bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atopic dermatitis: new evidence on the role of allergic inflammation
Authors: Heratizadeh Annice 
Published: August 2016

Purpose of review
Atopic dermatitis is a chronic relapsing inflammatory skin disease. In the presence of a complex genetic background, there is increasing evidence for the role of specific allergenic trigger factors in perpetuating skin inflammation in sensitized atopic dermatitis patients. In this review, clinical and in-vitro data so far published on allergen-induced adaptive immune responses in atopic dermatitis are summarized.

Recent findings
Emerging new data have been published particularly on adaptive immune responses to inhalant allergens in atopic dermatitis. In a randomized controlled study, the induction of a flare-up by grass pollen exposure in sensitized atopic dermatitis patients could be demonstrated for the first time. T cells directed to the two major allergens of house dust mite have been characterized to display a Th2, and moreover, a Th17 and Th2/Th17 phenotype in sensitized atopic dermatitis patients. With regard to microbial antigens, T cell-mediated immune responses directed to proteins of the species themselves can be observed – as has been published for Staphylococcus aureus and Malassezia spp. Beyond this, specific T-cell activation to cross-reacting human proteins might further trigger the disease in distinct patients. The role of ‘autoallergic’ phenomena in atopic dermatitis, because of human antigens without known cross-reactivity to environmental allergens, is currently under investigation as well.

Summary
Recent findings on immunological and clinical characteristics of adaptive immune responses to allergens in atopic dermatitis, but also on the identification of new, potentially relevant allergen sources might contribute to the development of effective treatment strategies ‘customized’ for allergic inflammation in atopic dermatitis in future.
A systematic review of the role of interleukin-17 and the interleukin-20 family in inflammatory allergic skin diseases
Authors: Hofmann Maja A. , Kiecker Felix , Zuberbier Torsten 
Published: August 2016

Purpose of review
Allergic skin diseases include atopic dermatitis/eczema, contact dermatitis, and drug hypersensitivity. Allergic skin diseases have a high prevalence. Atopic dermatitis is one of the most common inflammatory skin diseases and similar for allergic rhinitis and allergic asthma. Over a long period, allergic diseases have been regarded as immunoglobulin E-mediated T-helper-2 (Th2)-driven. But new cytokines and T cells have been discovered within the last years. In this systematic review, the focus is laid on interleukin-17 (IL-17) and the interleukin-20 (IL-20) family which appear to be fine-tuning the Th2-driven answer.

Recent findings
IL-17 is a proinflammatory cytokine, which is produced by T cells. Primarily, IL-17 is produced by activated CD4+ cells, called Th-17 cells. IL-17 regulates keratinocyte expression of adhesion molecules and chemokines. IL-17 is involved in the pathogenesis of inflammatory diseases as psoriasis, arthritis, and inflammatory bowel diseases. In allergic diseases, the involvement of the TH17/IL17-pathway has only been recently described. Regarding the IL-20 family, IL-22 is the most interesting and the most studied cytokine in terms of allergic inflammatory disorders. IL-22 is produced by T-helper 22 cells, a new subset of CD4+ cells.

Summary
IL-17 as well as IL-22 seem to play a role in the pathogenesis of allergic skin diseases.
Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department
Authors: Zhabenko Olena , Austic Elizabeth , Conroy Deirdre A. , Ehrlich Peter , Singh Vijay , Epstein-Ngo Quyen , Cunningham Rebecca M. , Walton Maureen A. 
Published: August 2016

Objectives:
To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers).

Methods:
A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011–2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit.

Results:
23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school.

Conclusions:
These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.
Racial Differences in Parental Responses to Children’s Chronic Pain
Authors: El-Behadli Ana F. , Gansert Patricia , Logan Deirdre E. 
Published: August 2016

Objective:
Parental responses to children’s pain are related to how youth cope with chronic pain. However, little research has explored cultural differences in the 4 major pain response categories (ie, protect, minimize, distract, and monitor). This study compared parental responses to children’s pain between minority parents (ie, black, Hispanic, multiracial) and parents of white children.

Materials and Methods:
Participants included 234 patients, ages 8 to 17, with chronic pain (73.5% female; age M [SD]=13.91 [2.38]; 50% white, 15.39% black, 20.90% Hispanic, 13.68% multiracial). Patients’ parents completed the Adult Responses to Children’s Symptoms. Parental responses included: protect, monitor, minimize, and distrct. For between-group comparisons, white participants (N=117) were matched on age and sex with black (N=36), Hispanic (N=49), and multiracial (N=32) participants.

