bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital Media and Autism Spectrum Disorders: Review of Evidence, Theoretical Concerns, and Opportunities for Intervention
Authors: Lane Rebecca , Radesky Jenny 
Published: April 2019

ABSTRACT:
As the digital media landscape becomes more complex, individualized, and interactive, pediatric providers often find themselves asked to be the source of guidance for children with developmental and behavioral conditions such as autism spectrum disorder (ASD). In this brief report, we review the current literature that exists regarding the use of traditional media (e.g., TV, video games) in children with ASD. We then outline a conceptual framework to describe the interaction between ASD-specific developmental and behavioral vulnerabilities and the aspects of new media (e.g., mobile devices, interactive apps, streaming video services) that could lead to problematic media use. This conceptual framework is then applied to clinical implications for how to prevent and manage problematic media usage in ASD and how to use modern media as tools to support optimal development.
Patient-reported outcome measures in benign gynecologic surgery: updates and selected tools
Authors: Traylor Jessica , Chaudhari Angela , Tsai Susan , Milad Magdy P. 
Published: April 2019

Purpose of review
Use of patient-reported outcome measures in clinical practice and research is becoming more prevalent and reflects initiatives to center the patient in healthcare delivery and outcomes assessment. The purpose of this review is to provide a summary description of selected, validated tools used to assess outcomes related to several benign gynecologic conditions: abnormal uterine bleeding, fibroids and endometriosis.

Recent findings
Given the availability of several validated instruments to assess patient outcomes in benign gynecology, there is still significant heterogeneity in tools used in trials.

Summary
Patient outcomes assessment should be an integral part of clinical practice and research in order to treat the whole patient and address any health-related impacts on quality of life. More attention is needed to increase standardization of tools used in research to facilitate assessment of comparative efficacy between treatments.
Sex, Age, Race/Ethnicity, Veteran Status, and the Likelihood of Reporting Cardiovascular Conditions in the National Health Interview Survey
Authors: Hinojosa Ramon 
Published: April 2019

Background
This study explores the likelihood of reporting the presence of cardiovascular health conditions in the National Health Interview Survey, with a focus on the moderating effects of veteran status, race/ethnicity, age, sex, and functional status.

Method
Data from the 2012–2015 National Health Interview Survey examine 5 cardiovascular health conditions/risk factors (hypertension, coronary heart disease, heart conditions, stroke, and heart attack).

Results
Age, sex, and functional status moderate the relationship between veteran status and cardiovascular conditions. Veterans who are younger (veteran × age) have a higher risk of reporting 1 cardiovascular condition compared with veterans who are older (relative risk [RR], 0.99; 95% confidence interval [CI], 0.99–0.99). Veterans with functional limitations (veteran × functional status) are at a lower risk of reporting 3 or more cardiovascular conditions compared with veterans with no functional limitations (RR, 0.73; 95% CI, 0.56–0.95). Interaction variables in the model (veteran × sex) show that female veterans had a higher risk than did female non-veterans of reporting 3 or more cardiovascular conditions compared with male veterans versus male non-veterans (RR, 0.71; 95% CI, 0.53–0.95). Race/ethnicity does not moderate the likelihood of reporting cardiovascular disease conditions in this sample.

Conclusion
This study demonstrates that previous military service is linked to the reporting of cardiovascular disease conditions by using nationally representative data to examine the moderating effects of veteran status on the relationship between race/ethnicity, sex, functional status, and age and cardiovascular disease for veterans living in the general US population. The findings suggest a waning healthy soldier effect for the youngest American veterans and indicate that female veterans' cardiovascular health is at greatest risk.
Acute renal impairment in older adults treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction
Authors: Khoury Shafik , Margolis Gilad , Rozenbaum Zach , Rozenfeld Keren-Lee , Keren Gad , Shacham Yacov 
Published: April 2019

Background
Elderly individuals ( ≥ 75 years) constitute an increasing proportion of patients presenting with myocardial infarction treated with primary percutaneous coronary intervention (PCI), but only limited data are available regarding the incidence and prognostic implications of acute kidney injury (AKI) in this group of patients.

Objective
To evaluate the incidence and prognostic implications of AKI in older adults ( ≥ 75 years) with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI.

