bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viral Detection Is Associated With Severe Disease in Children With Suspected Community-Acquired Pneumonia
Authors: Ramgopal Sriram , Cotter Jillian M. , Navanandan Nidhya , Shah Samir S. , Ruddy Richard M. , Ambroggio Lilliam , Florin Todd A. 
Published: June 2023

Objective
To evaluate the role of virus detection on disease severity among children presenting to the emergency department (ED) with suspected community-acquired pneumonia (CAP).

Methods
We performed a single-center prospective study of children presenting to a pediatric ED with signs and symptoms of a lower respiratory tract infection and who had a chest radiograph performed for suspected CAP. We included patients who had virus testing, with results classified as negative for virus, human rhinovirus, respiratory syncytial virus (RSV), influenza, and other viruses. We evaluated the association between virus detection and disease severity using a 4-tiered measure of disease severity based on clinical outcomes, ranging from mild (discharged from the ED) to severe (receipt of positive-pressure ventilation, vasopressors, thoracostomy tube placement, or extracorporeal membrane oxygenation, intensive care unit admission, diagnosis of severe sepsis or septic shock, or death) in models adjusted for age, procalcitonin, C-reactive protein, radiologist interpretation of the chest radiograph, presence of wheeze, fever, and provision of antibiotics.

Results
Five hundred seventy-three patients were enrolled in the parent study, of whom viruses were detected in 344 (60%), including 159 (28%) human rhinovirus, 114 (20%) RSV, and 34 (6%) with influenza. In multivariable models, viral infections were associated with increasing disease severity, with the greatest effect noted with RSV (adjusted odds ratio [aOR], 2.50; 95% confidence interval [CI], 1.30–4.81) followed by rhinovirus (aOR, 2.18; 95% CI, 1.27–3.76). Viral detection was not associated with increased severity among patients with radiographic pneumonia (n = 223; OR, 1.82; 95% CI, 0.87–3.87) but was associated with severity among patients without radiographic pneumonia (n = 141; OR, 2.51; 95% CI, 1.40–4.59).

Conclusions
The detection of a virus in the nasopharynx was associated with more severe disease compared with no virus; this finding persisted after adjustment for age, biomarkers, and radiographic findings. Viral testing may assist with risk stratification of patients with lower respiratory tract infections.
Accuracy of the American College of Surgeons Minimum Criteria for Full Trauma Team Activation for Children
Authors: Lerner E. Brooke , Drendel Amy L. , Badawy Mohamed , Cushman Jeremy T. , Fumo Nicole , Jones Courtney M.C. , Shah Manish N. , Gourlay David M. 
Published: June 2023

Objective
Pediatric trauma centers use reports from emergency medical service providers to determine if a trauma team should be sent to the emergency department to prepare to care for the patient. Little scientific evidence supports the current American College of Surgeons (ACS) indicators for trauma team activation. The objective of this study was to determine the accuracy of the ACS Minimum Criteria for Full Trauma Team Activation for children as well as the accuracy of the modified criteria used at the local sites for trauma activation.

Methods
Emergency medical service providers who transported an injured child aged 15 years or younger to a pediatric trauma center in 1 of 3 cities were interviewed after emergency department arrival. Emergency medical service providers were asked if each of the activation indicators were present based on their evaluation. The need for full trauma team activation was determined through a medical record review using a published criterion standard definition. Undertriage and overtriage rates and positive likelihood ratios (+LRs) were calculated.

Results
Emergency medical service provider interviews were conducted and outcome data were obtained for 9483 children. There were 202 (2.1%) cases that met the criterion standard for need for trauma team activation. Based on the ACS Minimum Criteria, 299 (3.0%) cases should have received a trauma activation. The ACS Minimum Criteria undertriaged 44.1% and overtriaged 20% (+LR, 27.9; 95% confidence interval, 23.1–33.7). Based on the actual activation status using the local criteria, 238 cases received a full trauma activation, 45% were undertriaged, and 1.4% were overtriaged (+LR, 40.1; 95% confidence interval, 32.4–49.7). There was 97% agreement between the ACS Minimum Criteria and the actual local activation status at the receiving institution.

Conclusions
The ACS Minimum Criteria for Full Trauma Team Activation for children have a high rate of undertriage. Changes that individual institutions have made to improve the accuracy of activations at their institutions seem to have had a limited effect on decreasing undertriage.
Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for Physical Abuse
Authors: Snyder Christopher W. , Barry Tara M. , Ciesla David J. , Thatch Keith , Danielson Paul D. , Chandler Nicole M. , Pracht Etienne E. 
Published: June 2023

Objectives
Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury.

Methods
Patients aged younger than 6 years from the 2009–2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity.

Results
A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83–8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40–7.27).