Results:
Paired-samples t tests revealed that protectiveness was higher for parents of black children (t
48=−3.84, P<0.001, black M [SD]=1.93 [0.69], white M [SD]=0.94 [0.77], Cohen d=1.09) and parents of Hispanic children (t
71=−7.10, P<0.001, Hispanic M [SD]=1.65 [0.76], white M [SD]=0.94 [0.77], Cohen d=1.52) compared with parents of white children. In addition, parents of black children (t
40=−2.90, P=0.006, black M [SD]=3.55 [0.49], white M [SD]=2.89 [0.93], Cohen d=0.80) and parents of Hispanic children (t
71=−3.62, P<0.001, Hispanic M [SD]=3.35 [0.69], white M [SD]=2.89 [0.93], Cohen d=0.81) were significantly more monitoring their children than were parents of white children. Parents of Hispanic children were also significantly more minimizing than parents of white children (t
71=−3.68, P<0.001, Hispanic M [SD]=0.88 [0.75], white M [SD]=0.51 [0.58], Cohen d=0.80). No other significant differences were found.

Discussion:
Results highlight the need to adapt pediatric chronic pain interventions to family culture and context. Further research is needed to understand pediatric chronic pain from a cross-cultural perspective.
Establishment of the Relationship Between Fathers and Premature Infants in Neonatal Units
Authors: Martel Marie-Josée , Milette Isabelle , Bell Linda , Tribble Denise St-Cyr , Payot Antoine 
Published: August 2016

Background:
Parents and their preterm infants (born between 32-37 weeks of gestation) are often overlooked by the healthcare system. And very little attention is given to the relationship parents develop with their infants in the neonatal unit (NNU). Specifically, very few studies focused on fathers and how they establish a relationship with their infants. However, we know that the father–infant relationship is extremely important for their future social development and more.

Purpose:
This article presents the results of a qualitative study of the establishment of the father–premature infant relationship in an NNU.

Methods/Search Strategy:
The study's theoretical framework was Bell's model of the parent–infant relationship, which encompasses discovery, physical proximity, communication, involvement, and emotional attachment. Ten fathers of premature infants (gestational age: 32-37 weeks) participated in 2 semistructured interviews (1 individual and 1 “in situ,” ie, at the infant's bedside) during the first week following the premature birth.

Findings/Results:
The results confirm the emergence of different components of the relationship between fathers and their children from the first days of hospitalization in the NNU. The commitment component is the basis for the development of other components in the relationship with their children. Furthermore, involvement influences the deployment of emotional attachment, discovery, physical proximity, and communication toward premature infants. Similarly, the 5 themes of the model can be seen as forming a dynamic nexus in which each theme influences the others.

Implications for Practice:
For neonatal nurses, this model of the early father–child relationship helps the understanding of the deployment of that relationship according to 5 components. Similarly, it provides awareness of the experiences of fathers so that nurses can be better equipped to support and individualize interventions tailored to their specific needs, thus helping them develop and sustain the relationship with their children.

Implications for research:
This study allows us to better understand fathers' experience regarding the establishment of the relationship to their premature infants born between 32 and 37 weeks of gestation. However, there is little understanding about the early paternal experience and more research on this dyad is necessary in neonatology.
Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness: A Systematic Review and Meta-Analysis
Authors: Price David R. , Mikkelsen Mark E. , Umscheid Craig A. , Armstrong Ehrin J. 
Published: August 2016

Objective:
The relationship between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness remains unclear. We examined the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, and critical illness myopathy.

Data Sources:
PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and bibliographies of included studies were searched from database inception until September 24, 2015.

Study Selection:
Randomized controlled trials and prospective observational studies examining the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, or critical illness myopathy.

Data Extraction:
One author screened titles/abstracts. Two authors independently reviewed full text and extracted data from included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model (OpenMetaAnalyst 10.10 for OS.X). We assessed reporting bias with funnel plots and heterogeneity with the I
2 statistic.

Data Synthesis:
Of 2,170 titles/abstracts screened, 99 full texts were selected for review, yielding one randomized controlled trial and 18 prospective observational studies, for a total of 2,254 patients. The randomized controlled trial did not show an association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness (odds ratio, 1.21; 95% CI, 0.67–2.19), but pooled data from all included studies suggested a modest association (odds ratio, 1.25; 95% CI, 1.06–1.48; I
2 = 16%). Funnel plots suggested reporting bias, and sensitivity analyses showed a disproportionate contribution from critical illness polyneuropathy/critical illness myopathy and severe sepsis/septic shock studies.

