bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated With Chlamydia and Gonorrhea Treatment Completion Among Sexual Health Clinic Patients, Baltimore City, Maryland; 2018 to 2019
Authors: Stracker Norberth , Williford Sarah L. , Gilliams Elizabeth , Rives Sarah , Page Kathleen R. , Hamill Matthew M. , Greenbaum Adena , Schumacher Christina M. 
Published: February 2023

Background
Prompt and appropriate treatment of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is critical to prevent transmission and serious sequelae. The objectives were to determine the prevalence of CT/NG treatment completion and identify demographic, behavioral, and clinical factors associated with treatment completion at sexual health clinics in Baltimore City, Maryland.

Methods
Electronic health record data from patients diagnosed with CT/NG during 2018–2019 were analyzed. Treatment completion was defined as documentation of Centers for Disease Control and Prevention–recommended treatment ≤30 days after testing. Regression was used to assess differences in treatment completion across groups; analyses were stratified by birth sex.

Results
Most of the 2426 male (86%) and 754 (72%) female patients diagnosed with CT/NG completed treatment in ≤30 days; 74% of male and 36% of female patients were treated same-day. Among 890 male patients not treated same-day, treatment completion was associated with other same-day antimicrobial treatments (adjusted prevalence ratio, 0.76 [95% confidence interval, 0.61–0.94]), longer test processing times (≥10 days; 0.78 [0.65—0.95]) infection at multiple anatomic sites (1.49 [1.25–1.76]), and patients with previous clinic visits (1.16 [1.03–1.31]). Among 483 female patients not treated same-day, treatment completion was associated with diagnosis year (2019 vs. 2018; 1.23 [1.05–1.43]) and residential addresses 2 to 5 miles (vs. <2 miles) from clinic (1.25 [1.02–1.53]). Demographic and behavioral characteristics were not associated with treatment completion.

Conclusions
Substantial proportions of male and female sexual health clinic patients did not complete treatment. Our findings underscore the need for implementation of highly sensitive and specific point-of-care (POC) CT/NG testing to improve treatment completion in this setting.
Intact Chorionic Vesicle in Very Early Products of Conception Specimens
Authors: Kayraklioglu Neslihan , Gasper Cynthia , Cho Soo Jin , Lage Janice , Rabban Joseph T. 
Published: February 2023

Among the morphologic mimics of hydatidiform moles, the chorionic vesicle of early first-trimester pregnancy has received scant attention. The chorionic vesicle is the stage of the implanted blastocyst in which the cytotrophoblastic shell is circumferentially lined by primary and secondary villi and envelops the notochord stage embryo, yolk sac, and amniotic sac, ∼5 to 6 weeks since the last menstrual period. Miscarriage specimens at this early gestational age that contain an intact chorionic vesicle may be misinterpreted as a complete hydatidiform mole because of its large size, cistern-like cavity, and circumferentially radiating villi and trophoblast, particularly so when embryonic tissue is absent. We present the clinicopathologic features of 26 products of conception specimens containing a chorionic vesicle, some of which were submitted for consultation as a possible complete mole. The median gestational age was 6 weeks. The majority were free-floating in the specimen, unattached to endometrium. The median diameter was 6.3 mm and ranged up to 11.3 mm. The embryo was absent in 81% of cases, leaving an empty cavity resembling the cistern of a complete mole in all but 2 cases. Most cases exhibited circumferential villi and variable degrees of proliferating polarized villous trophoblast and extravillous trophoblast but trophoblast atypia was absent. Villous stromal karyorrhexis and blue-gray myxoid extracellular stromal matrix were observed in the majority of cases. A minority exhibited focal abnormal villous morphology concerning for early molar pregnancy, including irregular projections (27%), invaginations (12%), or bulbous shapes (4%) of the villous contours and trophoblast pseudoinclusions (15%). In contrast, orderly hierarchical branching of the secondary villi occurred in 31%. p57 immunoexpression was intact in all 25 cases tested. Short tandem repeat genotype testing confirmed a biparental diploid genotype in both of 2 cases tested. Although uncommonly observed in early first-trimester products of conception specimens, the normal chorionic vesicle merits awareness as a potential diagnostic pitfall. While some morphologic features resemble those of a well-developed complete mole, at this early gestational age such features are not expected in a very early complete mole. Attention to the reported gestational age, if available, and presence of embryonic tissues will mitigate against misclassification as complete mole. As with the workup of any potential gestational trophoblastic disease, partnering the clinical and morphologic evaluation with molecular evaluation (intact p57 immunoexpression and lack of any of the characteristic molar genotypes) offers the most precise classification.
The Relationship Between Postoperative Complications and Children’s Quality of Life: A Mediation Analysis to Explore the Role of Family Factors
Authors: Brown Katherine L. , Moinuddin Mohammed , Jones Alison , Sheehan Karen , Wellman Paul , Rodrigues Warren , Ridout Deborah , Wray Jo 
Published: February 2023

