bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moving Toward Excellence in Pediatric Physical Therapy Education: A Scoping Review
Authors: Anderson Deborah K. , Furze Jennifer A. , Moore James G. 
Published: December 2018

Purpose:
The purpose of this scoping review was to identify and map current evidence that underpins excellence in pediatric physical therapy education.

Methods:
An extensive review was conducted of literature published over a 27-year period regarding pediatric physical therapy/medical/allied health education.

Results:
Thirty articles were reviewed and analyzed. Articles were classified as levels of evidence 4 to 7. Three major overarching concepts emerged: faculty characteristics, curriculum, and pedagogy.

Conclusions:
Few published studies with methodological rigor exist on this topic. More research and higher quality studies are needed to identify exemplar programs, curriculum, and pedagogy. The key concepts identified in this review will help inform the definition of excellence, as it is perceived through the lens of pediatric physical therapy educators, clinicians, and students.
Early Treadmill Practice in Infants Born With Myelomeningocele: A Pilot Study
Authors: Lee Do Kyeong , Sansom Jennifer K. 
Published: December 2018

Purpose:
To determine the feasibility of an early treadmill training program for infants with myelomeningocele (MMC) and to measure changes in overt infant motor development and control, including mechanisms underlying the overt changes.

Methods:
Ten infants with MMC were initially enrolled: 8 infants completed 12 consecutive months of training, and 2 completed 6 months of training. Training consisted primarily of home-based, parent-administered treadmill stepping practice 5 days per week, 10 minutes per day starting within 6 months postbirth. We measured motor milestones, treadmill steps, spinal-level reflexes, and body composition.

Results:
Infants showed earlier acquisition of gross motor skills than previously reported. The number of alternating steps performed increased, indicating more complex neuromotor control and strength. Integrity of monosynaptic pathways and body composition were improved after controlling for chronological age.

Conclusions:
This study demonstrates the feasibility of using early, home-based treadmill training for infants with MMC starting within 6 months postbirth.
Physical Activity Levels of Children With Down Syndrome
Authors: Fox Bianca , Moffett Gwendolyn E. , Kinnison Clara , Brooks Grace , Case Laura E. 
Published: December 2018

Purpose:
This systematic review of literature analyzed accelerometer use to measure physical activity (PA) in individuals 21 years and younger with Down syndrome (DS).

Summary of Key Points:
Comprehensive search strategy conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight articles met inclusion criteria. Six studies reported children with DS are not meeting PA guidelines; 4 studies found intensity levels decline with age. Three studies reported children with DS engage in significantly less vigorous PA than control groups. Determination of intensity levels varied, limiting additional comparisons.

Conclusions:
Children with DS engage in less PA than peers developing typically and are not meeting PA guidelines across age groups, increasing risk for numerous health conditions secondary to decreased activity.

Recommendations for Clinical Practice:
Promotion of more appropriate levels of PA and elimination of barriers to participation in PA are important for individuals with DS.
Effects of High-Intensity Interval Training on Fitness and Health in Youth With Physical Disabilities
Authors: Zwinkels Maremka , Verschuren Olaf , de Groot Janke F. , Backx Frank J. G. , Wittink Harriet , Visser-Meily Anne , Takken Tim 
Published: December 2018

Purpose:
To investigate the effects of high-intensity interval training (HIT) on physical fitness and cardiometabolic health in youth with physical disabilities.

Methods:
For this quasi-experimental study 70 participants were recruited from schools for special education and divided into runners and users of wheelchairs. HIT was performed for 8 weeks, twice a week, containing 30 seconds all-out exercises.

Results:
Exercise adherence was 84.5%. Following HIT, there were improvements in anaerobic performance, agility, aerobic performance, and systolic and diastolic blood pressure. There were no changes in peak oxygen uptake (

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O2peak), arterial stiffness, body composition, lipid profile, and fasting glucose.

