiver operating characteristics curve suggested that a threshold >8 (rather the current threshold of antibody index 1.2) improved the performance of the test.

Conclusions
Among men who have sex with men tested in HIV clinic, the syphilis reverse algorithm was inefficient because of high rates of prior syphilis and false-positive EIA screening. Frequent syphilis screening in high-prevalence populations is an important part of the US epidemic response, and the traditional algorithm is preferred.
Meibomian Gland Contrast Sensitivity and Specificity in the Diagnosis of Lipid-deficient Dry Eye: A Pilot Study
Authors: Yeh Thao N. , Lin Meng C. 
Published: February 2021

SIGNIFICANCE
Lipid deficiency due to meibomian gland (MG) dysfunction is believed to account for the vast majority of patients with dry eye compared with aqueous deficiency. Clinicians commonly evaluate MG length to determine a disease, but our research with isotretinoin users suggests that MG contrast is also an important characteristic to consider.

PURPOSE
This study aimed to determine the sensitivity and specificity of MG contrast for the diagnosis of lipid-deficient dry eye (LDDE).

METHODS
This case-control study used demographic data, Standard Patient Evaluation of Eye Dryness (SPEED) scores, average tear lipid layer thickness (TLLT), fluorescein tear breakup time (FTBUT), upper eyelid meibography images, and meibum quality and quantity scores for individuals with LDDE (SPEED score ≥10 and TLLT ≤35 interferometric color units) and normal individuals (SPEED ≤2 and TLLT ≥80 interferometric color units).

RESULTS
Thirty-one eyes of 22 controls (mean ± SD age, 22.7 ± 5.5 years) and 13 eyes of 12 cases (mean ± SD age, 43.9 ± 17.2 years) were included. Normalized MG contrast was significantly correlated with FTBUT (r = 0.35, P = .02), percent MG atrophy (r = −0.50, P < .001), and SPEED scores (r = −0.49, P < .001). The receiver operating characteristic curve for LDDE diagnosis classifiers MG contrast, MG atrophy, and meibum quantity score had areas under the curve of 0.83, 0.64, and 0.73, respectively. Meibomian gland contrast cutoff at 28.3 intensity units yielded optimal correct classification of subjects (84.1%; sensitivity, 0.69; specificity, 0.90). Cases had shorter FTBUT (P < .001), worse meibum quality (P = .02) and quantity (P = .02) scores, and lower MG contrast (P < .001) compared with controls. Subjects with low MG contrast (≤28.3) had 14.9 higher odds of having LDDE (95% confidence interval, 2.84 to 78.4) compared with subjects with high MG contrast (>28.3).

CONCLUSIONS
Meibomian gland contrast correlates well with clinical parameters and symptoms, shows good sensitivity and excellent specificity for diagnosing LDDE, and can be a useful diagnostic parameter for monitoring MG changes due to age, disease, or intervention.
Comparison of Subjective and Objective Methods of Corneoscleral Limbus Identification from Anterior Segment Optical Coherence Tomography Images
Authors: Skrok Marta K. , Alonso-Caneiro David , Przeździecka-Dołyk Joanna , Siedlecki Damian 
Published: February 2021

SIGNIFICANCE
This study evaluates the reliability and validity of an automatic method of the external and internal limbal points identification from anterior segment optical coherence tomography (OCT) images in comparison with manual delineation.

PURPOSE
The purpose of this work was to evaluate the repeatability and precision of a previously proposed automatic method of external and internal limbal points identification and to compare them with the manual delineation by experienced clinicians in terms of limbus diameter.

METHODS
Optical coherence tomography tomograms obtained for 12 healthy volunteers without a history of eye diseases were analyzed. Fifteen OCT tomograms were captured for each patient. For all the images, the external and internal limbal points were determined using both the automatic and manual methods. The external and internal limbus diameters were used as the comparative parameter between the methods under consideration. The statistical analysis included mean, standard deviation, the Passing-Bablok regression, and the Pearson correlation coefficient.

RESULTS
A strong linear dependence between the automatic and manual methods was identified. While compared with the subjective estimates from clinicians, the automatic technique overestimated the external limbus diameter (bias equals 0.21 mm for optometrist and 0.23 mm for ophthalmologist) and slightly underestimated the internal limbus diameter (bias equals 0.13 mm for optometrist and 0.04 mm for ophthalmologist). The automatic method showed significantly better repeatability than the manual method in the case of external limbal points identification and comparably high repeatability for internal limbal points recognition.