Patients and methods
A retrospective cohort, observational, single-center study of consecutive 416 older patients with STEMI (≥ 75 years) treated with primary PCI between January 2008 and August 2017 was conducted. AKI was defined as an increase of at least 0.3 mg/dl in serum creatinine within 48 h following admission.

Results
A total of 96/416 (23%) patients developed AKI. The occurrence of AKI was associated with adverse in-hospital outcomes, higher 30 days (25 vs. 6%; P < 0.001), and long-term mortality (46 vs. 17%; hazard ratio: 3.2; 95% confidence interval: 2.1–4.7; P < 0.001). Among patients with AKI, 46/96 (48%) demonstrated recovery of renal function at hospital discharge. Lack of renal function recovery at discharge (50/96 patients; 52%) was associated with the occurrence of new or progression of baseline chronic kidney disease.

Conclusion
Among older patients with STEMI undergoing primary PCI, AKI is a frequent complication associated with adverse renal short-term and long-term outcomes.
Evaluation of bone health in patients with adrenal tumors
Authors: Athimulam Shobana , Bancos Irina 
Published: April 2019

Purpose of review
Adrenal tumors occur in 5% of population with higher prevalence in elderly. Patients with adrenal tumors present with overt hormonal excess in up to 15% of cases, and mild autonomous cortisol secretion in 30–40% of cases. Overt Cushing syndrome, mild autonomous cortisol secretion, pheochromocytoma, and primary aldosteronism have been associated with higher cardiovascular morbidity and mortality. Increasing experimental and clinical evidence also suggests that adrenal hormone excess is detrimental to bone health. This review aims to discuss the effect of cortisol, aldosterone, and catecholamine excess on bone metabolism, secondary osteoporosis, and fragility fractures.

Recent findings
Several studies have reported that patients with hormonally active adrenal tumors demonstrate increased prevalence of fragility fractures incongruous to bone density scan findings. The utility of dual absorptiometry X-ray (DXA) in diagnosing secondary osteoporosis is unclear in patients with cortisol, aldosterone, and catecholamine excess. Trabecular bone score and bone turn over markers could serve as potential diagnostic tools in assessment of severity of bone disease in patients with hormonally active adrenal tumors.

Summary
Adrenalectomy is the mainstay of therapy in patients with overt hormone production. Appropriate case detection strategies to identify patients at risk of fragility fractures are needed in patients not treated with adrenalectomy, such as bilateral primary aldosteronism and mild autonomous cortisol secretion.
Improved outcomes with surgery compared to radiofrequency ablation in the treatment of resectable hepatocellular carcinoma
Authors: Ruff Samantha M. , Khader Adam , Conte Charles , Kadison Alan , Sullivan James , Wang John , Zaidi Raza , Deutsch Gary B. 
Published: April 2019

BackgroundWhile overall cancer incidence and mortality have decreased over the last decade, hepatocellular carcinoma (HCC) cases have increased sharply.ObjectiveThis study set out to evaluate the utility of surgery for resectable single tumor HCC in this setting.Patients and methodsThis study analyzed the National Cancer Database, selecting all patients with a histological diagnosis of HCC and an isolated tumor (≤5 cm) treated with radiofrequency ablation (RFA) or surgical resection.ResultsA total of 7821 patients were identified for this study. In the patients with a single tumor up to 3 cm, 40% had a surgical resection and 60% had RFA. In the group with a tumor 3.01–5 cm, 62% had a surgical resection and 38% had RFA. Patients with a single tumor up to 5 cm had a 3-year survival of 60% after resection compared to 42% with RFA. When the patients were split into those with a tumor up to 3 cm or a tumor 3.01–5 cm, there was a survival benefit in the surgical resection cohort.ConclusionSurgical resection may be underutilized in the USA for resectable HCC, especially in patients with a tumor up to 3 cm.
Pediatric lung transplantation: supply and demand
Authors: Benoit Tobias M. , Benden Christian 
Published: April 2019

Purpose of review
Lung transplantation has become an accepted therapy in infants, children, and adolescents suffering from end-stage lung diseases, an impaired quality of life and reduced life expectancy. The aim of this review is to highlight specific aspects of pediatric lung transplantation and to give an update on recent findings.

