bluuebunny/crossref_metadata_2025_split huggingface dataset:
How primary care providers can help prevent food allergies
Authors: Conroy Ellen , Ponda Punita 
Published: July 2022

Purpose of review
IgE-mediated food allergy rates have increased in recent decades, yet treatment options remain limited. Prevention strategies are thus essential. We will review recent research and consensus guidelines for food allergy prevention.

Recent findings
Research has continued to support that early introduction of allergens via the gastrointestinal tract induces tolerance and prevents development of food allergy. In contrast, allergen sensitization may occur via transcutaneous allergen exposure. This is supported by research that shows a decreased risk of food allergy with aggressive treatment of atopic dermatitis. More recent research suggests that transcutaneous sensitization could also be facilitated by frequent emollient use in the absence of atopic dermatitis but definitive research is lacking. Murine models have shown a likely role of dysbiosis, or disruption of the body's normal healthy microbiome, in development of food allergy, yet human studies have yet to show a conclusive benefit of probiotics in the prevention of food allergy.

Summary
Important approaches for food allergy prevention are: introduction of peanut and cooked egg at 4–6 months, early introduction of other allergenic foods, and early diagnosis and treatment of atopic dermatitis (because of a predisposition to food sensitization through the damaged skin barrier). More research is needed to clarify the role, if any, of emollient use and probiotics.
Pearls and updates: cutaneous signs of systemic malignancy
Authors: Paquette Gabriella M. , Cotter Chantal , Huang Jennifer T. 
Published: July 2022

Purpose of review
Children with systemic malignancies can present with concomitant dermatological manifestations. Cutaneous findings can occur before, during or after diagnosis. Recognizing these features can aid in diagnosis, inform prognosis, and help determine appropriate treatment. Following a review of the literature published over the past two years, we provide an update on cutaneous signs of pediatric systemic malignancies, concentrating on; leukemia cutis, lymphoma cutis, neuroblastoma, sarcomas, Langerhans cell histiocytosis and paraneoplastic syndromes.

Recent findings
Authors highlight the persistently heterogeneous features of cutaneous manifestations of systemic malignancy. Findings are often nonspecific, and a definitive diagnosis requires skin biopsy with immunophenotyping. Several studies describe dermoscopy features, demonstrating this as a useful tool in clinical evaluation. Genetic mutations underlying the pathogenesis of disease continue to be elucidated. Further, advances in medical treatment led to improved prognosis in many systemic malignancies, with early and aggressive treatment heralding better outcomes.

Summary
Comprehensive cutaneous evaluation alongside thorough clinical history and review of systems remains of paramount importance as dermatological manifestations of systemic malignancy are notoriously variable with a shared feature of often appearing benign but persisting despite usual treatment. Urgent referral to dermatology is recommended when suspicion for any cutaneous presentation of malignancy arises.
The Role of Depressive Disorders in Autonomic Cardiovascular Dysregulation in Fibromyalgia
Authors: Reyes del Paso Gustavo A. , Contreras-Merino Ana M. , Duschek Stefan 
Published: July 2022

ABSTRACT

Objective
Previous research revealed aberrances in autonomic cardiovascular regulation in fibromyalgia, which may be relevant to symptoms genesis and the increased risk of cardiovascular disorders in individuals with fibromyalgia. This study investigated the role of comorbid depression in autonomic cardiovascular dysregulations in fibromyalgia.

Methods
Cardiovascular recordings were obtained in 53 participants with fibromyalgia who also had depression (n = 27), in participants with fibromyalgia without depression (n = 26), and in 29 healthy controls, at rest and during a cold pressor test and an arithmetic task. Assessed parameters included interbeat interval, blood pressure, heart rate variability, baroreflex sensitivity, stroke volume, preejection period, left ventricular ejection time, Heather index, and total peripheral resistance.

