bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Utility of Mucosal Biopsies Taken During Colonoscopy-Guided Colonic Manometry Catheter Placement
Authors: Armstrong Derek G. , Chumpitazi Bruno P. , Chiou Eric H. , Balakrishnan Keshawadhana 
Published: August 2023

Objectives:
The diagnostic utility of mucosal biopsies taken during colonoscopy-guided colonic manometry catheter placement is unknown. The aims of our study were to determine the frequency and histopathology results of mucosal biopsies during these procedures and to assess whether there were any associations between the histology or gross findings with manometry results.

Methods:
We performed a retrospective chart review of children who had a colonic manometry study completed between 2008 and 2020 at a quaternary children’s hospital. We captured patient demographics, biopsy locations, histopathology results, gross endoscopy findings, and manometry results. The chi-squared test and when appropriate Fisher exact test was used to evaluate categorical associations.

Results:
One hundred forty-eight patients were included. One hundred eighteen (80%) had colonic biopsy and 63 (43%) had ileal biopsy. Colonic histology findings, which patients could have multiple, included lymphonodular hyperplasia (34%), normal (27%), chronic inflammation (24%), melanosis coli (21%), colonic eosinophilia (10%), and acute inflammation (8%). Ileal histology findings included increased Peyer patches (44%), normal (44%), acute inflammation (11%), chronic inflammation (3%), eosinophilia (5%), and eosinophilic ileitis (3%). The majority of acute and chronic inflammation was graded as mild. There were no statistically significant associations of histology to gross endoscopy or manometry findings.

Conclusions:
Colonic biopsies are obtained in the majority of patients presenting for colonic manometry evaluation with ileal biopsies obtained less frequently. Histopathology findings are noted frequently, but the majority are the result of or did not impact clinical care. There were no associations between abnormal histopathology or abnormal gross endoscopy findings with colonic manometry results.
Parental Perception and Measured Functional Status Following Pediatric Critical Illness: A Secondary Analysis of the Survivor Outcomes Study
Authors: Gouda Suzanne R. , Pinto Neethi P. 
Published: August 2023

OBJECTIVES:
We evaluated the concordance between parent/guardian perception of child long-term function and objectively scored long-term functional status using the Functional Status Scale (FSS) among PICU survivors.

DESIGN:
Secondary analysis of prospective cohort study.

SETTING:
Urban, tertiary, academic PICU.

PATIENTS:
PICU patients less than 18 years old were admitted between June and August 2012.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We conducted telephone interviews of parents/guardians of PICU survivors (n = 77) 6 months post-PICU discharge. We asked parents/guardians to characterize their child’s functional status, and we determined FSS scores using scripted interview questions. Concordance between parent/guardian perceptions and FSS scores was assessed, revealing that parent/guardian perceptions of their child’s functional status aligned poorly with FSS scores at 6 months (kappa coefficient 0.16).

CONCLUSIONS:
These findings shed light on a critical disconnect between parent/guardian perspective and our current tools to measure a child’s functional status following critical illness. In an era of decreased PICU mortality and increased long-term morbidity, the discordance between parent/guardian perception and available scoring tools in the assessment of long-term functional status highlights a key opportunity to improve communication and anchor expectations for long-term outcomes among PICU survivors.
Emergency Department Arrival Modes
Authors: Sacchetti Alfred , Hicken Eric , Bukata W. Richard , Durso Dana 
Published: August 2023

Introduction
Because small children can be transported by private vehicles, many children seek emergency care outside of Emergency Medical Services (EMS). Such transports may access the closest emergency departments (EDs) without knowledge of their pediatric competence. This study quantifies this practice and the concept of mandatory pediatric readiness.

Methods
The electronic health records of 3 general EDs and 2 pediatric EDs were queried for all pediatric and young adult visits for the year 2022. Data collected included patient age, ED type, arrival mode (EMS/police or private mode), and disposition (admission/transfer or discharge). Study patients were categorized as “small children” if aged younger than 10 years, “large children” if 10 to 18 years, and “young adult" if 19 to 40 years. Associations between mode of arrival, ED type, and disposition were analyzed through χ2 and analysis of variance.

Results
The study population included 37,866 small children, 19,108 large children, and 68,293 young adults. When compared with EMS/police transports, a private arrival mode was selected by 96.1% of small children, 90.0% of large children, and 85.4% of young adults (P < 0.0001). For the admission/transfer patients, private transportation was selected by 87.4% of small children, 73.8% of large children, and 78.8% of young adults (P < 0.0001). For admitted/transferred children, the private mode was used by 80.4% of those in the general ED and 81.9% in the pediatric ED (P > 0.41).

