bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimum dose of oral folic acid supplementation in transfusion-dependent thalassemia: a randomized controlled trial
Authors: Agrawal Titiksha , Dewan Pooja , Gomber Sunil , Agarwal Rachna , Sharma Sangeeta , Kotru Mrinalini 
Published: October 2022

Abstract

Aim and objectives
We compared the effect of different doses of oral folic acid (FA) supplementation (5 mg/day vs. 2.5 mg/day vs. 5 mg/week) on the proportion of children with folate excess (serum folate &gt;20 ng/ml) and plasma homocysteine (Hcys) excess (&gt;15 µmol/l) in transfusion-dependent thalassemia (TDT).

Materials and methods
Children with TDT aged 5–18 years received oral FA in doses of 5 mg/day (Group 1), 2.5 mg/day (Group 2) and 5 mg/week (Group 3) for 9 months, after a wash-off period of 8 weeks. Folate levels (Serum and RBC) and plasma Hcys levels were measured after the therapy.

Results
Ninety children were randomized to receive one of the three interventions (30 per group). After wash-off period, the median serum folate levels were significantly lower and five children developed folate deficiency; the median [interquartile range (IQR)] serum folate levels (ng/dl) were comparable in the three groups [Group 1: 6.5 (3.3–14.2), Group 2: 5.1 (2.6–10.5) and Group 3: 4.8 (3.4–10.0)]. After 9 months of intervention, the median (IQR) serum folate levels (ng/ml) were comparable in all participants [Group 1: 18.0 (6.5–28), Group 2: 13.5 (6.4–24.5) and Group 3: 9.7 (5.3–22.5); p = 0.11]. Proportion of children with serum folate excess was 40%, 26.7% and 26.7% in Group 1, Group 2 and Group 3 (p = 0.48). Proportion of children with RBC folate excess was 92%, 86.7% and 86.7% in Group 1, Group 2 and Group 3 (p = 0.79). Hyperhomocysteinemia was seen in eight children with no significant difference between median Hcys levels in the groups (p = 0.75).

Conclusion
Folic acid supplementation is recommended in TDT with 5 mg weekly dose being adequate.
Improving the Well-Being of Adolescent Girls in Developing Countries
Authors: Bergstrom Katy , Özler Berk 
Published: October 2022

Abstract
This paper conducts a large, narrative review of interventions that might plausibly (a) increase educational attainment, (b) delay childbearing, and/or (c) delay marriage for adolescent girls in low- and middle-income countries (LMICs). Using 108 interventions from 78 studies, predominantly in LMICs, the paper summarizes the performance of 15 categories of interventions in improving these outcomes. Transfer programs emerge as broadly effective in increasing educational attainment but their effects on delaying fertility and marriage remain mixed and dependent on context. Construction of schools in underserved areas and the provision of information on returns to schooling and academic performance also increase schooling. No category of interventions is found to be categorically effective in delaying pregnancies and reducing child marriages among adolescent girls. While targeted provision of sexual and reproductive health services, including vouchers and subsidies for family planning, and increasing job opportunities for women seem promising, more research is needed to evaluate the longer-term effects of such interventions. We propose that future studies should aim to measure short-term outcomes that can form good surrogates for long-term welfare gains and should collect detailed cost information.
Reconceptualizing the Juvenile Bunion
Authors: Zide Jacob R. , Hardin Caitlin , Shivers Claire , Tulchin-Francis Kirsten , Jo Chan-Hee , Riccio Anthony I. 
Published: October 2022

Background:
The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand what differentiates these 2 deformities. This study aims to (1) characterize the radiographic and pedobarographic features commonly encountered in the juvenile bunion and (2) determine which of these radiographic or pedobarographic parameters correlate with patient-reported outcome (PRO) scores at the time of presentation.

Methods:
An IRB-approved retrospective analysis of prospectively enrolled patients between 10 and 18 years of age with bunion deformities was performed at a single pediatric institution over a 4-year period. Standardized weight-bearing radiographs were used to determine hallux valgus angle (HVA), intermetatarsal angle, sesamoid position (SP), distal metatarsal articular angle (DMAA), and other radiographic parameters. Pedobarographic analysis was used to determine peak pressure, contact area, contact time, and pressure-time integral within 11 plantar regions. Foot-specific PRO measures were administered at the initial presentation.