Results
Participants with both fibromyalgia and depression displayed lower tonic interbeat interval, baroreflex sensitivity, and heart rate variability compared with participants with fibromyalgia without depression and controls (p values < .012, d values = 0.71–1.06). Participants with fibromyalgia but without depression did not differ from controls in these variables. Moreover, participants with fibromyalgia who also had depression, but not those without depression, exhibited lower Heather index, stroke volume, and left ventricular ejection time compared with controls (p values < .013, d values = 0.62–0.78). No group differences arose for preejection period or total peripheral resistance. Stress reactivity was reduced in participants with fibromyalgia, independently of depression, for diastolic blood pressure, interbeat interval, left ventricular ejection time, and heart rate variability, than in controls.

Conclusions
The role of depression in the autonomic dysregulation in fibromyalgia involves chronotropic cardiac control rather than adrenergic influences on contractility and vascular tone. Blunted cardiovascular reactivity may be ascribable to pathological factors inherent to fibromyalgia. These results underline the importance of diagnostics and treatment of comorbid depressive disorders in the management of fibromyalgia.
Associations of Modifiable Behavioral Risk Factor Combinations at 65 to 74 Years Old With Cognitive Health Span for 20 Years
Authors: Smagula Stephen F. , Biggs Mary L. , Jacob Mini E. , Rawlings Andreea M. , Odden Michelle C. , Arnold Alice , Newman Anne B. , Buysse Daniel J. 
Published: July 2022

ABSTRACT

Objective
Behavioral risk factors for dementia tend to co-occur and interrelate, especially poor diet, physical inactivity, sleep disturbances, and depression. Having multiple of these modifiable behavioral risk factors (MBRFs) may predict a particularly shortened cognitive health span and therefore may signal high-risk status/high intervention need.

Methods
These secondary analyses of data from the Cardiovascular Health Study included 3149 participants aged 65 to 74 years (mean [standard deviation {SD}] age = 69.5 [2.5] years; 59.6% female). MBRF exposures were self-reports regarding a) diet, b) activity, c) sleep, and d) depression symptoms. We primarily analyzed MBRF counts. For up to 26 years of follow-up, we assessed the a) number of remaining cognitively healthy life-years (CHLYs) and b) percentage of remaining life-years (LYs) that were CHLYs (%CHLY). We estimated CHLYs as time before a dementia diagnosis, cognitive screener scores indicating impairment, proxy report indicating significant cognitive decline, or dementia medication use.

Results
Participants averaged a remaining 16 LYs (SD = 7 LYs), 12.2 CHLYs (SD = 6.6 CHLYs), and 78.1% of LYs being CHLYs (SD = 25.6 CHLYs). Compared with having no MBRFs, having one was associated with ~1 less LY and CHLY, but not a relatively lower %CHLY. In contrast, having 3+ MBRFs was associated with about 2 to 3 fewer LYs and CHLYs as well as about 6% lower %CHLY (95% confidence interval = −9.0 to −2.5 %CHLYs; p = .001).

Conclusions
MBRF-related reductions in the cognitive health span are most apparent when people have multiple MBRFs. Future research is needed to determine if/how behavioral risks converge mechanistically and if dementia prevention efficacy improves when targeting MBRF combinations.
Challenges to the Implementation of the World Health Organization's International Classification for Patient Safety in Slovenia
Authors: Zupančič Vesna , Breuerbach Larsen Torsten 
Published: July 2022

Background and Objectives:
Slovenia lags behind international recommendations for reporting and learning from patient safety incidents and risk management in health care. To counter this, the country established the SenSys project, which receives technical support from the European Commission's Structural Reform Support Service, in cooperation with the Danish Patient Safety Authority, and pertains to an initiative to improve health care. A subproject of the SenSys project works to adapt and implement the International Classification for Patient Safety of the World Health Organization (ICPS-WHO). This article presents a case study of the national research process to identify the necessary Slovenian national adaptation and upgrade of the ICPS-WHO, the ICPS-SL, particularly regarding types of patient safety incidents. Our aim was to reflect on how we used the insights from different research elements and learned from different aspects of our project/system development.

