bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Fast Algorithm for Parameter Identification Problems Based on the Multilevel Augmentation Method
Authors: Cao Hui , Nair M. Thamban 
Published: September 2013

Abstract.
A multilevel augmentation method is considered to solve parameter identification problems in elliptic systems. With the help of the natural linearization technique, the identification problems can be
transformed into a linear ill-posed operation equation, where noise
exists not only in RHS data but also in operators. Based on multiscale decomposition in solution space, the multilevel augmentation method leads to a fast algorithm for solving discretized ill-posed problems.
Combining with Tikhonov regularization, in the implementation of the multilevel augmentation method, one only needs to invert
the same matrix with a relatively small size and perform a matrix-vector multiplication at the linear computational complexity. As a result, the
computation cost is dramatically reduced. The a posteriori regularization
parameter choice rule and the convergence rate for the regularized
solution are also studied in this work. Numerical tests illustrate the proposed algorithm and the theoretical estimates.
Mechanisms and pathways underlying the therapeutic effect of transcranial magnetic stimulation
Authors: Medina Francisco Javier , Túnez Isaac 
Published: September 2013

Abstract
It has been almost 40 years since Barker, Jalinous, and Freeston designed and used the first device of transcranial magnetic stimulation (TMS). From then until now, this technique has evolved vertiginously, appearing a lot of new protocols and device modifications, which associated with new technologies complement and enhance the versatility of this technique. TMS has demonstrated to be a safe technology and become a key tool in the study of the complex brain processes. Despite this, it is as a therapeutic tool where this technique has caused a revolution. In this regard, this type of non-invasive brain stimulation has been proven useful in a variety of neurodegenerative and psychiatric disorders due to its biochemical, molecular, and cellular effects, with depression being the paradigm of the therapeutic effectiveness of this technique. This review focuses on a detailed vision of how this type of radiation modifies different biochemical and cellular processes that induce the mechanisms and pathways underlying the therapeutic effects of TMS.
Research Needs of Pediatric Hospitalists
Authors: Bekmezian Arpi , Teufel Ronald J. , Wilson Karen M. 
Published: September 2013

Objective:
To assess the current state of research productivity, goals, obstacles, and needs of pediatric hospitalists.

Methods:
The American Academy of Pediatrics Section on Hospital Medicine performed a cross-sectional online survey of pediatric hospitalists. Questions assessed demographics, research productivity, system-level factors, research interests, goals and obstacles, and the perceived need for research training and support.

Results:
Two hundred twenty pediatric hospitalists in the United States completed the survey. Of these, 56% had presented at a national meeting, 24% were first authors of an article in a peer-reviewed journal, 8% had more than publications, and 12% had secured external grant support. While 90% of respondents had spent 10% or less time in research, 64% had an academic appointment at the assistant professor level or above. Nearly 40% felt that their institution expected them to do research, and 56% were interested and another 27% were very interested in conducting research. The main research interest was quality improvement (QI) evaluation. Common obstacles to research were lack of time, mentorship, and resources.

Conclusions:
Pediatric hospitalists want to conduct research to improve the quality of inpatient care but face significant obstacles including lack of dedicated time for research and mentorship. Coordinated efforts to improve access to academic resources are important for career development and academic growth of the field. National organizations and hospital programs interested in improving the quality of care for hospitalized children can provide support to meet the field’s professional needs for research.
Perceptions of Physician Bedside Handoff With Nurse and Family Involvement
Authors: Gosdin Craig H. , Vaughn Lisa 
Published: September 2013

Objective:
Physician-to-physician handoffs have been identified as a high-risk area of patient care. Few data exist to support any specific handoff process as being superior. We developed a handoff process entitled physician bedside handoff (PBH), which is unique for allowing all stakeholders, including the parents of patients, to be involved in the handoff at the bedside. Our goal was to compare stakeholder perceptions of PBH with traditional physician handoff and to learn which factors stakeholders believe are important for improving handoffs in general.

