bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital preparedness and response in CBRN emergencies: TIER assessment tool
Authors: Olivieri Carlo , Ingrassia Pier L. , Della Corte Francesco , Carenzo Luca , Sapori Jean-Marc , Gabilly Laurent , Segond Fredrique , Grieger Fiene , Arnod-Prin Philippe , Larrucea Xabier , Violi Chrisitan , Lopez Cédric , Djalali Ahmadreza 
Published: April 2016

Introduction
Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies.

Methods
An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study.

Results
The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts.

Conclusion
Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts’ consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.
Practice Variation Among Hospitals in Revascularization Therapy and Its Association With Procedure-related Mortality
Authors: Dalton Jarrod E. , Zidar David A. , Udeh Belinda L. , Patel Manesh R. , Schold Jesse D. , Dawson Neal V. 
Published: April 2016

Background:
While substantial practice variation in coronary revascularization has been described and deviation from clinical practice guidelines has been associated with worse outcomes, the degree to which this is driven by flawed decision making and/or appropriate deviation associated with comorbid conditions is unknown. We evaluated heterogeneity in procedure use, and the extent to which hospital-level practice variation is related to surgical mortality.

Methods:
We analyzed data on 554,563 inpatients undergoing either percutaneous coronary intervention or coronary artery bypass grafting at 391 centers in 6 states. Procedure-specific risk models were developed based on demographics and comorbidities, allowing for differential effects of comorbidities for each sex. For each patient, the revascularization procedure that minimized predicted probability of inhospital mortality was designated as the model-preferred procedure.
Hospital-level discordance rates—the proportion of cases in each hospital for which the opposite from the model-preferred procedure was performed—were calculated. Hierarchical linear models were used to analyze the relationship between HDRs and hospital-level risk-standardized mortality ratios (RSMRs).

Results:
Comorbidities and demographics alone explained between 68% and 86% of overall variation in inhospital mortality (corresponding C-statistics of 0.84–0.93). The mean (SD) HDR was 26.3% (9.6%). There was a positive independent association between HDRs and inhospital mortality, with a 10% increase in HDR associated with an 11% increase in RSMR (P<0.001).

Conclusions:
Variance in procedure use according to model preference was strongly associated with worse outcomes. A systematic approach to incorporating comorbidity as part of the decision-making process for coronary revascularization is needed.
Microenvironmental regulation of hematopoietic stem cells and its implications in leukemogenesis
Authors: Seshadri Madhav , Qu Cheng-Kui 
Published: April 2016

Purpose of review
Hematopoietic stem cells (HSCs) are a population of cells in the bone marrow which can self-renew, differentiate into late lineage progenitors, or remain quiescent. HSCs exist alongside several cell types in the bone marrow microenvironment that comprise the stem cell niche. These cells regulate HSC function and can contribute to leukemogenesis. In this review we will discuss recent advances in this field.

Recent findings
In the vascular niche, arteriolar and sinusoidal zones appear to play distinct roles in HSC function. Endothelial cells modulate HSC function via Notch and other signaling pathways. In the endosteal niche multiple cell types regulate HSCs. Osteoblasts promote HSC quiescence via secreted factors and possibly physical interactions, whereas adipocytes may oppose HSC quiescence. The balance of these opposing factors depends on metabolic cues. Feedback from HSC-derived cells, including macrophages and megakaryocytes also appears to regulate HSC quiescence. Dysfunction of the bone marrow microenvironment, including mesenchymal stem cell-derived stromal cells and the sympathetic nervous system can induce or alter the progression of hematologic malignancies.

Summary
Many cell types in the bone marrow microenvironment affect HSC function and contribute to malignancy. Further understanding how HSCs are regulated by the microenvironment has clinical implications for stem cell transplantation and other therapies for hematologic malignancies.
Spanish and English Language Symposia to Enhance Activation in Pediatric Inflammatory Bowel Disease
Authors: Martin Melissa , Garcia Manuel , Christofferson Megan , Bensen Rachel , Yeh Ann Ming , Park K.T. 
Published: April 2016