CONCLUSIONS
Because of high precision and excellent repeatability, the automatic method of limbal points identification may be successfully used for estimation of the dynamic changes in the geometry of the anterior segment of the eye, where the large number of captured OCT images needs to be processed automatically with high precision.
Tear Fluid and Serum Vitamin D Concentrations in Unilateral Pterygium
Authors: Örnek Nurgül , Oğurel Tevfik , Kısa Üçler 
Published: February 2021

SIGNIFICANCE
Vitamin D has antiangiogenic, anti-inflammatory, and antifibrotic properties, which may play an inhibitory role on pterygium formation. Vitamin D concentration was measured in few studies, and contradictory results have been reported. There is no study investigating tear fluid concentration of vitamin D in pterygium patients.

PURPOSE
This study evaluated tear fluid and serum vitamin D concentrations of pterygium patients in comparison with healthy controls.

METHODS
Thirty-five (21 male, 14 female) patients with unilateral pterygium and 25 (18 male, 7 female) healthy controls were included in this case-control study. After full ophthalmic examination, blood samples were taken, and basal tear fluid was collected using glass microcapillary tubes. Tear fluid and serum vitamin D concentrations were analyzed using enzyme-linked immunosorbent assay and analyzed statistically.

RESULTS
The mean ± standard deviation age of patients was 51.7 ± 16.7 years in the study group and 50.6 ± 18.7 years in the control group, respectively (P = .82). The mean tear fluid vitamin D concentration was statistically significantly higher than the mean serum concentration in the study groups (P < .0001). The mean tear fluid (P = .76) and serum vitamin D concentrations (P = .53) did not reveal statistically significant difference between patients and controls. There was no statistically significant difference for tear fluid vitamin D concentration between pterygium eyes and fellow eyes (P = .93). The difference in concentrations was compared within the pterygium subgroups, and it was found that the mean serum vitamin D concentration trended toward lower values as the stage of pterygium increased, and the mean tear fluid vitamin D concentration trended toward higher values as the stage of pterygium increased, although these differences were not statistically significant (all, P > .05).

CONCLUSIONS
Tear fluid and serum vitamin D concentrations do not seem to have a role in pterygium pathogenesis.
High- and Low-contrast Letter Acuity during Image Motion in Normal Observers and Observers with Infantile Nystagmus Syndrome
Authors: Bedell Harold E. , Song Sop 
Published: February 2021

SIGNIFICANCE
High-contrast acuity in individuals with infantile nystagmus syndrome (INS) is poorer than expected from their ongoing retinal image motion, indicating a sensory loss. Conversely, acuity for larger low-contrast letters in these observers may be limited by image motion alone.

PURPOSE
The aim of this study was to assess visual acuity for letters of different contrast in normal observers and individuals with idiopathic INS under conditions of comparable retinal image motion.

METHODS
Visual acuity was measured using projected Landolt C charts in 3 normal observers and 11 observers with presumed idiopathic INS. Normal observers viewed each chart after reflection from a front-surface mirror that underwent continuous 4-Hz ramp motion with amplitudes ranging from 4 to 9.6° and simulated foveation durations of 20 to 80 milliseconds. Observers with INS viewed the charts directly. By reciprocally varying the luminance of the projected charts and a superimposed veiling source, Landolt C's were presented on a background luminance of 43 cd/m2 with Weber contrasts between −12 and −89%.

RESULTS
Whereas normal observers' high-contrast acuity during imposed image motion depends only on the duration of the simulated foveation periods, acuity for low-contrast optotypes also worsens systematically as motion intensity (frequency × amplitude) increases. For comparable parameters of retinal image motion, high-contrast acuity in all but one of the observers with INS was poorer than in normal observers. On the other hand, low-contrast acuity in the two groups of observers was similar when the retinal image motion was comparable.

CONCLUSIONS
Reduced high-contrast acuity in observers with INS appears to be attributable primarily to a sensory deficit. On the other hand, the reduction of low-contrast acuity in observers with INS may be accounted for on the basis of retinal image motion.
Comparative Analysis of Tear Proteins in Keratoconic Scleral Lens Wearers with Variation in Limbal Clearance
Authors: Yeung Debby , Murphy Paul J. , Sorbara Luigina 
Published: February 2021

SIGNIFICANCE
Cytokine and protease analysis revealed relative changes in the post-lens tear film of scleral lenses with low and high limbal clearances. Results from this study indicate that midperipheral lens fit is an important fitting feature that can impact the inflammatory response of a keratoconic eye.