Conclusions:
This meta-analysis suggests a modest association between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness; limitations include studies with a high risk of bias and a disproportionate contribution from studies examining patients for critical illness polyneuropathy/critical illness myopathy and those with severe sepsis/septic shock.
Errors, Omissions, and Outliers in Hourly Vital Signs Measurements in Intensive Care
Authors: Maslove David M. , Dubin Joel A. , Shrivats Arvind , Lee Joon 
Published: August 2016

Objective:
To empirically examine the prevalence of errors, omissions, and outliers in hourly vital signs recorded in the ICU.

Design:
Retrospective analysis of vital signs measurements from a large-scale clinical data warehouse (Multiparameter Intelligent Monitoring in Intensive Care III).

Setting:
Data were collected from the medical, surgical, cardiac, and cardiac surgery ICUs of a tertiary medical center in the United States.

Patients:
We analyzed data from approximately 48,000 ICU stays including approximately 28 million vital signs measurements.

Interventions:
None.

Measurements and Main Results:
We used the vital sign day as our unit of measurement, defined as all the recordings from a single patient for a specific vital sign over a single 24-hour period. Approximately 30–40% of vital sign days included at least one gap of greater than 70 minutes between measurements. Between 3% and 10% of blood pressure measurements included logical inconsistencies. With the exception of pulse oximetry vital sign days, the readings in most vital sign days were normally distributed. We found that 15–38% of vital sign days contained at least one statistical outlier, of which 6–19% occurred simultaneously with outliers in other vital signs.

Conclusions:
We found a significant number of missing, erroneous, and outlying vital signs measurements in a large ICU database. Our results provide empirical evidence of the nonrepresentativeness of hourly vital signs. Additional studies should focus on determining optimal sampling frequencies for recording vital signs in the ICU.
Increased Ratio of Visceral to Subcutaneous Adipose Tissue in Septic Patients Is Associated With Adverse Outcome*
Authors: Pisitsak Chawika , Lee Joseph G. H. , Boyd John H. , Coxson Harvey O. , Russell James A. , Walley Keith R. 
Published: August 2016

Objectives:
Visceral and subcutaneous adipose tissue may contribute differentially to the septic inflammatory response. Accordingly, we tested the hypothesis that the ratio of visceral to subcutaneous adipose tissue is associated with altered sepsis outcome.

Design:
A retrospective analysis from a cohort of sepsis patients admitted between 2004 and 2009.

Setting:
A mixed medical-surgical ICU at St. Paul’s Hospital in Vancouver, Canada.

Patients:
Patients older than 16 years old who had sepsis and underwent abdominal CT scan (n = 257) for clinical reasons.

Interventions:
None.

Measurements and Main Results:
We measured the visceral adipose tissue and subcutaneous adipose tissue areas and calculated the visceral adipose tissue-to-subcutaneous adipose tissue ratio. Visceral adipose tissue/subcutaneous adipose tissue was not correlated with body mass index (r
2 = –0.015, p = NS) and therefore provides additional unique information independent of body mass index. Sepsis patients with higher visceral adipose tissue/subcutaneous adipose tissue had greater 90-day mortality than patients with lower visceral adipose tissue/subcutaneous adipose tissue (log-rank test, linear-by linear association p < 0.005). After adjustment for significant covariates using Cox regression, increased visceral adipose tissue/subcutaneous adipose tissue quartile was significantly associated with increased 90-day mortality with hazard ratios of 2.01 (95% CI, 1.01–3.99) for the third visceral adipose tissue/subcutaneous adipose tissue quartile compared with the first quartile and 2.32 (95% CI, 1.15–4.69) for the highest visceral adipose tissue/subcutaneous adipose tissue quartile when compared with the first quartile. Increased mortality for patients with higher visceral adipose tissue/subcutaneous adipose tissue was found for both patients with body mass index less than 25 kg/m2 (p = 0.004) and for body mass index greater than or equal to 25 kg/m2 (p = 0.023). Furthermore, we found significantly greater need for mechanical ventilation, renal replacement therapy, and ICU stay in patients in the highest visceral adipose tissue/subcutaneous adipose tissue quartile. The ratio of proinflammatory (interleukin-8) to anti-inflammatory (interleukin-10) plasma cytokine levels was greater in patients with higher visceral adipose tissue/subcutaneous adipose tissue than in those with lower visceral adipose tissue/subcutaneous adipose tissue (p = 0.043).

