bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical application of the head impulse test of semicircular canal function
Authors: Curthoys I. S. , Manzari L. 
Published: July 2017

Objective:
To review the theory, the validity and the clinical application and the new developments of the video head impulse test (vHIT) of semicircular canal function. vHIT has now superseded the caloric test as the first-line clinical test for vestibular patients.

Outcomes:
This review examines the origin and rationale for vHIT: how it is carried out; pitfalls in testing; the validation of the test; the interpretation of overt and covert compensatory saccades in patients with vestibular loss; how the area VOR gain is calculated.

Results:
The advantages of the test are considered: it is so innocuous that it can be given to patients even during acute vertigo attacks, and given repeatedly at short intervals; it is very successful for testing young children; it tests all six semicircular canals, and, unlike the caloric test, provides measures of the absolute level of canal function and so is valuable for monitoring the effect of ototoxic antibiotics as well as identifying bilateral vestibular loss. Patients with Menière’s disease have normal canal function, although their caloric results generally indicate otherwise, with hydrops being the possible cause for that divergence. vHIT has shown the new vestibular syndrome of bilateral loss of vertical canal function and it is now being used for identifying the likely cause of vertigo of patients arriving at a hospital Emergency Room – normal semicircular canal function in such patients indicating increased probability of a stroke. The theory and application of the new, but already widely used, variant called the suppression head impulse test (SHIMPs) is explained. SHIMPs is even simpler and more intuitive than the standard vHIT test and probably even better for testing children.

Conclusion:
This review provides the theoretical foundations for the practical application of the clinical vHIT test which has revolutionized the clinical testing of semicircular canal function.
Metagenomic assembly through the lens of validation: recent advances in assessing and improving the quality of genomes assembled from metagenomes
Authors: Olson Nathan D , Treangen Todd J , Hill Christopher M , Cepeda-Espinoza Victoria , Ghurye Jay , Koren Sergey , Pop Mihai 
Published: July 2017

AbstractMetagenomic samples are snapshots of complex ecosystems at work. They comprise hundreds of known and unknown species, contain multiple strain variants and vary greatly within and across environments. Many microbes found in microbial communities are not easily grown in culture making their DNA sequence our only clue into their evolutionary history and biological function. Metagenomic assembly is a computational process aimed at reconstructing genes and genomes from metagenomic mixtures. Current methods have made significant strides in reconstructing DNA segments comprising operons, tandem gene arrays and syntenic blocks. Shorter, higher-throughput sequencing technologies have become the de facto standard in the field. Sequencers are now able to generate billions of short reads in only a few days. Multiple metagenomic assembly strategies, pipelines and assemblers have appeared in recent years. Owing to the inherent complexity of metagenome assembly, regardless of the assembly algorithm and sequencing method, metagenome assemblies contain errors. Recent developments in assembly validation tools have played a pivotal role in improving metagenomics assemblers. Here, we survey recent progress in the field of metagenomic assembly, provide an overview of key approaches for genomic and metagenomic assembly validation and demonstrate the insights that can be derived from assemblies through the use of assembly validation strategies. We also discuss the potential for impact of long-read technologies in metagenomics. We conclude with a discussion of future challenges and opportunities in the field of metagenomic assembly and validation.
Fracture Table Application for Pediatric Femur Fractures: Incidence and Risk Factors Associated With Adverse Outcomes
Authors: Kelly Brian A. , Naqvi Manahil , Rademacher Emily S. , Miller Patricia E. , Hedequist Daniel J. , Glotzbecker Michael P. , Matheney Travis H. , Shore Benjamin J. 
Published: July 2017

Background:
Flexible elastic nails, submuscular plating, and rigid locked intramedullary nails are common methods of fixation for pediatric femur fractures (PFF) in which the fracture table is used to aid reduction. Little is known about complications associated with fracture table application in PFF. The purpose of this study was to determine the incidence and risk factors associated with adverse outcomes related to fracture table application for the treatment of PFF.

