bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Fluid Bolus Volume and Resolution of Acute Kidney Injury in Children With Diabetic Ketoacidosis
Authors: Bergmann Kelly R. , Boes Morgan , Velden Heidi Vander , Abuzzahab M. Jennifer , Watson David 
Published: January 2022

Objectives
To describe trends in creatinine and acute kidney injury (AKI) in children who present with diabetic ketoacidosis (DKA) and receive low versus high intravenous (IV) fluid bolus volumes. Further, to determine whether resolution of AKI is hastened by low versus high bolus volumes.

Methods
We conducted an observational retrospective cohort study between January 2012 and March 2020 among children ≤21 years presenting with DKA. Acute kidney injury was defined by the Kidney Disease/Improving Global Outcomes creatinine criteria, using the Schwartz estimating equation to calculate an expected baseline creatinine. Bolus volume was categorized as low (<15 mL/kg) or high (≥15 mL/kg). Generalized additive mixed models were used to model trends of creatinine ratios. Estimated mean creatinine ratios and differences by bolus volumes were assessed at the time of bolus, and 12, 24, 36, 48 hours. Cox proportional hazard models were used to estimate the association between resolution of AKI and bolus volume after adjustment for confounders.

Results
We identified 708 eligible encounters with DKA, of which 169 (23.9%) had AKI at presentation and 10 (1.4%) developed AKI after hospitalization. Comparing patients who received low versus high bolus volumes, the proportion of encounters with AKI on presentation was similar (P = 0.364) as was the mean difference in creatinine ratios over time. In adjusted analysis, treatment with high IV fluid bolus volume was only associated with a 6.2% faster resolution of AKI (hazard ratio, 1.062; 95% confidence interval, 0.61–1.87).

Conclusions
Intravenous fluid bolus volume was not associated with resolution of AKI in our cohort of children with DKA.
Musculoskeletal and Neurological Pain Symptoms Among Hospitalized COVID-19 Patients
Authors: Jena Debasish , Sahoo Jagannatha , Barman Apurba , Gupta Anil , Patel Vikas 
Published: January 2022

Objective
As the coronavirus disease 2019 pandemic continues to grow, its clinical manifestations are still emerging and are being widely investigated. However, the pain symptoms, including neurological and musculoskeletal pain symptoms, are still poorly understood.

Design
In this cross-sectional study, we investigated the prevalence of musculoskeletal and neurological pain symptoms among hospitalized coronavirus disease 2019 patients. Furthermore, the association of clinical and demographic factors with the prevalence of pain symptoms was also investigated.

Result
We included 182 hospitalized coronavirus disease 2019 patients with a mean age of 48.86 ± 13.98 yrs. Pain symptoms were reported by 61.54% patients (n = 112). Most common symptoms reported were generalized myalgia (n = 60, 32.96%), headache (n = 50, 27.47%), and low back pain (n = 41, 22.53%). Interestingly, neuropathic pain was present in 14 participants (7.69%). Logistic regression analysis revealed an association of pain symptoms with coronavirus disease 2019 severity, male sex, higher body mass index, and a history of addiction.

Conclusions
Pain symptoms are common manifestation of coronavirus disease 2019. Generalized myalgia, headache, and low back pain are the three most common new-onset pain symptoms in hospitalized coronavirus disease 2019 patients. Further investigation of pain symptoms and their predictive factors are recommended, which may guide healthcare workers and policymakers to plan in this direction.

To Claim CME Credits
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CME Objectives
Upon completion of this article, the reader should be able to: (1) Understand common musculoskeletal and neurological pain symptoms among hospitalized COVID-19 patients; (2) Understand the basic etiopathogenesis of COVID-19 associated pain; and (3) Identify factors associated with presence of COVID-19 pain symptoms.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Central nervous system monoaminergic activity in hip osteoarthritis patients with disabling pain: associations with pain severity and central sensitization
Authors: Bjurström Martin F. , Blennow Kaj , Zetterberg Henrik , Bodelsson Mikael , Waldén Markus , Dietz Nicholas , Hall Sara , Hansson Oskar , Irwin Michael R. , Mattsson-Carlgren Niklas 
Published: January 2022

Abstract

Introduction:
Monoaminergic activity modulates nociceptive transmission in the central nervous system (CNS). Although pain is the most disabling symptom of osteoarthritis (OA), limited knowledge exists regarding the CNS mechanisms that amplify pain and drive sensitization processes in humans.