Recent findings
Currently, over 100 lung transplant procedures are performed in children annually worldwide. Long-term success is limited by availability of donor organs and waitlist mortality pretransplant, and an increased infection risk because of immunosuppression, and most importantly late complications, such as chronic lung allograft dysfunction, medication nonadherence, and transition intricacies.

Summary
Specific aspects of pediatric lung transplantation will be reviewed and an update on most recent developments in the management of pediatric lung transplant recipients given.
The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation
Authors: Su Jennifer A. , Baxter-Lowe Lee Ann , Kantor Paul F. , Szmuszkovicz Jacqueline R. , Menteer JonDavid 
Published: April 2019

Purpose of review
Outcomes after cardiac transplantation have improved over past decades, but long-term graft survival remains limited in part because of uncertainty regarding clinical implications of donor-specific antibodies (DSAs). The purpose of this review is to consolidate recent advances in knowledge on the topic of DSA and their potential to impact long-term prognosis after heart transplantation.

Recent findings
The presence of persistent DSA increases the risk of poor outcome after heart transplantation, including development of antibody-mediated rejection (AMR), graft failure, cardiac allograft vasculopathy, and mortality. Importantly, different DSA vary in clinical significance. DSA capable of activating the complement cascade portend a higher risk of developing AMR. human leukocyte antigen class I and class II antigens are expressed differently within the heart, and so, clinical manifestations of class I and class II DSA vary accordingly. Further, compared with class I, class II DSA carry an increased risk of graft loss and mortality. When comparing preexisting DSA with formation of de-novo DSA, de-novo DSA are associated with worse outcome.

Summary
DSAs are generally associated worse long-term prognosis after heart transplantation but vary in their clinical significance. Recognition of specific risk profiles is essential for guiding posttransplant antibody management.
Describing Nurse Manager Role Preparation and Competency: Findings From a National Study
Authors: Warshawsky Nora , Cramer Emily 
Published: April 2019

OBJECTIVE
The aim of this study was to describe the role preparation and competency development of nurse managers.

BACKGROUND
Approximately 70 000 nurses are retiring annually. This represents a significant loss of nursing leadership wisdom. Few systematic studies of nurse manager role preparation and competency development have been conducted.

METHODS
An electronic survey was completed by a national sample of 647 nurse managers managing 964 patient care units in 54 hospitals.

RESULTS
Findings suggest that nurse managers rate themselves as competent for the 1st 6 years as a nurse manager. They begin to reach proficiency by year 7. Experience had the strongest association with nurse manager competence, followed by graduate leadership education.

CONCLUSIONS
Nurse executives need to evaluate the bench strength of their nursing leadership talent pool. They need to develop policies and strategies that promote nurse manager competence.
Early Recognition and Treatment of Acute Disseminated Encephalomyelitis in Pediatrics
Authors: George Tikku , Basin Alice , Avva Usha , Taylor Molly , Muhammed Jibran , Ogedegbe Chinwe 
Published: April 2019

Objective
Our aim is to emphasize the varied presentation of acute disseminated encephalomyelitis (ADEM) to help health care professionals improve recognition of the disease in a timely manner, thereby allowing for the selection of an appropriate treatment regimen. Therefore, this may avoid neurocognitive consequences and the ultimate fatality of the patient.

Patients and Methods
This is a retrospective case series involving 7 cases of children presenting to the Pediatric Emergency Department of Hackensack University Medical Center who were ultimately diagnosed with ADEM.

Results
In many of the cases, a preceding viral-like illness with nonspecific symptomatology made it difficult to accurately establish an initial diagnosis. Ultimately, the neurologic symptoms spontaneously resolved or improved with administration of high-dose steroids.

Conclusions
Children presenting to the emergency department with nonspecific symptoms associated with any neurological deficits should undergo further investigation using magnetic resonance imaging and lumbar puncture to rule out rare yet possibly fatal diseases such as ADEM.
ART in HIV-Positive Persons With Low Pretreatment Viremia: Results From the START Trial
Authors: Sereti Irini , Gulick Roy M. , Krishnan Sonya , Migueles Stephen A. , Palfreeman Adrian , Touzeau-Römer Veronique , Belloso Waldo H. , Emery Sean , Law Matthew G. ,   for the INSIGHT START Study Group
Published: April 2019

Background:
The benefit of immediate antiretroviral therapy (ART) at CD4 >500 cells/μL was established in the Strategic Timing of Antiretroviral Treatment (START) study. The benefits and risks of immediate ART in participants with low pretreatment viremia, including virologic suppressors, were further assessed.