Methods:
A retrospective chart review of all children (younger than 18 y) treated for a femur fracture with the use of the fracture table between 2004 and 2015 at a single tertiary pediatric hospital was performed. Data on demographics, mechanism of injury, treatment modality, radiographic characteristics, and fracture table–related complications were gathered. Complications of interest included nerve palsy, skin breakdown/ulceration, vascular injury, and compartment syndrome. Penalized likelihood logistic regression was used to determine risk factors associated with adverse outcomes.

Results:
In total, 260 patients were included. There were 8 patients with nerve palsies related to positioning and traction on the fracture table (1 bilateral and 6 ipsilateral peroneal nerve palsies, 1 contralateral tibial nerve palsy; incidence of 3.1%). No other fracture table–related complications were recorded. Patients who developed a nerve palsy were significantly heavier (78.7 vs. 44.3 kg, P<0.001) and had a significantly longer mean surgical time (188.6 vs. 117.0 min, P<0.001). Multivariate analysis demonstrated weight to be the only significant risk factor for complications, with a 5% increase in odds of complication with each additional kilogram (odds ratio, 1.05; confidence interval, 1.03-1.08; P<0.001).

Conclusions:
Nerve palsy related to the use of the fracture table during the fixation of PFF occurred in 3.1% of patients in our series. Patients who developed nerve palsies were significantly heavier and had significantly longer surgical times. Although the use of the fracture table for fixation of PFF is safe, every effort should be made to minimize time in traction to avoid iatrogenic nerve palsy, particularly in heavier children (>80 kg).

Level of Evidence:
Level III.
Growth Modulation in Achondroplasia
Authors: McClure Philip K. , Kilinc Eray , Birch John G. 
Published: July 2017

Introduction:
Achondroplasia is the most common skeletal dysplasia with a rate of nearly 1/10,000. The development of lower extremity deformity is well documented, and various modes of correction have been reported. There are no reports on the use of growth modulation to correct angular deformity in achondroplasia.

Methods:
Medical Records from 1985 to 2015 were reviewed for the diagnosis of achondroplasia and growth modulation procedures. Patients who had been treated for angular deformity of the legs by growth modulation were identified. A detailed analysis of their medical record and preoperative and final lower extremity radiographs was completed.

Results:
Four patients underwent growth modulation procedures, all to correct existing varus deformity of the legs. Three of the 4 patients underwent bilateral distal femoral and proximal tibial growth modulation. The remaining patient underwent tibial correction only. Two of the 4 patients had a combined proximal fibular epiphysiodesis. All limbs had some improvement of alignment; however, 1 patient went on to bilateral osteotomies. Only 1 limb corrected to a neutral axis with growth modulation alone at last follow-up, initial implantation was done before 5 years of age.

Conclusions:
Growth modulation is an effective means for deformity correction in the setting of achondroplasia. However implantation may need to be done earlier than would be typical for patients without achondroplasia. Osteotomy may still be required after growth modulation for incomplete correction.
Association Between Television Viewing and Parent-Child Reading in the Early Home Environment
Authors: Khan Kiren S. , Purtell Kelly M. , Logan Jessica , Ansari Arya , Justice Laura M. 
Published: July 2017

ABSTRACT:

Objective:
This study examines whether there is an association between time spent by preschoolers in parent-child shared book reading versus TV viewing in two distinct samples.

Methods:
Data were used from both the preschool wave of the Early Childhood Longitudinal Study Cohort, a nationally representative sample of 4-year-olds (N = 8900), as well as a low-income, rural sample of children enrolled in the Preschool Experience in Rural Classrooms study (N = 407). Information regarding frequency of shared book reading and daily TV consumption was obtained through caregiver report. A regression approach was used to estimate how the frequency of parent-child book reading accounted for variance in TV consumption. Estimated marginal mean values were then compared for the amount of TV viewed by children who were reported as being read to daily, frequently, occasionally, and not at all.

Results:
Parent–child book reading was negatively associated with the amount of TV viewed by children in both samples. Specifically, television consumption was significantly lower for children who were read to daily as compared to those who were read to occasionally. This inverse association was not moderated by contextual factors including maternal education, household size, and composition, or time spent in nonparental care.