Objectives:
The main objective of this study was to evaluate associations between cerebrospinal fluid (CSF) monoamine metabolites, pain severity, and central sensitization in patients with OA undergoing total hip arthroplasty (THA).

Methods:
Patients with OA (n = 52) and pain-free controls (n = 30) provided CSF samples for measurement of serotonin (5-hydroxyindoleacetic acid [5-HIAA]), noradrenaline (3-methoxy-4-hydroxyphenylglycol [HMPG]), and dopamine (homovanillic acid [HVA]) monoamine metabolites. Patients with OA completed longitudinal evaluation of pain using clinical measures and quantitative sensory testing.

Results:
Patients with OA had higher HMPG levels when compared with controls (P = 0.036). Within patients with OA undergoing THA, higher 5-HIAA and HVA levels were consistently associated with higher preoperative pain severity. Higher concentrations of 5-HIAA and HVA were also associated with lower conditioned pain modulation levels, whereas higher HMPG levels were linked to more efficient conditioned pain modulation. Patients with higher levels of CSF HVA exhibited increased pressure pain sensitivity (arm pressure pain detection threshold < 250 kPa vs ≥ 250 kPa, P = 0.042). Higher preoperative levels of CSF 5-HIAA predicted poorer pain control 6 months postoperatively (brief pain inventory pain severity; adjusted β = 0.010, 95% CI 0.001–0.019).

Conclusions:
In OA patients with disabling pain, higher CSF levels of serotonin and dopamine metabolites are associated with increased pain severity and central sensitization. Increased noradrenergic activity may be associated with more efficient pain inhibitory capacity.
Sleep and Daily Social Experiences as Potential Mechanisms Linking Social Integration to Nocturnal Blood Pressure Dipping
Authors: Chin Brian N. , Dickman Kristina D. , Koffer Rachel E. , Cohen Sheldon , Hall Martica H. , Kamarck Thomas W. 
Published: January 2022

ABSTRACT

Objective
Socially integrated individuals are at lower risk of cardiovascular disease morbidity and mortality compared with their more isolated counterparts. This association may be due, in part, to the effect of social integration on nocturnal blood pressure (BP) decline or “dipping,” a physiological process associated with decreased disease risk. However, the pathways linking social integration with nocturnal BP dipping are unknown. We sought to replicate the association between social integration and BP dipping, and to test whether sleep characteristics (duration, regularity, continuity) and/or daily social interactions (frequency, valence) helped to explain the association.

Methods
A total of 391 healthy midlife adults completed an actigraphy assessment protocol that measured sleep. During four actigraphy assessment days, participants also completed ambulatory BP monitoring and ecological momentary assessment protocols that measured BP and social interactions at regular intervals throughout the day. Social integration was assessed via a questionnaire.

Results
Linear regression controlling for age, sex, race, education, and body mass index indicated that higher levels of social integration were associated with greater nocturnal BP dipping, as indicated by a smaller ratio of night/day mean arterial pressure (β = −0.11, p = .031). Analyses of indirect effects suggested that this association was explained, in part, by greater sleep regularity among more integrated individuals. We did not find evidence for other hypothesized indirect effects.

Conclusions
This was the first study to investigate sleep and social mechanisms underlying the link between social integration and nocturnal BP dipping. Because sleep regularity is modifiable, this pathway represents a potential intervention target to promote nocturnal BP dipping.
Effects of Early Life Adversity on Pubertal Timing and Tempo in Black and White Girls: The National Growth and Health Study
Authors: Hamlat Elissa June , Laraia Barbara , Bleil Maria E. , Deardorff Julianna , Tomiyama A. Janet , Mujahid Mahasin , Shields Grant S. , Brownell Kristy , Slavich George M. , Epel Elissa S. 
Published: January 2022

ABSTRACT

Objective
Although exposure to abuse in early life predicts earlier pubertal timing, especially for girls, it is unclear if this association generalizes to nonabuse stressors. In addition, the impact of race on the stress-maturation association remains unknown. To address these issues, we examined whether race moderates the effects of early adversity on pubertal timing and tempo using a longitudinal study design.

