bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Descriptive and Geospatial Analysis of Environmental Factors Attributing to Sudden Unexpected Infant Death
Authors: Drake Stacy A. , Wolf Dwayne A. , Yang Yijiong , Harper Sherhonda , Ross Jennifer , Reynolds Thomas , Giardino Eileen R. 
Published: January 2019

Abstract
This study examined medicolegal death investigation records and autopsy reports of a medical examiner's office to identify the circumstances surrounding sudden unexpected infant deaths (SUID) and geospatial analyses to pinpoint areas of infant death concentration. Analysis of 732 records of SUID deaths occurring in a 10-year span resulted in the conclusion that environmental factors associated with the sudden death were to some extent modifiable. Co-sleeping (sharing a sleeping surface, or bed-sharing) on various surfaces (mattress, pallet, couch) occurred in 53.4% of the infant deaths. Geographic areas where the largest number of deaths occurred were characterized as areas of high poverty level. The inclusion of additional information at the time of investigation (eg, alcohol and tobacco use of co-sleepers, illness of others in household, exceptions to normal sleep routine of infant) may aid in identifying modifiable circumstances to reduce infant mortality attributable to sudden infant death.
Rapid Streptococcus Pneumonia Antigen Detection on Postmortem Urine in a Death Due to Pneumococcal Meningitis
Authors: Hensby-Bennett Sarah , Garland Jack , Philcox Winston , McCarthy Sinead , Playle Veronica , Kesha Kilak , Stables Simon , Tse Rexson 
Published: January 2019

Abstract

Streptococcus pneumoniae is the leading cause of adult bacterial meningitis. Differing from Neisseria meningitidis (the second most common cause of acute bacterial meningitis), contact tracing and chemoprophylaxis are not required. At postmortem, the differentiation between S. pneumoniae and N. meningitidis is traditionally done by culture and polymerase chain reaction performed on blood or cerebrospinal fluid, but may take hours, if not days, to analyze. We present a death from bacterial meningitis in a 73-year-old woman in which a rapid urinary pneumococcal antigen testing was able to identify S. pneumoniae as the causative organism within 1 hour. This was confirmed by subsequent brain swab culture. The rapid urinary pneumococcal antigen test in the case prevented the need for contact tracing and chemoprophylaxis. This case highlights the potential use of this test to rapidly identify the culprit organism at postmortem examination when acute bacterial meningitis is detected.
Association of Fluid Overload With Clinical Outcomes in Critically Ill Children With Bronchiolitis: Bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) Study*
Authors: Flores-González Jose C. , Valladares Cristina Montero , Yun Castilla Cristina , Mayordomo-Colunga Juan , Quesada Sonia Pérez , Martín Delgado Carmen María , Goñi-Orayen Concha , Fernández Carrión Francisco , Veiga Alicia Miras , Olmedilla-Jodar Marta , Alcaraz Romero Andrés J. , Eizmendi-Bereciartua Miren , Gutierrez Carmen Santiago , Luján Esther Aleo , Navarro-Mingorance Álvaro , Jordán Iolanda 
Published: January 2019

Objectives:
Increasing evidence supports the association of fluid overload with adverse outcomes in different diseases. To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis.

Design:
Descriptive, prospective, multicenter study.

Setting:
Sixteen Spanish PICUs.

Patients:
Severe acute bronchiolitis who required admission from October 2014 to May 2015 were included.

Interventions:
None.

Measurements and Main Results:
Total fluid intake and output were prospectively recorded during PICU assistance. Fluid balance was measured at 24, 48, and 72 hours after PICU admission. A total of 262 patients were enrolled; 54.6% were male. Median age was 1 month (interquartile range, 1–3 mo). Patients had a positive fluid balance during the first 4 days of PICU admission, reaching a neutral balance on day 4. A positive balance at 24 hours in patients admitted to the PICU with severe bronchiolitis was related with longer stay in PICU (p < 0.001), longer hospital stay (p < 0.001), longer duration of mechanical ventilation (p = 0.016), and longer duration of noninvasive ventilation (p = 0.0029).

