bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Positive Airway Pressure Following Middle Ear Surgery: A Practice Survey of Otologists
Authors: Ruhl Douglas S. , Tolisano Anthony M. , Kesser Bradley W. , Hashisaki George T. , Camacho Macario 
Published: May 2017

Background:
Positive airway pressure (PAP) devices are used as treatment for obstructive sleep apnea (OSA). PAP may increase middle ear pressure which is of interest to otologic surgeons. There is a lack of data to guide management of PAP therapy after middle ear surgery.

Objective:
To elucidate how otologic surgeons manage PAP in their patients after ear surgery.

Study Design:
A survey e-mailed to practicing members of the American Neurotology Society.

Results:
Among 60 respondents, the most common recommendations to patients were to avoid PAP use for 1 week (40%), return to normal use immediately (23.3%), avoid PAP for 1 month (13.3%), or avoid PAP for 1 day (13.3%) after surgery. Twenty percent of providers reported that they change their advice on the basis of the PAP pressure settings (i.e., shorter hiatus for higher settings). Among respondents, 47% think that they have patients with middle ear issues because of PAP and 13% attributed surgical failures to PAP use. One-third of providers routinely pack the Eustachian tube during surgery. Providers who attributed a negative surgical outcome to PAP use were more likely to routinely pack/plug the Eustachian tube during otologic surgery (p = 0.001).

Conclusion:
Treatment recommendations regarding postoperative PAP treatment for obstructive sleep apnea vary greatly among practicing otologists. Providers who think that an adverse outcome was attributed to PAP use were more likely to prophylactically plug the Eustachian tube during surgery. Future research will provide additional information which will allow a better understanding of the effect of PAP on the middle ear, especially after otologic surgery.
Unsedated In‐office Transgastrostomy Esophagoscopy to Monitor Therapy in Pediatric Esophageal Disease
Authors: Hall Caroline H.T. , Nguyen Nathalie , Furuta Glenn T. , Prager Jeremy , Deboer Emily , Deterding Robin , Menard‐Katcher Calies , Capocelli Kelley E. , Kramer Robert E. , Friedlander Joel A. 
Published: May 2017

ABSTRACTMonitoring therapy in esophageal inflammatory disorders such as eosinophilic esophagitis and reflux esophagitis often requires frequent endoscopic evaluation. We recently reported the effective use of unsedated in‐office transnasal esophagoscopy that significantly decreased costs and anesthetic exposure associated with pediatric esophagoscopy in eosinophilic esophagitis. Here we report a series of pediatric patients with esophagitis with gastrostomy tubes who underwent unsedated transgastrostomy esophagoscopy (TGE) in an office setting. Nine patients (ages 16 months–21 years) tolerated TGE without significant adverse events. Biopsy specimens were adequate for evaluation. This series confirms that unsedated in‐office TGE can be used to successfully obtain mucosal biopsies to monitor esophageal inflammatory conditions in children without the use of sedation.
Long‐term Follow‐up of Adolescents Treated for Rumination Syndrome in an Inpatient Setting
Authors: Alioto Anthony , Di Lorenzo Carlo 
Published: May 2017

ABSTRACTObjectives:Although several studies have demonstrated the short‐term benefit of the behavioral treatment of rumination syndrome, few have investigated the long‐term outcomes. Studies reporting long‐term benefit have involved combined pediatric and adult samples or have examined outcomes of patients involved in various types of treatment. The purpose of the present study was to examine several aspects of long‐term outcome in adolescent patients who took part in the same intensive, interdisciplinary, inpatient behavioral treatment approach.Methods:Self‐report measures were completed by 47 adolescent patients (mean age = 15.9) around 1 year or more from discharge from our inpatient program. Measures indexed changes in rumination, medical outcomes (eg, use of supplemental nutrition), somatic symptoms, and quality of life.Results:Most patients reported continued improvement in their rumination over time, with 20% reporting cessation of rumination for at least 6 months. The majority of patients no longer required supplemental nutrition and reported improvements in somatic symptoms and quality of life. Patients who reported greater improvement in rumination also reported more significant improvements in their somatic symptoms and quality of life.Conclusions:Intensive behavioral treatment of rumination syndrome leads to long‐term improvement in rumination as well as other related factors, including somatic symptoms and quality of life.
High Frequency of Neuroimaging Abnormalities Among Pediatric Patients With Sepsis Who Undergo Neuroimaging*
Authors: Sandquist Mary K. , Clee Mark S. , Patel Smruti K. , Howard Kelli A. , Yunger Toni , Nagaraj Usha D. , Jones Blaise V. , Fei Lin , Vadivelu Sudhakar , Wong Hector R. 
Published: May 2017

Objectives:
This study was intended to describe and correlate the neuroimaging findings in pediatric patients after sepsis.

