bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Children with Adhd Show Improvements in Memory and Behaviour When Stimulant Medication Dosage is Titrated?
Authors: Lemay JF , Kubas H , Witzke J , Murphy K , Bergstrom N , McKee J 
Published: September 2022

Abstract
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often negatively impacts behaviour, memory, cognition, and academic achievement. Children with ADHD also exhibit deficits in executive functioning (EF). Currently, stimulant medications are the most commonly used treatment for ADHD; however, finding an ideal dose remains a challenge in the day-to-day practice of pediatricians. Medication titration is a possible option that might help in treatment.
OBJECTIVES: 1) to determine if children with ADHD show improvements in both memory and behaviour when long active methylphenidate (MPH) medication dosage is titrated; 2) to report if differences exist in memory/behaviour results relative to baseline and placebo conditions.
DESIGN/METHODS: A randomized controlled MPH medication trial was conducted with children ages 8-12 with a diagnosis of ADHD. Participants began with 1-week of baseline assessment, followed by a randomized 3-week trial order of placebo, low MPH dose, and high MPH dose. The Wisconsin Selective Reminding Test (WSRT) was used to measure long-term memory storage, retrieval, and learning (memory component) and the Behavior Rating Inventory of Executive Function (BRIEF) was used to measure parental perceptions of EF (behavioural component). These neuropsychological and behavioural assessment results were then graphically depicted and an optimal “best dose” determined for each child that was most effective in improving memory and behaviour. Also, a repeated-measures ANOVA was run to compare between baseline, placebo, and best dose conditions.
RESULTS: A total of 19 children (10 males, 9 females) ages 8-12 (M = 10 years±1.3 years) were enrolled. Statistically significant improvements were noticed on the WSRT (F range = 22.30–48.17, p&lt;.001), and on the BRIEF (F=22.68, p&lt;.001) during the “best dose” condition relative to baseline and placebo. These improvements were similar across most measures for both males and females. In addition, no significant differences were noted between the baseline and placebo conditions for any measure on both the WSRT and BRIEF (F range 0 – 4.11, p range .061 – .994).
CONCLUSION: When neuropsychological and behavioural test results are used to titrate medication and help with “best dose” selection, MPH appears to improve both memory and behaviour in children with ADHD. Overall, no differences were observed between baseline and placebo. Thus, a better understanding of memory and behavioural dose-response relationships may ultimately lead to targeted intervention plans that help foster long-term treatment efficacy in these ADHD children.
Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study
Authors: Latimer M , Rudderham S , Harman K , Finley A , Dutcher L , Hutt-Macleod D , Paul K 
Published: September 2022

Abstract
BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment.
OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain.
DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was &gt;85%.
RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual.
CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.
Limited Access to Facial Feminization Geographically Despite Nationwide Expansion of Other Gender-Affirming Surgeries
Authors: Hauc Sacha C. , Mateja Kirby L. , Long Aaron S. , Glahn Joshua Z. , Acuna Higaki Adrian R. , Rivera Jean Carlo , Ihnat Jacqueline M. H. , Mukherjee Thayer , Oh SeungJu Jackie , Alperovich Michael 
Published: September 2022

Background:
Facial feminization surgery (FFS) is an integral aspect of gender-affirming surgery (GAS) for individuals seeking to align secondary sex characteristics and gender identity. Despite the importance of FFS in treating gender dysphoria, current trends and prevalence remain unknown. We sought to examine trends in GAS and FFS and investigate the payer status of facial feminization procedures in the United States.

Methods:
Data was extracted from the National Inpatient Sample from 2008 to 2017 by using International Classification of Diseases Ninth or Tenth diagnosis codes for gender identity disorder and procedure codes for FFS.

Results:
From 2008 to 2017, 3015 patients underwent GAS. The yearly number of cases increased as did the average cost of GAS, which rose from $13,657 in 2008 to $50,789 in 2017. From 2015 to 2017, when FFS data was available, 110 of 1215 (9.1%) GAS patients had FFS. Most were non-Hispanic White (66.7%) or Black (23.8%). Fifty percent of FFS cases occurred in the West, followed by the Northeast (31.8%), South (13.6%), and Midwest (4.8%) (P = 0.015). By payer the cases were, 36.4% self-pay, 31.8% Medicaid, and 27.3% private insurance (P < 0.0001). Approximately, 18% of patients undergoing male-to-female transition received FFS.

