bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term Association Between Meteorological Factors and Childhood Pneumonia Hospitalization in Hong Kong
Authors: Lam Holly Ching Yu , Chan Emily Ying Yang , Goggins William Bernard 
Published: June 2019

Background:
Pneumonia is a common cause of childhood hospitalization. Both host and pathogen factors are associated with environmental conditions, but the associations between childhood pneumonia and meteorological variables are unclear. This study investigated the short-term associations between childhood pneumonia admissions and meteorological variables.

Methods:
A retrospective time-series analysis was conducted using distributed lagged nonlinear models. Daily pneumonia admissions among children <15-year-old in Hong Kong during 2004–2011 were regressed on daily meteorological variables with air pollutants, influenza admissions, seasonal trend, and long-term trend adjusted. Analyses were stratified by age group.

Results:
There were 34,303 admissions during 2004–2011. Temperature had a u-shaped association with childhood pneumonia admissions with minimum morbidity temperature at 25°C and with a long lagged effect up to 45 days. The cumulative relative risk (cum RR [95% confidence interval]) (vs. 25°C; lag 0–45 days) at 30°C was 1.41 (1.11, 1.79) and was 1.58 (1.21, 2.06) at 12°C. Relative humidity (RH) showed a u-shaped association with minimum risk at 65% and lagged effect up to 45 days. The cum RR (vs. 65%; lag 0–45 days) at 53% was 1.26 (1.04, 1.54) and was 2.22 (1.78, 2.77) at 94%. Children 5- to 14-year-olds were highly sensitive to temperature and RH while admissions among children <5-year-old were only associated with high RH.

Conclusions:
Childhood pneumonia admissions were very strongly associated with both high and low temperature and RH for children 5–14-year-olds. Efforts to reduce exposure of children to extreme temperatures and RH may have the potential to reduce the burden of pediatric pneumonia.
Interaction of Air Pollutants and Meteorological Factors on Birth Weight in Shenzhen, China
Authors: Wang Qiong , Liang Qianhong , Li Changchang , Ren Meng , Lin Shao , Knibbs Luke D. , Zhang Huanhuan , Gong Wei , Bao Junzhe , Wang Suhan , Wang Xuemei , Zhao Qingguo , Huang Cunrui 
Published: June 2019

Background:
This study aimed to assess if air pollutants and meteorological factors synergistically affect birth outcomes in Shenzhen, China.

Methods:
A total of 1,206,158 singleton live births between 2005 and 2012 were identified from a birth registry database. Daily average measurements of particulate matter ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ambient air temperature (T), and dew point temperature (Td), a marker of humidity, were collected. Multivariable logistic regression models were used to evaluate associations between air pollution and small for gestational age (SGA), and full-term low birth weight (TLBW). We classified births into those conceived in the warm (May–October) and cold seasons (November–April) and then estimated interactions between air pollutants and meteorological factors.

Results:
An interquartile range (IQR) increase in PM10 exposure during the first trimester (23.1 µg/m3) and NO2 during both the first and second trimesters (15.1 and 13.4 µg/m3) was associated with SGA and TLBW risk; odds ratios ranged from 1.01 (95% confidence interval [CI] = 1.00, 1.02) to 1.09 (1.07, 1.12). We observed interactive effects of both air temperature and humidity on PM10 and SGA for newborns conceived in the warm season. Each IQR increase in PM10 (11.1 µg/m3) increased SGA risk by 90% (95% CI = 19%, 205%), 29% (23, 34%), 61% (10, 38%), and 26% (21, 32%) when T < 5th percentile, 5th < T < 95th percentile, Td < 5th percentile, and 5th < Td < 95th percentile, respectively.

