bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Ship Fire Monitoring and Alarm System
Authors: Han Huimin , Dai Wenjuan , Zhou Han , Sun Xinchun
Published: September 2021

This paper analyzed the application status of land fire protection system and the characteristics of ship fire protection, and analyzed the functional requirements of ship fire protection system according to the ship special environment with crowded escape routes and complex structure. Using distributed intelligent control mode and modular structure design, a monitoring and alarm system composed of sensor acquisition module, microprocessor, central server, audible and visual alarm module, liquid crystal display module and CAN bus communication is constructed. The designed system has simple structure, stable performance and high cost performance, and has certain application and promotion value.
Offshore drilling accident analysis based on Dynamic Bayesian Network
Authors: Wang Xingzhong , Kou Xinghua , Huang Jinfeng , Wang Wanli
Published: September 2021

Offshore drilling operations has the characteristics of far offshore, harsh environment, high risk and great technical difficulty. It is difficult to deal with offshore drilling accidents, and it is easy to cause serious social and economic problems. Based on the risk records of drilling engineering, this paper analyzes the forms and causes of offshore drilling accidents, and establishes a dynamic Bayesian network analysis model for offshore drilling accidents. With the dynamic Bayesian network, the prediction probability of drilling risk is calculated. According to the blowout accident in offshore drilling, the analysis results show that the risk of blowout accident is is as high as 50.6%. The research results show that the method and the model presented in the paper is contributed to analysis and prevention of offshore drilling accidents.
A novel detection method for signal disturbances in the ship distribution network based on morphological gradient
Authors: Zhang Yong , Li Chengjun
Published: September 2021

Aiming at the deficiencies of the current detection methods for signal disturbances in the ship distribution network, such as low accuracy and slow detection speed, a new detection method for signal disturbances in the ship distribution network based on morphological gradient is proposed. The effectiveness of the proposed method is verified by comparing its detection accuracy and speed with an existing method on five typical signal disturbances in the ship distribution network. The comparison results show that the proposed method can detect the signal disturbances in the ship distribution network quickly and accurately.
Research on the Application of Computer Aided Technology in Mechanical Innovation Design
Authors: Zhou Han , Zhao Feng , Chen Danping , Han Huimin
Published: September 2021

In this paper, Creo technology as a means to achieve innovative suspension design smart shoe, for example, describes computer-aided 3D modeling technology in mechanical product design, kinematics analysis, application of intelligent control and other aspects. And through sample manufacturing verification, the shoe cabinet has stable performance and reliable operation, and summarizes the feasible application methods and advantages of computer-aided technology in the innovative design of mechanical products.
Analysis on Variation of Oxygen Loss Rate in AIP System
Authors: Shi Feng , Zeng Fan , Zhou Zuo
Published: September 2021

In view of the complex thermodynamic state inside the lox tank of SE/AIP oxygen supply system, the evaporation rate of liquid oxygen is proposed as the index of oxygen loss inside the oxygen tank (evaporation rate in short). A formula is derived from the thermodynamic point of view based on SE/AIP system usage record data calculate the evaporation rate of liquid oxygen, and on this basis, the influence law of evaporation rate is calculated and analyzed from three aspects.
Hubris in Management
Authors: Sadler-Smith Eugene , Tourish Dennis
Published: September 2021

Hubris is a grandiose sense of self, characterized by overconfidence, arrogance, and contempt toward the advice and criticism of others. Hubristic leaders create the conditions that invite unintended negative consequences by overestimating the likelihood of positive outcomes and underestimating the likelihood of negative outcomes from their decisions and actions. The early decades of the 20th century witnessed an upsurge of interest in hubris. The study of hubris in business and management began in behavioral finance, but this has since extended into other subfields of business and management, including strategic management, top management teams, entrepreneurship, leadership, and business ethics.
Iran: Imperial and Republican Civil–Military Relations
Authors: Hashim Ahmed S.
Published: September 2021

Iran has traditionally been troubled by unstable civil–military relations throughout its history. In the past, even before the emergence of the academic study of civil–military relations, Iranian imperial monarchs attempted, but often failed to ensure complete oversight of their military forces, due to the nature of imperial rule with its multiple power centers, and to the existence of myriad military forces that were often not under the monarch’s control. The rise of a centralized state in the early 20th century under Reza Shah ensured the emergence of stability in civil–military relations by means of carrots and sticks. Under Mohammad Reza Shah (r.1941–1979), early civil–military relations were quite unstable due to political turmoil and the young ruler’s lack of confidence; in subsequent years, he managed to cement his control over the military by means of patronage, insulation from domestic politics, and stringent oversight of the senior officer corps. The Iranian revolution (1978–1979) succeeded, to a large extent, due to the Shah’s own failures and those of the senior officer corps, both of which were paralyzed in the face of massive political and social turmoil. The successor state, the Islamic Republic of Iran (IRI) achieved control over the armed forces through ideological control and oversight and the creation of institutionalized parallel military structures. Nonetheless, the IRI has faced and continues to face instability in civil–military relations due to war, domestic political and socioeconomic crises, and foreign pressures.
Attributing Inferred Causes and Explanations to Behavior
Authors: Moskowitz Gordon B. , Olcaysoy Okten Irmak , Sackett Alexandra
Published: September 2021

