bluuebunny/crossref_metadata_2025_split huggingface dataset:
Divergent Intramedullary Nailing (DIN): A Modified Intramedullary Nailing Technique to Treat Paediatric Distal Tibial Fractures
Authors: Harly Edouard , Angelliaume Audrey , Lalioui Abdelfetah , Pfirrmann Clémence , Harper Luke , Lefèvre Yan 
Published: March 2019

Introduction:
Elastic stable intramedullary nailing (ESIN) allows for efficient reduction and stabilization of fractures of the tibial shaft in children and adolescents. However, for fractures of the distal third of the tibia, traditional ESIN could be inappropriate, thus compromising the stability and the healing of the fracture. The aim of this study was to present and to assess a new technique of modified ESIN to treat fracture of the distal third of the tibia, called divergent intramedullary nailing (DIN).

Methods:
We performed a retrospective monocentric study. All patients less than 16 years old, managed in our pediatric orthopaedics department, and operated upon according to the DIN technique for a displaced and/or unstable fracture of the distal third of the tibia were included. Demographic and surgical data were collected. X-rays were performed preoperatively, postoperatively, at 6 weeks, and every 6 months. The surgical technique starts as does the classic ESIN. However, nails are not curved, so that they cross only once at the proximal part of the tibia; they are divergent and supported by the medial and lateral distal part of the tibial shaft. This allows for reduction and stabilization of the fracture.

Results:
A total of 13 patients were included, with a mean age of 10 years and a mean follow-up of 32 months. The size of the nail varied between 2.5 and 4 mm. The mean surgical time was 54 minutes. The DIN technique provided a satisfying reduction (coronal and sagittal angulation <3 degrees) for the 13 fractures. In addition, there was no secondary displacement at 6 weeks. All patients were healed at 6 months, with no clinical torsion or axis malalignment.

Conclusions:
The current study confirms the feasibility and the efficiency of the DIN method to treat fracture of the distal third of the tibia.
Infusing, sustaining, and replenishing compassion in health care organizations through compassion practices
Authors: McClelland Laura E. , Vogus Timothy J. 
Published: March 2019

Background
Human suffering is prevalent and costly in health care organizations. Recent research links the use of compassion practices with improved patient experience and employee well-being, but little is known about how these practices create and sustain compassion to address workplace suffering and enhance care quality.

Purpose
This study examines the dynamics of compassion practices, specifically how compassion practices create and sustain compassion in caregiving work.

Methodology
We conducted a qualitative field study at two acute care hospitals utilizing three forms of data collection: semistructured interviews, nonparticipant observation, and archival data. Data were analyzed utilizing thematic coding.

Results
Both organizations attempted to foster workplace compassion through their hiring, socialization, employee support, and rewards practices.

Conclusion
Organizations enable compassion through common organizational practices that perform three functions: (a) infusing the organization with new members and resources to enact compassion, (b) sustaining compassion by reinforcing its appropriateness in the workplace, and (c) replenishing compassion resources by improving and restoring employee well-being and ability to provide high-quality compassionate care.

Practice Implications
This study provides managers with a detailed guide for how health care organizations use compassion practices as a managerial tool to address two key challenges: (a) high rates of employee ill-being due to the demanding nature of the work and (b) providing high-quality compassionate care.
An international, consensus-derived Core Outcome Set for Cardiac Arrest effectiveness trials: the COSCA initiative
Authors: Haywood Kirstie L. , Whitehead Laura , Perkins Gavin D. 
Published: March 2019

Purpose of review
Accurate and relevant assessment is essential to determining the impact of ill-health and the relative benefit of healthcare. This review details the recent development of a core outcome set for cardiac arrest effectiveness trials – the COSCA initiative.

Recent findings
The reported heterogeneity in outcome assessment and a lack of outcome reporting guidance were key triggers for the development of the COSCA. The historical failure of existing research to adequately capture the perspective of survivors and their family members in defining survival is described. Working collaboratively with international stakeholders – including survivors, family members and advocates – as research partners and participants ensured that a range of perspectives were considered throughout all stages of COSCA development. Three core domains and methods of assessment were recommended: survival – at 30 days or hospital discharge; neurological function assessed at 30 days or hospital discharge with the modified Rankin Scale; and health-related quality of life assessed at 90 days (as a minimum) with one of three generic measures.

