bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Approach to Treating Adolescents with Opioid use Disorder in Pediatric Primary Care
Authors: Levy Sharon , Mountain-Ray Shannon , Reynolds Jason , Mendes Steven J. , Bromberg Jonas 
Published: March 2018

Background Medication treatment for opioid use disorder is effective, and recommended for adolescents, though very few adolescents with opioid use disorder ever receive medications. Reasons include lack of trained medication prescribers for this age group and difficulty in identifying adolescents with substance use disorders. This manuscript examines a novel implementation model of identifying and providing treatment for substance use disorders, including opioid use disorder, in a pediatric primary care practice. Methods Patients presenting to a selected primary care pediatrics practice for any reason between March 9, 2017 and July 24, 2017 that were identified by screening, self-report or other clinical information to have a substance use problem were referred to an integrated clinical social worker for treatment. We recorded the number of patients that were referred, number of visits completed and SUD and mental health diagnoses. Results In the first 4 months of this program, 683 patients aged 12–22 completed a health maintenance appointment; 20 were referred for substance use disorder treatment and 13 completed at least one substance use disorder treatment visit with the integrated clinical social worker. The mean number of visits completed was 5.3. Three patients with opioid use disorders were identified and 2 were induced on buprenorphine. Conclusions Our model for treatment of substance use disorders, including opioid use disorders, was feasible and acceptable in a pediatric primary care practice. Broadly implemented, such a model could substantially increase access to substance use disorder treatment for adolescents and young adults.
Breaking and making curriculum from inside ‘policy storms’ in an Australian pre‐service teacher education course
Authors: Lambert Karen , O'Connor Justen 
Published: March 2018

ABSTRACTHow teacher educators respond as policy actors from inside spaces where multiple policies and discourses collide provides insights into the ways in which policy plays out in educational contexts. By engaging and working within the uncertain space of our own contextual ‘policy storm’ we provide a narrative of enactment highlighting the roles and actions of policy actors simultaneously constrained and inspired by policy. We use the policy actor framework [Ball, S.J., Maguire, M., Braun, A., & Hoskins, K. (2011a). Policy actors: Doing policy work in schools, Discourse: Studies in the Cultural Politics of Education, 32(4), 625‐639] to unpack policy meaning‐making within university and faculty climates, teacher education, and curriculum reform in Health and Physical Education (HPE) in Australia. This paper has three tasks. Firstly, we set‐up the conditions of uncertainty and possibility as a ‘policy storm’ and place where four disparate policies converged. Secondly, we provide an empirical and theoretical account of policy interpretation and enactment from the actors perspective. Finally, we test the policy actor framework to determine if it adequately describes our insider policy work. In moving beyond reductionist policy narratives we provide policy possibilities that illustrate enactment, are innovative, and explore the productive potential inside policy reform.
Risk Factors for Orthostatic Hypotension: Differences Between Elderly Men and Women
Authors: Méndez Andrea S , Melgarejo Jesús D , Mena Luis J , Chávez Carlos A , González Alicex C , Boggia José , Terwilliger Joseph D , Lee Joseph H , Maestre Gladys E 
Published: March 2018

Abstract

BACKGROUND
Orthostatic hypotension (OH) occurs when mechanisms regulating blood pressure (BP) levels after standing-up are altered. It is unclear how prevalence and risk factors for OH are different between sexes. We aimed to investigate sex differences in prevalence and risk factors for OH elderly individuals.

METHODS
We included 882 participants from Maracaibo Aging Study. OH was a sustained reduction of ≥20 mm Hg in systolic BP, ≥10 mm Hg in diastolic BP, or both, after 3 minutes of changing positions from supine to standing. Multivariable logistic regression models were used to examine the relationships among risk factors for OH in men and women considering interaction sex-term and stratified by sex.

RESULTS
The mean age was 66.7 ± 8.5 years, being similar by sex. Women and men 55–74 years had similar prevalence of OH+ (18.5% vs. 20.9%, respectively). After 75 years, the proportion of women with OH+ was lower than men (11% vs. 30%, respectively). Hypertension, specifically systolic BP ≥140 mm Hg, and high pulse pressure (PP) were related with OH+ accounted by interaction sex-term, while diastolic BP ≥90 mm Hg, antihypertensive treatment, body mass index (BMI), diabetes mellitus and age were not. Systolic BP ≥140 mm Hg increases the risk of OH only among women, while BMI showed an inverse association in both sexes.