ABSTRACTObjectives:Patient activation is an important consideration for improved health outcomes in the management of chronic diseases. Limited English proficiency among patients and primary care providers has been shown to be a predictor for worse health across disease states. We aimed to determine the baseline patient activation measure (PAM) among Spanish‐speaking (SP) and English‐speaking (ES) pediatric patients with IBD and parents, and to describe the feasibility and efficacy of a novel peer‐group education symposium designed to enhance patient activation as measured with the PAM.Methods:Two separate half‐day educational symposia in either Spanish or English were presented and moderated by 2 native SP physicians. Content for each of the presentations were highly standardized and interactive, designed to address each of the activation domains (self‐management, collaboration with a health care provider, maintenance of function and prevention of disease exacerbation, and appropriate access to high‐quality care). Descriptive statistics were used to describe changes between pre‐ and postsymposium PAM trends.Results:Eleven primarily SP and 21 ES families participated in their respective symposium. Paired pre‐ and post‐PAM scores were available from 24 pediatric patients with IBD (8 SP, 16 ES) and 41 parents (15 SP, 26 ES). The mean age for SP and ES patients was 11.6 and 12.0 years, and female sex in 80% and 62%, respectively. Paired pre‐ and post‐PAM scores for all participants (n = 65) were analyzed. PAM scores uniformly increased in all 4 groups after the symposia (SP patients 59.1–70.3, P = 0.05; SP parents 69.8–75.2, P = 0.2; ES patients 59.9–64.0, P = 0.08; ES parents 61.9–69.1, P = 0.002), although only the ES‐parents group had sufficient sample size (n = 26) to achieve statistical significance. The overall cohort had an aggregate increase from pre‐PAM of 62.9 (SD 14.5) to post‐PAM of 69.4 (SD 13.9) (<0.001).Conclusions:We describe a novel peer‐group educational symposium presented in Spanish and English languages to increase patient and parent activation in pediatric patients with IBD and their caregiving parents. The use of PAM to assess levels of activation appears to be feasible and effective in these groups.
Transitions in Pediatric Gastroenterology
Authors: Bensen Rachel , McKenzie Rebecca B. , Fernandes Susan M. , Fishman Laurie N. 
Published: April 2016

ABSTRACTObjectives:Transition and transfer to adult‐oriented health care is an important yet challenging task for adolescents and young adults with chronic medical conditions. Transition practices vary widely, but a paucity of data makes determination of best practices difficult. We described North American pediatric gastroenterologists’ preferences and present transition practice patterns and explored whether experience affected providers’ perspectives.Methods:An online survey was distributed via e‐mail to members of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. Participation was voluntary and answers were anonymous. Quantitative and qualitative analysis was performed.Results:Almost three quarters of the 175 respondents describe providing transition or self‐care management education, but only 23% use structured readiness assessments. Most respondents (88%) report having age cutoffs above which they no longer accept new referrals, with the most common age being 18 years (57%). One third report the ability to provide age‐appropriate care to patients older than 21 years. Only 6% indicate that their practice or institution should provide care for individuals older than 25 years. Many (63%) indicate that their practice or institution has a policy regarding age of transfer, but most (79%) are flexible. Provider preferences for triggers to transfer to adult care diverge widely between age, milestones, and comorbidities. Overall, parent (81%) and patient (74%) attachment to pediatric health care providers are cited as the most common barriers to transition.Conclusions:Preferences and practices surrounding transition preparation and transfer to adult care vary widely, reflecting continued uncertainty regarding optimal transition strategies.
Ascites in Children
Authors: Karnsakul Wikrom , Ingviya Thammasin , Seaberg Eric , Laengvejkal Pavis , Imteyaz Hejab , Vasilescu Alexandra , Schwarz Kathleen B. , Scheimann Ann O. 
Published: April 2016

ABSTRACTObjectives:The aim of our study was to describe the changing prevalence, demographic features, etiologies, and treatment of ascites in children hospitalized during a 27‐year period at the Johns Hopkins Hospital (Baltimore, MD).Methods:We retrospectively reviewed discharges from 1983 to 2010 to select patients whose records included a diagnosis of ascites. We assessed the etiologies and degrees of ascites (ascites grade 1 detectable only by radiologic tests; ascites grades 2 and 3 recognized by moderate and marked abdominal distension by physical examinations).Results:We classified 518 children into 9 etiology groups: intrahepatic disease (IH) (105), hepatic vein outflow obstruction (HVOO) (45), congestive heart disease (CH) (33), nephrotic syndrome (NS) (36), pancreatitis (26), inflammatory and infectious diseases (77), malignancy (49), idiopathic (71), and miscellaneous (76). IH and CH were predominant in the younger age group (0–5 years) versus HVOO, pancreatitis, and malignancy in the older age group (13–21 years) (P < 0.001). The prevalence of ascites increased over time from 1983 to 2006 and declined thereafter. Ascites grade 1 was more common than ascites grades 2 and 3 in all the groups (P = 0.048). IH and NS were more likely to have ascites grade 2 and 3 (P = 0.02). Although spironolactone was more frequently used in the IH group versus other etiologies, furosemide was used more frequently in NS and CH versus other etiologies (P < 0.001).Conclusions:The increased prevalence of ascites during the initial study period could reflect improved detection radiologic detection. The proportion of severe ascites and the various medical treatments differed among the etiologic groups.
IBD‐Like Features in Syndromic Diarrhea/Trichohepatoenteric Syndrome
Authors: Busoni Veronica B. , Lemale Julie , Dubern Beatrice , Frangi Fernando , Bourgeois Patrice , Orsi Marina , Badens Catherine , Fabre Alexandre 
Published: April 2016