Methods
In a cohort of 9- and 10-year-old Black and White girls, pubertal (areolar and pubic hair) maturation was assessed annually for 7 years. In adulthood, 368 participants (186 Black, 182 White) reported on abuse and nonabuse stressors they experienced from ages 0 to 12 years.

Results
Early life abuse was associated with earlier pubertal timing, as indexed by younger age at menarche (b = −0.22, p = .005, 95% confidence interval [CI] = −0.39 to −0.06) and greater pubic hair development (b = 0.11, p = .003, 95% CI = 0.04 to 0.18), in addition to slower pubertal tempo, as indexed by slower rate of pubic hair (b = −0.03, p < .001, 95% CI = −0.05 to −0.01) and areolar (b = −0.02, p = .02, 95% CI = −0.03 to −0.003) development. These associations were not found for nonabuse adversity. Black girls with early life abuse had greater pubic hair development (b = 0.23, p < .001, 95% CI = 0.12 to 0.35) and were slower in pubic hair tempo (b = −0.07, p < .001, 95% CI = −0.09 to −0.04) than their White counterparts.

Conclusions
Screening for early life abuse may help address health disparities related to earlier pubertal timing.
Associations Between Maternal Distress, Cortisol Levels, and Perinatal Outcomes
Authors: Lundholm Cecilia , Rejnö Gustaf , Brew Bronwyn , Smew Awad I. , Saltvedt Sissel , Almqvist Catarina 
Published: January 2022

ABSTRACT

Objective
Stress during pregnancy may decrease gestational age at birth and birth size. We aimed to investigate the associations between maternal subjective stress measures, salivary cortisol, and perinatal outcomes.

Methods
A cohort of pregnant women (n = 1693) was recruited from eight antenatal care clinics in Stockholm, Sweden. Questionnaires on subjective distress (perceived stress, worry, depression symptoms, sleep quality) and saliva samples for cortisol measurement (morning and evening) were collected in early and late pregnancy. Perinatal outcomes were birth weight, birth length, gestational age, and birth weight for gestational age. We used linear regression to estimate associations adjusted for maternal characteristics.

Results
All associations between subjective distress and cortisol levels were close to null and nonsignificant, for example, exp(β) = 1.001 (95% confidence interval = 0.995 to 1.006) for the morning cortisol level and perceived stress in early pregnancy. Likewise, most associations between distress (subjective and cortisol) and perinatal outcomes were weak and not statistically significant, for example, β = 1.95 (95% confidence interval = −4.16 to 8.06) for perceived stress in early pregnancy and birth weight. An exception was a statistically significant association between birth weight for gestational age and depression symptoms in early pregnancy, with somewhat higher weight with more symptoms (β = 0.08; 95% CI = 0.04 to 0.13). The results were similar for stress in early and late pregnancy.

Conclusions
We found no association between subjective distress and cortisol measures irrespective of when in pregnancy the measures were taken. Furthermore, we found no evidence for a longitudinal association between psychological measures of stress or cortisol with lower birth weight, birth weight for gestational age, or gestational age.
Developing Methods to Support Collaborative Learning and Co-creation of Resilient Healthcare—Tips for Success and Lessons Learned From a Norwegian Hospital Cancer Care Study
Authors: Bergerød Inger Johanne , Clay-Williams Robyn , Wiig Siri 
Published: January 2022

Background
There is a growing attention on the role of patients and stakeholders in resilience, but there is lack of knowledge and methods on how to support collaborative learning between stakeholders and co-creation of resilient healthcare. The aim of this article was to demonstrate how the methodological process of a consensus process for exploring aspects of next of kin involvement in hospital cancer care can be replicated as an effort to promote resilient healthcare through co-creation with multiple stakeholders in hospitals.

Methods
The study applied a modified nominal group technique process developed by synthesizing research findings across 4 phases of a research project with a mixed-methods approach. The process culminated in a 1-day meeting with 20 stakeholder participants (5 next of kin representatives, 10 oncology nurses, and 5 physicians) from 2 Norwegian university hospitals.