CONCLUSIONS
Although the prevalence of OH is similar in both sexes, there are different risk factors associated by sex. Systolic BP ≥140 mm Hg was associated with increased risk of OH only with women while BMI was a protective factor for OH in men and women.
A stroboscopic averaging algorithm for highly oscillatory delay problems
Authors: Sanz-Serna J M , Zhu Beibei 
Published: March 2018

Abstract
We propose and analyse a heterogeneous multiscale method for the efficient integration of constant-delay differential equations subject to fast periodic forcing. The stroboscopic averaging method suggested here may provide approximations with $\mathscr{O}\big (H^{2}+1/\varOmega ^{2}\big )$ errors with a computational effort that grows like $H^{-1}$ (the inverse of the step size), uniformly in the forcing frequency $\varOmega $.
Universal Gröbner Bases and Cartwright–Sturmfels Ideals
Authors: Conca A , De Negri E , Gorla E 
Published: March 2018

Abstract
The main theoretical contribution of the paper is the description of two classes of multigraded ideals named after Cartwright and Sturmfels and the study of their surprising properties. Among other things we prove that these classes of ideals have very special multigraded generic initial ideals and are closed under several operations including arbitrary multigraded hyperplane sections. As a main application we describe the universal Gröbner basis of the ideal of maximal minors and the ideal of 2-minors of a multigraded matrix of linear forms generalizing earlier results of various authors including Bernstein, Sturmfels, Zelevinsky, and Boocher.
Equality Cases in Viterbo’s Conjecture and Isoperimetric Billiard Inequalities
Authors: Balitskiy Alexey 
Published: March 2018

Abstract
We apply the billiard technique to deduce some results on Viterbo’s conjectured inequality between the volume of a convex body and its symplectic capacity. We show that the product of a permutohedron and a simplex (properly related to each other) delivers equality in Viterbo’s conjecture. Using this result as well as previously known equality cases, we prove some special cases of Viterbo’s conjecture and interpret them as isoperimetric-like inequalities for billiard trajectories.
Enteropathogen Detection in Children with Diarrhea and/or Vomiting: A Cohort Study Comparing Rectal Flocked Swabs and Stool Specimens
Authors: Freedman Stephen , Nettel-Aguirre Alberto , Xie Jianling , Lee Bonita , Chui Linda , Pang Xiao-Li , Zhuo Ran , Parsons Brendon , Dickinson James , Vanderkooi Otto G , Ali Samina , Osterreicher Lara , Lowerison Karen , Tarr Phillip ,   Alberta Pediatric EnTeric Infection TEam (APPETITE)
Published: March 2018

Abstract

Background
Diarrheal stool samples are currently preferred for enteropathogen detection, but they are inconvenient to collect if they are not immediately available, leading to suboptimal return rates and delayed or missed diagnostic opportunities. We sought to compare the enteropathogen yields of rectal swabs and stool specimens in an outpatient cohort of children with diarrhea and/or vomiting.

Methods
Eligible children were &lt; 18 years of age, with ≥3 episodes of vomiting or diarrhea in 24 hours and &lt;7 days of symptoms. After excluding those enrolled within the prior fortnight, unable to follow-up, having psychiatric illness, neutropenia, or requiring emergent care, we attempted to collect rectal swabs and stool from all participants. Specimens were subjected to testing with the Luminex xTAG Gastrointestinal Pathogen Panel, an in-house 5-virus panel and bacterial culture. Primary outcomes were comparative (submitted paired specimens only) and overall (all specimens, unsubmitted specimens analyzed as negative) yields. We used McNemar’s test to conduct pathogen-specific analyses, and generalized estimating equations to perform global (i.e., any) pathogen analyses with adjustments made for the presence of diarrhea, location, and their interactions with specimen type.

Results
Of the 1,519 subjects enrolled, 1,147 (75·5%) and 1,514 (99·7%) provided stool and swab specimens, respectively. The proportions of specimens positive for any pathogen were 75.9% (871/1,147) and 67.6% (1,024/1,514); P &lt; 0.0001. Comparative yield adjusted OR in stool relative to swabs were 1.24 (95% CI: 1.11, 1.38) and 1.76 (95% CI: 1.47, 2.11) in children with and without diarrhea at presentation, respectively. Overall concordance analysis yielded a kappa of 0.76 (95% CI: 0.71, 0.80). Paired positive viral specimens had lower median cycle threshold values (i.e., higher viral loads; P &lt; 0·0001) in SSs compared with swabs for all viruses. In overall yield analysis, the proportions positive for a pathogen were 57.3% and 67.4 for stool and rectal swabs, respectively; unadjusted OR: 0.65 (95% CI: 0.59, 0.72) for stool relative to swab.