ABSTRACTBackground:Very early onset inflammatory bowel disease (VEOIBD) (inflammatory bowel disease [IBD] before 6 years of age) may manifest as a monogenic disease affecting the gastrointestinal tract. Syndromic diarrhea/trichohepatoenteric syndrome (SD/THE), a rare disorder caused by alteration of a complex involved in RNA degradation, has been reported to present with some degree of colitis and in some cases an IBD‐like presentation.Methods:We reviewed clinical and biological data of 4 previously published cases and added detailed data of 2 new cases of SD/THE with an IBD‐like presentation.Results:All the 6 patients presented with typical intractable diarrhea and hair abnormalities. The colon was affected in all of the patients: 1 had ileitis, 2 had panenteritis, and 2 presented with perianal disease. Fecal calprotectin level and erythrosedimentation rate were elevated in 2 cases each. All the therapeutic classes of IBD treatment (mesalazine, steroids, immunomodulators, and biological therapy) were used in the 6 cases. In 2 patients, treatment had no effect. Three showed a partial effect, and 1 patient sustained only a transient effect.Conclusions:SD/THE can have a similar presentation as VEOIBD, often as pancolitis. IBD treatments appear to have little efficacy for SD/THE, suggesting a different pathogenesis for the IBD‐like features in SD/THE compared with classical IBD.
Preschoolers With Allergic Diseases Have an Increased Risk of Irritable Bowel Syndrome When Reaching School Age
Authors: Tan Teck‐King , Chen An‐Chyi , Lin Cheng‐Li , Shen Te‐Chun , Li Tsai‐Chung , Wei Chang‐Ching 
Published: April 2016

ABSTRACTObjectives:The aim of the study was to systemically investigate the risk of subsequent irritable bowel syndrome (IBS) in children with antecedent allergic diseases in a population‐based case‐control study in Taiwan.Methods:We evaluated 11,242 children (age range: 7–18 years) with IBS and 44,968 age‐ and sex‐matched control subjects who had been examined between 2000 and 2008. IBS odds ratios were calculated for children with antecedent allergic diseases, including allergic conjunctivitis, allergic rhinitis, asthma, atopic dermatitis, urticaria, and food allergy.Results:Children with antecedent allergic diseases had a greater risk of IBS than did control subjects (P < 0.001). Among the 6 evaluated diseases, the highest adjusted odds ratio of 1.78 was observed with allergic rhinitis (95% confidence interval [CI], 1.69–1.87). With 2 or more allergic diseases, the adjusted odds ratios increased to 2.06 (95% CI, 1.93–2.19) for all subjects, 2.07 (95% CI, 1.88–2.28) for girls, and 2.18 (95% CI, 2.02–2.35) for children 12 years or older.Conclusions:Preschoolers with a history of allergic disease had an increased risk of subsequent IBS development upon reaching school age. This risk increased in the presence of concurrent allergic disease and a higher clinical allergy burden.
Childhood Precursors of Adult Borderline Personality Disorder Features
Authors: Cramer Phebe 
Published: April 2016

Abstract
This study identifies childhood personality traits that are precursors of adult Borderline Personality Disorder (BPD) features. In a longitudinal study, childhood personality traits were assessed at age 11 (N = 100) using the California Child Q-set (CCQ: Block and Block, 1980). A number of these Q-items were found to be significantly correlated (p < 0.001) with a prototype-based measure of BPD features at age 23. Factor analysis of these Q-items suggested that they could be characterized by two underlying personality dimensions: Impulsivity and Nonconformity/Aggression. The findings thus provide evidence that childhood personality traits predict adult BPD features. Identifying such childhood precursors provides an opportunity for early intervention.
Effects of Intensive Short-Term Dynamic Psychotherapy on Depressive Symptoms and Executive Functioning in Major Depression
Authors: Ajilchi Bita , Nejati Vahid , Town Joel M. , Wilson Ryan , Abbass Allan 
Published: April 2016

