bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid Accurate Identification of Tuberculous Meningitis Among South African Children Using a Novel Clinical Decision Tool
Authors: Goenka Anu , Jeena Prakash M. , Mlisana Koleka , Solomon Tom , Spicer Kevin , Stephenson Rebecca , Verma Arpana , Dhada Barnesh , Griffiths Michael J. 
Published: August 2017

Background:
Early diagnosis of tuberculous meningitis (TBM) is crucial to achieve optimum outcomes. There is no effective rapid diagnostic test for use in children. We aimed to develop a clinical decision tool to facilitate the early diagnosis of childhood TBM.

Methods:
Retrospective case–control study was performed across 7 hospitals in KwaZulu-Natal, South Africa (2010–2014). We identified the variables most predictive of microbiologically confirmed TBM in children (3 months to 15 years) by univariate analysis. These variables were modelled into a clinical decision tool and performance tested on an independent sample group.

Results:
Of 865 children with suspected TBM, 3% (25) were identified with microbiologically confirmed TBM. Clinical information was retrieved for 22 microbiologically confirmed cases of TBM and compared with 66 controls matched for age, ethnicity, sex and geographical origin. The 9 most predictive variables among the confirmed cases were used to develop a clinical decision tool (CHILD TB LP): altered Consciousness; caregiver HIV infected; Illness length >7 days; Lethargy; focal neurologic Deficit; failure to Thrive; Blood/serum sodium <132 mmol/L; CSF >10 Lymphocytes ×106/L; CSF Protein >0.65 g/L. This tool successfully classified an independent sample of 7 cases and 21 controls with a sensitivity of 100% and specificity of 90%.

Conclusions:
The CHILD TB LP decision tool accurately classified microbiologically confirmed TBM. We propose that CHILD TB LP is prospectively evaluated as a novel rapid diagnostic tool for use in the initial evaluation of children with suspected neurologic infection presenting to hospitals in similar settings.
The Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome
Authors: Wick Cameron C. , Moore Amy M. , Killeen Daniel E. , Isaacson Brandon 
Published: August 2017

Objective:
CHARGE syndrome is associated with a variety of temporal bone anomalies and deafness. The lack of surgical landmarks and facial nerve irregularities make cochlear implantation in this population a challenging endeavor. This study aims to describe a safe and efficacious transcanal approach for cochlear implantation that obviates the need to perform a mastoidectomy and facial recess.

Patients:
Three children with profound hearing loss secondary to CHARGE syndrome.

Intervention:
Transcanal cochlear implantation with closure of the ear canal via a modified Rambo meatoplasty.

Main Outcome Measure(s):
Retrospective chart review of temporal bone anomalies associated with CHARGE syndrome, technical nuances of this transcanal approach, and cochlear implant outcomes.

Results:
The mean patient age was 2.5 years (range 1.5–3.8 yr). Two were male and two were left ears. All patients had a hypoplastic mastoid, semicircular canal aplasia, and had some degree of cochlear dysplasia. A full cochlear implant insertion was achieved in all cases, even in the presence of grossly abnormal middle ear and facial nerve anatomy. There were no intraoperative or postoperative complications. The mean follow-up was 12.4 months (range, 3.9–25.2 mo). All three patients use their device daily. Their guardians report improved vocalization and environmental awareness.

Conclusions:
The modified Rambo transcanal approach provides a safe corridor for cochlear implantation in patients with CHARGE syndrome. This approach minimizes the anatomical variations associated with the syndrome and may reduce the risk of electrode extrusion. Implant outcomes in this patient population remain highly variable based on the patient's global cognitive capacity.
Improving compliance with a chronic obstructive pulmonary disease bundle of care in Australian emergency departments: a clinical network quality improvement project
Authors: Kelly Anne-Maree , Pannifex Jan 
Published: August 2017

Objective
The aim of this study was to describe the impact of a clinical network-led quality improvement project on compliance with bundle of care elements (individually and as a ‘bundle’) for patients treated for chronic obstructive pulmonary disease exacerbations in the emergency department.

Participants and methods
A 9-month quality improvement project was performed by a modified knowledge transfer methodology with analysis by before and after data collection. The primary outcomes of interest were compliance with key bundle of care elements (individually and as a ‘bundle’). The analysis is descriptive.