Conclusions:
Our study found evidence of an interactive effect of air temperature and humidity on the relationship between PM10 exposure and SGA among newborns conceived in the warm season (May–October). Relatively low air temperature or humidity exacerbated the effects of PM10.
Exposure Duration and History of Hypertension Predicted Neurological Sequelae in Patients with Carbon Monoxide Poisoning
Authors: Huang Chien-Cheng , Lee Jui-Chi , Lin Kao-Chang , Lin Hung-Jung , Su Shih-Bin , Hsu Chien-Chin , Guo How-Ran 
Published: June 2019

Background:
Carbon monoxide poisoning (COP) accounts for a large number of emergency department visits worldwide and is fatal in many cases. In surviving patients, neurological sequelae (NS) attributable to cerebral hypoxia are the most devastating outcome, but reliable predictors are limited. Therefore, we conducted a study to identify predictors of NS in patients with COP and evaluate their effects.

Methods:
In this retrospective case–control study, we identified patients with COP in a medical center in Southern Taiwan between January 2005 and December 2014. Cases were patients with NS, and controls were patients without NS. We obtained information on potential predictors of NS from medical records and evaluated their association with NS, including demographic characteristics, exposure source, suicide attempts, duration of exposure (by tertile), histories, symptoms, signs, laboratory data, treatment, and the length of hospital stay.

Results:
We included 371 patients with COP. Of them, 93 developed NS, and their mean ages (41.4 ± 14.7 years vs. 39.7 ± 14.2 years) and proportions of males (59.1% vs. 58.6%) were similar to those in the 298 controls. Multivariate logistic regression showed that a history of hypertension (adjusted odds ratio = 2.1; 95% confidence interval = 1.0, 4.5) and a longer duration of carbon monoxide exposure (adjusted odds ratio = 1.7; 95% confidence interval = 1.1, 2.8; the longest tertile [>5 hours] vs. the other two tertiles [≤5 hours]) were independent predictors for NS, but not the level of carboxyhemoglobin.

Conclusions:
This study identified two independent predictors for NS that may be useful for public healthcare workers and physicians in predicting outcomes and deciding on treatment strategies for COP patients.
Association Between Ambient Air Pollution Exposure and Spontaneous Pneumothorax Occurrence
Authors: Han Changwoo , Lim Youn-Hee , Jung Kweon , Hong Yun-Chul 
Published: June 2019

Background:
Spontaneous pneumothorax is hypothesized to be associated with air pollution exposure based on pathophysiological mechanisms involving airway inflammation. Therefore, we analyzed the association between daily concentrations of air pollutants [sulfur dioxide, nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), particulate matter (PM) less than 2.5 μm in diameter (PM2.5), PM less than 10 μm in diameter (PM10), and coarse PM (PM10-2.5)] and the number of spontaneous pneumothorax-related hospital visits.

Methods:
We analyzed a subset of data from the National Health Insurance Service-National Sample Cohort, a nationally representative dynamic cohort based on health insurance claims data in Korea. Using time series analysis with the Poisson generalized additive model, we evaluated hospital visit data of over 100,000 male cohort members residing in Seoul from 2007 to 2010.

Results:
We identified 516 hospital visits due to spontaneous pneumothorax. In a single-pollutant model, an interquartile range increase of PM and CO exposure at lag day 1 was associated with spontaneous pneumothorax hospital visits (relative risk, 95% confidence interval: PM2.5: 1.10 (1.01, 1.21); PM10: 1.09 (1.01, 1.18); PM10-2.5: 1.06 (1.00, 1.12); CO: 1.11 (1.01, 1.23)). For lag day 2, NO2 and PM exposure was associated with pneumothorax hospital visits (NO2: 1.15 (1.01, 1.32); PM10: 1.10 (1.02, 1.18); PM10-2.5: 1.07 (1.02, 1.13)). In a multipollutant model, the association was consistent for PM.

Conclusion:
The number of hospital visits due to spontaneous pneumothorax increased with air pollution exposure, especially with PM. Our finding suggests that air pollution is a possible predisposing factor for spontaneous pneumothorax.
Assessing the relationship of the human resource, finance, and information technology functions on reported performance in hospitals using the Lean management system
Authors: Shortell Stephen M. , Rundall Thomas G. , Blodgett Janet C. 
Published: June 2019

Background
Given pressures to control costs and improve quality of care, one of the most prevalent transformational performance improvement approaches in health care is Lean management. However, the roles of support functions such as human resource (HR), finance, and information technology (IT) in Lean management and the relationships of these support functions with performance are unknown.

