bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening Criteria Improve Access to Palliative Care in the PICU*
Authors: Lutmer Jeffrey E. , Humphrey Lisa , Kempton Tanya Maria , Moore-Clingenpeel Melissa , Ayad Onsy 
Published: July 2016

Objectives:
To test the ability of palliative care screening criteria to improve access to palliative care services in the PICU and examine the association between palliative care team involvement and ICU and hospital length of stay.

Design:
Prospective interventional quality improvement study.

Setting:
PICU at a quaternary academic medical center.

Patients:
All patients admitted to the PICU who met criteria for palliative care referral over a 9-month period.

Intervention:
Consensus palliative care consultation criteria were created by pediatric critical care medicine and palliative care providers, and palliative care referral was encouraged for all PICU patients meeting criteria.

Measurements and Main Results:
Palliative care referral rates increased significantly after screening criteria implementation. We identified 100 patients who were eligible for palliative care services, and referrals were made for 70 patients (70%). Patients were divided into three groups based on palliative care status: patients new to the palliative care team, patients with an existing palliative care relationship, and patients who did not have a palliative care referral. By the end of study, patients who had an existing relationship with the palliative care team were more likely to still be alive and to have limitations of medical interventions in place, whereas patients who did not have a palliative care referral were more likely to be deceased and to have died in the PICU. After correcting for other factors, including severity of illness, patients who were new to the palliative care team experienced greater delay in palliative care referral and had significantly longer PICU and hospital length of stay than those who were already known to the palliative care team.

Conclusions:
Palliative care screening criteria are effective tools for improving access to palliative care services in the PICU; however, widespread adoption may produce a significant increase in palliative care demand. The association between an existing palliative care relationship and reduction in resource utilization deserves further investigation as does the perceived benefit of palliative care involvement in the patient, family, and staff experience.
Temporal Trends of Respiratory Syncytial Virus–Associated Hospital and ICU Admissions Across the United States*
Authors: Gupta Punkaj , Beam Brandon W. , Rettiganti Mallikarjuna 
Published: July 2016

Objectives:
To describe the regionality and seasonality of respiratory syncytial virus–associated hospital and ICU admissions for 10 consecutive years using a national database.

Design:
Post hoc analysis of data from an existing national database, Pediatric Health Information System. We modeled the adjusted odds of hospital and ICU admissions for varied seasons (fall, winter, spring, and summer) and regions (Northeast, South, Midwest, and West) using a mixed-effects logistic regression model after adjusting for several patient and center characteristics.

Setting:
Forty-two children’s hospitals across the Unites States.

Patients:
Patients 1 day through 24 months old with inpatient admission (ward and/or ICU) for respiratory syncytial virus– associated infection at a Pediatric Health Information System–participating hospital were included (2004–2013).

Interventions:
None.

Measurements and Main Results:
Of 1,937,994 inpatient admissions during the study period, 146,357 children were admitted for respiratory syncytial virus–associated acute respiratory illness. Of these inpatient admissions, 32,470 children(22%) were admitted to ICU during their hospital stay. Overall adjusted odds of respiratory syncytial virus–associated hospital and ICU admissions in recent years (2010–2013) were higher than previous years (2004–2006 and 2007–2009). In recent years, respiratory syncytial virus–associated hospital and ICU admissions have increased in winter and spring seasons. Regionally in recent years, the overall adjusted odds of both respiratory syncytial virus–associated hospital and ICU admissions have increased in the South and West regions.

Conclusions:
Wide variations in regional and seasonal patterns in hospital and ICU admissions were noted in children with respiratory syncytial virus–associated acute respiratory illness across the United States. Results from our study help us better understand the seasonality and regionality of respiratory syncytial virus infection in the United States with the goal to decrease the financial impact on our already stressed healthcare system by being better prepared for respiratory syncytial virus season.
Sevoflurane Therapy for Severe Refractory Bronchospasm in Children
Authors: Palacios Alba , Mencía Santiago , Llorente Ana M. , Cruz Jaime , Toledo Blanca , Ordóñez Olga , Olmedilla Marta , Lopez-Herce Jesus 
Published: July 2016

Objectives:
To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children.