Conclusions:
Both anaerobic and aerobic performance improved after HIT, with no changes in

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O2peak. There were no effects on cardiometabolic health, except for a decrease in blood pressure.
Caspase-(8/3) activation and organ inflammation in a rat model of resuscitated hemorrhagic shock: A role for uric acid
Authors: Gilbert Kim , Rousseau Guy , Bouchard Caroline , Dunberry-Poissant Sophie , Baril Frédérique , Cardinal Anne Marie , Khazoom François , Vega Melissa Aubin , Brochiero Emmanuelle , Charbonney Emmanuel 
Published: December 2018

BACKGROUND
Multiple organ failure can develop after hemorrhagic shock (HS). Uric acid (UA) is released from dying cells and can be proinflammatory. We hypothesized that UA could be an alternative mediator of organ apoptosis and inflammation after HS.

METHODS
Ventilated male Wistar rats were used for the HS model. Two durations of shock (5 minutes vs. 60 minutes) were compared, and shams were instrumented only; animals were resuscitated and observed for 24 hours/72 hours. Caspases-(8/3), myeloperoxidase (MPO), TNF-α were measured in lungs and kidneys. Plasma UA and cytokine (IL-1β, IL-18, TNF-α) were measured. A second set of animals were randomized to vehicle versus Rasburicase intraperitoneal intervention (to degrade UA) during resuscitation. Another group received exogenous UA intraperitoneally without HS. Measures mentioned above, in addition to organs UA, were performed at 24 hours. In vitro, caspases-(8/3) activity was tested in epithelial cells exposed to UA.

RESULTS
Hemorrhagic shock increased organ (kidney and lung) TNF-α, MPO, and caspases activity in various patterns while caspase-8 remained elevated over time. Hemorrhagic shock led to increased plasma UA at 2 hours, which remained high until 72 hours; TNF-α and IL-18 were elevated at 24 hours. The exogenous UA administration in sham animals reproduced the activation of caspase-8 and MPO in organs, and TNF-α in the lung. The increased plasma and organ UA levels, plasma and lung TNF-α, as well as organ caspase-(8/3) and MPO, observed at 24 hours after HS, were prevented by the administration of Rasburicase during resuscitation. In vitro, soluble UA induced caspases-(3/8) activity in epithelial cells.

CONCLUSION
Uric acid is persistently high after HS and leads to the activation of caspases-8 and organ inflammation; these can be prevented by an intervention to degrade UA. Therefore, UA is an important biomarker and mediator that could be considered a therapeutic target during HS resuscitation in human.
Comparing short-, long-, and oblique-axis approaches to ultrasound-guided internal jugular venous catheterization: A meta-analysis of randomized controlled trials
Authors: Chen Jen-Yin , Wang Li-Kai , Lin Yao-Tsung , Lan Kuo-Mao , Loh El-Wui , Chen Chih-Heng , Tam Ka-Wai 
Published: December 2018

BACKGROUND
Internal jugular venous catheterization is performed for numerous therapeutic interventions. Although ultrasound-guided internal jugular venous catheterization is the gold standard for this procedure, complications can still occur. Various scanning axes, namely, the short axis (SA), long axis (LA), and oblique axis (OA), have been developed to ameliorate these complications. This study compared the efficacy and safety of SA, LA, and OA approaches.

METHODS
PubMed, Embase, and Cochrane Library databases were searched for studies published before September 2018. Only randomized controlled trials were included. We conducted meta-analyses using a random-effects model. Treatment efficacy was measured by total success rate, first-pass success rate, number of needle passes, and incidence of complications, namely, arterial puncture, hematoma, and catheter-related bloodstream infection.

RESULTS
Six randomized controlled trials with 621 patients were included. No significant differences were observed in total success rate and first-pass success rate, as well as in the arterial puncture, hematoma, or catheter-related bloodstream infection complications between SA and LA approaches. Moreover, no significant difference was found between SA and OA approaches in terms of total success rate, first-pass success rate, number of needle passes, and complications of arterial puncture and hematoma. However, the number of needle passes was significantly fewer in SA approach than in LA approach (weighted mean difference, −0.18; 95% confidence interval, −0.35 to −0.01).

