bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emotional Responsiveness in Borderline Personality Disorder
Authors: Bortolla Roberta , Roder Emanuela , Ramella Pietro , Fossati Andrea , Maffei Cesare 
Published: February 2019

Abstract
The present study aims to test the hypothesis of biological hyperarousal and hyperreactivity underpinning the dysfunctional emotional processes of borderline personality disorder (BPD). Self-reported (quality and intensity of emotions) and physiological (respiratory sinus arrhythmia [RSA] and heart rate) data were collected in 14 clinical subjects with BPD and in 14 control subjects (healthy controls [HCs]), during the administration of six video clips with different emotional contents. Our findings showed a constant hyperarousal state (lower RSA) in the clinical group, supporting the hypothesis of a biological vulnerability to emotional dysregulation. BPD patients showed lower self-reported happiness in positive stimuli compared with HCs and a significant association between emotional dysregulation and physiological hyperreactivity to neutral stimuli. Our data support the hypothesis of a constant condition of physiological preparedness to threat and danger in BPD subjects. Moreover, our results highlight the influence of self-reported ability in regulating emotions in explaining BPD responses to specific emotional situations.
A Protocol to Assess Feasibility, Acceptability, and Usability of Mobile Technology for Symptom Management in Pediatric Transplant Patients
Authors: Vaughn Jacqueline , Summers-Goeckerman Erika , Shaw Ryan J. , Shah Nirmish 
Published: February 2019

Background
Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress, and the use of mobile health (mHealth) technologies may enhance symptom management by providing patient-generated health data to foster personalized health strategies.

Objectives
The aim of this study was to present a study protocol to explore feasibility, acceptability, and usability of integrating mHealth technologies to collect and monitor symptom data for PBMT patients.

Methods
An exploratory mixed-methods design is employed for 20 PBMT patients to monitor symptoms using real-time data from two mHealth devices: (a) a self-developed mHealth application and (b) a wearable tracking device. Patient-Reported Outcomes Measurement Information System surveys for fatigue, pain, and sleep disturbance are obtained monthly. Interviews are conducted to obtain further feasibility and usability data.

Results
The study began in October 2017; data collection should be completed in 2018. Feasibility and usability results to monitor and record symptom-related data daily via mobile devices will be reported. Patient-Reported Outcomes Measurement Information System surveys and interviews will further explore patients’ symptoms and experiences with the mobile devices.

Discussion
This study will be among the first to explore the feasibility, acceptability, and usability of integrating multiple mHealth technologies to obtain patient-generated symptom data for the PBMT population. Results will enhance our understanding of how these data present, interact, and cluster together throughout the posttransplant period for these children and lead to symptom management strategies. Results will focus on a high-risk population that potentially stands to benefit from the use of mobile technologies.
Prevalence, Macrolide Resistance, and Fluoroquinolone Resistance in Mycoplasma genitalium in Men Who Have Sex With Men Attending an Sexually Transmitted Disease Clinic in Dublin, Ireland in 2017–2018
Authors: Mulligan Vanessa , Lynagh Yvonne , Clarke Susan , Unemo Magnus , Crowley Brendan 
Published: February 2019

Abstract
This is the first prevalence study of Mycoplasma genitalium and antimicrobial resistance study in Ireland. In urine samples from men who have sex with men (n = 400) attending a sexually transmitted disease clinic in Dublin, the prevalence of M. genitalium was 3% (12 of 400 specimens; 95% confidence interval, 1.3–4.7%), and the prevalences of macrolide resistance (75%), fluoroquinolone resistance (33.3%), and multidrug resistance (33.3%) were very high.
Monitoring HIV Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Washington State: Findings From an Internet-Based Survey
Authors: Rao Darcy White , Carr Jason , Naismith Kelly , Hood Julia E. , Hughes James P. , Morris Martina , Goodreau Steven M. , Rosenberg Eli S. , Golden Matthew R. 
Published: February 2019

Background
Many state and local health departments now promote and support the use of HIV preexposure prophylaxis (PrEP), yet monitoring use of the intervention at the population level remains challenging.