Conclusions:
From 2008 to 2017, GAS cases increased nationwide while the average cost of surgery rose steeply. FFS cases were primarily in the Western and Northeast United States. Despite high cost, roughly 18% of transgender women in our sample received FFS, highlighting the importance of FFS in gender transition.
Improving Foodborne Disease Surveillance and Outbreak Detection and Response Using Peer Networks—The Integrated Food Safety Centers of Excellence
Authors: White Alice E. , Garman Katie N. , Hedberg Craig , Pennell-Huth Paula , Smith Kirk E. , Sillence Elizabeth , Baseman Janet , Scallan Walter Elaine 
Published: September 2022

Context:
Foodborne disease surveillance and outbreak investigations are foundational to the prevention and control of foodborne disease in the United States, where contaminated foods cause an estimated 48 million illnesses, 128 000 hospitalizations, and 3000 deaths each year. Surveillance activities and rapid detection and investigation of foodborne disease outbreaks require a trained and coordinated workforce across epidemiology, environmental health, and laboratory programs.

Program:
Under the 2011 Food Safety Modernization Act, the Centers for Disease Control and Prevention (CDC) was called on to establish Integrated Food Safety (IFS) Centers of Excellence (CoEs) at state health departments, which would collaborate with academic partners, to identify, implement, and evaluate model practices in foodborne disease surveillance and outbreak response and to serve as a resource for public health professionals.

Implementation:
CDC designated 5 IFS CoEs in August 2012 in Colorado, Florida, Minnesota, Oregon, and Tennessee; a sixth IFS CoE in New York was added in August 2014. For the August 2019-July 2024 funding period, 5 IFS CoEs were designated in Colorado, Minnesota, New York, Tennessee, and Washington. Each IFS CoE is based at the state health department that partners with at least one academic institution.

Evaluation:
IFS CoEs have built capacity across public health agencies by increasing the number of workforce development opportunities (developing >70 trainings, tools, and resources), supporting outbreak response activities (responding to >50 requests for outbreak technical assistance annually), mentoring students, and responding to emerging issues, such as changing laboratory methods and the COVID-19 pandemic.
Assessing Risks of Early Childhood Caries in Primary Care Practice Using Electronic Health Records and Neighborhood Data
Authors: Tuan Wen-Jan , Leinbach Leah I. , Gill Stephanie A. 
Published: September 2022

Context:
Early childhood caries (ECC) is a persistent public health challenge, affecting more than 56% of US toddlers and preschool-aged children. Despite this, ECC is largely preventable with routine oral hygiene practices, diet, and application of topical fluoride.

Objective:
This study assessed the utilization of preventive oral health care in primary care practices and evaluated the variation in patient characteristic and geographic disparities.

Design:
We conducted a retrospective study using electronic health records (EHRs) over a 2-year period. Patients' home addresses were geocoded and linked to census-based neighborhood statistics and fluoridated water accessibility. Multiple logistic regression modeling was used to assess the risk of ECC in patients with fluoride preventive care, controlled for demographics, comorbid conditions, and neighborhood risk factors.

Participants:
Patients aged 6 to 71 months who had primary care providers at family medicine and general pediatric clinics in a large academic medical center.

Main Outcome Measure:
The presence of dental caries based on diagnoses in EHRs.

Results:
The study consisted of 10 836 patients: 17% treated with topical fluoride varnish (TFV), 12% prescribed oral fluoride supplement, 6.1% with both TFV and supplement, and 64% without fluoride treatment. Patients with fluoride treatment were 24% to 53% less likely to have ECC. Children living in rural and nonfluoridated water communities had 1.7 to 1.8 times greater risk of developing ECC. Minority, under/uninsured, and low-income patients also were at an increased risk of ECC.

Conclusion:
Despite continuing efforts to improve access to dental care for vulnerable populations, substantial disparities remain among socioeconomically disadvantaged children. To address dental care shortage, primary care clinicians should serve as the safety net to care for vulnerable and underserved children who have no or limited access to oral health services. Future research into the collaboration between primary care and dental providers at the level of both practice and professional education should be considered.
Duration of Treatment With Glucocorticoids in Giant Cell Arteritis
Authors: Moreel Lien , Betrains Albrecht , Molenberghs Geert , Blockmans Daniel , Vanderschueren Steven 
Published: September 2022