Conclusions
Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.
Patients Who Decompensate and Trigger Rapid Response Immediately Upon Hospital Admission Have Higher Mortality Than Equivalent Patients Without Rapid Responses
Authors: Lykins V Joseph D. , Freedman Matthew T. , Zemore Zachary , Sedhai Yub Raj , Lubin Shannon , Sessler Curtis N. , Hogan Christopher , Kashiouris Markos G. 
Published: June 2023

Background
Rapid response teams (RRTs) have impacted the management of decompensating patients, potentially improving mortality. Few studies address the significance of RRT timing relative to hospital admission. We aimed to identify outcomes of adult patients who trigger immediate RRT activation, defined as within 4 hours of admission and compare with RRT later in admission or do not require RRT activation, and identify risk factors that predispose toward immediate RRT activation.

Methods
A retrospective case-control study was performed using an RRT activation database, comprising 201,783 adult inpatients at an urban, academic, tertiary care hospital. This group was subdivided by timing of RRT activation regarding admission: within the first 4 hours (immediate RRT), between 4 and 24 hours (early RRT), and after 24 hours (late RRT). The primary outcome was 28-day all-cause mortality. Individuals triggering an immediate RRT were compared with demographically matched controls. Mortality was adjusted for age, Quick Systemic Organ Failure Assessment score, intensive care unit admission, and Elixhauser Comorbidity Index.

Results
Patients with immediate RRT had adjusted 28-day all-cause mortality of 7.1% (95% confidence interval [CI], 5.6%–8.5%) and death odds ratio of 3.27 (95% CI, 2.5–4.3) compared with those who did not (mortality, 2.9%; 95%CI, 2.8%–2.9%; P < 0.0001). Patients triggering an immediate RRT were more likely to be Black, be older, and have higher Quick Systemic Organ Failure Assessment scores than those who did not trigger RRT activation.

Conclusions
In this cohort, patients who require immediate RRT experienced higher 28-day all-cause mortality, potentially because of evolving or unrecognized critical illness. Further exploring this phenomenon may create opportunities for improved patient safety.
Association between LH level decrease on the triggering day and pregnancy outcome for IVF/ICSI patients following GnRH antagonist protocol: a retrospective cohort study
Authors: Li Qing-Fang , Tang Min-Yue , Wang Gui-Quan , Chen Xi-Jing , Feng Guo-Fang , Zhu Yi-Min 
Published: June 2023

Objective:
Optimal luteinizing hormone (LH) levels for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients following the GnRH antagonist protocol remain controversial. This study aimed to estimate the association between serum LH levels on the triggering day (LHLOT) and clinical pregnancy outcomes in IVF/ICSI patients following the GnRH antagonist protocol.

Methods:
We enrolled 4743 IVF/ICSI cycles using flexible or fixed GnRH antagonist protocols between January 2017 and June 2021. The patients were stratified into four groups according to the LHLOT quartiles (Q1-Q4). Each group was further divided into two subgroups according to the median basal LH/LHLOT. The main outcomes were clinical pregnancy, birth, and miscarriage rates. Secondary outcomes were oocyte yield, number of MII, 2PN, and high-quality embryos.

Results:
Serum LHLOT levels were negatively correlated with oocyte yield and the numbers of MII, 2PN, and high-quality embryos. Reproductive outcomes were compared among the different quartiles and subgroups. The absolute difference in the clinical pregnancy rates between the Q4 and Q1 groups was 6.4% (47.2% vs. 40.8%, P˂0.05). Clinical pregnancy rates between the subgroups with basal LH/LHLOT˃ 3.04 and ≤ 3.04 were 32.7% and 48.6% (P˂0.01), respectively, in Q1. Within Q3, the clinical pregnancy rates between the subgroups with basal LH/LHLOT ˃2.14 and ≤2.14 were 50.2% and 41.9%, respectively (P˂0.05). The greater the decrease in LH levels, the lower the oocyte maturation rate across all quartiles.

Conclusions:
According to the LHLOT quartiles, the Q1 of serum LHLOT ˂ 1.43 IU/L may result in a higher number of oocytes but reduced oocyte maturation and lower clinical pregnancy rates. A decrease in LH levels by approximately 2.14–3.04 times compared to basal LH levels may lead to higher clinical pregnancy rates in IVF/ICSI patients following the GnRH antagonist protocol.
Factors influencing the accuracy of sonography-estimated fetal weight: a retrospective cohort study in the Chinese population
Authors: Sun Fang-Can , Wang Hai-Hong , Zhang Jing-Jing , Gu Xin-Xian , Hu Ting , Wang Ming-Yue , Zhu Yin-Di , Chen You-Guo , Han Bing 
Published: June 2023

Objective:
To evaluate the accuracy of sonography-estimated fetal weight (EFW) and to determine the potential factors influencing EFW accuracy in the Chinese population.