Conclusions
Pediatric patients seeking ED care overwhelmingly arrive through a private mode regardless of the severity of their problem or type of ED in which treated. Emergency Medical Services programs and state hospital regulatory agencies need to recognize this practice and assure the pediatric competence of every ED within their system.
Improved Compliance of Pediatrics High Blood Pressure Guidelines in Well-Child Clinic Visits
Authors: Khin Ei Ei , Villanos Maria Theresa , Alvarado Juliana Garcia , Rodriguez David , Arbab Bisma , De Guzman Kris Nicole 
Published: August 2023

Introduction:
Childhood hypertension can lead to cardiovascular morbidity and mortality in young adult life. We aim to improve compliance with the American Academy of Pediatrics recommended blood pressure (BP) guideline steps to 75% over 12 months in children 9 to 18 years old during well-child visits.

Methods:
The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts.

Results:
Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%–100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle.

Conclusion:
Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.
Increasing Engagement of Imaging Professionals in Quality Improvement Using an Encounter-specific Quality-reporting Tool
Authors: Ruess Lynne , Thompson Benjamin P. , Mesi Erin L. , Chmil Margarita , Zumberge Nicholas A. , Jorgenson Kari , Krishnamurthy Rajesh 
Published: August 2023

Introduction:
The involvement of pediatric imaging professionals in quality improvement (QI) in our department was low, with few available informatics tools to report issues or suggest improvement opportunities in a timely and efficient manner. We aimed to increase QI engagement in radiology by creating a real-time, encounter-specific reporting tool embedded into the clinical imaging workflow.

Methods:
A multidisciplinary team outlined requirements for a new electronic quality-reporting tool, including point-of-care access during imaging workflow and simultaneous automatic capture of encounter-specific clinical information from the hospital information system. Information system experts created a user-friendly interface for categories based on stages of imaging workflow (Planning, Acquisition, Processing, Interpretation, Communication, and Data Collection). Team members trained all department staff. Quality coordinators sorted entries and monitored personnel engagement for two 36-week periods: immediately after launch and 3 years later. Descriptive statistics were used to analyze proposed and completed QI projects during these periods.

Results:
There were 1,498 entries during the first 36 weeks. Ninety-three percent of radiologists and 56% of technologists participated. Three years later, there were 1,251 entries in 36 weeks. Data collection entries for established QI projects increased from 380 (25%) to 487(39%). The engagement continued among radiologists but decreased among technologists over time. Submissions for QI projects increased from baseline. The project completion rate increased.

Conclusion:
We created a QI reporting tool embedded into the clinical imaging workflow, which improved the participation of our imaging professionals and increased the number of completed QI projects.
Improving Usability of the Pediatric Code Cart by Combining Lean and Human Factors Principles
Authors: Frazier Maria , Webster Kristen , Dewan Maya , Hutson Tamara , Collins Kelly , Fettig Tina , Grooms Taylor , Cordray Mary , Tegtmeyer Ken 
Published: August 2023

Introduction:
Cardiac arrests are common in hospitalized children. Well-organized code carts are needed during these events to help staff efficiently find supplies and medications for the patient. This study aimed to improve the efficiency and utilization of the code cart at a major academic pediatric medical center.

Methods:
This quality improvement project used a phased approach to redesign the code cart. A multidisciplinary team used Lean and Human Factors principles to improve the efficiency and intuitiveness of the redesigned cart. Nurses and respiratory therapists participated in simulations asking for certain supplies with the original and redesigned code cart and filled out surveys for feedback on each code cart. Facilitators measured retrieval times during each simulation.

Results:
We performed 10 simulations with the original code cart and 13 with the redesigned code cart. Staff could find intraosseous access equipment more quickly (23.9 versus 46.4 seconds; P = 0.003). In addition, staff reported they were less likely to open the wrong drawer or grab the wrong equipment and that the redesigned code cart was overall more well organized than the original code cart. Finally, the redesigned code cart reduced the cost by over 800 dollars per full cart restock.

Conclusion:
Revising the code cart using Lean and Human Factors improves efficiency and usability and can contribute to cost savings.
Quality Improvement to Eliminate Disparities in Developmental Screening for Patients Needing Interpreters
Authors: Brown Courtney M. , Dillon Beth , Toth Christina , Decker Emily , Alexander Robin N. , Chandawarkar Aarti R. , Bester Stefanie , Ricket Elizabeth , Snyder Dane A. 
Published: August 2023

Background:
Children from households with a preferred language other than English are less likely to receive timely identification and treatment for developmental delay than children of native English speakers. In dismantling this inequity, the role of primary care pediatrics is to establish equitable systems for screening and referral. This project, conducted in a network of twelve pediatric primary care centers, focused on eliminating a small but systematic disparity in developmental screening rates between families who did and did not require interpreters (86% versus 92%). The specific aim was to increase developmental screen completion among patients needing interpreters from 86% to 92% of age-appropriate well-child visits.

