bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital Cytomegalovirus and HIV Perinatal Transmission
Authors: Adachi Kristina , Xu Jiahong , Ank Bonnie , Watts D. Heather , Camarca Margaret , Mofenson Lynne M. , Pilotto Jose Henrique , Joao Esau , Gray Glenda , Theron Gerhard , Santos Breno , Fonseca Rosana , Kreitchmann Regis , Pinto Jorge , Mussi-Pinhata Marisa M. , Machado Daisy Maria , Ceriotto Mariana , Morgado Mariza G. , Bryson Yvonne J. , Veloso Valdilea G. , Grinsztejn Beatriz , Mirochnick Mark , Moye Jack , Nielsen-Saines Karin 
Published: March 2018

Background:
Congenital cytomegalovirus (CMV) infection (cCMV) is an important cause of hearing loss and cognitive impairment. Prior studies suggest that HIV-exposed children are at higher risk of acquiring cCMV. We assessed the presence, magnitude and risk factors associated with cCMV among infants born to HIV-infected women, who were not receiving antiretrovirals during pregnancy.

Methods:
cCMV and urinary CMV load were determined in a cohort of infants born to HIV-infected women not receiving antiretrovirals during pregnancy. Neonatal urines obtained at birth were tested for CMV DNA by qualitative and reflex quantitative real-time polymerase chain reaction.

Results:
Urine specimens were available for 992 (58.9%) of 1684 infants; 64 (6.5%) were CMV-positive. Mean CMV load (VL) was 470,276 copies/ml (range: < 200–2,000,000 copies/ml). Among 89 HIV-infected infants, 16 (18%) had cCMV versus 42 (4.9%) of 858 HIV-exposed, uninfected infants (P < 0.0001). cCMV was present in 23.2% of infants with in utero and 9.1% infants with intrapartum HIV infection (P < 0.0001). Rates of cCMV among HIV-infected infants were 4-fold greater (adjusted OR, 4.4; 95% CI: 2.3–8.2) and 6-fold greater among HIV in utero–infected infants (adjusted OR, 6; 95% CI: 3–12.1) compared with HIV-exposed, uninfected infants. cCMV was not associated with mode of delivery, gestational age, Apgar scores, 6-month infant mortality, maternal age, race/ethnicity, HIV viral load or CD4 count. Primary cCMV risk factors included infant HIV-infection, particularly in utero infection.

Conclusion:
High rates of cCMV with high urinary CMV VL were observed in HIV-exposed infants. In utero HIV infection appears to be a major risk factor for cCMV in infants whose mothers have not received combination antiretroviral therapy in pregnancy.
Community-acquired Pneumonia With Pleural Effusion in Children and Municipal Human Development Index in Rio de Janeiro, Brazil
Authors: Land Marcelo , Maia Paula , de Fátima March Maria , Ferreira Alvaro , Sant´Anna Clemax 
Published: March 2018

Background:
This study evaluated admissions with severe community-acquired pneumonia (CAP) with pleural effusion (PE) in a pediatric university hospital and the impact of the increased average municipal human development index (M-HDI) in the local incidence of the disease in the last decade.

Methods:
This is a retrospective longitudinal study of patients (0–13 years old) with CAP. The municipal human development index (M-DHI) of the place of residence of patients was obtained. We calculate the crude odds ratios (ORs) of variables related to risk of developing PE. The variables that reached a significance level of 80% (P < 0.20) were selected for multivariate analysis. The logistic regression model was used for the selection of the parsimonious model, according to the likelihood ratio.

Results:
The 465 patients’ ages ranged from 1 to 174 months. The median of age (months) in children with PE was 36.00; in children without the PE was 29.00 (P < 0.011); media of variation in M-HDI in the period in patients with PE was 0.767 ± 0.002 and in patients without PE was 0.778 ± 0.002 (P < 0.001). In the logistic regression model, the absence of comorbidity (OR = 2.909) and the HDI < 0.770 (OR = 3.015) were predictive factors associated with PE.

Conclusion:
The progressive increase of the M-DHI during the study period, although to a slightly higher level, was correlated with the reduction in the number of admissions with CAP with PE.
Cost-effectiveness of CI in developing countries
Authors: Magro Isabelle , Emmett Susan D. , Saunders James 
Published: March 2018

Purpose of review
Cost-effectiveness of cochlear implants is a major concern for expanding these services to low-income and middle-income developing countries.

