bluuebunny/crossref_metadata_2025_split huggingface dataset:
LB20. Impact of School-Located Influenza Vaccination on Vaccination Coverage, School Absenteeism, and Influenza Hospitalization
Authors: Benjamin-Chung Jade 
Published: November 2018

Abstract

Background
School-located influenza vaccination programs aim to increase influenza vaccination coverage and produce indirect effects by interrupting influenza transmission. We evaluated the impact of a program that delivered the inactivated influenza vaccine in 2016–2017 to elementary schools in a large, diverse urban school district in Oakland, California on vaccination coverage, school absenteeism, and influenza hospitalization.

Methods
We conducted a prospective cohort study and used pre-program data from the California Department of Education on school characteristics to identify a control school district with similar characteristics to the program district. We measured parent recall of student influenza vaccination in surveys in 2017 in 44 schools per district (N = 6,070). We obtained absence data from school districts and influenza hospitalization data for district catchment areas prior to and during the program. We used generalized linear models to estimate difference-in-differences (DIDs) in absence rates during influenza season adjusting for month, race, and grade to account for differences in pre-program rates. Standard errors accounted for school clusters. For influenza hospitalization, we estimated cumulative incidence rates using census data to obtain the population size and risk ratios (RR) using modified Poisson regression.

Results
Vaccination coverage was 56.7% in control schools and 63.9% in program schools (difference = 7.2%; 95% CI 3.6%, 10.8%). 24% of students in program schools were vaccinated at school. Absences per 100 days were 5.40 vs. 6.68 in program vs. control sites for all absences and 3.01 vs. 3.60 for illness-related absences; DIDs were statistically significant for illness absences. Among all ages, the risk ratio for influenza hospitalization in program vs. control districts was 0.65 (95% CI 0.55, 0.78) among all ages and 0.71 for adults 65 or older (95% CI 0.57, 0.89). Hospitalization was too rare among elementary aged students to estimate RRs in that group.

Conclusion
Elementary school-located influenza vaccination increased influenza vaccination and decreased school absence and influenza hospitalization. There was an indirect effect on hospitalization in the elderly and nonelementary aged groups.

Disclosures
All authors: No reported disclosures.
LB21. Preemptive Therapy (PET) vs. Prophylaxis for Prevention of Cytomegalovirus (CMV) Disease in High-Risk Donor Seropositive/Recipient Seronegative (D+R−) Liver Transplant Recipients (LTR): A NIH-Sponsored, Randomized, Controlled, Multicenter Trial
Authors: Singh Nina , Winston Drew , Razonable Raymund R , Lyon III G Marshall , Silveira Fernanda P , Wagener Marilyn , Limaye Ajit P 
Published: November 2018

Abstract

Background
Current guidelines preferentially recommend valganciclovir (VGCV) prophylaxis over PET in most D+R− organ transplant populations, but adequately powered direct comparative clinical trials are lacking.

Methods
D+R− LTR were randomly assigned (1:1, stratified by site and T-cell depleting induction) to receive either PET (weekly plasma CMV DNAemia at central laboratory for 100 days, with VGCV 900 mg bid for DNAemia at any level, until two consecutive negative weekly tests) or prophy (VGCV 900 mg qd for 100 days). The primary outcome was CMV disease by 12 months as adjudicated by an independent, blinded, endpoint committee in ITT population. Secondary outcomes were opportunistic infections (OIs) (invasive fungal and bacterial), neutropenia (ANC &lt; 1000/µL), acute rejection, graft loss, and mortality assessed at12 months.

Results
From October 2012 to June 2017, 205 patients were randomized at six centers; 100 to PET, 105 to prophy. The incidence of CMV disease was 9% (9/100) in PET and 19% (20/105) in prophy (P = 0.039) with majority of difference due to post-prophylaxis disease: 6% in PET vs. 17% in prophy (P = 0.027). CMV disease included syndrome in 55% (16/29) and end-organ in 45% (13/29), with similar proportions in two groups. Secondary outcomes were not different for PET and prophy groups: OIs (19% vs. 21%), neutropenia (34% vs.. 28%), acute rejection (27% vs. 27%), graft loss (2% vs. 2%), and mortality (10% vs. 6%), respectively, P &gt; 0.05 for all comparisons. Mortality at last follow-up (median 3.2 years) was not different for PET vs. prophy (14% vs. 18%, P = 0.43).