PURPOSE
The purpose of this study was to investigate changes in levels of inflammatory mediators in the post-lens tear film of keratoconic scleral lens wearers with varying limbal clearance designs.

METHODS
Twenty-two keratoconic eyes were fitted with two sets of scleral lenses that were consistent in lens diameter and central sagittal depth but varied in limbal clearance by approximately 50 μm. Lenses were worn in a randomly assigned order for a 2-week period each. At each follow-up visit, immediately after lens removal, tear samples were collected with a microcapillary tube (10 μL, 0.5 mm in diameter) from the bowl of the inverted scleral lens. Tear cytokine and protease analysis was performed using a multiplex electrochemiluminescent array (Meso Scale Discovery, Rockville, MD) instrument. Levels of interleukins 1, 6, and 8; tumor necrosis factor α; and matrix metalloproteinases 1 and 9 were compared and analyzed.

RESULTS
Levels of interleukin 1β, tumor necrosis factor α, and matrix metalloproteinase 1 increased with high limbal clearance (P = .01, .006, and .02, respectively). No change in interleukins 6 and 8 levels was found (P > .05). A decrease in matrix metalloproteinase 9 was noted in post-lens tear film of scleral lenses with high limbal clearance (P = .10).

DISCUSSION
Relative changes in the cytokine and protease levels were found when comparing low and high limbal clearance, indicating that the midperipheral lens fit is an important feature that can impact the inflammatory response of the keratoconic eye.
Twenty-Four–Hour Esophageal pH Measurement in Mechanically Ventilated Children: A Prospective Cohort Study*
Authors: Gupta Priyanka , Sankar Jhuma , Kumar B. Kiran , Jat Kana Ram , Mukherjee Aparna , Kapil Arti , Kabra Sushil K. , Lodha Rakesh 
Published: February 2021

Objectives:
To assess the prevalence of gastroesophageal reflux in mechanically ventilated children using 24-hour esophageal pH-metry and its role as a risk factor for ventilator-associated pneumonia.

Design:
Prospective cohort study.

Setting:
PICU of a tertiary care hospital from North India.

Patients:
Mechanically ventilated children 1–15 years old in PICU from July 2015 to June 2017, excluding those receiving acid suppressants, known cases of gastroesophageal reflux disease, having upper gastrointestinal bleed.

Intervention:
Demographic details, baseline investigations, diagnosis, treatment details, and Pediatric Risk of Mortality III score were recorded at enrollment. Gastroesophageal reflux was evaluated using 24-hour esophageal pH-metry. Children were followed up for 7 days or 48 hours after extubation for development of ventilator-associated pneumonia using Centers for Disease Control and Prevention criteria. Pathologic acidic gastroesophageal reflux was defined as fall in esophageal pH less than 4 for more than 4% of total time, whereas pathologic alkaline gastroesophageal reflux as rise in esophageal pH greater than 7 for more than 17% of total time.

Measurements and Main Results:
Sixty-one children (median [interquartile range], age 73 mo [30–132 mo]; 44 boys [72%]) were enrolled. Median Pediatric Risk of Mortality III score was 10.0 (3–16). Median duration of ventilation was 6 days (3–9 d). Pathologic gastroesophageal reflux (acidic or alkaline) was present in 47 children (77%). Twelve children (19.7%) met criteria for pathologic acidic gastroesophageal reflux, whereas 44 children (72.1%) had pathologic alkaline gastroesophageal reflux; nine children (14.7%) had both pathologic acidic and alkaline gastroesophageal reflux. Of the enrolled children, 17 (27.9 %) developed ventilator-associated pneumonia. No patient had both pathologic acidic gastroesophageal reflux and ventilator-associated pneumonia. Of 17 children who developed ventilator-associated pneumonia, 12 (70.5%) had pathologic alkaline gastroesophageal reflux as compared to 32 children (72.7%) among the 44 children who did not develop ventilator-associated pneumonia (p = 0.87).

