bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Hypoglycemia and the Occurrence of Early Onset Sepsis in Premature Infants
Authors: Kumar Karan R , Shah Sonam J , Fayyad Rawan M , Turla Toby M , O’Sullivan Laura M , Wallace Beatriz , Clark Reese H , Benjamin Daniel K , Greenberg Rachel G , Hornik Christoph P 
Published: December 2023

Abstract

Background
We examined the association between hypoglycemia and the occurrence of early onset sepsis (EOS) in premature infants admitted to the neonatal intensive care unit (NICU).

Methods
We included infants discharged from 358 NICUs between 1997 and 2020 with gestational age &lt;34 weeks, ≥1 culture collected in the first 3 days of life, and ≥1 serum glucose value recorded on the day of or day prior to culture collection. We used multivariable logistic regression and inverse probability weighting (IPW) and constructed models for three definitions of hypoglycemia: American Academy of Pediatrics (AAP), Pediatric Endocrine Society, and a definition based on neurodevelopmental studies. We performed subgroup analysis in EOS episodes caused by Gram-negative and Gram-positive organisms.

Results
Of the 62,178 infants and 64,559 cultures that met study inclusion criteria, 739 (1%) cultures were positive. The median (25th, 75th percentile) glucose value was 75 mg/dL (50, 106) on the day of or day prior to a positive culture versus 70 mg/dL (50, 95) on the day of or day prior to a negative culture. We found that hypoglycemia was not associated with the occurrence of EOS for all organisms and Gram-positive organisms, whereas there was a small but significant association between the lower AAP glucose cutoff value and EOS due to Gram-negative organisms (logistic regression: risk difference [RD] 0.24% [95% CI, 0.01-0.47]; IPW: RD 0.22% [95% CI, 0.00-0.43]).

Conclusions
Hypoglycemia may be an early marker of EOS, particularly in episodes caused by Gram-negative organisms and when using a stricter definition of hypoglycemia.
Diagnostic Utility of Cerebrospinal Fluid White Blood Cell Components for the Identification of Bacterial Meningitis in Infants
Authors: Lamb Ashley E , Rent Sharla , Brannon Asia J , Greer Jonathan L , Ndey-Bongo Nyssa P , Cho Stephen H , Greenberg Rachel G , Benjamin Daniel K , Clark Reese H , Kumar Karan R 
Published: December 2023

Abstract

Background
To evaluate the diagnostic and predictive utility of cerebrospinal fluid (CSF) white blood cell (WBC) components in the diagnosis of bacterial meningitis in infants discharged from the neonatal intensive care unit (NICU).

Methods
We identified a cohort of infants discharged from a Pediatrix NICU between 1997 and 2020 who did not have an immunodeficiency, had at least 1 CSF culture collected within the first 120 days of life, and at least 1 CSF laboratory specimen obtained on the day of culture collection. We only included an infant’s first CSF culture and excluded cultures from CSF reservoirs and those growing contaminants or nonbacterial organisms. We examined the utility of CSF WBC components to diagnose or predict bacterial meningitis by calculating sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the receiver operating curve (AUC) at different cutoff values for each parameter. We performed subgroup analysis excluding infants treated with antibiotics the day before CSF culture collection.

Results
Of the 20 756 infants that met the study inclusion criteria, 320 (2%) were diagnosed with bacterial meningitis. We found (AUC [95% CI]) CSF WBC count (0.76 [0.73–0.79]), CSF neutrophil count (0.74 [0.70–0.78]), and CSF neutrophil percent (0.71 [0.67–0.75]) had the highest predictive values for bacterial meningitis, even when excluding infants with early antibiotic administration.

Conclusions
No single clinical prediction rule had the optimal discriminatory power for predicting culture-proven bacterial meningitis, and clinicians should be cautious when interpreting CSF WBC parameters in infants with suspected meningitis.
Leveraging School Infection Data to Address Community COVID-19 Data Gaps
Authors: Moreda Eba , Al-Dhalimy Hedille , Ha Mary , Nwanaji-Enwerem Ezeji , Nguyen Anh , Pieters Keshiyena , Alan Brookhart M , Hickerson Jesse , Benjamin Daniel K , Zimmerman Kanecia O , Boutzoukas Angelique E 
Published: December 2023

Abstract

Background
At-home COVID-19 tests became available in the USA in April 2021 with widespread use by January 2022; however, the lack of infrastructure to report test results to public health agencies created a gap in public health data. Kindergarten through grade 12 (K-12) schools often tracked COVID-19 cases among students and staff; leveraging school data may have helped bridge data gaps.