Behavior is a reflection of the intentions, attitudes, goals, beliefs, and desires of a person. These intra-individual factors are coordinated with what opportunities the situation affords and the perceived constraints placed on the person by their context and the norms of the culture they are in. Further, the intentions, attitudes, goals, beliefs, and desires of a person are often not known to them in any given moment, and because they reside within the mind of that person they are almost always not known to the people who are perceiving that person. To know anything about other people we must observe and identify/classify their behavior and then attribute to the observed behavior inferences and judgments about the internal states of that person serving as the motivating force behind their behavior. This entry explores this process of attribution. Heider described attribution as the process that determines “how one person thinks and feels about another person, how he perceives him and what he does to him, what he expects him to do or think, how he reacts to the actions of the other.” The entry explores the rules that people follow in order to make sense of behavior, and the rational versus non-rational nature of the procedure. Even when highly motivated to think rationally, this process can be biased, and flaws can appear in the attribution process, such as from chronic differences among perceivers due to culture, experience, or personality. How the process would unfold if accurate and purely rational is contrasted with how it unfolds when biased. How we feel, and how we choose to act, are derived from how we make sense of the world. Thus, attribution processes are foundational for understanding how we feel, for establishing expectations, and planning how to act in turn.
Poverty in South Asia: An Intellectual History
Authors: Fennell Shailaja
Published: September 2021

The Oxford English Dictionary defines poverty as “destitution” with respect to lack of wealth and material possessions. It denotes a condition where an individual has inadequate resources and earnings to afford those necessities they require in order to stay alive and well. This condition can stem from extraneous shocks, such as the death of the head of the household or a poor harvest, or can result from systematic factors like power relations or institutions that have, since ancient times, kept some groups in society in precarious conditions. Descriptions of poverty are plentiful in ancient and medieval texts, which tend to characterize poverty with regard to natural, cultural, and personal features. In sharp contrast, the emergence of poverty as a public policy concern did not become evident until the latter part of the 19th century. It is also noteworthy that the means of measuring poverty that began to emerge in 19th and early 20th centuries identified poverty as a cultural or individual trait, rather than as a consequence of legal or administrative policy making. These latter day quantitative methods of measurement also provide the earliest evidence base for the design of public policies for poverty alleviation and advancing human development.
Agostinho Neto
Authors: Birmingham David
Published: September 2021

Agostinho Neto was an Angolan medical doctor who was born in the agricultural hinterland of Luanda City in 1922 and died in a Moscow hospital in 1979. He had been assimilated into Portuguese colonial society by gaining a school education at a Methodist mission station where his father was the minister, and he proceeded to university studies in Lisbon. There his radical politics fell foul of the dictatorial police, and after a spell in prison he escaped, via London, to become an itinerant political exile in Africa. There he became a guerrilla commander leading small bands of soldiers who fought a
gainst both a Portuguese conscript army and rival political movements seeking independence for Angola. In 1974 the Portuguese colonial empire imploded, and Neto found himself leader of the largest nationalist movement in Luanda, the Movement for the Popular Liberation of Angola (Movimento Popular de Libertação de Angola; MPLA). On November 11, 1975, he became Angola’s president as the last Portuguese governor-general sailed away on a gun-boat under cover of darkness. Neto’s four years in the presidential palace were not happy ones. Rival political movements not only challenged his legitimacy but also made unholy military alliances with South Africa, Congo, and the United States. He also alienated his domestic constituents, and when they attempted a coup d’état he rounded on them with all the ferocity that he had experienced himself when being persecuted by the Portuguese political police. His health rapidly deteriorated, and two years later he was flown to Moscow, albeit too late, to seek a cure.
Jews and Jewish Communal Identity in Early America
Authors: Snyder Holly
Published: September 2021

Jewish communities in the Americas followed in the wake of European contact with the western hemisphere at the end of the 15th century, and were a byproduct of the process of European colonization. Early Jewish settlements relied on a combination of economic investment, political negotiation, social networking, and subterfuge to establish the means of communal survival. While the Jewish experience in the Americas continued to operate within the sphere of European attitudes and modalities of behavior brought over to the western hemisphere by the colonizers, the remoteness of these New World communities and the friction caused by competing inter-imperial goals eventually allowed Jews to take advantage of new economic opportunities and expand their social and political range beyond what was feasible for Jewish communities in Europe in the same period.

