bluuebunny/crossref_metadata_2025_split huggingface dataset:
Per-Pass Performance Characteristics of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Malignant Solid Pancreatic Masses in a Large Multicenter Cohort
Authors: Ge Phillip S. , Wani Sachin , Watson Rabindra R. , Sedarat Alireza , Kim Stephen , Marshall Carrie , Wilson Robert H. , Makker Jitin , Mohamadnejad Mehdi , Komanduri Srinadh , Muthusamy V. Raman 
Published: February 2018

Objectives
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely performed for the evaluation of pancreatic masses. We evaluated the performance characteristics of EUS-FNA in obtaining a diagnosis of pancreatic malignancy.

Methods
We performed a multicenter study of patients who underwent EUS-FNA for a solid pancreatic mass. Endoscopic ultrasound-guided FNA was standardized using a 25-gauge needle, slow-pull stylet technique for specimen acquisition, and on-site cytopathology. For the primary analysis, only malignant cytology was regarded as positive. A secondary analysis was performed in which malignant and/or suspicious cytology was regarded as positive.

Results
A total of 138 patients underwent EUS-FNA. In the primary analysis, the sensitivity of EUS-FNA for malignancy was 56.7% on first pass, 73.3% on second pass, 83.3% on third pass, 89.2% on fourth pass, and 90.8% on fifth pass, with no increase beyond the fifth pass. In the secondary analysis, the sensitivity was 75.0% on first pass, 89.2% on second pass, 93.3% on third pass, and 95.8% on fourth pass, with no increase beyond the fourth pass. No significant relationship was seen between lesion size and diagnostic yield.

Conclusions
Using a 25-gauge needle, the maximal diagnostic yield of EUS-FNA for a solid pancreatic mass is reached after 4 needle passes.
Long-term Outcomes of Gastroenteropancreatic Neuroendocrine Tumors
Authors: Chi Weiwei , Warner Richard R.P. , Chan David L. , Singh Simron , Segelov Eva , Strosberg Jonathan , Wisnivesky Juan , Kim Michelle K. 
Published: February 2018

Objectives
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare but have been increasing in incidence. Limited data on the long-term outcomes of patients with these tumors are available.

Methods
In this study, we used population-based data from the National Cancer Institute to assess long-term disease-specific survival (DSS) of patients who have undergone surgery for nonmetastatic disease. All patients with NETs of the stomach, small intestine, colon, rectum, appendix, and pancreas diagnosed between 1988 and 2009 were identified from the Surveillance, Epidemiology and End Results registry. Staging was derived from Surveillance, Epidemiology and End Results data using the European Neuroendocrine Tumor Society guidelines. Cases with incomplete staging data were excluded, along with those with stage IV disease, or those who did not undergo surgical resection.

Results
Kaplan-Meier analyses were constructed to determine DSS. Analyses were further stratified according to tumor site, stage at diagnosis, and tumor grade. Overall, 13,348 patients with GEP-NETs meeting the inclusion criteria were identified.

Conclusions
There were excellent outcomes for most GEP-NET patients, with a 20-year DSS of greater than 75% across all sites and stages. Pancreatic tumors had the worst outcomes, but DSS remains greater than 50% at 20 years.
Molecular Comparison of Adult and Pediatric Ulcerative Colitis Indicates Broad Similarity of Molecular Pathways in Disease Tissue
Authors: Li Katherine , Strauss Richard , Ouahed Jodie , Chan Daphne , Telesco Shannon E. , Shouval Dror S. , Canavan James B. , Brodmerkel Carrie , Snapper Scott B. , Friedman Joshua R. 
Published: February 2018