OBJECTIVES:
To explore whether postoperative morbidities after pediatric cardiac surgery affected children’s health-related quality of life (HRQOL) at 6 months, through potentially modifiable parental psychological factors.

DESIGN:
We undertook a mediation analysis, to explore the causal pathway, based on data from a prospective, case-matched cohort study.

PATIENTS:
Six hundred sixty-six children undergoing cardiac surgery.

SETTING:
Five centers in the United Kingdom.

INTERVENTIONS:
No intervention.

MEASUREMENTS AND MAIN RESULTS:
Cases of morbidity were identified early after pediatric cardiac surgery, and matched controls with no morbidities were identified at discharge. Four mediators were assessed at 6 weeks after surgery, using the PedsQL Family Impact Module (Parent HRQOL and Family Function) and the PHQ-4 (Anxiety and Depression). The study outcome of child HRQOL was assessed at 6 months with the PedsQL. Of 666 children, 408 (65% of those surviving) contributed to the primary outcome. Children who had extracorporeal life support (ECLS) (n = 11) (p < 0.05) and multiple morbidities (n = 62) (p < 0.01) had worse 6-month HRQOL than those with a single morbidity (n = 125) or no morbidity (n = 209). After adjustment for case mix complexity and sociodemographic variables, there were significant indirect effects of parent HRQOL at 6 weeks, on the PedsQL Total Score (ECLS, –5.1 [–8.4 to –1.8]; p = 0.003; multiple morbidities, –2.1 [–3.7 to –0.5]; p = 0.01), PedsQL Physical Score (ECLS, –5.1 [–8.7 to –1.4]; p = 0.007; multiple morbidities, –2.1 [–3.8 to –0.4]; p = 0.016), and PedsQL Psychosocial Score (ECLS: –5.3 [–8.7 to –1.8); p = 0.003; multiple morbidities, –2.2 [–3.9 to –0.5]; p = 0.01). The proportion of the total effect of ECLS and multiple morbidity on the study outcomes mediated through parent HRQOL ranges between 18% and 61%. There was no evidence that the other three mediators had indirect effects on the study outcome.

CONCLUSIONS:
Parental HRQOL at 6 weeks after surgery contributes to child HRQOL at 6 months, among those with the severest types of morbidity, and as such should be a target for future interventions.
Adolescent Drug Ingestions Requiring ICU Stay: Single-Center Retrospective Cohort Study
Authors: Titus Lauren , Kosasih Matthew , Liegl Melodee , Pan Amy , Porada Kelsey , McFadden Vanessa 
Published: February 2023

OBJECTIVES:
Ingestions are a prevalent form of self-harm in teenagers and are unfortunately an increasingly common reason for admission to both acute care and critical care services. The goal of this study was to identify characteristics associated with requiring PICU stay among adolescents hospitalized for ingestions.

DESIGN:
Retrospective cohort study comparing patients admitted to hospital medicine service and critical care service from January 2019 to December 2019.