Methods
We examined infection rates reported by school districts to ABC Science Collaborative with corresponding community rates from March 15, 2021 to June 3, 2022. We computed weekly ratios of community-to-district-reported rates (reporting ratios) across 3 study periods (spring 2021, fall 2021, and spring 2022) and estimated the difference and 95% confidence intervals (CIs) in the average reporting ratio between study periods.

Results
In spring 2021, before approval or widespread use of at-home testing, the community-reported infection rate was higher than the school-reported infection rate (reporting ratio: 1.40). In fall 2021 and spring 2022, as at-home testing rapidly increased, school-reported rates were higher than community-reported rates (reporting ratios: 0.82 and 0.66). Average reporting ratios decreased between spring 2021 and fall 2021 (−0.58, 95% CI −0.84, −0.32) and spring 2021 and spring 2022 (−0.73, 95% CI −0.96, −0.48); there was no significant change between fall 2021 and spring 2022 (−0.15, 95% CI −0.36, 0.06).

Conclusions
At-home COVID-19 testing resulted in significant data gaps; K-12 data could have supplemented community data. In future public health emergencies, reporting of school data could minimize data gaps, but requires additional resources including funding to track infections and standardized data reporting methods.
Voluntary Attrition Among Traditional Baccalaureate Nursing Students: An Integrative Review
Authors: Shaver Danielle E. , Viveiros Jennifer D. 
Published: December 2023

Abstract

AIM
The purpose of this review is to synthesize what is known about voluntary attrition from baccalaureate nursing education.

BACKGROUND
Understanding the reasons behind elective, voluntary attrition from nursing programs can help maximize resources and graduate more nurses into the workforce.

METHOD
An integrative review of the literature was conducted using the search strategy outlined by Whittemore and Knafl. The validated Mixed-Methods Appraisal Tool was used to assess the quality of the studies found in the search.

RESULTS
Ten studies met review criteria. Studies showed that academic and emotional underpreparedness, economic challenges, feelings of isolation, differences between perceptions of nursing and the realities of professional practice, and incongruence with learning objectives in clinical settings led to dissatisfaction.

CONCLUSION
It is important to educate the public about nursing as a rigorous college major. The realities of nursing school, feelings of acceptance, and academic preparedness must be addressed by educators.
The STAMPPed Initiative for Pediatric Nurse Practitioner Students
Authors: Quinn Margaret , Mahat Ganga , Seaman Kimberly , Rawlins Latoya , Gillooly Diane 
Published: December 2023

Abstract
As the demand for nurse practitioners increases to meet health care needs, pathways to facilitate the transition into specialty advanced practice nursing education must be developed. The STudent Advisor/Mentorship Program for Pediatrics (STAMPPed) program was an innovative strategy established to support graduate nursing students with little to no pediatric clinical experience who demonstrated an interest in becoming pediatric nurse practitioners. The program provided structured guidance and support from experienced pediatric nursing faculty through monthly group meetings and the formulation of one-to-one student-faculty mentoring dyads. Mentees found the program to be helpful and foster supportive relationships.
Small G-Protein Rheb Gates Mammalian Target of Rapamycin Signaling to Regulate Morphine Tolerance in Mice
Authors: Wang Wenying , Ma Xiaqing , Du Wenjie , Lin Raozhou , Li Zhongping , Jiang Wei , Wang Lu-Yang , Worley Paul F. , Xu Tao 
Published: December 2023

Background
Analgesic tolerance due to long-term use of morphine remains a challenge for pain management. Morphine acts on μ-opioid receptors and downstream of the phosphatidylinositol 3-kinase signaling pathway to activate the mammalian target of rapamycin (mTOR) pathway. Rheb is an important regulator of growth and cell-cycle progression in the central nervous system owing to its critical role in the activation of mTOR. The hypothesis was that signaling via the GTP-binding protein Rheb in the dorsal horn of the spinal cord is involved in morphine-induced tolerance.

Methods
Male and female wild-type C57BL/6J mice or transgenic mice (6 to 8 weeks old) were injected intrathecally with saline or morphine twice daily at 12-h intervals for 5 consecutive days to establish a tolerance model. Analgesia was assessed 60 min later using the tail-flick assay. After 5 days, the spine was harvested for Western blot or immunofluorescence analysis.