Conclusion
Rectal swabs should be performed when enteropathogen identification, and/or rapid detection, is needed, molecular diagnostic technology available, and stool not immediately available.

Disclosures
All authors: No reported disclosures.
Predictive Clinical Rule for Readmissions in OPAT. Improving in Security
Authors: Bengoetxea Itsaso , Onaindia Miren J , Apezetxea Antonio , Gomez Montserrat , Goyeneche Muskilda , Fernandez Magdalena , Vazquez Begoña , Berroete Miriam , Olarreaga Itziar , Quintana Jose M , Aguirre Urko ,   HOSPITAL AT HOME BASQUE SOCIETY
Published: March 2018

Abstract

Background
Outpatient Parenteral Antibiotic Therapy (OPAT) is a safe, effective and beneficial practice but studies report 10–20% of readmissions rate. The risk factors for readmissions in OPAT have been investigated, although there are no clinical tools that allow us to predict these situations. The main goal of this study is to develop and validate a predictive model for readmission in OPAT patients.

Methods
Prospective study was conducted during 1 year (10/2012–09/2013), 1488 patients with OPAT were recruited at 8 units of Hospital at Home in Spain. Potential risk factors related to patient demographics, lead-time factors, clinical and microbiologic features were collected. We developed the prediction model in a derivation sample and after that, we validated this model in the validation sample. Sensitivity, specificity and area under the curve were obtained and the calibration capacity of the models were evaluated using the Hosmer-Lemeshow test (H-L).

Results
The mean age of patients was 63 years (range 11–102), 58.74% men and most common diagnoses were urinary tract infections (23%). Our readmission rate during OPAT episode at home was 8.67% and the 30-days readmissions were 12.29%. The 72% of the readmissions during OPAT episode was related to the infectious pathology and 27.90% to the the patient’s comorbidity.
The leading indicators for readmission were: gender, age, presence of caregivers, risk factor for infection, Charlsonand Barthel Index, microorganisme number, presence of multirresistent or micotic infection, venous access, antibiotic type and creatinine, proteine and leucocyte level at admissions. Finally, those factors included in the model were: antibiotic type (OR 3.93; IC 95% 1.90–8.11; P = 0.0002), presence of infection risk factor (OR 2.53; IC 95% 1.47–4.38; P = 0.001) and leucocytosis at admission (OR 2.21; IC 95% 1.32–3.71; P = 0.003). The AUC for the model was 0.72 (IC 95% 0.66–0.78) and the H-L value was 0.23. After the validation the AUC was 0.71 (IC 95% 0.64–0.78) and H-L value 0.9.

Conclusion
Patients at high risk of readmission during OPAT may be identified using predictive rules. This will allow us to implement measures that reduce the rate of readmissions and contribute to increase the safety of this therapy.

Disclosures
All authors: No reported disclosures.
High Genetic Variability of Norovirus Leads to Diagnostic Test Challenges
Authors: Pang Xiaoli , Zhuo Ran , Qiu Yuanyuan , Parsons Brendon , Lee Bonita , Chui Linda , Freedman Stephen ,   the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE)
Published: March 2018

Abstract

Background
It is important to understand the diagnostic accuracy of syndromic multiplex panels such as the Luminex xTAG® Gastrointestinal Pathogen Panel (GPP) as they are increasingly employed as routine diagnostic tests in laboratories worldwide. Recent evaluations in our laboratory identified lower detection rates of norovirus genogroup II (NoV GII) using the GPP as compared with our lab-developed RT-qPCR Gastroenteritis Virus Panel (GVP). This study is to characterize the NoV strains in samples with discordant NoV GII test results between GPP and GVP and determine the sensitivity of the two assays for specific NoV GII genotypes.

Methods
We genotyped all NoV GII strains with discordant test result in stool samples or rectal swabs collected prospectively from a cohort of children with acute gastroenteritis between December 2014 and July 2016. The sensitivity of GVP and GPP for NoV GII were compared by analyzing GVP threshold cycle (Ct) and using ten-fold serial dilutions of positive samples of various NoV GII genotypes.