Methods:
We used the SQUIRE 2.0 (Standards of Quality Improvement Reporting Excellence) to present our case study. The methods used to collect information on the necessary adaptations to establish an optimal ICPS-SL included a literature review, qualitative analysis of national consultation meetings, and a 2-cycle Delphi study. This process took place between January 2018 and August 2019, and we found 18 useful articles. Participants such as providers, users, and national bodies from national consultation meetings were all key stakeholders.

Results:
The relevant stakeholders agreed upon changes to the ICPS-WHO to implement in the ICPS-SL as an integrated part of a Slovenia's incident reporting and learning system. Notably, they implemented changes in terminology in the translation of some English terms. They also added or hierarchically reordered some patient safety incident types: for example, they added the nation-specific point “treatment of pain” as a type of patient safety incident. The stakeholders will also partially integrate the following indicators: monitoring systems, vigilance systems, and complaint systems.

Conclusion:
Different research elements contributed to the ICPS-SL's new knowledge and more reliable development. We emphasized a cooperative process with a consensus-building approach while linking the knowledge, experience, and needs of various stakeholders. All interested parties adopted this process, aiming to establish conditions for national learning from patient safety incidents and better preventive action for health care quality and safety. Vertical and horizontal multidisciplinary teamwork was a focal point as well. Technical assistance proved especially useful. It is now necessary to clinically test the ICPS-SL classification framework as Slovenia's internationally harmonized standard, and have the Health Council adopt it for use both online and in practice.
Engaging Patients in the Veterans Health Administration's Lean Enterprise Transformation: A Qualitative Study
Authors: Gray Caroline P. , Azevedo Kathryn J. , Urech Tracy H. , Lerner Barbara , Charns Martin P. , Vashi Anita A. 
Published: July 2022

Background and Objectives:
Lean management is a strategy for improving health care experiences of patients. While best practices for engaging patients in quality improvement have solidified in recent years, few reports specifically address patient engagement in Lean activities. This study examines the benefits and challenges of incorporating patient engagement strategies into the Veterans Health Administration's (VA) Lean transformation.

Methods:
We conducted a multisite, mixed-methods evaluation of Lean deployment at 10 VA medical facilities, including 227 semistructured interviews with stakeholders, including patients.

Results:
Interviewees noted that a patient-engaged Lean approach is mutually beneficial to patients and health care employees. Benefits included understanding the veteran's point of view, uncovering inefficient aspects of care processes, improved employee participation in Lean events, increased transparency, and improved reputation for the organization. Challenges included a need for focused time and resources to optimize veteran participation, difficulty recruiting a diverse group of veteran stakeholders, and a lack of specific instructions to encourage meaningful participation of veterans.

Conclusions/Implications:
As the first study to focus on patient engagement in Lean transformation efforts at the VA, this study highlights ways to effectively partner with patients in Lean-based improvement efforts. Lessons learned may also help optimize patient input into quality improvement more generally.
Multicenter Assessment of Cryoanalgesia Use in Minimally Invasive Repair of Pectus Excavatum
Authors: Arshad Seyed A. , Garcia Elisa I. , Bell Cynthia , Avritscher Elenir B.C. , Kumar Mohineesh , Brahmamdam Pavan , Fraser James A. , St. Peter Shawn D. , Aranda Arturo , Hill Madelyn , Marquart John , Van Arendonk Kyle , Plumblee Leah , Streck Christian J. , Zamora Irving J. , Ghani Muhammad O.A. , Reichard Kirk W. , Sacks Karen , Kallis Michelle , Hong Andrew , Richards Holden , Lin Saunders , Gross Erica R. , Kabeer Mustafa H. , Reyna Troy , Paton Elizabeth A. , Camp Lauren B. , Stephenson Krista , Dassinger Melvin , Vali Kaveh , Filipescu Radu , DeUgarte Daniel A. , Krishna Vikram , Slater Bethany , Islam Saleem , Thompson Grace , Moore James T. , Englum Brian R. , Scholz Stefan , Sharbaugh Elizabeth , Gander Jeffrey W. , Tsao KuoJen ,   Pediatric Surgery Research Collaborative (PedSRC)
Published: July 2022

Objective:
To assess the clinical implications of cryoanalgesia for pain management in children undergoing minimally invasive repair of pectus excavatum (MIRPE).

