bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Levels of HIV-1 Drug Resistance in Children Who Acquired HIV Infection Through Mother to Child Transmission in the Era of Option B+, Haiti, 2013 to 2014
Authors: Louis Frantz Jean , Segaren Nathanael , Desinor Olbeg , Beard R. Suzanne , Jean-Louis Reginald , Chang Joy , Boisson Sylvie , Hulland Erin N. , Wagar Nick , DeVos Joshua , François Kesner , Buteau Josiane , Boncy Jacques , Marston Barbara J. , Domerçant Jean Wysler , Yang Chunfu , Charles Macarthur 
Published: January 2019

Background:
The main objective of this study was to determine the frequency and patterns of HIV drug resistance–associated mutations among children under 18 months of age born to HIV-1–positive mothers enrolled in the prevention of mother-to-child transmission services in Haiti.

Methods:
Between January 1, 2013 and December 31, 2014, HIV-positive remnant dried blood spots collected from children under 18 months of age for Early Infant Diagnosis at the National Public Health Laboratory were used for HIV-1 genotyping. HIV drug resistance mutations were analyzed using the Stanford Drug Resistance HIVdb program.

Results:
Of the 3555 dried blood spots collected for Early Infant Diagnosis, 360 (10.1%) were HIV-positive and 355 were available for genotyping. Of these, 304 (85.6%) were successfully genotyped and 217 (71.4%) had ≥1 drug resistance mutation. Mutations conferring resistance to nucleoside reverse transcriptase inhibitor (NRTIs) and non-NRTIs were present in 40.5% (123) and 69.1% (210), respectively. The most frequent mutations were K103N/S (48.0%), M184V (37.5%), G190A/S (15.1%), and Y181C/G/V (14.1%). Predicted drug resistance analysis revealed that 68.8% of the children had high-level resistance to non-NRTIs and 11.5% had intermediate to high-level resistance to abacavir.

Conclusions:
This study showed high rates of resistance to NRTIs and non-NRTIs among newly HIV-diagnosed children in Haiti, suggesting that in the era of “Option B+” (initiation of lifelong combination antiretroviral therapy to pregnant women with HIV), the majority of children who acquire HIV infection through mother-to-child transmission of HIV have resistant HIV. These results have led the National HIV Program to revise the pediatric guidelines to include protease inhibitors in first-line regimens for all HIV-positive newborns.
Burden of Respiratory Syncytial Virus Disease and Mortality Risk Factors in Argentina: 18 Years of Active Surveillance in a Children’s Hospital
Authors: Gentile Angela , Lucion María Florencia , Juarez María del Valle , Areso María Soledad , Bakir Julia , Viegas Mariana , Mistchenko Alicia 
Published: January 2019

Background:
Respiratory syncytial virus is the leading cause of acute lower respiratory infection in children. We aimed to describe the clinical-epidemiologic pattern and risk factors for mortality associated with RSV infection.

Methods:
This is a prospective, cross-sectional study of acute lower respiratory infection in children admitted to the Children’s Hospital during 2000 to 2017. Viral diagnosis was made by fluorescent antibody techniques or real-time-polymerase chain reaction. We compared clinical-epidemiologic characteristics of RSV infection in nonfatal versus fatal cases. Multiple logistic regression was used to identify independent predictors of mortality.

Results:
Of 15,451 patients with acute lower respiratory infection, 13,033 were tested for respiratory viruses and 5831 (45%) were positive: RSV 81.3% (4738), influenza 7.6% (440), parainfluenza 6.9% (402) and adenovirus 4.3% (251). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV cases show a case fatality rate of 1.7% (82/4687). Fatal cases had a higher proportion of prematurity (P < 0.01), perinatal respiratory history (P < 0.01), malnourishment (P < 0.01), congenital heart disease (P < 0.01), chronic neurologic disease (P < 0.01) and pneumonia at clinical presentation (P = 0.014). No significant difference between genders was observed. Most deaths occurred among children who had complications: respiratory distress (80.5%), nosocomial infections (45.7%), sepsis (31.7%) and atelectasis (13.4%). Independent predictors of RSV mortality were moderate-to-severe malnourishment, odds ratio (OR): 3.69 [95% confidence interval (CI): 1.98–6.87; P < 0.0001]; chronic neurologic disease, OR: 4.14 (95% CI: 2.12–8.08; P < 0.0001); congenital heart disease, OR: 4.18 (95% CI: 2.39–7.32; P< 0.0001); and the age less than 6 months, OR: 1.99 (95% CI: 1.24–3.18; P = 0.004).