Results
All discordant samples (11%; 63/607) tested positive for NoV GII by GVP but negative by GPP. Thirty-five percent (22/63) were successfully genotyped; 64% (14/22) of those were NoV GII genotype 2 (GII.2). The median Ct value of concordant positive was lower than those with discordant results (19.8 vs.. 33.7 respectively; P &lt; 0.0001). GVP was 10-fold and at least 10,000-fold more sensitive than GPP in detecting NoV GII.3 and GII.2, respectively, but has similar sensitivity for NoV GII.4. The GII.2 variants with discordant test results differed genetically from the concordant GII.2 variants.

Conclusion
GPP has suboptimal sensitivity to detect NoV GII.2 and its use may lead to an underestimation of NoV disease burden with some cases not being detected.

Disclosures
All authors: No reported disclosures.
Relationship Between Enteropathogen and Acute Gastroenteritis Disease Severity: A Prospective Cohort Study
Authors: Freedman Stephen , Xie Jianling , Nettel-Aguirre Alberto , Lee Bonita , Chui Linda , Pang Xiao-Li , Zhuo Ran , Parsons Brendon , Vanderkooi Otto G , Tarr Phillip , Ali Samina , Dickinson James A , Hagen Evan , Svenson Lawrence W , MacDonald Shannon E , Drews Steven J , Tellier Raymond , Graham Tim , Lavoie Martin , Macdonald Judy ,   Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE)
Published: March 2018

Abstract

Background
Little is known about the association between specific enteropathogens and disease severity in outpatient children with acute gastroenteritis. Recent advances in diagnostics enabling the rapid and simultaneous detection of common enteropathogens have become readily available. While such knowledge can be used to optimize therapy it also has the potential to predict disease severity. Such knowledge can aid clinical decision making, can clarify guidance and expectations provided to families, and can guide public health policy.

Methods
We conducted a prospective cohort study of children with acute gastroenteritis who were brought for emergency department care. The primary outcome measure was the 20-point Modified Vesikari Scale (MVS) score calculated from symptom onset until day14 of follow-up (total MVS score). Stool and/or rectal swab specimens were collected and analyzed for 18 unique pathogens by molecular diagnostic assays (in-house 5 virus panel, Luminex xTAG Gastrointestinal Pathogen Panel) and/or bacterial culture. An enteropathogen was deemed to be present if a candidate pathogen was identified in the rectal swab or stool specimens by any testing method. Binary logistic regression was performed to assess the association between pathogens (including all pathogens as present or not) and disease severity with the dependent variable being the total MVS score categorized as severe (11–20 points) vs.. non-severe (0–10 points).

Results
The mean total MVS score (SD) was 12.8 (3.2) and 73.0% (807/1102) of participants experienced severe disease. A pathogen was identified in 72.8% (802/1102) of study participants. Rotavirus, norovirus GII and adenovirus were identified in 26.6% (293/1102), 23.0% (253/1102) and 16.0% (176/1102) of participants respectively. After adjusting for other pathogens significant predictors of severe disease were: rotavirus (OR=8.0; 95% CI: 4.8, 13.2), Salmonella (OR=5.4; 95% CI: 1.2, 24.4), adenovirus (OR=2.1; 95% CI: 1.3, 3.3), and norovirus GII (OR=1.8; 95% CI: 1.3, 2.6). Clostridium difficile (OR=1.6; 95% CI: 0.96, 2.6) and Aeromonas (OR=0.97; 95% CI: 0.2, 4.7) were not significantly associated with severe disease.

Conclusion
In children with acute gastroenteritis, the enteropathogens associated with severe disease included rotavirus, Salmonella, adenovirus and norovirus GII.

Disclosures
All authors: No reported disclosures.
Mobilization of the Anterior Inferior Cerebellar Artery When Firmly Adherent to the Petrous Dura Mater—A Technical Nuance in Retromastoid Transmeatal Vestibular Schwannoma Surgery: 3-Dimensional Operative Video
Authors: Tatagiba Marcos S , Evangelista-Zamora Rocío , Lieber Stefan 
Published: March 2018

