bluuebunny/crossref_metadata_2025_split huggingface dataset:
PET/CT Response Assessment in Pediatric Hodgkin Lymphoma: Does Deauville Score 3 Reflect Negativity?
Authors: Semary Samah , Moussa Emad , Salama Maram , Fakhry Mona , Attia Asmaa , Mehesen Maha , Khorshed Eman , Elwekeel Madeeha , Elnashar Amr , Sedky Mohamed , Hamoda Asmaa 
Published: August 2024

Background:
FDG PET is required for the staging and response evaluation of pediatric Hodgkin lymphoma. This study aimed to evaluate the outcomes of pediatric patients with Hodgkin’s lymphoma based on interim PET CT assessments of early response following second-cycle chemotherapy using the Deauville score (DS). It also determines whether DS–3 is providing an adequate or inadequate response.

Methods:
We conducted a retrospective cohort study including 504 pediatric patients with classic Hodgkin lymphoma who were treated with chemotherapy based on the Euro-Net protocol at the Children Cancer Hospital Egypt from March 2019 till the end of October 2022.

Results:
Patients with adequate response DS 1/2 and DS 3 showed nearly the same 3-year event-free survival (EFS) of 91.9% and 91.5%, respectively, compared with those patients with inadequate response DS 4/5, who showed an EFS of 80.4% (P=0.001). Patients with a DS 3 at interim PET evaluation were considered negative as DS 1/2. Patients of DS 3 group who did not receive radiotherapy had a much worse 3-year EFS by the existence of positive B symptoms, an ESR>30, or an advanced stage. Radiation therapy did not improve the 3-year EFS in patients with an inadequate response (DS4/5) and poor prognostic characteristics. They still need more advanced treatment.

Conclusion:
DS 1/2 and DS 3 had about the same 3-year EFS, which is better than the 3-year EFS of patients with DS 4/5. Therefore, we can classify DS 3 as having negative FDG PET CT uptake.
Closing the Provider Gap in Rural and Underserved Communities
Authors: Tapp Jannyse , Ketel Christian , Vick Rose , Zsamboky Marci , Pfieffer Mary Lauren , Gardner Virginia , Cole Shannon , Pitts Courtney 
Published: August 2024

Background:
Health care disparities in rural and underserved areas necessitate quality primary care, especially in behavioral health management. Family nurse practitioners (FNPs) are critical in these regions, which often lack psychiatric specialists.

Problem:
Rural communities face unique challenges exacerbated by primary care and mental health provider shortages. The deficit in behavioral health specialists highlights the need to optimize FNP education programs.

Approach:
The Collaborative Academic Practice (CAP) program prepares FNP students for entry-to-practice through hybrid learning, immersive training, and comprehensive behavioral health integration, effectively training them to meet the health care needs of underserved populations.

Outcomes:
The CAP program prepares FNPs, resulting in increased practice in underserved areas and enhanced preceptor satisfaction. Key measures contribute to its effectiveness, including immersive training, telehealth education, and preceptor enhancement.

Conclusions:
Despite financial and communication challenges, the CAP program transforms FNP education, addressing mental health needs and bridging critical gaps in health care delivery.
Impact of COVID-19 and Public Health Measures on Positive Suicide Screens Among Emergency Department Children
Authors: Cafferty Rachel , Haasz Maya , Leonard Jan , Ambroggio Lilliam 
Published: August 2024

Objective
The aim of this study was to examine the association between prolonged time in the COVID-19 pandemic and rates of positive routine suicide screens among youth accessing healthcare in the pediatric emergency department.

Methods
Participants were English- and Spanish-speaking youth aged 10–18 years presenting without an acute mental/behavioral health concern to the emergency department or urgent care of a large hospital system, serving a 7-state region, who completed routine screening for suicide risk. Visits between March 1, 2019 and December 31, 2021 were included. We conducted a quasi-experimental interrupted time series analysis and categorized visits into the prepandemic year, COVID-19 year 1 (Y1), and COVID-19 year 2 (Y2). The primary outcome measure was rate of positive suicide screen.

Results
A total of 33,504 children completed routine suicide screening; 2689 children had a positive screen. The overall rate of positive suicide screens increased throughout the pandemic compared with baseline (7.5% prepandemic, 8.4% Y1, 9.3% Y2; P < 0.01). Rates of positive suicide screens in Y1 increased 0.04% per week and surpassed prepandemic rates, then decreased 0.1% per week throughout Y2 (P < 0.01), during a time when social distancing mitigation efforts decreased.