ABSTRACTBackground:Efficacy data from adult ulcerative colitis (UC) clinical trials are often extrapolated for pediatric prescribing. Consequently, it is important to understand similarities/differences in pediatric and adult UC. Pediatric UC tends to have more extensive disease at presentation, yet genetic studies have not detected pathways that distinguish the populations, and differences in mucosal gene expression between adult and pediatric UC are not well characterized.Methods:Using colonic microarray data from a phase 3 trial of golimumab in adult UC (87 UC; 21 healthy), the GSE10616 pediatric dataset (10 UC; 11 healthy), and a phase 1B trial of golimumab in pediatric UC (n = 19), UC expression profiles were compared and unique genes were defined as those with significant changes (|FC|>2×, adjusted P < 0.05) in one population, but not the other (|FC| < 1.2×, adjusted P > 0.05). Pathway and upstream regulator analyses were performed. Profiles by disease extent (extensive [pancolitis] vs limited [left‐sided] involvement) were compared within each population.Results:Pediatric and adult disease profiles overlapped substantially, with ~50% to 75% overlap, depending on the fold‐change cutoff used. Conversely, <10% of the disease profiles were unique to each population. Similar canonical pathways were enriched in both datasets. Predicted upstream regulators were also concordant, including lipopolysaccharide, interleukin‐1β, and tumor necrosis factor‐α. Expression profiles of extensive UC were indistinguishable from those of patients with limited involvement in each population.Conclusions:The UC gene expression landscape is shared by adults and children, independent of disease extent. This supports extrapolation of efficacy from adults to children in developing new therapies for UC.
Safety and Efficacy of Bedside Percutaneous Endoscopic Gastrostomy Placement in the Neonatal Intensive Care Unit
Authors: Driver Kelly , Schilling Rebecca , Goodwin Annie , Martinez Denise , Amankwah Ernest , Shakeel Fauzia , Wilsey Michael 
Published: February 2018

ABSTRACTObjective:The aim of the study is to describe the safety and efficacy of bedside percutaneous endoscopic gastrostomy (PEG) placement in a level 3 neonatal intensive care unit (NICU).Methods:A retrospective chart review was performed on 106 infants with a birthweight ⩽6 kg receiving bedside PEG placement at Johns Hopkins All Children's Hospital between 2007 and 2013. Preprocedure, postprocedure, and demographic data were collected. The main safety outcome was postprocedure complication rate and the main efficacy outcome was time to initiate feeds and time on respiratory support.Results:The mean birth weight and mean gestational age of our population at the time of procedure were 2.2 kg and 33 weeks, respectively. There were 9 total complications (8.5%) with major complications being only 2 (1.8%). There were no instances of blood stream infections. The mean length of time to initiate feeds was 1.2 days (standard deviation [SD] = 1.2). Ninety‐three percent of patients were extubated within 24 hours.Conclusions:Bedside PEG placement is safe with minimal complications. It is associated with little need for ventilator support and allows for early re‐initiation of feeds and early success at reaching goal feedings.
Creation of Experience‐based Celiac Benchmarks
Authors: Fishman Laurie N. , Kearney Jennifer , DeGroote Maya , Liu Enju , Arnold Janis , Weir Dascha C. 
Published: February 2018

ABSTRACTObjectives:Transition planning for children with chronic disease includes the development of independence in many self‐management tasks. Conditions that depend on diet have distinct skill sets not well assessed by the traditional transition‐readiness tools. There has been literature that describes age‐appropriate skill acquisition for diabetes and food allergy patients. There are, however, no age‐appropriate benchmarks established for celiac disease (CD).Methods:CD experts (including physician, nurse, dietician, social worker, patient, and parent) created a list of celiac‐related tasks, which formed the basis of the survey. Patients with CD, and their parents, were recruited from outpatient celiac clinic and support groups, and invited to report the age each task was mastered.Results:Respondents included 204 patients and 155 parents. Mean age was 12 years (standard deviation 4.6) with average of 4 years since diagnosis. The earliest tasks were mastered by a median age of 8 years, such as recognizing GF as gluten‐free, eating safely in a shared space and recognizing basic unsafe foods. Describing the effects of eating gluten or explaining CD to a friend or stranger occurred around age 10. Asking about gluten‐free preparation in a restaurant, and identifying gluten‐free medications or vitamins was mastered around age 12, whereas tasks involved with safe domestic travel or assessing risk in a job environment occurred between 14 and 16. The interquartile range was about 4 years for each question. No significant difference seen between patient and parent reports.Conclusions:This novel patient‐centered celiac skill list may improve anticipatory guidance and accelerate self‐management skills.
Decision-Making Data
Authors: Swift Marcie C. , Townsend Robert , Edwards Douglas W. , Loudon Janice K. 
Published: February 2018

Purpose:
The purpose of this study was to explore the difference in maximal lifting capability between 2 modes of lifting (traditional crate and XRTS Lever Arm) over multiple days. The differences in absolute strength values were compared with existing criteria for sincere effort during distraction-based lifting. In addition, rate of perceived exertion (RPE) is presented for the 2 modes of lifting on each day.