Results
Chronic morphine administration resulted in the upregulation of spinal Rheb by 4.27 ± 0.195-fold (P = 0.0036, n = 6), in turn activating mTOR by targeting rapamycin complex 1 (mTORC1). Genetic overexpression of Rheb impaired morphine analgesia, resulting in a tail-flick latency of 4.65 ± 1.10 s (P < 0.0001, n = 7) in Rheb knock-in mice compared to 10 s in control mice (10 ± 0 s). Additionally, Rheb overexpression in spinal excitatory neurons led to mTORC1 signaling overactivation. Genetic knockout of Rheb or inhibition of mTORC1 signaling by rapamycin potentiated morphine-induced tolerance (maximum possible effect, 52.60 ± 9.56% in the morphine + rapamycin group vs. 16.60 ± 8.54% in the morphine group; P < 0.0001). Moreover, activation of endogenous adenosine 5′-monophosphate-activated protein kinase inhibited Rheb upregulation and retarded the development of morphine-dependent tolerance (maximum possible effect, 39.51 ± 7.40% in morphine + metformin group vs. 15.58 ± 5.79% in morphine group; P < 0.0001).

Conclusions
This study suggests spinal Rheb as a key molecular factor for regulating mammalian target of rapamycin signaling.

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Simple Moving Average Applied to "ISO Method" CPAM Concentration Estimates: An Unexpected Result
Authors: Evans William C. 
Published: December 2023

AbstractA surprisingly large amount of variance reduction has been observed when filtering International Organization for Standardization (ISO) “ISO Method” continuous particulate air monitor (CPAM) airborne radioactivity concentration estimates with a simple three-point moving average. This processing has relatively little lag relative to the amount of variance reduction obtained. The key factor producing this effect is the specific autocorrelation structure of the estimated concentrations, which are based on taking first differences of integrated-count data; this scheme results in successive count differences that contain a common count value between them. The observed variance reduction factor has also been derived analytically.
SWEEPING TECHNIQUE FOR THE REMOVAL OF EMULSIFIED SILICONE OIL DROPLETS FROM THE ANTERIOR SURFACE OF THE IRIS USING AN OPHTHALMIC ABSORPTION SPONGE
Authors: Kurihara Tomoki , Iwahashi Chiharu , Mano Fukutaro , Kusaka Shunji 
Published: December 2023

Purpose:
Silicone oil (SO) tamponade is frequently used in complex vitreoretinal surgeries, and SO migration into the anterior chamber can lead to complications, such as glaucoma and corneal decompensation. A new technique is described for the efficient removal of emulsified SO droplets, which can adhere strongly to the anterior surface of the iris.

Methods:
The tip of an ophthalmic absorption sponge was cut to an approximately 1 mm × 1 mm size. Using forceps, the sponge was inserted through a 25-gauge trocar and then through a corneal paracentesis to gently scrape the surface of the iris to dislodge the adherent SO droplets, which were subsequently aspirated.

Results:
This technique efficiently and effectively dislodged and mobilized most emulsified SO droplets, thereby allowing removal through aspiration using a vitrector. Two months after surgery, the retina remained attached, the intraocular pressure decreased from 18 mm Hg to 15 mm Hg, and there were no visible SO droplets in the anterior chamber.

Conclusion:
The sweeping technique is a safe and efficient method to dislodge, mobilize, and aspirate emulsified SO droplets that are adherent to the anterior surface of the iris, thereby decreasing the risk of future SO-related complications.
Deep Anterior Lamellar Keratoplasty–Treated Keratoconic Eyes With Descemet Membrane Rupture
Authors: Peng Rongmei , Du Kaiyue , Yuan Bowei , Xiao Gege , Qu Yi , Xu Yonggen , Liu Enshuo , Hong Jing 
Published: December 2023

Purpose:
The aim of this study was to evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) and compare it with penetrating keratoplasty (PKP) in keratoconic eyes with Descemet membrane (DM) rupture.

Methods:
In this comparative retrospective case series, 33 keratoconic eyes with a history of hydrops underwent DALK and 27 received PKP. Baseline and postoperative visual acuity, corneal astigmatism, mean keratometry, endothelial cell density, and complication rates were measured.