New World colonization shifted the ways that Jews were seen within European cultures, as contact with Indigenous peoples of the Americas and the importation of Africans as slaves allowed Europeans to see Jews as comparatively less alien than they had previously been defined. While Jews, as individuals and as communities, continued to face discriminatory treatment (such as extraordinary taxation, prohibitions on voting and officeholding, scapegoating, and social exclusion), they were able to exercise many of the status privileges accorded to those with European Christian identities. These privileges included the capacity to freely pursue economic activities in trade and agriculture and to exploit enslaved peoples for their labor and for other purposes. With this elevated status came tension within the Jewish community over assimilation to European Christian norms, and an ongoing struggle to preserve Jewish identity and communal distinctiveness.
Portuguese-Lexified Creoles
Authors: Clements J. Clancy
Published: September 2021

The Portuguese colonial enterprise has had myriad and long-lasting consequences, not the least of which involves language. The many Portuguese-lexified creole languages in Africa and Asia are the product of Portugal’s colonial past. The creoles to be discussed that developed in Africa belong to two subgroups: the Upper Guinea Creoles (Cape Verdean, Guiné Bissau Creole, Casamance Creole) and the Gulf of Guinea Creoles (Santome, Angolar, Principense, Fa d’Ambô). Among the Asian Portuguese creoles, three subgroups are distinguishable, based on shared linguistic traits: the northern Indian group (Diu, Daman, Korlai), which retains some verbal morphology from Portuguese and distinguishes the subject/object case and informal-formal forms in the pronominal systems; Sri Lanka Creole, which retains less Portuguese verbal morphology but distinguishes the subject/object case and informal-formal forms in the pronominal system; and the East Asian group (Papiá Kristang, Makista), which retains very little, if any, Portuguese verbal morphology and has no informal-formal or subject/object case distinctions in the pronominal systems. Despite these differences, all creoles share a common lexicon, to a large extent, and, to varying degrees, aspects of Portuguese culture.
Perfects in the Romance Languages
Authors: Schaden Gerhard
Published: September 2021

This article is devoted to the description of perfect tenses in Romance. Perfects can be described as verbal forms which place events in the past with respect to some point of reference, and indicate that the event has some special relevance at the point of reference ; in that, they are opposed to past tenses, which localize an event in the past with respect to the moment of utterance. Romance is an interesting language family with respect to perfect tenses, because it features a set of closely related constructions, descending almost all from the same diachronic source yet differing in interesting ways among each other. Romance also provides us with a lesson in the difficulty of clearly pinning down and stating a single, obvious and generally agreed upon criterion of defining a perfect.
Attlee, Clement
Authors: Dickens Jonathan
Published: September 2021

Clement Attlee was prime minister of the United Kingdom from 1945 to 1951, leading his Labour government on a radical program of postwar reconstruction. Attlee himself came from a privileged background, and the decisive influences that brought him to left-wing politics came from his time working with children and families in the East End of London, in the years before World War I. His book The Social Worker, published in 1920, drew on these experiences.
Proper characterisation of the parol evidence rule and its applicability in international arbitration
Authors: Chan Darius , Lau Yi Hang Louis
Published: September 2021

Most arbitral statutes and institutional rules give great latitude to tribunals on the admissibility of evidence, and do not mandate application of domestic rules of evidence. In common law jurisdictions where the parol evidence rule applies, the issue that arises is whether the parol evidence rule is necessarily a procedural rule of evidence which tribunals are not bound to apply, especially in jurisdictions which have codified the rule under domestic evidence legislation. Notwithstanding any codification, this article argues that the parol evidence rule at common law is a substantive rule of contractual interpretation that should be applied as part of the lex contractus in international arbitration proceedings. Faithful application of the parol evidence rule as a substantive rule of contractual interpretation ensures that adjudicators arrive at the same interpretation on the same set of facts, thereby promoting uniformity, predictability, and consistency, regardless of the mode of dispute resolution.
Construction of Lightweight Authenticated Joint Arithmetic Computation for 5G IoT Networks
Authors: Hsu Chingfang , Harn Lein , Xia Zhe , Cui Jianqun , Chen Jingxue
Published: September 2021

The next generation of Internet of Things (IoT) networks and mobile communications (5G IoT networks) has the particularity of being heterogeneous, therefore, it has very strong ability to compute, store, etc. Group-oriented applications demonstrate its potential ability in 5G IoT networks. One of the main challenges for secure group-oriented applications (SGA) in 5G IoT networks is how to secure communication and computation among these heterogeneous devices. Conventional protocols are not suitable for SGA in 5G IoT networks since multiparty joint computation in this environment requires lightweight communication and computation overhead. Furthermore, the primary task of SGA is to securely transmit various types of jointly computing data. Hence, membership authentication and secure multiparty joint arithmetic computation become two fundamental security services in SGA for 5G IoT networks. The membership authentication allows communication entities to authenticate their communication partners and the multiparty joint computations allow a secret output to be shared among all communication entities. The multiparty joint computation result can be used to protect exchange information in the communication or be used as a result that all users jointly compute by using their secret inputs. A novel construction of computation/communications-efficient membership authenticated joint arithmetic computation is proposed in this paper for 5G IoT networks, which not only integrates the function of membership authentication and joint arithmetic computation but also realizes both computation and communication efficiency on each group member side. Our protocol is secure against inside attackers and outside attackers, and also meets all the described security goals. Meanwhile, in this construction the privacy of tokens can be well protected so tokens can be reused multiple times. This proposal is noninteractive and can be easily extended to joint arithmetic computation with any number of inputs. Hence, our design has more attraction for lightweight membership authenticated joint arithmetic computation in 5G IoT networks.
Ivabradine-sensitive incessant atrial tachycardia during pregnancy: a case report
Authors: Tonko Johanna B , Douglas Hannah , Wright Matthew J
Published: September 2021

Background 

Automaticity is the dominant mechanism in maternal focal atrial tachycardia (FAT) during pregnancy and if incessant, can cause tachycardia-induced cardiomyopathy. Medication failure for FATs is common, however, for the subgroup due to increased automaticity ivabradine sensitivity has been described and may represent a valuable treatment option. Little data are available regarding the safety profile of ivabradine during pregnancy.