Results:
Thirty-two patients (57 feet) met the inclusion criteria of which56/57 feet (98.2%) had an elevated DMAA (average 21.4degrees±8.9 degrees), and 51/57 (89.4%) had a congruent joint. The DMAA correlated positively with the HVA (r=0.734 P<0.001), intermetatarsal angle (r=0.439 P=0.001), and SP (r=0.627 P<0.001). Pedobarographic analysis (available in 15/32 patients) demonstrated that the HVA correlated with increased second metatarsal head peak pressure (r=0.667 P=0.011) and pressure-time integral (r=0.604 P=0.002), which in turn was strongly correlated with worse PROs. Conversely, increased first metatarsal head contact area correlated with improved PROs. Analysis of radiographic measurements demonstrated that HVA and lateralized SP correlated significantly with worse PRO scores.

Conclusions:
Nearly all juvenile bunions have an elevated DMAA and a congruent joint. There is a clear correlation between the severity of radiographic and pedobarographic deformity and worse PRO scores at the time of presentation. We believe that the presence of elevated DMAA is the defining factor that differentiates the juvenile bunion from the deformity typically seen in adults.

Level of Evidence:
III.
Comparing the Clinical Frailty Scale and an International Classification of Diseases-10 Modified Frailty Index in Predicting Long-Term Survival in Critically Ill Patients
Authors: Subramaniam Ashwin , Ueno Ryo , Tiruvoipati Ravindranath , Darvall Jai , Srikanth Velandai , Bailey Michael , Pilcher David , Bellomo Rinaldo 
Published: October 2022

IMPORTANCE:
The Clinical Frailty Scale (CFS) is the most used frailty measure in intensive care unit (ICU) patients. Recently, the modified frailty index (mFI), derived from 11 comorbidities has also been used. It is unclear to what degree the mFI is a true measure of frailty rather than comorbidity. Furthermore, the mFI cannot be freely obtained outside of specific proprietary databases.

OBJECTIVE:
To compare the performance of CFS and a recently developed International Classification of Diseases-10 (ICD-10) mFI (ICD-10mFI) as frailty-based predictors of long-term survival for up to 1 year.

DESIGN:
A retrospective multicentric observational study.

SETTING AND PARTICIPANTS:
All adult (≥16 yr) critically ill patients with documented CFS scores admitted to sixteen Australian ICUs in the state of Victoria between April 1, 2017 to June 30, 2018 were included. We used probabilistic methods to match de-identified ICU admission episodes listed in the Australia and New Zealand Intensive Care Society Adult Patient Database with the Victorian Admission Episode Dataset and the Victorian Death Index via the Victorian Data Linkage Centre.

MAIN OUTCOMES AND MEASURES:
The primary outcome was the longest available survival following ICU admission. We compared CFS and ICD-10mFI as primary outcome predictors, after adjusting for key confounders.

RESULTS:
The CFS and ICD-10mFI were compared in 7,001 ICU patients. The proportion of patients categorized as frail was greater with the CFS than with the ICD-10mFI (18.9% [n = 1,323] vs. 8.8% [n = 616]; p < 0.001). The median (IQR) follow-up time was 165 (82–276) days. The CFS predicted long-term survival up to 6 months after adjusting for confounders (hazard ratio [HR] = 1.26, 95% CI, 1.21–1.31), whereas ICD-10mFI did not (HR = 1.04, 95% CI, 0.98–1.10). The ICD-10mFI weakly correlated with the CFS (Spearman’s rho = 0.22) but had a poor agreement (kappa = 0.06). The ICD-10mFI more strongly correlated with the Charlson comorbidity index (Spearman’s rho 0.30) than CFS (Spearman’s rho = 0.25) (p < 0.001).

CONCLUSIONS:
CFS, but not ICD-10mFI, predicted long-term survival in ICU patients. ICD-10mFI correlated with co-morbidities more than CFS. These findings suggest that CFS and ICD-10mFI are not equivalent.