Methods:
A convenience sample of 34 stakeholders (including attending physicians, residents, nurses, patient care attendants, patient parents, and medical students) participated in 1 of 3 group level assessments (GLAs), a participatory method in which valid data are generated regarding an issue of importance through an interactive and collaborative process.

Results:
In comparing PBH and traditional handoffs, participants uniformly perceived that both processes have value and that neither is superior in all cases; individual circumstances and parental preference should dictate which is used. Participation of all stakeholders was identified as being essential in improving handoffs in general. Other themes included that handoffs should occur in both verbal and written formats, and that providers and learners, specifcally medical students and residents, should be comfortable with both types of handoffs.

Conclusions:
Participants identified that including all stakeholders is essential to improve handoffs, that PBH is not superior to traditional handoffs, and that both processes have value. Further research should be conducted to determine if including all stakeholders in the handoff process results in improved quality of care and safety.
Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009
Authors: Ghelani Sunil J. , Pastor William , Parikh Kavita 
Published: September 2013

Objective:
Approximately 10% to 15% of Kawasaki disease (KD) is refractory to treatment with initial intravenous immunoglobulin (IVIG). However, there is no consensus on pharmacologic treatment of refractory KD (rKD). Demographic characteristics of patients with rKD and regional variability in their treatment in the United States have not been reported on a large scale. The goal of this study was to describe the demographic and treatment variability in rKD by using a large multi-institutional database.

Methods:
Data were obtained for patients with KD from January 2005 to June 2009 by using the Pediatric Health Information System. Patients who received a single dose of IVIG were labeled as having standard KD (sKD) and those who required additional medications were labeled as having rKD.

Results:
Of the 5633 patients studied, 4818 (85.5%) received 1 dose of IVIG (sKD) and 815 (14.5%) received &gt;1 medication (rKD). Median age was 30 months (interquartile range: 14-53) and 30 months (interquartile range: 15-54) for rKD and sKD patients, respectively (P= .438). No significant change was noted in the gender or ethnic distribution of patients between rKD and sKD groups. Seasonal distribution of rKD was comparable to sKD. IVIG was the most common (64.5%) initial medication chosen to treat rKD, followed by methylprednisolone (27.1%) and infliximab (8.3%); however, there was significant regional variability. Of patients with rKD, 81% required only 1 additional medication (after the initial IVIG) for treatment.

Conclusions:
Patients with rKD have similar age, gender, ethnic, and seasonal distribution as sKD patients. IVIG is the most common initial medication chosen to treat rKD; however, there is regional variation.
Resident Perceptions of Autonomy in a Complex Tertiary Care Environment Improve When Supervised by Hospitalists
Authors: Burgis Jennifer C. , Lockspeiser Tai M. , Stumpf Emily C. , Wilson Stephen D. 
Published: September 2013

Background and Objective:
Increasingly, academic hospitals have adopted hospitalist-based systems of inpatient pediatric care. Some studies comparing hospitalists with other attending physicians have suggested trainees are more satisfied with education from hospitalists. However, there are published concerns that the increased presence of hospitalists may reduce residents’ autonomy. The objective of the current study was to evaluate pediatric residents’ perceptions of their own autonomy after a broad ward restructuring to hospitalist-led teams.

Methods:
We analyzed data from standardized attending evaluations before and after a pediatric ward restructuring at an academic tertiary care hospital. Provision of most inpatient pediatric care changed from subspecialist-led teams to hospitalist-led teams. Numerical scores from evaluations before and after the restructuring were compared quantitatively. Comments from the evaluations were analyzed qualitatively to identify key themes.

Results:
Before the restructuring, there were 65 evaluations of 5 hospitalists and 602 evaluations of 32 subspecialists. After the restructuring, there were 188 evaluations of 8 hospitalists. Hospitalists were rated significantly higher on all teaching attributes compared with all attending physicians before the restructuring. The attending role in promoting autonomy was mentioned infrequently and reflected residents’ perceived lack of autonomy before the restructuring. The primary theme after the restructuring was autonomy, specifically emphasizing resident leadership and decision-making and the appropriate balance of resident autonomy and supervision.

