bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mean arterial pressure drop is an independent risk factor of hepatorenal syndrome in patients with HBV-ACLF
Authors: Zheng Xingrong , Lian Yunwen , Wang Peipei , Zheng Lihua , Wu Hewei , Lin Jiaxin , Chen Xiyao , Gao Zhiliang , Peng Liang , Xie Chan 
Published: February 2022

Background/aims
In patients with acute-on-chronic liver failure (ACLF), type 1 hepatorenal syndrome (HRS) is a critical organ failure complication that resulted in rapid mortality. There are no efficient parameters to predict HRS in hepatitis B virus (HBV)-related ACLF. To assess HBV-ACLF risk factors and evaluate the association between mean arterial pressures (MAP), HRS and survival in patients with HBV-ACLF.

Methods
A total of 420 ACLF patients were screened from June 2015 to June 2016, and 57 HBV-ACLF patients were included in the study. Clinical data and MAP measurements of these patients were collected. Multivariate analyses, Cox proportional hazards regression and receiver operator characteristic (ROC) curves were used to analyze.

Results
In a 30-day study period, 43 (75.44%) patients survived. Patients in the HRS group were older and had higher Model for End-Stage Liver Disease (MELD) scores than patients in the non-HRS group. A MAP drop of ≥9.5 mmHg was an independent predictor of HRS with a sensitivity and specificity of 92.86 and 69.77%, respectively. The baseline MELD score was also an independent risk factor of HRS. MAP drop (OR, 1.582; P = 0.000), prothrombin time, HRS, MELD and FIB were independent prognostic factors for 30-day mortality. The area under the ROC curve of MAP drop was 0.808 (P = 0.001).

Conclusion
A decrease in MAP was a valuable predictor of HRS in patients with HBV-related ACLF. MAP drop ≥9.5 mmHg may be useful for predicting patient prognosis and exploring new treatment measures in patients with HBV-related ACLF.
Accuracy of Weight Estimation in Children Using the Broselow, PAWPER XL, PAWPER XL-MAC, and Mercy Tapes
Authors: Cosmos Yakubu Rafiuk , Ayi-bisah Nedda , Nguah Samuel Blay 
Published: February 2022

Objectives
Quick and accurate estimate of a child’s weight is often required for medical interventions like drug dose calculation when scale measured weights cannot be obtained safely. Length-based methods of weight estimation are more accurate than age-based methods, with the most accurate being the length-based, habitus-modified methods. This study sought to determine and compare the accuracies of the 2017 Broselow tape, Paediatric Advanced Weight Prediction in the Emergency Room Extra-Long (PAWPER XL) tape, Paediatric Advanced Weight Prediction in the Emergency Room Extra-Long Mid-Arm Circumference (PAWPER XL-MAC) tape, and the 2-dimensional (2D) Mercy tape in Ghanaian children.

Methods
A cross-sectional study was conducted at the Tamale Teaching Hospital in Ghana. Eight hundred forty children between 2 months and 13 years had their weights estimated by the 2017 Broselow, PAWPER XL, PAWPER XL-MAC, and 2D Mercy tapes. Accuracy of the methods was determined by percentage of weight estimated to within 10% and 20% of actual weight. Mean percentage error and the Bland-Altman analysis were used to assess bias and precision.

Results
The proportion of weight estimates within 10% and 20% of actual weight for Broselow tape were 47.5% and 82.3%, for 2D Mercy tape were 73.1% and 96.3%, for PAWPER XL-MAC were 77.6% and 97.5%, and for PAWPER XL were 81.7% and 96.8%, respectively. The Broselow tape had the greatest bias and least precision among the 4 methods. The Mercy, PAWPER XL-MAC, and PAWPER XL tapes had similar performance, but all performed significantly better than the Broselow tape in pairwise comparison. The best weight estimation method overall was the PAWPER XL tape as it also had the least bias and greatest precision.