SETTING:
Freestanding children’s hospital in the midwestern United States.

PATIENTS:
Adolescents 12–18 years old hospitalized for ingestion.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Out of 209 patients included in the study cohort, 95 required PICU admission. High-risk behaviors (having had sex or usage of alcohol, drugs, tobacco, or vaping) were endorsed by 190 of 209 patients (91%). We compared patient characteristics, ingestion history, workup, and pharmacological and PICU-specific interventions between patients hospitalized on the hospital medicine service and the PICU. We failed to identify an association between reason for ingestion, substance ingested, and previously identified suicide risk factors including previous suicide attempt, previous self-harm, and psychiatric comorbidity and admission to PICU, as opposed to non-PICU admission. PICU stay was associated with longer peak corrected QT interval value, receiving a pharmacological intervention, and longer duration of hospital stay. Fifteen of 95 patients (16% [95% CI, 9–25%]) in the PICU received a PICU-specific intervention.

CONCLUSIONS:
We failed to identify specific patient demographics or mental behavioral health characteristics associated with PICU stay after ingestion. Therefore, we believe that all adolescents hospitalized due to ingestion—irrespective of disposition—should receive standardized high-risk behavior screening due to the pervasive nature of these behaviors among this patient population. PICU-specific care, beyond observation, could be needed in as high as one-in-four PICU admissions. Further research is needed to inform optimal disposition and resource allocation for this patient population.
Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial
Authors: Olszewski Aleksandra E. , Dervan Leslie A. , Smith Mallory B. , Asaro Lisa A. , Wypij David , Curley Martha A. Q. , Watson R. Scott 
Published: February 2023

OBJECTIVES:
To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation.

DESIGN:
Nonprespecified secondary analysis of a randomized clinical trial.

SETTING:
Thirty-one U.S. PICUs.

PATIENTS:
Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov) over 8 years old who completed PTSD screening 6 months after discharge.

INTERVENTIONS:
RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care.

MEASUREMENTS AND MAIN RESULTS:
PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork (n = 18, 58%) and happiness (n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family’s residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3–458.1 and $40,000–$79,999 OR, 15.6; 95% CI, 1.3–182.8), renal dysfunction (OR 5.3, 95% CI 1.7–16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9–35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen.

CONCLUSIONS:
Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.
Pediatric Croup Due to Omicron Infection Is More Severe Than Non-COVID Croup
Authors: Scribner Camille , Patel Kavita I. , Tunik Michael 
Published: February 2023

Objective
Croup due to infection with the omicron variant of COVID is an emerging clinical entity, but distinguishing features of omicron croup have not yet been characterized. We designed a study to compare the clinical features of croup patients presenting to the pediatric emergency department pre-COVID pandemic with COVID-positive croup patients who presented during the initial omicron surge.

Methods
This was a retrospective observational cohort study of children 0 to 18 years old who presented to our urban, tertiary care pediatric emergency department with symptoms of croup. The study compared a cohort of croup patients who presented in the year before the onset of the COVID pandemic to a cohort of COVID-positive croup patients who presented during the initial omicron surge. The primary outcomes included illness severity and treatments required in the emergency department. The secondary outcome was hospital admission rate.

Results
There were 499 patients enrolled in the study, 88 in the omicron croup cohort and 411 in the classic croup cohort. Compared with the classic croup patients, omicron croup patients were more likely to present with stridor at rest (45.4% vs 31.4%; odds ratio [OR], 1.82; confidence interval [CI], 1.14–2.91) and hypoxia (3.4% vs 0.5%; OR, 7.22; CI, 1.19–43.86). Omicron croup patients required repeat dosing of inhaled epinephrine in the emergency department more often (20.4% vs 6.8%; OR, 3.51; CI, 1.85–6.70), and they were more likely to require respiratory support (9.1% vs 1.0%; OR, 10.18; CI, 2.99–34.60). Admission rates were significantly higher for omicron croup patients than for classic croup patients (22.7% vs 3.9%; OR, 7.26; CI, 3.58–14.71), and omicron croup patients required intensive care more frequently (5.7% vs 1.5%; OR, 4.07; CI, 1.21–13.64).