Conclusions:
Although patient complexity was unchanged, a comparison of numerical ratings and resident comments before and after the restructuring indicates that hospitalists lead teams differently from subspecialists, with more emphasis on resident decision-making and autonomy.
Career Satisfaction and the Role of Mentorship: A Survey of Pediatric Hospitalists
Authors: Pane Laurie A. , Davis Aisha B. , Ottolini Mary C. 
Published: September 2013

Background and Objective:
Attending physicians’ career satisfaction is associated with higher patient satisfaction, better patient care, and even medical student career choice. Previous studies indicate that adequate mentorship improves job satisfaction, but finding mentors may be challenging for some hospitalists. Little is known about pediatric hospitalist career satisfaction or the role of mentorship. The goal of this study was to assess career satisfaction among pediatric hospitalists, determine which interventions may improve satisfaction, and investigate the role of mentorship in satisfaction.

Methods:
This study included the use of an anonymous electronic cross-sectional survey sent to the American Academy of Pediatrics’ Section on Hospital Medicine Listserv between November 2009 and January 2010.

Results:
A total of 222 pediatric hospitalists responded; 92% agreed with the statement, “Overall, I am pleased with my work.” Of the 23 satisfaction statements, “I have adequate mentorship in my career” was rated lowest (P ≤ .001); only 44% agreed. Adequate mentorship was significantly correlated with overall career satisfaction, having sufficient opportunity for promotion, feeling valued by one’s administration, and wishing to remain at one’s current hospital. Adequate mentorship was negatively correlated with planning to change specialty or leave clinical medicine. Mentorship satisfaction did not differ by age, years as a hospitalist, gender, or practice setting. Of the 15 potential interventions, creating a formal mentorship program ranked in the top 5. Only increasing base salary received a significantly higher score.

Conclusions:
Although surveyed hospitalists have substantial overall career satisfaction, lack of mentorship is a significant problem that spans the demographic spectrum. Establishing a mentorship program may be an effective way for hospitalist groups to improve satisfaction.
Validity of Respiratory Scores in Bronchiolitis
Authors: Destino Lauren , Weisgerber Michael C. , Soung Paula , Bakalarski Deborah , Yan Ke , Rehborg Rebecca , Wagner Duke R. , Gorelick Marc H. , Simpson Pippa 
Published: September 2013

Objective:The primary objective of this study was to establish the validity and reliability of 2 respiratory scores, the Respiratory Distress Assessment Instrument (RDAI) and the Children’s Hospital of Wisconsin Respiratory Score (CHWRS), in bronchiolitis. A secondary objective was to identify the respiratory score components that most determine overall respiratory status.Methods:This was a prospective cohort study in infants aged &lt;1 year seen at Children’s Hospital of Wisconsin for bronchiolitis. We evaluated: (1) discriminative validity (the score’s ability to discriminate between 2 different outcomes) of the respiratory scores to identify emergency department (ED) disposition by using receiver operating characteristic curves; and (2) construct validity (the score’s ability to measure what it is thought to measure, overall respiratory status) by using length of stay (LOS) as a proxy for disease severity and comparing correlations between changes in respiratory scores and LOS. Interrater reliability was established by using intraclass correlation. The contribution of individual respiratory score components to determine ED disposition was studied by using multivariate logistic regression.Results:A total of 195 infants were included. The area under the receiver operating characteristic curve was 0.68 for CHWRS versus 0.51 for RDAI in predicting disposition. There was no correlation between initial respiratory scores or change in respiratory scores over the first 24 hours and LOS. Item analysis revealed that oxygen delivery, subcostal retractions, and respiratory rate were independently correlated with ED disposition. The CHWRS was more reliable than the RDAI.Conclusions:The CHWRS had modest discriminative validity in predicting ED disposition. Neither the CHWRS nor the RDAI had good construct validity. Respiratory rate, oxygen need, and presence of retractions were most useful in predicting ED disposition.
A Preliminary Screening Instrument for Early Detection of Medical Child Abuse
Authors: Greiner Mary V. , Palusci Vincent J. , Keeshin Brooks R. , Kearns Stephen C. , Sinal Sara H. 
Published: September 2013