Methods:
Eleven widely used formulae were chosen to evaluate the accuracy of EFW in 7016 cases in a retrospective cohort study. Nine potential factors (prenatal body mass index (BMI), gestational age (GA), birth weight (BW), fetal sex, fetal presentation, amniotic fluid volume (AFV), seniority of sonographers, the time interval between ultrasonic measurement and delivery, and diabetes mellitus) were analyzed by binary logistic regression to determine whether they influenced sonography-EFW.

Results:
All 11 models had high correlation coefficients between EFW and BW (r = 0.819–0.843). Model 3 was the most accurate formula for the Chinese population. Compared to fetuses with EFW of 2500g–3999g, the accuracy of EFW decreased by 69.10% (P<0.001) for fetuses less than 2500g, and decreased by 54.10% (P<0.001) for fetuses larger than 4000g. The accuracy of EFW in female fetuses decreased by 21.70% compared with male fetuses (P=0.021). Compared to the EFW calculated 1 day before delivery, the accuracy of the EFW performed 4–7 days before delivery showed a significant decrease (P=0.014). The accuracy of EFW was influenced by the individual measurement accuracy of the sonographers. Maternal BMI, DM, GA, fetal presentation, and AFV did not influence the accuracy of EFW after adjustment.

Conclusion:
Model 3 was the most accurate model for the Chinese population. The BW, fetal sex, time interval, and technique of the sonographers had different influences on the accuracy of EFW.
Quality and Readability of Accessible Facial Feminization Literature
Authors: Alper David P. , Almeida Mariana N. , De Baun Heloise M. , Glahn Joshua Z. , Rivera Jean Carlo , Williams Mica C.G. , Collar John L. , Mookerjee Vikram , Persing John A. , Alperovich Michael 
Published: June 2023

Background
Facial feminization surgery (FFS) consists of multiple, complex procedures. Well-informed patients have been shown to have better outcomes and expectations. However, there is limited data evaluating FFS patient-oriented material online. This study aims to evaluate the quality and readability of FFS literature online.

Methods
Facial feminization surgery–related terms were queried in Google with location, cookies, and user account information disabled. Websites were analyzed for readability using Flesch Reading Ease and Flesch-Kincaid Reading Grade Level, suitability using the suitability assessment of materials (SAM), and quality using the DISCERN scale. Unpaired t tests and χ2 tests were used to compare the websites of community-based and academic or public institutions.

Results
One hundred twenty websites met inclusion criteria (71 community-based and 49 academic). The average reading grade level was 11.68 ± 1.71. The average SAM score was 53.11 ± 11.75, denoting adequate readability. Only 16.67% of websites contained visual aids to assist in explaining procedures and benefits. Overall, 68.33% of websites' DISCERN score was rated very poor or poor, whereas only 8.33% were rated as good. The following DISCERN elements had the lowest scores across all graded websites: “clear source and date of information,” “details of additional source of support,” “refers to areas of uncertainty,” and “describes risks of each treatment.” Websites published by community-based institutions were significantly better in describing how FFS works and the benefits of each procedure. Academic sites overall were less biased (4.84 vs 4.62, P = 0.03) and provided additional sources of support (2.35 vs 1.32, P = <0.001).

Conclusions
Online FFS patient resources should be written at a more inclusive reading level and should increase the use of pictorial aids to improve patient comprehension. Facial feminization surgery patient resources were significantly above the recommended sixth grade reading level for health literature. Academic and community-based institutions should include more information about procedural risks and limitations in surgical outcomes to ensure a broader scope of understanding.
Revisiting Bipedicled Flaps for Lower Extremity Distal Third Defects
Authors: Bhagat Neel , Berns Jessica , Newsom Keeley , Dawson Steven , Archual Anthony , Christie Brian M. , Weber Erin L. , Hassanein Aladdin H. 
Published: June 2023

Background
Lower extremity reconstruction of the distal third of the leg is challenging. Free tissue transfer is the criterion standard. The COVID-19 pandemic encouraged seeking alternatives for resource consuming procedures. Bipedicled flaps are flaps with a dual-source subdermal perfusion. The purpose of this study was to assess outcomes of patients who had bipedicled flaps primary or auxiliary local flap for distal third leg/foot reconstruction.

Methods
A retrospective review of patients undergoing lower extremity reconstruction (2020–2021) was performed. Inclusion criteria were patients older than 18 years with lower extremity wounds secondary to traumatic injury for which bipedicled flaps were used in the reconstruction. Exclusion criteria included lower extremity wounds secondary to peripheral vascular disease or diabetes.