Conclusions:
Visceral obesity, defined by a high visceral adipose tissue-to-subcutaneous adipose tissue ratio, contributes to adverse outcome in sepsis patients perhaps because of a greater pro- versus anti-inflammatory response.
Computational Analysis Supports an Early, Type 17 Cell-Associated Divergence of Blunt Trauma Survival and Mortality*
Authors: Abboud Andrew , Namas Rami A. , Ramadan Mostafa , Mi Qi , Almahmoud Khalid , Abdul-Malak Othman , Azhar Nabil , Zaaqoq Akram , Namas Rajaie , Barclay Derek A. , Yin Jinling , Sperry Jason , Peitzman Andrew , Zamora Ruben , Simmons Richard L. , Billiar Timothy R. , Vodovotz Yoram 
Published: August 2016

Objective:
Blunt trauma patients may present with similar demographics and injury severity yet differ with regard to survival. We hypothesized that this divergence was due to different trajectories of systemic inflammation and utilized computational analyses to define these differences.

Design:
Retrospective clinical study and experimental study in mice.

Setting:
Level 1 trauma center and experimental laboratory.

Patients:
From a cohort of 493 victims of blunt trauma, we conducted a pairwise, retrospective, case-control study of patients who survived over 24 hours but ultimately died (nonsurvivors; n = 19) and patients who, after ICU admission, went on to be discharged(survivors; n = 19).

Interventions:
None in patients. Neutralizing anti-interleukin-17A antibody in mice.

Measurements and Main Results:
Data on systemic inflammatory mediators assessed within the first 24 hours and over 7 days were analyzed with computational modeling to infer dynamic networks of inflammation. Network density among inflammatory mediators in nonsurvivors increased in parallel with organ dysfunction scores over 7 days, suggesting the presence of early, self-sustaining, pathologic inflammation involving high-mobility group protein B1, interleukin-23, and the Th17 pathway. Survivors demonstrated a pattern commensurate with a self-resolving, predominantly lymphoid response, including higher levels of the reparative cytokine interleukin-22. Mice subjected to trauma/hemorrhage exhibited reduced organ damage when treated with anti-interleukin-17A.

Conclusions:
Variable type 17 immune responses are hallmarks of organ damage, survival, and mortality after blunt trauma and suggest a lymphoid cell–based switch from self-resolving to self-sustaining inflammation.
Association of Freestanding Children’s Hospitals With Outcomes in Children With Critical Illness*
Authors: Gupta Punkaj , Rettiganti Mallikarjuna , Fisher Paige L. , Chang Anthony C. , Rice Tom B. , Wetzel Randall C. 
Published: August 2016

Objectives:
Little is known about the relationship between freestanding children’s hospitals and outcomes in children with critical illness. The purpose of this study was to evaluate the association of freestanding children’s hospitals with outcomes in children with critical illness.

Design:
Propensity score matching was performed to adjust for potential confounding variables between patients cared for in freestanding or nonfreestanding children’s hospitals. We tested the sensitivity of our findings by repeating the primary analyses using inverse probability of treatment weighting method and regression adjustment using the propensity score.

Setting:
Retrospective study from an existing national database, Virtual PICU Systems (LLC) database.

Patients:
Patients less than 18 years old admitted to one of the participating PICUs in the Virtual PICU Systems, LLC database were included (2009–2014).

Interventions:
None.

Measurements and Main Results:
A total of 538,967 patients from 140 centers were included. Of these, 323,319 patients were treated in 60 freestanding hospitals. In contrast, 215,648 patients were cared for in 80 nonfreestanding hospitals. By propensity matching, 134,656 patients were matched 1:1 in the two groups (67,328 in each group). Prior to matching, patients in the freestanding hospitals were younger, had greater comorbidities, had higher severity of illness scores, had higher incidence of cardiac arrest, had higher resource utilization, and had higher proportion of patients undergoing complex procedures such as cardiac surgery. Before matching, the outcomes including mortality were worse among the patients cared for in the freestanding hospitals (freestanding vs nonfreestanding, 2.5% vs 2.3%; p < 0.001). After matching, the majority of the study outcomes were better in freestanding hospitals (freestanding vs nonfreestanding, mortality: 2.1% vs 2.8%, p < 0.001; standardized mortality ratio: 0.77 [0.73–0.82] vs 0.99 [0.87–0.96], p < 0.001; reintubation: 3.4% vs 3.8%, p < 0.001; good neurologic outcome: 97.7% vs 97.1%, p = 0.001).

Conclusions:
In this large observational study, we demonstrated that ICU care provided in freestanding children’s hospitals is associated with improved risk-adjusted survival chances compared to nonfreestanding children’s hospitals. However, the clinical significance of this change in mortality should be interpreted with caution. It is also possible that the hospital structure may be a surrogate of other factors that may bias the results.