Objective:The goal of this research was to develop a screening instrument for early identification among hospitalized children of medical child abuse (MCA).Methods:We developed a preliminary screening instrument for the early identification of MCA. Items were chosen based on published characteristics of MCA, including caregiver, patient, and illness information. Each item in the instrument was scored with 1 point if positive. This instrument was tested by reviewing the hospital charts of child protective services–confirmed MCA patients and comparing the results with charts of children with admissions for apnea, vomiting/diarrhea, and seizures who were not diagnosed with MCA. Nineteen cases and 389 controls were used for analysis. We used receiver operating characteristic curves, starting with items most highly associated with MCA in our sample. Predictive values and strengths of association were assessed by using χ2 and Fisher’s exact tests, as appropriate.Results:From an initial 46 questions, we determined that 26 items showed a statistically significant difference between cases and control patients. From these, an instrument with 15 items maximized the area under the receiver operating characteristic curve, and a score of ≥4 had a sensitivity of 0.947 and a specificity of 0.956 (P &lt; .05) in detecting MCA.Conclusions:This chart review screening instrument identified differences in characteristics of children, caregivers, and illness during hospitalization that may allow for earlier detection of MCA and referral for further assessment to the multidisciplinary team.
Hospitalization of Early Preterm, Late Preterm, and Term Infants During the First Year of Life by Gestational Age
Authors: Ray Kristin N. , Lorch Scott A. 
Published: September 2013

Objectives:
The goal of this study was to describe hospitalizations of infants during the first year of life according to week of gestational age (GA). We hypothesized that odds of any hospitalization would generally decrease with increasing GA, with late preterm infants experiencing additional increased risk of specific hospitalizations, such as hyperbilirubinemia.

Methods:
Birth certificates for &gt;6.6 million infants born in California hospitals between 1993 and 2005 and surviving to discharge were linked to hospital discharge records during the first year of life. Odds of any hospitalization and any hospitalization for specific diagnoses during the first year of life were determined for infants 23 to 44 weeks’ GA. Further analysis determined odds of any hospitalization within 14, 30, and 90 days of birth discharge, and observed odds were compared with expected odds obtained through quadratic modeling.

Results:
Odds of any hospitalization within the first year of life decreased with advancing GA, but observed odds of any hospitalization exceeded expected odds for 35-, 36-, and 37-week GA infants for all time periods after discharge. Odds of any hospitalization for hyperbilirubinemia were greatest for infants 33 to 38 weeks’ GA (peak odds ratio at 36 weeks’ GA: 2.86 [95% confidence interval: 2.73–3.00]), and a relative peak in odds of any hospitalization for specific infections was observed among infants 33 to 36 weeks’ GA.

Conclusions:
Odds of any hospitalization during the first year of life exceeded expected odds of hospitalization for 35-, 36-, and 37-week GA infants. GAs at risk overlapped with, but were not identical to, GAs identified as late preterm infants.
Morphine Is Associated With Acute Chest Syndrome in Children Hospitalized With Sickle Cell Disease
Authors: Birken Catherine S. , Khambalia Amina , Dupuis Annie , Pastor Aimee , Lee Michelle , Padavattan Karen , Mekky Magda , Odame Isaac , Parkin Patricia C. 
Published: September 2013

Objective:To determine if intravenous morphine is associated with acute chest syndrome (ACS) in children with homozygous for hemoglobin S sickle cell disease (SCD) hospitalized with acute pain.Methods:Health records of patients with homozygous for hemoglobin S SCD aged 2 to 18 years hospitalized with acute pain were reviewed. Patients developed ACS at least 12 hours after emergency department triage; controls did not develop ACS. Survival analyses were performed.Results:There were 38 cases and 45 randomly selected controls. The mean hourly dose of morphine 1, 2, and 3 hours before ACS and cumulative mean morphine dose up to 5 hours before ACS were significantly associated with ACS (P &lt; .05). Adjusted analysis showed that 1 hour before ACS, the mean morphine dose was significantly higher in cases (40 µg/kg) compared with controls (34 µg/kg), and the risk of ACS increased by 23% for each additional 10 µg/kg of morphine received (P = .02).Conclusions:We recommend close observation for ACS in hospitalized patients with SCD who are receiving morphine.
The Clinical Management of Preterm Infants With Bronchiolitis
Authors: Alverson Brian , McCulloh Russell J. , Dawson-Hahn Elizabeth , Smitherman Sarah E. , Koehn Kristin L. 
Published: September 2013