Methods:
Data were extracted from the electronic health record (EHR) to measure the proportion of 9-, 18-, 24-, and 30-month well-child visits at which developmental screens were completed, stratified by interpreter need (n = 31,461 visits; 7500 needing interpreters). One primary care center tested small changes to standardize processes, eliminate workarounds, and leverage EHR features using the Institute for Healthcare Improvement’s Model for Improvement. The QI team plotted screen completion on control charts and spread successful changes to all 12 clinics. Statistical process control evaluated the significance of changes in screening rates.

Results:
For patients needing interpreters, screen completion rose across all clinics from 86% to 93% when the clinics implemented the new process. Screen completion for patients not needing interpreters remained at 92%.

Conclusion:
A standardized process supported by the EHR improved developmental screening among patients needing interpreters, eliminating disparities.
Development, Validation, and Comparison of 2 Ultrasound Feature–Guided Machine Learning Models to Distinguish Cervical Lymphadenopathy
Authors: Zhong Rong , Wang Yuegui , Chen Yifeng , Yang Qiuting , Yang Caiyun , Lin Congmeng , Shen Haolin 
Published: August 2023

Abstract
The objective of this study is to develop and validate the performance of 2 ultrasound (US) feature–guided machine learning models in distinguishing cervical lymphadenopathy. We enrolled 705 patients whose US characteristics of lymph nodes were collected at our hospital. B-mode US and color Doppler US features of cervical lymph nodes in both cohorts were analyzed by 2 radiologists. The decision tree and back propagation (BP) neural network were developed by combining clinical data (age, sex, and history of tumor) and US features. The performance of the 2 models was evaluated by calculating the area under the receiver operating characteristics curve (AUC), accuracy value, precision value, recall value, and balanced F score (F1 score). The AUC of the decision tree and BP model in the modeling cohort were 0.796 (0.757, 0.835) and 0.854 (0.756, 0.952), respectively. The AUC, accuracy value, precision value, recall value, and F1 score of the decision tree in the validation cohort were all higher than those of the BP model: 0.817 (0.786, 0.848) vs 0.674 (0.601, 0.747), 0.774 (0.737, 0.811) vs 0.702 (0.629, 0.775), 0.786 (0.739, 0.833) vs 0.644 (0.568, 0.720), 0.733 (0.694, 0.772) vs 0.630 (0.542, 0.718), and 0.750 (0.705, 0.795) vs 0.627 (0.541, 0.713), respectively. The US feature–guided decision tree model was more efficient in the diagnosis of cervical lymphadenopathy than the BP model.
THE EFFICACY AND SAFETY OF VASOPRESSORS FOR SEPTIC SHOCK PATIENTS: A SYSTEMIC REVIEW AND NETWORK META-ANALYSIS
Authors: Jia Lu , Wang Pufeng , Li Cong , Xie Jianfeng 
Published: August 2023

ABSTRACT

Background: Septic shock is a distributive shock with decreased systemic vascular resistance and MAP. Septic shock contributes to the most common causes of death in the intensive care unit (ICU). Current guidelines recommend the use of norepinephrine as the first-line vasopressor, whereas adrenergic agonists and vasopressin analogs are also commonly used by physicians. To date, very few studies have synthetically compared the effects of multiple types of vasoactive medications. The aim of this study was to systemically evaluate the efficacy of vasoactive agents both individually and in combination to treat septic shock. Methods: The PubMed, MEDLINE, Embase, Web of Science, and Cochrane Central Register for Controlled Trials (CENTRAL) were searched up to May 12, 2022, to identify relevant randomized controlled trials. A network meta-analysis was performed to evaluate the effect of different types of vasopressors. The primary outcome was 28-day all-cause mortality. The secondary outcome was the ICU length of stay. Adverse events are defined as any undesirable outcomes, including myocardial infarction, cardiac arrhythmia, peripheral ischemia, or stroke and cerebrovascular events. Findings: Thirty-three randomized controlled trials comprising 4,966 patients and assessing 8 types of vasoactive treatments were included in the network meta-analysis. The surface under the cumulative ranking curve provided a ranking of vasoactive medications in terms of 28-day all-cause mortality from most effective to least effective: norepinephrine plus dobutamine, epinephrine, vasopressin, terlipressin, norepinephrine, norepinephrine plus vasopressin, dopamine, and dobutamine. Dopamine was associated with a significantly shorter ICU stay than norepinephrine, terlipressin, and vasopressin, whereas other vasoactive medications showed no definite difference in ICU length of stay. Regarding adverse events, norepinephrine was associated with the highest incidences of myocardial infarction and peripheral ischemia. Dopamine was associated with the highest incidence of cardiac arrhythmia. Epinephrine and terlipressin were associated with the highest incidences of myocardial infarction and peripheral ischemia. Interpretation: The results of this network meta-analysis suggest that norepinephrine plus dobutamine is associated with a lower risk of 28-day mortality in septic shock patients than other vasoactive medications, and the use of dopamine is associated with a higher risk of 28-day mortality due to septic shock than norepinephrine, terlipressin, and vasopressin.
How ‘visual’ is the visual cortex? The interactions between the visual cortex and other sensory, motivational and motor systems as enabling factors for visual perception
Authors: Pennartz Cyriel M. A. , Oude Lohuis Matthijs N. , Olcese Umberto 
Published: August 2023