Case Summary 

We report the case of a 38-year-old woman with background of peripartum cardiomyopathy and incessant atrial tachycardia with deteriorating ventricular function during her second pregnancy unresponsive to betablockade and demonstrating the immediate successful rate-controlling effect of ivabradine.

Discussion 

Early recognition of persistent maternal FAT is essential due to its frequent association with tachycardia-mediated cardiomyopathy. Our case report highlights the challenges of providing an equally safe and effective treatment of these notoriously difficult to treat arrhythmias during pregnancy. Ivabradine in combination with a betablocker can be effective for abnormal automaticity but its safety profile during pregnancy remains uncertain.
Needs or Symbols? The Logic of United Nations Counterterrorism Treaty Ratification
Authors: Milton Daniel , Jadoon Amira , Warner Jason
Published: September 2021

Why do states commit to UN counterterrorism treaties? This article posits that state accession to UN counterterrorism treaties is likely informed by the nature of the terrorist threats a state faces, and consequently, the pressures that such threats generate from domestic and international audiences on the state to address (or appear to address) them. As such, we hypothesize that states ratify UN CT treaties for either material, needs-based reasons—to gain external assistance for counterterror capacity building—or for symbolic reasons—to visibly signal their commitment to fight terrorism in order maintain legitimacy, and mitigate reputational costs to both domestic and international audiences. To test these hypotheses, we use a newly compiled dataset of state accessions to the 19 UN counterterrorism treaties from 1970–2016, testing both our needs-based versus symbolic hypotheses, as well as more “traditional” explanations for state treaty accession. Across the universe of 19 UN counterterrorism treaties, our study implies that states may be more likely to ratify treaties as mechanisms to signal intent to address terror threats rather than to build threat-specific counterterrorism capacity. This research thus broadens both academic and policy-related understandings of state counterterror treaty ratification.
GENETEX—a GENomics Report TEXt mining R package and Shiny application designed to capture real-world clinico-genomic data
Authors: Miller David M , Shalhout Sophia Z
Published: September 2021

Objectives

Clinico-genomic data (CGD) acquired through routine clinical practice has the potential to improve our understanding of clinical oncology. However, these data often reside in heterogeneous and semistructured data, resulting in prolonged time-to-analyses.

Materials and Methods

We created GENETEX: an R package and Shiny application for text mining genomic reports from electronic health record (EHR) and direct import into Research Electronic Data Capture (REDCap).

Results

GENETEX facilitates the abstraction of CGD from EHR and streamlines the capture of structured data into REDCap. Its functions include natural language processing of key genomic information, transformation of semistructured data into structured data, and importation into REDCap. When evaluated with manual abstraction, GENETEX had >99% agreement and captured CGD in approximately one-fifth the time.

Conclusions

GENETEX is freely available under the Massachusetts Institute of Technology license and can be obtained from GitHub (https://github.com/TheMillerLab/genetex). GENETEX is executed in R and deployed as a Shiny application for non-R users. It produces high-fidelity abstraction of CGD in a fraction of the time.
High attack rate of COVID-19 in an organized tour group of vaccinated travellers to Iceland
Authors: Benenson Shmuel , Ottolenghi Miriam , Cohen Matan J , Nir-Paz Ran , Oster Yonatan
Published: September 2021

In a COVID-19 outbreak in a group of 25 twice-vaccinated Israeli travellers, the attack rate was 84%, despite negative preflight polymerase chain reaction tests. This extremely high breakthrough infection rate is attributed mainly to close and prolonged exposures during long bus drives. Masking, distancing and personal responsibility are required to avoid such outbreaks.
Interleukin-6 in Critical Coronavirus Disease 2019, a Driver of Lung Inflammation of Systemic Origin?
Authors: Aarskog Nikolai Ravn , Aass Hans Christian , Holter Jan Cato , Rostrup Morten , Holten Aleksander Rygh
Published: September 2021

OBJECTIVES:

To examine whether interleukin-6 in critical coronavirus disease 2019 is higher in arterial than in central venous blood, as a sign of predominantly local pulmonal rather than systemic interleukin-6 production.

DESIGN:

Prospective cohort pilot study with repeated weekly measurements of interleukin-6 in arterial and central venous blood. Respiratory function, assessed with Pao
2/Fio
2 ratio, was measured at the time of blood sampling.