CONCLUSION
None of the scanning axes exhibited unique features that could enhance their suitability for application. Hence, scanning axes should be selected by considering various factors that include patient characteristics, clinician expertise, and ease of procedures.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, level I.
The effectiveness of junctional tourniquets: A systematic review and meta-analysis
Authors: Smith Shane , White John , Wanis Kerollos Nashat , Beckett Andrew , McAlister Vivian C. , Hilsden Richard 
Published: December 2018

BACKGROUND
Junctional tourniquets have been incorporated into tactical combat casualty care for junctional vascular trauma. They apply external compression to stop blood flow in the groin and axilla.

OBJECTIVES
The primary outcome was effectiveness in achieving arterial occlusion. Secondary outcomes included time to application and pain scores.

DATA SOURCES
Medline and EMBASE databases were searched.

Study Appraisal and Synthesis Methods
A random-effects meta-analysis was conducted to estimate the average effectiveness and time to effective application for each device.

RESULTS
Eight studies reported the effectiveness of junctional tourniquets in healthy volunteers. The average effectiveness was 52% (95% confidence interval [CI], 15–87%) for the abdominal application of the abdominal aortic and junctional tourniquet (AAJT), 83% (95% CI, 73–89%; 26%) for the junctional Emergency Treatment Tool, 87% (95% CI, 79–92%; 15%) for the SAM junctional tourniquet (SJT), and 95% (95% CI, 90–98%) for the Combat Ready Clamp. The groin application of the AAJT was studied in two articles with 100% in both studies. The average time to application was 101 seconds for the SAM junctional tourniquet (95% CI, 50–152 seconds) and the Combat Ready Clamp (95% CI, 63–139 seconds), while it was 130 seconds (95% CI, 85–176 seconds) for the Junctional Emergency Treatment Tool. The abdominal application of AAJT had an average time to application of 92 and 171 seconds in two studies.

LIMITATIONS
All studies were conducted in healthy volunteers.

CONCLUSION AND IMPLICATIONS
Junctional tourniquets may meet a medical need in combat, and in the civilian environment, to control hemorrhage from these difficult injuries. All four Food and Drug Administration–approved devices demonstrate the ability to achieve vascular occlusion in healthy volunteers; however, effectiveness in patient transport has not been evaluated, and outcomes of their use in the field need to be captured and reported.

LEVEL OF EVIDENCE
Systematic review, level III.
Symptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery: A study of the nationwide inpatient sample
Authors: Sandler Britt J. , Davis Kimberly A. , Schuster Kevin M. 
Published: December 2018

BACKGROUND
The impact of human immunodeficiency virus (HIV) infection on outcomes following common emergency general surgery procedures has not been evaluated since the widespread introduction of highly active antiretroviral therapy.

METHODS
A retrospective cohort study was conducted using the Nationwide Inpatient Sample. Records of patients who underwent laparoscopic or open appendectomy, cholecystectomy, or colon resection after emergency admission from 2004 to 2011 were obtained. Outcomes analyzed included in-hospital mortality, length of stay, total charges, and selected postoperative complications. Patients were divided among three groups, HIV-negative controls, asymptomatic HIV-positive patients, and symptomatic HIV/acquired immune deficiency syndrome (AIDS) patients. Data were analyzed using χ2 and multivariable regression with propensity score matching among the three groups, with p value less than 0.05 significant.

RESULTS
There were 974,588 patients identified, of which 1,489 were HIV-positive and 1,633 were HIV/AIDS-positive. The HIV/AIDS patients were more likely to die during their hospital stay than HIV-negative patients (4.4% vs. 1.6%, adjusted odds ratio, 3.53; 95% confidence interval [CI], 2.67–4.07; p < 0.001). The HIV/AIDS patients had longer hospital stays (7 days vs. 3 days; adjusted difference, 3.66 days; 95% CI, 3.53–4.00; p < 0.001) and higher median total charges than HIV-negative patients (US $47,714 vs. US $28,405; adjusted difference, US $15,264; 95% CI, US $13,905–US $16,623; p < 0.001). The HIV/AIDS patients also had significantly increased odds of certain postoperative complications, including sepsis, septic shock, pneumonia, urinary tract infection, acute renal failure and need for transfusion (p < 0.05 for each). Differences persisted irrespective of case complexity and over the study period. Asymptomatic HIV-positive patients had outcomes similar to HIV-negative patients.