Conclusion:
This study provides empirical support for an inverse association between TV viewing and parent-child book reading activities. Implications for policy and practice are discussed.
Feasibility of Conducting Autism Biomarker Research in the Clinical Setting
Authors: Sices Laura , Pawlowski Katherine , Farfel Laura , Phillips Deirdre , Howe Yamini , Cochran David M. , Choueiri Roula , Forbes Peter W. , Brewster Stephanie J. , Frazier Jean A. , Neumeyer Ann , Bridgemohan Carolyn ,   on behalf of the Autism Consortium Biomarkers Study Clinicians
Published: July 2017

ABSTRACT:

Objective:
Recruitment and completion of research activities during regular clinical care has the potential to increase research participation in complex neurodevelopmental disorders. We evaluated the feasibility, and effect on clinical care, of conducting biomarker research within a subspecialty clinical visit for autism spectrum disorder (ASD).

Methods:
Children, aged 5 to 10 years, were recruited by providers in ASD clinics at 5 institutions. Biomarkers collected were growth measurements, head circumference, neurologic and dysmorphology examinations, digit ratio (2D:4D) measurement, and platelet serotonin and urinary melatonin sulfate excretion levels. Parents completed the Aberrant Behavior Checklist—Community and a medical/demographic questionnaire. Cognitive level was abstracted from the medical record. Parents and clinicians completed surveys on the effect of the study on the clinical visit.

Results:
Eighty-three children and their caregivers participated. Factors limiting participation included difficulty reaching families by phone and parent concern about the study blood draw requirement. All children completed at least 4 of 7 planned research activities. Demographic factors, educational placement, and child behavior were not associated with completion of study activities. Lower nonverbal cognitive function was weakly associated with fewer activities completed. Forty-four percent of clinicians reported an effect of the research study on the clinical visit. However, neither parent-reported nor clinician-reported effect was associated with the degree of study activity completion.

Conclusion:
Recruiting study participants in the context of scheduled ASD clinical visits required significant effort. However, once recruited, participants completed most study activities, regardless of behavioral symptom severity. Research activities did not adversely affect the clinical visit.
LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY
Authors: Ciulla Thomas A. , Tatikonda Mohan V. , ElMaraghi Yehya A. , Hussain Rehan M. , Hill Amanda L. , Clary Julie M. , Hattab Eyas 
Published: July 2017

Purpose:
Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times (“patient flow times”) limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care.

Methods:
Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement.

Results:
Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved.

Conclusion:
Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.
Anterior Chamber Angle and Trabecular Meshwork Measurements Made by Fourier-domain Optical Coherence Tomography in Healthy White Children
Authors: Fernández-Vigo José I. , De-Pablo-Gómez-de-Liaño Lucía , Fernández-Vigo Cristina , Arcos-Villegas Gabriel , Fernández-Pérez Cristina , García-Feijóo Julián , Fernández-Vigo José Á. 
Published: July 2017

Purpose:
To obtain anterior chamber angle and trabecular meshwork (TM) measurements by Fourier-domain optical coherence tomography (FD-OCT) in a population of healthy white children.

Materials and Methods:
This was a cross-sectional study examining 409 right eyes of 409 children. Trabecular-iris angle (TIA) and TM length and area were measured by FD-OCT (RTVue 100) in the nasal and temporal quadrants to analyze correlations between angle or TM measurements and age, sex, and refractive error.

Results:
Mean participant age was 10.5±3.4 years (range, 3 to 18 y); 51% were boys. Mean spherical error was 0.56±2.4 D (range, −9 to +7.5 D). TIA could be measured in 99%, whereas TM measurements could only be made in 83%. Mean TIA was 43.1±10.0 degrees (range, 16 to 76 degrees). No differences were observed in angle width according to sex (P=0.299; t test). TIA was correlated with age (R=0.204; P<0.001) and with spherical error (R=−0.457; P<0.001). Mean TM length was 530±106 μm (range, 299 to 891 μm) and mean TM area was 0.065±0.021 mm2 (range, 0.030 to 0.180 mm2). No correlation was observed between TM metrics and age, sex or refractive error (R<0.08; P≥0.172).