Conclusions
The Mercy, PAWPER XL-MAC, and PAWPER XL tapes were more accurate than the 2017 Broselow tape and should be used in preference in Ghana and countries with similar population structure.
Implementation of an Integrated Total Quality Management System in a Pulmonary Function Laboratory
Authors: Sánchez-Jerónimo Patricia , Silva-Cerón Mónica , López-López Miriam , Hernández-Morales Víctor , Gochicoa-Rangel Laura 
Published: February 2022

Background and Objectives:
A worldwide objective in the area of health is to offer high-quality services supported by certification strategies that contribute to improving standards for processes commonly used in medicine. However, few pulmonary function test laboratories (PFTLs) follow official standards in their daily operations or are organized around an integrated total quality management system (ITQMS) focused on their established processes. The aim was to determine the feasibility of implementing an ITQMS to accredit the International Organization for Standardization (ISO) 9001:2015 standard in a high-demand PFTL where 13 respiratory function tests are routinely performed together with teaching and research activities.

Methods:
This project was conducted at the PFTL of the Instituto Nacional de Enfermedades Respiratorias in Mexico City from November 2014 to August 2017 and involved the implementation of an ITQMS guided by ISO 9001:2015 in 5 phases: (1) the establishment of a work team; (2) the elaboration of situational diagnoses; (3) the development of guidelines for the ITQMS; (4) the implementation of the ITQMS model; and (5) the evaluation of the ITQMS.

Results:
Upon completing the 5 phases, an evaluation of the system by an internal audit identified 3 minor cases of nonconformity (NC), while additional observations and an external audit found 5 minor cases of NC. These issues were addressed through a root-cause analysis to establish an action plan for each one. At the end of the process, the institution was granted the ISO 9001:2015 certification for its 3 processes: medical attention in support of diagnoses, teaching, and research.

Conclusions:
It is possible to implement an ISO quality management system as a routine operating methodology in a high-demand PFTL.
Hyperglycemia Management Prior to Admission in an Urban Emergency Department
Authors: Benbrahim Meissane , Cashman Lauri , Baker William E. , Gendron Bryan J. , Lookabill Sara , Farrell Natalija 
Published: February 2022

Background and Objectives:
The aim of this quality improvement project was to decrease the percentage of emergency department (ED) patients admitted with blood glucose (BG) level above 250 mg/dL to less than 20%.

Methods:
A work group comprised physicians, pharmacists, and endocrinologists collaborated to standardize management of ED hyperglycemia. Plan-Do-Study-Act cycles included education, monitoring of patients with BG level above 200 mg/dL, and development of an ED-specific insulin protocol.

Results:
Following the initiative, 24.8% fewer patients were admitted with BG level above 250 mg/dL. The average admission BG level was reduced by 65.8 mg/dL, creating a significant shift toward improved average BG level. No difference was seen in hospital mortality, hospital length of stay, ED length of stay, hypoglycemia, or inhospital diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

Conclusion:
Implementation of a standardized hyperglycemia treatment protocol along with pharmacist interventions reduced average admission BG and the percentage of patients with BG level above 250 mg/dL on admission.
CovidStats: Development and Implementation of a Daily COVID-19 Clinical Dashboard in an Urban Teaching Hospital
Authors: Gazivoda Victor , Stolz Adam , Saunders Paul , Marshall John , Lockerman Zachary , Samy Sameh , Motov Sergey , Savel Richard H. 
Published: February 2022

Background and Objectives:
Dashboards have been utilized in health care to improve quality and patient care. The purpose of our project was to create a concise, timely, and accurate dashboard for administrative and clinical leadership during the COVID-19 pandemic.

Methods:
Two authors collaborated to identify 14 metrics and design a comprehensive dashboard (CovidStats, CS) using Microsoft Excel. The dashboard was updated daily and distributed to leadership between December 2020 and April 2021. The utility of this quality measure was assessed by survey of hospital leadership.

Results:
The 14 metrics included were as follows: (1) elective surgery census threshold; (2) daily COVID admissions; (3) daily COVID discharges; (4) net COVID admissions; (5) ED (emergency department) bed holds; (6) COVID ED bed holds; (7) hospital census; (8) percent COVID census; (9) active COVID census; (10) COVID ICU (intensive care unit); (11) MICU (medical ICU) census; (12) ventilators in use; (13) high-flow oxygen devices in use; and (14) weekly hospital census. The leadership response survey revealed unanimous approval for CS, with a mean rating of 4.9 ± 0.3 (rated 1-5).