Design:
Retrospective chart review.

Setting:
Single tertiary care PICU.

Patients:
Patients admitted to Cincinnati Children’s Hospital Medical Center with a discharge diagnosis of sepsis or septic shock between 2004 and 2013 were crossmatched with patients who underwent neuroimaging during the same time period.

Interventions:
All neuroimaging studies that occurred during or subsequent to a septic event were reviewed, and all new imaging findings were recorded and classified. As many patients experienced multiple septic events and/or had multiple neuroimaging studies after sepsis, our statistical analysis utilized the most recent or “final” imaging study available for each patient so that only brain imaging findings that persisted were included.

Measurements and Main Results:
A total of 389 children with sepsis and 1,705 concurrent or subsequent neuroimaging studies were included in the study. Median age at first septic event was 3.4 years (interquartile range, 0.7–11.5). Median time from first sepsis event to final neuroimaging was 157 days (interquartile range, 10–1,054). The most common indications for final imaging were follow-up (21%), altered mental status (18%), and fever/concern for infection (15%). Sixty-three percentage (n = 243) of final imaging studies demonstrated abnormal findings, the most common of which were volume loss (39%) and MRI signal and/or CT attenuation abnormalities (21%). On multivariable logistic regression, highest Pediatric Risk of Mortality score and presence of oncologic diagnosis/organ transplantation were independently associated with any abnormal final neuroimaging study findings (odds ratio, 1.032; p = 0.048 and odds ratio, 1.632; p = 0.041), although early timing of neuroimaging demonstrated a negative association (odds ratio, 0.606; p = 0.039). The most common abnormal finding of volume loss was independently associated with highest Pediatric Risk of Mortality score (odds ratio, 1.037; p = 0.016) and oncologic diagnosis/organ transplantation (odds ratio, 2.207; p = 0.001) and was negatively associated with early timing of neuroimaging (odds ratio, 0.575; p = 0.037).

Conclusions:
The majority of pediatric patients with sepsis and concurrent or subsequent neuroimaging have abnormal neuroimaging findings. The implications of this high incidence for long-term neurologic outcomes and follow-up require further exploration.
Beyond “Option B+”: Understanding Antiretroviral Therapy (ART) Adherence, Retention in Care and Engagement in ART Services Among Pregnant and Postpartum Women Initiating Therapy in Sub-Saharan Africa
Authors: Myer Landon , Phillips Tamsin K. 
Published: May 2017

Background:
Several studies from sub-Saharan Africa have highlighted significant challenges in providing antiretroviral therapy (ART) to pregnant and postpartum women, with specific concerns around maintaining optimal levels of adherence to ART and/or retaining women in long-term services. However, there are few conceptual frameworks to help understand nonadherence and nonretention, as well as the drivers of these, among HIV-infected women, particularly in the postpartum period.

Methods:
This review provides an overview of the key issues involved in thinking about ART adherence, retention in care and engagement in ART services among pregnant and postpartum women.

Results:
The related behaviors of adherence and retention may be understood as components of effective engagement of patients in ART services, which share the goal of achieving and maintaining suppressed maternal viral load on ART. Under this framework, the existing literature indicates that disengagement from care is widespread among postpartum women, with strikingly similar data emerging from ART services around the globe and indications that similar challenges may be encountered by postpartum care services outside the context of HIV. However, the drivers of disengagement require further research, and evidence-based intervention strategies are limited.

Conclusions:
The challenges of engaging women in ART services during pregnancy and the postpartum period seem pervasive, although the determinants of these are poorly understood. Looking forward, a host of innovative intervention approaches are needed to help improve women's engagement, and in turn, promote maternal and child health in the context of HIV.
Patterns of HIV Care Clinic Attendance and Adherence to Antiretroviral Therapy Among Pregnant and Breastfeeding Women Living With HIV in the Context of Option B+ in Zimbabwe
Authors: Erlwanger Alison S. , Joseph Jessica , Gotora Tendai , Muzunze Blandina , Orne-Gliemann Joanna , Mukungunugwa Solomon , Farley Tim , Mangwiro Alexio-Zambezi 
Published: May 2017

Background:
Consistent use of antiretroviral therapy (ART) during pregnancy and breastfeeding reduces the likelihood of mother-to-child HIV transmission. All pregnant and breastfeeding women living with HIV in Zimbabwe are offered ART with same-day initiation regardless of CD4 count (Option B+). We investigated patterns of clinic attendance and adherence to ART among HIV-infected pregnant women in Zimbabwe.