Objectives:The goal of this study was to determine physician management choices for hospitalized premature infants with bronchiolitis compared with term infants and to evaluate predictors of steroid use in premature infants.Methods:A chart review was conducted of premature and nonpremature infants admitted to 2 children’s hospitals with bronchiolitis. Reviewers selected charts based on International Classification of Diseases, Ninth Revision diagnosis codes and collected demographic and historical information, as well as evaluation, treatment, treatment effectiveness, length of stay, hospital readmission rates, and adverse outcomes. Reviewers compared documented rates of utilization and effectiveness of inhaled racemic epinephrine and albuterol between patients with and without a history of prematurity. Patients with a history of prematurity underwent subgroup analysis of factors relating to steroid use.Results:A total of 1223 patients met the study criteria for inclusion. Premature infants represented 19% of all children hospitalized with bronchiolitis. These infants had a longer length of stay (3.8 vs 2.6 days; P &lt; .001) and a more severe hospital course. Rates of inhaled therapy and steroid utilization did not differ between premature and term infants. There was no difference in rates of documented positive response to albuterol, but premature infants were more likely to have a positive response to epinephrine. Steroid use in premature infants was associated with older age, history of wheeze, and albuterol use; documentation of albuterol efficacy did not correlate with steroid use, however.Conclusions:Management decisions among term and premature infants with bronchiolitis were similar. Premature infants who received albuterol were more likely to receive steroids; however, the decision regarding steroid use was not associated with documentation of efficacy of albuterol.
High-Fidelity Simulation Enhances Pediatric Residents’ Retention, Knowledge, Procedural Proficiency, Group Resuscitation Performance, and Experience in Pediatric Resuscitation
Authors: Mills David M. , Wu Chang L. , Williams Daniel C. , King Lydia , Dobson Joseph V. 
Published: September 2013

Objective:
The goal of this study was to assess the effect of high-fidelity simulation (HFS) pediatric resuscitation training on resident performance and self-reported experience compared with historical controls.

Methods:
In this case-control study, pediatric residents at a tertiary academic children’s hospital participated in a 16-hour HFS resuscitation curriculum. Primary outcome measures included cognitive knowledge, procedural proficiency, retention, and self-reported comfort and procedural experience. The intervention group was compared with matched-pair historical controls.

Results:
Forty-one residents participated in HFS training with 32 matched controls. The HFS group displayed significant initial and overall improvement in knowledge (P &lt; .01), procedural proficiency (P &lt; .05), and group resuscitation performance (P &lt; .01). Significant skill decay occurred in all performance measures (P &lt; .01) with the exception of endotracheal intubation. Compared with controls, the HFS group reported not only greater comfort with most procedures but also performed more than twice the number of successful real-life pediatric intubations (median: 6 vs 3; P = .03).

Conclusions:
Despite significant skill decay, HFS pediatric resuscitation training improved pediatric resident cognitive knowledge, procedural proficiency, and comfort. Residents who completed the course were not only more proficient than historical controls but also reported increased real-life resuscitation experiences and related procedures.
Bevacizumab for Advanced Breast Cancer: Hope, Hype, and Hundreds of Headlines
Authors: Fralick Michael , Ray Monali , Fung Christina , Booth Christopher M. , Mallick Ranjeeta , Clemons Mark J. 
Published: September 2013

Learning ObjectivesSummarize findings regarding the media's portrayal of bevacizumab with each phase of therapeutic development. Identify media sources of information about bevacizumab in each phase of therapeutic development.