RELEVANCE:
CFS and ICD-10mFI are not equivalent in screening for frailty in critically ill patients and therefore ICD-10mFI in its current form should not be used.
An Analytical Study of Primus Stove Burns: A Catastrophic and Costly but Preventable Tragedy
Authors: Soltany Amjad , Al Aissami Salman , Al Aissami Maen 
Published: October 2022

Background:
Burns are still considered to be an enormous public issue. Syrian burn centers have to deal, especially during the current war, with burns caused by manually processed petroleum derivatives, and particularly‚ primus stove injuries. This kind of burn is severe and devastating. Prevention is key in management. This is one of the leading studies to include this high number of cases in relative medical literature.

Methods:
This retrospective descriptive cross-sectional study was conducted at Al-Mouwasat University Hospital, from June 2021 to October 2021. Inclusion criteria included admitted patients with a clear history of kerosene primus stove burn, either gender, and any age. Exclusion criteria included no clear history of a primus stove burn, injuries with causes other than primus stove, and outpatients. Data were recorded in Microsoft Excel sheets, and analyzed using IBM SPSS Statistics 26 software.

Results:
In total, 135 burn patients were included. Of the total number of 135 patients, 65 (48%) patients were admitted with primus stove burns, with 70 (52%) non-primus stove injury patients. Of the 65 patients, 25 were men and 40 were women (38% and 62% respectively). The mean percentage of total body surface area was 45%. Average hospital stay was 30.5 days, whereas 16 of 65 (25%) primus stove admissions died.

Conclusions:
Primus stove injuries are catastrophic and costly, but preventable. This study provides a detailed analytic and epidemiological approach to these injuries, hoping to shed light on the severity of such cases‚ and stresses the importance of prevention, which is always better than cure.
NEW ARTIFICIAL INTELLIGENCE ANALYSIS FOR PREDICTION OF LONG-TERM VISUAL IMPROVEMENT AFTER EPIRETINAL MEMBRANE SURGERY
Authors: Crincoli Emanuele , Savastano Maria Cristina , Savastano Alfonso , Caporossi Tomaso , Bacherini Daniela , Miere Alexandra , Gambini Gloria , De Vico Umberto , Baldascino Antonio , Minnella Angelo Maria , Scupola Andrea , DAmico Guglielmo , Molle Fernando , Bernardinelli Patrizio , De Filippis Alessandro , Kilian Raphael , Rizzo Clara , Ripa Matteo , Ferrara Silvia , Scampoli Alessandra , Brando Davide , Molle Andrea , Souied Eric H. , Rizzo Stanislao 
Published: October 2022

Purpose:
To predict improvement of best-corrected visual acuity (BCVA) 1 year after pars plana vitrectomy for epiretinal membrane (ERM) using artificial intelligence methods on optical coherence tomography B-scan images.

Methods:
Four hundred and eleven (411) patients with Stage II ERM were divided in a group improvement (IM) (≥15 ETDRS letters of VA recovery) and a group no improvement (N-IM) (<15 letters) according to 1-year VA improvement after 25-G pars plana vitrectomy with internal limiting membrane peeling. Primary outcome was the creation of a deep learning classifier (DLC) based on optical coherence tomography B-scan images for prediction. Secondary outcome was assessment of the influence of various clinical and imaging predictors on BCVA improvement. Inception-ResNet-V2 was trained using standard augmentation techniques. Testing was performed on an external data set. For secondary outcome, B-scan acquisitions were analyzed by graders both before and after fibrillary change processing enhancement.

Results:
The overall performance of the DLC showed a sensitivity of 87.3% and a specificity of 86.2%. Regression analysis showed a difference in preoperative images prevalence of ectopic inner foveal layer, foveal detachment, ellipsoid zone interruption, cotton wool sign, unprocessed fibrillary changes (odds ratio = 2.75 [confidence interval: 2.49–2.96]), and processed fibrillary changes (odds ratio = 5.42 [confidence interval: 4.81–6.08]), whereas preoperative BCVA and central macular thickness did not differ between groups.

