bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Ventilation Modes
Authors: Lei Yuan
Published: August 2017

‘Mechanical Ventilation Modes’ seeks to shed light on this hotly debated topic, one that is complicated by ventilator manufacturers’ non-standardized terminology. The chapter looks at conventional modes, adaptive modes, and biphasic modes, which it classifies based on the mechanical breath types in each mode. It includes a comparison chart of the terminology used for common modes on popular IPPV ventilators. Using their signature waveforms, the author describes the assist/control, SIMV, and pressure support ventilation or PSV modes. It defines the modes by their application of spontaneous breaths and mandatory breaths. It continues with a discussion of adaptive modes and biphasic modes. It ends by discussing how to select the appropriate ventilation mode.
Ventilator Monitoring
Authors: Lei Yuan
Published: August 2017

‘Ventilator Monitoring’ describes that group of functions that enables us to understand the functional status of a ventilator system and the ventilated patient. This chapter begins by introducing general monitoring concepts, describing the operation of the flow sensors and oxygen sensors that make the measurements, which are displayed as numerical monitoring parameters, waveforms, dynamic loops, and trend curves. The chapter details common monitoring parameters for pressure, flow, volume, time, and oxygen concentration. Examples of normal and abnormal ventilator graphics are shown. Finally, the chapter details each typical monitoring parameter and gives background information about its significance.
The Concept of Resilience
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 2 covers information on infrastructure and community resilience, emergency planning, identifying and managing the vulnerable, emergency planning process, and types of emergency plans. The chapter describes the concept and approach to integrated emergency management. The principles of emergency planning are outlined in reference to the local, regional, and governmental levels, including Local Resilience Forums, the National Risk Register (NRR), and risk classification within the National Risk Register, critical national infrastructure, and building resilience within an organization.
The Framework for a Major Incident Response
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 3 covers information on legislation including the Civil Contingencies Act 2004 and related guidance. It describes the use of established emergency plans, determination of the level of response related to impact, a generic major incident multiagency response framework, the subnational (multi-LRF) response, and examples of specific hazards and contingencies. Key components of the response are discussed: recognition, reporting (including public awareness), delegation, responders and their objectives, containment, and risk assessment. Each of the tiers of command control and coordination are described in detail. Major incident funding is also briefly covered.
Responsibilities of Relevant Agencies, Services, and Other Bodies and Individuals
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 4 covers information on concept of operations, emergency services responsibilities, the role of the coroner, use of air assets, other agencies, responders not included in the Civil Contingencies Act 2004, voluntary aid organizations and their capabilities, voluntary services response funding, the role of the armed forces (Military Aid to the Civil Authorities), and the responsibilities of first attenders on scene.
Chemical Incidents
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 8 covers information on types of chemical incident, toxic industrial chemicals, the initial response to a chemical incident, decontamination, UK Reserve National Stock, clinical syndromes (toxidromes), toxicology and forensics, the chain of evidence, transport, public information, advice to individuals, personal protective equipment, specific antidotes, the hospital response to a chemical incident, reporting chemical exposure cases, and chemical hazard labels.
Cardiopulmonary resuscitation and the post-cardiac arrest syndrome
Authors: Nolan Jerry P
Published: August 2017

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient’s final neurological outcome. These interventions aim to restore myocardial function and minimize neurological injury.
Echocardiography and thoracic ultrasound
Authors: Flachskampf Frank A , Myrianthefs Pavlos , Beyer Ruxandra , Myrianthefs Pavlos M.
Published: August 2017

For the emergency management of cardiovascular disorders, echocardiography and thoracic ultrasound are indispensable imaging techniques at the bedside. In the intensive care environment, crucial questions, such as left and right ventricular function, valvular heart disease, volume status, aortic disease, cardiac infection, pleural effusion, pulmonary oedema, pneumothorax, and many others, can be sufficiently and reliably answered by using these techniques; in fact, it is almost impossible to manage patients with acute severe haemodynamic impairment reasonably well without a prompt and repeated access to echocardiography. This is confirmed by the prominent place that echocardiography has in the guideline-based diagnosis and treatment of all major cardiovascular emergencies, from acute heart failure to the acute coronary syndrome to pulmonary embolism, etc. Moreover, it is the ideal tool to follow the patient, since repeat examinations pose no risk to the patient and demand relatively little logistics and resources. To benefit from the wealth of information that echocardiography and thoracic ultrasound can provide, modern equipment (including a transoesophageal probe) and systematic training of echocardiographers must be ensured. The availability of prompt and experienced echocardiography and thoracic ultrasound services at all times is fundamental for sound contemporary cardiovascular intensive care.
Atrial fibrillation and supraventricular arrhythmias
Authors: Katritsis Demosthenes , Camm A John
Published: August 2017