Conclusions
PET significantly reduced the incidence of CMV disease compared with prophy in D+R- LTR, and was associated with similar other clinical outcomes. Current guidelines should be revised to recommend PET over prophylaxis in this setting, and similar trials conducted in other D+R− transplant populations. (Funded by NIAID; ClinicalTrials.gov# NCT01552369.)

Disclosures
D. Winston, Merck: Investigator, Research support. Chimerix: Investigator, Research support. Shire: Investigator, Research support. Gilead: Investigator, Research support. Oxford Immunotech: Investigator, Research support. G. M. Lyon III, Shire: Investigator, institutional research support. Hookipa: Investigator, institutional research support. Merck: Investigator, institutional research support. F. P. Silveira, Shire: contracted clinical research, site investigator. A. P. Limaye, Merk: Consultant and Investigator, Consulting fee and Research grant. Astellas Pharma Inc.: Consultant and Investigator, Consulting fee. Helocyte Inc.: Consultant, Consulting fee.
Oral 17β-estradiol/progesterone (TX-001HR) and quality of life in postmenopausal women with vasomotor symptoms
Authors: Simon James A. , Kaunitz Andrew M. , Kroll Robin , Graham Shelli , Bernick Brian , Mirkin Sebastian 
Published: November 2018

Abstract

Objective:
The aim of the study was to describe the effects of TX-001HR (17β-estradiol [E2] and natural progesterone [P4] in a single oral capsule) on menopause-specific quality of life in women with moderate to severe vasomotor symptoms (VMS).

Methods:
The REPLENISH study (NCT01942668) was a phase 3, randomized, double-blind, placebo-controlled, multicenter trial which evaluated four E2/P4 doses in postmenopausal women with VMS and a uterus. Women with moderate to severe hot flushes (≥7/d or ≥50/wk) were included in a VMS substudy. Participants self-administered the Menopause-Specific Quality of Life (MENQOL) questionnaire. Baseline changes in MENQOL overall and domains were determined as well as correlations between changes in MENQOL scores and VMS frequency or severity.

Results:
In the VMS substudy, women treated with E2/P4 had significantly greater improvements from baseline in their MENQOL overall score at week 12, and months 6 and 12, compared with placebo (all, P < 0.05, except the lowest E2/P4 dose at months 6 and 12). Improvements from baseline for the MENQOL vasomotor domain score were significantly greater with TX-001HR doses versus placebo at all time points (all, P < 0.01). Changes in MENQOL vasomotor scores moderately correlated with changes in VMS frequency (r = 0.56, P < 0.0001) and severity (r = 0.55, P < 0.0001).

Conclusion:
In the REPLENISH trial, women with moderate to severe VMS treated with most E2/P4 doses reported significant improvements in quality of life from baseline to 12 weeks compared with placebo, which were maintained up to 12 months. TX-001HR, if approved, may provide the first oral hormone therapy formulation in a single capsule containing E2 and P4 for the treatment of VMS in postmenopausal women with a uterus.
Comparative Study of Performance using Five Different Gamma-ray Spectrometers for Thyroid Monitoring under Nuclear Emergency Situations
Authors: Hosoda Masahiro , Iwaoka Kazuki , Tokonami Shinji , Tamakuma Yuki , Shiroma Yoshitaka , Fukuhara Takahiro , Imajyo Yusuke , Taniguchi Jun , Akata Naofumi , Osanai Minoru , Tsujiguchi Takakiyo , Yamaguchi Masaru , Kashiwakura Ikuo 
Published: November 2018