Results
The consensus method established reflexive spaces with collective sharing of experiences between the 2 hospitals and between the next of kin and healthcare professionals. The method promoted collaborative learning processes including identification and reflection upon new ideas for involvement, and reduction of the gap between healthcare professionals’ and next of kin experiences and expectations for involvement. Next of kin were considered as important resources for resilient performance, if involved with a proactive approach. The consensus process identified both successful and unsuccessful collaborative practices and resulted in a co-designed guide for healthcare professionals to support next of kin involvement in hospital cancer care.

Conclusions
This study expands the body of knowledge on methods development that is relevant for collaborative learning and co-creation of resilient healthcare. This study demonstrated that the consensus methods process can be used for creating reflexive spaces to support collaborative learning and co-creation of resilience in cancer care. Future research within the field of collaborative learning should explore interventions that include a larger number of stakeholders.
Discrepancies Between Clinical and Autopsy Diagnoses in Rapid Response Team–Assisted Patients: What Are We Missing?
Authors: Giugni Fernando Rabioglio , Salvadori Fernanda Aburesi , Smeili Luciana Andrea Avena , Marcílio Izabel , Perondi Beatriz , Mauad Thais , de Paiva Edison Ferreira , Duarte-Neto Amaro Nunes 
Published: January 2022

Objectives
The rapid response team (RRT) assists hospitalized patients with sudden clinical deterioration. There is scarce evidence of diagnostic accuracy in this scenario, but it is possible that a considerable rate of misdiagnosis exists. Autopsy remains a valuable tool for assessing such question. This study aimed to compare clinical (premortem) and autopsy (postmortem) diagnoses in patients assisted by the RRT and describe major discrepancies.

Methods
We reviewed 104 clinical data and autopsies from patients assisted by the RRT during a cardiac arrest event in a tertiary care hospital in Brazil. Clinical and autopsy diagnostic discrepancies were classified using the Goldman criteria. Other clinical and pathological data were described, and the group with major diagnostic discrepancies was further analyzed.

Results
We found 39 (37.5%) patients with major diagnostic discrepancies. Most frequent immediate causes of death in this group determined by autopsy were sepsis (36%), pulmonary embolism (23%) and hemorrhagic shock (21%). Pulmonary embolism was the cause of death significantly more frequent in the major discrepancy group than in the minor discrepancy group (23% versus 3%, P = 0.002). We individually described all major diagnostic discrepancies.

Conclusions
We found a high rate (37.5%) of major misdiagnosis in autopsies from patients assisted by the RRT in a tertiary teaching hospital. Pulmonary embolism was the most inaccurate fatal diagnosis detected by autopsy.
Development of a Quality Improvement Dental Chart Review Training Program
Authors: Kalenderian Elsbeth , Hebballi Nutan B. , Franklin Amy , Yansane Alfa , Ibarra Noriega Ana M. , White Joel , Walji Muhammad F. 
Published: January 2022

Introduction
Chart review is central to understanding adverse events (AEs) in medicine. In this article, we describe the process and results of educating chart reviewers assigned to evaluate dental AEs.

Methods
We developed a Web-based training program, “Dental Patient Safety Training,” which uses both independent and consensus-based curricula, for identifying AEs recorded in electronic health records in the dental setting. Training included (1) didactic education, (2) skills training using videos and guided walkthroughs, (3) quizzes with feedback, and (4) hands-on learning exercises. In addition, novice reviewers were coached weekly during consensus review discussions. TeamExpert was composed of 2 experienced reviewers, and TeamNovice included 2 chart reviewers in training. McNemar test, interrater reliability, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to compare accuracy rates on the identification of charts containing AEs at the start of training and 7 months after consensus building discussions between the 2 teams.

Results
TeamNovice completed independent and consensus development training. Initial chart reviews were conducted on a shared set of charts (n = 51) followed by additional training including consensus building discussions. There was a marked improvement in overall percent agreement, prevalence and bias-adjusted κ correlation, and diagnostic measures (sensitivity, specificity, positive predictive value, and negative predictive value) of reviewed charts between both teams from the phase I training program to phase II consensus building.