Methods
We report the results of an online survey designed to measure PrEP use among men who have sex with men (MSM) in Washington State. Data on the proportion of men with indications for PrEP based on state guidelines and levels of awareness, interest, and use of PrEP are presented for 1080 cisgender male respondents who completed the survey between January 1 and February 28, 2017. We conducted bivariate and multivariable logistic regression to identify factors associated with current PrEP use. To examine patterns of discontinuation, we conducted Cox proportional hazards regression and fit a Kaplan-Meier curve to reported data on time on PrEP.

Results
Eighty percent of respondents had heard of PrEP, 19% reported current use, and 36% of men who had never used PrEP wanted to start taking it. Among MSM for whom state guidelines recommend PrEP, 31% were taking it. In multivariable analysis, current PrEP use was associated with older age, higher education, and meeting indications for PrEP use. Our data suggest that 20% of PrEP users discontinue within 12 months, and men with lower educational attainment were more likely to discontinue.

Conclusions
Despite high levels of use, there is significant unmet need for PrEP in Washington. Our experience indicates that Internet surveys are feasible and informative for monitoring PrEP use in MSM.
Extragenital Gonorrhea and Chlamydia Among Men and Women According to Type of Sexual Exposure
Authors: Bamberger David M. , Graham Georgia , Dennis Lesha , Gerkovich Mary M. 
Published: February 2019

Background
Current guidelines recommend screening for extragenital gonorrhea (GC) and chlamydia (CT) only among men having sex with men (MSM). Extragenital GC and CT is associated with treatment failure and disease transmission. The prevalence of extragenital GC/CT infections in women and in men having sex with women (MSW) are less well studied. We sought to determine the prevalence of extragenital CG and CT among all persons attending a sexually transmitted diseases clinic who engaged in extragenital sexual activity.

Methods
We examined demographic and clinical data of all patients who engaged in extragenital sexual activity between January 2012 and October 2014. Nucleic acid amplification testing for GC and CT was performed at sites of exposure among all men and women at pharyngeal, rectal, and urogenital sites. Multivariable logistic regression analyses were performed to determine the extent that age, race/ethnicity, and number of sexual partners predicted a positive test result.

Results
Pharyngeal GC was found in 3.1% of MSW, representing 35% of the GC infections in MSW. Thirty-six percent of MSW with pharyngeal GC tested negative at their urogenital site. Pharyngeal GC in MSW prevalence was higher among those with younger age or a higher number of sex partners. Pharyngeal GC, rectal GC, and rectal CT rates were 8.5%, 15.0%, and 16.5%, respectively, among MSM and 3.8%, 4.8%, and 11.8% among women having sex with men (WSM), respectively.

Conclusions
Extragenital GC and CT rates of infection was highest among MSM but was also observed in WSM and MSW, representing an unrecognized disease burden.
Human Immunodeficiency Virus Incidence Among Women at High-Risk of Human Immunodeficiency Virus Infection Attending a Dedicated Clinic in Kampala, Uganda: 2008–2017
Authors: Kasamba Ivan , Nash Stephen , Seeley Janet , Weiss Helen A. 
Published: February 2019

Background
High attrition and irregular testing for human immunodeficiency virus (HIV) in cohort studies for high-risk populations can bias incidence estimates. We compare incidence trends for high-risk women attending a dedicated HIV prevention and treatment clinic, using common methods for assigning when seroconversion occurs and whether seroconversion occurs among those with attrition.

Methods
Between April 2008 and May 2009, women were enrolled into cohort 1 and from January 2013 into cohort 2, then scheduled for follow-up once every 3 months. Incidence trends based on assuming a midpoint in the seroconversion interval were compared with those of assigning a random-point. We also compared estimates based on the random-point with and without multiple imputation (MI) of serostatuses for participants with attrition.