Conclusions
Cumulative time in the COVID-19 pandemic was associated with increased positive suicide screens in children. School reopening and normalization of social routines preceded an observed negative trend in rates of positive suicide screens in Y2 of the pandemic. This study demonstrates fluctuating trends in suicide screen positivity, potentially influenced by social distancing and public health measures. Our study may support that maintaining social connectedness and access to school-based or community resources may be a protective factor for youth suicide risk during a pandemic or other natural occurrence.
Decreasing Invasive Urinary Tract Infection Screening in a Pediatric Emergency Department to Improve Quality of Care
Authors: Paluck Felicia , Kestenbom Inbal , Test Gidon , Carscadden Emma , Ostrow Olivia 
Published: August 2024

Objectives
Obtaining urine samples in younger children undergoing urinary tract infection (UTI) screening can be challenging in busy emergency departments (EDs), and sterile techniques, like catheterization, are invasive, traumatizing, and time consuming to complete. Noninvasive techniques have been shown to reduce catheterization rates but are variably implemented. Our aim was to implement a standardized urine bag UTI screening approach in febrile children aged 6 to 24 months to decrease the number of unnecessary catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs).

Methods
After forming an interprofessional study team and engaging key stakeholders, a multipronged intervention strategy was developed using the Model for Improvement. A urine bag screening pathway was created and implemented using Plan, Do, Study Act (PDSA) cycles for children aged 6 to 24 months being evaluated for UTIs. A urine bag sample with point-of-care (POC) urinalysis (UA) was integrated as a screening approach. The outcome measure was the rate of ED urine catheterizations, and balancing measures included ED LOS and RVs. Statistical process control methods were used for analysis.

Results
During the 3-year study period from January 2019 to June 2022, the ED catheterization rate successfully decreased from a baseline of 73.3% to 37.7% and was sustained for approximately 2 years. Unnecessary urine cultures requiring microbiology processing decreased from 79.8% to 40.7%. The ED LOS initially decreased; however, it increased by 17 minutes during the last 8 months of the study. There was no change in RVs.

Conclusion
A urine bag screening pathway was successfully implemented to decrease unnecessary, invasive catheterizations for UTI screening in children with only a slight increase in ED LOS. In addition to the urine bag pathway, an ED nursing champion, strategic alignment, and broad provider engagement were all instrumental in the initiative's success.
Impact of Surgical Team Involvement at the Time of Trauma Activation for Pediatric Patients With Motorized Cycle or All-Terrain Vehicle Injury Mechanism
Authors: Bergus Katherine , Srinivas Shruthi , Ligorski Celia , Castellanos Sydney , Thakkar Rajan , Schwartz Dana 
Published: August 2024

Objectives
At our institution, level 2 trauma (L2T) activations are primarily managed by pediatric emergency medicine (PEM) physicians, whereas level 1 activations are co-managed by pediatric surgery and PEM. Starting in September 2019, the response to L2T activations due to all-terrain vehicles or motorized cycles (ATVs/MCs) changed to include surgical assessment upon patient arrival due to increased likelihood of significant injuries and need for higher level of care. The impact of PEM/surgery co-management of ATV/MC L2T patients on time to an admission decision is unknown.

Methods
We retrospectively reviewed patients <18 years of age presenting to our American College of Surgeons–verified level 1 pediatric trauma center as L2T activations with ATV/MC mechanism between 1/2016 and 10/2022. Patient demographics, injury characteristics, details of imaging, interventions, and emergency department (ED) course were recorded. The χ2 and Fisher exact tests were performed.

Results
One hundred fifty-five patients met the inclusion criteria prior to augmenting our response to include surgical presence at L2T-ATV/MC activations, and 216 patients were treated after our protocol change. There were no statistically significant differences in age, sex, race, transfer status, vehicle subtype, or Injury Severity Scores between groups. Trauma surgery was involved in the care of 74.8% of L2T-ATV/MC patients before protocol augmentation and 87% after (P = 0.003). Time to an admission decision significantly decreased by 22.5 minutes (117 minutes [interquartile range, 72–178] vs 94.5 minutes [interquartile range, 60–139]; P = 0.023) after protocol augmentation. There was a trend toward increased completion of mandated postsecondary survey communication huddles after protocol change (84.6% to 91.2%, P = 0.089). The median total ED length of stay did not differ between admitted and discharged patients.