Results
Fourteen patients were included in the study. All patients had distal third of the leg/foot wounds, and 12 patients (87.5%) had concurrent leg fractures. In 8 patients (57.1%), the bipedicled flap was used to decrease the wound size and facilitate another concurrent flap: hemisoleus (21.4%), anterior tibialis muscle turnover (14.3%), medial plantar artery (14.3%), and posterior tibial artery perforator (14.3%). Mean wound size for bipedicle flaps used alone was 42.0 ± 18.3 cm2, whereas wounds that required a bipedicled flap with an additional flap were 69.9 ± 80.8 cm2 (P = 0.187). Two patients had partial flap necrosis (14.3%) but healed their defect. One patient had nonunion (7.1%). Limb salvage rate was 100%.

Conclusions
Bipedicled flaps can be used as an alternative to free flaps in distal third leg/foot defects in select patients. If distal extremity wounds cannot be covered with a bipedicled flap alone, the flap can be used an accessory flap to facilitate reconstruction with other local flaps.
Novel Colon Preparation Method Combining Bowel Cleanser Reduction and Unique Walking
Authors: Koyama Muneyuki , Shiba Hiroaki , Kaneda Yosuke , LuLu Li , Ohya Tomohiko , Takano Yasuhiro , Nishikawa Katsunori , Ohkuma Masahisa , Eto Ken 
Published: June 2023

Background and Purpose:
Poor bowel preparation increases the difficulty of colonoscopy and affects lesion detection. In this study, we investigated the usefulness of a new bowel preparation method using polyethylene glycol electrolyte formulation containing ascorbic acid (PEG plus ascorbic acid: PEG-Asc, MOVIPREP) to improve bowel cleansing and shorten preparation time.

Methods:
This was a single-center, retrospective study. In the new method, patients were instructed to take a laxative the day before the examination and PEG1L on the day of the examination. In addition, we instructed the patients to walk, which we designed. The primary endpoints were the degree of bowel cleansing (assessed by the Boston bowel preparation scale, BBPS) and time to the cecum.

Results:
The conventional group reached the cecum in 606.5±225.8 seconds (mean±SD), whereas the introduced group reached the cecum in 500±217.1 seconds, a significantly shorter time (P<0.05). In the BBPS, the score in the introduced group was significantly higher (P<0.01): 6.8±2.14 points in the conventional group and 8.6±0.74 points in the introduction group.

Conclusion:
Pretreatment combining the 1L weight loss method and walking improves bowel cleansing and shortens the time to reach the cecum.
Comparison of Different Weight Meshes in Ventral/Incisional Hernia Repair, the Outcomes of Systematic Review and Meta-analysis
Authors: Li Junsheng , Shao Xiangyu , Cheng Tao 
Published: June 2023

Background:
The use of mesh is not without complications. Decreasing the mesh weight with the light-weight (LW) mesh may improve tissue growth and diminish mesh-related complications, yet, clinically, there are conflicting results regarding the influence of different weight meshes in ventral/incisional hernia repair. The aim of the present study is to compare the outcomes of different weight meshes for ventral/incisional hernia repair.

Methods:
The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies were published through January 1, 2022, using the keywords “heavy weight” “light weight” “mesh” “ventral hernia” “incisional hernia”. All relevant articles and reference lists in these original studies were also obtained from the above databases.

Results:
Eight trials (4 randomized controlled trials, 3 prospective studies, and 1 retrospective study) containing 1844 patients were included in the present meta-analysis. The pooled results showed that there was a significantly more rate of foreign body perception in the heavy-weight mesh group compared with the LW mesh group (odds ratio = 5.02, 95% CI: 1.05, 24.06). There was no significant difference concerning hernia recurrence, seroma, hematoma, surgical site infection, reoperation rate, chronic pain, quality of life, and hospital stay among different weight mesh groups.

Conclusion:
Different weight meshes showed similar clinical results in ventral/incisional hernia repair, except that, perception of foreign body was reported more frequently in the heavy-weight mesh group as compared with the LW mesh group. However, the long-term hernia recurrence with different weights of meshes needs to be reevaluated considering the relative short-term follow-up in these studies.
Electroconvulsive Therapy in Patients With Cerebral Aneurysms
Authors: Buntting Christopher Shane , Tran David , Fish Charles , Chatha Gurkirat , Jithoo Rondhir 
Published: June 2023

Abstract
Subarachnoid hemorrhage due to cerebral aneurysm rupture is a devastating event with a high mortality and significant morbidity. The safety of patients undergoing electroconvulsive therapy (ECT) in the presence of an aneurysm is not clear and is a cause of anxiety for both health care workers and patients. The present article collated the available evidence related to ECT in the presence of an aneurysm and found that there were no case reports where ECT directly led to the rupture of an aneurysm, although 1 case reported a rupture of an aneurysm between sessions of ECT. The epidemiology of cerebral aneurysms is discussed, as are key clinical considerations related to the care of patients with aneurysms who require ECT.