Setting:
Randomized prospective international study.

Methods:
START participants with enrollment viremia <3000 c/mL were included. We compared clinical outcomes (grade 4 adverse events, hospitalizations, or death), plasma viremia, CD4 counts, and changes in biomarkers in immediate versus deferred ART groups.

Results:
Participants (N = 1134 including 93 with viremia ≤50 c/mL) had a median age of 37 years, 40% were women, and median CD4 was 713 cells/µL. Ninety-seven percent in the immediate and 29% in the deferred arm initiated ART at a median of 6 and 699 days, respectively. Clinical outcomes were experienced in 64 versus 61 patients in immediate and deferred arms (hazard ratio 1.10, 95% confidence interval: 0.77 to 1.56). The CD4 count difference was 125 cells/µL at 12 and 235 cells/µL at 36 months higher in the immediate versus deferred groups. D-dimer and VCAM levels decreased, and C-reactive protein increased, in the immediate arm at month 8. No significant changes in CD4 counts or biomarkers were observed in persons who maintained spontaneous virologic suppression.

Conclusions:
START participants with low enrollment viremia experienced higher CD4 counts, greater proportion with suppressed viremia, and decreases in D-dimer levels on immediate ART despite the lack of difference in serious clinical outcomes. These data support immediate ART in people with low viremia, although equipoise remains for suppressors.
Metabolic immunomodulation of macrophage functional plasticity in nonhealing wounds
Authors: Anders Catherine B. , Lawton Tyler M.W. , Ammons Mary Cloud B. 
Published: April 2019

Purpose of review
Despite modern advances in medicine, nonhealing wounds are the number one cause of nontraumatic, lower-limb amputation. Nonhealing wounds are characterized by a healing process stalled between inflammation and tissue remodel/repair, a stage characterized by a shift in macrophage functional phenotype. Characterization of diversity in macrophage functional phenotype in wounds and metabolic contributions to macrophage polarization are discussed.

Recent findings
Macrophage functional diversity in phenotype has recently evolved from duality (classically activated, pro-inflammatory M1 and alternatively activated, anti-inflammatory M2) to include an additional four alternately activated subphenotypes (M2a, M2b, M2c and M2d). Metabolic pathway utilization shifts characterize macrophage polarization with resulting metabolic and immune outcomes impacting host–pathogen interactions during wound healing.

Summary
Recognition of the key role macrophage diversity plays in wound healing, along with better characterization of diverse macrophage phenotypes, will inform our understanding of pathogenicity in wound healing. Comprehensive profiling of the metabolism regulating macrophage polarization and host–pathogen interaction creates opportunity of discovery for innovative new diagnostics and therapeutics for treating nonhealing wounds.
Single-Institution, Multidisciplinary Experience of Soft Tissue Sarcomas in the Chest Wall
Authors: Kuwahara Hiroaki , Salo Juho , Nevala Riikka , Tukiainen Erkki 
Published: April 2019

Introduction
We report our single-institution, multidisciplinary experience of nearly 20 years of working on chest wall soft tissue sarcoma cases. The aim of this study was to evaluate clinical outcomes in patients with chest wall soft tissue sarcoma.

Materials and Methods
A retrospective review of 49 surgically treated patients with chest wall soft tissue sarcoma was conducted from 1997 to 2015.

Results
The median age of the patients was 57.0 years. There were 19 full-thickness and 30 partial-thickness resections. Reconstruction was warranted in 37 cases. Sarcomas were high grade in 31 (63.3%) and low grade in 18 (36.7%) cases. Local recurrence developed in 8 and metastasis in 9 patients. No 30-day mortality occurred. By the end of the study period, 35 patients were alive and 14 had died. The 1-, 5-, and 10-year survival rates were 93.8%, 76.0%, and 71.6%, whereas the overall recurrence-free rates were 84.4%, 70.7%, and 70.7% respectively. Favorable prognostic variables for survival included age <50 years and radical treatment (resection with wide margin or resection with marginal margin and adjuvant radiotherapy). Patients who had undergone nonradical treatment had a 3.1-fold lower chance of survival than did those who had undergone radical treatment (95% confidence interval, 0.96–10.12; P = 0.06).