Conclusions
Early surgical assessment for pediatric patients with ATV/MC injuries improved time to an admission decision and trauma communication huddle compliance. Next steps include identifying process improvement opportunities to decrease ED total length of stay for patients with ATV/MC injuries.
Degradation of Unsintered Hydroxyapatite and Poly-L-Lactide Composite Sheets In Vivo and In Vitro
Authors: Kawabata Tomoya , Ikeda Mika , Miyakoshi Chisato , Matsuzoe Haruka , Oka Shungo , Kataoka Kazuya 
Published: August 2024

Bioabsorbable sheet-shaped implants made of forged composites of unsintered hydroxyapatite and poly-L-lactide (F-u-HA/PLLA) have been used for orbital fracture repair with good results. This is the first report using multiple specimens implanted in the human orbit to demonstrate the biodegradation and loss of strength of F-u-HA/PLLA sheets. Among the patients who underwent various facial fracture repairs with F-u-HA/PLLA sheets implanted in their orbits, those whose sheets were subsequently extracted were included in the study. Viscosity-average molecular weight, crystallinity, and bending strength of the extracted implants were measured. An in vitro degradation test was also performed for comparison. Among the 111 patients who underwent F-u-HA/PLLA sheet implantation, 13 subsequently underwent surgical extraction of implants; the majority were due to secondary correction of complex fractures. One patient developed an infection; none developed foreign body reactions. Overall, 11 specimens from 10 patients with consent were examined. The time from implantation to extraction ranged from 43 to 632 days (median: 210 d). Compared with the results of the in vitro degradation test, the viscosity-average molecular weight and bending strength had a slower decrease. The F-u-HA/PLLA sheets retained more than 50% of their initial bending strength after 12 months. Crystallinity varied widely. F-u-HA/PLLA sheets implanted in human orbits did not degrade faster than those of in vitro testing. Sheet-shaped implants made of forged composites of unsintered hydroxyapatite and poly-L-lactide can be considered appropriate reconstructive materials for orbital fractures as they retained sufficient strength to support the orbital contents at 12 months postoperatively, and no case of delayed foreign body reactions was observed.
POSTINJURY PNEUMONIA INDUCES A UNIQUE BLOOD MICROBIOME SIGNATURE
Authors: Munley Jennifer A. , Kelly Lauren S. , Park Gwoncheol , Pons Erick E. , Kannan Kolenkode B. , Bible Letita E. , Efron Philip A. , Nagpal Ravinder , Mohr Alicia M. 
Published: August 2024

ABSTRACT

Background: Previous preclinical studies have demonstrated a pathobiome after traumatic injury; however, the impact of postinjury sepsis on gut epithelial permeability and bacterial translocation remains unknown. We hypothesized that polytrauma with postinjury pneumonia would result in impaired gut permeability leading to specific blood microbiome arrays. Methods: Male and proestrus female Sprague-Dawley rats were subjected to either polytrauma (PT), PT plus 2-hours daily chronic restraint stress (PT/CS), PT with postinjury day 1 inoculation with pseudomonas pneumonia (PT + PNA), PT/CS + PNA, or naive controls. Whole blood microbiome was measured serially using high-throughput 16S rRNA sequencing and QIIME2 bioinformatics analyses. Microbial diversity was assessed using Chao1/Shannon indices and principle coordinate analysis. Intestinal permeability was evaluated by plasma occludin and lipopolysaccharide-binding protein assays. Results: PT/CS + PNA had increased intestinal permeability compared to uninfected counterparts (PT/CS) with significantly elevated occludin (P < 0.01). Bacteria was not detected in the blood of naïve controls, PT or PT/CS, but was present in both PT + PNA and PT/CS + PNA on days 2 and 7. The PT/CS + PNA blood biome showed dominance of Streptococcus compared to PT + PNA at day 2 (P < 0.05). Females PT/CS + PNA had a significant abundance of Staphylococcus at day 2 and Streptococcus at day 7 in the blood biome compared to male counterparts (P < 0.05). Conclusion: Multicompartmental trauma with postinjury pneumonia results in increased intestinal permeability and bacteremia with a unique blood biome, with sexual dimorphisms evident in the blood biome composition. These findings suggest that postinjury sepsis has clinical significance and could influence outcomes after severe trauma and critical illness.
NETWORK ANALYSIS OF SINGLE-NUCLEOTIDE POLYMORPHISMS ASSOCIATED WITH ABERRANT INFLAMMATION IN TRAUMA PATIENTS SUGGESTS A ROLE FOR VESICLE-ASSOCIATED INFLAMMATORY PROGRAMS INVOLVING CD55
Authors: El-Dehaibi Fayten , Zamora Ruben , Yin Jinling , Namas Rami A. , Billiar Timothy R. , Vodovotz Yoram 
Published: August 2024