Conclusions:
RSV showed an epidemic pattern affecting mostly young children. Malnourishment, chronic neurologic disease, congenital heart disease and the age less than 6 months were the independent risk factors for RSV mortality.
Prevalence of Functional GI Diseases and Pelvic Floor Symptoms in Marfan Syndrome and Ehlers-Danlos Syndrome
Authors: Nee Judy , Kilaru Saikiran , Kelley John , Oza Sveta S. , Hirsch William , Ballou Sarah , Lembo Anthony , Wolf Jacqueline 
Published: January 2019

Background and Aims:
Prior studies have shown a high prevalence of gastrointestinal (GI) symptoms, diagnoses of functional GI diseases (FGIDs), and pelvic floor symptoms associated with Ehlers-Danlos syndrome (EDS). It is unclear if Marfan syndrome (MFS), another common hereditary noninflammatory connective tissue disorder, is also associated these symptoms. This study evaluates the prevalence of and compares FGIDs and pelvic floor symptoms in a national cohort of EDS and MFS patients.

Methods:
A questionnaire was sent to members of local and national MFS and EDS societies. The questionnaire evaluated the presence of GI and pelvic floor symptoms and diagnoses. The presence of FGIDs was confirmed using Rome III criteria. Quality of life was evaluated and scored with the CDC quality of life.

Key Results:
Overall, 3934 patients completed the questionnaire, from which 1804 reported that they had some form of EDS and 600 had MFS. In total, 93% of patients with EDS complained of GI symptoms and qualified for at least one FGID compared with 69.8% of patients with MFS. When comparing EDS prevalence of upper and lower GI symptoms as well as FGIDs, subjects with EDS reported significantly higher prevalence of Rome III FGIDs as compared with those with MFS. Irritable bowel syndrome (57.8% vs. 27.0%, P<0.001), functional dyspepsia (FD) (55.4% vs. 25.0%, P<0.001), postprandial distress (49.6% vs. 21.7%, P<0.001), heartburn (33.1% vs. 16.8%, P<0.001), dysphagia (28.5% vs. 18.3%, P<0.001), aerophagia (24.7% vs. 12.3%, P<0.001), and nausea (24.7% vs. 7.2%, P<0.001) were all significantly greater in the EDS population compared with MFS population. The prevalence of FGIDs was similar across subtypes of EDS. In general, participants with EDS were more likely to have nearly all pelvic floor symptoms as compared with participants with MFS.

Conclusions:
The prevalence of FGIDs and pelvic floor symptoms in EDS is higher than that found in MFS. The prevalence of FGIDs were similar across EDS subtypes. This study supports the mounting evidence for FGIDs in those with connective tissue diseases, but more specifically, in EDS.
Narcissism and Attachment
Authors: Cramer Phebe 
Published: January 2019

AbstractResearch often shows that narcissism and attachment style are related. The present research examines the question of whether early parenting style contributes to adult attachment style, beyond the relation between narcissism and attachment. Parents reported on their parenting style at age 3, and offspring were assessed for attachment style and narcissism at age 23. The results indicated that early parenting style was not directly related to narcissism, but along with narcissism added to the prediction of attachment style. In combination with vulnerable narcissism, authoritarian parenting was positively related to secure attachment, and negatively related to preoccupied attachment, whereas permissive and responsive parenting were negatively related to secure attachment and positively related to preoccupied attachment.
Cognitive Deficits in Euthymic Patients With Bipolar Disorder
Authors: Srivastava Chhitij , Bhardwaj Anupam , Sharma Mukul , Kumar Sanjay 
Published: January 2019