Results
By May 2017, 3084 HIV-negative women had been enrolled with 18,364 clinic visits. Before attrition, 27.6% (6990 of 25,354) were missed visits. By August 2017, 65.8% (426 of 647) of those enrolled in cohort 1 and 49.0% (1194 of 2437) in cohort 2 were defined with attrition. Among women with 1 or more follow-up visit, 93 of 605 in cohort 1 and 77 of 1601 in cohort 2 seroconverted. Periods with longer seroconversion intervals appeared to have noticeable differences in incidences when comparing the midpoint and random-point values. The MI for attrition is likely to have overestimated incidence after escalated attrition of participants. Based on random-point without MI for attrition, incidence at end of observation was 3.8/100 person-years in cohort 1 and 1.8/100 in cohort 2.

Conclusions
The random-point approach attenuated variation in incidence observed using midpoint. The high incidence after years of ongoing prevention efforts in this vulnerable population should be investigated to further reduce incidence.
Concurrent and Time-Lagged Effects of Social Disorganization on Chlamydia Rate Trajectories Among United States Counties and the District of Columbia, 2010–2015
Authors: Sheehan Diana M. , Gebrezgi Merhawi T. , Sanchez Mariana , Li Tan , Fennie Kristopher P. , Trepka Mary Jo 
Published: February 2019

Objective
To examine the longitudinal relationship between social disorganization (SD) and genital Chlamydia trachomatis infection.

Methods
US county-level data for 2010 to 2015 were used. Reliability and principal component analysis revealed 2 SD factors: socioeconomic deprivation and demographic instability. Growth curve models examined the degree to which SD factors affected chlamydia rates (number of new reported cases per 100,000 population) at baseline and over time adjusting for population percentage aged 15 to 24 years, male to female ratio for population aged 15 to 24 years, and rural percentage. Regression models explored 1- and 3-year time-lagged effects.

Results
Among 2961 counties, the average baseline chlamydia rate was 320.3 with an average increase of 7.7 cases per year. Higher baseline deprivation was associated with higher baseline chlamydia rates (P < 0.0001) but lower increases over time (P < 0.0001). Higher demographic instability was associated with lower baseline rates (P < 0.0001) but higher increases over time (P < 0.0001). Deprivation was associated with 1- and 3-year lagged rates (P < 0.0001).

Conclusions
On average, chlamydia rates increased across US counties, and more rapidly for counties with the highest demographic instability.
Outcomes of Children With Bronchiolitis Treated With High-Flow Nasal Cannula or Noninvasive Positive Pressure Ventilation*
Authors: Clayton Jason A. , McKee Bryan , Slain Katherine N. , Rotta Alexandre T. , Shein Steven L. 
Published: February 2019

Objectives:
Initial respiratory support with noninvasive positive pressure ventilation or high-flow nasal cannula may prevent the need for invasive mechanical ventilation in PICU patients with bronchiolitis. However, it is not clear whether the initial choice of respiratory support modality influences the need for subsequent invasive mechanical ventilation. The purpose of this study is to compare the rate of subsequent invasive mechanical ventilation after initial support with noninvasive positive pressure ventilation or high-flow nasal cannula in children with bronchiolitis.

Design:
Analysis of the Virtual Pediatric Systems database.

Setting:
Ninety-two participating PICUs.

Patients:
Children less than 2 years old admitted to a participating PICU between 2009 and 2015 with a diagnosis of bronchiolitis who were prescribed high-flow nasal cannula or noninvasive positive pressure ventilation as the initial respiratory treatment modality.

Interventions:
None. Subsequent receipt of invasive mechanical ventilation was the primary outcome.

Measurements and Main Results:
We identified 6,496 subjects with a median age 3.9 months (1.7–9.5 mo). Most (59.7%) were male, and 23.4% had an identified comorbidity. After initial support with noninvasive positive pressure ventilation or high-flow nasal cannula, 12.3% of patients subsequently received invasive mechanical ventilation. Invasive mechanical ventilation was more common in patients initially supported with noninvasive positive pressure ventilation compared with high-flow nasal cannula (20.1% vs 11.0%: p < 0.001). In a multivariate logistic regression model that adjusted for age, weight, race, viral etiology, presence of a comorbid diagnosis, and Pediatric Index of Mortality score, initial support with noninvasive positive pressure ventilation was associated with a higher odds of subsequent invasive mechanical ventilation compared with high-flow nasal cannula (odds ratio, 1.53; 95% CI, 1.24–1.88).