Conclusions:
FD-OCT proved useful for the noninvasive measurement of TIA and TM metrics in children. Spherical error was the main determinant of TIA.
Evaluation of the Adequacy of the 2010 Revised World Health Organization Recommended Dosages of the First-line Antituberculosis Drugs for Children
Authors: Yang Hongmei , Enimil Anthony , Gillani Fizza S. , Antwi Sampson , Dompreh Albert , Ortsin Antoinette , Adu Awhireng Eugene , Owusu Maxwell , Wiesner Lubbe , Peloquin Charles A. , Kwara Awewura 
Published: July 2017

Background:
The World Health Organization recommended increased dosages of the first-line antituberculosis (anti-TB) drugs for children in 2010. We examined the frequency of and factors associated with low plasma maximum concentration (Cmax) of each drug in children treated with the revised dosages.

Methods:
Children on anti-TB therapy for at least 4 weeks underwent pharmacokinetic testing. Plasma Cmax below the lower limit of proposed reference range was considered low. Bivariate and multivariate analyses were used to examine the factors associated with low Cmax of each drug.

Results:
Of the 100 children, 58% were male, 50% HIV-infected and 49% younger than 5 years old. The median (interquartile range) Cmax was 5.9 (4.5–7.7) µg/mL for isoniazid, 6.5 (4.9–8.8) µg/mL for rifampin, 26.0 (21.2–33.4) µg/mL for pyrazinamide and 1.7 (0.9–2.7) µg/mL for ethambutol. There was a strong correlation between Cmax and AUC0-8h for all drugs. Low Cmax occurred in 9/100 (9.0%), 61/100 (61.0%), 17/97 (17.5%) and 60/97 (61.9%) for isoniazid, rifampin, pyrazinamide and ethambutol, respectively. In addition, 75/97 (77.3%) children had pyrazinamide Cmax < 35 µg/mL. Factors associated with low Cmax were NAT2 metabolizer phenotype status for isoniazid; height, dosage and HIV coinfection status for rifampin; height for pyrazinamide; and age, dosage and HIV coinfection status for ethambutol.

Conclusions:
The high frequency of low rifampin and ethambutol Cmax in our study is consistent with emerging pharmacokinetic data in children treated according to the new WHO recommendations. Higher dosages than currently recommended especially for rifampin may be necessary in children.
Safety of Quadrivalent Meningococcal Conjugate Vaccine in Children 2–10 Years
Authors: Tartof Sara Yee , Sy Lina S. , Ackerson Bradley K. , Hechter Rulin C. , Haag Mendel , Slezak Jeffrey M. , Luo Yi , Fischetti Christine A. , Takhar Harp S. , Miao Yan , Solano Zendi , Jacobsen Steven J. , Tseng Hung-Fu 
Published: July 2017

Background:
Quadrivalent meningococcal conjugate vaccine is recommended for children, adolescents and adults at increased risk of meningococcal disease. In 2011, MenACWY-CRM (Menveo, GSK, Siena, Italy) was approved for children 2–10 years of age in the United States. Although no safety concerns arose from clinical trials, it remains important to monitor its safety in routine clinical settings.

Methods:
Kaiser Permanente Southern California members 2–10 years old who received MenACWY-CRM between September 2011 and September 2014 were included. Electronic health records were searched using a validated algorithm to identify 26 prespecified events of interests (EOIs) and serious medically attended events (SMAEs) from inpatient or emergency settings up to 1 year after MenACWY-CRM vaccination. SMAEs were categorized by International Classification of Diseases, 9th revision diagnostic categories. All events were reviewed to confirm the diagnosis and symptom onset date. The study was descriptive (NCT01452438); no statistical tests were performed.

Results:
Among 387 vaccinated children, 327 with ≥6 months membership before vaccination were analyzed. Among EOIs, 9 asthma cases and 1 myasthenia gravis case underwent chart review which confirmed 1 incident asthma case occurring 237 days after concomitant vaccination with MenACWY-CRM and typhoid vaccine. Thirty-one children experienced SMAEs, most commonly because of unrelated injury and poisoning. The remaining events occurred sporadically after vaccination and most were unlikely related to vaccination based on medical record review.