Recent findings
Recent studies have applied appropriate methodology to make determination of cost-effectiveness for cochlear implants in developing countries. In addition, important parameters that effect cost-effectiveness have been reviewed in a systematic way. The combination of these new studies along with existing reports of cochlear implant programmes in developing countries allows for a discussion of cost and outcomes determinants that drive cost-effectiveness in these environments.

Summary
Cochlear implants are a very cost-effective treatment for profound hearing loss in all high-resource countries and in many low-income and middle-income developing countries. A number of cost considerations affect cost-effectiveness of cochlear implants in developing countries including device cost and device-related expenses such as power consumption and reliability, but also including rehabilitation and access-related expenses. Large-scale programmes confer an advantage for cost-effectiveness, primarily through device-related savings.
The “Double Whammy”: Women's Experiences of Weight Gain After Diagnosis and Treatment for Schizophrenia Spectrum Disorders
Authors: Haracz Kirsti , Hazelton Michael , James Carole 
Published: March 2018

AbstractHigh levels of lifestyle risk factors compound medication side effects, resulting in high rates of obesity among people with schizophrenia spectrum disorders (SSDs). Obesity and related comorbidities increase the levels of disability and disadvantage in this population. Little research has explored the lived experiences in relation to this issue, and less has considered the experiences of women. Our aim in this study was to understand the experiences of women who gained weight after their diagnosis and treatment for SSDs. We carried out up to three in-depth qualitative interviews with 11 women over 2 years. Data were analyzed using constructivist grounded theory procedures. The women described a “double whammy”–like experience whereby weight gain and obesity came with their diagnosis and treatment of an SSD and brought with it additional challenges. The double whammy parallels the co-occurrence of mental illness and substance misuse. Implications of these parallels for service provision are discussed.
Biomedical Research Priorities for Modern Syphilis Clinical Management, Diagnosis, and Vaccines: Overview and Commentary for Unit 1
Authors: Kersh Ellen N. , Lukehart Sheila A. 
Published: March 2018

Abstract
The first session at the 2016 Syphilis Summit provided an opportunity for laboratory researchers and clinicians to comment on gaps in biomedical knowledge and technologies. Predominant themes in the presentations and discussion included the need for optimization of existing diagnostic tests, commercial availability, and Food and Drug Administration approval of nucleic acid amplification tests for primary and secondary syphilis, development of sensitive and specific new blood tests for diagnosis of active (vs treated) syphilis infection, clarification of the best measures for adequacy of response to treatment, continued study of complications of syphilis, including neurosyphilis and ocular syphilis, and development of a safe and effective vaccine that will protect against transmission and complications of disseminated infection (including congenital and neurosyphilis). Renewed and sustained support of biomedical syphilis research and an influx of talent could move the needle in the fight against this reemerging ancient disease.
Syphilis Vaccine Development: Requirements, Challenges, and Opportunities
Authors: Cameron Caroline E. 
Published: March 2018

Abstract
Syphilis, caused by the spirochete Treponema pallidum subspecies pallidum, continues to be a prevalent disease in low- and middle-income countries, and has reemerged in key populations, including men who have sex with men, in high-income nations. The rising number of cases shows that syphilis elimination will require augmentation of public health screening and treatment campaigns with syphilis vaccine development and implementation initiatives. Optimal vaccine candidates, deciphered from careful consideration of the pathogenic mechanisms used by T. pallidum, will need to be paired with appropriate human-track adjuvants designed to elicit the correlates of protection needed to prevent infection/disease. This article provides an overview of the development pipeline customized for a syphilis vaccine, including the preferred product characteristics, the investment case, and a proposed vaccinogen selection strategy outlining the essential qualities that need to be targeted by a syphilis vaccine.
Acceptability and Feasibility of Rapid Chlamydial, Gonococcal, and Trichomonal Screening and Treatment in Pregnant Women in 6 Low- to Middle-Income Countries
Authors: Shannon Chelsea Lee , Bristow Claire , Hoff Nicole , Wynn Adriane , Nguyen Minh , Medina-Marino Andrew , Cabeza Jeanne , Rimoin Anne , Klausner Jeffrey D. 
Published: March 2018

Background

Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) infections during pregnancy are linked with adverse birth outcomes. However, few countries have prenatal CT, NG, or TV screening programs. In this study, we aimed to evaluate the acceptability and feasibility of CT, NG, and TV screening and treatment among pregnant women across 6 low- to middle-income countries.