Conclusions
Pediatric patients with omicron croup develop more severe disease than do children with classic croup. They are more likely to require additional emergency department treatments and hospital admission than patients with croup before the COVID pandemic.
Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department
Authors: Kenneally Allison , Cummins Megan , Bailey Abby , Yackey Katelyn , Jones Landon , Carter Craig , Dugan Adam , Baum Regan A. 
Published: February 2023

Objectives
In recent years, dexmedetomidine has gained traction as a treatment for anxiolysis in the emergency department (ED). When used with an atomizer, it may also be given intranasally for anxiolysis. The primary objective was to determine the level of ED provider satisfaction and comfort with intranasal (IN) dexmedetomidine for anxiolysis in pediatric patients with behavioral agitation and/or acute psychosis. The secondary objectives included determining safety, rates of therapy failure, and ED length of stay compared with oral midazolam. The efficacy of IN dexmedetomidine versus oral midazolam in patients with autism spectrum disorder (ASD) was also evaluated.

Methods
This was a single-center, prospective study in a pediatric ED from March 1 to December 31, 2021. Patients were included in the study if the ED provider requested IN dexmedetomidine anxiolysis and completed a postadministration survey. Safety and efficacy outcomes were assessed by chart review and compared with patients who received oral midazolam during the same study period. Efficacy was defined as the rate of treatment failure, as the need for procedural termination, progression to procedural sedation, or the requirement of additional medications for anxiolysis.

Results
Sixty-two patients received IN dexmedetomidine {median dose [interquartile range (IQR)] of 3.05 [2.04–4.00] μg/kg/dose} compared with 58 who received oral midazolam [median (IQR) dose of 0.29 (0.25–0.48) mg/kg/dose). Providers reported high comfort and satisfaction scores, with median (IQR) scores of 90 (75–100) and 88 (60–100) of 100. Twenty-nine percent of patients experienced treatment failure, most commonly because of the need for additional medications. Those who received IN dexmedetomidine had a longer ED length of stay (6.0 vs 4.4 hours, P = 0.010). Among the patients with ASD, those who received IN dexmedetomidine had a lower rate of treatment failure compared with oral midazolam (21.2% vs 66.7%, P = 0.039).

Conclusions
This study demonstrates that IN dexmedetomidine has high levels of provider comfort and satisfaction, moderately high success rate, and a promising safety profile. In addition, IN dexmedetomidine may be superior to oral midazolam in patients with ASD for anxiolysis, but additional studies are needed.
Short- and long-term effects of repetitive transcranial magnetic stimulation on post stroke visuospatial neglect: a systematic review and meta-analysis of randomized controlled trials
Authors: Yang Fu-An , Lin Chien-Lin , Cho Sheng-Yun , Chou I-Ling , Han Ting-I , Yang Pei-Yu 
Published: February 2023

Abstract

Objective
This systematic review and meta-analysis aimed to assess the effects of repetitive transcranial magnetic stimulation (rTMS) and select a suitable protocol for post stroke visuospatial neglect.

Design
PubMed, Cochrane Library, and Embase databases were searched for relevant studies from the inception date to October 31, 2021. The inclusion criteria were (1) randomized controlled trials (RCTs), (2) people with visuospatial neglect, (3) treatment with different rTMS protocols, (4) comparison with sham or blank control, and (5) reports of performance measurements.

Results
Data were obtained from 11 RCTs. The effects of immediate and one-month post intervention were measured using line bisection test, cancellation test and Catherine Bergego Scale. Results showed statistically significant improvement when applying low-frequency (0.5–1 Hz) rTMS or continuous theta burst stimulation to the left hemisphere on short- and long-term line bisection test [SMD = −1.10, 95% CI [−1.84, −0.37]; SMD = −1.25, 95% CI [−2.11, −0.39]] and cancellation test [SMD = 1.08, 95% CI [0.45, 1.71]; SMD = 1.45, 95% CI [0.42, 2.47]].

