bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of oral antibiotic cocktail in medically refractory paediatric acute severe colitis: a case series
Authors: Morgan Manal , Loel Benjamin , Lang Ray , Reilly Claire , Balouch Fariha , Burgess Chris , Thapar Nikhil , Lewindon Peter 
Published: February 2025

Objective
Paediatric acute severe colitis (ASC) is a life-threatening gastroenterological emergency and a predictor of poor long-term inflammatory bowel disease outcomes. We report our experience with oral antibiotic combination therapy as rescue therapy for children with ASC failing to respond to conventional medical therapy (CMT).

Methods
We analysed data of children admitted with ASC between January 2020 and January 2023 who failed steroids and infliximab and received the oral antibiotic combination therapy (vancomycin, amoxicillin, metronidazole and doxycycline). Treatments and responses including Paediatric Ulcerative Colitis Activity Index (PUCAI), biochemical markers, intestinal ultrasound (IUS) and colectomy rates (acute and deferred) were collated.

Results
Oral antibiotic combination therapy was prescribed in 12 episodes of ASC in 11 children following failure of CMT. Improvements were seen in PUCAI (mean difference = −27.86, 95% confidence interval = −43.43 to −12.28, P < 0.001), albumin (mean: 29.5–33.6) and CRP (mean: 12–4), as well as in IUS (bowel wall thickening, extent of involvement or vascularity in five of seven). Five of 11 children were colectomy free at a maximum follow-up of 24 months. Three children had acute colectomy during index admission and three underwent deferred colectomy at a mean of 4 months.

Conclusion
Oral antibiotic combination therapy shows promise in deferring and, in some cases, averting the need for acute colectomy in medically refractory ASC. This notable finding warrants confirmation in larger studies.
An Integrative Review of Quality Improvement Competence and Engagement Among Frontline Nurses
Authors: Chang Jung-Hsin , Tschannen Dana 
Published: February 2025

Background:
Nurses providing direct care have firsthand knowledge of gaps in practice and thus must actively engage in quality improvement (QI) to enhance patient outcomes.

Purpose:
This integrative review evaluated QI competence and engagement among frontline nurses.

Methods:
Using Souza et al’s 6-step framework, literature on QI engagement and competence was synthesized using a rigorous search strategy and quality assessment.

Results:
Sixteen studies revealed generally low QI engagement and competence. Factors such as education, experience, and role influenced engagement, with higher levels of education and experience linked to higher QI involvement. Nurse leaders had higher engagement, underscoring the need for strong leadership in creating a culture of improvement.

Conclusions:
Successful and sustainable QI programs and supportive environments enhance QI engagement and competence among frontline nurses.
Diagnostic Accuracy of Transvaginal Ultrasonography for Endometriosis According to the International Deep Endometriosis Analysis Consensus
Authors: Mick Ido , Freger Shay M. , Marien Melissa , Gholiof Mahsa , Leonardi Mathew 
Published: February 2025

OBJECTIVE:
To evaluate the diagnostic accuracy of transvaginal ultrasonography (TVUS) in detecting deep endometriosis, ovarian endometriosis, and superficial endometriosis using the IDEA (International Deep Endometriosis Analysis) consensus and novel International Terminology definitions for endometriosis phenotypes.

METHODS:
This prospective diagnostic accuracy study was conducted at McMaster University from November 2021 to January 2023. Participants included 125 individuals aged 18–50 years with suspected endometriosis who were undergoing TVUS followed by laparoscopic surgery. The index test, TVUS, was performed in accordance with the IDEA consensus, with results compared with laparoscopy and histopathologic findings, which served as the reference standard. Deep endometriosis was defined as endometriosis with any depth of infiltration, and superficial endometriosis was defined as endometriosis without any infiltration beyond the peritoneal surface. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated.

RESULTS:
The study demonstrated high diagnostic accuracy for endometriomas and deep endometriosis with TVUS, achieving a sensitivity of 95.0% for left ovarian endometrioma, 94.9% for right ovarian endometrioma, and sensitivity ranging from 84.3% to 100% for various deep endometriosis sites. Transvaginal ultrasonography showed high specificity for endometriomas (98.9%) and deep endometriosis (range 97.0–100%). However, TVUS showed lower sensitivity for superficial endometriosis (range 4.0–43.5%) but high specificity (99.0–100%) and PPV (90.0–100%). The accuracy of detecting superficial endometriosis improved when cases with ovarian endometriosis, deep endometriosis, and pouch of Douglas obliteration were excluded.