Conclusions:
Critically ill patients with severe acute bronchiolitis who present a positive balance in the first 24 hours of PICU admission have poorer clinical outcomes with longer PICU and hospital length of stay and duration of invasive and noninvasive mechanical ventilation.
Association Between Tidal Volumes Adjusted for Ideal Body Weight and Outcomes in Pediatric Acute Respiratory Distress Syndrome*
Authors: Imber David A. , Thomas Neal J. , Yehya Nadir 
Published: January 2019

Objectives:
The impact of tidal volume on outcomes in mechanically ventilated children with pediatric acute respiratory distress syndrome remains unclear. To date, observational investigations have failed to calculate tidal volume based on standardized corrections of weight. We investigated the impact of tidal volume on mortality and probability of extubation in pediatric acute respiratory distress syndrome using ideal body weight–adjusted tidal volume.

Design:
Retrospective analysis of an ongoing prospective cohort of pediatric acute respiratory distress syndrome patients. Tidal volume was calculated based on actual body weight and two different formulations of ideal body weight.

Setting:
PICU at a large, tertiary care children’s hospital.

Patients:
Pediatric acute respiratory distress syndrome patients on conventional ventilation with a documented height or length.

Interventions:
None.

Measurements and Main Results:
There were 483 patients with a measured height or length at pediatric acute respiratory distress syndrome onset included in the final analysis, with 73 nonsurvivors (15%). At 24 hours, there remained 400 patients on conventional ventilation. When calculating tidal volume based on ideal body weight by either method, volumes were larger both at onset and at 24 hours compared with tidal volume based on actual body weight (all p < 0.001), and the proportion of patients being ventilated with tidal volumes greater than 10 mL/kg based on ideal body weight was larger both at onset (12.4% and 15.5%) and 24 hours (10.3% and 11.5%) compared with actual body weight at onset (3.5%) and 24 hours (4.0%) (all p < 0.001). Tidal volume, based on both actual body weight and ideal body weight, was not associated with either increased mortality or decreased probability of extubation after adjusting for oxygenation index in the whole cohort, whereas associations between higher tidal volume and poor outcomes were seen in subgroup analyses in overweight children and in severe pediatric acute respiratory distress syndrome.

Conclusions:
Our retrospective analysis of a cohort of pediatric acute respiratory distress syndrome patients did not find a consistent association between tidal volume adjusted for ideal body weight and outcomes, although an association may exist in certain subgroups. Although it remains to be shown in a prospective trial whether high volumes or pressures are injurious in pediatric acute respiratory distress syndrome, tidal volume is likely an imprecise parameter for titrating lung-protective ventilation.
Effectiveness of a Ventilator Care Bundle to Prevent Ventilator-Associated Pneumonia at the PICU: A Systematic Review and Meta-Analysis
Authors: de Neef Marjorie , Bakker Leo , Dijkstra Sandra , Raymakers-Janssen Paulien , Vileito Alicija , Ista Erwin 
Published: January 2019

Objectives:
Ventilator-associated pneumonia is one of the most frequent hospital-acquired infections in mechanically ventilated children. We reviewed the literature on the effectiveness of ventilator care bundles in critically ill children.

Data Sources:
Embase, Medline OvidSP, Web-of-Science, Cochrane Library, and PubMed were searched from January 1990 until April 2017.

Study Selection:
Studies were included if they met the following criteria: 1) implementation of a ventilator care bundle in PICU setting; 2) quality improvement or multicomponent approach with the (primary) objective to lower the ventilator-associated pneumonia rate (expressed as ventilator-associated pneumonia episodes/1,000 ventilator days); and 3) made a comparison, for example, with or without ventilator care bundle, using an experimental randomized or nonrandomized study design, or an interrupted-times series. Exclusion criteria were (systematic) reviews, guidelines, descriptive studies, editorials, or poster publications.

Data Extraction:
The following data were collected from each study: design, setting, patient characteristics (if available), number of ventilator-associated pneumonia per 1,000 ventilator days, ventilator-associated pneumonia definitions used, elements of the ventilator care bundle, and implementation strategy. Ambiguities about data extraction were resolved after discussion and consulting a third reviewer (M.N., E.I.) when necessary. We quantitatively pooled the results of individual studies, where suitable. The primary outcome, reduction in ventilator-associated pneumonia per 1,000 ventilator days, was expressed as an incidence risk ratio with a 95% CI. All data for meta-analysis were pooled by using a DerSimonian and Laird random effect model.