This chapter discusses the acute management of patients presenting with tachyarrhythmias suggestive of regular supraventricular tachycardias (SVT) and/or atrial fibrillation (AF). A classification of narrow- and wide-QRS tachycardias is presented, and the differential diagnosis of narrow- and wide-QRS tachycardias is discussed. Principles of acute therapy are presented either in the context of acute therapy before establishing a definitive diagnosis or for particular arrhythmia entities with an established diagnosis of a regular SVT or AF.
Stroke
Authors: Leys Didier , Cordonnier Charlotte , Caso Valeria
Published: August 2017

Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, mechanical thrombectomy in case of proximal occlusion (middle cerebral artery, intracranial internal carotid artery, basilar artery), on top of thrombolysis in the absence of contraindication or alone otherwise, aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, while surgery does not seem effective to reduce death and disability.
Magnetospherically-trapped dust and a possible model for the unusual transits at WD 1145+017
Authors: Farihi J , von Hippel T , Pringle J E
Published: August 2017

The rapidly evolving dust and gas extinction observed towards WD 1145+017 has opened a real-time window on to the mechanisms for destruction-accretion of planetary bodies on to white dwarf stars, and has served to underline the importance of considering the dynamics of dust particles around such objects. Here it is argued that the interaction between (charged) dust grains and the stellar magnetic field is an important ingredient in understanding the physical distribution of infrared emitting particles in the vicinity of such white dwarfs. These ideas are used to suggest a possible model for WD 1145+017 in which the unusual transit shapes are caused by opaque clouds of dust trapped in the stellar magnetosphere. The model can account for the observed transit periodicities if the stellar rotation is near 4.5 h, as the clouds of trapped dust are then located near or within the co-rotation radius. The model requires the surface magnetic field to be at least around some tens of kG. In contrast to the eccentric orbits expected for large planetesimals undergoing tidal disintegration, the orbits of magnetospherically-trapped dust clouds are essentially circular, consistent with the observations.
HESS J0632+057: hydrodynamics and non-thermal emission
Authors: Bosch-Ramon Valentí , Barkov Maxim V. , Mignone Andrea , Bordas Pol
Published: August 2017

HESS J0632+057 is an eccentric gamma-ray Be binary that produces non-thermal radio, X-rays, GeV and very high-energy gamma-rays. The non-thermal emission of HESS J0632+057 is modulated with the orbital period, with a dominant maximum before apastron passage. The nature of the compact object in HESS J0632+057 is not known, although it has been proposed to be a young pulsar as in PSR B1259–63, the only gamma-ray emitting high-mass binary known to host a non-accreting pulsar. In this letter, we present hydrodynamical simulations of HESS J0632+057 in the context of a pulsar and a stellar wind interacting in an eccentric binary, and propose a scenario for the non-thermal phenomenology of the source. In this scenario, the non-thermal activity before and around apastron is linked to the accumulation of non-thermal particles in the vicinity of the binary, and the sudden drop of the emission before apastron is produced by the disruption of the two-wind interaction structure, allowing these particles to escape efficiently. In addition to providing a framework to explain the non-thermal phenomenology of the source, this scenario predicts extended, moving X-ray emitting structures similar to those observed in PSR B1259–63.
Photometric redshifts for Hyper Suprime-Cam Subaru Strategic Program Data Release 1
Authors: Tanaka Masayuki , Coupon Jean , Hsieh Bau-Ching , Mineo Sogo , Nishizawa Atsushi J , Speagle Joshua , Furusawa Hisanori , Miyazaki Satoshi , Murayama Hitoshi
Published: August 2017

Photometric redshifts are a key component of many science objectives in the Hyper Suprime-Cam Subaru Strategic Program (HSC-SSP). In this paper, we describe and compare the codes used to compute photometric redshifts for HSC-SSP, how we calibrate them, and the typical accuracy we achieve with the HSC five-band photometry (grizy). We introduce a new point estimator based on an improved loss function and demonstrate that it works better than other commonly used estimators. We find that our photo-z’s are most accurate at 0.2 ≲ zphot ≲ 1.5, where we can straddle the 4000 Å break. We achieve σ[Δzphot/(1 + zphot)] ∼ 0.05 and an outlier rate of about 15% for galaxies down to i = 25 within this redshift range. If we limit ourselves to a brighter sample of i < 24, we achieve σ ∼ 0.04 and ∼8% outliers. Our photo-z's should thus enable many science cases for HSC-SSP. We also characterize the accuracy of our redshift probability distribution function (PDF) and discover that some codes over-/underestimate the redshift uncertainties, which has implications for N(z) reconstruction. Our photo-z products for the entire area in Public Data Release 1 are publicly available, and both our catalog products (such as point estimates) and full PDFs can be retrieved from the data release site, 〈https://hsc-release.mtk.nao.ac.jp/〉.
Ban the Box, Criminal Records, and Racial Discrimination: A Field Experiment*
Authors: Agan Amanda , Starr Sonja
Published: August 2017