Purpose
The aim of this study was to examine the relationships between the HR, finance, and IT functions, overall Lean implementation, and self-reported performance improvement in hospitals that have implemented Lean.

Methodology/Approach
Data from a national survey of Lean in U.S. hospitals (N = 1,222; 847 reported using Lean) were analyzed using multivariable regression and bootstrapped mediation analysis. The extent to which HR, finance, and IT functions support Lean management was measured using indices including six, three, and six items respectively. Lean implementation was measured by the number of units doing Lean (up to 29) and by a four-level self-reported maturity scale. Performance improvement was measured using an index of self-reported achievements (ranging from 0 to 16).

Results
There were significant positive associations between Lean HR, finance, and IT functions and self-reported performance impact (controlling for organizational and market variables). Tests of mediation indicated that the associations of HR, finance, and IT functions with self-reported performance were significantly mediated by the number of Lean units (mediated proportion ranging from 40% to 73%), and HR function was also mediated by self-reported maturity (61% mediated). There were no moderating effects.

Conclusion
HR, finance, and IT functions are positively associated with self-reported Lean impact on performance and primarily explained by the overall degree of Lean implementation.

Practice Implications
Efforts to align HR, finance, and IT functions with overall Lean implementation can help to ensure that frontline caregivers and managers have the data and skills required to meet transformational improvement goals.
Clinical features of liver cirrhosis patients with muscle cramping: a multicenter study
Authors: Hiraoka Atsushi , Yoshiji Hitoshi , Iwasa Motoh , Nakanishi Hiroyuki , Karino Yoshiyasu , Nakajima Tomoaki , Miyaaki Hisamitsu , Shiraki Makoto , Kawaguchi Takumi , Sawada Yasuhiko , Michitaka Kojiro , Okita Kiwamu 
Published: June 2019

Background
There has been a small number of reports mention the clinical features including quality of life (QOL) in liver cirrhosis (LC) patients with muscle cramping and therapeutic efficacy for muscle cramping. We evaluated clinical features of muscle cramping and treatments in such patients.

Patients and methods
Two-hundred and eighty-nine LC outpatients (70.6 ± 10.5 years old; male: female = 149: 140) were questioned regarding the presence or absence of muscle cramps within the last 3 months, including frequency, severity of related pain using a visual analogue scale, cramp locations, time of day, duration, sleep disturbance, daily activity decline, and being conscious of QOL decline. At the next hospital-visit, 3 or 4 months later, the subjects, who treated with medical intervention, received the same questionnaire.

Results
Patients with muscle cramps (n = 160) included a higher percentage of females (53.8 vs. 41.9%, P = 0.045), worse Child–Pugh score (5: 6: 7: 8: 9: 10 = 91: 36: 15: 10: 4: 4 vs. 85: 25: 12: 5: 0: 2, P = 0.043) and lower platelet count (10.2 ± 4.7 vs. 11.8 ± 5.0 × 104/µl, P = 0.006) as compared to those without cramps (n = 129). Of the 160 with cramping, 82 (51.3%), received treatment with several types of medication, with l-carnitine the most administered drug (n = 66: 80.5%), and those also showed a tendency to complain about muscle cramps at night, sleep disturbance, reduced daily activity, and being conscious of QOL decline (each P < 0.01). We observed that frequency, visual analogue scale, sleep disturbance, daily activity, duration of muscle cramping, and being conscious of QOL decline were improved after the intervention (each P < 0.001, respectively).

Conclusion
Intervention for muscle cramping improves total QOL in LC patients with such symptom.
Gluteal Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Mendes José , Mendes Maykeh Vinicius A. , Frascino Luiz Fernando , Zacchi Flavia F. S. 
Published: June 2019

