bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Factors for Central Line–Associated Bloodstream Infections in Pediatric Cardiac Surgery Patients With Chylothorax
Authors: Waterhouse Stephanie G. , Vergales Jeffrey E. , Conaway Mark R. , Lee Laura 
Published: June 2018

Objectives:
To assess the prevalence of central line–associated bloodstream infections in pediatric patients with and without chylothorax after cardiac surgery and identify risk factors that predict those patients at highest risk for developing a central line–associated bloodstream infection.

Design:
Retrospective single-center cohort study.

Setting:
A PICU located within a tertiary-care academic pediatric hospital.

Patients:
All pediatric patients admitted to the PICU after cardiac surgery between 2008 and 2014.

Interventions:
None.

Measurements and Main Results:
We identified 1,191 pediatric cardiac surgery patients in the study time frame, of which 66 (5.5%) had chylothorax. Patients with chylothorax were more likely to have a central line–associated bloodstream infection (23% vs 3.8%; p < 0.001). Patients with both chylothorax and central line–associated bloodstream infection had longer durations of central venous catheter, higher Risk Adjustment Congenital Heart Surgery score, longer PICU stay, and higher mortality compared with patients with chylothorax who did not have a central line–associated bloodstream infection. Multivariable analysis identified higher Risk Adjustment Congenital Heart Surgery score, longer duration of central venous catheter, and higher chest tube output at 24 hours after initiating treatment for chylothorax to be predictive of increased central line–associated bloodstream infection risk in patients with chylothorax.

Conclusions:
The prevalence of central line–associated bloodstream infection is higher in pediatric patients with chylothorax after heart surgery. In patients with chylothorax, complexity of surgery, central venous catheter duration, and chest tube output are associated with increased risk for developing a central line–associated bloodstream infection. Using this knowledge will allow us to identify patients at increased risk for central line–associated bloodstream infections and to focus extra prevention efforts on them.
Pulmonary Functions in Children Ventilated for Acute Hypoxemic Respiratory Failure*
Authors: Chakdour Stanzen , Vaidya Pankaj C. , Angurana Suresh Kumar , Muralidharan Jayashree , Singh Meenu , Singhi Sunit C. 
Published: June 2018

Objective:
To assess pulmonary functions of children who received mechanical ventilation for acute hypoxemic respiratory failure.

Design:
Longitudinal study.

Setting:
PICU and Pediatric Pulmonology Clinic of a tertiary care teaching hospital in North India.

Patients:
All children, 5–12 years old, ventilated for acute hypoxemic respiratory failure in PICU from July 2012 to June 2013 and survived.

Interventions:
The baseline admission variables recorded were as follows: age, sex, duration of illness, primary diagnosis at admission, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices, and duration of PICU stay. The children were followed up twice, at 3 and 9–12 months, after discharge from PICU and evaluated for any residual respiratory symptoms and signs, pulse oximetry, chest radiograph, 6-minute walk test, peak expiratory flow rate, and spirometry. Age, sex, duration of illness, primary diagnosis, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices (Pao
2/Fio
2 ratio and oxygenation index), and duration of PICU stay were recorded from patient records.

Measurements and Main Results:
Twenty-nine children (25 boys and four girls; mean [sd] age, 8.4 [2.4] yr) were followed up at 3.5 (± 1.2) and 10.6 (± 2.7) months after discharge from PICU. Recurrent respiratory symptoms were noted in 37.9% patients (11/29) during first and in none during second follow-up. None had limitation of physical activity or need of supplemental oxygen. Chest examination was normal in all, except one during first follow-up, but 13.8% (4/29) had abnormal chest radiograph during first follow-up. Nearly all children could perform 6-minute walk test although mean distance walked increased significantly from first (352 ± 66.7 m) to second follow-up (401 ± 60.7 m; p = 0.002). Abnormal spirometry was seen in 82.7% (24/29) versus 18.5% (5/27) children during first and second follow-up visits, respectively (p = 0.0001). Most cases had restrictive abnormality (58.6% vs 11.1%; p = 0.002) during first and second follow-up, respectively. There was no correlation between pulmonary functions and lung injury scores, oxygenation indices (Pao
2/Fio
2 ratio and oxygenation index), and mechanical ventilation parameters.