Conclusions:
Effective clinical dashboards can be created using affordable basic computer software. Implementation of the CS dashboard conveyed relevant and timely information, which influenced the decision making of hospital leadership during the COVID-19 pandemic.
Persistent Obstructive Sleep Apnea in Children with Down Syndrome After Adenotonsillectomy: Drug Induced Sleep Endoscopy-Directed Treatment
Authors: Abdel-Aziz Mosaad , Abdel-Naseer Usama , Elshahawy Eslam , Elsherbeeny Motaz , Nassar Ahmed 
Published: February 2022

Abstract
Children with down syndrome (DS) are more liable to develop obstructive sleep apnea (OSA) which is usually treated with adenotonsillectomy. However, OSA may persist in many of those patients after the procedure. The aim of this study was to assess the efficacy of drug-induced sleep endoscopy (DISE)-directed treatment in management of DS children with persistent OSA after adenotonsillectomy. Sixteen DS children with persistent OSA after adenotonsillectomy were evaluated. DISE was done in the operating theatre to identify the site of obstruction, and surgical intervention was performed according to the finding. Polysomnographic study was used pre- and post-operatively to measure the outcome. DISE revealed obstruction in different sites of the airway. DISE-directed treatment was done according to the site of obstruction. Polysomnographic study showed postoperative significant changes for all parameters. The authors achieved improvement of overall apnea-hypopnea index which was normalized in seven patients (44%). In conclusion, DISE-directed treatment is an effective procedure for persistent OSA in DS children who underwent adenotonsillectomy. However, residual obstruction in those children may be due to many characteristic features that cause narrowing of the airway.
Vertical HIV-1 transmission in the setting of maternal broad and potent antibody responses
Authors: Tu Joshua J , Kumar Amit , Giorgi Elena E , Eudailey Josh , LaBranche Celia C , Martinez David R , Fouda Genevieve G , Moreau Yvetane , Thomas Allison , Montefiori David , Gao Feng , Sagar Manish , Permar Sallie R 
Published: February 2022

AbstractDespite the worldwide availability of antiretroviral therapy (ART), approximately 150,000 pediatric HIV infections continue to occur annually. ART can dramatically reduce HIV mother-to-child transmission (MTCT), but inconsistent drug access and adherence, as well as primary maternal HIV infection during pregnancy and lactation are major barriers to eliminating vertical HIV transmission. Thus, immunologic strategies to prevent MTCT, such as an HIV vaccine, will be required to attain an HIV-free generation. A primary goal of HIV vaccine research has been to elicit broadly neutralizing antibodies (bnAbs) given the ability of passive bnAb immunization to protect against sensitive strains, yet we previously observed that HIV-transmitting mothers have more plasma neutralization breadth than non-transmitting mothers. Additionally, we have identified infant transmitted/founder (T/F) viruses that escape maternal bnAb responses. In this study, we examine a cohort of postpartum HIV-transmitting women with neutralization breadth to determine if certain maternal bnAb specificities drive the selection of infant T/F viruses. Using HIV pseudoviruses that are resistant to neutralizing antibodies targeting common bnAb epitopes, we mapped the plasma bnAb specificities of this cohort. Significantly more transmitting women with plasma bnAb activity had a mappable plasma bnAb specificity (six of seven, or 85.7%), compared to that of non-transmitting women with plasma bnAb activity (seven of twenty-one, or 33.3%, p=0.029 by 2-sided Fisher exact test). Our study suggests that having multispecific broad activity and/or uncommon epitope-specific bnAbs in plasma may be associated with protection against the vertical HIV transmission in the setting of maternal bnAb responses.ImportanceAs mother to child transmission (MTCT) of HIV plays a major part in the persistence of the HIV/AIDS epidemic and bnAb-based passive and active vaccines are a primary strategy for HIV prevention, research in this field is of great importance. While previous MTCT research has investigated the neutralizing antibody activity of HIV-infected women, this is to our knowledge the largest study identifying differences in bnAb specificity of maternal plasma between transmitting and non-transmitting women. Here, we show that among HIV-infected women with broad and potent neutralization activity, more postpartum-transmitting women had a mappable plasma broadly neutralizing antibody (bnAb) specificity, compared to that of non-transmitting women, suggesting that the non-transmitting women more often have multi-specific bnAb responses or bnAb responses that target uncommon epitopes. Such responses may be required for protection against vertical HIV transmission in the setting of maternal bnAb responses.
The role of the gut microbiota in patients with Kleefstra syndrome
Authors: Bloemendaal Mirjam , Vlaming Priscilla , de Boer Anneke , Vermeulen-Kalk Karlijn , Bouman Arianne , Kleefstra Tjitske , Vasquez Alejandro Arias 
Published: February 2022