Abstract
The aim of this meta-analysis was to estimate the mean duration of glucocorticoid (GC) treatment in patients with giant cell arteritis. PubMed, EMBASE, and Cochrane databases were searched from inception until November 30, 2021. The outcome measures were the proportion of patients on GCs at years 1, 2, and 5 after diagnosis and the mean GC dose (in the entire cohort and expressed in prednisone equivalents) at these time points. Twenty-two studies involving a total of 1786 patients were included. The pooled proportions of patients taking GCs at years 1, 2, and 5 were 89.7% (95% confidence interval [CI], 83.2%–93.9%), 75.2% (95% CI, 58.7%–86.6%), and 44.3% (95% CI, 15.2%–77.6%), respectively. The pooled GC dose at years 1 and 2 was 9.1 mg/d (95% CI, 2.8–15.5 mg/d) and 7.8 mg/d (95% CI, 1.4–14.1 mg/d), respectively. The proportion of patients taking GCs at year 1 was lower in multicenter studies (p = 0.003), in randomized controlled trials (p = 0.01), and in studies using a GC-tapering schedule (p = 0.01). There were no significant differences in the proportion of patients taking GCs at years 1 and 2 according to study design (retrospective vs. prospective), initial GC dose, use of pulse GCs, publication year, enrolment period, duration of follow-up, age, and sex. This meta-analysis showed that giant cell arteritis is a chronic disease that requires substantial and prolonged GC treatment in a considerable proportion of patients. A predefined GC-tapering schedule may help to avoid inadequately long GC treatment.
NOT ALL CELL-FREE MITOCHONDRIAL DNA IS EQUAL IN TRAUMA PATIENTS
Authors: Briggs Gabrielle D. , Gelzinnis Scott , Meakes Simone , King Kate L. , Balogh Zsolt J. 
Published: September 2022

ABSTRACT
Mitochondrial DNA (mtDNA) acts as a proinflammatory damage-associated molecular pattern that stimulates innate immune activation via Toll-like receptor 9, similarly to bacterial DNA. A number of clinical studies have measured elevated cell-free mtDNA in the plasma of trauma patients, thought to originate from tissue injury and inflammatory processes; however, the magnitude of this increase, the absolute concentration, and the association with poor outcomes varies considerably across studies. Measurements of cell-free mtDNA in healthy individuals have shown that the majority of “cell-free” mtDNA (>95%) can be centrifuged/filtered from plasma in the size range of 0.45 to 5 μm, suggesting that there are larger forms of mtDNA-containing complexes in the plasma that could be considered cell-free. Whether this is true for trauma patients (and other relevant disease states) and the clinical relevance of the larger forms of mtDNA is unknown. These findings from healthy individuals also suggest that the centrifugation speeds used to generate cell-free plasma (which are rarely consistent among studies) could result in mixed populations of cell-free mtDNA that could confound associations with outcomes. We demonstrate in this study of 25 major trauma patients that the majority of the cell-free mtDNA in trauma patient plasma (>95%) is removed after centrifugation at 16,000g. Despite the larger forms of mtDNA being predominant, they do not correlate with outcomes or expected parameters such as injury/shock severity, multiple organ failure, and markers of inflammation, whereas low-molecular-weight cell-free mtDNA correlates strongly with these variables.
Clinical and molecular response of AML harboring non-canonical FLT3 N676K driver mutations to contemporary FLT3 inhibitors
Authors: Roloff Gregory W. , Wen Frank , Ramsland Aubrianna , Artz Andrew S. , Kosuri Satyajit , Stock Wendy , Odenike Olatoyosi , Larson Richard A. , Liu Hongtao , Godley Lucy A. , Thirman Michael J. , Patel Anand A. , Daugherty Christopher K. , DuVall Adam S. , Nawas Mariam T. , Dworkin Emily , Wool Geoffrey D. , Fitzpatrick Carrie , Segal Jeremy P. , Wang Peng , Drazer Michael W. 
Published: September 2022