Abstract
Cognitive deficits have been demonstrated in people in the euthymic phase of bipolar disorder. This cross-sectional study compared euthymic bipolar disorder patients (n = 30) with never psychiatrically ill controls (n = 30) on a neuropsychological test battery containing tasks of executive function, the Wisconsin Card Sorting Test (WCST), attention and working memory, digits forward and backward, and speed of information processing digit symbol. Scores on the Mini-Mental State Examination (MMSE) and vocabulary test did not differ between the groups. The bipolar group was significantly impaired compared with controls on various indices of executive function on the WCST and on the digit tests. The impaired performance on the digit tests, but not the WCST, was significantly associated with medication status, notably prescribed benzodiazepines. There was no significant effect of severity or course of illness on performance. The findings support the hypothesis that impairments in executive function are present between illness episodes in bipolar disorder, and so they are not simply state markers.
Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale
Authors: Park C. Hyung Keun , Kim Hyeyoung , Kim Bora , Kim Eun Young , Lee Hyun Jeong , Kim Daewook , Ahn Yong Min 
Published: January 2019

Abstract
Identifying predictors of planned suicide attempts (PSA) is critical because these are associated with grave consequences. Using data of suicide attempters visiting emergency departments, we investigated whether the Columbia-Suicide Severity Rating Scale (C-SSRS) subscales, by retrospectively evaluating ideation before an attempt, could predict the occurrence of PSA versus unplanned suicide attempts using logistic regression analyses. The severity subscale was used as a continuous (model A) and a categorical (model B) variable. In model A, higher scores on each subscale were associated with increased risk of PSA. In model B, the highest score on the severity subscale and a higher intensity subscale score predicted PSA. The severity and intensity subscales had areas under receiver operating curves of 0.712 and 0.688 with optimum cutoff points of 4/5 and 15/16, respectively. In addition, being aged 30 to 49 and 50 to 69 years, being male, interpersonal stress, and depressive and adjustment disorders increased PSA risk. The C-SSRS subscales, along with sociodemographic and clinical risk factors, can predict PSA.
Clinicians' Empathy and Professional Quality of Life
Authors: Laverdière Olivier , Ogrodniczuk John S. , Kealy David 
Published: January 2019

Abstract
Psychotherapists can experience emotional drain as a result of their work with distressed and traumatized patients. It has been suggested that psychotherapists' empathy, which is central to clinical work, may be an important risk factor in the development of burnout or secondary traumatic stress. This apparent contradiction is thought provoking, especially given the complexity of empathic response. The current study aimed to explore the relationship of empathy to compassion satisfaction, burnout, and secondary traumatic stress, while also considering the influence of important work conditions. To do so, 240 psychotherapists described their current practice and reported their levels of empathy and their professional quality of life. Results revealed various relationships between dimensions of empathy and professional quality of life, and the moderating role of empathy regarding the impact of work conditions on professional quality of life. Results highlight the importance of a multidimensional assessment of empathy and the importance of different training and supervision strategies that could help psychotherapists to be more resilient in their work.
Improving Student Engagement in Community Disaster Preparedness
Authors: Shannon Crystal 
Published: January 2019

Background
Recent events continue to demonstrate the need for effective community-level disaster preparedness. Nurses remain key figures in supporting local response efforts and disaster education for unexpected events.

Problem
Although improved efforts have promoted disaster nursing practice knowledge, nursing education remains challenged in engaging students in disaster management efforts.

Approach
Students collaborated over 4 semesters to assess and deliver a variety of disaster-related interventions to the community.

Outcomes
The multisemester project improved students' understanding of disaster nursing, the nursing program's engagement with community partners, and community members' knowledge and ability for emergency preparedness.

Conclusion
The project was instrumental in improving the community's awareness and engagement of the regional nursing programs in community-based emergency response. The details of the project are provided for replication by other faculty and nursing programs.
The Association of Hospital Rate of Delayed Epinephrine Administration With Survival to Discharge for Pediatric Nonshockable In-Hospital Cardiac Arrest
Authors: Raymond Tia T. , Praestgaard Amy , Berg Robert A. , Nadkarni Vinay M. , Parshuram Chris S. 
Published: January 2019

Objectives:
To evaluate the variation of hospital rates of delayed epinephrine administration in pediatric patients with nonshockable in-hospital cardiac arrest, and the association of those rates with event, 24-hour, and overall survival to hospital discharge.

Design:
A retrospective evaluation was performed. Delayed epinephrine was defined as greater than 5 minutes between the time the need for chest compressions was identified and epinephrine was administered. The main outcome was the association of hospital rate of delayed epinephrine administration with survival to hospital discharge. Secondary outcomes were event and 24-hour survival. Evaluation used hierarchical logistic regression and included 13 patient/event-level and seven hospital-level factors.