Data Synthesis:
Eleven articles were included. The median ventilator-associated pneumonia incidence decreased from 9.8 (interquartile range, 5.8–18.5) per 1,000 ventilator days to 4.6 (interquartile range, 1.2–8.6) per 1,000 ventilator days after implementation of a ventilator care bundle. The meta-analysis showed that the implementation of a ventilator care bundle resulted in significantly reduced ventilator-associated pneumonia incidences (incidence risk ratio = 0.45; 95% CI, 0.33–0.60; p < 0.0001; I
2 = 55%).

Conclusions:
Implementation of a ventilator-associated pneumonia bundle has the potential to reduce the prevalence of ventilator-associated pneumonia in mechanically ventilated children.
Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study*
Authors: Sankar Jhuma , Dhochak Nitin , Kumar Kiran , Singh Man , Sankar M. Jeeva , Lodha Rakesh 
Published: January 2019

Objectives:
To evaluate the proportion of children fulfilling “Sepsis-3” definition and International Pediatric Sepsis Consensus Conference definition among children diagnosed to have septic shock and compare the mortality risk between the two groups.

Design:
Retrospective chart review.

Setting:
PICU of a tertiary care teaching hospital from 2014 to 2017.

Patients:
Children (≤ 17 yr old) with a diagnosis of septic shock at admission or during PICU stay.

Interventions:
None.

Measurements and Main Results:
We applied both International Pediatric Sepsis Consensus Conference and the new “Sepsis-3” definition (sepsis with hypotension requiring vasopressors and a lactate value of ≥ 2 mmol/L) to identify cases of septic shock by these definitions. Key outcomes such as mortality, proportion attaining shock reversal at 24 hours and organ dysfunction were compared between those fulfilling “Sepsis-3” definitions (“Sepsis-3” group) and those fulfilling “International Pediatric Sepsis Consensus Conference” definition (“International Pediatric Sepsis Consensus Conference” group). A total of 216 patients fulfilled International Pediatric Sepsis Consensus Conference definitions of septic shock. Of these, only 104 (48%; 95% CI, 42–55) fulfilled “Sepsis-3” definition. Children fulfilling “Sepsis-3 plus International Pediatric Sepsis Consensus Conference definitions” (“Sepsis-3 and International Pediatric Sepsis Consensus Conference” group) had lower proportion with shock resolution (61% vs 82%; relative risk, 0.73; 95% CI, 0.62–0.88) and higher risk of multiple organ dysfunction (85% vs 68%; 1.24; 1.07–1.45) at 24 hours. The mortality was 48.5% in “Sepsis-3 and International Pediatric Sepsis Consensus Conference” group as compared with 37.5% in the “International Pediatric Sepsis Consensus Conference only” group (relative risk, 1.3; 95% CI, 0.94–1.75).

Conclusions:
Less than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per “Sepsis-3” definitions. Lack of difference in the risk of mortality between children who fulfilled “Sepsis-3” definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children.
Modified Lung Ultrasound Examinations in Assessment and Monitoring of Positive End-Expiratory Pressure-Induced Lung Reaeration in Young Children With Congenital Heart Disease Under General Anesthesia*
Authors: Wu Lei , Hou Qiaoru , Bai Jie , Zhang Jianwei , Sun Liping , Tan Ruizhen , Zhang Mazhong , Zheng Jijian 
Published: January 2019

Objectives:
Lung ultrasound can reliably diagnose pulmonary atelectasis. The object of this study is to determine the most efficient region to assess changes in atelectasis in children with congenital heart disease under general anesthesia.

Design:
Randomized controlled trial.

Setting:
Operating room at university-affiliated children’s hospital.

Patients:
Children between 3 months and 3 years old, scheduled for elective congenital heart disease surgery under general anesthesia.

Interventions:
Forty children with congenital heart disease were randomly allocated to either a 5 cm H2O positive end-expiratory pressure group or a standard therapy control group.