“Ban the Box” (BTB) policies restrict employers from asking about applicants’ criminal histories on job applications and are often presented as a means of reducing unemployment among black men, who disproportionately have criminal records. However, withholding information about criminal records could risk encouraging racial discrimination: employers may make assumptions about criminality based on the applicant's race. To investigate BTB’s effects, we sent approximately 15,000 online job applications on behalf of fictitious young, male applicants to employers in New Jersey and New York City before and after the adoption of BTB policies. These applications varied whether the applicant had a distinctly black or distinctly white name and the felony conviction status of the applicant. We confirm that criminal records are a major barrier to employment: employers that asked about criminal records were 63% more likely to call applicants with no record. However, our results support the concern that BTB policies encourage racial discrimination: the black-white gap in callbacks grew dramatically at companies that removed the box after the policy went into effect. Before BTB, white applicants to employers with the box received 7% more callbacks than similar black applicants, but BTB increased this gap to 43%. We believe that the best interpretation of these results is that employers are relying on exaggerated impressions of real-world racial differences in felony conviction rates.
A Beacon for Applied Plant Pathology: The Origins of Plant Disease
Authors: Peterson Paul D. , Nelson Steve C. , Scholthof Karen-Beth G.
Published: August 2017

This year marks a full century since the founding of the journal Plant Disease. The story of how the journal developed, from its origins as a service publication of the USDA in 1917 to the leading applied journal in the field today, reflects on major historical themes in plant pathology. Central to this narrative is the delicate balancing act in plant pathology between fundamental and applied science. During the 1960s and 1970s, substantial numbers of plant pathologists in the U.S. expressed concerns through the American Phytopathological Society (APS) over what they viewed as an alarming and increasing scarcity of applied papers in the flagship journal, Phytopathology. These concerns led increasingly to calls for a second APS journal devoted to applied research. After a period of uncertainty and indecision, the dissolution of the USDA Plant Disease Reporter (PDR) in 1979 offered APS leadership an unusual opportunity to assume publication of a journal with a 63-year legacy of publishing practical plant pathology. In a bold move, APS Council, with the decision in 1979 to take on the publication of PDR under the new title, Plant Disease, provided plant pathologists and the larger agricultural science community with an innovative vehicle to communicate applied plant pathology.
Comparison of 3% Hypertonic Saline and 20% Mannitol for Reducing Intracranial Pressure in Patients Undergoing Supratentorial Brain Tumor Surgery: A Randomized, Double-blind Clinical Trial
Authors: Ali Achmet , Tetik Aylin , Sabanci Pulat A. , Altun Demet , Sivrikoz Nukhet , Abdullah Taner , Aydoseli Aydin , Sencer Altay , Akinci Ibrahim O.
Published: August 2017

Background:

In the present study, we hypothesized that 3% hypertonic saline (HS) is more effective than 20% mannitol to reduce intracranial pressure (ICP) and to modify brain bulk in patients undergoing an elective supratentorial craniotomy.

Materials and Methods:

After institutional review board approval, patients scheduled to undergo supratentorial craniotomy were enrolled into this prospective, randomized, double-blind study. The patients were monitored for routine hemodynamic parameters, depth of anesthesia, and ICP. They received 5 mL/kg 20% mannitol (n=20) or 3% HS (n=19) as infusion for 15 minutes. The patients’ ICP values were monitored during hypertonic fluid infusion and throughout 30 minutes after infusion as a primary outcome. Secondary outcomes were hemodynamic variables, serum sodium value, blood gases, and surgeon brain relaxation assessment score (1=relaxed, 2=satisfactory, 3=firm, 4=bulging). In addition, the length of intensive care unit and hospital stay were recorded.

Results:

Demographic and tumor characteristics were similar between groups. The basal (before hypertonic infusion, ICPT0) and last (30 min after hypertonic infusion finished, ICPT45) ICP values were 13.7±3.0 and 9.5±1.9 mm Hg, respectively, for the M group, which were comparable with the corresponding levels of 14.2±2.8 and 8.7±1.1 mm Hg in the HS group (P>0.05). The median amount of ICP reduction between T0 and T45 timepoints were 4 (1 to 7) and 5 (1 to 9) mm Hg for group M and group HS, respectively (P=0.035). Baseline central venous pressure, pulse pressure variation, and serum sodium and lactate values were similar between groups, but the last measured pulse pressure variation and lactate value were lower, and sodium value was higher in group HS than in group M (P<0.05). Duration of hospital and intensive care unit stay were similar between groups.