CONCLUSION:
Transvaginal ultrasonography demonstrates robust diagnostic accuracy for deep endometriosis and ovarian endometriosis, reaffirming its utility as a first-line diagnostic tool in endometriosis management despite changes in definitions of deep endometriosis and superficial endometriosis. However, its sensitivity for superficial endometriosis remains limited, suggesting the need for additional diagnostic techniques or refined ultrasound approaches for accurate detection of superficial endometriosis. The findings support the integration of TVUS in clinical practice while highlighting the need for further advancements in diagnosing superficial endometriosis to mitigate diagnostic delays.
Sepsis in Critically Ill Children in Bolivia: Multicenter Retrospective Evaluation of the Phoenix Criteria for Sepsis in a 2023 Cohort
Authors: Copana-Olmos Raul , Casson-Rodriguez Nils , Diaz-Villalobos Willmer , Urquieta-Clavel Victor , Tejerina-Ortiz Mary , Mendoza-Montoya Carol , Fernandez-Vidal Maricruz , Forest-Yepez Mariel , Blanco-Espejo Danny , Rivera-Murguia Ibeth , Castro-Auza Claudia , Gamboa-Lanza Milenka , Paco-Barral Jhovana E. , Choque-Osco Gustavo , Vera-Dorado Betzhi , Cuellar-Gutierrez Magbely , Sarmiento-Zurita Alan J. , Carrillo-Vargas Michelle G. , Ledezma-Hurtado Brisa W. , Sanchez-Pinto L. Nelson 
Published: February 2025

Objectives:
We evaluated the Phoenix criteria and the Phoenix Sepsis Score in a multicenter retrospective cohort of critically ill children with a clinical diagnosis of sepsis or septic shock in Bolivia. In addition, we aimed to assess whether management in a PICU at high altitude in the Bolivian Andes was associated with the performance of the respiratory dysfunction component in the Phoenix Sepsis Score.

Design:
Multicenter retrospective cohort study.

Setting:
Fourteen PICUs in Bolivia.

Patients:
Children admitted to the PICU with a clinical diagnosis of sepsis or septic shock from January 2023 to December 2023.

Interventions:
None.

Measurements and Main Results:
There were 273 patients with a diagnosis of sepsis in 2023, of which 257 (94.1%) met the 2024 Phoenix criteria for sepsis, and 166 (60.8%) met the systemic inflammatory response syndrome (SIRS)-based criteria for sepsis. Among the 257 patients meeting Phoenix sepsis criteria, 86 died (33.5%). Of the patients with Phoenix-based sepsis, there were 100 of 257 (38.9%) who were SIRS-negative, and 27 of 100 died (27.0%). After correcting the oxygenation indices for altitude, 149 of 273 patients (54.6%) had a lower Phoenix respiratory score and an associated mortality more consistent with the expected mortality of the newly derived subscore. Patients at higher altitudes had higher hemoglobin levels and higher estimated oxygen carrying capacity, and these data were independently associated with lower odds of mortality after controlling for altitude-corrected Phoenix score.

Conclusions:
In this 2023, retrospective cohort of PICU patients with sepsis in Bolivia, we have found that the majority met the 2024 Phoenix sepsis criteria, but less than two-thirds met the SIRS-based criteria for diagnosis. However, the respiratory score in the Phoenix criteria overestimated the severity of respiratory dysfunction in more than half of the cohort, likely because the score does not take account of the Andean adaptation to high altitude, with higher oxygen carrying capacity.
Cardiac Point-of-Care Ultrasound Findings in Multisystem Inflammatory Syndrome in Children in the Pediatric Emergency Department
Authors: Kestenbom Inbal , Scheier Eric , Daviko Bat-Hen Annie , Berant Ron , Buchshtav Nachshon , Sheinberg Natalia , Friedman Nir ,   On Behalf of the Israeli PEM POCUS Group
Published: February 2025

Objectives:
Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening condition associated with cardiac involvement. Cardiac point-of-care ultrasound (POCUS) can be performed at the bedside in the pediatric emergency department (PED) to identify cardiac pathology. There is limited data on cardiac POCUS findings in children with MIS-C in the PED. The main outcome objective of our study was to describe the cardiac POCUS findings in MIS-C patients in the PED.