Conclusion:
The DLC showed high performances in predicting 1-year visual outcome in ERM surgery patients. Fibrillary changes should also be considered as relevant predictors.
Incidence and Severity of Kawasaki Disease Among Vietnamese Children
Authors: Doan Nguyen-Huong , Sivilay Nipha , Shimizu Chisato , Nguyen Hai , Bainto Emelia , Nguyen Quyen , Tremoulet Adriana H. , Burns Jane C. 
Published: October 2022

Background:
Kawasaki disease (KD) disproportionately affects children of Asian descent. San Diego is home to a large Vietnamese population but no previous study has addressed the outcome of KD in this group.

Methods:
We performed a retrospective review of Vietnamese patients seen at Rady Children’s Hospital San Diego from 2001 to 2019. Non-Vietnamese Asian and non-Asian KD patients were matched (2:1) based on date of onset and age with Vietnamese patients. Demographic, clinical, and echocardiographic data were compared. Interviews with cardiologists at the Children’s Hospital 1 in Ho Chi Minh City, Vietnam, explored local practices in the diagnosis and management of KD patients. KD publications in Vietnamese were translated and summarized.

Results:
Of 978 KD patients for whom both parents had the same ethnicity, 20 were Vietnamese (2.1%), 168 (17%) were non-Vietnamese Asian, and 789 (81%) were non-Asian. Vietnamese and non-Vietnamese Asians had an earlier median day of diagnosis at day 6 (interquartile range [IQR] 5–6) and 5.5 (IQR 4–6.75), respectively, compared with non-Asians (day 7, IQR 5–8.75, P = 0.02). Prominent cervical lymphadenopathy at diagnosis was more common in both Vietnamese and non-Vietnamese Asians (20% and 40%, respectively) compared with non-Asians (12.5%, P = 0.01). Importantly, Vietnamese KD patients had a higher rate of coronary artery aneurysms (60% vs. 27.5%) compared to non-Asians (P = 0.024). Vietnamese literature review and structured interviews suggested a high incidence and severity of KD in Vietnamese children.

Conclusions:
Physicians should be aware that Vietnamese children may be disproportionately affected by KD and have worse coronary artery outcomes.
Impact of ICU strain on outcomes
Authors: Duggal Abhijit , Mathews Kusum S. 
Published: October 2022

Purpose of review
Acute surge events result in health capacity strain, which can result in deviations from normal care, activation of contingencies and decisions related to resource allocation. This review discusses the impact of health capacity strain on patient centered outcomes

Recent findings
This manuscript discusses the lack of validated metrics for ICU strain capacity and a need for understanding the complex interrelationships of strain with patient outcomes. Recent work through the coronavirus disease 2019 pandemic has shown that acute surge events are associated with significant increase in hospital mortality. Though causal data on the differential impact of surge actions and resource availability on patient outcomes remains limited the overall signal consistently highlights the link between ICU strain and critical care outcomes in both normal and surge conditions.

Summary
An understanding of ICU strain is fundamental to the appropriate clinical care for critically ill patients. Accounting for stain on outcomes in critically ill patients allows for minimization of variation in care and an ability of a given healthcare system to provide equitable, and quality care even in surge scenarios.
Quality, safety, and implementation science in acute kidney care
Authors: Rewa Oleksa G. , Kashani Kianoush 
Published: October 2022

Purpose of review
Quality and safety are important themes in acute kidney care (AKC). There have been many recent initiatives highlighting these aspects. However, for these to become part of clinical practice, a rigorous implementation science methodology must be followed. This review will present these practices and will highlight recent initiatives in acute kidney injury (AKI), kidney replacement therapy (KRT) and recovery from AKI.

Recent findings
The 22nd Acute Disease Quality Initiative (ADQI) focused on achieving a framework for improving AKI care. This has led to various quality improvement (QI) initiatives that have been implemented following a robust implementation science methodology. In AKI, QI initiatives have been focused on implementing care bundles and early detection systems for patients at risk or with AKI. KRT initiatives have focused on measuring and reporting key performance indicators (KPIs), and providing targeted feedback and education to improve delivery of KRT. Finally, it has been recognized that post-AKI care is vitally important, and ongoing work has been focused on implementing pathways to ensure continuing kidney-focused care.