ABSTRACT

Background: Critical illness stemming from severe traumatic injury is a leading cause of morbidity and mortality worldwide and involves the dysfunction of multiple organ systems, driven, at least in part, by dysregulated inflammation. We and others have shown a key role for genetic predisposition to dysregulated inflammation and downstream adverse critical illness outcomes. Recently, we demonstrated an association among genotypes at the single-nucleotide polymorphism (SNP) rs10404939 in LYPD4, dysregulated systemic inflammation, and adverse clinical outcomes in a broad sample of ~1,000 critically ill patients. Methods: We sought to gain mechanistic insights into the role of LYPD4 in critical illness by bioinformatically analyzing potential interactions among rs10404939 and other SNPs. We analyzed a dataset of common (i.e., not rare) SNPs previously defined to be associated with genotype-specific, significantly dysregulated systemic inflammation trajectories in trauma patients, in comparison to a control dataset of common SNPs determined to exhibit an absence of genotype-specific inflammatory responses. Results: In the control dataset, this analysis implicated SNPs associated with phosphatidylinositol and various membrane transport proteins, but not LYPD4. In the patient subset with genotypically dysregulated inflammation, our analysis suggested the co-localization to lipid rafts of LYPD4 and the complement receptor CD55, as well as the neurally related CNTNAP2 and RIMS4. Segregation of trauma patients based on genotype of the CD55 SNP rs11117564 showed distinct trajectories of organ dysfunction and systemic inflammation despite similar demographics and injury characteristics. Conclusion: These analyses define novel interactions among SNPs that could enhance our understanding of the response to traumatic injury and critical illness.
Risk of Incident Cardiovascular Events Following Roux en Y Gastric Bypass versus Sleeve Gastrectomy
Authors: Lewis Kristina H. , Argetsinger Stephanie , LeCates Robert F. , Zhang Fang , Arterburn David E. , Ross-Degnan Dennis , Fernandez Adolfo , Wharam James F. 
Published: August 2024

Objective:
To compare the risk of incident cardiovascular disease (CVD) events following sleeve gastrectomy (SG) and Roux en Y gastric bypass (RYGB).

Summary Background Data:
Bariatric surgery is associated with reduced CVD risk but the differential effect of contemporary bariatric procedures is unclear.

Methods:
We used insurance claims to conduct a retrospective cohort study of CVD outcomes for patients who underwent RYGB versus SG between 2010 and 2021. Patients were followed for up to 5 years for a primary composite major adverse cardiovascular event (MACE) outcome as well as individual outcomes including myocardial infarction, stroke, heart failure, and arrhythmia. We compared cumulative risks of CVD events using multivariable Cox proportional hazards modeling, in overall cohorts and in sub-cohorts of older adults and those with type 2 diabetes (T2D) or pre-existing CVD and elevated morbidity.

Results:
Matched, weighted cohorts of 13,545 SG and RYGB patients were observed for an average of 2.5 years after surgery, with 26.2% not lost to follow-up by the end of 5 years. There was no difference in MACE risk between procedures (aHR 1.01 for RYGB vs. SG [95% CI 0.90, 1.12]) in the overall cohort or among the subgroup of older adults (aHR 0.97 for RYGB vs. SG [95% CI 0.85, 1.10]). Patients with T2D experienced lower risk of MACE following RYGB compared to SG (aHR 0.78 [95% CI 0.66, 0.92]), as did those with pre-existing CVD or elevated morbidity prior to surgery (aHR 0.81 [95% CI 0.70, 0.93]).

Conclusions:
These findings further support the preferential use of RYGB over SG for patients with T2D or who have pre-existing CVD. However, among other groups of patients, including older adults, we did not observe a relative benefit of RYGB during the time horizon in this study.
Sensor–Head Distance and Signal Strength in Whole-Head Magnetoencephalography: Report of 996 Patients With Epilepsy
Authors: Tanaka Naoaki , Ahlfors Seppo P. , Stufflebeam Steven M. 
Published: August 2024

Purpose:
Although the sensor-to-head distance is theoretically known to affect the signal strength in magnetoencephalography (MEG), these values have not been reported for a whole-head MEG system in a large population. We measured the distance and signal strength in 996 patients with epilepsy.