Methods:
This is a multicenter, retrospective, cohort study between February 15, 2021 and March 31, 2022, during the alpha, delta, and omicron severe acute respiratory syndrome coronavirus 2 waves in 6 PEDs in Israel. We included patients diagnosed with MIS-C who received a cardiac POCUS examination in the PED. All POCUS clips were analyzed by a PED POCUS expert.

Results:
We included 32 MIS-C patients who underwent cardiac POCUS during the study period. The median age was 8 years (interquartile range = 6 to 10 y), and 20 (63%) were males. The median time from onset of symptoms upon PED visit was 5 days (interquartile range = 4 to 5 d). Overall, 27 patients (84%) were diagnosed with normal cardiac function and 5 patients with decreased cardiac function (16%). No patients were diagnosed with pathologic cardiac effusion. Three patients were diagnosed with plethoric inferior vena cava. Among the patients, 17 (53%) were admitted to the pediatric wards and 15 (47%) to the pediatric intensive care unit. There was no mortality.

Conclusion:
Cardiac POCUS by PEM physicians is an applicable tool for the evaluation of MIS-C patients in the PED. In our study, 16% of MIS-C patients who underwent POCUS had decreased cardiac function per POCUS on their PED presentation. Future studies are needed to evaluate the impact of cardiac POCUS in the PED of patients with MIS-C.
A Prediction Rule to Identify Children and Young Adults at Low Risk for Myocarditis
Authors: Genadry Katia C. , Monuteaux Michael C. , Michelson Kenneth A. , Bucholz Emily M. , Mannix Rebekah 
Published: February 2025

Objective:
(1) To derive a prediction rule for pediatric myocarditis that distinguishes low-risk patients for whom additional work-up, including venipuncture or cardiac imaging, may be avoided, (2) to assess the test characteristics of troponin in our study population.

Methods:
This retrospective case-control study included all patients who presented to a pediatric emergency department between 2010 and 2021 and underwent troponin testing for suspected myocarditis. Myocarditis cases (identified using American Heart Association criteria) and controls were to approximate a 1:2 ratio. Logistic regression with forward selection was used to derive a prediction rule for myocarditis. As the goal was to derive a rule for low-risk children, in whom venipuncture would be unnecessary, laboratory results were analyzed separately.

Results:
We identified 93 case patients and 202 control patients. The final prediction rule included chest pain [adjusted odds ratio (aOR): 3.5, 95% CI: 1.8 to 7.0], reported or measured fever (aOR: 1.7, 95% CI: 1.0 to 3.1,) and atrioventricular conduction delays or ST segment changes (aOR: 2.6, 95% CI: 1.4 to 4.7). Sensitivity, calculated as the proportion of cases with at least one of the 3 predictors was 99% (95% CI: 0.94 to 0.99), and specificity was 14% (95% CI: 0.09 to 0.20). With at least 2 predictors, sensitivity was 60% (95% CI: 0.50 to 0.71) and specificity was 72% (95% CI: 0.65 to 0.78).

Conclusion:
The prediction rule developed can help identify children at low risk for myocarditis and, therefore, avoid troponin testing and/or further evaluation including cardiology consult or cardiac imaging. Specificity was insufficient to rule in myocarditis without additional investigation.
Single Doses of Pediatric Dolutegravir-Dispersible Tablets in Neonates Support Multi-Dosing: PETITE-DTG Study
Authors: Cressey Tim R. , Salvadori Nicolas , Rabie Helena , du Toit Samantha , Than-in-at Kanchana , Groenewald Maria , Capparelli Edmund , Owen Andrew , Cressey Ratchada , Lallemant Marc , Cotton Mark F. , Bekker Adrie 
Published: February 2025

Background:
Dolutegravir dispersible tablets (DTG-DT) are approved for infants ≥4 weeks and ≥3 kg but their suitability for neonates remains unknown.

Methods:
PETITE-DTG is a Phase I/II, open-label, single center, two-stage trial in South Africa to evaluate the pharmacokinetics (PK) and safety of DTG in term neonates of pregnant individuals receiving DTG-based therapy. In Stage 1, neonates on standard antiretroviral prophylaxis received a single dose of 5 mg DTG-DT between ≥14 and <28 days of life (Cohort 1A); or <14 days of life (Cohort 1B), followed by PK and safety assessments. A population PK model was developed and multi-dose scenarios simulated [DTG targets: geometric mean (GM) Ctau>0.67 µg/mL and Cmax<17.0 µg/mL].