Design:
Retrospective case series.

Setting:
Two PICUs of tertiary general university hospitals in Spain.

Patients:
Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015.

Intervention:
Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator.

Measurements and Main Results:
Inhaled sevoflurane resulted in statistically significant decreases of Paco
2 of 34.2 torr (95% CI, 8.3–60), peak inspiratory pressure of 14.3 cm H2O (95% CI, 8.6–19.9), and improvement in pH of 0.17 (0.346–0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46–216).

Conclusions:
Inhaled sevoflurane therapy decreases the levels of Paco
2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.
Factors Associated With Continuous Low-Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide
Authors: Onyeama Sara-Jane N. , Hanson Sheila J. , Dasgupta Mahua , Hoffmann Raymond G. , Faustino Edward Vincent S. 
Published: July 2016

Objectives:
To identify patient, hospital, and central venous catheter factors that may influence the use of low-dose heparin infusion for central venous catheter patency in critically ill children.

Design:
Secondary analysis of an international multicenter observational study.

Setting:
Fifty-nine PICUs over four study dates in 2012, involving seven countries.

Patients:
Children less than 18 years old with a central venous catheter who were admitted to a participating unit and enrolled in the completed Prophylaxis against Thrombosis Practice study were included. All overflow patients were excluded.

Interventions:
None.

Measurements and Main Results:
Of the 2,484 patients in the Prophylaxis against Thrombosis Practice study, 1,312 patients had a central venous catheter. Five hundred seven of those patients used low-dose heparin infusion. The frequency of low-dose heparin infusion was compared across various patient, hospital, and central venous catheter factors using chi-square, Mann-Whitney U, and Fisher exact tests. In the multivariate analysis, age was not a significant factor for low-dose heparin infusion use. Patients with pulmonary hypertension had decreased low-dose heparin infusion use, whereas those with active surgical or trauma diagnoses had increased low-dose heparin infusion use. All centrally inserted central venous catheters were more likely to use low-dose heparin infusion when compared with peripherally inserted central venous catheters. The Asia-Pacific region showed increased low-dose heparin infusion use, along with community hospitals and smaller ICUs (< 10 beds).

Conclusions:
Patient, central venous catheter, and hospital factors are associated with the use of low-dose heparin infusion in critically ill children. Further study is needed to evaluate the efficacy and persistence of low-dose heparin infusion use.
A Cross-Sectional Study of Emergency Department Visits by Children After All-Terrain Vehicle Crashes, Motor Vehicle Crashes, and Sports Activities
Authors: Nabaweesi Rosemary , Robbins James M. , Goudie Anthony , Onukwube Jennifer I. , Bowman Stephen M. , Aitken Mary E. 
Published: July 2016

Objectives
All-terrain vehicle (ATV) crashes have been responsible for significant injuries among children, despite public education efforts. Our study examined pediatric ATV injury patterns in US emergency departments (EDs) compared with injuries after motor vehicle crash (MVC) and sports activities.

Methods
We studied 2006 to 2011 data from the Nationwide Emergency Department Sample. Children younger than 18 years and involved in ATV crashes, MVC, or sports activities were included. The primary outcome analyzed was a constructed binary measure identifying severe trauma, defined as injury severity score greater than 15. Logistic regression models were fit to determine the association between mechanism of injury and severe trauma.

Results
A total of 6,004,953 ED visits were identified. Of these, ATV crashes accounted for 3.4%, MVC accounted for 44.7%, and sports activities accounted for 51.9%. Emergency department visits after ATV crashes were more likely to result in admission (8%) and incur higher median charges ($1263) compared with visits after sports activities (1%, $1013). Visits after sports activities were 90% less likely to result in severe trauma when compared with ATV crash visits. Emergency department visits after ATV crashes result in severe injuries similar to those sustained in MVC (odds ratio, 1.03; P = 0.626).