Summary
The COSCA recommendation describes a small group of outcomes that should be reported as a minimum across large, randomized clinical effectiveness trials for cardiac arrest.
Emotional Awareness and Cognitive Performance in Borderline Intellectual Functioning Young Adolescents
Authors: Smirni Daniela , Smirni Pietro , Di Martino Giovanni , Operto Francesca Felicia , Carotenuto Marco 
Published: March 2019

AbstractAccording toDSM-5andICD-10, borderline intellectual functioning (BIF) should not be classified properly as a disorder. However, BIF people may present relevant problems of adaptive functioning in several areas of daily activities, and they seem to be more vulnerable to mental diseases. Young adolescence may be considered a particular period for emotional information processing. The “own and others' emotions” awareness can play a crucial role in many daily life situations, such as decision making, interpersonal relationships, and decoding of facial expressions. On this background, a BIF young adolescents group underwent a neuropsychological assessment including emotional and cognitive domains, and was compared with a healthy young adolescents control group (HC). In the overall sample, a significant negative correlation between general intellectual abilities and emotional awareness was found. The BIF group showed a significantly greater level of alexithymia and a poorer performance in higher cognitive tasks than HC group. As hypothesized, a border cognitive functioning influences mentalization processes as ability to discriminate and monitor emotions, as well as higher domains of cognition.
Prediction of Mortality in Newborn Infants With Severe Congenital Diaphragmatic Hernia Using the Chest Radiographic Thoracic Area*
Authors: Dassios Theodore , Ali Kamal , Makin Erica , Bhat Ravindra , Krokidis Miltiadis , Greenough Anne 
Published: March 2019

Objectives:
To evaluate whether the preoperative chest radiographic thoracic area in newborn infants with congenital diaphragmatic hernia was related to the length of mechanical ventilation and the total length of stay and whether chest radiographic thoracic area predicted survival to discharge from neonatal care.

Design:
Retrospective observational cohort study.

Setting:
Tertiary neonatal unit at King’s College Hospital National Health Service Foundation Trust, London, United Kingdom.

Patients:
Newborn infants admitted with congenital diaphragmatic hernia at King’s College Hospital in a 10-year period (2007–2017).

Interventions:
The chest radiographic thoracic area was assessed by free hand tracing of the perimeter of the thoracic area as outlined by the diaphragm and the rib cage and excluded the mediastinal structures and abdominal contents in the thorax and calculated using the Sectra PACS software (Sectra AB, Linköping, Sweden).

Measurements and Main Results:
Eighty-four infants with congenital diaphragmatic hernia (70 left-sided) were included with a median (interquartile range) gestation of 36 weeks (34–39 wk). Fifty-four (64%) survived to discharge from neonatal care. In the infants who survived the chest radiographic thoracic area was not related to the length of mechanical ventilation (r = 0.136; p = 0.328) or the total duration of stay (r = 0.095; p = 0.495). The median (interquartile range) chest radiographic thoracic area was higher in infants who survived (1,780 mm2 [1,446–2,148 mm2]) compared with in the deceased infants (1,000 mm2 [663–1,449 mm2]) after correcting for confounders (adjusted p = 0.01). Using receiver operator characteristics analysis, the chest radiographic thoracic area predicted survival to discharge from neonatal care with an area under the curve of 0.826. A chest radiographic thoracic area higher than 1,299 mm2 predicted survival to discharge with 85% sensitivity and 73% specificity.

Conclusions:
The chest radiograph in infants with severe congenital diaphragmatic hernia can predict survival from neonatal care with high sensitivity and moderate specificity.
Bleeding Scales Applicable to Critically Ill Children: A Systematic Review
Authors: Nellis Marianne E. , Levasseur Julie , Stribling Judy , Faustino E. Vincent S. , Zantek Nicole D. , Sheth Sujit , Karam Oliver 
Published: March 2019

Objectives:
To summarize current bleeding scales and their validation to assess applicability to bleeding in critically ill children.