Results:
16 neonates, 8 per cohort, completed Stage 1. Median (range) birth weight was 3.1 (2.6-4.2) kg and PK sampling was performed between 3-22 days of life. No Grade 3 or higher adverse events were observed. DTG clearance was influenced by body weight and postnatal age. Simulations predicted that >10% of neonates would have a Cmax>17.0 µg/mL with DTG once daily (q24) during the first 2 weeks of life. Administration of DTG every 48 hours (q48) from day 1-14 of life, followed by DTG every 24 hours through day 28, predicted a GM Ctau between 0.86-4.35 µg/mL; 98% with a Cmax<17.0 µg/mL.

Conclusions:
Due to the slow postnatal DTG clearance after birth, a multi-dose strategy of 5 mg DTG-DT q48 for the first 2 weeks of life, followed by q24 through 28 days, was selected for assessment in Stage 2.
THE ASSOCIATION BETWEEN HIV-RELATED STIGMA, ART ADHERENCE AND CARDIOVASCULAR DISEASE RISK IN PEOPLE LIVING WITH HIV.
Authors: Shilabye Patane S. , Scheuermaier Karine , Vos-Seda Alinda G. , Barth Roos E. , Devillé Walter , Coutinho Roel A. , Umunnakwe Chijioke J. , Grobbee Diederick E. , Venter Francois , Tempelman Hugo , Klipstein-Grobusch Kerstin 
Published: February 2025

Introduction:
HIV/AIDS continues to be a significant health issue in Sub-Saharan Africa, with stigma likely affecting ART adherence, and subsequently viremia, inflammation, and cardiovascular disease (CVD). We investigated the association between stigma, ART adherence, and CVD risk among people living with HIV (PLWH).

Setting:
A longitudinal study was conducted among 325 PLWH from the Ndlovu Cohort Study, South Africa.

Methods:
Stigma was assessed using a 12-item questionnaire (range: 0-44; higher scores indicate greater stigma). Pulse wave velocity (PWV, CVD surrogate marker) and viral load (VL) were assessed at 12 and 36 months. VL was considered a surrogate marker of ART adherence: VL>1000 copies indicating poor/no adherence, VL 50-1000 copies suboptimal, and VL<50 copies good adherence. The relationship between stigma, VL, and PWV, was assessed by linear regression and changes in PWV overtime by mixed linear models.

Results:
At baseline, PLWH (n=325, mean age (SD)=41.1 (10.2) years, 67% female) had mean PWV of 7.3m/s. Good, suboptimal, and poor adherence were 78%, 15%, and 7%, respectively. Mean (SD) stigma score was 16.9 (1.4) and was not associated with viral load and PWV. Suboptimal and poor adherence were associated with higher PWV [Beta=4.18 (95%CI 1.79_6.57)] at 12 months and between 12 and 36 months [Beta=1.30 (95%CI 0.06_2.55)] in mixed model analyses in PLWH>49 years, respectively. PWV increased by 0.21m/s (95%CI 0.02_0.40; p=0.03) between 12 and 36 months overall.

Conclusion:
In this study, poor ART adherence was associated with higher PWV. Stigma score was low and not associated with ART adherence and PWV.
Mathematically tractable models of random phylogenetic networks: an overview of some recent developments
Authors: Bienvenu François 
Published: February 2025

Models of random phylogenetic networks have been used since the inception of the field, but the introduction and rigorous study of mathematically tractable models is a much more recent topic that has gained momentum in the last 5 years. This manuscript discusses some recent developments in the field through a selection of examples. The emphasis is on the techniques rather than on the results themselves, and on probabilistic tools rather than on combinatorial ones.
This article is part of the theme issue ‘“A mathematical theory of evolution”: phylogenetic models dating back 100 years’.
Speciation completion rates have limited impact on macroevolutionary diversification
Authors: Veron Pierre , Andréoletti Jérémy , Giraud Tatiana , Morlon Hélène 
Published: February 2025