Conclusions:

Our results suggest that 3% HS provided more effective ICP reduction than 20% mannitol during supratentorial brain tumor surgery.
Comparison of two radiological methods in the determination of skeletal maturity in the Indian pediatric population
Authors: Keny Swapnil M. , Sonawane Dhiraj V. , Pawar Eknath , Saraogi Akash A. , Singh Vikram , Khan Feroz , Bande Pravin P. , Chandanwale Ajay
Published: August 2017

To determine a more precise and reliable method between Greulich–Pyle (GP) and MacKay’s (MK) method for the determination of skeletal age in an Indian pediatric population. We carried out a cross sectional study for the assessment of skeletal age on the basis of examination of hand and wrist radiographs of 106 patients (1–15 years of age) who presented with soft tissue injury to hand by the GP and the MK method. These radiographs were evaluated by a radiologist and an orthopedic surgeon independently. In girls, the mean age difference between chronological and skeletal age was 8 months by the GP method, whereas it was 17 months by MK method. For boys, the mean age difference was 10 months by the GP method and by MKs method, it was 20 months. By the GP method, 44% of the boys showed a more reliable estimate of age whereas it was 10% by the MK method. However, the same for girls was 25% by the GP method and 16% by the MK method. The inter-rater reliability for the raters was found to be κ=0.68 and this was statistically significant (P<0.001), 95% confidence interval (0.504–0.848). We concluded that the GP method appeared to be more reliable in the determination of skeletal age in the Indian pediatric population.
Efficacy of Modified Dose-dense Paclitaxel in Recurrent Cervical Cancer
Authors: Machida Hiroko , Moeini Aida , Ciccone Marcia A. , Mostofizadeh Sayedamin , Takiuchi Tsuyoshi , Brunette Laurie L. , Roman Lynda D. , Matsuo Koji
Published: August 2017

Objective:

To examine survival outcomes of women with recurrent cervical cancer who received salvage chemotherapy with modified dose-dense paclitaxel (MDDP) monotherapy (paclitaxel 80 mg/m2, administered on day 1, 8, and 15 without day 22).

Materials and Methods:

A retrospective study was conducted to evaluate cause-specific survival after the first recurrence (SAR) of women with recurrent cervical cancer diagnosed between 2006 and 2014. Pooled analyses were performed to examine SAR in women who received MDDP monotherapy (n=17) for any treatment line, compared with those who received salvage chemotherapy with paclitaxel-doublet (n=18) and nonpaclitaxel regimens (n=52).

Results:

In the whole cohort, median SAR was 13.7 months including 63 (72.4%) events. MDDP monotherapy regimen was most commonly used in the second-line setting (35.3%) followed by the third/fourth lines (both, 23.5%). Among the women who received MDDP regimen, there were 6 (35.3%) women who received ≥6 cycles; there was 1 (5.9%) women who discontinued the regimen due to adverse effects (grade 3 transaminitis); regimen postponement was seen in 2 (1.4%) of 140 total cycles; and the response rate after the sixth cycle of this regimen was 29.4% (1 complete and 4 partial responses). On univariate analysis, MDDP usage had the highest 2-year SAR rate (MDDP 54.1%, paclitaxel-doublet 43.6%, and nonpaclitaxel regimens 28.1%; P
trend=0.044). On multivariate analysis, MDDP monotherapy remained an independent prognostic factor for improved SAR compared with the nonpaclitaxel regimen (adjusted-hazard ratio, 0.50; 95% confidence interval, 0.26-0.95; P=0.036).

Conclusion:

Our results suggested that MDDP monotherapy is a tolerable and relatively effective regimen for recurrent cervical cancer.
Intramuscularly injected neurotropin reduced muscular mechanical hyperalgesia induced by repeated cold stress in rats
Authors: Nasu Teruaki , Murase Shiori , Takeda-Uchimura Yoshiko , Mizumura Kazue
Published: August 2017

An extract of rabbit skin inflamed by inoculation with the vaccinia virus, neurotropin [by intravenous, oral, and intramuscular (i.m.) administration], has been used in China and Japan for the treatment of chronic pain. In this study, we investigated the analgesic mechanism of i.m. neurotropin. Rats were exposed to repeated cold stress, and muscular mechanical hyperalgesia was evaluated by measuring the withdrawal threshold of the gastrocnemius muscle using Randall–Selitto apparatus. I.m. but not subcutaneous, neurotropin dose dependently reduced the repeated cold stress-induced muscular mechanical hyperalgesia for 3 h, but it had no effect in normal rats. Injections of neurotropin into the right gastrocnemius, quadriceps femoris, biceps brachii, and trapezius muscles reduced the muscular mechanical hyperalgesia of the gastrocnemius muscle bilaterally. Intrathecal administration of antagonists to GABAergic, serotonergic, and cholinergic receptors, but not α2-adrenergic receptors, and intraperitoneal administration of opioid receptor antagonist inhibited the analgesic effect of neurotropin. These results indicated that an i.m. injection of neurotropin induced long-lasting wide-spread bilateral muscular analgesia by activating spinal serotonergic and GABAergic receptors. As distinct from analgesia by systemic administration, spinal cholinergic and opioidergic, but not adrenergic receptors, are also involved. The present study supports the effectiveness of neurotropin treatment for muscular mechanical hyperalgesia.
Cardiovascular fat in women at midlife: effects of race, overall adiposity, and central adiposity. The SWAN Cardiovascular Fat Study
Authors: Hanley Carrie , Matthews Karen A. , Brooks Maria M. , Janssen Imke , Budoff Matthew J. , Sekikawa Akira , Mulukutla Suresh , El Khoudary Samar R.
Published: August 2017