Conclusions
rTMS may be considered a treatment option for post stroke visuospatial neglect. This review proves that a decrease in neuronal excitation in the left hemisphere, which restores the interhemispheric balance, benefits post stroke visuospatial neglect.
Development of connective tissue area increases by initial impact with high-intensity exercise after reloading in rat soleus muscle
Authors: Tanaka Shoji , Inaoka Pleiades Tiharu , Madokoro Sachiko , Yamazaki Toshiaki 
Published: February 2023

ABSTRACT

Objective
To clarify whether or not high-intensity exercise in atrophied skeletal muscle after reloading 1) increases the injury and promotes the development of the muscle connective tissue area (mCTA) in the soleus muscle, and 2) delays muscle strength recovery.

Design
Rats had their hindlimbs suspended for 14 days followed by hindlimb reloading and squat exercise of 30% or 70%-one repetition maximum exercise (30%Ex or 70%Ex) until 14 days of reloading (R14d). The influences of reloading and exercise in muscles were examined by histological and immunofluorescence analyses based on the exercise load.

Results
70%Ex increased the extramyofiber area more than the control group and the central nuclear fiber number than the other groups after 7 days of reloading (R7d). 70%Ex resulted in a larger mCTA than the control and reload groups after R14d. Myogenin and M2-type macrophages after R7d increased by reloading but were not increased by the exercise load.

Conclusions
70%Ex to atrophied muscle increased injury early in post-reloading and increased the mCTA after R14d, but evidence that it delays muscle strength recovery was lacking. Therefore, mCTA induced by high-intensity exercise after reloading appears to be associated with initial exercise damage but not with repetition over 14 days.
Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation
Authors: Andreae Mollie E. , Grafton Lori M. , Hong Justin S. , Vidt Meghan E. 
Published: February 2023

Abstract
The purpose of this narrative review was to assess work-related mild traumatic brain injury (mTBI) treatment approaches and outcomes. Literature indicates that incidence of work-related mTBI is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g. financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States (US) demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by Physical Medicine and Rehabilitation (PM&R) physicians. Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mTBI are discussed. It is concluded that challenges persist in treatment and management of patients with work-related mTBI as they present unique challenges not seen in those with non-work related mTBIs. The unique position of PM&R and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.
Medical Leadership in Inpatient Rehabilitation Facilities in the United States
Authors: Davis Shane M. , Davis Austin , Wong Theodora , Mekany Majid , Majors David , Perret Karimi Danielle 
Published: February 2023

Abstract

Objective
Inpatient rehabilitation facilities (IRFs) treat patients with extensive post-acute care rehabilitation needs. Physiatrists are uniquely trained in the complexities of such patients, however, not all IRFs employ physiatrists as medical leadership. This study identifies the training background and credentials of medical directors in all IRFs within the United States.

Design
Using internet search, e-mail and telephone communication, the following data was collected: medical director credential and specialty information, board certification rates and years of practice experience, as well as bed numbers for each IRF listed on The Centers for Medicare & Medicaid Services (CMS) website. Data was collected between November 2019 and November 2020.

Results
Of the 1,114 open facilities, 85% have medical directors with an MD, while 13% have a DO. 2% reported no physician medical director. Physiatry is the most common specialty (80%), followed by internal medicine, family medicine, neurology, orthopedic surgery, general surgery and medicine/pediatrics. The mean number of beds per facility is 35.6 (median 24, range 4-350). There is an average of 11.4 IRF beds per 100,000 people nationally.

Conclusion
Physiatry is the predominant specialty to fulfill medical leadership at IRFs, although there remains room for growth. Additionally, MDs greatly outnumber DOs in medical leadership.