Methods:
The Evidence for Elimination cluster-randomized trial evaluating point-of-care CD4 testing included 1150 HIV-infected ART-naive women attending antenatal care between January 2014 and June 2015. Thirty-two primary care facilities were randomized between 2 arms. In this secondary analysis of Evidence for Elimination data collected from routine clinic records, we classified women by number of pills dispensed, and estimated adherence from the ratio of pills to days since ART initiation (Medication Possession Ratio, adherent if ≥95%) or the period when they stopped receiving medication.

Results:
Two-thirds (67.7%) were still receiving medication 1 year after initiation; less than half of the cohort (39.1%) were adherent. Younger women, newly diagnosed with HIV, and/or first presenting to antenatal care in their third trimester were more likely to drop from care or be nonadherent 360 days after ART initiation.

Conclusion:
Adherence to ART is suboptimal particularly among young, newly diagnosed, and/or late presenting patients. Interventions that target these groups, as well as provide additional support to all women who are newly diagnosed, may improve Option B+ ART care. More information is needed about the barriers to ART care among late presenters and teenagers.
Integrating HIV and Maternal, Neonatal and Child Health Services in Rural Malawi: An Evaluation of the Implementation Processes and Challenges
Authors: Gunda Andrews , Jousset Aurelie , Tchereni Timothy , Joseph Jessica , Mwapasa Victor 
Published: May 2017

Introduction:
Introducing Option B+ in Malawi increased antiretroviral therapy coverage among pregnant and breastfeeding women 3 fold. The Promoting Retention among Infants and Mothers Effectively (PRIME) study integrated care of Maternal, Neonatal and Child Health services through a mother–infant pair (MIP) clinic. This article evaluates the implementation processes and challenges health care workers' experienced in implementing these MIP clinics.

Methods:
Between May 2013 and August 2016, 20 health facilities implemented MIP clinics. Health care workers' performance implementing MIP clinics was assessed through a mentorship score from 0 to 5 and supplemented with qualitative data from mentorship reports. Visit alignment of participants' appointment and attendance dates with MIP clinic dates were calculated and summarized by overall proportions among all patient visits.

Results:
The average mentorship score was 3.8, improving from 3.0 to 4.2 from quarter one 2015 to quarter one 2016. Proportions of maternal and infant appointment dates that aligned with MIP clinic dates were 47.0% and 5.9%, with greatest improvement between 2013 and 2015. Proportions of maternal and infant attendance dates that aligned with MIP clinic dates were 41.7% and 51.2% and improved over time.

Discussion:
Despite improvement in staff mentorship scores, many MIPs were not exposed to integrated HIV and Maternal, Neonatal and Child Health services offered through MIP clinics primarily because of clinic scheduling challenges. To improve utilization of integrated MIP clinics, careful design of a delivery approach is needed that is acceptable to clinic staff, addresses local realities, and includes appropriate investment and oversight.
Machine Learning for Predicting Outcomes in Trauma
Authors: Liu Nehemiah T. , Salinas Jose 
Published: May 2017

ABSTRACT
To date, there are no reviews on machine learning (ML) for predicting outcomes in trauma. Consequently, it remains unclear as to how ML-based prediction models compare in the triage and assessment of trauma patients. The objective of this review was to survey and identify studies involving ML for predicting outcomes in trauma, with the hypothesis that models predicting similar outcomes may share common features but the performance of ML in these studies will differ greatly. MEDLINE and other databases were searched for studies involving trauma and ML. Sixty-five observational studies involving ML for the prediction of trauma outcomes met inclusion criteria. In total 2,433,180 patients were included in the studies. The studies focused on prediction of the following outcome measures: survival/mortality (n = 34), morbidity/shock/hemorrhage (n = 12), hospital length of stay (n = 7), hospital admission/triage (n = 6), traumatic brain injury (n = 4), life-saving interventions (n = 5), post-traumatic stress disorder (n = 4), and transfusion (n = 1). Six studies were prospective observational studies. Of the 65 studies, 33 used artificial neural networks for prediction. Importantly, most studies demonstrated the benefits of ML models. However, algorithm performance was assessed differently by different authors. Sensitivity-specificity gap values varied greatly from 0.035 to 0.927. Notably, studies shared many features for model development. A common ML feature base may be determined for predicting outcomes in trauma. However, the impact of ML will require further validation in prospective observational studies and randomized clinical trials, establishment of common performance criteria, and high-quality evidence about clinical and economic impacts before ML can be widely accepted in practice.
Epidemiology of Anaphylactic Shock and its Related Mortality in Hospital Patients in Taiwan: A Nationwide Population-Based Study
Authors: Liu Fu-Chao , Chiou Hung-Jr , Kuo Chang-Fu , Chung Ting-Ting , Yu Huang-Ping 
Published: May 2017