SETTING:

ICU at a university hospital.

SUBJECTS:

Nine adult patients with critical coronavirus disease 2019, actively treated and receiving mechanical ventilation.

MEASUREMENTS AND MAIN RESULTS:

No difference between arterial and central venous interleukin-6 was found. There was a significant negative relationship between interleukin-6 concentration and P/F ratio in both arterial (p = 0.04) and central venous (p = 0.03) blood.

CONCLUSIONS:

The absence of an arteriovenous interleukin-6 difference implies that interleukin-6 in critical coronavirus disease 2019 is mainly produced outside the lungs as part of a systemic inflammatory response syndrome and act as a driver of local inflammation and damage in the lungs.
Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults
Authors: Wu Ting Ting , Ko Sally , Kooken Rens , van den Boogaard Mark , Devlin John W.
Published: September 2021

OBJECTIVES:

Ketamine is increasingly being used for analgosedation, but its effect on delirium remains unclear. We compared delirium risk variables and ketamine analgosedation use between adults who developed incident delirium and those who did not, evaluated whether ketamine analgosedation increases delirium risk, and compared ICU delirium characteristics, treatments, and outcomes between ketamine and nonketamine patients with delirium.

DESIGN:

Secondary, subgroup analysis of a cohort study.

SETTING:

Single, 36-bed mixed medical-surgical ICU in the Netherlands from July 2016 to February 2020.

PATIENTS:

Consecutive adults were included. Patients admitted after elective surgery, not expected to survive greater than or equal to 48 hours, admitted with delirium, or where delirium occurred prior to ketamine use were excluded.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

Trained ICU nurses evaluated patients without coma (Richmond Agitation Sedation Scale. –4/–5) every 8 hours with the Confusion Assessment Method ICU; a delirium day was defined by greater than or equal to1 + Confusion Assessment Method ICU and/or scheduled antipsychotic use. Among 11 variables compared between the delirium and nondelirium groups (Baseline: age, Charlson Comorbidity score, cognitive impairment, admission type, and Acute Physiology and Chronic Health Evaluation-IV score, daily ICU [until delirium occurrence or discharge]: Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) and total ICU days, 7 (age, Charlson score, Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) were significantly different and were entered, along with delirium occurrence, in a logistic regression model. A total of 332 of 925 of patients (36%) developed delirium. Ketamine use was greater in patients with delirium (54 [16%] vs 4 [0.7%]; p < 0.01). Ketamine use (adjusted odds ratio, 5.60; 95% CI, 1.09–29.15), age (adjusted odds ratio, 1.03; 95% CI, 1.01–1.06), coma (adjusted odds ratio, 2.10; 95% CI, 1.15–3.78), opioid use (adjusted odds ratio, 171.17; 95% CI, 66.45–553.68), and benzodiazepine use (adjusted odds ratio, 34.07; 95% CI, 8.12–235.34) were each independently and significantly associated with increased delirium. Delirium duration, motoric subtype, delirium treatments, and outcomes were not different between the ketamine and nonketamine groups.

CONCLUSIONS:

Ketamine analgosedation may contribute to increased ICU delirium. The characteristics of ketamine and nonketamine delirium are similar. Further prospective research is required to evaluate the magnitude of risk for delirium with ketamine use.
Estimated Pao 2: A Continuous and Noninvasive Method to Estimate Pao 2 and Oxygenation Index
Authors: Sauthier Michaël , Tuli Gaurav , Jouvet Philippe A. , Brownstein John S. , Randolph Adrienne G.
Published: September 2021

BACKGROUND:

Pao
2 is the gold standard to assess acute hypoxic respiratory failure, but it is only routinely available by intermittent spot checks, precluding any automatic continuous analysis for bedside tools.

OBJECTIVE:

To validate a continuous and noninvasive method to estimate hypoxemia severity for all Spo
2 values.

DERIVATION COHORT:

All patients who had an arterial blood gas and simultaneous continuous noninvasive monitoring from 2011 to 2019 at Boston Children’s Hospital (Boston, MA) PICU.

VALIDATION COHORT:

External cohort at Sainte-Justine Hospital PICU (Montreal, QC, Canada) from 2017 to 2020.

PREDICTION MODEL:

We estimated the Pao
2 using three kinds of neural networks and an empirically optimized mathematical model derived from known physiologic equations.

RESULTS:

We included 52,879 Pao
2 (3,252 patients) in the derivation dataset and 12,047 Pao
2 (926 patients) in the validation dataset. The mean function on the last minute before the arterial blood gas had the lowest bias (bias –0.1% validation cohort). A difference greater than or equal to 3% between pulse rate and electrical heart rate decreased the intraclass correlation coefficients (0.75 vs 0.44; p < 0.001) implying measurement noise. Our estimated Pao
2 equation had the highest intraclass correlation coefficient (0.38; 95% CI, 0.36–0.39; validation cohort) and outperformed neural networks and existing equations. Using the estimated Pao
2 to estimate the oxygenation index showed a significantly better hypoxemia classification (kappa) than oxygenation saturation index for both Spo
2 less than or equal to 97% (0.79 vs 0.60; p < 0.001) and Spo
2 greater than 97% (0.58 vs 0.52; p < 0.001).