AbstractKleefstra Syndrome (KS) is a rare monogenetic syndrome, caused by haploinsufficiency of the EHMT1 gene, an important regulator of neurodevelopment. The clinical features of KS include intellectual disability, autistic behavior and gastrointestinal problems. The gut microbiota may constitute a, yet unexplored, mechanism underlying clinical variation, as they are an important modifier of the gut-brain-axis. To test whether variation in the gut microbiota is part of KS, we investigated the gut microbiota composition of 23 individuals with KS (patients) and 40 of their family members. Both alpha and beta diversity of patients were different from their family members. GenusCoprococcus3 was lower in abundance in patients compared to family members. Moreover, abundance of genusMerdibacterwas lower in patients versus family members, but only in the participants reporting intestinal complaints. Within the patient group, behavioral problems explained 7% variance in the beta diversity. Also, within this group, we detected higher levels ofCoprococcus3 andAtopobiaceae – unculturedassociated with higher symptoms severity. Our results show significant differences in the gut microbiota composition of patients with KS compared to their family members, suggesting that these differences are part of the KS phenotype.
A Workflow for High Through-Put, High Precision Livestock Diagnostic Screening of Locomotor Kinematics
Authors: Mielke Falk , Van Ginneken Chris , Aerts Peter 
Published: February 2022

1AbstractLocomotor kinematics have been challenging inputs for automated diagnostic screening of livestock. Locomotion is a highly variable behavior, and influenced by subject characteristics (e.g. body mass, size, age, disease). We assemble a set of methods from different scientific disciplines, composing an automatic, high through-put workflow which can disentangle behavioral complexity and generate precise individual indicators of non-normal behavior for application in diagnostics and research. For this study, piglets (Sus domesticus) were filmed from lateral perspective during their first ten hours of life, an age at which maturation is quick and body mass and size have major consequences for survival. We then apply deep learning methods for point digitization, calculate joint angle profiles, and apply information-preserving transformations to retrieve a multivariate kinematic data set. We train probabilistic models to infer subject characteristics from kinematics. Model accuracy is validated for strides from piglets of normal birth weight (i.e. the category it was trained on), but the models infer the body mass and size of low birth weight piglets (which were left out of training, out-of-sample inference) to be “normal”. The age of some (but not all) low birth weight individuals is underestimated, indicating developmental delay. Such individuals could be identified automatically, inspected, and treated accordingly. This workflow has potential for automatic, precise screening in livestock management.
BASH-GN: A new machine learning derived questionnaire for screening obstructive sleep apnea
Authors: Huo Jiayan , Quan Stuart F. , Roveda Janet , Li Ao 
Published: February 2022

AbstractPurposeThis study aims to develop a machine learning based questionnaire (BASH-GN) to classify obstructive sleep apnea (OSA) risk by considering risk factor subtypes.MethodsA total of 4,527 participants that met study inclusion criteria were selected from Sleep Heart Health Study Visit 1 (SHHS 1) database. Another 1,120 records from Wisconsin Sleep Cohort (WSC) served as an independent test data set. Participants with an apnea hypopnea index (AHI) ≥ 15/h were considered as high OSA risk. Potential risk factors were ranked using mutual information between each factor and the AHI, and only the top 50% were selected. We classified the subjects into 2 different groups, low- and high phenotype groups, according to their risk scores. We then developed the BASH-GN, a machine learning based questionnaire that consists of two logistic regression classifiers for the 2 different subtypes of OSA risk prediction.ResultsWe evaluated the BASH-GN on the SHHS 1 test set (n = 1237) and WSC set (n = 1120) and compared its performance with four commonly used OSA screening questionnaires, the Four-Variable, Epworth Sleepiness Scale, Berlin, and STOP-BANG. The model outperformed these questionnaires on both test sets regarding the area under the receiver operating characteristic (AUROC) and the area under the precision-recall curve (AUPRC). The model achieved AUROC (SHHS 1: 0.78, WSC: 0.76) and AUPRC (SHHS 1: 0.72, WSC: 0.74), respectively. The questionnaire is available at:https://c2ship.org/bash-gnConclusionConsidering OSA subtypes when evaluating OSA risk can improve the accuracy of OSA screening.
Comparison of two T cell assays to evaluate T cell responses to SARS-CoV-2 following vaccination in naïve and convalescent healthcare workers
Authors: Phillips Eloise , Adele Sandra , Malone Tom , Deeks Alexandra , Stafford Lizzie , Dobson Susan L. , Amini Ali , Skelly Donal , Eyre David , Jeffery Katie , Conlon Christopher P. , Dold Christina , Otter Ashley , D’Arcangelo Silvia , Turtle Lance ,   PITCH Consortium, Klenerman Paul , Barnes Eleanor , Dunachie Susanna J. 
Published: February 2022