Background:
MIRPE entails significant pain management challenges, often requiring high postoperative opioid use. Cryoanalgesia, which blocks pain signals by temporarily ablating intercostal nerves, has been recently utilized as an analgesic adjunct. We hypothesized that the use of cryoanalgesia during MIRPE would decrease postoperative opioid use and length of stay (LOS).

Materials and Methods:
A multicenter retrospective cohort study of 20 US children’s hospitals was conducted of children (age below 18 years) undergoing MIRPE from January 1, 2014, to August 1, 2019. Differences in total postoperative, inpatient, oral morphine equivalents per kilogram, and 30-day LOS between patients who received cryoanalgesia versus those who did not were assessed using bivariate and multivariable analysis. P value <0.05 is considered significant.

Results:
Of 898 patients, 136 (15%) received cryoanalgesia. Groups were similar by age, sex, body mass index, comorbidities, and Haller index. Receipt of cryoanalgesia was associated with lower oral morphine equivalents per kilogram (risk ratio=0.43, 95% confidence interval: 0.33–0.57) and a shorter LOS (risk ratio=0.66, 95% confidence interval: 0.50–0.87). Complications were similar between groups (29.8% vs 22.1, P=0.07), including a similar rate of emergency department visit, readmission, and/or reoperation.

Conclusions:
Use of cryoanalgesia during MIRPE appears to be effective in lowering postoperative opioid requirements and LOS without increasing complication rates. With the exception of preoperative gabapentin, other adjuncts appear to increase and/or be ineffective at reducing opioid utilization. Cryoanalgesia should be considered for patients undergoing this surgery.
The Persistence of Poverty and its Impact on Cancer Diagnosis, Treatment and Survival
Authors: Papageorge Marianna V. , Woods Alison P. , de Geus Susanna W.L. , Ng Sing Chau , McAneny David , Tseng Jennifer F. , Kenzik Kelly M. , Sachs Teviah E. 
Published: July 2022

Objective:
To determine the effect of persistent poverty on the diagnosis, surgical resection and survival of patients with non–small cell lung (NSCLC), breast, and colorectal cancer.

Background:
Disparities in cancer outcomes exist in counties with high levels of poverty, defined as ≥20% of residents below the federal poverty level. Despite this well-established association, little is known about how the duration of poverty impacts cancer care and outcomes. One measure of poverty duration is that of “persistent poverty,” defined as counties in high poverty since 1980.

Methods:
In this retrospective cohort study, patients with NSCLC, breast and colorectal cancer were identified from SEER (2012–2016). County-level poverty was obtained from the American Community Survey (1980–2015). Outcomes included advanced stage at diagnosis (stage III–IV), resection of localized disease (stage I–II) and cancer-specific survival. Hierarchical generalized linear models and accelerated failure time models with Weibull distribution were used, adjusted for patient-level covariates and region.

Results:
Overall, 522,514 patients were identified, of which 5.1% were in persistent poverty. Patients in persistent poverty were more likely to present with advanced disease [NSCLC odds ratio (OR): 1.12, 95% confidence interval (CI): 1.06–1.18; breast OR: 1.09, 95% CI: 1.02–1.17; colorectal OR: 1.00, 95% CI: 0.94–1.06], less likely to undergo surgery (NSCLC OR: 0.81, 95% CI: 0.73–0.90; breast OR: 0.82, 95% CI: 0.72–0.94; colorectal OR: 0.84, 95% CI: 0.70–1.00) and had increased cancer-specific mortality (NSCLC HR: 1.09, 95% CI: 1.06–1.13; breast HR: 1.18, 95% CI: 1.05–1.32; colorectal HR: 1.09, 95% CI: 1.03–1.17) as compared with those without poverty. These differences were observed to a lesser magnitude in counties with current, but not persistent, poverty and disappeared in counties no longer in poverty.