Conclusions
Our study suggests that surgical resection with wide margins should continue to be the mainstay for patients with chest wall sarcoma. Even extensive chest wall resections and reconstructions are safe. If wide margins are not achieved, (neo)adjuvant radiotherapy should be considered to improve local control.
Patient Behaviors and Characteristics Related to Weight Regain After Roux-en-Y Gastric Bypass
Authors: King Wendy C. , Belle Steven H. , Hinerman Amanda S. , Mitchell James E. , Steffen Kristine J. , Courcoulas Anita P. 
Published: April 2019

Objective:
To identify patient behaviors and characteristics related to weight regain after Roux-en-Y gastric bypass surgery (RYGB).

Background:
There is considerable variation in the magnitude of weight regain after RYGB, highlighting the importance of patient-level factors.

Methods:
A prospective cohort study of adults who underwent bariatric surgery in 6 US cities between 2006 and 2009 included presurgery, and 6-month and annual assessments for up to 7 years. Of 1573 eligible participants, 1278 (81%) with adequate follow-up were included (80% female, median age 46 years, median body mass index 46 kg/m2). Percentage of maximum weight lost was calculated each year after weight nadir.

Results:
Weight was measured a median of 8 (25th–75th percentile, 7–8) times over a median of 6.6 (25th–75th percentile, 5.9–7.0) years. β coefficients, that is, the mean weight regain, compared with the reference, and 95% confidence interval, are reported. Postsurgery behaviors independently associated with weight regain were: sedentary time [2.9% (1.2–4.7), for highest vs lowest quartile], eating fast food [0.5% (0.2–0.7) per meal/wk], eating when feeling full [2.9% (1.2–4.5)], eating continuously [1.6% (0.1–3.1)], binge eating and loss-of-control eating [8.0% (5.1–11.0) for binge eating; 1.6 (−0.1 to 3.3) for loss of control, vs neither], and weighing oneself <weekly [4.2% (2.9–5.4)]. Postsurgery characteristics independently associated with greater weight regain included: younger age, venous edema, poorer physical function, and more depressive symptoms.

Conclusion:
Several behaviors and characteristics associated with greater weight regain were identified, which inform integrated healthcare approaches to patient care and identify high-risk patients to improve long-term weight loss maintenance after RYGB.
The Cost of Postoperative Complications and Economic Validation of the Comprehensive Complication Index
Authors: de la Plaza Llamas Roberto , Hidalgo Vega Álvaro , Latorre Fragua Raquel A. , López Marcano Aylhín J. , Medina Velasco Aníbal A. , Díaz Candelas Daniel A. , García Gil José M. , Ramia Ángel José M. 
Published: April 2019

Objective:
To validate the Comprehensive Complication Index (CCI) via an assessment of its relation to postoperative costs.

Background:
The CCI summarizes all the postoperative complications graded by the Clavien-Dindo classification (CDC) on a numerical scale. Its relation to hospital costs has not been validated to date.

Methods:
Prospective observational cohort study, including all patients undergoing surgery at a general surgery service during the 1-year study period. All complications graded with the CDC and CCI and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. The surgeries were classified according to their Operative Severity Score (OSS) and in 4 groups of homogeneous surgeries. All postoperative costs were recorded.

Results:
In all, 1850 patients were included, of whom 513 presented complications (27.7%). The CDC and the CCI were moderately to strongly correlated with overall postoperative costs (OPCs) in all OSS groups (r
s = 0.444–0.810 vs 0.445–0.820; P < 0.001), homogeneous surgeries (r
s = 0.364–0.802 vs 0.364–0.813; P < 0.001), prolongation of postoperative stay (r
s = 0.802 vs 0.830; P < 0.001), and initial operating room costs (r
s = 0.448 vs 0.451; P < 0.001). This correlation was higher in emergency surgery. With higher CDC grades, the OPC tended to increase an upward trend. In the multivariate analysis, CDC, CCI, age, and duration of surgery were all associated with OPC (P < 0.001).

Conclusions:
In our environment, the CCI presented associations with OPC. This demonstration of its economic validity enhances its clinical validity.