Methods
A total of 1817 pregnant women were screened for CT, NG, and TV in Botswana, the Democratic Republic of Congo, Haiti, South Africa, and Vietnam. An additional 640 pregnant women were screened for CT in Peru. Screening occurred between December 2012 and October 2017. Acceptability of screening was evaluated at each site as the proportion of eligible women who agreed to participate in screening. Feasibility of treatment was calculated as the proportion of women who tested positive that received treatment.

Results
Acceptability of screening and feasibility of treatment was high across all 6 sites. Acceptability of screening ranged from 85% to 99%, and feasibility of treatment ranged from 91% to 100%.

Discussion
The high acceptability and feasibility of screening and treatment of CT, NG, and TV among pregnant women supports further research to evaluate the cost-effectiveness of prenatal CT, NG, and TV screening programs.
Reactor Grids for Prioritizing Syphilis Investigations: Are Primary Syphilis Cases Being Missed?
Authors: Cha Susan , Matthias James M. , Rahman Mohammad , Schillinger Julia A. , Furness Bruce W. , Pugsley River A. , Kidd Sarah , Bernstein Kyle T. , Peterman Thomas A. 
Published: March 2018

Background
Health departments prioritize investigations of reported reactive serologic tests based on age, gender, and titer using reactor grids. We wondered how reactor grids are used in different programs, and if administratively closing investigations of low-titer tests could lead to missed primary syphilis cases.

Methods
We obtained a convenience sample of reactor grids from 13 health departments. Interviews with staff from several jurisdictions described the role of grids in surveillance and intervention. From 5 jurisdictions, trends in reactive nontreponemal tests and syphilis cases over time (2006–2015) were assessed by gender, age, and titer. In addition, nationally-reported primary syphilis cases (2013–2015) were analyzed to determine what proportion had low titers (≤1:4) that might be administratively closed by grids without further investigation.

Results
Grids and follow-up approaches varied widely. Health departments in the study received a total of 48,573 to 496,503 reactive serologies over a 10-year period (3044–57,242 per year). In 2006 to 2015, the number of reactive serologies increased 37% to 169%. Increases were largely driven by tests for men although the ratios of tests per reported case remained stable over time. Almost one quarter of reported primary syphilis had low titers that would be excluded by most grids. The number of potentially missed primary syphilis cases varied by gender and age with 41- to 54-year-old men accounting for most.

Conclusions
Reactor grids that close tests with low titers or from older individuals may miss some primary syphilis cases. Automatic, computerized record searches of all reactive serologic tests could help improve prioritization.
Reduction in Mortality Following Pediatric Rapid Response Team Implementation*
Authors: Kolovos Nikoleta S. , Gill Jeff , Michelson Peter H. , Doctor Allan , Hartman Mary E. 
Published: March 2018

Objective:
To evaluate the effectiveness of a physician-led rapid response team program on morbidity and mortality following unplanned admission to the PICU.

Design:
Before-after study.

Setting:
Single-center quaternary-referral PICU.

Patients:
All unplanned PICU admissions from the ward from 2005 to 2011.

Interventions:
The dataset was divided into pre- and post-rapid response team groups for comparison.

Measurements and Main Results:
A Cox proportional hazards model was used to identify the patient characteristics associated with mortality following unplanned PICU admission. Following rapid response team implementation, Pediatric Risk of Mortality, version 3, illness severity was reduced (28.7%), PICU length of stay was less (19.0%), and mortality declined (22%). Relative risk of death following unplanned admission to the PICU after rapid response team implementation was 0.685.

Conclusions:
For children requiring unplanned admission to the PICU, rapid response team implementation is associated with reduced mortality, admission severity of illness, and length of stay. Rapid response team implementation led to more proximal capture and aggressive intervention in the trajectory of a decompensating pediatric ward patient.
Survival and Long-Term Functional Outcomes for Children With Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation
Authors: Torres-Andres Francesc , Fink Ericka L. , Bell Michael J. , Sharma Mahesh S. , Yablonsky Eric J. , Sanchez-de-Toledo Joan 
Published: March 2018

Objectives:
To identify patient- and disease-related factors related to survival and favorable outcomes for children who underwent extracorporeal cardiopulmonary resuscitation after a refractory cardiac arrest.