Conclusions:
The duration of poverty has a direct impact on cancer-specific outcomes, with the greatest effect seen in persistent poverty and resolution of disparities when a county is no longer in poverty. Policy focused on directing resources to communities in persistent poverty may represent a possible strategy to reduce disparities in cancer care and outcomes.
Preoperative Plasma Tau-PT217 and Tau-PT181 Are Associated With Postoperative Delirium
Authors: Liang Feng , Baldyga Kathryn , Quan Qimin , Khatri Ashok , Choi Shawn , Wiener-Kronish Jeanine , Akeju Oluwaseun , Westover M. Brandon , Cody Kathryn , Shen Yuan , Marcantonio Edward R. , Xie Zhongcong 
Published: July 2022

Objective:
This study aims to identify blood biomarkers of postoperative delirium.

Background:
Phosphorylated tau at threonine 217 (Tau-PT217) and 181 (Tau-PT181) are new Alzheimer disease biomarkers. Postoperative delirium is associated with Alzheimer disease. We assessed associations between Tau-PT217 or Tau-PT181 and postoperative delirium.

Methods:
Of 491 patients (65 years old or older) who had a knee replacement, hip replacement, or laminectomy, 139 participants were eligible and included in the analysis. Presence and severity of postoperative delirium were assessed in the patients. Preoperative plasma concentrations of Tau-PT217 and Tau-PT181 were determined by a newly established Nanoneedle technology.

Results:
Of 139 participants (73±6 years old, 55% female), 18 (13%) developed postoperative delirium. Participants who developed postoperative delirium had higher preoperative plasma concentrations of Tau-PT217 and Tau-PT181 than participants who did not. Preoperative plasma concentrations of Tau-PT217 or Tau-PT181 were independently associated with postoperative delirium after adjusting for age, education, and preoperative Mini-Mental State score [odds ratio (OR) per unit change in the biomarker: 2.05, 95% confidence interval (CI):1.61–2.62, P<0.001 for Tau-PT217; and OR: 4.12; 95% CI: 2.55–-6.67, P<0.001 for Tau-PT181]. The areas under the receiver operating curve for predicting delirium were 0.969 (Tau-PT217) and 0.885 (Tau-PT181). The preoperative plasma concentrations of Tau-PT217 or Tau-PT181 were also associated with delirium severity [beta coefficient (β) per unit change in the biomarker: 0.14; 95% CI: 0.09–0.19, P<0.001 for Tau-PT217; and β: 0.41; 95% CI: 0.12–0.70, P=0.006 for Tau-PT181).

Conclusions:
Preoperative plasma concentrations of Tau-PT217 and Tau-PT181 were associated with postoperative delirium, with Tau-PT217 being a stronger indicator of postoperative delirium than Tau-PT181.
Teacher Attitudes towards Research-Based Classroom Exercises and Intensive Virtual Summer Professional Development
Authors: Nestorovic Miroslav , Gage Gregory J. 
Published: July 2022

AbstractA study based on a survey questionnaire was conducted with 55 teachers across multiple high schools in the United States to understand their perceptions about their attitudes and confidence towards using research-based classroom exercises, which models they use to develop such exercises and their availability and preferences for an intensive summer professional development course. Our preliminary results indicate that while teachers are comfortable teaching research-based classroom activities, they are none-the-less very interested in paid professional development courses on teaching research practices to students (79%), more than two-thirds (69%) would be willing to devote at least one hour a week during the school year and three-quarters (75%) would be willing to spend 2-3 hours a week or more during the summer.