Conclusions:
Significant number of children ventilated for acute hypoxemic respiratory failure had subclinical pulmonary function abnormality, without limiting physical activity, which improved over time. Further research on this topic with a larger sample size and patient categorization according to recent pediatric acute respiratory distress syndrome definition is needed.
Factors Associated With Mechanical Ventilation Use in Children With Sickle Cell Disease and Acute Chest Syndrome
Authors: Takahashi Takuto , Okubo Yusuke , Pereda Maria A. , Handa Atsuhiko , Miller Scott 
Published: June 2018

Objectives:Acute chest syndrome is the leading cause of death in children with sickle cell disease and is generally due to respiratory failure. Epidemiologic factors for a need for mechanical ventilation in children with acute chest syndrome require further clarification.Design:Retrospective observational study.Setting:Nationally representative pediatric inpatient records in the United States by using the Kids’ Inpatient Database for the years 2003, 2006, 2009, and 2012.Patients:Patients age less than 20 years old with a discharge diagnosis of acute chest syndrome.Measurements and Marin Results:Data were weighted to estimate annual hospitalizations according to hospital characteristics in the United States. Multivariable logistic regression was conducted to ascertain factors associated with use of mechanical ventilation, after adjusting for patient and hospital characteristics. Total hospitalizations for acute chest syndrome were 5,018 in 2003, 6,058 in 2006, 6,072 in 2009, and 6,360 in 2012. Mechanical ventilation use was associated with comorbidities of obesity (odds ratio, 3.35; 95% CI, 1.94–5.78), obstructive sleep apnea (odds ratio, 3.72; 95% CI, 2.23–6.20), and heart disease (odds ratio, 2.19; 95% CI, 1.47–3.27). In addition, nonblack compared with black children (odds ratio, 1.53; 95% CI, 1.02–2.31) and the fall season (p= 0.018) were associated with mechanical ventilation use.Conclusions:Comorbidity of obesity, obstructive sleep apnea, or heart disease could be potentially associated with mechanical ventilation use during an episode of acute chest syndrome. Prospective observational studies would be required to confirm these findings and infer potential interventions for preventing illness severity.
Changes in Therapist Actions During a Novel Pediatric Physical Therapy Program: Successes and Challenges
Authors: Akhbari Ziegler Schirin , Dirks Tineke , Reinders-Messelink Heleen A. , Meichtry André , Hadders-Algra Mijna 
Published: June 2018

Purpose:
To monitor changes in time spent on pediatric physical therapy actions during a COPing With and CAring for Infants With Special Needs (COPCA) course.

Methods:
Data were collected before (T0), during, and after (T3) the course, which was attended by 15 Swiss physical therapists. Four treatment sessions of each therapist were video recorded and analyzed with the Groningen Observation Protocol 2.0, allowing for quantification of relative duration of therapeutic actions.

Results:
Between T0 and T3, time spent on caregiver coaching and hands-off approaches significantly increased.

Conclusions:
The shift from caregiver trainer to family coach and the increasing hands-off techniques represent successful changes in various domains of behavior. The moderate changes in hands-off approaches suggest that changing habits requires specific attention. The COPCA course will be adapted accordingly.
Use of an In-Home Body Weight Support System by a Child With Spina Bifida
Authors: Kokkoni Elena , Logan Samuel W. , Stoner Tracy , Peffley Terri , Galloway James C. 
Published: June 2018

Purpose:
To examine the feasibility of a new open-area body weight support system (BWSS) to act as both an “assistive” and a “rehabilitative” device within the home.

Intervention:
A 5-year-old boy with spina bifida used the BWSS during self-selected activities for 10 weeks. Feasibility, behavioral, and clinical assessments provided a quantification of his activity in and out of the BWSS.