Results
Seven emergency departments participated in the project. A total of 179 patients were included in the predata and 203 in the postdata. Administration of controlled oxygen therapy (if oxygen given) increased from 74 to 80% (P=nonsignificant). Administration of inhaled bronchodilators increased from 80 to 91% (P=0.004). Administration of systemic corticosteroids increased from 76 to 88% (P=0.003). Administration of antibiotics (if evidence of infection) increased from 85 to 99% (P<0.001). Analysis of a blood gas in nonmild disease increased from 82 to 91% (P=0.04) and administration of noninvasive ventilation if pH less than 7.3 increased from 53 to 81% (P=0.01). Compliance with all appropriate elements of the defined bundle of care increased from 43 to 63% (P<0.001).

Conclusion
A locally managed, clinical network-supported quality improvement project resulted in significant improvements in compliance with chronic obstructive pulmonary disease bundle of care elements.
Role of Polyethylene Glycol in the Treatment of Functional Constipation in Children
Authors: Koppen Ilan J.N. , Broekaert Ilse J. , Wilschanski Michael , Papadopoulou Alexandra , Ribes‐Koninckx Carmen , Thapar Nikhil , Gottrand Frederic , Orel Rok , Lionetti Paolo , Benninga Marc A. 
Published: August 2017

ABSTRACTAccording to international guidelines, polyethylene glycol (PEG) is the laxative of first choice in the treatment of functional constipation in children, both for disimpaction and for maintenance treatment. PEG acts as an osmotic laxative and its efficacy is dose dependent. PEG is highly effective, has a good safety profile, and is well tolerated by children. Only minor adverse events have been reported. Overall the use of PEG in children has been reported to be safe, although in patients predisposed to water and electrolyte imbalances monitoring of serum electrolytes should be considered.
Ataxia and Headache in a Child
Authors: Hewett Kathryn M. , Lorenzetti Brett , Jackson Benjamin F. 
Published: August 2017

Abstract
A 4-year-old female patient presents to the pediatric emergency department with acute onset of ataxia and occipital headache. Initial investigation, including computed tomography imaging, failed to demonstrate any focal neurologic lesion. Subsequent studies, however, reveal an acute thrombosis of the superior cerebellar artery. Further work up identified the likely causative factor to be a heterozygous mutation at the methylene tetrahydrofolate reductase gene. In this case report, we will discuss the work-up of pediatric ataxia, the evaluation and management of cerebrovascular accidents in children, and the association between stroke and mutation of the methylene tetrahydrofolate reductase gene.
Mistaken Identity
Authors: Owusu-Ansah Sylvia , Badaki-Makun Oluwakemi , Ngo Thuy L. 
Published: August 2017

Abstract
Cough is one of the most common presenting complaints encountered in primary care settings and the emergency department. In 2010, the Centers for Disease Control and Prevention reported approximately 31 million visits to ambulatory care centers for cough, making cough the most frequent presenting complaint in ambulatory visits (2010 National Ambulatory Medical Care Survey). Significant causes of cough can often be overlooked because it is a common symptom of a myriad of pathologies. We report the case of an otherwise healthy 9-year-old male who presented with worsening cough over a month and a half, subsequently noted to have a mediastinal mass, and diagnosed with lymphoma. We discuss the challenges of diagnosing life-threatening pathologies, which present with common symptoms.
Pediatric Life Support Update
Authors: Gill Carson , Kissoon Niranjan 
Published: August 2017

Abstract
Despite improving survival rates for pediatric cardiac arrest victims, they remain strikingly low. Evidence for pediatric cardiopulmonary resuscitation is limited with many areas of ongoing controversy. The American Heart Association provides updated guidelines for life support based on comprehensive reviews of evidence-based recommendations and expert opinions. This facilitates the translation of scientific discoveries into daily patient care, and familiarization with these guidelines by health care providers and educators will facilitate the widespread, consistent, and effective care for patients.
Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014
Authors: Raifman Julia R. , Gebo Kelly A. , Mathews William Christopher , Korthuis Philip Todd , Ghanem Khalil G. , Aberg Judith A. , Moore Richard D. , Nijhawan Ank E. , Monroe Anne K. , Berry Stephen A. ,   for the HIV Research Network
Published: August 2017

Objectives:
Annual screening for gonorrhea [Neisseria gonorrhoeae (NG)] and chlamydia [Chlamydia trachomatis (CT)] is recommended for all sexually active persons living with HIV but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004–2014, a period of expanding testing.