Conclusions:
In this large, multicenter database study of infants with acute bronchiolitis that received initial respiratory support with high-flow nasal cannula or noninvasive positive pressure ventilation, noninvasive positive pressure ventilation use was associated with higher rates of invasive mechanical ventilation, even after adjusting for demographics, comorbid condition, and severity of illness. A large, prospective, multicenter trial is needed to confirm these findings.
Monitoring Gas Exchange During Hypothermia for Hypoxic-Ischemic Encephalopathy
Authors: Afzal Bushra , Chandrasekharan Praveen , Tancredi Daniel J. , Russell James , Steinhorn Robin H. , Lakshminrusimha Satyan 
Published: February 2019

Objectives:
Therapeutic hypothermia is standard of care in management of moderate/severe hypoxic-ischemic encephalopathy. Persistent pulmonary hypertension of the newborn is associated with hypoxic-ischemic encephalopathy and is exacerbated by hypoxemia and hypercarbia. Gas exchange is assessed by arterial blood gas analysis (with/without correction for body temperature), pulse oximetry, and end-tidal Co
2.

Design:
A retrospective chart review.

Settings:
Regional perinatal center in Western New York.

Patients:
Fifty-eight ventilated neonates with indwelling arterial catheter on therapeutic hypothermia.

Intervention:
None.

Measurement and Main Results:
We compared pulse oximetry, Pao
2, end-tidal Co
2, and Paco
2 during hypothermia and normothermia in neonates with hypoxic-ischemic encephalopathy using 1,240 arterial blood gases with simultaneously documented pulse oximetry. During hypothermia, pulse oximetry 92–98% was associated with significantly lower temperature-corrected Pao
2 (51 mmHg; interquartile range, 43–51) compared with normothermia (71 mmHg; interquartile range, 61–85). Throughout the range of pulse oximetry values, geometric mean Pao
2 was about 23% (95% CI, 19–27%) lower during hypothermia compared with normothermia. In contrast, end-tidal Co
2 accurately assessed temperature-corrected Paco
2 during normothermia and hypothermia.

Conclusions:
Hypothermia shifts oxygen-hemoglobin dissociation curve to the left resulting in lower Pao
2 for pulse oximetry. Monitoring oxygenation with arterial blood gas uncorrected for body temperature and pulse oximetry may underestimate hypoxemia in hypoxic-ischemic encephalopathy infants during whole-body hypothermia, while end-tidal Co
2 reliably correlates with temperature-corrected Paco
2.
Evidence of Endotypes in Pediatric Acute Hypoxemic Respiratory Failure Caused by Sepsis*
Authors: Yehya Nadir , Thomas Neal J. , Wong Hector R. 
Published: February 2019

Objectives:
Subclassification based on clinical or biologic commonalities (endotypes) is one approach to reduce heterogeneity in acute hypoxemic respiratory failure. In adults, biomarker-defined endotypes of respiratory failure have been described, with differential outcome profiles and response to therapy. To date, no studies have tested whether endotypes exist in pediatric acute hypoxemic respiratory failure, although messenger RNA expression-based endotypes have been described in pediatric sepsis. The aim of the present study was to test whether endotypes identified in pediatric sepsis are applicable to pediatric acute hypoxemic respiratory failure.

Design:
Secondary analysis of a previously reported microarray-based study of pediatric sepsis.

Setting:
Multiple PICUs in the United States.

Patients:
Sixty-seven children with acute hypoxemic respiratory failure caused by sepsis.

Interventions:
None.