CONCLUSION:

The estimated Pao
2 using pulse rate and electrical heart rate Spo
2 validation allows a continuous and noninvasive estimation of the oxygenation index that is valid for Spo
2 less than or equal to 97% and for Spo
2 greater than 97%. Display of continuous analysis of estimated Pao
2 and estimated oxygenation index may provide decision support to assist with hypoxemia diagnosis and oxygen titration in critically ill patients.
Beneficial Effect of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019*
Authors: Zaaqoq Akram M. , Barnett Adrian G. , Griffee Matthew J. , MacLaren Graeme , Jacobs Jeffrey P. , Heinsar Silver , Suen Jacky Y. , Bassi Gianluigi Li , Fraser John F. , Dalton Heidi J. , Peek Giles J. ,   on behalf of the COVID-19 Critical Care Consortium (COVID Critical)
Published: September 2021

OBJECTIVES:

The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome.

DESIGN:

An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders.

SETTING:

Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry.

PATIENTS:

Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31; 95% CI, 0.14–0.68).

CONCLUSIONS:

Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings.
Clinical Benefit of Extubation in Patients on Venoarterial Extracorporeal Membrane Oxygenation
Authors: Massart Nicolas , Mansour Alexandre , Flecher Erwan , Ross James T. , Ecoffey Claude , Verhoye Jean-Philippe , Launey Yoann , Auffret Vincent , Nesseler Nicolas
Published: September 2021

OBJECTIVES:

Although patients on venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock are usually supported with mechanical ventilation, it is not clear whether sedation cessation and extubation might improve outcomes.

DESIGN:

Retrospective cohort study with propensity score overlap weighting analysis.

SETTING:

Three ICUs in a 1,500-bed tertiary university hospital.

PATIENTS:

From an overall cohort of 641 patients with venoarterial-extracorporeal membrane oxygenation support, the primary analysis was performed in 344 patients who had been successfully decannulated in order to reduce immortal time bias.

MEASUREMENTS AND MAIN RESULTS:

Seventy-five patients (22%) were extubated during extracorporeal membrane oxygenation support and were subsequently decannulated alive. Forty-nine percent received noninvasive ventilation, and 25% had emergency reintubation for respiratory, neurologic, or hemodynamic reasons. Higher Simplified Acute Physiology Score II at admission (odds ratio, 0.97; 95% CI [0.95–0.99]; p = 0.008) was associated with a lower probability of extubation, whereas cannulation in cardiac surgery ICU (odds ratio, 3.14; 95% CI [1.21–8.14]; p = 0.018) was associated with an increased probability. Baseline characteristics were well balanced after propensity score overlap weighting. The number of ICU-free days within 30 days of extracorporeal membrane oxygenation decannulation was significantly higher among extubated patients compared with nonextubated patients (22 d [11–26 d] vs 18 d [7–25 d], respectively; p = 0.036). There were no differences in other outcomes including ventilator-associated pneumonia (odds ratio, 0.96; 95% CI [0.51–1.82]; p = 0.90) and all-cause mortality within 30 days of extracorporeal membrane oxygenation decannulation (5% vs 17%; hazard ratio, 0.54; 95% CI [0.19–1.59]; p = 0.27).

As a secondary analysis, outcomes were compared in the overall cohort of 641 venoarterial extracorporeal membrane oxygenation–supported patients. Results were consistent with the primary analysis as extubated patients had a higher number of ICU-free days (18 d [0–24 d] vs 0 d [0–18 d], respectively; < 0.001) and a lower risk of death within 30 days of extracorporeal membrane oxygenation cannulation (hazard ratio, 0.45; 95% CI [0.29–0.71]; p = 0.001).

CONCLUSIONS:

Extubation during venoarterial-extracorporeal membrane oxygenation support is safe, feasible, and associated with greater ICU-free days.
Routine Neuroimaging: Understanding Brain Injury in Pediatric Extracorporeal Membrane Oxygenation*
Authors: Farhat Abdelaziz , Li Xilong , Huet Beverley , Tweed Jefferson , Morriss Michael C. , Raman Lakshmi
Published: September 2021

OBJECTIVES:

This project aims to describe brain injuries on routine neuroimaging in a large single-center neonatal and pediatric cohort supported by extracorporeal membrane oxygenation. The study also aims to examine the association of these injuries with neurocognitive outcomes in survivors and identify laboratory findings associated with neurologic injury.

DESIGN:

Retrospective observational single-center cohort study.

SETTING:

Tertiary care PICU.

PATIENTS:

Pediatric patients with noncardiac indications for extracorporeal membrane oxygenation supported by venoarterial or venovenous extracorporeal membrane oxygenation, with on-extracorporeal membrane oxygenation brain CT or postextracorporeal membrane oxygenation brain CT/MRI.

INTERVENTIONS:

Extracorporeal membrane oxygenation support.