Outcomes:
On average, the child used the device on 2.7 days/week and for 67 minutes/day during intervention. When in the BWSS (assistive role), the child's locomotor activity and engagement in adapted sports activities increased. When not in the BWSS (rehabilitative role), the child's functional mobility and ambulatory ability increased.

What This Case Adds:
The use of the open-area in-home BWSS was feasible for regular home use and associated with an increase in functional mobility for a child with spina bifida.
Cost Analysis of 3 Concurrent Public Health Response Events: Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County
Authors: McCullough J. Mac , Fowle Nicole , Sylvester Tammy , Kretschmer Melissa , Ayala Aurimar , Popescu Saskia , Weiss Jolie , England Bob 
Published: June 2018

Objective:
To generate estimates of the direct costs of mounting simultaneous emergency preparedness and response activities to respond to 3 major public health events.

Design:
A cost analysis was performed from the perspective of the public health department using real-time activity diaries and retrospective time and activity self-reporting, wage and fringe benefit data, and financial records to track costs.

Setting:
Maricopa County Department of Public Health (MCDPH) in Arizona. The nation's third largest local public health jurisdiction, MCDPH is the only local health agency serving Maricopa's more than 4 000 000 residents. Responses analyzed included activities related to a measles outbreak with 2 confirmed cases, enhanced surveillance activities surrounding Super Bowl XLIX, and ongoing Ebola monitoring, all between January 22, 2015, and March 4, 2015.

Participants:
Time data were sought from all MCDPH staff who participated in activities related to any of the 3 relevant responses. In addition, time data were sought from partners at the state health department and a community hospital involved in response activities. Time estimates were received from 128 individuals (response rate 88%).

Main Outcome Measure:
Time and cost to MCDPH for each response and overall.

Results:
Total MCDPH costs for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, were $224 484 (>5800 hours). The majority was for personnel ($203 743) and the costliest response was measles ($122 626 in personnel costs). In addition, partners reported working more than 700 hours for these 3 responses during this period.

Conclusions:
Funding for public health departments remains limited, yet public health responses can be cost- and time-intensive. To effectively plan for future public health responses, it may be necessary to share experiences and financial lessons learned from similar public health responses. External partnerships represent a key contribution for responses such as those examined. It can be expensive for local public health departments to mount effective responses, especially when multiple responses occur simultaneously.
The Value of Real-Time Thoracic Radiology Consulting in an Integrated Lung Center Clinic
Authors: Mortani Barbosa Eduardo J. , Novak Sean 
Published: June 2018

Purpose:
We have established an integrated thoracic radiology reading room within a multidisciplinary lung center clinic (LC). While our subjective experience has been positive, we sought to quantify how this model affects radiology workflow and whether the referring practitioners perceive value in having real-time access to a radiologist consultant.

Materials and Methods:
Two diagnostic radiology workstations staffed by rotating thoracic radiologists and trainees were integrated within the LC. We assessed the impact on workflow by recording over 6 months the number, duration, and type of face-to-face radiology consultations to LC practitioners. We also conducted an anonymous survey to assess how LC practitioners felt with regard to the utility and value of our service.

Results:
Face-to-face consultations account for an average of 10% of total time spent by radiologists in the LC, although on busy clinical days this can reach 25% to 30%. Our survey response rate was very high (86.4%, n=51), with overwhelming positive response by referring practitioners, who unanimously rate the usefulness of this service as high (9.8%) or extremely high (90.2%). Not a single respondent had a negative or even neutral view of this service. Moreover, 90.2% thought that radiology consultations directly add clinical value in >60% of episodes, whereas 86.2% responded that these alter management in >40% of episodes.