Results:
The median follow-up of patients who underwent DALK was 45 months (range, 4–76 months) and that of patients who underwent PKP was 84 months (range, 4–136 months). Both procedures had comparable postoperative visual acuity, astigmatism, and mean keratometry. Significantly higher endothelial cell densities were observed in DALK than in PKP at 2, 3, and 5 years postsurgery (2043 ± 767 vs. 1165 ± 683 cell/mm2, P = 0.007, n = 12 in both groups at 2 years). Intra-DALK, 15 perforations occurred (44.12%) and 1 (2.94%) was converted to PKP. Graft rejection was diagnosed in 1 (3.03%) DALK procedure versus 8 (29.63%) PKP (P = 0.008), and other long-term complication rates were equivalent. Kaplan–Meier survival analysis also revealed a higher rejection-free survival rate for the DALK group (P = 0.012). Subgroup analysis within both groups based on the severity of preoperative DM rupture revealed no significant difference in any major 2-year outcomes.

Conclusions:
DALK showed similar beneficial visual outcome and safety but significantly better endothelial protection over PKP in eyes with keratoconus and previous hydrops. Therefore, DALK is recommended in posthydrops cases irrespective of the DM rupture severity.
Long-Term Follow-Up of Descemet Stripping Only: Data Up to 7 Years Postoperatively
Authors: Rizk Maria , Dubois Mathieu , Elahi Sina , Ghazal Wassim , Flamant Roxane , Tordjmane Ilan , Courtin Romain , Panthier Christophe , Gatinel Damien , Saad Alain 
Published: December 2023

Purpose:
The aim of this study was to report long-term follow-up of eyes undergoing Descemet stripping only (DSO).

Methods:
This was a retrospective study including 26 eyes of 20 patients undergoing DSO between December 2015 and November 2022. Eligibility criteria included peripheral endothelial cell count (ECC) >1000 cells/mm2 and symptoms caused by central guttata. Patients underwent a central circular 4-mm descemetorhexis using a reverse Sinskey hook and a pair of descemetorhexis forceps using a peeling technique. Three parameters were measured before surgery and at last follow-up: best-corrected visual acuity (BCVA), central corneal thickness (CCT), and ECC measured centrally and at the periphery.

Results:
The mean age was 73 ± 9 years [52–90 years]. The average follow-up period was 23.7 ± 24.8 months [3–84]. Twenty-two eyes responded to DSO with 20 female eyes (91%) and 2 male eyes (9%). The mean postoperative BCVA improved from 0.3 ± 0.17 logMAR to 0.09 ± 0.13 logMAR (P value <0.05). The mean postoperative CCT decreased from 588 ± 41 μm to 546 ± 50 μm (P-value <0.05). The mean postoperative central ECC was 780 ± 257 cells/mm2 [484–1500]. Peripheral ECC decreased postoperatively (1837 ± 407 cells/mm2 preoperatively to 864 ± 340 cells/mm2 postoperatively, P value >0.05). Peripheral endothelial cell polymegathism was stable (average of 26.8% ± 6.8% preoperatively and 30.2% ± 14% postoperatively). Average peripheral endothelial cells polymorphism decreased postoperatively (63.1 ± 20.5% preoperatively to 33% ± 25% postoperatively, P value >0.05). Four eyes did not show improvement after DSO and underwent Descemet membrane endothelial keratoplasty surgery. There were 3 men (75%) and 1 women (25%). The preoperative trend was for nonresponders to have lower BCVA, higher CCT, more abnormal peripheral polymorphism, and polymegathism.

Conclusions:
The results of this study, with up to 7 years follow up, demonstrate the durability of DSO.
The Effects of Injury Type on Health-Related Quality of Life in Youth Athletes: A Cross-Sectional Analysis
Authors: Verma Rajiv , DeMaio Emily , Render Alexandria , Wild Jacob , Hunt Danielle , Cato Sarah , Shenvi Neeta , LaBella Cynthia , Stracciolini Andrea , Jayanthi Neeru 
Published: December 2023

Objective:
The relationship between health-related quality of life (HRQoL) and injury type has not been analyzed for young athletes. We hypothesized that there would be no difference in HRQoL between injured athletes, injured nonathletes, and normative data for healthy youth (NDHY) or among athletes with acute, overuse, or concussion injuries.

Design:
Cross-sectional clinical cohort.

Setting:
Primary care sports medicine clinics at 3 academic institutions.

Participants:
Patients aged 8 to 18 years presenting with injury.