Conclusions
Pediatric ED visits after ATV crashes result in significant injuries and charges. Public health interventions such as education, legislation, and engineering are needed to reduce injuries among children and the subsequent ED visits for care. The impact of proven interventions may be greatest for children living in rural areas and among older children, 10 to 17 years old.
Elevated Baseline Cortisol Levels Are Predictive of Bad Outcomes in Critically Ill Children
Authors: Levy-Shraga Yael , Pinhas-Hamiel Orit , Molina-Hazan Vered , Tamir-Hostovsky Liran , Eini Zeev Motti , Lerner-Geva Liat , Paret Gideon 
Published: July 2016

Objective
The definition of an adequate adrenal response in critically ill children continues to be controversial. We aimed to evaluate the cortisol levels at baseline and after adrenocorticotropin (ACTH) stimulation and determine their association to clinical outcome of critically ill children.

Methods
All children who underwent an ACTH test in the pediatric intensive care unit (PICU) in a tertiary medical center between 2006 and 2013 were included in the study. Data on age, sex, diagnosis, vasoactive-inotropic score, length of pediatric intensive care unit stay, and mortality were obtained. Laboratory variables included hematologic and chemistry data, arterial lactate, and total plasma cortisol levels at baseline and after ACTH stimulation.

Results
Ninety-nine patients (61 males; median [range] age, 2 [0–204] months) were enrolled. The mortality rate of children with a baseline cortisol level of 600 nmol/L or greater was 36% (12/33 patients) versus 18% (12/66 patients) for children with a baseline cortisol level of less than 600 nmol/L (odds ratio, 2.6 [95% confidence interval, 1–6.6]; P = 0.05). There was a positive correlation between baseline cortisol and lactate levels (r = 0.40, P < 0.0001), vasoactive-inotropic scores (r = 0.24, P = 0.02), and mortality (P = 0.05). There was no correlation between peak cortisol measured at the ACTH test or the delta increment of cortisol from baseline and mortality.

Conclusions
A high baseline cortisol level in critically ill children was associated with more severe illness, higher lactate level, and a higher mortality rate. Routine baseline cortisol assessment is recommended to identify patients at high mortality risk.
Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient
Authors: Orlik Kseniya , Simon Erin Leslie , Hemmer Carrie , Ramundo Maria 
Published: July 2016

Abstract
We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the Pediatric Population
Authors: Alerhand Stephen , Cassella Courtney , Koyfman Alex 
Published: July 2016

Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic reactions with mucocutaneous involvement that carry elevated mortality rates. They differ along a spectrum of severity based upon body surface area affected. These conditions, usually caused by a drug or infection, are believed to result from cell-mediated and often drug-specific cytotoxic reactions against keratinocytes, leading to widespread dermal-epidermal detachment. Studies attempting to identify potential curative therapies such as intravenous immune globulin (IVIG) and corticosteroids remain inconclusive. However, improved outcomes have been demonstrated by early withdrawal of offending medications, early transfer to an intensive care unit or burn unit, and aggressive supportive care. Due to the rare incidence of SJS and TEN, its recurrence among survivors hints at future vulnerability for these patients, and notorious offending medications should thus be avoided. This clinical review will highlight the diagnostic and therapeutic challenges posed by SJS and TEN, while emphasizing the need to maintain them high on the emergency medicine physician's differential. The review will also detail the supportive measures to take for preventing the rapid progression of mucocutaneous complications and subsequent sepsis-related mortality.
The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days
Authors: Joseph Nataria T. , Muldoon Matthew F. , Manuck Stephen B. , Matthews Karen A. , MacDonald Leslie A. , Grosch James , Kamarck Thomas W. 
Published: July 2016

ABSTRACT

Objectives
The objectives of this study were to determine whether job strain is more strongly associated with higher ambulatory blood pressure (ABP) among blue-collar workers compared with white-collar workers, to examine whether this pattern generalizes across working and nonworking days and across sex, and to examine whether this pattern is accounted for by psychosocial factors or health behaviors during daily life.