Design:
Retrospective observational study with prospective assessment of long-term functional outcome.

Patients:
Fifty-six consecutive children undergoing extracorporeal cardiopulmonary resuscitation at our institution from 2007 to 2015. Median age at arrest was 3.5 months (interquartile range, 1–53).

Setting:
Tertiary pediatric university hospital with a referral heart center.

Interventions:
Health-related quality of life and family functioning assessment with the Pediatric Quality of Life Inventory and the McMaster Family Assessment Device.

Measurements and Main Results:
Fifty-eight consecutive extracorporeal cardiopulmonary resuscitation episodes were included, with 46 (79.3%) related to primary cardiac conditions. Initial cannulation site was central in 19 (32.8%) and peripheral in 39 (67.2%). Survival to decannulation was 77.6% with survival at hospital discharge and at the end of the follow-up period being 65.5% and 62.1%, respectively. Time to follow-up was 38 months (interquartile range, 19–52). Patients who survived tended to be younger (3.5 mo [1 mo to 2 yr] vs 7 mo [1.25 mo to 17 yr]; p = 0.3) with decreased extracorporeal cardiopulmonary resuscitation times (28 min [15–47 min] vs 37.5 min [28.5–55 min]; p = 0.04). Those who received therapeutic hypothermia tended to have higher hospital survival (21/28 [75%] vs 16/29 [55%]; p = 0.08). Follow-up assessments of survivors demonstrated good quality of life and family functioning (Pediatric Quality of Life Inventory, 84 [76–89.5]; McMaster Family Assessment Device, 1.62 [1.33–1.83]).

Conclusions:
In this series, extracorporeal cardiopulmonary resuscitation was associated with relatively high survival rates and a good health-related quality of life and family functioning. Larger series are needed to assess whether this technique should be more broadly available in the pediatric critical care community.
Hospital Variation in Intensive Care Resource Utilization and Mortality in Newly Diagnosed Pediatric Leukemia*
Authors: Fitzgerald Julie C. , Li Yimei , Fisher Brian T. , Huang Yuan-Shung , Miller Tamara P. , Bagatell Rochelle , Seif Alix E. , Aplenc Richard , Thomas Neal J. 
Published: March 2018

Objectives:
To evaluate hospital-level variability in resource utilization and mortality in children with new leukemia who require ICU support, and identify factors associated with variation.

Design:
Retrospective cohort study.

Setting:
Children’s hospitals contributing to the Pediatric Health Information Systems administrative database from 1999 to 2011.

Patients:
Inpatients less than 25 years old with newly diagnosed acute lymphocytic leukemia or acute myeloid leukemia requiring ICU support (n = 1,754).

Interventions, Measurements, and Main Results:
Evaluated exposures included leukemia type, year of diagnosis, and hospital-wide proportion of patients with public insurance. The main outcome was hospital mortality. Wide variability existed in the ICU resources used across hospitals. Combined acute lymphocytic leukemia and acute myeloid leukemia mortality varied by hospital from 0% (95% CI, 0–14.8%) to 42.9% (95% CI, 17.7–71.1%). A mixed-effects model with a hospital-level random effect suggests significant variation across hospitals in mortality (p = 0.007). When including patient and hospital factors as fixed effects into the model, younger age, acute myeloid leukemia versus acute lymphocytic leukemia diagnosis, leukemia diagnosis prior to 2005, hospital-wide proportion of public insurance patients, and hospital-level proportion of leukemia patients receiving ICU care are significantly associated with mortality. The variation across hospitals remains significant with all patient factors included (p = 0.021) but is no longer significant after adjusting for the hospital-level factors proportion of public insurance and proportion receiving ICU care (p = 0.48).