AbstractBackgroundT cell responses to SARS-CoV-2 following infection and vaccination are less characterised than antibody responses, due to a more complex experimental pathway.MethodsWe measured T cell responses in 108 healthcare workers (HCWs) in an observational cohort study, using the commercialised Oxford Immunotec T-SPOT Discovery SARS-CoV-2 assay (OI T-SPOT) and the PITCH ELISpot protocol established for academic research settings.ResultsBoth assays detected T cell responses to SARS-CoV-2 spike, membrane and nucleocapsid proteins. Responses were significantly lower when reported by OI T-SPOT than by PITCH ELISpot. Four weeks after two doses of either Pfizer/BioNTech BNT162b or ChAdOx1 nCoV-19 AZD1222 vaccine, the responder rate was 63% for OI T-SPOT Panels1+2 (peptides representing SARS-CoV-2 spike protein excluding regions present in seasonal coronaviruses), 69% for OI T-SPOT Panel 14 (peptides representing the entire SARS-CoV-2 spike), and 94% for the PITCH ELISpot assay. The two OI T-SPOT panels correlated strongly with each other showing that either readout quantifies spike-specific T cell responses, although the correlation between the OI T-SPOT panels and the PITCH ELISpot was moderate.ConclusionThe standardisation, relative scalability and longer interval between blood acquisition and processing are advantages of the commercial OI T-SPOT assay. However, the OI T-SPOT assay measures T cell responses at a significantly lower magnitude compared to the PITCH ELISpot assay, detecting T cell responses in a lower proportion of vaccinees. This has implications for the reporting of low-level T cell responses that may be observed in patient populations and for the assessment of T cell durability after vaccination.
The influence of biological, epidemiological, and treatment factors on the establishment and spread of drug-resistant Plasmodium falciparum
Authors: Masserey Thiery , Lee Tamsin , Golumbeanu Monica , Shattock Andrew J , Kelly Sherrie L , Hastings Ian M , Penny Melissa A 
Published: February 2022

AbstractThe effectiveness of artemisinin-based combination therapies (ACTs) to treat Plasmodium falciparum malaria is threatened by resistance. The complex interplay between sources of selective pressure – treatment properties, biological factors, transmission intensity, and access to treatment – obscures understanding how, when, and why resistance establishes and spreads across different locations. We developed a disease modelling approach with emulator-based global sensitivity analysis to systematically quantify which of these factors drive establishment and spread of drug resistance. Drug resistance was more likely to evolve in low transmission settings due to the lower levels of (i) immunity and (ii) within-host competition between genotypes. Spread of parasites resistant to artemisinin partner drugs depended on the period of low drug concentration (known as the selection window). Spread of partial artemisinin resistance was slowed with prolonged parasite exposure to artemisinin derivatives and accelerated when the parasite was also resistant to the partner drug. Thus, to slow the spread of partial artemisinin resistance, molecular surveillance should be supported to detect resistance to partner drugs and to change ACTs accordingly. Furthermore, implementing more sustainable artemisinin-based therapies will require extending parasite exposure to artemisinin derivatives, and mitigating the selection windows of partner drugs, which could be achieved by including an additional long-acting drug.Impact StatementDetailed models of malaria and treatment dynamics were combined with emulator-based global sensitivity analysis to elucidate how the interplay of drug properties, infection biology, and epidemiological dynamics drives evolution of resistance to artemisinin-based combination therapies. The results identify mitigation strategies.