Methods:
We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women, and women.

Results:
Among 15,614 patients (50% MSM, 26% men who have sex exclusively with women, and 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 [adjusted odds ratio (AOR) per year 1.22 (1.21–1.22)]. Despite the increase in testing, test positivity also increased [AOR per year 1.10 (1.07–1.12)], and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 [AOR per year 1.20 (1.17–1.22)]. Case detection was highest among MSM but increased over time among all 3 groups.

Conclusions:
NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among persons living with HIV to decrease transmission and complications of NG/CT and of HIV.
Stepped-Wedge Cluster Randomized Controlled Trial to Promote Option B+ Retention in Central Mozambique
Authors: Pfeiffer James T. , Napúa Manuel , Wagenaar Bradley H. , Chale Falume , Hoek Roxanne , Micek Mark , Manuel João , Michel Cathy , Cowan Jessica Greenberg , Cowan James F. , Gimbel Sarah , Sherr Kenneth , Gloyd Stephen , Chapman Rachel R. 
Published: August 2017

Background:
This randomized trial studied performance of Option B+ in Mozambique and evaluated an enhanced retention package in public clinics.

Setting:
The study was conducted at 6 clinics in Manica and Sofala Provinces in central Mozambique.

Methods:
Seven hundred sixty-one pregnant women tested HIV+, immediately initiated antiretroviral (ARV) therapy, and were followed to track retention at 6 clinics from May 2014 to May 2015. Clinics were randomly allocated within a stepped-wedge fashion to intervention and control periods. The intervention included (1) workflow modifications and (2) active patient tracking. Retention was defined as percentage of patients returning for 30-, 60-, and 90-day medication refills within 25–35 days of previous refills.

Results:
During control periods, 52.3% of women returned for 30-day refills vs. 70.8% in intervention periods [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.05 to 3.08]. At 60 days, 46.1% control vs. 57.9% intervention were retained (OR: 1.82; CI: 1.06 to 3.11), and at 90 days, 38.3% control vs. 41.0% intervention (OR: 1.04; CI: 0.60 to 1.82). In prespecified subanalyses, birth before pickups was strongly associated with failure—women giving birth before ARV pickup were 33.3 times (CI: 4.4 to 250.3), 7.5 times (CI: 3.6 to 15.9), and 3.7 times (CI: 2.2 to 6.0) as likely to not return for ARV pickups at 30, 60, and 90 days, respectively.

Conclusions:
The intervention was effective at 30 and 60 days, but not at 90 days. Combined 90-day retention (40%) and adherence (22.5%) were low. Efforts to improve retention are particularly important for women giving birth before ARV refills.
Post-Treatment/Pre-operative PET Response Is Not an Independent Predictor of Outcomes for Patients With Gastric and GEJ Adenocarcinoma
Authors: Hernandez Jonathan M. , Beylergil Volkan , Goldman Debra A. , van Beek Elke , Gonen Mithat , Tang Laura , Downey Robert , Rizk Nabil , Shah Manish , Strong Vivian , Janjigian Yelena , Schöder Heiko , Coit Daniel G. 
Published: August 2017

Objective:
To determine whether changes in positron emission tomography (PET) avidity correlated with histologic response and were independently associated with outcome.

Background:
The implications of metabolic response to neoadjuvant therapy as measured by repeat PET imaging remain ill-defined for patients with gastric and gastroesophageal junction (GEJ) cancers.

Methods:
We identified patients with gastric and GEJ adenocarcinoma who were evaluated with PET imaging before and following neoadjuvant treatment, and subsequently underwent curative resections. Spearman rank correlation and Cox proportional hazards regression were used to evaluate standardized uptake value (SUV) and histologic response, pathologic parameters, and disease-specific survival (DSS).