Measurements and Main Results:
Preoperative lung ultrasound was performed twice in each patient—after 1 and 15 minutes of mechanical ventilation. Atelectatic areas and B-lines were compared between two examinations. Different ultrasound regions were evaluated using Bland-Altman plots. The occurrence rate of atelectasis was much higher in inferoposterior lung regions (Scans 4–6) than in anterior and lateral regions (Scans 1–3). The median (interquartile range) lung ultrasound scores were lower in the positive end-expiratory pressure group than in the control group after treatment: 8 (3.3–9.8) versus 13 (8.3–17.5; p < 0.001). The atelectatic area was significantly decreased after treatment in the positive end-expiratory pressure group: 128 mm2 (34.5.5–213.3 mm2) versus 49.5 mm2 (5.3–75.5 mm2; p < 0.001). Bland-Altman plots revealed concordance between measurements in Scans 1–6 and those in Scans 4–6. In the posterior axillary line regions, changes in atelectatic area were significantly larger in the positive end-expiratory pressure group than in the control group (p = 0.03, 0.007, and 0.018).

Conclusions:
Lung ultrasound in inferoposterior lung regions may be more likely to reflect changes in atelectasis and save examination time; 5 cm H2O positive end-expiratory pressure may be useful in lung reaeration and can reduce, but not eliminate, atelectasis in children with congenital heart disease.
Influence of Cardiopulmonary Resuscitation Coaching and Provider Role on Perception of Cardiopulmonary Resuscitation Quality During Simulated Pediatric Cardiac Arrest*
Authors: Cheng Adam , Kessler David , Lin Yiqun , Tofil Nancy M. , Hunt Elizabeth A. , Davidson Jennifer , Chatfield Jenny , Duff Jonathan P. 
Published: January 2019

Objectives:
We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest.

Design:
Prospective, observational study.

Setting:
We conducted secondary analysis of data collected from a multicenter, randomized trial of providers who participated in a simulated pediatric cardiac arrest.

Subjects:
Two-hundred pediatric acute care providers.

Interventions:
Participants were randomized to having a cardiopulmonary resuscitation coach versus no cardiopulmonary resuscitation coach. Cardiopulmonary resuscitation coaches provided feedback on cardiopulmonary resuscitation performance and helped to coordinate key tasks. All teams used cardiopulmonary resuscitation feedback technology.

Measurements and Main Results:
Cardiopulmonary resuscitation quality was collected by the defibrillator, and perceived cardiopulmonary resuscitation quality was collected by surveying participants after the scenario. We calculated the difference between perceived and measured quality of cardiopulmonary resuscitation and defined accurate perception as no more than 10% deviation from measured quality of cardiopulmonary resuscitation. Teams with a cardiopulmonary resuscitation coach were more likely to accurately estimate chest compressions depth in comparison to teams without a cardiopulmonary resuscitation coach (odds ratio, 2.97; 95% CI, 1.61–5.46; p < 0.001). There was no significant difference detected in accurate perception of chest compressions rate between groups (odds ratio, 1.33; 95% CI, 0.77–2.32; p = 0.32). Among teams with a cardiopulmonary resuscitation coach, the cardiopulmonary resuscitation coach had the best chest compressions depth perception (80%) compared with the rest of the team (team leader 40%, airway 55%, cardiopulmonary resuscitation provider 30%) (p = 0.003). No differences were found in perception of chest compressions rate between roles (p = 0.86).

Conclusions:
Healthcare providers improved their perception of cardiopulmonary resuscitation depth with a cardiopulmonary resuscitation coach present. The cardiopulmonary resuscitation coach had the best perception of chest compressions depth.
The Effect of Lumbosacral Orthosis on the Thickness of Deep Trunk Muscles Using Ultrasound Imaging
Authors: Azadinia Fatemeh , Ebrahimi Takamjani Ismail , Kamyab Mojtaba , Kalbassi Gitta , Sarrafzadeh Javad , Parnianpour Mohamad 
Published: January 2019

Objective
This study was conducted to evaluate the changes occurring in the thickness of deep trunk muscles, measured using ultrasound imaging, after 4 wks of lumbosacral orthosis use in conjunction with routine physical therapy.