Conclusions:
One incident EOI of asthma late in the 1-year observation period and sporadic distribution of SMAEs were observed. These data do not suggest safety concerns associated with MenACWY-CRM vaccination in children 2–10 years old.
Fecal Matrix Metalloprotease-9 and Lipocalin-2 as Biomarkers in Detecting Endoscopic Activity in Patients With Inflammatory Bowel Diseases
Authors: Buisson Anthony , Vazeille Emilie , Minet-Quinard Régine , Goutte Marion , Bouvier Damien , Goutorbe Félix , Pereira Bruno , Barnich Nicolas , Bommelaer Gilles 
Published: July 2017

Background:
Fecal biomarkers are emerging tools in the assessment of mucosal healing in inflammatory bowel diseases (IBD).

Goals:
We aimed to evaluate the accuracy of fecal matrix metalloprotease-9 (MMP-9) and fecal lipocalin-2 (LCN-2) compared with calprotectin in detecting endoscopic activity in IBD

Study:
Overall, 86 IBD adults underwent colonoscopy consecutively and prospectively, with Crohn’s disease Endoscopic Index of Severity (CDEIS) in Crohn’s disease (CD) patients or Mayo endoscopic subscore calculation for ulcerative colitis (UC) patients, and stool collection. Fecal calprotectin was measured using quantitative immunochromatographic testing. Fecal MMP-9 and LCN-2 was quantified by enzyme-linked immunosorbent assay. MMP-9 and LCN-2 thresholds were determined using receiver operating curves.

Results:
In 54 CD patients, fecal calprotectin, MMP-9 and LCN-2 correlated with CDEIS and were significantly increased in patients with endoscopic ulcerations. MMP-9 >350 ng/g detected endoscopic ulceration in CD with a sensitivity of 90.0% and a specificity of 63.6%, compared with fecal calprotectin >250 μg/g (sensitivity=90.5% and specificity=59.1%). Fecal LCN-2 demonstrated lower performances than the 2 other biomarkers (sensitivity=85.7% and specificity=45.5%).
In 32 UC patients, fecal MMP-9, LCN-2, and calprotectin levels were significantly increased in patients with endoscopic activity. In UC patients, fecal MMP-9 >900 ng/g had the best efficacy to detect endoscopic activity (sensitivity=91.0% and specificity=80.0%, compared with fecal calprotectin >250 μg/g (sensitivity=86.4% and specificity=80.0%) and LCN-2 >6700 ng/g (sensitivity=82.0% and specificity=80.0%).

Conclusions:
Fecal MMP-9 is a reliable biomarker in detecting endoscopic activity in both UC and CD patients.
Risk of Colorectal Cancer in Chronic Kidney Disease
Authors: Komaki Yuga , Komaki Fukiko , Micic Dejan , Ido Akio , Sakuraba Atsushi 
Published: July 2017

Background:
Association between chronic kidney disease and colorectal cancer (CRC) remains unclear.

Goals:
To assess the risk of CRC in patients with various chronic kidney diseases before and after kidney transplantation.

Study:
Electronic databases were searched for cohort studies assessing the risk of CRC in patients with chronic kidney diseases. The primary outcome was the risk of CRC among studies that reported the risk as standardized incidence rate (SIR).

Results:
Fifty-four studies, including 1,208,767 patients that reported the incidence of CRC in chronic kidney diseases were identified. SIR of CRC were obtained from 17 retrospective cohort studies. Among the 3 studies (4 reports) that included chronic kidney disease patients without kidney transplantation, there was a significant increased risk of CRC (pooled SIR 1.18) (95% confidence interval, 1.01-1.37; P=0.033). High heterogeneity was seen (I
2=85.6%), and metaregression showed that there were positive correlations between the risk of CRC and the proportions of males, age and follow-up period. Among the 15 studies (17 reports) that included postkidney transplant patients, the pooled SIR was significantly increased at 1.40 (95% confidence interval, 1.15-1.71; P=0.00080). High heterogeneity was seen (I
2=88.9%), and metaregression showed that the follow-up period correlated with the risk of CRC.

Conclusions:
In the present systematic review and meta-analysis, we demonstrated that patients with chronic kidney disease, regardless of a history of transplant, have a significant increased risk of CRC. A more intensive surveillance for CRC is required in this population.