ABSTRACTThe treatment of acute myeloid leukemia (AML) has been enhanced by the development and regulatory approval of a series of novel agents, including midostaurin and gilteritinib (FLT3 inhibitors), venetoclax (BCL2 inhibitor), ivosidenib (IDH1 inhibitor), and enasidenib (IDH2 inhibitor). A difficulty that has arisen in the era of molecular therapies, however, is determining the efficacy of these agents for patients with AML harboring atypical driver mutations. The non-canonical FLT3 p.N676K variant was initially described as an acquired resistance mechanism in patients with FLT3 internal tandem duplication (ITD) mutations who were treated with midostaurin. Clinical data from patients with the FLT3 N676K mutations are limited. Here, we detail our experience caring for nine different patients with AML harboring FLT3 N676K at the University of Chicago. Seven of nine (78%) individuals received intensive induction chemotherapy, with FLT3 inhibitors utilized in three patients upfront and five patients during subsequent lines of treatment. With the use of FLT3 inhibitors, we noted reduction, and in some instances, complete molecular suppression of detectable FLT3 N676K variant allele fraction (VAF) on NGS, underscoring the activity of FLT3 inhibitors in this population regardless of line of therapy. Individuals with FLT3 N676K-mutated AML who received FLT3 inhibitors had longer median survival (940 days) than those who did not (408 days), however, the difference was not significant likely due to small size of the study (p = 0.2). The presence of concurrent canonical FLT3 mutations was associated with loss of treatment response. In silico visualization models of the FLT3 tyrosine kinase domain in the presence of gilteritinib demonstrate that the mechanism of N676K-mediated resistance is not due to disruption of FLT3 inhibitor binding at the ATP-binding site but rather influenced by other allosteric forces on protein structure. In conclusion, this is the largest study to date demonstrating that the atypical FLT3 N676K driver mutation is sensitive to contemporary FLT3 inhibitors, such as midostaurin and gilteritinib. Our data suggest that FLT3 inhibitors should be included in both the upfront induction setting as well as in the relapsed/refractory setting for patients harboring the FLT3 N676K mutation.
Predictors of 30-Day Readmission & Reoperations Post Strictureplasty in Crohn’s Disease: A NSQIP Retrospective Review and Analysis
Authors: Patel Apar S. , Satchel Emma K. , Guru Swadha , Hart Rachel , Serniak Nicholas , Byrne Raphael , Cagir Burt 
Published: September 2022

INTRODUCTIONStrictureplasty, introduced in 1978, has been suggested as an alternative to small bowel resection for cases of intestinal obstruction involving multiple segments, such as in Crohn’s disease. Despite research supporting the operation, little is known about outcomes after strictureplasty. Specifically, 30-day readmission and reoperation rates, which are widely recognized as surrogates for quality of surgical care have not been studied for this procedure. We sought to study the rate of, as well as factors associated with 30-day outcomes, including readmission and reoperation.METHODSWe used the National Surgical Quality Improvement Program (NSQIP) participant user files (PUF) for the years 2012-2020. Primary Current Procedural Terminology (CPT) code “44615” was used to identify patients undergoing strictureplasty as their principal procedure. The outcomes of interest included related thirty-day readmissions and reoperations, non-routine discharge, and prolonged length of stay (LOS). Multivariable analyses were performed to identify factors associated with each outcome.RESULTSA total of 535 patients were identified with mean age 44.14 years (SD= 15.74). 52.5% were female. Thirty-day related readmission and reoperation rates were 9% (n=48) and 6% (n=32) respectively. Average LOS was 8.16 days (SD= 6.9). Non-routine discharge rate was4.2% (n=21). On multivariable logistic regression, factors associated with 30-day readmissions included longer operative time (OR 1.00, 95% CI 1.00-1.01, p=0.0008) and any surgical site infection (SSI) (OR 6.4, 95% CI 2.89-14.2, p<0.001). Increased LOS (OR 1.7, 95%CI 1.03-1.11, p=0.0009) and SSI (OR 28.1, 95%CI 10.44-75.47, p<0.001) were associated with 30-day related reoperation. Predictors of non-routine discharge included older age (65+ vs 18-40: OR 30.72, 95%CI 3.14-300.74, p=0.003) and longer LOS (OR 1.09, 95%CI 1.03-1.14, 0.0009). Factors associated with increased odds of prolonged LOS included higher ASA class (OR 3.29, 95%CI 2.10-5.14, p<0.001), longer operative time (1.00, 95%CI 1.00-1.01, p=0.0008) and SSI (OR 3.05, 95%CI 1.57-5.90, p=0.0009). Factors associated with lower odds of prolonged LOS included male sex (OR 0.56, 96%CI 0.36-0.88, p=0.011) and preoperative steroid use (OR 0.62, 95%CI 0.38-0.99, p=0.04).CONCLUSIONOur analyses indicate that among patients undergoing strictureplasty, longer operative time, wound complications, and longer length of stay are associated with increased odds of readmission and reoperation within 30 days. These findings may be important for hospitals, providers, payors, and other stakeholders in further refining standards of quality of care for patients undergoing strictureplasty.