Results:
From 2002 to 2013, 192 patients met our inclusion criteria. The median SUVmax response was 57.3% (range: -110% to 100%) for patients with GEJ cancers, with a corresponding median pathologic treatment response of 80% (range: 0% to 100%). The median SUVmax response was 32.5% (-230% to 100%) for patients with gastric cancers, with a corresponding median pathologic treatment response of 35% (range: 0% to 100%). The Spearman correlation between SUVmax response and histologic response was significant for patients with GEJ (rho = 0.19, P = 0.04) and gastric (rho = 0.44, P < 0.0001) cancers. For patients with GEJ (P <0.0001 to 0.046) and gastric cancers (P = 0.0003 to 0.016), histopathologic response and tumor staging predicted DSS. SUVmax response failed to demonstrate a relationship with DSS when entered into multivariable models containing conventional pathologic variables.

Conclusion:
Following completion of neoadjuvant therapy for gastric and GEJ adenocarcinoma, histopathologic staging remains the best predictor of outcome. Repeat post-treatment/preoperative PET imaging for the purpose of prognostication is of limited value.
Deleterious Effect of RAS and Evolutionary High-risk TP53 Double Mutation in Colorectal Liver Metastases
Authors: Chun Yun Shin , Passot Guillaume , Yamashita Suguru , Nusrat Maliha , Katsonis Panagiotis , Loree Jonathan M. , Conrad Claudius , Tzeng Ching-Wei D. , Xiao Lianchun , Aloia Thomas A. , Eng Cathy , Kopetz Scott E. , Lichtarge Olivier , Vauthey Jean-Nicolas 
Published: August 2017

Objective:
To assess the impact of somatic gene mutations on survival among patients undergoing resection of colorectal liver metastases (CLM).

Background:
Patients undergoing CLM resection have heterogeneous outcomes, and accurate risk stratification is necessary to optimize patient selection for surgery.

Methods:
Next-generation sequencing of 50 cancer-related genes was performed from primary tumors and/or liver metastases in 401 patients undergoing CLM resection. Missense TP53 mutations were classified by the evolutionary action score (EAp53)—a novel approach that dichotomizes mutations as low or high risk.

Results:
The most frequent somatic gene mutations were TP53 (65.6%), followed by KRAS (48.1%) and APC (47.4%). Double mutation in RAS/TP53, identified in 31.4% of patients, was correlated with primary tumor location in the right colon (P = 0.006). On multivariable analysis, RAS/TP53 double mutation was an independent predictor of shorter overall survival (hazard ratio 2.62, 95% confidence interval 1.41–4.87, P = 0.002). In patients with co-mutated RAS, EAp53 high-risk mutations were associated with shorter 5-year overall survival of 12.2%, compared with 55.7% for TP53 wild type (P < 0.001). The negative prognostic effects of RAS and TP53 mutations were limited to tumors harboring mutations in both genes.

Conclusions:
Concomitant RAS and TP53 mutations are associated with decreased survival after CLM resection. A high EAp53 predicts a subset of patients with worse prognosis. These preliminary analyses suggest that surgical resection of liver metastases should be carefully considered in this subset of patients.
Incidence and Risk Factors of Long-term Opioid Use in Elderly Trauma Patients
Authors: Daoust Raoul , Paquet Jean , Moore Lynne , Gosselin Sophie , Gélinas Céline , Rouleau Dominique M. , Bérubé Mélanie , Morris Judy 
Published: August 2017

Objective:
Evaluate the incidence and risk factors of opioid use 1 year after injury in elderly trauma patients.

Background:
The current epidemic of prescription opioid misuse and overdose observed in North America generally concerns young patients. Little is known on long-term opioid use among the elderly trauma population.

Methods:
In a retrospective observational multicenter cohort study conducted on registry data, all patients 65 years and older admitted (hospital stay >2 days) for injury in 57 adult trauma centers in the province of Quebec (Canada) between 2004 and 2014 were included. We searched for filled opioid prescriptions in the year preceding the injury, up to 3 months and 1 year after the injury.