Summary
Quality and safety continue to be important focuses in AKC. Although recent work have focused on initiatives to improve these themes, additional work is necessary to further develop these items as we strive to improve the care to patients with AKI.
The 2016 Presidential Election and Prenatal Care Utilization Among Foreign-born Hispanic Pregnant People
Authors: Young Anna Marie Pacheco , Catalano Ralph , Gemmill Alison 
Published: October 2022

Background:
Few studies have evaluated the relationship between adequate and timely prenatal care among immigrant pregnant people and the recent political climate, including the 2016 election and associated campaigns.

Objectives:
We examine whether the 2016 presidential election was associated with changes in prenatal care utilization among US foreign-born Hispanic pregnant people.

Research Design:
Interrupted time series.

Subjects:
All foreign-born Hispanic and US-born non-Hispanic White people delivering singleton infants from 2008 to 2017 who resided in the 23 states that fully implemented the 2003 version of the birth certificate before January 2008 (n=12,397,503).

Measures:
We examine the relationship between the presidential election and changes in the odds of inadequate or late/no prenatal care among immigrant Hispanic pregnant people, as well as trends in prenatal care utilization before the election.

Results:
Our results show no unexpected changes in receipt of inadequate prenatal care, and late/no prenatal care, among the 7 monthly conception cohorts exposed to the election before the third trimester. However, we detected increases in the odds of both inadequate care and late/no prenatal care among foreign-born Hispanic pregnant people in June 2015 and January 2016, respectively. These upward level shifts persisted through the remainder of our time series ending with the cohort conceived around December 2016.

Conclusions:
The worsening shifts in prenatal care utilization we observe may serve as a bellwether for worsening outcomes among immigrant women and their families. Research is therefore urgently needed to investigate the determinants and consequences of these concerning trends.
Depression in transplantation
Authors: Zimbrean Paula C. 
Published: October 2022

Purpose of review
To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population.

Recent findings
Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role.

Summary
Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.
Video-Recorded In Situ Simulation Before Moving to the New Combined Neonatal/Pediatric Intensive Care Facility: An Observational Study
Authors: Krammer Theresa , Kessler Lisa , Aspalter Gerhard , Kuster Lucas , Fussenegger Barbara , Aichner Heidi , Simma Burkhard 
Published: October 2022

OBJECTIVES:
Moving an ICU to a new location is a challenge. The objective of this study was to use in situ simulation to identify potential problems and solutions with the new environment before commencing patient care.

DESIGN:
Planned, observational video-recorded simulation study using four scenarios: delivery room management of term-neonate; delivery room management of extremely low-birth-weight infant; management and transfer of an infant with respiratory syncytial virus bronchiolitis and apnea; and management and transfer of an adolescent with septic shock.

SETTING:
Academic tertiary neonatal and combined neonatal ICU/PICU.

PARTICIPANTS:
Sixteen volunteers (eight physicians, eight nurses).

INTERVENTIONS:
Standardized briefing introduction, with before versus after survey of thoughts about each scenario, and after 8 weeks, debriefing at least 60 minutes and additional video recording.

MEASUREMENTS AND MAIN RESULTS:
A total of 91 potential problem areas were identified and included issues related to technical aspects (n = 29), infrastructure (n = 27), administration (n = 19), and structure (n = 16). Fifty-three (58%) of these potential issues could be resolved before the move, including: 15 of 29 technical, 15 of 27 infrastructure, nine of 19 administration, and 14 of 16 structural. The video analysis revealed an additional 13 problem areas (six technical, three infrastructure, two administration, and two structural). Participants felt more confident 8 weeks after the simulations (χ2 = 12.125; p < 0.002). All 16 participants confirmed the usefulness of the in situ simulation, the majority wanted further introductions to the new ward (n = 13) and noted a positive impact of the changes on the new ward (n = 12).

CONCLUSIONS:
In situ simulation before moving into a new facility identifies numerousness potential problem areas. Survey shows that providers feel better prepared and are more confident. Video recording reveals additional difficulties not addressed in conventional verbal debriefing.