Conclusions:
Face-to-face radiology consultations in an integrated LC are numerous and comprise a sizable share of radiologist workload. More importantly, the radiologist is highly praised as a consultant, and this service is considered valuable and impactful for patient care.
Survey of In Situ Splitting Rib Harvesting Surgery for Orbital Deformity: Follow-Up
Authors: Sun Xiao-Ming , Ye Ling-Xiao , Jin Rong , Cheng Li-Ying , Zhang Ying , Zhang Yu-Guang , Zhang Lu 
Published: June 2018

Background:
Our previous study indicated that in situ splitting rib harvesting surgery clinically reduced in related complications compared with the traditional surgical approach in the early stage, but there are few studies pay close attention to long-term recovery of donor area after rib harvesting. In this study, the authors conducted a follow-up study on recovery condition of donor and graft site of patients after in situ rib splitting grafting or simple whole rib grafting surgery.

Methods:
Between 2013 and 2016, 8 Chinese patients with orbital deformity were corrected using autogenous rib, of which 3 patients received conventional rib harvesting surgery, 3 patients received in situ splitting harvesting surgery, and 2 patients underwent both. In all patients, 3-dimensional computed tomography study of donor site and graft site were performed before and after operation. The ribs of donor site and graft site volume measurement were assessed using computed tomography 7 days and 12 months postoperation.

Results:
After 12 months operation, the integrity of rib arch recovered 94.1 ± 2.2% after in situ splitting rib harvesting, compared with 41.4 ± 5.0% after whole rib harvesting. The volume of grafted rib in situ splitting rib harvesting group reduced 69.8 ± 10.0% after 12 months operation compared with the volume after 1 week operation, and the reduced volume of ribs in whole rib harvesting group was 73.62 ± 9.5%.

Conclusion:
Rib regeneration occurred more quickly by in situ rib splitting harvesting approach compared with the traditional surgical approach.
The emerging role of digital health in monitoring and supporting people living with cancer and the consequences of its treatments
Authors: Harris Jenny , Cheevers Katy , Armes Jo 
Published: June 2018

Purpose of review
As rising numbers of people are living with the long-term impact of cancer, digital health is playing an increasingly important role in the monitoring and support of survivors and their caregivers. This article reviews current evidence, practice and developments, and identifies emerging issues and opportunities.

Recent findings
Digital health innovations, primarily using internet or smartphone-enabled applications, have been successfully developed, particularly in the areas of symptom management, decision-making, survivorship and follow-up care and palliative care. The research is characterized by much developmental activity, and evidence is accruing for efficacy and effectiveness. Opportunities afforded by digital health include timelier and patient-centred evidence-based care, offering improved clinical outcomes and independence. Barriers to implementation include lack of patient and professional engagement, perceived burden, depersonalization and missed care.

Summary
There is much enthusiasm for the role of digital health in monitoring and providing support to cancer survivors, but further research is needed to establish clinical efficacy and understand the mechanisms for successful implementation in practice. The role of wearables, the internet of things and big data analytics is yet to be fully explored in supportive cancer care and may present new opportunities to enhance care and survivor experience.
Predictors of Postdischarge Surgical Recovery Following Laparoscopic Sacrocolpopexy: A Prospective Cohort Study
Authors: Heit Michael , Carpenter Janet S. , Chen Chen X. , Stewart Ryan , Hamner Jennifer , Rand Kevin L. 
Published: June 2018

Objectives
Our aim was to identify sociodemographic/clinical, surgical, and psychosocial predictors of postdischarge surgical recovery after laparoscopic sacrocolpopexy.

Methods
Study participants (N = 171) with at least stage 2 pelvic organ prolapse completed a preoperative survey measuring hypothesized sociodemographic/clinical, surgical, and psychosocial recovery predictors followed by a postoperative survey at 4 time points (days 7, 14, 42, and 90) that included the Postdischarge Surgical Recovery 13 scale. One multivariate linear regression model was constructed for each time point to regress Postdischarge Surgical Recovery 13 scores on an a priori set of hypothesized predictors. All variables that had P < 0.1 were considered significant predictors of recovery because of the exploratory nature of this study and focus on model building rather than model testing.

Results
Predictors of recovery at 1 or more time points included the following: sociodemographic/clinical predictors: older age, higher body mass index, fewer comorbidities, and greater preoperative pain predicted greater recovery; surgical predictors: fewer perioperative complications and greater change in the leading edge of prolapse after surgery predicted greater recovery; psychosocial predictors: less endorsement of doctor's locus of control, greater endorsement of other's locus of control, and less sick role investment predicted greater recovery.