Setting:
Hospitals with greater than 6 months data in the American Heart Association’s Get With the Guidelines—Resuscitation registry (2000–2016) and greater than or equal to five total pediatric cardiac arrests with nonshockable rhythm.

Patients:
Children less than 18 years old with index nonshockable in-hospital cardiac arrest treated with greater than or equal to one epinephrine dose.

Interventions:
None.

Measurements and Main Results:
One-thousand four-hundred sixty-two patients at 69 hospitals were included: 218 patients (14.9%) had epinephrine delay rates ranging from 0% to 80% of events (median, 15.6%; interquartile range, 7–25%). The median and interquartile range of hospital level delay was 16% (7–25%). Patient/event-level predictors of delayed epinephrine were asystole (odds ratio, 1.54 [95% CI, 1.10–2.16]) and insertion of an endotracheal tube (odds ratio, 1.86 [95% CI, 1.27–2.73]). Hospital size less than 200 compared with greater than or equal to 500 beds (odds ratio, 3.07 [95% CI, 1.22–7.73]) and ICU location (odds ratio, 0.51 [95% CI, 0.36–0.74]) were associated with epinephrine delay rates. After adjustment, increasing quartiles of epinephrine delay were associated with lower patient and hospital-level return of spontaneous circulation (p = 0.019, p = 0.006) and 24-hour survival (p = 0.018, p = 0.002) respectively, but not survival to discharge (p = 0.20, p = 0.24).

Conclusions:
Delayed epinephrine administration following pediatric nonshockable in-hospital cardiac arrest varies significantly between hospitals. Hospitals with higher rates of delayed epinephrine administration had worse patient- and hospital-level outcomes after adjusting for multiple patient- and hospital-level factors. Delayed epinephrine administration may directly contribute to increased mortality risk and/or may be a marker of unmeasured elements of hospital resuscitation performance.
Asthma-Related Emergency Department Visits Among Low-Income Families With Young Children by Race/Ethnicity and Primary Language
Authors: Aratani Yumiko , Nguyen Hong-An , Sharma Vrinda 
Published: January 2019

Objective
The aim of this study was to examine the existence of racial/ethnic and language disparities in asthma-related emergency department (ED) initial and return visits among young children in low-income families in California.

Methods
Children younger than 6 years with at least 1 asthma-related ED visit recorded in the California Office of Statewide Health Planning and Development data set between January 1, 2009, and December 31, 2013, and on Medicaid (Medi-Cal) were assessed. Primary outcomes were hospitalization at the first asthma-related ED visit and a return asthma-related ED visit within 12 months. Data were analyzed using multivariate logistic regression.

Results
Among 47,657 children, approximately 55% were Hispanic, 20% were black, and 2.7% were Asian/Pacific Islander. For non–English-speaking families, 82% were Hispanic. Among English-speaking families, blacks were less likely to be hospitalized at the first ED visit (odds ratio [OR], 0.787; 95% confidence interval [CI], 0.715–0.866) but more likely to return to the ED (OR, 1.291; 95% CI, 1.205–1.383) compared with whites. Conversely, Asian/Pacific Islanders whose primary language was English were more likely to be hospitalized (OR, 2.150; 95% CI, 1.827–2.530) compared with whites. Among families whose primary language was not English, Hispanic and Asian/Pacific Islanders are more likely to be hospitalized at the first ED visit and all groups are less likely to return to the ED compared with English-speaking whites.

Conclusions
The findings suggest that racial/ethnic and language disparities exist in eventual asthma-related hospitalizations and repeat ED visits. Continued research is needed to understand the existence of these differences and to inform future comprehensive and linguistically appropriate asthma interventions for children in low-income families.
Universal Intimate-Partner Violence Assessment in the Pediatric Emergency Department and Urgent Care Setting
Authors: Litzau Megan , Dowd M. Denise , Stallbaumer-Rouyer Jennifer , Miller Melissa K. , Randell Kimberly A. 
Published: January 2019

Objective
The aim of this study was to examine universal intimate-partner violence (IPV) assessment in the pediatric acute care setting.

Methods
We reviewed universal IPV assessment over 1 year in 2 emergency departments and 3 urgent care centers within a children's hospital system. Written IPV assessment used 2 questions (ie, safety concerns at home, information desired); “yes” to either was considered positive. We identified positive assessments via preexisting quality report. We collected demographics, resource utilization, and reason for positive screen by chart review. Positive assessment for IPV was determined by chart documentation.