The definition of the visual cortex is primarily based on the evidence that lesions of this area impair visual perception. However, this does not exclude that the visual cortex may process more information than of retinal origin alone, or that other brain structures contribute to vision. Indeed, research across the past decades has shown that non-visual information, such as neural activity related to reward expectation and value, locomotion, working memory and other sensory modalities, can modulate primary visual cortical responses to retinal inputs. Nevertheless, the function of this non-visual information is poorly understood. Here we review recent evidence, coming primarily from studies in rodents, arguing that non-visual and motor effects in visual cortex play a role in visual processing itself, for instance disentangling direct auditory effects on visual cortex from effects of sound-evoked orofacial movement. These findings are placed in a broader framework casting vision in terms of predictive processing under control of frontal, reward- and motor-related systems. In contrast to the prevalent notion that vision is exclusively constructed by the visual cortical system, we propose that visual percepts are generated by a larger network—the extended visual system—spanning other sensory cortices, supramodal areas and frontal systems.
This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Causal inference during closed-loop navigation: parsing of self- and object-motion
Authors: Noel Jean-Paul , Bill Johannes , Ding Haoran , Vastola John , DeAngelis Gregory C. , Angelaki Dora E. , Drugowitsch Jan 
Published: August 2023

A key computation in building adaptive internal models of the external world is to ascribe sensory signals to their likely cause(s), a process of causal inference (CI). CI is well studied within the framework of two-alternative forced-choice tasks, but less well understood within the cadre of naturalistic action–perception loops. Here, we examine the process of disambiguating retinal motion caused by self- and/or object-motion during closed-loop navigation. First, we derive a normative account specifying how observers ought to intercept hidden and moving targets given their belief about (i) whether retinal motion was caused by the target moving, and (ii) if so, with what velocity. Next, in line with the modelling results, we show that humans report targets as stationary and steer towards their initial rather than final position more often when they are themselves moving, suggesting a putative misattribution of object-motion to the self. Further, we predict that observers should misattribute retinal motion more often: (i) during passive rather than active self-motion (given the lack of an efference copy informing self-motion estimates in the former), and (ii) when targets are presented eccentrically rather than centrally (given that lateral self-motion flow vectors are larger at eccentric locations during forward self-motion). Results support both of these predictions. Lastly, analysis of eye movements show that, while initial saccades toward targets were largely accurate regardless of the self-motion condition, subsequent gaze pursuit was modulated by target velocity during object-only motion, but not during concurrent object- and self-motion. These results demonstrate CI within action–perception loops, and suggest a protracted temporal unfolding of the computations characterizing CI.
This article is part of the theme issue ‘Decision and control processes in multisensory perception’.
Metacognition in the audiovisual McGurk illusion: perceptual and causal confidence
Authors: Meijer David , Noppeney Uta 
Published: August 2023

Almost all decisions in everyday life rely on multiple sensory inputs that can come from common or independent causes. These situations invoke perceptual uncertainty about environmental properties and the signals' causal structure. Using the audiovisual McGurk illusion, this study investigated how observers formed perceptual and causal confidence judgements in information integration tasks under causal uncertainty. Observers were presented with spoken syllables, their corresponding articulatory lip movements or their congruent and McGurk combinations (e.g. auditory B/P with visual G/K). Observers reported their perceived auditory syllable, the causal structure and confidence for each judgement. Observers were more accurate and confident on congruent than unisensory trials. Their perceptual and causal confidence were tightly related over trials as predicted by the interactive nature of perceptual and causal inference. Further, observers assigned comparable perceptual and causal confidence to veridical ‘G/K’ percepts on audiovisual congruent trials and their causal and perceptual metamers on McGurk trials (i.e. illusory ‘G/K’ percepts). Thus, observers metacognitively evaluate the integrated audiovisual percept with limited access to the conflicting unisensory stimulus components on McGurk trials. Collectively, our results suggest that observers form meaningful perceptual and causal confidence judgements about multisensory scenes that are qualitatively consistent with principles of Bayesian causal inference.
This article is part of the theme issue ‘Decision and control processes in multisensory perception’.