Methods
A total of 480 healthy workers (mean age = 43 years, 53% female) in the Adult Health and Behavior Project–Phase 2 completed ABP monitoring during 3 working days and 1 nonworking day. Job strain was operationalized as high psychological demand (> sample median) combined with low decision latitude (<sample median; Karasek model; Job Content Questionnaire).

Results
Covariate-adjusted multilevel random coefficient regressions demonstrated that associations between job strain and systolic and diastolic ABP were stronger among blue-collar workers compared with white-collar workers (b = 6.53 [F(1,464) = 3.89, p = .049] and b = 5.25 [F(1,464) = 6.09, p = .014], respectively). This pattern did not vary by sex, but diastolic ABP findings were stronger when participants were at work. The stronger association between job strain and ABP among blue-collar workers was not accounted for by education, momentary physical activity, or substance use, but was partially accounted for by covariation between higher hostility and blue-collar status.

Conclusions
Job strain is associated with ABP among blue-collar workers. These results extend previous findings to a mixed-sex sample and nonworking days and provide, for the first time, comprehensive exploration of several behavioral and psychosocial explanations for this finding.
Sex and Gender Roles in Relation to Mental Health and Allostatic Load
Authors: Juster Robert-Paul , Pruessner Jens C. , Desrochers Alexandra Bisson , Bourdon Olivier , Durand Nadia , Wan Nathalie , Tourjman Valérie , Kouassi Edouard , Lesage Alain , Lupien Sonia J. 
Published: July 2016

ABSTRACT

Objectives
Beyond male/female binaries, gender roles represent masculine and feminine traits that we assimilate and enact throughout life span development. Bem proposed that “androgynous” individuals adeptly adapt to different contexts by alternating from a strong repertoire of both masculine and feminine gender roles. By contrast, “undifferentiated” individuals may not adapt as well to social norms because of weak self-endorsed masculinity and femininity.

Methods
Among 204 adults (mean [standard error] age = 40.4 [0.9] years; 70% women) working in a psychiatric hospital, we hypothesized that androgynous individuals would present better mental health and less physiological dysregulations known as allostatic load (AL) than undifferentiated individuals. AL was indexed using 20 biomarkers using the conventional “all-inclusive” formulation that ascribes cutoffs without regard for sex or an alternative “sex-specific” formulation with cutoffs tailored for each sex separately while controlling for sex hormones (testosterone, estradiol, progesterone). Well-validated questionnaires were used.

Results
Independent of sex, androgynous individuals experienced higher self-esteem and well-being and lower depressive symptoms than did undifferentiated individuals. Men manifested higher AL than did women using the all-inclusive AL index (p = .044, η
2
P = 0.025). By contrast, the sex-specific AL algorithm unmasked a sex by gender roles interaction for AL (p = .043, η
2
P = 0.048): with the highest AL levels in undifferentiated men. Analysis using a gender index based on seven gendered constructs revealed that a greater propensity toward feminine characteristics correlated only with elevated sex-specific AL (r = 0.163, p = .025).

Conclusions
Beyond providing psychobiological evidence for Bem's theory, this study highlights how sex-specific AL formulations detect the effects of sociocultural gender.
Molecular Mechanisms of Stress-Induced Myocardial Injury in a Rat Model Simulating Posttraumatic Stress Disorder
Authors: Liu Mi , Xu Feifei , Tao Tianqi , Song Dandan , Li Dong , Li Yuzhen , Guo Yucheng , Liu Xiuhua 
Published: July 2016

ABSTRACT

Objective
Posttraumatic stress disorder (PTSD) is an independent risk factor for cardiovascular diseases. This study investigated the molecular mechanisms underlying myocardial injury induced by simulated PTSD.