Abstract
A performance test was carried out using five different gamma-ray spectrometers applicable to thyroid monitoring. The energy resolution and efficiency for 7.6-cm × 7.6-cm NaI(Tl), 5.1-cm × 5.1-cm CeBr3, 3.8-cm × 3.8-cm SrI2(Eu), and 2.5-cm × 2.5-cm SrI2(Eu) gamma-ray scintillation spectrometers and a CdTe gamma-ray semiconductor spectrometer were evaluated using the Oak Ridge Institute for Nuclear Studies thyroid-neck phantom with a mock 131I source for prompt thyroid monitoring after a nuclear emergency. The respective energy resolutions of the full-energy peak for ~0.360 MeV of 3.8-cm × 3.8-cm SrI2(Eu) and 2.5-cm × 2.5-cm SrI2(Eu) scintillation spectrometers were 4.2% and 4.3%, and these values were very close to the value obtained by the CdTe semiconductor spectrometer. The efficiencies of four of the gamma-ray spectrometers were compared based on the efficiency of the 7.6-cm × 7.6-cm NaI(Tl) scintillation spectrometer at 0 cm from the phantom surface, and these values were ~70% for 5.1-cm × 5.1-cm CeBr3, ~30% for 3.8-cm × 3.8-cm SrI2(Eu), 10% for 2.5-cm × 2.5-cm SrI2(Eu) and 2% for 1-cm2 × 0.1-cm CdTe. Furthermore, the detection limits at various dose rates for the four gamma-ray scintillation spectrometers were evaluated using the method based on International Organization for Standardization publication ISO 11929:2010.
Thrombosis in the portal venous system caused by hypereosinophilic syndrome
Authors: Lin Jinfeng , Huang Xiaoying , Zhou Weihua , Zhang Suyan , Sun Weiwei , Wang Yadong , Ren Ke , Tian Lijun , Xu Junxian , Cao Zhilong , Pu Zunguo , Han Xudong 
Published: November 2018

Abstract

Rationale:
Extensive thrombosis in the portal venous system caused by hypereosinophilic syndrome (HES) is rare, and there is no consensus on anticoagulant and thrombolytic treatments for arteriovenous thrombosis caused by HES.

Patient concerns:
The clinical data of a patient with extensive thrombosis in his portal venous system (superior mesenteric, splenic, hepatic, and portal veins), renal artery thrombosis, and mesenteric thrombosis caused by HES with secondary gastrointestinal bleeding and intestinal necrosis were retrospectively analyzed. Before admission, his eosinophil count increased to 7.47 × 109/L, and HES had been confirmed via bone marrow cytology. The patient experienced fever, cough, abdominal pain, massive hematemesis, and hematochezia that developed in succession. Abdominal computed tomography showed portal vein and superior mesenteric vein thromboses.

Diagnosis:
Hypereosinophilic syndrome; extensive thrombosis in the portal venous system; acute eosinophil-associated pneumonia; gastrointestinal bleeding; intestinal necrosis.

Interventions:
The patient was first treated with methylprednisolone, plasma exchange/hemofiltration, and single or combined use of unfractionated heparin and argatroban for anticoagulation. He was also administered alteplase and urokinase, successively, for thrombolytic treatment. Once the thromboses finally disappeared, the patient underwent surgery to excise a necrotic intestinal canal.

Outcomes:
The thromboses disappeared with these treatments, and the patient recovered after the necrotic intestinal canal was excised.

Lessons:
The clinical manifestations of HES are complex and varied, and this condition can cause severe and extensive arteriovenous thrombosis. Anticoagulation therapy and thrombolysis are necessary interventions, and appear to be safe and effective.
Prospective Study of Pulmonary Embolism Presenting as Syncope
Authors: Pop Calin , Ianos Raluca , Matei Claudia , Mercea Delia , Todea Bogdan , Dicu Daniela , Tarus Mariana , Filip Dan , Kozma Gabriela , Cotoraci Coralia , Petris Antoniu , Tint Diana 
Published: November 2018

Background:
Syncope represents a common condition among the general population. It is also a frequent complaint of patients in the emergency department (ED). Pulmonary embolism (PE) considers a differential diagnosis, particularly in a case of syncope without chest pain.

Study Question:
What is the prevalence of PE among patients who presented an episode of syncope to the ED and among those hospitalized for syncope in a tertiary care hospital?

Study Design:
From January 2012 to December 2017, we conducted a prospective observational study among adult patients presenting themselves to the ED consecutively or admitted for syncope.

Measures and Outcomes:
Syncope and PE were defined by professional guidelines. PE was ruled out in patients who had a low pretest clinical probability, as per Wells score and a negative D-dimer assay. In other patients, computed tomography pulmonary angiography was performed.

Results:
Seventeen thousand eight-two patients (mean age 71.3 ± 13.24 years) visited the ED for syncope. PE was detected in 45 patients (mean age 65.75 ± 9.45 years): 4 with low risk, 26 with intermediate risk, and 15 with high risk. The prevalence of PE in those hospitalized with syncope was 11.47%, which is 45 of 392 (confidence interval 95% 8.48–15.04), and was 2.52%, 45 of 1782 (confidence interval 95% 1.8–3.3), in patients presenting with syncope to the ED. The location of the embolus was bilateral in 24 patients (53.33%), in a main pulmonary artery in 10 (22.22%), in a lobar artery in 10 (22.22%), and in a segmental artery in 1 (2.22%).