Results
Intimate-partner violence assessment was documented in 169,399 visits (96% of all visits); 511 (0.3%) were positive. Four hundred ninety cases were reviewed; 21 cases were excluded (incomplete data). One hundred twenty positive assessments were classified as misunderstood (“yes” marked in error); these were associated with nonwhite race (P < 0.001). We identified IPV in 169 (46%) of the remaining 370 positive assessments. Intimate-partner violence identification was associated with white race (P = 0.004), female caregiver (P < 0.001), and English as primary home language (P = 0.045). Non-IPV concerns triggered 239 positive assessments; concerns included child maltreatment (n = 125), mental/behavioral health (n = 46), other violence (n = 33), and parenting (n = 21). Intimate-partner violence was identified by social work in 82 cases triggered by non-IPV concerns. Resources utilized included social work (99%), non-IPV resources (59%), IPV advocate (21%), law enforcement (0.8%), and child protective services (1.6%).

Conclusions
Universal IPV assessment in the pediatric acute care setting is feasible and may enable resource provision for IPV and non-IPV concerns.
A Novel Pediatric Emergency Department Intervention to Improve Adolescent Sexual Health Care
Authors: Jayamaha Dharshinie , Finocchario-Kessler Sarah , Giovanni Joan , Michael Jeffrey , Moffatt Mary E. , Sherman Ashley K. , Miller Melissa K. 
Published: January 2019

Objective
The aim of this study was to evaluate a novel educational intervention for physician trainees to improve sexual health care provision, including condom distribution, in the pediatric emergency department.

Methods
Resident physicians and medical students in an urban pediatric emergency department viewed an evidence-based educational video on sexual health care provision. It featured role-plays and a description of the condom distribution process, and targeted trainees who provide health care to patients aged 14 years or more with potential genitourinary complaints. Trainees completed pre- and postintervention surveys to assess attitudes, motivation, and confidence for 4 recommended practices (Likert scale, 1 = not at all to 4 = extremely). We used Wilcoxon signed rank tests to assess differences in paired responses to motivation and confidence statements. A subset of 33 trainees completed a brief survey to assess condom distribution during emergency department clinical encounters.

Results
Of 56 trainees, 51 (91%) participated: 53% female, 58% from pediatrics. At baseline, participants reported high levels of confidence and motivation to provide sexual health care. Postintervention, there were significant increases in the proportion of participants who reported greater motivation and confidence to (1) ask a parent to step out of the room, (2) obtain sexual history, (3) discuss condom use, and (4) offer condoms (all P < 0.05). Postintervention, fewer participants “agreed/strongly agreed” that there is inadequate time to obtain sexual histories (22% vs 45%; P < 0.05). Most (60%) sexually active patients accepted condoms during clinical care.

Conclusion
In this pediatric emergency department, a low-cost intervention showed promise to improve trainee attitudes, motivation, and confidence toward adolescent sexual health care provision. These data may inform strategies to improve access to care for this population.
Sudden Diplopia at a Pediatric Emergency Department
Authors: Brambilla Alice , Pasti Mattia , Parri Niccolò 
Published: January 2019

Objective
Otitis media, facial pain in trigeminal region, and ipsilateral abducens nerve palsy clinically define Gradenigo syndrome, a rare but serious complication of suppurative middle ear infection. Radiological investigation is required to confirm petrous apex involvement and to exclude further consequences as sinus thrombosis, meningitis, and intracranial abscess.

Methods/Results
We report the case of an 8-year-old child referred to our emergency department for recurrent headache and sudden strabismus. Clinical evidence of suppurative otitis media raised the suspicion for Gradenigo syndrome, definitively confirmed at computed tomography and magnetic resonance imaging scans. Conservative treatment alone enabled complete clinical and radiological remission, without long-term sequelae.

Conclusions
Despite being a rare condition, Gradenigo syndrome should be taken into account as potential differential diagnosis in children referred to emergency department for recurrent headache and strabismus. An accurate anamnesis to document recent ear infection is mandatory to orientate the diagnosis and focus radiological investigations. Early recognition and timely intervention may allow conservative management to succeed, avoiding the need for surgery and serious sequelae.