Measurements and Main Results:
Of the larger septic shock cohort, 67 met eligibility for acute hypoxemic respiratory failure. Twenty-three subjects were assigned to endotype A, and 44 to endotype B. Subjects assigned to endotype A had over four-fold greater unadjusted 28-day mortality, and nearly three-fold greater rates of complicated course. The association with mortality (odds ratio, 8.0; 95% CI, 1.6–41.0) and complicated course (odds ratio, 4.2; 95% CI, 1.2–14.9) persisted after adjustment for age, severity of illness, and Pao
2/Fio
2.

Conclusions:
Applying a previously reported endotyping strategy in children with septic shock identified endotypes of pediatric acute hypoxemic respiratory failure secondary to sepsis, with differential risk for poor outcomes. To our knowledge, this is the first demonstration of endotypes in pediatric respiratory failure. Our results support an investigation into using transcriptomics to identify messenger RNA-based endotypes in a dedicated, well-defined acute hypoxemic respiratory failure cohort.
Perceptions of Public Health 3.0: Concordance Between Public Health Agency Leaders and Employees
Authors: Balio Casey P. , Yeager Valerie A. , Beitsch Leslie M. 
Published: February 2019

Context and Background:
The newest era of public health, deemed “Public Health 3.0,” supports cross-sector collaborations to address social determinants of health. These activities often require collaborations with nontraditional public health entities. As this new era begins, it is important to understand perceptions of the public health workforce with regard to Public Health 3.0.

Objective:
To assess perceptions of support toward Public Health 3.0 activities by the public health workforce, identify characteristics associated with support, and measure concordance in support between agency directors and the general workforce.

Design:
This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey to understand support and concordance regarding Public Health 3.0 activities by a nationally representative sample of governmental public health employees. Logistic regression models are used to identify characteristics associated with support of each 3.0 activity and concordance.

Main Outcome Measures:
Governmental public health employees' opinions on how involved their agency should be in the K-12 education system, the economy, the built environment, transportation, housing, social connectedness, and health equity within their jurisdiction and concordance in support of involvement between agency directors and the general workforce.

Results:
Overall, individual perceptions supporting involvement were highest for health equity and social connectedness and lowest for transportation. Supervisory status, education, and being at a local health department were associated with greater odds of supporting all 3.0 activities. Concordance with agency directors was greatest among other executives relative to nonsupervisors.

Conclusions:
There is overall generally high support of many 3.0 activities, but there are gaps in agreement by supervisory status, gender, race/ethnicity, education, role type, and jurisdiction. Findings may help support agency leaders in better communicating the role of their agencies in Public Health 3.0 activities, and workforce education regarding such activities may be necessary for the success of Public Health 3.0's success.
The Financial and Business Analysis Capacities of the State and Local Public Health Workforce
Authors: McCullough J. Mac 
Published: February 2019

Objective:
To assess the financial competencies and skills of the state and local public health workforce.

Design:
Analysis of the 2017 wave of the Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate statistics and logistic regression models identified correlates and predictors of financial skills and skills gaps in the workforce.

Setting:
PH WINS was fielded to a nationally representative sample of all staff at all local health departments serving 25 000 or more persons and all state health agency staff.

Participants:
A total of 47 604 people responded to PH WINS in 2017 (overall response rate 48%).

Main Outcome Measures:
Financial competencies were measured in 3 areas: public health program and service delivery, public health agency funding, and public health agency business planning.

Results:
A moderate percentage of the state and local public health workforce (36.7%-40.6%) reported that financial skills were not applicable to their job. Skill levels tended to be modestly but significantly higher for the state health workforce than for the local health workforce. Correlates of financial proficiency and skills gaps varied for the 3 areas assessed and by state versus local setting. In general, administrators, managers and executives, older individuals, and persons working in decentralized or shared departments tended to have higher levels of financial skills proficiency. Persons working in clinical roles, supervisors, newer managers, and persons reporting higher levels of burnout were more likely to report a skills gap.

Conclusions:
There are areas of notable strengths in state and local public health workforce financial skills. Yet portions of the workforce that may have been subjected to newer financial training approaches did not consistently report higher financial skills. Findings suggest areas for further improvement in the financial competency of the state and local public health workforce.