Conclusions:
The occurrence of syncope, if not explained otherwise, should alert one to consider PE as a differential diagnosis. PE rate, presenting as syncope, is the highest in patients with large thrombi, which is responsible for bilateral or proximal obstruction in a main or lobar pulmonary artery.
Health Equity Demands Health Literacy
Authors: Dreisinger Naomi , Nahn Jeffrey 
Published: November 2018

Abstract
The ability of the patient or the parent, in pediatrics, to read, understand, and act upon health information is termed health literacy. Health literacy has been shown to be of primary importance when determining a patient's ability to achieve optimal health. As physicians, we often fail to recognize the enormous obstacles facing our patients. In the pediatric emergency department (PED), communication is complicated. Physicians must be able to effectively relay information to the patient's caregiver while still not forgetting to provide developmentally appropriate instructions to the child. Individuals who do not have a good understanding of what is needed to properly care for themselves or their children are at a disadvantage, and it is therefore the responsibility of the pediatric provider to do all they can to identify gaps in health literacy. As providers, we need to always be questioning as to whether we properly conveyed the information to our patients. Teaching which results in good understanding is the ultimate goal when treating and releasing our patients in the pediatric emergency department. Matching the method of delivery of information and education to the family's health literacy will help the care team deliver effective information so that it is applied at home hopefully preventing a rapid revisit.
Things Are Not Always What They Seem
Authors: Vukovic Adam A. , Poole Meifawn D. , Hoehn Erin F. , Caldwell Alicia K. , Schondelmeyer Amanda C. 
Published: November 2018

Abstract
We describe 2 cases of child maltreatment who presented as common pediatric conditions: preseptal cellulitis and gastroenteritis. The first case is an 8-year-old girl who presented with progressive right eye pain, swelling, and discharge. She was initially treated for preseptal cellulitis, but eye cultures ultimately grew Neisseria gonorrhoeae. Further investigation revealed sexual abuse by a male family member. The second case is a 2-year-old previously healthy girl who presented with 6 hours of emesis, lethargy, and abdominal pain. Initially attributed to viral gastroenteritis, her serum blood urea nitrogen and creatinine were above what was expected for her clinical course, and she later developed signs of peritonitis. She was ultimately found to have a large bladder wall defect secondary to inflicted blunt abdominal trauma. These cases are presented to emphasize the need for pediatricians to consider child abuse even when patients present with common pediatric complaints.
Oncofertility
Authors: Irene Su H. , Lee Yuton Tony , Barr Ronald 
Published: November 2018

Abstract
Adolescents and young adults aged 15 to 39 years who are diagnosed with cancer (AYA survivors) undergo a range of therapies for cancer cure but subsequently may be at risk of treatment-related infertility, and for female AYA survivors, adverse pregnancy outcomes. Future fertility is important to AYA survivors. Meeting their fertility goals requires awareness of this importance, knowledge of cancer treatment–related fertility risks, appropriate fertility counseling on these risks, and access to fertility care. Epidemiologic and dissemination and implementation research are needed to estimate more precise risks of traditional and novel cancer therapies on fertility and pregnancy outcomes and improve the delivery of fertility care.
Cancer Burden in Adolescents and Young Adults
Authors: Trama Annalisa , Botta Laura , Steliarova-Foucher Eva 
Published: November 2018

Abstract
Cancer burden in adolescents and young adults (AYAs) is expressed through a large proportion of the quality of life lost on individual level and also causes losses to the society in terms of a decreased productivity and social structure. A specific cancer spectrum and distinctive needs of AYA patients require targeted studies and cancer control measures. Incidence is intermediate between that for children and for older adults, and two-thirds of the AYA cancers affect women. Cancers of the breast and cervix uteri, representing a large portion of the burden, are amenable to prevention. Survival is relatively high, but it is lower in AYA patients with certain cancers that are common in childhood or older adulthood. Tailored cancer care with centralized multidisciplinary provision improves the outcome, as demonstrated by survival of leukemia patients. Mortality is decreasing in high-income countries for the cancers that contribute to the burden most, but lack of progress is seen for some rarer subtypes, such as brain tumors and sarcomas of the bone and soft tissue. There is unacceptable lack of information on cancer burden in low-income countries in which the outcomes for AYA patients are likely dreadful. Investment is required to establish cancer registration system and appropriate cancer care delivery in these settings.
Anatomical Variation in Morphometry and Morphology of the Foramen Magnum and Occipital Condyle in Dried Adult Skulls
Authors: Degno Sisay , Abrha Mueez , Asmare Yared , Muche Abebe 
Published: November 2018

Background:
The foramen magnum (FM) is the largest opening and is outlet through which medulla oblongata and spinal cord along with meninges, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane, alar ligaments, and spinal branch of the accessory nerve. Occipital condyle (OC) is an important part of craniovertebral or craniocervical junction located anterolaterally on either side of the FM. The objective of the study was to assess variations of FM and OC in Ethiopian dried adult skulls.