Conclusions
Identified sociodemographic/clinical, surgical, and psychosocial predictors should provide physicians with evidence-based guidance on recovery times for patients and family members. This knowledge is critical for informing future research to determine if these predictors are modifiable by changes to our narrative during the preoperative consultation visit. These efforts may reduce the postdischarge surgical recovery for patients with pelvic organ prolapse after laparoscopic sacrocolpopexy, accepting the unique demands on each individual's time.
Influence of Serotonin Transporter SLC6A4 Genotype on the Effect of Psychosocial Stress on Cognitive Performance: An Exploratory Pilot Study
Authors: Beversdorf David Q. , Carpenter Allen L. , Alexander Jessica K. , Jenkins Neil T. , Tilley Michael R. , White Catherine A. , Hillier Ashleigh J. , Smith Ryan M. , Gu Howard H. 
Published: June 2018

Background and Objective:
Previous research has shown an effect of various psychosocial stressors on unconstrained cognitive flexibility, such as searching through a large set of potential solutions in the lexical-semantic network during verbal problem-solving. Functional magnetic resonance imaging has shown that the presence of the short (S) allele (lacking a 43–base pair repeat) of the promoter region of the gene (SLC6A4) encoding the serotonin transporter (5-HTT) protein is associated with a greater amygdalar response to emotional stimuli and a greater response to stressors. Therefore, we hypothesized that the presence of the S-allele is associated with greater stress-associated impairment in performance on an unconstrained cognitive flexibility task, anagrams.

Methods:
In this exploratory pilot study, 28 healthy young adults were genotyped for long (L)-allele versus S-allele promoter region polymorphism of the 5-HTT gene, SLC6A4. Participants solved anagrams during the Trier Social Stress Test, which included public speaking and mental arithmetic stressors. We compared the participants’ cognitive response to stress across genotypes.

Results:
A Gene×Stress interaction effect was observed in this small sample. Comparisons revealed that participants with at least one S-allele performed worse during the Stress condition.

Conclusions:
Genetic susceptibility to stress conferred by SLC6A4 appeared to modulate unconstrained cognitive flexibility during psychosocial stress in this exploratory sample. If confirmed, this finding may have implications for conditions associated with increased stress response, including performance anxiety and cocaine withdrawal. Future work is needed both to confirm our findings with a larger sample and to explore the mechanisms of this proposed effect.
Growth adaptation ofgndandsdhCB Escherichia colideletion strains diverges from a similar initial perturbation of the transcriptome
Authors: McCloskey Douglas , Xu Sibei , Sandberg Troy E. , Brunk Elizabeth , Hefner Ying , Szubin Richard , Beeken Lydia , Feist Adam M. , Palsson Bernhard O. 
Published: June 2018

AbstractAdaptive laboratory evolution (ALE) has emerged as a new approach with which to pursue fundamental biological inquiries and, in particular, new insights into the systemic function of a gene product. TwoE. coliknockout strains were constructed: one that blocked the Pentose Phosphate Pathway (gnd KO) and one that decoupled the TCA cycle from electron transport (sdhCDABKO). Despite major perturbations in central metabolism, minimal growth rate changes were found in the two knockout strains. More surprisingly, many similarities were found in their initial transcriptomic states that could be traced to similarly perturbed metabolites despite the differences in the network location of the gene perturbations and concomitant rerouting of pathway fluxes around these perturbations. However, following ALE, distinct metabolomic and transcriptomic states were realized. These included divergent flux and gene expression profiles in thegndandsdhCDABKOs to overcome imbalances in NADPH production and nitrogen/sulfur assimilation, respectively, that were not obvious limitations of growth in the unevolved knockouts. Therefore, this work demonstrates that ALE provides a productive approach to reveal novel insights of gene function at a systems level that cannot be found by observing the fresh knockout alone.