Primary Practice Setting:
Workers' compensation.

Methodology and Sample:
Forty-four subjects between the ages of 20 and 44 years participated in this study. Investigators established 1 repetition maximum (RM) for each subject performing the crate lift. Subjects were randomly assigned 5 weights ranging from 10% to 100% of their determined 1RM and asked to give their rating of perceived exertion after each lift. The same procedure was repeated 2–5 days later using the XRTS Lever Arm. Paired t tests and Spearman's correlation coefficient were used for data analysis. Alpha was set at less than .05.

Results:
There was a statistically significant difference (p < .04) between maximal lift values for the 2 lifting modes. The percent difference between the modes of lifting was 10.5% ± 6.4%. In addition, there was a positive correlation between the RPE on the 2 modes of lifting (p = .87).

Implications for Case Management Practice:
A functional capacity evaluation (FCE) is typically ordered after the completion of physical rehabilitation and before releasing a patient to full or modified duty. In addition to assessing the ability to function within normal job demands, an assessment of effort by the participant typically takes place during an FCE. Case managers and physicians are presented with information, allowing them to make comparisons between functional lifting abilities displayed during treatment sessions and the FCE. These comparisons may often take place with the subpoena of medical records and may be discussed during the deposition or trial process. If an FCE takes place at a different facility than the physical therapy or work conditioning treatment, 2 different modes of lifting may take place based on the equipment within each facility. The results of this study indicate that the 2 modes of lifting on separate days meet established criteria for lift comparison testing during FCEs.
Blur Detection, Depth of Field, and Accommodation in Emmetropic and Hyperopic Children
Authors: Roberts Tawna L. , Stevenson Scott B. , Benoit Julia S. , Manny Ruth E. , Anderson Heather A. 
Published: February 2018

SIGNIFICANCE
Our results demonstrate that blur detection thresholds are elevated in young children compared with adults, and poorer blur detection thresholds are significantly correlated with the magnitude of accommodative microfluctuations. Given that accommodative microfluctuations are greater with greater accommodative responses, these findings may have implications for young uncorrected hyperopes.

PURPOSE
This study investigated the association between subjective blur detection thresholds and accommodative microfluctuations in children 3 years to younger than 10 years old and adults.

METHODS
Blur detection thresholds were determined in 49 children with habitually uncorrected refractive error (+0.06 to +4.91 diopters [D] spherical equivalent) and 10 habitually uncorrected adults (+0.08 to +1.51 D spherical equivalent) using a custom blur chart with 1° sized optotypes at 33 cm. Letters were blurred by convolution using a Gaussian kernel (SDs of 0.71 to 11.31 arc minutes in √2 steps). Subjective depth of field was determined in subjects 6 years or older and adults. Accommodative microfluctuations, pupils, and lag were measured using infrared photorefraction (25 Hz).

RESULTS
Children had greater blur detection thresholds (P < .001), accommodative microfluctuations (P = .001), and depth of field (P < .001) than adults. In children, increased blur detection thresholds were associated with increased accommodative microfluctuations (P < .001), increased uncorrected hyperopia (P = .01), decreased age (P < .001), and decreased pupil size (P = .01). In a multiple linear regression analysis, blur detection thresholds were associated with accommodative microfluctuations (P < .001) and age (P < .001). Increased accommodative microfluctuations were associated with increased uncorrected hyperopia (P = .004) and decreased pupil size (P = .003) and independently associated with uncorrected hyperopia (P = .001) and pupil size (P = .003) when controlling for age and lag.

CONCLUSIONS
Children did not have adult-like blur detection thresholds or depth of field. Increased accommodative microfluctuations and decreased age were independently associated with greater blur detection thresholds in children 3 years to younger than 10 years. Larger amounts of uncorrected hyperopia in children appear to increase blur detection thresholds because the greater accommodative demand and resulting response increase accommodative microfluctuations.
Association between Contrast Sensitivity and Reading with Macular Pathology
Authors: Brussee Tamara , van den Berg Thomas J. T. P. , van Nispen Ruth M. A. , de Boer Ilon , van Rens Ger H. M. B. 
Published: February 2018

SIGNIFICANCE
Comparison between the role of spatial and temporal contrast sensitivities in the association with reading may provide insight into how visual tasks (such as reading) are related to primary optical or neural (or both) effects. More insight into primary visual factors influencing reading is important for understanding reading problems.