Abstract
The anterior inferior cerebellar artery (AICA) usually runs loosely within the cerebellopontine cistern; in rare cases, however, it is firmly adherent to the petrous dura mater.
1,2
Recognizing this variation is particularly important in vestibular schwannoma surgery via the retrosigmoid transmeatal approach to prevent the high morbidity associated with vascular injury. This video demonstrates a surgical technique to effectively mobilize the AICA when firmly adherent to the petrous dura mater. A 39-year-old man presented with a history of progressive right-sided hearing loss without facial weakness or other associated symptoms
3
. Magnetic resonance imaging (MRI) demonstrated an intracanalicular lesion, suggestive of vestibular schwannoma. During follow-up, audiometry confirmed a further slight deterioration of hearing and repeated MRI demonstrated tumor growth (T2 according to Hannover classification). Since the patient opted against radiosurgery, a retrosigmoid transmeatal approach under continuous intraoperative monitoring was performed in supine position. Following drainage of cerebrospinal fluid and exposure of the cerebellopontine cistern, the AICA was found to be firmly adherent to the petrous dura mater. Both structures were elevated conjointly and displaced medially for safe drilling of the inner auditory canal, sufficient exposure, and complete excision of the vestibular schwannoma. The patient had an excellent recovery, hearing and facial function were preserved, and no secondary neurological deficits noted.
The patient consented to publication of this anonymized video.
Endoscopic Resection of an Intraventricular Tumor With Second Window Indocyanine Green: 2-Dimensional Operative Video
Authors: Hitti Frederick L , Lee John Y K 
Published: March 2018

Abstract
A 26-year-old woman presented to our clinic with years of headaches and mental clouding. She had a nonfocal neurological examination including benign ophthalmological examination. Head computed tomography and brain magnetic resonance imaging (MRI) demonstrated asymmetry of the lateral ventricles due to a lesion arising from the foramen of Monro. At the top of our differential diagnosis were choroid plexus tumor and colloid cyst. We offered the patient treatment via an endoscopic approach. Here, we demonstrate the feasibility of using tumor-localizing dyes such as indocyanine green (ICG) in conjunction with endoscopes equipped with lasers to localize and treat intraventricular lesions. While ICG is FDA approved, the technique presented here is investigational and the dye is being used off-label. The laser-equipped endoscope is also being used off-label. To treat the ventricular asymmetry, we performed an endoscopic septostomy between the frontal horns of the lateral ventricles. For our tumor-localizing dye technique, we injected the patient with ICG 24 hours before the planned surgery. We were able to clearly visualize the lesion at the foramen of Monro as it was intensely fluorescent. The dye also appeared to localize to the presumably normal choroid plexus. We resected the lesion endoscopically and permanent pathology revealed that the lesion was a choroid plexus papilloma. The postoperative MRI showed improvement in her ventricular asymmetry and complete resection of the enhancing lesion at the foramen of Monro. The patient recovered well and was uneventfully discharged. She was seen in follow-up and has had improvement in her headaches.
Consent for surgery was obtained from the patient. Consent for publication of the operative video was also obtained from the patient.
Microvascular Decompression of Facial Nerve and Pexy of the Left Vertebral Artery for Left Hemifacial Spasm: 3-Dimensional Operative Video
Authors: Cheng Chun-Yu , Shetty Rakshith , Martinez Vicente , Sekhar Laligam N 
Published: March 2018

Abstract
A 73-yr-old man presented with intractable left hemifacial spasm of 4 yr duration. Brain magnetic resonance imaging showed significant compression of left facial nerve by the left vertebral artery (VA) and anterior inferior cerebellar artery (AICA).
The patient underwent a left retrosigmoid craniotomy and a microvascular decompression of the cranial nerve (CN) VII. Intraoperatively, we found that the distal AICA had a protracted subarcuate extradural course.
1
This was relieved by intra/extradural dissection. The left VA and the AICA loop were compressing the root exit zone of CN VII. The VA was mobilized, and pexy into the petrosal dura was done with 8-0 nylon sutures (Ethilon Nylon Suture, Ethicon Inc, a subsidiary of Johnson & Johnson, Somerville, New Jersey). Once this was done, the lateral spread disappeared.
2
The AICA loop was decompressed with 2 pieces of Teflon felt (Bard PTFE felt, Bard peripheral Vascular Inc, a subsidiary of CR Bard Inc, Temp, Arizona). After this, wave V of the brainstem auditory evoked potential (BAEP) disappeared completely, with no recovery despite the application of the nicardipine on the internal auditory artery (IAA). The IAA appeared to be stretched by the microvascular decompression. Arachnoidal dissection was done to release the CN VIII and an additional felt piece was placed to elevate the AICA loop; the BAEP recovered completely. The patient had a complete disappearance of the hemifacial spasm postoperatively, and hearing was unchanged.
This 3-D video shows the technical nuances of performing a vertebropexy, release of the AICA from its extradural subarcuate course, and the surgical maneuvers in the event of an unexpected change in neuromonitoring response. The suture technique of vertebropexy is preferred to a loop technique, to avoid kinking of the VA.
3

Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.