Objectives:

Cardiovascular fat (CF) is associated with greater coronary heart disease (CHD) risk. Postmenopausal women have greater CF volumes than premenopausal women, and the association between specific CF depot volumes and CHD risk is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact CF volumes. Whether racial differences in CF volumes and in their associations with central (visceral fat [VAT]) and general adiposity (body mass index [BMI]) exist in midlife women have not been addressed before.

Methods:

In all, 524 participants from the Study of Women's Health Across the Nation (mean age: 50.9 ± 2.9 years; 62% White and 38% Black) who had data on CF volumes (epicardial fat [EAT], paracardial fat [PAT], total heart fat, and aortic perivascular fat), VAT, and BMI were studied.

Results:

In models adjusted for age, study site, menopausal status, comorbid conditions, alcohol consumption, and physical activity, Black women had 19.8% less EAT, 24.5% less PAT, 20.4% less total heart fat, and 13.2% less perivascular fat than White women (all P < 0.001). These racial differences remained significant after additional adjustment for BMI or VAT. Race significantly modified associations between adiposity measures and CF volumes. Every 1-SD higher BMI was associated with 66.7% greater PAT volume in White compared with 42.4% greater PAT volume in Black women (P = 0.004), whereas every 1-SD higher VAT was associated with 32.3% greater EAT volume in Black compared with 25.3% greater EAT volume in White women (P = 0.039).

Conclusions:

Racial differences were found in CF volumes and in their associations with adiposity measures among midlife women. Future research should determine how race-specific changes in CF volumes impact CHD risk in women.
Body composition, cardiometabolic risk factors, physical activity, and inflammatory markers in premenopausal women after a 10-year follow-up: a MONET study
Authors: Razmjou Sahar , Abdulnour Joseph , Bastard Jean-Philippe , Fellahi Soraya , Doucet Éric , Brochu Martin , Lavoie Jean-Marc , Rabasa-Lhoret Rémi , Prud’homme Denis
Published: August 2017

Objective:

Menopausal transition and postmenopause are usually associated with changes in body composition and a decrease in physical activity energy expenditure (PAEE). This study investigated body composition, cardiometabolic risk factors, PAEE, and inflammatory markers in premenopausal women after a 10-year follow-up.

Methods:

In all, 102 premenopausal women participated in the 5-year observational longitudinal Montreal Ottawa New Emerging Team (MONET) study. This present substudy included 48 participants (age: 60.0 ± 1.7 years; body mass index: 23.2 ± 2.2 kg/m2) 6.0 ± 0.3 years after completion of the initial MONET study. Measures included body composition, waist circumference (WC), fasting glucose and insulin levels, insulin sensitivity (QUICKI model), plasma lipid levels, PAEE, and inflammatory markers.

Results:

Compared with baseline measures of the MONET study, analyses revealed no significant increase in body weight, although there were significant increases in WC, fat mass (FM), % FM, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, haptoglobin, apolipoprotein B, ferritin, adiponectin, and soluble cluster of differentiation 14 (all P < 0.001) after the 10-year follow-up. However, significant decreases were observed for fat-free mass, PAEE, fasting glucose levels, interleukin-8 levels, and soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2) levels (all P < 0.05). To determine the effect of postmenopausal years, data were restructured based on final menstrual period (FMP), and one-way analyses of variance were performed.

Waist circumference, % FM, total cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, ferritin, adiponectin, and soluble cluster of differentiation 14 were higher in early and late postmenopausal periods in these women. sTNFR-1 and sTNFR-2 levels were higher at the FMP and early postmenopausal years as compared with the late postmenopausal periods. Finally, interleukin-8 levels were lower in years after FMP.

Conclusion:

The number of years elapsed since the FMP can affect body composition, cardiometabolic risk factors, and inflammatory markers in healthy premenopausal women going through menopausal transition and postmenopausal periods.
Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women
Authors: Cruz Vera L. , Steiner Marcelo L. , Pompei Luciano M. , Strufaldi Rodolfo , Fonseca Fernando L. Afonso , Santiago Lucila H. Simardi , Wajsfeld Tali , Fernandes Cesar E.
Published: August 2017

Objective:

The aim of the study was to evaluate efficacy of fractional CO2 vaginal laser treatment (Laser, L) and compare it to local estrogen therapy (Estriol, E) and the combination of both treatments (Laser + Estriol, LE) in the treatment of vulvovaginal atrophy (VVA).