PURPOSE
The aim of this study was to gain insight into the association between optical and neural components of contrast sensitivity (CS), operationalized as spatial CS (optical and neural) or temporal CS (solely neural), and reading speed in a clinical sample of participants with macular pathologies. The precision and agreement were also investigated.

METHODS
The Mars test and temporal CS implementation of the C-Quant device were used to measure spatial CS and temporal CS, respectively. Tests were performed with 47 participants: mean age, 77 years (range, 52 to 92 years). Associations were investigated with correlations and linear regression models. Precision was defined by coefficients of repeatability. The 95% limits of agreement between spatial CS and temporal CS values were assessed.

RESULTS
Reading speed correlated with both spatial CS (r = 0.35, P = .015) and temporal CS (r = 0.66, P < .001). After correction for visual acuity, central loss, and education level, the association between temporal CS and reading speed was not significant anymore. The coefficients of repeatability and reproducibility were 0.20 and 0.28 log unit (spatial CS) and 0.33 and 0.35 log unit (temporal CS), respectively. The values for temporal CS were 0.08 and 0.13 log unit higher than those for spatial CS.

CONCLUSIONS
For spatial CS and temporal CS, moderate to strong correlations were found, respectively, with reading speed in patients with maculopathies. The stronger association between temporal CS and reading speed is suggested to reflect a high sensitivity for neural integrity of temporal CS. The differences in coefficients of repeatability and reproducibility could be explained by the psychometrical differences between methods.
Retinal Nerve Fiber Layer Protrusion Associated with Tilted Optic Discs
Authors: Chiang Jaclyn , Yapp Michael , Ly Angelica , Hennessy Michael P. , Kalloniatis Michael , Zangerl Barbara 
Published: February 2018

SIGNIFICANCE
This study resulted in the identification of an optic nerve head (ONH) feature associated with tilted optic discs, which might potentially contribute to ONH pathologies. Knowledge of such findings will enhance clinical insights and drive future opportunities to understand disease processes related to tilted optic discs.

PURPOSE
The aim of this study was to identify novel retinal nerve fiber layer (RNFL) anomalies by evaluating tilted optic discs using optical coherence tomography. An observed retinal nerve fiber protrusion was further investigated for association with other morphological or functional parameters.

METHODS
A retrospective review of 400 randomly selected adult patients with ONH examinations was conducted in a referral-only, diagnostic imaging center. After excluding other ONH pathologies, 215 patients were enrolled and evaluated for optic disc tilt and/or torsion. Gross anatomical ONH features, including size and rim or parapapillary region elevation, were assessed with stereoscopic fundus photography. Optical coherence tomography provided detailed morphological information of individual retinal layers. Statistical analysis was applied to identify significant changes between individual patient cohorts.

RESULTS
A dome-shaped hyperreflective RNFL bulge, protruding into the neurosensory retina at the optic disc margins, was identified in 17 eyes with tilted optic discs. Available follow-up data were inconclusive regarding natural changes with this ONH feature. This RNFL herniation was significantly correlated with smaller than average optic disc size (P = .005), congenital disc tilt (P < .0001), and areas of rim or parapapillary elevation (P < .0001).

CONCLUSIONS
This study reports an RNFL protrusion associated with tilted optic discs, which has not previously been assessed as an independent ONH structure. The feature is predominantly related to congenital crowded, small optic discs and variable between patients. This study is an important first step to elucidate diagnostic capabilities of tilted disc morphological changes and understanding associated functional deficits.
Hyperchloremia Is Associated With Complicated Course and Mortality in Pediatric Patients With Septic Shock*
Authors: Stenson Erin K. , Cvijanovich Natalie Z. , Anas Nick , Allen Geoffrey L. , Thomas Neal J. , Bigham Michael T. , Weiss Scott L. , Fitzgerald Julie C. , Checchia Paul A. , Meyer Keith , Quasney Michael , Hall Mark , Gedeit Rainer , Freishtat Robert J. , Nowak Jeffrey , Raj Shekhar S. , Gertz Shira , Grunwell Jocelyn R. , Wong Hector R. 
Published: February 2018

Objective:
Hyperchloremia is associated with poor outcome among critically ill adults, but it is unknown if a similar association exists among critically ill children. We determined if hyperchloremia is associated with poor outcomes in children with septic shock.