Conclusions:
The current study shows high incidence of gastroesophageal reflux on 24-hour esophageal pH-metry in mechanically ventilated children with medical diagnoses. The significance of this finding and its impact on ventilator-associated pneumonia and other ventilator-associated events need to be examined in larger studies.
Left Ventricular Diastolic Dysfunction in Pediatric Sepsis: Outcomes in a Single-Center Retrospective Cohort Study*
Authors: Ginsburg Sarah , Conlon Thomas , Himebauch Adam , Glau Christie , Weiss Scott , Weber Mark D. , O’Connor Matthew J. , Nishisaki Akira 
Published: February 2021

Objectives:
Left ventricular diastolic dysfunction is associated with difficulty in ventilator weaning and increased mortality in septic adults. We evaluated the association of left ventricular diastolic dysfunction with outcomes in a cohort of children with severe sepsis and septic shock.

Design:
Retrospective cohort study.

Setting:
Single-center noncardiac PICU.

Patients:
Age greater than 1 month to less than 18 years old with severe sepsis or septic shock from January 2011 to June 2017 with echocardiogram within 48 hours of sepsis onset.

Interventions:
None.

Measurements and Main Results:
Echocardiograms were retrospectively assessed for mitral inflow E (early) and A (atrial) velocity and e′ (early mitral annular motion) septal and lateral velocity. Left ventricular diastolic dysfunction was defined as E/e′ greater than 10, E/A less than 0.8, or E/A greater than 1.5. Left ventricular diastolic dysfunction was present in 109 of 204 patients (53%). The data did not demonstrate an association between the presence of left ventricular diastolic dysfunction and the proportion of children requiring invasive mechanical ventilation at the time of echocardiogram (difference in proportion, +5% [72% vs 67%; 95% CI, –8% to 17%]; p = 0.52). The duration of mechanical ventilation was median 192.9 hours (interquartile range, 65.0–378.4 hr) in the left ventricular diastolic dysfunction group versus 151.0 hours (interquartile range, 45.7–244.3 hr) in the group without left ventricular diastolic dysfunction. The presence of left ventricular diastolic dysfunction was not significantly associated with ICU length of stay or mortality. Exploratory analyses revealed that an alternative definition of left ventricular diastolic dysfunction, solely defined by E/e′ greater than 10, was found to have an association with mechanical ventilation requirement at the time of echocardiogram (difference in proportion, +15%; 95% CI, 3–28%; p = 0.02) and duration of mechanical ventilation (median, 207.3 vs 146.9 hr).

Conclusions:
The data failed to show an association between the presence of left ventricular diastolic dysfunction defined by both E/e′ and E/A and the primary and secondary outcomes. When an alternative definition of left ventricular diastolic dysfunction with E/e′ alone was used, there was a significant association with respiratory outcomes.
Personality Factors and Attachment Styles as Predictors of the Therapeutic Efficacy of a Short-Term Ambulatory Intervention for Depression
Authors: BARTOLOMEI JAVIER , BAERISWYL-COTTIN RACHEL , FRAMORANDO DAVID , ZANELLO ADRIANO , BACCHETTA JEAN-PIERRE , HERRMANN FRANÇOIS , SENTISSI OTHMAN 
Published: February 2021

Background:
Several studies have shown a significant positive impact of intensive short-term ambulatory psychiatric interventions for depression. However, data on outcomes related to factors that are predictive of the efficacy of these interventions in terms of remission or response to treatment remain scarce. The goal of this naturalistic prospective study was to identify factors, including Big Five Inventory personality traits and attachment style, that are predictive of the efficacy of crisis interventions (CIns) in major depressive disorder.

Methods:
The study included 234 adult outpatients with major depressive disorder who completed all assessments in a study of a short-term intensive ambulatory CIn. In this study, we evaluated sociodemographic factors, and scores on the Global Assessment of Functioning Scale, the Big Five Inventory personality assessment, the Montgomery-Åsberg Depression Rating Scale, and the Adult Attachment Scale.

Results:
Mean scores on the Montgomery-Åsberg Depression Rating Scale decreased significantly from 26.3 (SD=9.0) at admission to 10.6 (SD=8.1) at the end of the CIn (t=23.9; P<0.001); 99 patients (42%) experienced remission, 151 patients (65%) were considered treatment responders, and 98 patients (42%) both responded to treatment and experienced remission. Results of multivariate regression analysis showed that education level and family intervention were associated with response to treatment. Neuroticism traits were related to a lower rate of response to treatment. The dependency dimension attachment style had a positive impact on response to treatment.

Conclusions:
Neuroticism traits can predict clinical outcomes after a short-term intensive psychiatric intervention for depression. Results of family interviews, education level, and Global Assessment of Functioning scores should also be taken into account in predicting clinical outcomes.