ABSTRACT
Anaphylactic shock is potentially life-threatening. However, there is a paucity of data about its incidence and associated mortality, particularly in Asian populations. We aimed to investigate the epidemiology of anaphylactic shock and its related mortality after the hospitalization of patients in the general population of Taiwan. The National Health Insurance Research Database was used to identify patients with anaphylactic shock and estimate its incidence for inpatients sampled from 2005 to 2012. The pattern of anaphylactic shock and anaphylactic shock-related mortality rate was also examined. Of 22,080,199 patients who were admitted to hospitals from 2005 to 2012, there were 2,289 incident cases of anaphylactic shock and 2,219 people were included. Incidence of hospitalizations due to anaphylactic shock ranged from 12.71 to 13.23 per million of the population between 2005 and 2012. The incidence of anaphylactic shock in our study was substantially lower than other western countries, including the United States. There were 24 deaths due to drug-induced anaphylactic shock among the hospitalizations; overall mortality rate was 1.08%. Eighteen (0.81%) patients died within 30 days; 22 (0.99%) died within 2 months following the anaphylactic shock. The highest incidence occurred in patients aged 70–79 years. Conversely, food-induced anaphylactic shock was not influenced by age. In conclusion, drug-induced anaphylactic shock was a major cause of death due to anaphylactic shock in hospitalized patients. Most cases of anaphylactic shock occurred in the older population, and the mortality rate was lower in females than in males, though the difference was not significant.
Wearable Sensor Technology Efficacy in Peripheral Vascular Disease (wSTEP)
Authors: Normahani Pasha , Kwasnicki Richard , Bicknell Colin , Allen Louise , Jenkins Mike P. , Gibbs Richard , Cheshire Nicholas , Darzi Ara , Riga Celia 
Published: May 2017

Objective:
To evaluate the effect of using wearable activity monitors (WAMs) in patients with intermittent claudication (IC) within a single-center randomized controlled trial.

Background:
WAMs allow users to set daily activity targets and monitor their progress. They may offer an alternative treatment to supervised exercise programs (SEPs) for patients with IC.

Methods:
Thirty-seven patients with IC were recruited and randomized into intervention or control group. The intervention consisted of a feedback-enabled, wrist-worn activity monitor (WAM) in addition to access to SEP. The control group was given access to SEP only. The outcome measures were maximum walking distance (MWD), claudication distance (CD), and quality of life as measured by the VascuQol questionnaire. Participants were assessed upon recruitment, and at 3, 6, and 12 months.

Results:
Patients in the WAM group showed significant improvement in MWD at 3 and 6 months (80–112 m, to 178 m; P < 0.001), which was sustained at 12 months. The WAM group also increased CD (40 vs 110 m; P < 0.001) and VascuQol score (4.7 vs 5.8; P = 0.004). The control group saw a temporary increase in VascuQol score at 6 months (4.5 vs 4.7; P = 0.028), but no other improvements in MWD or CD were observed. Significantly higher improvements in MWD were seen in the WAM group compared with that in the control group at 6 months (82 vs −5 m; P = 0.009, r = 0.47) and 12 months (69 vs 7.5 m; P = 0.011, r = 0.52).

Conclusions:
The study demonstrates the significant, sustained benefit of WAM-led technologies for patients with IC. This potentially resource-sparing intervention is likely to provide a valuable adjunct or alternative to SEP.
Hospital Minimally Invasive Surgery Utilization for Gastrointestinal Cancer
Authors: Mason Meredith C. , Tran Cao Hop S. , Awad Samir S. , Farjah Farhood , Chang George J. , Massarweh Nader N. 
Published: May 2017

Objective:
The aim of the study was to evaluate the impact of receiving care at high minimally invasive surgery (MIS)-utilizing hospitals

Background:
MIS techniques are used across surgical specialties. The extent of MIS utilization for gastrointestinal (GI) cancer resection and impact of receiving care at high utilizing hospitals is unclear.