Data Sources:
We conducted electronic searches of Ovid MEDLINE, Ovid EMBASE, Cochrane Library, and Web of Science Core Collection databases from database inception to 2017.

Study Selection:
Included studies contained a bleeding score, bleeding measurement tool, or clinical measurement of hemorrhage.

Data Extraction:
We identified 2,097 unique citations; 20 full-text articles were included in the final review.

Data Synthesis:
Of the 18 studies that included subjects (two others were expert consensus definitions), seven (39%) were pediatric-only, seven (39%) were adult-only, and four (22%) included both adults and children. Nine (50%) occurred with inpatients (two studies in critical care units), seven (39%) involved outpatients and two (11%) included both inpatients and outpatients. Thirty-nine percent of the scales were developed for those with idiopathic thrombocytopenic purpura and only two (12%) described critically ill patients. The majority (80%) included need for treatment (either RBC transfusion or surgical intervention). The majority (65%) did not report measures of reliability or validation to clinical outcomes.

Conclusions:
There is a lack of validated bleeding scales to adequately assess bleeding and outcomes in critically ill children. Validated scales of bleeding are necessary and urgently needed.
Age Matching of Elderly Liver Grafts With Elderly Recipients Does Not Have a Synergistic Effect on Long-term Outcomes When Both Are Carefully Selected
Authors: Gilbo Nicholas , Jochmans Ina , Sainz-Barriga Mauricio , Nevens Frederik , van der Merwe Schalk , Laleman Wim , Verslype Chris , Cassiman David , Verbeke Len , van Malenstein Hannah , Roskams Tania , Pirenne Jacques , Monbaliu Diethard 
Published: March 2019

Background
Older donors and recipients are increasingly considered for liver transplantation. Both donor and recipient age have a negative impact on outcomes. Large registry analyses show that older donors are frequently matched to older recipients. Whether age-related risks accumulate in a synergic negative effect on outcomes because of donor-recipient age matching is poorly understood.

Methods
We investigated the impact of donor-recipient age interaction on patient and death-censored graft survival in multivariate Cox regressions in 849 transplants (January 2000 to December 2015).

Results
Donors 70 years or older did not affect long-term patient or graft survival. Recipient age independently increased the risk of death (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.05, P < 0.0001), but donor-recipient age interaction was noninfluential. The negative impact of recipient age on patient survival was significant as early as 6 months after transplantation (HR, 1.06; 95% CI, 1.03-1.09; P = 0.00008). The adjusted risk of death was significant for patients aged 60 to 69 years (HR, 1.995; 95% CI, 1.40-2.85; P < 0.0001) and 70 years or older (HR, 2.001; 95% CI, 1.10-2.66; P = 0.04). In contrast, the risk of graft loss was not influenced by recipient age (HR, 1.02; 95% CI, 0.996-1.04; P = 0.11) or age interaction.

Conclusions
Older livers can be safely used in older recipients without jeopardizing graft and patient survival if other risk factors are minimized.
Phenotyping women based on dietary macronutrients, physical activity and body weight using machine-learning tools
Authors: Ramyaa Ramyaa , Hosseini Omid , Krishnan Giri P , Krishnan Sridevi 
Published: March 2019