Independent Variables:
Injury type and athletic participation.

Main Outcome Measures:
Health-related quality of life measured 1 month after injury through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 v2.0 assessed pain interference, peer relationships, depression, fatigue, anxiety, and mobility. One-way analysis of variance was performed with P values of <0.05 considered significant. Concussion Learning Assessment and School Survey (CLASS) evaluated academic performance.

Results:
Three hundred fifty-seven patients (36% male), with average age of 14.2 years, completed HRQoL and CLASS surveys following injury. There were 196 overuse injuries (55%), 119 acute injuries (33%), and 42 concussions (12%). Ninety-four percent were athletes. Six percent were nonathletes; 90.5% of concussed patients reported grades worsening. Concussed athletes reported more fatigue (P = 0.008) compared with other injury types but no worse than NDHY. Athletes with overuse injuries had lower mobility (P = 0.005) than other injury types and NDHY. Patients with lower HRQoL were female, older age, or required surgery. No other domains had significant differences by injury type nor did HRQoL differ between the athletes, nonathletes, and NDHY.

Conclusions:
With the exception of injuries requiring surgery, HRQoL of injured young athletes was similar to NDHY in most domains.
Patient Safety in Nursing Homes From an Ecological Perspective: An Integrated Review
Authors: Min Deulle , Park Seungmi , Kim Suhee , Park Hye Ok 
Published: December 2023

ObjectivesThe aims of the study were to identify the systemic factors affecting the characteristics and safety of older adults living in nursing homes and the resulting resident outcomes and to explore the relationship between them through an integrated literature review.MethodsA literature search was conducted from April 22 to May 6, 2021, in the PubMed, Embase, Cochrane CENTRAL, CIHNAL, RISS, NDL, and KoreaMed databases. The following key words and MeSH terms were used for the search: “nursing home,” “skilled nursing facility,” “long-term care facility,” and “patient safety” or “safety.”ResultsForty-seven qualifying articles were finally selected. Three domains were derived as personal factors, 12 as facility factors, and one as a policy factor. The interrelationships between them could result in positive or negative resident outcomes. The relationship between them was also reconstructed from an ecological perspective.ConclusionsThe results demonstrated that the safety and quality of life of older adults living in nursing homes were affected by both individual and institutional factors.
Methylated ctDNA Quantification: Noninvasive Approach to Monitoring Hepatocellular Carcinoma Burden
Authors: Angeli-Pahim Isabella , Chambers Anastasia , Duarte Sergio , Soma Daiki , Beduschi Thiago , Sahin Ilyas , Hughes Steven , Zarrinpar Ali 
Published: December 2023

BACKGROUND:
Noninvasive, precision monitoring of hepatocellular carcinoma (HCC) treatment efficacy would greatly facilitate personalized therapy and improve patient outcomes. We hypothesize that quantifying methylated circulating tumor DNA (ctDNA) can be used to effectively monitor HCC burden without the need for biopsy.

STUDY DESIGN:
Blood samples were collected from 25 patients, 21 with HCC and 4 with benign liver masses, at various timepoints throughout the course of treatment at a high-volume academic medical center. Quantification of methylated ctDNA molecules assessed CpG sites on more than 550 preselected cancer-specific amplicons. The tumor methylation score (TMS) was calculated by measuring the difference between the amount of methylation in the plasma and buffy coat with a normal cutoff value of 120 or less.

RESULTS:
Among 10 patients with surgical HCC (5 surgical resections and 5 liver transplants), TMS revealed a statistically significant, rapid postoperative decline in 9. One patient who had a persistently elevated TMS on postoperative day 1 was subsequently found to have had metastatic disease. Patients in the negative control cohort all had normal-range pre- and postoperative TMS. Preoperative TMS correlated moderately with tumor burden on pathology (Spearman r = 0.54) of surgical specimens. From 11 subjects undergoing systemic therapy or Y90 radioembolization, analysis of 16 time periods demonstrated that the change in TMS (ΔTMS) was better associated with tumor progression than the change in Δalpha-fetoprotein (area under the curve 0.800 and 0.783, respectively). A composite score combining ΔTMS and Δalpha-fetoprotein further improved performance for detecting tumor progression with an area under the curve of 0.892.

CONCLUSIONS:
These findings indicate that ctDNA methylation scores can effectively evaluate changes in tumor burden without the need for tumor biopsy.