Methods:

A total of 45 postmenopausal women meeting inclusion criteria were randomized in L, E, or LE groups. Assessments at baseline, 8 and 20 weeks, were conducted using Vaginal Health Index (VHI), Visual Analog Scale for VVA symptoms (dyspareunia, dryness, and burning), Female Sexual Function Index, and maturation value (MV) of Meisels.

Results:

Forty-five women were included and 3 women were lost to follow-up. VHI average score was significantly higher at weeks 8 and 20 in all study arms. At week 20, the LE arm also showed incremental improvement of VHI score (P = 0.01). L and LE groups showed a significant improvement of dyspareunia, burning, and dryness, and the E arm only of dryness (P < 0.001). LE group presented significant improvement of total Female Sex Function Index (FSFI) score (P = 0.02) and individual domains of pain, desire, and lubrication. In contrast, the L group showed significant worsening of pain domain in FSFI (P = 0.04), but FSFI total scores were comparable in all treatment arms at week 20.

Conclusions:

CO2 vaginal laser alone or in combination with topical estriol is a good treatment option for VVA symptoms. Sexual-related pain with vaginal laser treatment might be of concern.
Safety of Outpatient Parenteral Antimicrobial Therapy in Children
Authors: Fernandes Priyanka , Milliren Carly , Mahoney-West Helen M. , Schwartz Laura , Lachenauer Catherine S. , Nakamura Mari M.
Published: August 2017

Background and Objective:

Outpatient parenteral antimicrobial therapy (OPAT) provides numerous benefits but may pose unique risks in children. We aimed to determine rates of OPAT antimicrobial- and intravenous access-related complications and their associations with specific antimicrobials and type of intravenous access in pediatric patients.

Methods:

Observational cohort study of patients receiving OPAT from August 2008 to May 2015 cared for by the Infectious Diseases service at a tertiary children’s hospital. Primary outcome was antimicrobial discontinuation (AD) because of OPAT-associated complications. Secondary outcomes were unplanned outpatient healthcare visits and readmissions from OPAT-associated complications.

Results:

Seven hundred and seven intravenous antimicrobials were prescribed in 540 cases. Nondevice-associated musculoskeletal infection was the most common diagnosis (39%). Ceftriaxone (30%), cefazolin (27%) and vancomycin (22%) were the most commonly used antimicrobials. Complications led to AD, ≥1 unplanned outpatient healthcare visit and ≥1 readmission in 23%, 30% and 17% of cases, respectively. Compared with use of ceftriaxone, use of oxacillin was associated with a significantly higher risk of AD because of any antimicrobial-related complication [hazard ratio (HR), 3.3; 95% confidence interval (CI): 1.2–9.7) and because of hepatic transaminitis (HR, 32.8; 95% CI: 4.02–268.2). Subjects treated with intravenous clindamycin (HR, 2.6; 95% CI: 1.1–5.8) and with a peripherally inserted central catheter (HR, 2.6; 95% CI: 1.04–6.3) were more likely to have unplanned outpatient visits.

Conclusions:

Use of oxacillin during OPAT was associated with higher rate of AD. Patients treated with clindamycin and those with a peripherally inserted central catheter had higher rates of unplanned outpatient visits. Providers should strongly consider alternative treatment options when possible.
Epidemiology of Sepsis-like Illness in Young Infants
Authors: de Jong Eveline P. , van den Beuken Monique G. A. , van Elzakker Erika P. M. , Wolthers Katja C. , Sprij Arwen J. , Lopriore Enrico , Walther Frans J. , Brus Frank
Published: August 2017

Background:

Sepsis-like illness is a main cause for hospital admission in young infants. Our aim was to investigate incidence, epidemiology and clinical characteristics of enterovirus (EV) and human parechovirus (HPeV) infections in young infants with sepsis-like illness.

Methods:

This is a prospective observational cohort study in which infants younger than 90 days of age, presenting with sepsis-like symptoms in a secondary care children’s hospital, underwent a full sepsis work-up. Clinical signs and infectious indices were recorded. EV or HPeV RNA was detected by polymerase chain reaction in plasma and/or cerebrospinal fluid (CSF).

Results:

Infants were diagnosed with EV, HPeV, fever of unknown origin or severe infection. EV and HPeV were detected in 132 of 353 (37%) and 52 of 353 (15%) of cases, respectively. EV and HPeV have distinct seasonability. Some differences in clinical signs and symptoms occurred between children with EV and HPeV infection but were of limited clinical value. CSF pleocytosis occurred in 44% of EV positive infants, and only in 13% of those with HPeV infection.