AbstractBackgroundNutritional phenotyping is a promising approach to achieve personalized nutrition. While conventional statistical approaches haven’t enabled personalizing well yet, machine-learning tools may offer solutions that haven’t been evaluated yet.ObjectiveThe primary aim of this study was to use energy balance components – input (dietary energy intake and macronutrient composition), output (physical activity) to predict energy stores (body weight) as a way to evaluate their ability to identify potential phenotypes based on these parameters.MethodsWe obtained data from the Women’s Health Initiative –Observational Study (WHI-OS) from BioLINCC. We chose dietary macronutrients – carbohydrate, protein, fats, fiber, sugars & physical activity variables – energy expended from mild, moderate and vigorous intensity activity h/wk to predict current body weight either numerically (as kg of body weight) or categorically (as BMI categories). Several machine-learning tools were used for this prediction – k-nearest neighbors (kNN), decision trees, neural networks (NN), Support Vector Machine (SVM) regressions and Random Forest. Further, predictive ability was refined using cluster analysis, in an effort to identify putative phenotypes.ResultsFor the numerical predictions, kNN performed best (Mean Approximate Error (MAE) of 2.71kg, R2 of 0.92, Root mean square error (RMSE) of 4.96kg). For categorical prediction, ensemble trees (with nearest neighbor learner) performed best (93.8% accuracy). K-means cluster analysis identified 11 clusters suggestive of phenotypes, based on significantly improved predictive accuracy. Within clusters, individual macronutrient gain and loss modeling identified that some clusters were strongly predicted by dietary carbohydrate while others by dietary fat.ConclusionsMachine-learning tools in nutritional epidemiology could be used to identify putative phenotypes.
Bocaparvovirus, Erythroparvovirus and Tetraparvovirus in New World Monkeys from Central America
Authors: Chaves-Friedlander A. , Ibarra-Cerdena C.N. , López-Pérez A.M. , Monge O. , Avendaño R. , Ureña-Saborio H. , Chavarría M. , Zaldaña K. , Sánchez L. , Ortíz-Malavassi E. , Suzan G. , Foley J. , Gutiérrez-Espeleta G.A. 
Published: March 2019

SUMMARYParvoviruses in the genera Bocaparvovirus (HBoV), Erythroparvovirus (B19) and Tetraparvovirus (PARV4) are the only autonomous parvoviruses known to be associated with human and non-human primates based on studies and clinical cases in humans worldwide and non-human primates in Asia and Africa. Here, the presence of these pathogenic agents was assessed by PCR in blood and feces from 55 howler monkeys, 112 white-face monkeys, 3 squirrel monkeys, and 127 spider monkeys in Costa Rica and El Salvador. Overall, 3.7% of the monkeys had HboV DNA, 0.67% had B19 DNA, and 14.1% had PARV4 DNA, representing the first detection of these viruses in New World monkeys. Sex was significantly associated with the presence of HBoV, males having risk up to nine times compared with females. Captivity was associated with increased prevalence for PARV4 and when all viruses were analyzed together. This work underscores the importance of future research aimed at understanding how these viruses behave in natural environments of the Neotropics, and what variables may favor their presence and transmission.
Global state of deworming coverage and inequity in low-income and middle-income countries: a spatiotemporal study of household health surveys
Authors: Lo Nathan C. , Heft-Neal Sam , Coulibaly Jean T. , Leonard Leslie , Bendavid Eran , Addiss David G. 
Published: March 2019