Methods
Sprague-Dawley rats were randomly divided into two groups: control group (n = 18) and PTSD group (n = 30). The PTSD model was replicated using the single prolonged stress (SPS) method. On the 14th day poststress, the apoptotic cells in myocardium were assessed using both TUNEL method and transmission electron microscopy; the protein levels of the endoplasmic reticulum stress (ERS) molecules were measured by using Western blotting analysis.

Results
Exposure to SPS resulted in characteristic morphologic changes of apoptosis in cardiomyocytes assessed by transmission electron microscopy. Moreover, TUNEL staining was also indicative of the elevated apoptosis rate of cardiomyocytes from the SPS rats (30.69% versus 7.26%, p < .001). Simulated PTSD also induced ERS in myocardium, demonstrated by up-regulation of protein levels of glucose-regulated protein 78 (0.64 versus 0.26, p = .017), calreticulin (p = .040), and CCAAT/enhancer-binding protein-homologous protein (0.95 versus 0.43, p = .047), phosphorylation of protein kinase RNA–like ER kinase (p = .003), and caspase 12 activation (0.30 versus 0.06, p < .001) in myocardium from the SPS rats. The ratio of Bcl-2 to Bax decreased significantly in myocardium from the SPS rats (p = .005).

Conclusions
The ERS-related apoptosis mediated by the protein kinase RNA–like ER kinase/CCAAT/enhancer-binding protein-homologous protein and caspase 12 pathways may be associated with myocardial injury in a rat model simulating PTSD. This study may advance our understanding of how PTSD contributes to myocardial injury on a molecular level.
Structural Remodeling of Sympathetic Innervation in Atherosclerotic Blood Vessels: Role of Atherosclerotic Disease Progression and Chronic Social Stress
Authors: Noller Crystal M. , Mendez Armando J. , Szeto Angela , Boulina Marcia , Llabre Maria M. , Zaias Julia , Schneiderman Neil , McCabe Philip M. 
Published: July 2016

ABSTRACT

Objective
The sympathetic nervous system (SNS) can undergo dramatic structural plasticity in response to behavioral factors and/or the presence of disease, leading to SNS hyperinnervation of peripheral tissues. The SNS has been proposed as an important mediator between stressful behavior and the progression of atherosclerosis in the vasculature. The present study examined whether structural remodeling of the SNS occurs in the vasculature in a genetically hyperlipidemic animal model of atherosclerosis, the Watanabe heritable hyperlipidemic rabbit (WHHL; relative to normolipidemic New Zealand white rabbits [NZW]), and whether SNS plasticity is driven by the progression of disease and/or by stressful social behavior.

Methods
WHHL and NZW rabbits were assigned to an unstable or stable social environment for 4 months. Aortic atherosclerosis was assessed and SNS aortic innervation quantified using immunofluorescent microscopy.

Results
Numerous SNS varicosities were observed throughout the aorta in WHHLs and NZWs, extending into the vascular media and intima, an innervation pattern not previously reported. WHHLs exhibited significantly greater innervation than NZWs (F(1,41) = 55.3, p < .001), with extensive innervation of the atherosclerotic neointima. The innervation density was highly correlated with the extent of disease in the WHHLs (r(21) = 0.855, p < .001). Social environment did not influence innervation in NZWs (aortic arch: p = .078, thoracic aorta: p = .34) or WHHLs (arch: p = .97, thoracic: p = .61).

Conclusions
The findings suggest that hyperinnervation is driven largely by the progression of disease rather than social environment. SNS innervation patterns observed in atherosclerotic human and mouse aortas were consistent with the rabbit, suggesting that SNS hyperinnervation of the diseased vessel wall is a general feature across mammalian species.