Methods:
The MEG sensor array consisted of 102 measurement sites, each of which had two gradiometers and one magnetometer. The sensor–head distance was defined as the minimum distance between each site and a set of digitized scalp points. For the signal strength, we calculated the root-mean-square of the signal values in each sensor over a recording of 4 minutes. For analyses at the individual and sensor levels, these values were averaged over the sensors and patients, respectively. We evaluated the correlation between distance and signal strength at both individual and sensor levels. At the sensor level, we investigated regional differences in these measures.

Results:
The individual-level analysis showed only a weak negative correlation between the sensor–head distance and the signal strength. The sensor-level analysis demonstrated a considerably negative correlation for both gradiometers and magnetometers. The sensor–head distances showed no significant differences between the regions, whereas the signal strength was higher in the temporal and occipital sensors than in the frontal and parietal sensors.

Conclusions:
Sensor–head distance was not a definitive factor for determining the magnitude of MEG signals in individuals. Yet, the distance is important for the signal strength at a sensor level. Regional differences in signal strength may need to be considered in the analysis and interpretation of MEG.
Patients' Cognitive Potential Is Associated With Cognitive Performance After an Acute Course of Electroconvulsive Therapy
Authors: Massaneda-Tuneu Clara , Loo Colleen , Martin Donel 
Published: August 2024

Objectives
Cognitive function after an acute treatment of electroconvulsive therapy (ECT) can highly vary between individuals. This study aimed to extend prior research on individual factors, which influence outcomes by assessing whether a combination of 2 individual factors, level of education and lifetime occupational attainment, may be informative.

Methods
A retrospective study was conducted using data from 24 patients with major depressive episode who underwent acute treatment with ECT. Cognitive functioning was assessed at pretreatment, during the acute course and 1–3 days after acute treatment. Participants were divided into higher and lower function groups based on a combination of their highest educational level and lifetime occupational attainment.

Results
Statistically significant differences were observed between the 2 groups in retrograde memory function after ECT, assessed as percentage of consistency scores of the Columbia Autobiographical Memory Short Form (F(1,15) = 4.66, P < 0.05) and recovery of orientation during the acute ECT course (F(1,25.33) = 7.99, P = 0.009). No significant differences were found between groups for the other outcomes, which included verbal and visual anterograde memory, verbal fluency, and processing speed.

Conclusions
Results from this preliminary study suggest that patients with higher educational and lifetime occupational attainment may experience less retrograde amnesia and have faster recovery of orientation after ECT. Identifying markers of higher and lower ‘cognitive potential’ before ECT may assist in customizing ECT treatment for each patient.
Leukocyte Telomere Length and Mitochondrial DNA Copy Number in Treatment-Resistant Depression and Response to Electroconvulsive Therapy
Authors: Squassina Alessio , Pisanu Claudia , Menesello Valentina , Meloni Anna , Congiu Donatella , Manchia Mirko , Paribello Pasquale , Abate Maria , Bortolomasi Marco , Baune Bernhard T. , Gennarelli Massimo , Minelli Alessandra 
Published: August 2024

Objectives
In this study, we investigated if changes in leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNA-cn), 2 markers of cellular aging, are associated with treatment-resistant depression (TRD) and with response to electroconvulsive therapy (ECT).

Methods
LTL and mtDNA-cn were measured in 31 TRD patients before (T0), 1 week (T1), and 4 weeks (T2) after the ECT course, as well as in a sample of 65 healthy controls.

Results
TRD patients had significantly shorter LTL and higher mtDNA-cn compared with healthy controls at baseline. In the TRD sample, LTL was inversely correlated with Montgomery-Åsberg Depression Rating Scale scores at baseline. Baseline levels of LTL or mtDNA-cn were not correlated with response to ECT. Similarly, changes in LTL or mtDNA-cn were not associated with response to ECT either when considered as a dichotomous trait (responders vs nonresponders) or as a percentage change in symptoms improvements.

Conclusions
Ours is the first longitudinal study exploring the role of LTL and mtDNA-cn in response to ECT. Findings of this pilot investigation suggest that LTL and mtDNA-cn may constitute disease biomarkers for TRD but are not involved in response to ECT.