Conclusions
This study detailed the process of training new chart reviewers and evaluating their performance. Our results suggest that standardized training and continuous coaching improves calibration between experts and trained chart reviewers.
Effects of Framingham 10-Year Cardiovascular Risk Score and Viral Load on Brain Integrity in Persons With HIV
Authors: Glans Michelle , Cooley Sarah A. , Vaida Florin , Boerwinkle Anna , Tomov Dimitre , Petersen Kalen J. , Rosenow Alexander , Paul Robert H. , Ances Beau M. 
Published: January 2022

Background:
Combination antiretroviral therapy (cART) has allowed for viral load (VL) suppression and increased life expectancy for persons with HIV (PWH). Altered brain integrity, measured by neuropsychological (NP) performance and neuroimaging, is still prevalent among virally suppressed PWH. Age-related conditions such as cardiovascular disease may also affect brain integrity. This study investigated the effects of cardiovascular risk, VL, and HIV serostatus on cerebral blood flow (CBF), brain volumetrics, and cognitive function in PWH and persons without HIV (PWoH).

Methods:
Ten-year cardiovascular risk, using the Framingham Heart Study criteria, was calculated in PWH (n = 164) on cART with undetectable (≤20 copies/mL; n = 134) or detectable (>20 copies/mL; n = 30) VL and PWoH (n = 66). The effects of cardiovascular risk on brain integrity (CBF, volume, and cognition) were compared for PWH (undetectable and detectable VL) and PWoH.

Results:
PWH had smaller brain volumes and worse NP scores than PWoH. PWH with detectable and undetectable VL had similar brain integrity measures. Higher cardiovascular risk was associated with smaller volumes and lower CBF in multiple brain regions for PWH and PWoH. Significant interactions between HIV serostatus and cardiovascular risk on brain volumes were observed in frontal, orbitofrontal, and motor regions. Cardiovascular risk was not associated with cognition for PWH or PWoH.

Conclusions:
Neuroimaging, but not cognitive measures, was associated with elevated cardiovascular risk. HIV serostatus was associated with diminished brain volumes and worse cognition while CBF remained unchanged, reflecting potential protective effects of cART. Neuroimaging measures of structure (volume) and function (CBF) may identify contributions of comorbidities, but future longitudinal studies are needed.
Epidemiology of Digital Clubbing and Hypertrophic Osteoarthropathy
Authors: Essouma Mickael , Nkeck Jan Réné , Agbor Valirie N. , Noubiap Jean Jacques 
Published: January 2022

Abstract
Digital clubbing and hypertrophic osteoarthropathy (HOA) are long-standing clinical entities, but their prevalence have not been synthesized. We aimed to estimate the prevalence of digital clubbing and HOA in people with existing medical conditions.
We comprehensively searched PubMed, Embase, and Web of Science to select studies addressing HOA or digital clubbing and published through March 23, 2021. Summary estimates of the prevalence were derived through random-effects meta-analysis and narrative synthesis. The review protocol has been registered with PROSPERO, CRD42021243934.
Of 3973 records, we included 142 studies. In adults, the pooled prevalence of digital clubbing was 33.4% (95% confidence interval [CI], 16.6–52.8), 31.3% (95% CI, 22.4–41.1), 27% (95% CI, 9.4–49.5), and 22.8% (95% CI, 10.8–37.6) in subjects with intestinal diseases, interstitial lung diseases, infective endocarditis, and hepatic diseases, respectively. In children and adolescents, the pooled prevalence of digital clubbing was 29.1% (95% CI, 19.4–39.9), 23% (95% CI, 9.0–41.1), 19.5% (95% CI, 4.1–42.4), and 17.1% (95% CI, 9.5–26.5) in subjects with human immunodeficiency virus infection, hemoglobinopathies, cystic fibrosis, and tuberculosis. The pooled prevalence of HOA was 10.1% (95% CI, 2.0–23.1) in adults with cancers, and 5% (95% CI, 2.5–8.2) in children and adolescents with cystic fibrosis.
In conclusion, the prevalence of digital clubbing varied across disease groups in both adults and children. Full-spectrum HOA was mostly reported in adults with liver disease and cancers, and in children and adolescents with cystic fibrosis.