AbstractIntroductionMass deworming against soil-transmitted helminthiasis (STH) is a hallmark program in the neglected tropical diseases portfolio that is designed to be equitable and “pro-poor”. However, the extent to which current deworming treatment programs achieve equitable coverage across wealth class and gender remains unclear, and the current public health metric of national deworming coverage does not include representation of inequity. This study develops a framework to measure both coverage and equity in global deworming to guide future programmatic evaluation, investment, and metric design.MethodsWe used nationally representative, geospatial household survey data that measured mother-reported deworming receipt in pre-school age children (age 1-4 years) in the previous 6 months. We estimated global deworming coverage disaggregated by geography, wealth quintile and gender and computed an equity index. We examined trends in coverage and equity index across countries, within countries, and over time. We used a regression model to compute the household correlates of deworming receipt and ecological correlates of equitable deworming.FindingsOur study included 820,883 pre-school age children living in 50 STH-endemic countries between 2004 and 2017. Globally, the mean global deworming coverage in pre-school children was estimated at 36%. The sub-national coverage ranged from 0.5% to 87.5%, and within-country variation was greater than between-country variation in coverage. The equity index was undesirable (deworming was consistently concentrated in the wealthier populations) in every endemic region of 12 countries. Of the 31 study countries that WHO reported achieving the goal of 75% national coverage, 26 had persistent inequity in deworming as defined by the mean equity index. Deworming equity modestly improved over time, and within-country variation in inequity decreased over time. We did not detect differences in deworming equity by gender. We found the strongest household correlates of deworming to be vitamin A supplementation and receipt of three doses of diphtheria-tetanus-pertussis vaccine (DTP3), while the strongest ecological predictors of equitable deworming were regions with higher coverage of health services such as DTP3 and vitamin A supplementation.InterpretationAlthough mass deworming is considered to be “pro-poor”, we find substantial inequities by wealth, despite often high reported national coverage. These inequities appear to be geographically heterogeneous, modestly improving over time, and we found no evidence of gender differences in inequity. Future reporting of deworming coverage should consider disaggregation by geography, wealth, and gender with incorporation of an equity index to complement national deworming coverage.FundingBill and Melinda Gates Foundation, Stanford University Medical Scientist Training Program
Seasonal stability and dynamics of DNA methylation in plants in a natural environment
Authors: Ito Tasuku , Nishio Haruki , Tarutani Yoshiaki , Emura Naoko , Honjo Mie N. , Toyoda Atsushi , Fujiyama Asao , Kakutani Tetsuji , Kudoh Hiroshi 
Published: March 2019

AbstractOrganisms survive in naturally fluctuating environments by responding to long-term signals, such as seasonality, by filtering out short-term noise. DNA methylation has been considered a stable epigenetic mark but has also been reported to change in response to experimental manipulations of biotic and abiotic factors. However, it is unclear how they behave in natural environments. Here, we analyzed seasonal patterns of genome-wide DNA methylation at a single-base resolution using a single clone from a natural population of the perennial Arabidopsis halleri. The genome-wide pattern of DNA methylation was primarily stable, and most of the repetitive regions were methylated across the year. Although the proportion was small, we detected seasonally methylated cytosines (SeMCs) in the genome. SeMCs in the different contexts showed distinct seasonal patterns of methylation. SeMCs in CHH context were detected predominantly at repetitive sequences in intergenic regions. Additionally, we found that CHH methylation within AhgFLC locus showed a seasonal pattern that was negatively associated with changes in gene expression. Gene-body CG methylation (gbM) itself was generally stable across seasons, but the levels of gbM were positively associated with seasonal stability of RNA expression of the genes. These results suggest the existence of two distinct aspects of DNA methylation in natural environments: sources of epigenetic variation and epigenetic marks for stable gene expression.
The causal effect of adiposity on hospital costs: Mendelian Randomization analysis of over 300,000 individuals from the UK Biobank
Authors: Dixon Padraig , Hollingworth William , Harrison Sean , Davies Neil M , Smith George Davey 
Published: March 2019

AbstractEstimates of the marginal effect of measures of adiposity such as body mass index (BMI) on healthcare costs are important for the formulation and evaluation of policies targeting adverse weight profiles. Many existing estimates of this association are affected by endogeneity bias caused by simultaneity, measurement error and omitted variables. The contribution of this study is to avoid this bias by using a novel identification strategy – random germline genetic variation in an instrumental variable analysis – to identify the presence and magnitude of the causal effect of BMI on inpatient hospital costs. We also use data on genetic variants to undertake much richer testing of the sensitivity of results to potential violations of the instrumental variable assumptions than is possible with existing approaches. Using data on over 300,000 individuals, we found effect sizes for the marginal unit of BMI more than 50% larger than multivariable effect sizes. These effects attenuated under sensitivity analyses, but remained larger than multivariable estimates for all but one estimator. There was little evidence for non-linear effects of BMI on hospital costs. Within-family estimates, intended to address dynastic biases, were null but suffered from low power. This paper is the first to use genetic variants in a Mendelian Randomization framework to estimate the causal effect of BMI (or any other disease/trait) on healthcare costs. This type of analysis can be used to inform the cost-effectiveness of interventions and policies targeting the prevention and treatment of overweight and obesity, and for setting research priorities.