CONCLUSION
The HIV/AIDS patients have a greater risk of death, infectious, and noninfectious complications after emergency surgery regardless of operative complexity and despite advanced highly active antiretroviral therapy. Patients who have not developed advanced disease, however, have similar outcomes to HIV-negative patients.

LEVEL OF EVIDENCE
Prognostic and epidemiologic study, level III.
Development of a Predictive Model Using Endoscopic Features for Gastric Cytomegalovirus Infection in Renal Transplant Patients
Authors: Yeo Seong Jae , Kwon Ki Tae , Kim Eun Soo , Jung Min Kyu , Kim Sung Kook , Lee Hyun Seok , Lee Jun Seop , Lee Sang Won , Lee Yoo Jin , Kwak Sang Gyu , Han Seungyeup 
Published: December 2018

Background.
Cytomegalovirus (CMV) is a common viral pathogen in transplant patients which often targets the stomach. However, the endoscopic characteristics of gastric CMV infection are not well established. We aimed to develop a predictive model using endoscopic findings for gastric CMV infection in renal transplant patients.

Methods.
A retrospective study of 287 kidney transplant recipients who underwent endoscopy with biopsy for suspected CMV infection from January 2006 to November 2015 at a tertiary referral hospital was performed. CMV infection was defined based on inclusion bodies in hematoxylin and eosin and immunohistochemical staining. Endoscopic and clinical parameters related to gastric CMV infection were selected by univariate analyses. Multivariate logistic regression was used to create a predictive model from β-coefficients.

Results.
CMV was present in 107 (37.7%) of the 287 patients. Multivariate analysis found age (odds ratio [OR], 0.964; 95% confidence interval [CI], 0.938-0.99; P = 0.008), erosions with surface exudate (OR, 5.34; 95% CI, 2.687-10.612; P < 0.001), raised shape of erosions (OR, 3.957; 95% CI, 1.937-8.083; P < 0.001), and antral location of ulcers (OR, 15.018; 95% CI, 5.728-39.371; P < 0.001) as independent predictive factors for gastric CMV infection. Using the predictive model created from this analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71.03%, 85.56%, 74.51%, 83.24%, and 80.14%, respectively. The area under the receiver operating characteristic curve of this model for detecting CMV infection was 0.850 (95% CI, 0.803-0.889; P < 0.001).

Conclusions.
The predictive model with typical endoscopic findings may be useful for detecting gastric CMV infection in renal transplant patients.
Subclinical Antibody-mediated Rejection After Kidney Transplantation: Treatment Outcomes
Authors: Parajuli Sandesh , Joachim Emily , Alagusundaramoorthy Sayee , Blazel Justin , Aziz Fahad , Garg Neetika , Muth Brenda , Mohamed Maha , Mandelbrot Didier , Zhong Weixong , Djamali Arjang 
Published: December 2018

Background.
Antibody-mediated rejection (AMR) is a leading cause of morbidity and mortality after kidney transplantation. Early diagnosis and treatment of subclinical AMR based on the donor-specific antibody (DSA) testing may result in better outcomes.

Methods.
We tested this hypothesis in 220 kidney transplant recipients who underwent an indication or DSA-based surveillance protocol biopsies between March 1, 2013 and December 31, 2016. Patients were divided into 3 groups: clinical AMR (n = 118), subclinical AMR (n = 25), or no rejection on protocol biopsy (controls; n = 77).