Conclusions:
Wide hospital-level variability in ICU resource utilization and mortality exists in the care of children with leukemia requiring ICU support. Hospital payer mix is associated with some mortality variability. Additional study into how ICU support could be standardized through clinical practice guidelines, impact of payer mix on hospital resources allocation to the ICU, and subsequent impact on patient outcomes is warranted.
Cognitive Impairment in Fibromyalgia: A Meta-Analysis of Case–Control Studies
Authors: Wu Yu-Lin , Huang Chun-Jen , Fang Su-Chen , Ko Ling-Hsin , Tsai Pei-Shan 
Published: March 2018

ABSTRACT

Objective
Cognitive dysfunction has been reported in individuals with fibromyalgia. However, findings regarding cognitive function examined using neuropsychological tests have been inconsistent. The aim of the study was to determine domain-specific cognitive impairment in patients with fibromyalgia compared with healthy controls.

Methods
We conducted a meta-analysis that systematically searched six databases (PubMed, Ovid MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) for articles published before September 2017.

Results
Twenty-three case–control studies with a total of 2096 participants were included in the meta-analysis. Cognitive function was significantly lower (g = 0.87, 95% confidence interval [CI] = 0.60–1.15) in individuals with fibromyalgia than in healthy controls. Large effect sizes were found in learning/memory and attention/psychomotor speed (g = 0.94, p = .013; g = 1.22, p < .001, respectively); medium effect sizes were reported in executive function and working memory (g = 0.72, p < .001; g = 0.75, p < .001, respectively). Depression and anxiety scores were associated with the effect size of group differences in cognitive function (B = 0.11, p < .001, 95% CI = 0.09–0.13; B = 0.02, p < .001, 95% CI = 0.01–0.02, respectively).

Conclusions
Cognitive impairment across different cognitive domains was found in individuals with fibromyalgia compared with healthy controls. Mood states (depression and anxiety) may explain the heterogeneity across studies.
A Preliminary Study of Computed Tomography Coronary Angiography Within a Single Cardiac Cycle in Patients With Atrial Fibrillation Using 256-Row Detector Computed Tomography
Authors: Wen Bo , Xu Lei , Liang Junfu , Fan Zhanming , Sun Zhonghua 
Published: March 2018

Objective
The purpose of this study was to evaluate the image quality and radiation dose of computed tomography (CT) coronary angiography using a 256-row detector CT scanner in a single cardiac cycle in patients with atrial fibrillation (AF).

Methods
Seventy consecutive patients (41 men and 29 women; age range was from 37 to 84 years, mean age was 61.7 ± 10.2 years; body mass index range was from 15.08 to 36.45 kg/m2, mean body mass index was 25.9 ± 3.5 kg/m2) with persistent or paroxysmal AF during acquisition, who were not receiving any medications for heart rate (HR) regulation, were imaged with a 256-row detector CT scanner (Revolution CT, GE healthcare). According to the HR or HR variability (HRV) the patients were divided into 4 groups: group A (HR, ≥75 bpm; n = 36), group B (HR, <75 bpm; n = 34), group C (HRV, ≥50 bpm; n = 26), and group D (HRV, <50 bpm; n = 44). The snapshot freeze algorithm reconstruction was used to reduce motion artifacts whenever necessary. Two experienced radiologists, who were blinded to the electrocardiograph and reconstruction information, independently graded the CT images in terms of visibility and artifacts with a 4-grade rating scale (1, excellent; 2, good; 3, poor; 4, insufficient) using the 18-segment model. Subjective image quality scores and effective dose (ED) were calculated and compared between these groups.

Results
The HR during acquisition ranged from 47 to 222 bpm (88.24 ± 36.80 bpm). A total of 917 in 936 coronary artery segments were rated as diagnostically evaluable (98.2 ± 0.04%). There was no significant linear correlation between mean image quality and HR or HRV (P > 0.05). Snapshot freeze reconstruction technique was applied in 28 patients to reduce motion artifacts and thus showed image quality was improved from 93.2% to 98.4%. The ED was 3.05 ± 2.23 mSv (0.49–11.86 mSv) for all patients, and 3.76 ± 2.22 mSv (0.92–11.17 mSv), 2.30 ± 2.02 mSv (0.49–11.86 mSv), 3.89 ± 2.35 mSv (1.18–11.86 mSv), and 2.56 ± 2.03 mSv (0.49–11.17 mSv) for groups A, B, C, and D, respectively. There were significant differences in mean ED between groups A and B, as well as C and D (P <0.05).

Conclusions
This study shows that CT coronary angiography with use of a new 256-row detector CT in single cardiac cycle achieves diagnostic image quality but with lower radiation dose in patients with AF. Heart rate or HRV has no significant effect on image quality.