MEASUREMENTS AND MAIN RESULTS:

Occurrence of brain injury on CT and MRI was reviewed; injuries were scored. Clinical and laboratory results associated with injury were identified. Survivor neurocognitive outcomes were obtained using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale. Of 132 imaged patients, 98 (74%) had radiological evidence of brain injury. Mean injury score was 6.5 (± 3.8). Head ultrasounds and clinician suspicion performed poorly in suspecting the presence of injury. Of 104 respondents to neurodevelopmental assessments, 61 (59%) had normal scores; 12.5%, 17%, and 11.5% had mild, moderate, or severe disability. A neuroimaging score greater than 10 was associated with an unfavorable outcome on the Pediatric Cerebral Performance Category (odds ratio, 3.4; p < 0.01) and Pediatric Overall Performance Category (odds ratio, 1.7; p < 0.05). Ischemic injury correlated with worse neurodevelopmental outcome. Preextracorporeal membrane oxygenation lactate, Vasoactive-Inotropic Scores, transaminitis, elevated bilirubin and creatinine levels, and thrombocytopenia were associated with injury occurrence.

CONCLUSIONS:

Brain injury is frequent in extracorporeal membrane oxygenation patients, although the majority of survivors have favorable neurocognitive outcomes. More research is needed in order to understand the etiology of such injuries. Head ultrasound and clinician suspicion are not sensitive in detecting extracorporeal membrane oxygenation–related brain injuries. Protocolizing postextracorporeal membrane oxygenation imaging with brain MRI allows the identification of injuries and provision of timely neurocognitive intervention.
Neuromuscular Blocker Use in Critically Ill Children: Assessing Mortality Risk by Propensity Score–Weighted Analysis
Authors: Daverio Marco , Sperotto Francesca , Stefani Chiara , Mondardini Maria Cristina , Tessari Anna , Biban Paolo , Izzo Francesca , Montani Cinzia , Lapi Maria , Picconi Enzo , Racca Fabrizio , Marinosci Geremia Zito , Savron Fabio , Wolfler Andrea , Amigoni Angela ,   on behalf of the Italian Network of PICU Study Group (TIPNet)
Published: September 2021

OBJECTIVES:

We aim to describe the use of continuous infusion of neuromuscular blocking agents in mechanically ventilated critically ill children and to test its association with in-hospital mortality.

DESIGN:

Multicenter, registry-based, observational, two-cohort-comparison retrospective study using prospectively collected data from a web-based national registry.

SETTING:

Seventeen PICUs in Italy.

PATIENTS:

We included children less than 18 years who received mechanical ventilation and a neuromuscular blocking agent infusion from January 2010 to October 2017. A propensity score–weighted Cox regression analysis was used to assess the relationship between the use of neuromuscular blocking agents and in-hospital mortality.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of the 23,227 patients admitted to the PICUs during the study period, 3,823 patients were included. Patients who received a continuous infusion of neuromuscular blocking agent were more likely to be younger (p < 0.001), ex-premature (p < 0.001), and presenting with less chronic respiratory insufficiency requiring home mechanical ventilation (p < 0.001). Reasons for mechanical ventilation significantly differed between patients who received a continuous infusion of neuromuscular blocking agent and patients who did not receive a continuous infusion of neuromuscular blocking agent, with a higher frequency of respiratory and cardiac diagnosis among patients who received neuromuscular blocking agents compared with other diagnoses (all p < 0.001). The covariates were well balanced in the propensity-weighted cohort. The mortality rate significantly differed among the two cohorts (patients who received a continuous infusion of neuromuscular blocking agent 21% vs patients who did not receive a continuous infusion of neuromuscular blocking agent 11%; p < 0.001 by weighted logistic regression). Patients who received a continuous infusion of neuromuscular blocking agent experienced longer mechanical ventilation and PICU stay (both p < 0.001 by weighted logistic regression). A weighted Cox regression analysis found the use of neuromuscular blocking agents to be a significant predictor of in-hospital mortality both in the unadjusted analysis (hazard ratio, 1.7; 95% CI, 1.3–2.2) and in the adjusted one (hazard ratio, 1.6; 95% CI, 1.2–2.1).

CONCLUSIONS:

Thirteen percent of mechanically ventilated children in PICUs received neuromuscular blocking agents. When adjusting for selection bias with a propensity score approach, the use of neuromuscular blocking agent was found to be a significant predictor of in-hospital mortality.
Effects of heavy metals on hypertension during menopause: a Korean community-based cross-sectional study
Authors: Nguyen Hai Duc , Oh Hojin , Kim Min-Sun
Published: September 2021

Objective:

To examine the associations between serum cadmium, lead, and mercury and hypertension in pre- and postmenopausal women.

Methods:

Serum heavy metal (cadmium, lead, and mercury) levels were analyzed in 7,226 randomly selected women who participated in Korean National Health and Nutrition Examination Surveys from 2009 to 2017. Odds ratios (ORs) for hypertension were calculated for log2-transformed serum heavy metal levels, median tertile levels of serum cadmium, mercury, and lead, and for interactions between heavy metal levels and tertiles, after covariate adjustment.