Design:
Retrospective analysis of a pediatric septic shock database.

Setting:
Twenty-nine PICUs in the United States.

Patients:
Eight hundred ninety children 10 years and younger with septic shock.

Interventions:
None.

Measurements and Main Results:
We considered the minimum, maximum, and mean chloride values during the initial 7 days of septic shock for each study subject as separate hyperchloremia variables. Within each category, we considered hyperchloremia as a dichotomous variable defined as a serum concentration greater than or equal to 110 mmol/L. We used multivariable logistic regression to determine the association between the hyperchloremia variables and outcome, adjusted for illness severity. We considered all cause 28-day mortality and complicated course as the primary outcome variables. Complicated course was defined as mortality by 28 days or persistence of greater than or equal to two organ failures at day 7 of septic shock. Secondarily, we conducted a stratified analysis using a biomarker-based mortality risk stratification tool. There were 226 patients (25%) with a complicated course and 93 mortalities (10%). Seventy patients had a minimum chloride greater than or equal to 110 mmol/L, 179 had a mean chloride greater than or equal to 110 mmol/L, and 514 had a maximum chloride greater than or equal to 110 mmol/L. A minimum chloride greater than or equal to 110 mmol/L was associated with increased odds of complicated course (odds ratio, 1.9; 95% CI, 1.1–3.2; p = 0.023) and mortality (odds ratio, 3.7; 95% CI, 2.0–6.8; p < 0.001). A mean chloride greater than or equal to 110 mmol/L was also associated with increased odds of mortality (odds ratio, 2.1; 95% CI, 1.3–3.5; p = 0.002). The secondary analysis yielded similar results.

Conclusion:
Hyperchloremia is independently associated with poor outcomes among children with septic shock.
Beyond Survival: Pediatric Critical Care Interventional Trial Outcome Measure Preferences of Families and Healthcare Professionals*
Authors: Merritt Courtney , Menon Kusum , Agus Michael S. D. , Choong Karen , McNally Dayre , O’Hearn Katie , Watson R. Scott , Wong Hector R. , Duffett Mark , Wypij David , Zimmerman Jerry J. 
Published: February 2018

Objectives:
To identify, in addition to survival, preferred outcome measures of PICU family care providers and PICU healthcare professionals for interventional trials enrolling critically ill children, and to describe general attitudes of family care providers and healthcare professionals regarding research in the PICU.

Design:
Cross-sectional survey examining subject experience with clinical research and personal preferences for outcome measures for a hypothetical interventional clinical trial.

Setting:
PICUs within four academic children’s hospitals in the United States and Canada.

Subjects:
Two cohorts including family members of critically ill children in PICUs (family care providers) and multidisciplinary staff working in the PICUs (healthcare professionals).

Interventions:
Administration of a short, deidentified survey.

Measurements:
Demographic data were collated for the two subject groups. Participants were queried regarding their attitudes related to research conducted in the PICU. In addition to survival, each group was asked to identify their three most important outcomes for an investigation examining whether or not an intervention helps seriously ill children recover.

Main Results:
Demographics for family care providers (n = 40) and healthcare professionals (n = 53) were similarly distributed. Female respondents (79.8%) predominated. Participants (98.9%) ascertained the importance of conducting research in the PICU, but significant challenges associated with this goal in the high stress PICU environment. Both quality of life and functioning after leaving the hospital were chosen as the most preferred outcome measure, with 77.5% of family care providers and 84.9% of healthcare professionals indicating this choice. Duration of organ dysfunction was identified by 70.0% of family care providers and 40.7% of healthcare professionals as the second most preferred outcome measure.

Conclusions:
In addition to survival, long-term quality of life/functional status and duration of organ dysfunction represent important interventional trial outcome measures for both families of critically ill children, as well as the multidisciplinary team who provides critical care.