Summary:
The association of anaplastic large cell lymphoma (ALCL) to breast implants (breast implant-associated ALCL) has brought back the discussion on the clinical safety of the use of silicone implants. A 63-year-old woman came to our institution in early 2015, reporting a gluteal augmentation with silicone implants in 2006 and a recent increasing volume and distortion of the left buttock. Radiologic imaging showed a large amount of fluid collection around the implant. The left side implant was removed and the capsule was left intact, presupposing a future reimplantation. The fluid collected was positive for Staphylococcus aureus. Three years later, she presented again with a new seroma on the explanted side and was submitted to total capsulectomy and fluid drainage, and the material was submitted to laboratory examination. Culture results were negative. Pathologic preparation and sections of the capsule and lumps showed large cells characterized by horseshoe-shaped nuclei. Immunohistochemistry was positive for CD30/CD4 and negative for anaplastic lymphoma kinase, confirming the presence of ALCL, then associated with gluteal implant, an event not described in literature. Positron emission tomography/computed tomography and bone marrow biopsy were performed, and neither showed any other sites involved. The same disease in a new location introduces important discussions about the understanding of this abnormality and poses certain risks and safety issues to clinical scenarios to be discussed. Regardless of whether it is a breast implant-associated ALCL or a gluteal implant-associated ALCL, now we are probably facing an implant augmentation–associated disease and a new international alert should be addressed to the scientific community.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review
Authors: Bennett Katelyn G. , Vick Alexis D. , Ettinger Russell E. , Archer Steven M. , Vercler Christian J. , Buchman Steven R. 
Published: June 2019

Background:
Ocular abnormalities in craniosynostosis are a persistent concern for patients and providers, and some surgeons feel that early surgical intervention for synostosis alleviates the progression of ophthalmologic abnormalities. In contradistinction, the authors hypothesize that operating early will have no bearing on postoperative ophthalmologic outcomes.

Methods:
Single-suture craniosynostosis patients who underwent surgical correction between 1989 and 2015 were reviewed. Patients with multisuture craniosynostosis, syndromic diagnoses, no preoperative ophthalmology evaluation, and less than 2 years of follow-up were excluded. Logistic regression was used to determine odds of preoperative and postoperative ophthalmologic abnormalities by age, while controlling for patient-level covariates.

Results:
One hundred seventy-two patients met inclusion criteria. The median age at surgery was 10 months (interquartile range, 7 to 12.9 months). Increasing age at the time of surgery was associated with increased odds of preoperative ophthalmologic diagnoses (OR, 1.06; p = 0.037) but not postoperative diagnoses (OR, 1.00; p = 0.91). Increasing age at surgery was also not associated with increased odds of ophthalmologic diagnoses, regardless of timing (OR, 1.04; p = 0.08). Patients with coronal synostosis (OR, 3.94; p = 0.036) had significantly higher odds of preoperative ophthalmologic diagnoses. Patients with metopic (OR, 5.60; p < 0.001) and coronal (OR, 7.13; p < 0.001) synostosis had significantly higher odds of postoperative ophthalmologic diagnoses.

Conclusions:
After reviewing an expansive cohort, associations of both overall and postoperative ophthalmologic diagnoses with age at surgery were not found. The authors’ findings thus run counter to the theory that early surgical intervention lessens the likelihood of postoperative ophthalmologic diagnoses and improves ophthalmologic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
A Prospective Evaluation of Complications after Use of Exposed Pins in the Hand and Wrist
Authors: Lutsky Kevin F. , Edelman David , Leinberry Charles , Takei T. Robert , Kwok Moody , Gallant Greg , Beredjiklian Pedro 
Published: June 2019

Background:
Kirschner wires are commonly used during hand surgical procedures. These pins are often left exposed (protruding from the skin) for ease of removal. Complications such as loosening, migration, or infection are not uncommon (ranging from 7 to 18 percent in current retrospective studies) and can compromise surgical outcome. This study evaluated the frequency of Kirschner wire–related complications.

Methods:
All patients who had Kirschner wires placed as part of their surgical procedure in the hand or wrist by one of 12 attending hand surgeons over a 6-month period were enrolled prospectively. Complications were recorded by the attending surgeon at follow-up visits. Demographics and patient comorbidities including diabetes mellitus and smoking history were recorded.