Abstract
This study examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) on depressive symptoms and executive functioning in patients with major depression. We examined pretest, posttest, and follow-up depression scores as well as pretest–posttest executive functioning scores between 16 participants receiving ISTDP and 16 allocated to wait-list control. Participants in each group were matched according to age, sex, and educational level. Mixed-models analyses demonstrated significant interaction effects of group and time on depression scores when the group ISTDP was compared with the wait-list control group; participants receiving ISTDP had significantly reduced depression severity both after treatment and at follow-up. Next, a series of hierarchical regression models demonstrated modest improvements on most tests of executive functioning in participants receiving ISTDP. Depressed patients receiving ISTDP show a sustained reduction in depression severity after treatment and after 12-month follow-up and improvements in executive functioning after treatment compared with a wait-list control.
Relationship between Reduced Accommodative Lag and Myopia Progression
Authors: Koomson Nana Yaa , Amedo Angela Ofeibea , Opoku-Baah Collins , Ampeh Percy Boateng , Ankamah Emmanuel , Bonsu Kwaku 
Published: April 2016

ABSTRACT

Purpose
To determine the relationship between accommodative lag and rate of myopia progression when Ghanaian myopic school children are either undercorrected or fully corrected with single vision lenses.

Methods
A 2-year single masked randomized control trial was conducted using 150 Ghanaian myopic children aged 10 to 15 years with mean baseline myopia of −1.98 ± 0.50D. The children were randomly assigned to wear either a full correction (n = 75) or +0.50D undercorrection (UC) (n = 75) single vision lenses. Repeated measurements which included refractive error and accommodative response at 33 and 28.6 cm for FC and UC, respectively, were performed using Open-Field Autorefractor whereas ocular biometry results were obtained using A-Scan ultrasonography. Results were based on the right eye and analyzed using STATA 11.

Results
After 24 months, the mean myopia progression of children in the FC group (−0.54 ± 0.26D) was not significantly different from that of the children in the UC group (−0.5 ± 0.22D) (p = 0.31). There was no significant difference between the mean values of the initial near lag and the average lag measured 24 months later in both groups (FC: initial lag −0.74 ± 0.17D, average lag −0.72 ± 0.15D, p = 0.44; UC: initial lag −0.57 ± 0.14D, average lag −0.58 ± 0.15D; p = 0.67). Also, there was no significant correlation between refractive change seen in 24 months and either the first near lag for both FC (r = −0.05, p = 0.43) and UC (r = −0.08, p = 0.43) or the average near lag of accommodation for both FC (r = −0.02, p = 0.49) and UC (r = −0.04, p = 0.49).

Conclusions
This study showed no relationship between lag of accommodation and rate of myopia progression in children with progressing myopia. Different ethnic groups may respond differently to the same size of hyperopic blur.
Evaluation of Disseminated Intravascular Coagulation Scores in Critically Ill Pediatric Patients
Authors: Jhang Won Kyoung , Ha Eun Ju , Park Seong Jong 
Published: April 2016

Objectives:
Disseminated intravascular coagulation is a complex systemic thrombohemorrahgic disorder, which may contribute to organ failure. We aimed to compare the detection rate of the disseminated intravascular coagulation, early in the course of ICU admission, of the two disseminated intravascular coagulation scoring systems defined by International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine criteria and the prognostic value of disseminated intravascular coagulation scores in critically ill pediatric patients.

Design:
Single-center retrospective observational study.

Setting:
PICU in a tertiary care children’s hospital.

Patients:
Pediatric patients admitted in the PICU between January 2013 and December 2014.

Interventions:
None.

Measurements and Main Results:
A total of 191 patients were included. Among them, 15.7% and 29.8% of the patients were diagnosed with disseminated intravascular coagulation by International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine criteria, respectively. The diagnostic concordance rate between the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems was 52.6%. As the Pediatric Risk of Mortality III, the modified Sequential Organ Failure Assessment, and the Pediatric Multiple Organ Dysfunction Syndrome scores increased, the percentage of patients with disseminated intravascular coagulation increased stepwise. The disseminated intravascular coagulation scores correlated well with these severity scores. Overall, the 28-day mortality was 9.9%. There were significant differences in most variables consisting of the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems between survivor and nonsurvivors. Patients detected to have disseminated intravascular coagulation by the International Society on Thrombosis and Hemostasis and Japanese Association for Acute Medicine scoring systems showed higher mortality than patients without disseminated intravascular coagulation. The areas under the receiver operating characteristic curve of the Japanese Association for Acute Medicine score and International Society on Thrombosis and Hemostasis score were 0.788 (95% CI, 0.675–0.900) and 0.716 (95% CI, 0.598–0.834), respectively.

Conclusions:
Both the International Society on Thrombosis and Hemostasis and the Japanese Association for Acute Medicine scoring systems are useful for detection of the disseminated intravascular coagulation in critically ill pediatric patients. These scores correlate well with other severity scores, including Pediatric Risk of Mortality III, modified Sequential Organ Failure Assessment, and Pediatric Multiple Organ Dysfunction Syndrome. Disseminated intravascular coagulation scores are also significantly associated with 28-day mortality, suggesting that these could be promising prognostic factors.