Conclusions:

EV and HPeV infections are major causes of sepsis-like illness in infants < 90 days of age. Neither clinical characteristics nor laboratory indices were predictive for EV/HPeV infection. CSF pleocytosis occurs, but not in all patients. Testing for EV and HPeV in all young infants with sepsis-like illness is strongly advised.
Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity
Authors: Guimarães-Pereira Luís , Reis Pedro , Abelha Fernando , Azevedo Luís Filipe , Castro-Lopes José Manuel
Published: August 2017

Persistent postoperative pain (PPP) has been described as a complication of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by conducting a systematic review of the literature regarding its incidence, intensity, location, and the presence of neuropathic pain, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The review comprised 3 phases: a methodological assessment of 6 different databases identifying potential articles and screening for inclusion criteria by 2 independent reviewers; data extraction; and study quality assessment. Meta-analysis was used to estimate the pooled incidence rates using a random effects model. We have identified 442 potentially relevant studies through database searching. A total of 23 studies (involving 11,057 patients) met our inclusion criteria. Persistent postoperative pain affects 37% patients in the first 6 months after CS, and it remains present more than 2 years after CS in 17%. The reported incidence of PPP during the first 6 months after CS increased in recent years. Globally, approximately half of the patients with PPPCS reported moderate to severe pain. Chest is the main location of PPPCS followed by the leg; neuropathic pain is present in the majority of the patients. This is the first systematic review and meta-analysis to provide estimates regarding incidence and intensity of PPPCS, which elucidates its relevance. There is an urgent need for adequate treatment and follow-up in patients with PPPCS.
Defining chronic pain in epidemiological studies: a systematic review and meta-analysis
Authors: Steingrímsdóttir Ólöf Anna , Landmark Tormod , Macfarlane Gary J. , Nielsen Christopher Sivert
Published: August 2017

The objective was to document the operational definitions applied in epidemiological studies of chronic pain and to examine whether pain definitions and other methodological factors are systematically related to prevalence estimates. MEDLINE, EMBASE, and PsychINFO were searched for original research reports with study samples of at least 1000 individuals, excluding studies of less than 5 out of 15 selected body regions and studies solely concerned with specific pain conditions. Meta-analyses and meta-regressions were applied with random effects models; covariates were geography, sampling year, survey method, sampling frame, participation rate, percentage women of all participants, pain duration, and pain location. Of 6791 hits, 86 studies were included in the syntheses. The phrasing, content, and combinations of the chronic pain definition criteria were highly inconsistent, with virtually no 2 studies from independent research groups using the exact same criteria. Prevalence estimates ranged from 8.7% to 64.4%, with a pooled mean of 31%. Huge heterogeneity was shown in all forest plots. Prevalence estimates were significantly related to survey method (β = −10.8 [95% confidence interval: −17.2 to −4.4]), but it only counted for a small fraction of the between-studies variation in the estimates. There were also interaction effect of survey method by sex (female–male prevalence ratio [95% confidence interval]: questionnaire = 1.20 [1.16 to 1.25], and interview = 1.38 [1.29 to 1.47]). The other covariates investigated were not significantly related to the prevalence estimates. Researchers and clinicians should be aware of the probability that interview survey method of collecting data may give lower chronic pain reporting than questionnaire survey method and that this effect may be stronger in men than women.
Can the Sum of Adenoma Diameters (Adenoma Bulk) on Index Examination Predict Risk of Metachronous Advanced Neoplasia?
Authors: Anderson Joseph C. , Morris Carolyn B. , Robertson Douglas J. , Barry Elizabeth L.R. , Figueiredo Jane C. , Cruz-Correa Marcia , Bostick Roberd M. , Ahnen Dennis J. , Baron John A.
Published: August 2017

Background:

Recent data suggest that adenoma size and number are more important predictors of metachronous colorectal neoplasia than advanced histology. Furthermore, there is poor reproducibility in diagnosing advanced histology; high-grade dysplasia and villous histology. Therefore we developed a new metric, adenoma bulk, the sum of diameters of all baseline adenomas, regardless of advanced features.

Goal:

Compare the predictive value for metachronous advanced neoplasia of adenoma bulk to conventional paradigm.

Study:

Data were collected prospectively in a multicenter adenoma-chemoprevention trial (2004 to 2013). For the conventional paradigm, high-risk baseline findings were defined as ≥3 adenomas, large adenomas (≥1 cm) or adenomas with villous components or high-grade dysplasia. Adenoma bulk was examined across quartiles and as a continuous variable. Predictive characteristics (sensitivities, specificities, c-statistics) for metachronous advanced neoplasia using conventional criteria and adenoma bulk were calculated. receiver operator characteristic curves were computed using logistic regression.

Results:

In total, 1948 adults had index and follow-up colonoscopies (mean follow-up, 45.2 mo). Those with an adenoma bulk ≥10 mm (4th quartile) had a higher metachronous advanced neoplasia risk (14.4% vs. 6.9–8.2% in lower 3 quartiles; P=0.0002). The c-statistics and sensitivities (specificity fixed at 0.73) for the adenoma bulk and conventional models were 0.587 and 0.563 (P=0.17) and 0.396 and 0.390, respectively.