Results:

A doubling of serum cadmium was associated with hypertension in premenopausal (OR 2.47; 95% CI, 1.01-6.10, P = 0.049) and postmenopausal women (OR 1.70; 95% CI, 1.02-2.84, P = 0.043), and significant trends were observed for cadmium tertiles (P < 0.01). In premenopausal women, a two-fold increase in serum mercury increased the OR of hypertension by 3.08 (95% CI, 1.12-8.43, P = 0.029), and significant trends were also observed for serum mercury tertiles (P < 0.01). Interactions between serum cadmium, lead, and mercury levels in pre- and postmenopausal women were found to impact the prevalence of hypertension.

Conclusion:

Given increasing exposure to heavy metals in Korea, further prospective study is needed to identify associations between heavy metal exposures, both separately and in combination, with the prevalence of cardiovascular disease risk factors in well-characterized cohorts of different populations and to determine means of preventing heavy metal exposure.
Mobile health technologies in the diagnosis and management of atrial fibrillation
Authors: Passman Rod
Published: September 2021

Purpose of review

Atrial fibrillation is the most common sustained rhythm abnormality and is associated with stroke, heart failure, cognitive decline, and premature death. Digital health technologies using consumer-grade mobile technologies (i.e. mHealth) capable of recording heart rate and rhythm can now reliably detect atrial fibrillation using single lead or multilead ECG or photoplethysmography (PPG). This review will discuss how these developments are being used to detect and manage atrial fibrillation.

Recent findings

Studies have established the accuracy of mHealth devices for atrial fibrillation detection. The feasibility of using mHealth technology to screen for atrial fibrillation has also been established, though the utility of screening is controversial. In addition to screening, key aspects of atrial fibrillation management can also be performed remotely and effectively using mHealth, though with some important limitations.

mHealth technologies have proven disruptive in the diagnosis and management of atrial fibrillation. Healthcare providers can leverage these advances to better care for their atrial fibrillation patients whenever necessary.
AUTOLOGOUS RETINAL TRANSPLANT FOR REFRACTORY SEROUS RETINAL DETACHMENT SECONDARY TO OPTIC DISK PIT: A NOVEL SURGICAL APPROACH
Authors: Jalil Assad , Ziaei Hadi , Ivanova Tsveta
Published: September 2021

Purpose:

To present a new technique to treat refractory retinal detachment secondary to optic disk pit.

Methods:

An interventional case report.

Results:

A 25-year-old man with congenital optic disk pit had two failed vitrectomies involving laser around the optic disk, internal limiting membrane peel and flap to plug the disk pit, and gas tamponade to reattach the retina. With all options running out, a further vitrectomy with autologous retinal transplant and silicone oil tamponade was performed to treat the refractory serous retinal detachment; the silicone oil was removed at 6 weeks after the last procedure. The retina remained successfully attached at 6 months postsurgery with the patient maintaining his baseline visual acuity.

Conclusion:

The use of autologous retinal transplant is a new approach to treat refractory retinal detachment secondary to congenital optic disk anomalies, and adds to our options of dealing with this complex condition when first-line approaches have failed.
NONSYNDROMIC RETINITIS PIGMENTOSA WITH BILATERAL RETINAL NEOVASCULARIZATION DUE TO HGSNAT MUTATION
Authors: Carrera William , Ng Caleb , Burckhard Braden , Ng Joshua , McDonald Henry. Richard , Agarwal Anita
Published: September 2021

Purpose:

To describe a case of nonsyndromic retinitis pigmentosa caused by presumed compound heterozygous A615T and T522M mutations in HGSNAT, characterized by bilateral cystoid macular edema and retinal neovascularization.

Methods:

Case report. The patient underwent clinical evaluation, multimodal imaging, and next-generation panel sequencing. In silico analysis was performed with PolyPhen-2, SIFT, and MutationTaster. Segregation analysis was not available.

Results:

A 35-year-old hypertensive man presented with nyctalopia, photopsia, and difficulty reading for six months. He had no family history of visual deficits. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Examination revealed midperipheral bone spicules and macular neovascularization in both eyes. Multimodal imaging demonstrated cystoid macular edema, ellipsoid band loss outside the central macula, and leakage from the neovascularization in both eyes. Sequencing detected four mutations in three genes, including two heterozygous mutations in HGSNAT (c.1843G>A, p.A615T and c.1565C>T, p.T522M). A615T is a pathogenic, hypomorphic mutation. T522M has not been previously phenotypically described. It is predicted damaging by in silico analysis and occurs at a conserved position near the eighth transmembrane domain, adjacent to residues in which missense mutations result in protein misfolding.

Conclusion:

This is, to the best of our knowledge, the first reported case of retinal neovascularization in a case of nonsyndromic retinitis pigmentosa due to HGSNAT mutation. The T522M variant likely functions as a severe mutation alongside the hypomorphic A615T mutation. These findings expand the genotypic and phenotypic spectrum of nonsyndromic retinitis pigmentosa.