Results.
Both clinical and subclinical AMR groups underwent similar treatment including plasmapheresis, pulse steroids, IVIG, and rituximab (P = ns). Mean follow-up after AMR was 29.5 ± 16.8 months. There were 2 (3%), 2 (8%), and 54 (46%) death-censored graft failures in the control, subclinical, and clinical AMR groups, respectively (P < 0.001). Graft outcomes were similar in the subclinical rejection and control groups. In adjusted Cox regression analysis, only clinical rejection (hazards ratio [HR], 4.31; 95% confidence interval [CI], 1.01-18.94; P = 0.05) and sum chronicity scores (HR, 1.16; 95% CI, 1.01-1.35; P = 0.03) were associated with increased risk of graft failure, while estimated glomerular filtration rate at time of biopsy (HR, 0.98; 95% CI, 0.96-0.99; P = 0.01) was associated with decreased risk of graft failure.

Conclusions.
Our study suggests that early diagnosis and treatment of subclinical AMR using DSA monitoring may improve outcomes after kidney transplantation.
Identification of human genetic variants controlling circular RNA expression
Authors: Ahmed Ikhlak , Karedath Thasni , Al-Dasim Fatima M. , Malek Joel A. 
Published: December 2018

AbstractCircular RNAs (circRNAs) are abundant in eukaryotic transcriptomes and have been linked to various human disorders. However, understanding genetic control of circular RNA expression is in early stages. Here we present the first integrated analysis of circRNAs and genome sequence variation from lymphoblastoid cell lines of the 1000 genomes project. We identified thousands of circRNAs in the RNA-seq data and show their association with local single nucleotide polymorphic sites, referred to as circQTLs, which influence the circRNA transcript abundance. Strikingly, we found that circQTLs exist independently of eQTLs with most circQTLs having no effect on mRNA expression. Only a fraction of the polymorphic sites are shared and linked to both circRNA and mRNA expression with mostly similar effects on circular and linear RNA. A shared intronic QTL, rs55928920, of HMSD gene drives the circular and linear expression in opposite directions, potentially modulating circRNA levels at the expense of mRNA. Finally, circQTLs and eQTLs are largely independent and exist in separate linkage disequilibrium (LD) blocks with circQTLs highly enriched for functional genomic elements and regulatory regions. This study reveals a previously uncharacterized role of DNA sequence variation in human circular RNA regulation.
Dynamically Evolving Cell Sizes During Early Development Enable Normal Gastrulation Movements In Zebrafish Embryos
Authors: Menon Triveni , Borbora Asfa Sabrin , Kumar Rahul , Nair Sreelaja 
Published: December 2018

ABSTRACTCurrent knowledge of the mechanisms of cell migration is based on differentiated cells in culture where it is known that the actomyosin machinery drives migration via dynamic interactions with the extracellular matrix and adhesion complexes. However, unlike differentiated cells, cells in early metazoan embryos must also dynamically change cell sizes as they migrate. The relevance of cell size to cell migration and embryonic development is not known. Here we investigate this phenomena in zebrafish embryos, a model system in which reductive cell divisions causes cell sizes to decrease naturally over time as cells migrate collectively to sculpt the embryonic body plan. We show that cell size reduction during early development follows power-law scaling. Because mutations that can perturb cell sizes so early in development do not exist, we generate haploid and tetraploid zebrafish embryos and show that cell sizes in such embryos are smaller and larger than the diploid norm, respectively. Cells in embryos made of smaller or larger than normal cells migrate sub-optimally, leading to gastrulation defects. Multiple lines of evidence suggest that the observed defects originate from altered cell size rather than from pleotropic effects of altered ploidy. This interpretation is strengthened by the result wherein restoring cell sizes to normal diploid-like values rescues gastrulation defects. Live imaging of chimeric embryos where haploid/tetraploid cells are introduced into diploid embryos reveal the cell-autonomous nature of the migration defects. Additionally, aberrant intracellular actin dynamics with respect to the vectorial direction of motion suggests a cellular mechanism behind the migration defects. Taken together, early reductive cell divisions potentially allow dynamic, stage-specific cell size norms to emerge, which enables efficient collective cell migration to correctly position cells in space and time to shape an amorphous ball of blastoderm into an embryo.