Design
This parallel-group, randomized, controlled trial was conducted on 44 patients with nonspecific chronic low back pain, randomly allocated to the experimental and control groups. Both groups received eight sessions of physical therapy twice per week for 4 wks. The experimental group wore nonextensible lumbosacral orthosis, in addition to undergoing routine physical therapy. The thickness of the transversus abdominis, obliquus internus, and lumbar multifidus was measured by ultrasound before and after the 4-wk intervention.

Results
The deep trunk muscles differed in thickness in various test positions. Four weeks of intervention with lumbosacral orthosis and routine physical therapy, however, did not change the thickness of the obliquus internus, transversus abdominis, and lumbar multifidus.

Conclusions
Wearing lumbosacral orthosis for an average of 7.21 hrs/d for 4 wks in conjunction with routine physical therapy did not affect the thickness of obliquus internus, transversus abdominis, and lumbar multifidus.
Predictors of Work-Related Disability During Early Phases of Breast Cancer Treatment
Authors: Brick Rachelle , Skidmore Elizabeth , Terhorst Lauren , McCue Michael , Bender Catherine 
Published: January 2019

Objective
This study examined the magnitude of work-related disability in postmenopausal women with breast cancer compared with healthy controls. It also examined demographic and clinical correlates of work-related disability in postmenopausal women with breast cancer.

Study Design
This was an exploratory secondary analysis of longitudinal study.

Outcome Measure
The Work Limitations Questionnaire measured the percentage of at-work productivity loss.

Results
The analysis revealed a significant group-by-time interaction effect (F
1,40 = 4.705, P = 0.036, partial η2 = .105) on work-related disability. Participants with breast cancer (mean = 2.364, SE = 0.374) had significantly higher percentage of at-work productivity loss compared with the healthy control group (mean = 1.263, SE = 0.392). At baseline, cognitive-emotional symptoms were moderately to strongly associated with work-related disability. At 6 months, physical symptoms were moderately associated with work-related disability.

Conclusions
Women with newly diagnosed breast cancer are likely to experience higher rates of work-related disability compared with health counterparts. Health care providers should provide intervention to parallel the shift in symptoms that lead to higher work-related disability and job cessation.
Metabolic Syndrome and Neurocognitive Deficits in HIV Infection
Authors: Yu Beverly , Pasipanodya Elizabeth , Montoya Jessica L. , Moore Raeanne C. , Gianella Sara , McCutchan Allen , Ellis Ron , Heaton Robert K. , Jeste Dilip V. , Moore David J. , Marquine María J. 
Published: January 2019

Background:
The adverse consequences of HIV and related comorbidities on the central nervous system remain prevalent in the era of combination antiretroviral therapy. Metabolic syndrome (MetS) is a common comorbidity in HIV and has been linked to increased neurocognitive impairment in the general population. We investigated the association between MetS and neurocognition among persons living with HIV (PLHIV).

Methods:
Participants included 109 PLHIV and 92 HIV-uninfected adults (HIV−) from the Multi-dimensional Successful Aging cohort study at the University of California San Diego (age: M = 50.8, SD = 8.0). Participants completed neuromedical, psychiatric, and neurocognitive assessments. Based on a comprehensive neurocognitive battery, we examined global neurocognitive deficits (based on the entire battery) and neurocognitive deficits in 7 domains (verbal fluency, learning, recall, executive function, working memory, speed of information processing, and fine motor skills). MetS was determined via the standard criteria by the National Cholesterol Education Program's Adult Treatment Panel-III. Covariates examined included demographics and psychiatric comorbidities (and HIV disease characteristics among PLHIV).

Results:
MetS had an independent significant effect on global neurocognitive deficits among PLHIV (P = 0.03) but not among their HIV− counterparts (P = 0.93). Among PLHIV, MetS was most strongly associated with the neurocognitive domains of learning, fine motor skills, and executive function. Diabetes and elevated triglycerides were the MetS components most strongly linked with increased global neurocognitive deficits in PLHIV.

Conclusions:
The present findings underscore the need for early identification of PLHIV at risk for MetS and the implementation of preventive and treatment approaches to lessen the development of MetS and neurocognitive impairment among PLHIV.