Methods:
Observation-based descriptive study design was employed. The study was undertaken in 54 FM and 108 OC of 54 adult Ethiopian skulls. The morphometry of FM and OC were determined using a sliding vernier caliper.

Results:
The mean values of anteroposterior and transverse diameters of the FM were 35.19 and 30.17 mm, respectively, and the mean area of the FM was 853.36 mm2. The shapes of FM were determined as round in 22.2%, oval in 18.5%, egg like in 20.4%, triangular in 3.7%, pentagonal in 11.1%, hexagonal in 7.4%, irregular in 13%, and rectangular in 3.7% of the cases. The mean length of right and left OC was 25.69 and 26.96 mm, respectively, and the mean widths of the right and left OC were 12.76 and 13.04 mm, respectively.

Conclusion:
Our study identified various shapes of FM and diameter. The anteroposterior diameter is greater than the transverse diameter. The morphometric study of OC confirmed the length of left side is significantly greater than the right side.
The Precise Midline Positioning Instrument for Le Fort I Osteotomy
Authors: Sun Xiumei , Xiao Yanju , Wu Guomin 
Published: November 2018

Abstract
To reduce the deviations in the horizontal direction of posterior maxilla during the maxilla Le Fort I osteotomy, the authors develop and validate the precise midline positioning instrument for Le Fort I osteotomy, which can guide the precise relocation of the truncated maxillary bone segment. The patent application for the precise midline positioning instrument for Le Fort I osteotomy is already submitted (patent no: 201711245533.6, China). The accuracy of Le Fort I osteotomy can be improved significantly, because of the amplification effect of this patent on the rotation/micro-movement of the posterior maxilla in all directions to achieve the precise movement and pairing of the maxillary bone segment. And this method is simple, efficient, and laborsaving.
Sensory Changes in Periocular Skin After Upper Eyelid Surgery
Authors: Koval Tal , Ofir Shay , Belkin Avner , Segal Ori , Nemet Achia , Nemet Arie Y. 
Published: November 2018

Abstract
The aim of this interventional, prospective study is to estimate the change in periocular cutaneous sensation after upper eyelid surgery. The trial included 48 eyes of 24 patients undergoing upper eyelid blepharoplasty or upper eyelid blepharoplasty and blepharoptosis repair. Eyelid sensation was measured using a Cochet–Bonnet filament-type esthesiometer at 4 predetermined anatomical locations in the upper eyelid. The mean esthesiometry reading was calculated at the preoperative visit (4.06 cm), at 2-week postoperative visit (4.38 cm), and at final postoperative visit (4.52 cm). Paired t test showed no significant difference in sensation measurement at second visit compared with baseline (P = 0.205) or at final visit compared with baseline (P = 0.092). Paired t test showed no correlation between type of surgery and change in sensation. Sex and age did not influence change in sensation. In 40 of 42 eyelids, (95.24%), patients reported no reduction in subjective eyelid sensation. The authors conclude that eyelid sensation was not compromised objectively or subjectively by upper eyelid skin incision surgery. Surgeons can reassure patients contemplating surgery that it is very unlikely that cutaneous sensation will be damaged.
Hydrodynamic descriptions for surface roughness in fracture front propagation
Authors: Basu Abhik , Chakrabarti Bikas K. 
Published: November 2018

Fracture is ubiquitous in a crystalline material. Inspired by the observed phenomenological similarities between the spatial profile of a fractured surface and velocities in hydrodynamic turbulence, we set up a hydrodynamic description for the dynamics of fracture surface propagation mode I or opening fracture front. We consider several related continuum hydrodynamic models and use them to extract the similarities between the profile of a fractured surface and velocities in hydrodynamic turbulence. We conclude that a fractured surface should be generically self-similar with an underlying multifractal behaviour.
This article is part of the theme issue ‘Statistical physics of fracture and earthquakes’.