Results:
There were 141 patients enrolled and 230 pins used, including 65 women and 76 men. The mean age was 40.7 years. Thirteen patients were smokers, and eight had a history of diabetes. There were 35 soft-tissue procedures and 106 fractures. There were 35 complications (25 percent). There was a 12 percent rate of infection (n = 17), including two cases of osteomyelitis. There were 18 other complications, nine of which were major complications (6.4 percent). Smoking, age, and location (hand/fingers versus wrist) were significantly associated with infection.

Conclusions:
In this study, one in four patients treated with Kirschner wires developed a minor or major complication, a rate that is substantially higher than reported in existing retrospective studies. Although Kirschner wires are often needed during hand surgery, surgeons should be aware that adverse events are frequent. Patients and surgeons should be vigilant in the perioperative period.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Modified Sliding Alar Cartilage Flap: A Novel Way to Preserve the Internal Nasal Valve as Illustrated by Three-Dimensional Modeling
Authors: Racy Emmanuel , Fanous Amanda , Pressat-Laffouilhere Thibaut , Benmoussa Nadia 
Published: June 2019

Background:
Preservation of the scroll area is essential when performing rhinoplasty to achieve a good functional outcome. This is of particular concern with tip-plasty procedures. The objectives of this study were (1) to describe a novel tip-plasty procedure consisting of sliding the cephalic portion of the alar cartilage beneath its caudal portion to preserve the scroll area and (2) to present the authors’ prospective case series, which includes Nasal Obstruction Symptom Evaluation and peak nasal inspiratory flow scores to objectively evaluate functional outcomes.

Methods:
The modified sliding alar cartilage surgical technique is described and illustrated by intraoperative photographs and videos and by three-dimensional modeling software. A prospective study of all patients undergoing tip-plasty with alar reduction by the sliding alar cartilage technique was performed from September of 2016 to December of 2017. Peak nasal inspiratory flow and Nasal Obstruction Symptom Evaluation scores were collected preoperatively and at 1 week and 6 months postoperatively.

Results:
Twenty-five patients were included in the study. Aesthetic outcomes were good, with no major complications. The average preoperative peak nasal inspiratory flow score was 114 liters/minute (95 percent CI, 108.1321 to 119.8679 liters/minute), whereas the average score at 6 months postoperatively was 115.82 liters/minute (95 percent CI, 106.6241 to 125.0159 liters/minute; p = 0.513). The average preoperative Nasal Obstruction Symptom Evaluation score was 17.2 (95 percent CI, 15.99655 to 18.40345), whereas the average score at 6 months postoperatively was 15.2 (95 percent CI, 13.18131 to 17.21869; p = 0.08353), indicating no significant change.

Conclusion:
The sliding alar cartilage is a simple technique allowing tip definition while maintaining nasal airway function by preserving the crucial anatomical scroll area.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Grief: A Brief History of Research on How Body, Mind, and Brain Adapt
Authors: O’Connor Mary-Frances 
Published: June 2019

ABSTRACT

Objective
Using an integrative view of psychology, neuroscience, immunology, and psychophysiology, the present review of literature curates the findings that have had an impact on the field of bereavement research and shaped its development.

Methods
Beginning with pivotal systematic descriptions of medical and psychological responses to the death of a loved one by Lindemann in the mid-1940s, this selective review integrates findings in bereavement research from studies that investigate medical outcomes after loss, their psychological predictors, and biopsychosocial mechanisms.

Results
Morbidity and mortality after the death of a loved one have long been a topic of research. Early researchers characterized somatic and psychological symptoms and studied immune cell changes in bereaved samples. More recent research has repeatedly demonstrated increased rates of morbidity and mortality in bereaved samples, as compared with married controls, in large epidemiological studies. Recent developments also include the development of criteria for prolonged grief disorder (also termed complicated grief). Newer methods, including neuroimaging, have observed that the greatest impact of the death of a loved one is in those who have the most severe psychological grief reactions. Research addressing the mechanisms tying bereavement to medical outcomes is relatively scarce, but differences in rumination, in inflammation, and in cortisol dysregulation between those who adapt well and those who do not have been offered with some evidence.

Conclusions
Recommendations to propel the field forward include longitudinal studies to understand differences between acute reactions and later adaptation, comparing samples with grief disorders from those with more typical responses, and integrating responses in brain, mind, and body.