Conclusions:

Categorizing sporadic adenoma patients as high versus low risk for metachronous advanced neoplasia by adenoma bulk of <versus ≥10 mm may be comparably predictive as conventional paradigm and simplifies risk stratification by obviating need for additional histology regarding extent of villous component or degree of dysplasia in resected polyps. The adenoma bulk metric and the 10 mm cutoff in particular would have to be validated in other populations before it can be used in clinical practice.
Endoscopic gastroenterostomy: techniques and review
Authors: Irani Shayan , Baron Todd H. , Itoi Takao , Khashab Mouen A.
Published: August 2017

Purpose of review

Gastric outlet obstruction (GOO) can result from benign and malignant causes. Until recently, surgical gastrojejunostomy was the treatment of choice for patient with benign and malignant GOO with a good functional status. Endoscopic placement of luminal self-expandable metal stents is currently widely accepted as the first line of treatment for malignant GOO because of its effectiveness and minimally invasive nature. The main shortcoming of luminal stents is the high incidence of recurrent GOO most commonly because of tumor ingrowth/overgrowth. More recently, endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) has emerged as an alternative to both luminal stent placement and surgical gastrojejunostomy. Advantages of EUS-GE include its minimally invasive nature, efficacy and low incidence of recurrent GOO in cancer patient. We will describe five different techniques to perform this novel and rapidly evolving procedure using a biflanged, lumen-apposing metal stent and compare benefits and risks of each approach. These approaches include antegrade EUS-GE or ‘traditional/downstream’ and ‘rendezvous’ methods, retrograde EUS-GE or ‘enterogastrostomy,’17 (EPASS), and antegrade EUS-GE ‘direct’ method.

Recent findings

A preprocedural computed tomography scan allows the proximity of the duodenum or jejunum to the stomach to be determined and to assess for the presence of significant ascites, which is a contraindication to EUS-GE. Technical success rates even in the early studies approximate 90%, regardless of the technique used. Clinical success rates have been exceptionally high as well, with only a minority of patients experiencing persistent symptoms despite technical success. One procedure-related death has been reported so far with an overall low morbidity. Pain, bleeding, pneumoperitoneum and peritonitis have been reported in one patient each. However, duration of follow-up in these studies has been short.

We describe five different techniques to performing EUS-GE. Early studies show excellent efficacy. Stent misdeployment/displacement is the most frequent relevant adverse event. Prospective and preferably randomized trials with comparison to endoluminal enteral stents and surgical gastroenterostomy are needed.
The Care Team Visit
Authors: Malec Ann , Mørk Anne , Hoffman Robert , Carlson Elizabeth
Published: August 2017

Interdisciplinary bedside rounds serve as a key mechanism to coordinate patient-centered care. With a focus on optimizing rounds, an interdisciplinary team developed an enhanced, structured process, coined the care team visit. Key findings included improved nurse participation, increased staff collaboration, and decreased Foley catheter days. The process outlined can be used by health care professionals to improve the effectiveness of interdisciplinary bedside rounds.
Environmental Health Tracking Improves Pesticide Use Data to Enable Research and Inform Public Health Actions in California
Authors: Richardson Maxwell J. , Madrigal Daniel S. , Wilkie Alexa , Wong Michelle , Roberts Eric
Published: August 2017

Pesticides have adverse impacts on the environment and public health. In response to growing public concern over these impacts, California implemented the Pesticide Use Reporting (PUR) program in 1990. The PUR program is widely recognized as the world's most comprehensive pesticide reporting system, and its pesticide application records are highly detailed. However, the complexity and volume of PUR data require a level of data skills and resources beyond many government agencies, public health professionals, and community stakeholders. Over the past decade, the California Environmental Health Tracking Program has undertaken multiple strategies to make PUR data more accessible, understandable, and useful to a diversity of data users. Three specific efforts are described in detail—the Pesticide Linkage Service, the Pesticide Mapping Tool, and a policy-relevant analysis on pesticide use near schools—as are their impacts on environmental and public health research, community outreach and education, and policy change.
Using Tracking Data to Promote Environmental Public Health Through Regulatory and Legislative Processes in New York City
Authors: McKelvey Wendy , Blank Jeffrey , Kheirbek Iyad , Torin Beth
Published: August 2017

Legislation and regulation are powerful tools for decreasing health risks from environmental hazards. Legislation is enacted by an elected body, and regulations are issued by an agency in the executive branch delegated authority by the legislature to carry out enacted laws. The New York City (NYC) Environmental Public Health Tracking Program makes data and analytic findings available to policy makers to inform development of sound and effective environmental health legislation and regulation. Tracking data and associated science create awareness of environmental hazards and health impacts, guide strategies for mitigating hazards, and sustain support for effective law by documenting beneficial impacts on the environment and health. We describe how environmental and health surveillance data and analytic findings have informed legislation and regulations related to restaurant food safety and air pollution control in NYC. Using data to guide legislative and regulatory processes helps ensure that policy decisions and directions are based on objective evidence.