Standard birth–death (BD) processes used in macroevolutionary studies assume instantaneous speciation, an unrealistic premise that limits the interpretation of speciation and extinction rates. The protracted birth–death (PBD) model instead assumes that speciation involves two steps: initiation and completion. In order to understand their respective influence on macroevolutionary speciation rates, we compute a standard time-varying BD scenario that is ‘equivalent’ to the PBD model in terms of speciation and extinction probabilities. First, we find a sharp decline in the equivalent birth rate near the present, indicating that rates estimated at the tips of phylogenies may not accurately reflect the underlying speciation process. Second, the completion rate controls the timing of the decay rather than the asymptotic equivalent rates. The equivalent birth rate in the past scales with the speciation initiation rate, with a scaling factor depending mostly on the population extinction rate. Our results suggest that the rates of population formation and extinction may often play a larger role than the speed of accumulation of reproductive isolation in modulating speciation rates. Our study establishes a theoretical framework for understanding how microevolutionary processes combine to explain the diversification of species on macroevolutionary time scales.
This article is part of the theme issue ‘“A mathematical theory of evolution”: phylogenetic models dating back 100 years’.
Genomic insights into an outbreak of SHV-98, TEM-1 and DHA-1 producingKlebsiella pneumoniaein a paediatric cardiac unit
Authors: Fraser Alice J. , Parry Christopher M. , Larru Beatriz , Case Lindsay , Ball Kate , Duggan Caitlin , Edwards Thomas , Heinz Eva 
Published: February 2025

AbstractThis study reports the outbreak of a carbapenem-resistantKlebsiella pneumoniaeclonal lineage in a specialist children’s hospital in Liverpool, UK. Carbapenem resistantK. pneumoniaeis unusual in the UK, and the identification of two cases in the same ward in December 2022 raised concerns and triggered an outbreak investigation. This led to the identification of a potential transmission hotspot in the form of shared equipment, and 11 patients that were colonized or both colonized and infected by a phenotypically similar strain were identified. Multi-locus sequence typing supported a clonal lineage, and whole-genome sequencing was performed on all isolates using short-read sequencing; three isolates were furthermore long-read sequenced to confidently resolve the plasmid structure. Comparing the whole-genome sequences confirmed a clonal lineage and strongly supports the suspected nosocomial transmission, highlighting again the risk ofK. pneumoniaeby its ability to colonise a range of surfaces. Detailed analysis of the resistance determinants indicates that the carbapenem resistance was driven by a combination of different beta-lactamases that would by themselves not convey this resistance profile, a synergistic interaction is thus likely. This highlights how highly resistant strains could be mislabelled as predicted sensitive when considering genetic determinants in isolation, which would have added further complexity to this investigation as the strains would get assessed as a mismatch to the observed resistance profile, and highlights the need to study beta-lactam resistances beyond presence or absence of specific genes but also consider co-occurrence.
Molecular genetic influences on attentional control and other executive processes and their links with psychopathology in the AFFECT study
Authors: Tubbs Justin D. , Mallard Travis T. , Dalby Maria , Jiang Yunxuan , Lee Younga H. , Choi Karmel W. , Ge Tian , Plath Niels , Hammer-Helmich Lene , Granka Julie M. ,   23andMe Research Group, Grotzinger Andrew D. , Hinds David , Smoller Jordan W. , Buckholtz Joshua W. 
Published: February 2025

AbstractBackgroundAttentional control is a critical component of executive functioning involved in numerous psychiatric and neurological disorders, yet its etiological relationships with many cognitive and behavioral phenotypes remain underexplored.MethodsWe conducted the first multivariate characterization of molecular genetic influences on attentional control and other executive processes in a cohort of more than 20,000 individuals enriched for mood disorders. We used Genomic Structural Equation Modeling to formally model patterns of genetic covariance among these task-based measures of cognition, as well as their relationships with other cognitive, clinical, and imaging-derived phenotypes.ResultsWe identified two independent latent genetic factors: one broadly influencing executive function and one narrowly influencing attentional control. Both theCommon Executive Function (CEF)andAttentional Control (AC)factors were genetically correlated with cognitive and clinical phenotypes, with each latent factor uniquely linked to liability for psychiatric disorders. For example, we observed myriad relationships between the factors and psychopathology, including robust and conditionally independent genetic associations with ADHD. However, despite clear links to brain-related phenotypes, genetic correlations with imaging-derived phenotypes themselves were modest and non-significant after correcting for multiple comparisons.ConclusionsOverall, the results of our study suggest that genetic influences on attentional control are generally distinct from those that influence broader aspects of executive function. TheCEFandACfactors show distinct patterns of genetic overlap with multiple cognitive and psychiatric outcomes, underscoring the need for more detailed phenotyping of cognition to generate new insights into the etiology of psychopathology.