Methods:
This is a retrospective cohort study of 137,581 surgically resected esophageal, gastric, pancreatic, hepatobiliary, colon, and rectal cancer patients within the National Cancer Data Base (2010–2013). Disease-specific, hospital-level, reliability-adjusted MIS utilization rates were calculated to evaluate perioperative outcomes. Among patients for whom adjuvant chemotherapy (AC) was indicated, the association between days to AC and hospital MIS utilization was examined using generalized estimating equations. Association with risk of death was evaluated using multivariable Cox regression.

Results:
Disease-specific MIS use increased significantly [42.0%–68.3% increase; trend test, P < 0.001 for all except hepatobiliary (P = 0.007)] over time. Most hospitals [range—30.3% (colon); 92.9% (pancreatic)] were low utilizers (≤30% of cases). Higher MIS utilization is associated with increased lymph nodes examined (P < 0.001, all) and shorter length of stay (P < 0.001, all). Each 10% increase in MIS utilization is associated with fewer days to AC [3.3 (95% confidence interval, 1.2–5.3) for MIS gastric; 3.3 ([0.7–5.8) for open gastric; 1.1 (0.3–2.0) days for open colon]. An association between MIS utilization and risk of death was observed for colon [Q2—hazard ratio (HR) 0.96 (0.89–1.02); Q3—HR 0.91 (0.86–0.98); Q4—HR 0.87 (0.82–0.93)] and rectal cancer [Q2—HR 0.89 (0.76–1.05); Q3—HR 0.84 (0.82–0.97); Q4—HR 0.86 (0.74–0.98)].

Conclusions:
Most hospitals treating GI malignancies are low MIS utilizers. Our findings may reflect real-world MIS effectiveness for oncologic resection and could be useful for identifying hospitals with infrastructure and/or processes beneficial for multimodality cancer care.
A note on the self-similar solutions to the spontaneous fragmentation equation
Authors: Breschi Giancarlo , Fontelos Marco A. 
Published: May 2017

We provide a method to compute self-similar solutions for various fragmentation equations and use it to compute their asymptotic behaviours. Our procedure is applied to specific cases: (i) the case of mitosis, where fragmentation results into two identical fragments, (ii) fragmentation limited to the formation of sufficiently large fragments, and (iii) processes with fragmentation kernel presenting a power-like behaviour.
Specific hypersensitive response-associated recognition of new apoplastic effectors fromCladosporium fulvumin wild tomato
Authors: Mesarich Carl H. , Ökmen Bilal , Rovenich Hanna , Griffiths Scott A. , Wang Changchun , Karimi Jashni Mansoor , Mihajlovski Aleksandar , Collemare Jérôme , Hunziker Lukas , Deng Cecilia H. , Burgt Ate van der , Beenen Henriek G. , Templeton Matthew D. , Bradshaw Rosie E. , de Wit Pierre J.G.M. 
Published: May 2017

ABSTRACTTomato leaf mould disease is caused by the biotrophic fungusCladosporium fulvum. During infection,C. fulvumproduces extracellular small secreted protein (SSP) effectors that function to promote colonization of the leaf apoplast. Resistance to the disease is governed byCfimmune receptor genes that encode receptor-like proteins (RLPs). These RLPs recognize specific SSP effectors to initiate a hypersensitive response (HR) that renders the pathogen avirulent.C. fulvumstrains capable of overcoming one or more of all clonedCfgenes have now emerged. To combat these strains, newCfgenes are required. An effectoromics approach was employed to identify wild tomato accessions carrying newCfgenes. Proteomics and transcriptome sequencing were first used to identify 70 apoplasticin planta-inducedC. fulvumSSPs. Based on sequence homology, 61 of these SSPs were novel or lacked known functional domains. Seven, however, had predicted structural homology to antimicrobial proteins, suggesting a possible role in mediating antagonistic microbe−microbe interactionsin planta. Wild tomato accessions were then screened for HR-associated recognition of 41 SSPs using thePotato virus X-based transient expression system. Nine SSPs were recognized by one or more accessions, suggesting that these plants carry newCfgenes available for incorporation into cultivated tomato.