Results:
In all, 39,833 patients were selected for analysis. Mean age was 79.3 years (±7.7), 69% were women, and 87% of the sample was opioid-naive. After the injury, 38% of the patients filled an opioid prescription within 3 months and 10.9% [95% confidence interval (CI) 10.6%–11.2%] filled an opioid prescription 1 year after trauma: 6.8% (95% CI 6.5%–7.1%) were opioid-naïve and 37.6% (95% CI 36.3%–38.9%) were opioid non-naive patients. Controlling for confounders, patients who filled 2 or more opioid prescriptions before the injury and those who filled an opioid prescription within 3 months after the injury were, respectively, 11.4 and 3 times more likely to use opioids 1 year after the injury compared with those who did not fill opioid prescriptions.

Conclusions:
These results highlight that elderly trauma patients are at risk of long-term opioid use, especially if they had preinjury or early postinjury opioid consumption.
Distress tolerance across self-report, behavioral and psychophysiological domains in women with eating disorders and healthy controls
Authors: Yiu Angelina , Christensen Kara , Arlt Jean M. , Chen Eunice Y. 
Published: August 2017

AbstractBackground and objectivesThe tendency to engage in impulsive behaviors when distressed is linked to engagement in disordered eating. The current study comprehensively examines emotional responses to a distress tolerance task by utilizing self-report, psychophysiological measures (respiratory sinus arrhythmia [RSA], skin conductance responses [SCRs] and tonic skin conductance levels [SCLs]), and behavioral measures (i.e., termination of task, latency to quit task).Methods26 healthy controls (HCs) and a sample of treatment-seeking women with Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Anorexia Nervosa (AN) (N=106) completed the Paced Auditory Serial Addition Task-Computerized (PASAT-C). Psychophysiological measurements were collected during baseline, PASAT-C, and recovery, then averaged for each time-period. Self-reported emotions were collected at baseline, post-PASAT-C and post-recovery.ResultsOverall, we found an effect of Time, with all participants reporting greater negative emotions, less happiness, lower RSA, more SCRs and higher tonic SCLs after completion of the PASAT-C relative to baseline. There were no differences in PASAT-C performance between groups. There was an effect of Group for negative emotions, with women with BN, BED and AN reporting overall higher levels of negative emotions relative to HCs. Furthermore, we found an effect of Group for greater urges to binge eat and lower RSA values among BED, relative to individuals with BN, AN and HCs.LimitationsThis study is cross-sectional and lacked an overweight healthy control group.ConclusionDuring the PASAT-C, individuals with EDs compared to HCs report higher levels of negative emotions, despite similar physiological and behavioral manifestations of distress.
Categorical Biases in Human Occipitoparietal Cortex
Authors: Ester Edward F. , Sprague Thomas C. , Serences John T. 
Published: August 2017

AbstractCategorization allows organisms to generalize existing knowledge to novel stimuli and to discriminate between physically similar yet conceptually different stimuli. Humans, nonhuman primates, and rodents can readily learn arbitrary categories defined by low-level visual features, and learning distorts perceptual sensitivity for category-defining features such that differences between physically similar yet categorically distinct exemplars are enhanced while differences between equally similar but categorically identical stimuli are reduced. We report a basis for these distortions in human occipitoparietal cortex. In three experiments, we used an inverted encoding model to recover population-level representations of stimuli from multivoxel and multi-electrode patterns of human brain activity while human participants (both sexes) classified continuous stimulus sets into discrete groups. In each experiment, reconstructed representations of to-be-categorized stimuli were systematically biased towards the center of the appropriate category. These biases were largest for exemplars near a category boundary, predicted participants’ overt category judgments, emerged shortly after stimulus onset, and could not be explained by mechanisms of response selection or motor preparation. Collectively, our findings suggest that category learning can influence processing at the earliest stages of cortical visual processing.Significance StatementCategory learning enhances perceptual sensitivity for physically similar yet categorically different stimuli. We report a possible mechanism for these distortions in human occipitoparietal cortex.. In three experiments, we used an inverted encoding model to recover population-level representations of stimuli from multivariate patterns in occipitoparietal cortex while participants categorized sets of continuous stimuli into discrete groups. The recovered representations were systematically biased by category membership, with larger biases for exemplars adjacent to a category boundary. These results suggest that mechanisms of categorization shape information processing at the earliest stages of the visual system.