bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019
Authors: Devlin John W. , O’Neal Hollis R. , Thomas Christopher , Barnes Daly Mary Ann , Stollings Joanna L. , Janz David R. , Ely E. Wesley , Lin John C. 
Published: June 2020

Objectives:
The severe acute respiratory syndrome coronavirus 2 pandemic has stretched ICU resources in an unprecedented fashion and outstripped personal protective equipment supplies. The combination of a novel disease, resource limitations, and risks to medical personnel health have created new barriers to implementing the ICU Liberation (“A” for Assessment, Prevention, and Manage pain; “B” for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; “C” for Choice of Analgesia and Sedation; “D” for Delirium Assess, Prevent, and Manage; “E” for Early Mobility and Exercise; and “F” for Family Engagement and Empowerment [ABCDEF]) Bundle, a proven ICU care approach that reduces delirium, shortens mechanical ventilation duration, prevents post-ICU syndrome, and reduces healthcare costs. This narrative review acknowledges barriers and offers strategies to optimize Bundle performance in coronavirus disease 2019 patients requiring mechanical ventilation.

Data Sources, Study Selection, and Data Extraction:
The most relevant literature, media reports, and author experiences were assessed for inclusion in this narrative review including PubMed, national newspapers, and critical care/pharmacology textbooks.

Data Synthesis:
Uncertainty regarding coronavirus disease 2019 clinical course, shifts in attitude, and changes in routine behavior have hindered Bundle use. A domino effect results from: 1) changes to critical care hierarchy, priorities, and ICU team composition; 2) significant personal protective equipment shortages cause; 3) reduced/restricted physical bedside presence favoring; 4) increased depth of sedation and use of neuromuscular blockade; 5) which exacerbate drug shortages; and 6) which require prolonged use of limited ventilator resources. Other identified barriers include manageable knowledge deficits among non-ICU clinicians unfamiliar with the Bundle or among PICU specialists deploying pediatric-based Bundle approaches who are unfamiliar with adult medicine. Both groups have been enlisted to augment the adult ICU work force to meet demand. Strategies were identified to facilitate Bundle performance to liberate patients from the ICU.

Conclusions:
We acknowledge current challenges that interfere with comprehensive management of critically ill patients during the coronavirus disease 2019 pandemic. Rapid response to new circumstances precisely requires established safety mechanisms and protocols like the ABCDEF Bundle to increase ICU and ventilator capacity and help survivors maximize recovery from coronavirus disease 2019 as early as possible.
Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019
Authors: Warrior Krishnan , Chung Paul A. , Ahmed Nida , Soult Michael C. , Simpson Kevin P. 
Published: June 2020

Objectives:
To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019.

Design:
Clinical observation of a patient.

Setting:
Academic medical center.

Patient:
A 59-year-old female with history of hypertension, hyperlipidemia, and prior smoking.

Intervention:
Clinical observation and data extraction from electronic medical records.

Measurements and Main Results:
We report a case of peripheral arterial thrombosis associated with coronavirus disease 2019, resulting in acute limb ischemia of the right lower extremity. This event was heralded by a sudden and significant elevation in d-dimer levels. At the time of surgery, a long, gelatinous clot was retrieved from the right popliteal artery. Perioperatively, she continued to have absent pedal Doppler signals and after multiple embolectomy attempts, required distal arterial cut down with removal of additional thrombi and resultant improvement of distal arterial flow.

Conclusions:
This case demonstrates the importance of regularly checking d-dimer levels and vigilant monitoring for arterial thrombotic events, as they can rapidly become catastrophic.
Gestational Age and Risk of Mortality in Term-Born Critically Ill Neonates Admitted to PICUs in Australia and New Zealand*
Authors: Namachivayam Siva P. , Carlin John B. , Millar Johnny , Alexander Janet , Edmunds Sarah , Ganeshalingham Anusha , Lew Jamie , Erickson Simon , Butt Warwick , Schlapbach Luregn J. , Ganu Subodh , Festa Marino , Egan Jonathan R. , Williams Gary , Young Janelle ,   on behalf of Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG) and Australian and New Zealand Paediatric Intensive Care Registry (ANZPICR)
Published: June 2020

Objectives:
Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk’) admitted to PICUs in Australia and New Zealand.

Design:
Observational multicenter cohort study.

Setting:
PICUs in Australia and New Zealand.

Patients:
Term-born neonates (≥ 37 wk) admitted to PICUs.

Interventions:
None

Measurements and Main Results:
We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2–40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11–28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25–57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2–6%).

Conclusions:
Among neonates born at “term” who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries.
MONOZYGOTIC TWINS DISCORDANT FOR ASYMMETRIC PIGMENTED PARAVENOUS CHORIORETINAL ATROPHY
Authors: Fischer Naomi , Duignan Emma , Robson Anthony G. , Webster Andrew R. , Ba-Abbad Rola 
Published: June 2020

Purpose:
To demonstrate phenotypic discordance between a monozygotic twin pair, one of whom exhibited pigmented paravenous chorioretinal atrophy (PPCRA).

Methods:
A patient and his identical twin brother, attending Moorfields Eye Hospital, were reviewed. Clinical assessment included visual acuity and color vision testing, fundus imaging including autofluorescence, spectral-domain optical coherence tomography, and static perimetry. In addition, the affected sibling underwent pattern and full-field electroretinography (PERG and ERG) according to ISCEV standards. Zygosity testing was performed using short tandem repeat analysis.

Results:
The 48-year-old proband was referred with abnormal visual fields and difficulty reading at near. Examination revealed 20/20 Snellen visual acuity bilaterally, normal color vision, and bilateral asymmetric outer retinal atrophy with intraretinal pigment migration along the course of the retinal veins, consistent with PPCRA. The visual field defects were contiguous with the blind spot and mirrored the retinal involvement in both eyes. Pattern ERG showed mild macular dysfunction and full-field ERG was within normal limits. Blood testing for common uveitic entities was noncontributory. The proband's twin brother's clinical assessment and retinal imaging showed no abnormality. Zygosity testing showed the twins to be identical for 24 short tandem repeat microsatellite markers, indicative of monozygosity.

Conclusion:
Some cases of PPCRA, without an obvious inflammatory etiology, do not have a clear Mendelian inheritance pattern and may represent an acquired disorder.
Barriers to Delivery of Enteral Nutrition in Pediatric Intensive Care: A World Survey
Authors: Tume Lyvonne N. , Eveleens Renate D. , Verbruggen Sascha C. A. T. , Harrison Georgia , Latour Jos M. , Valla Frédéric V. ,   on behalf of the ESPNIC Metabolism, Endocrine and Nutrition section
Published: June 2020

Objectives:
To explore the perceived barriers by pediatric intensive care healthcare professionals (nurses, dieticians, and physicians) in delivering enteral nutrition to critically ill children across the world.

Design:
Cross-sectional international online survey adapted for use in pediatric settings.

Setting:
PICUs across the world.

Subjects:
PICU nurses, physicians, and dietitians.

Interventions:
The 20-item adult intensive care “Barriers to delivery of enteral nutrition” survey was modified for pediatric settings, tested, and translated into 10 languages. The survey was distributed online to pediatric intensive care nurses, physicians, and dieticians via professional networks in March 2019 to June 2019. Professionals were asked to rate each item indicating the degree to which they perceived it hinders the provision of enteral nutrition in their PICUs with a 7-point Likert scale from 0 “not at all a barrier” to 6 “an extreme amount.”

Measurement and Main Results:
Nine-hundred twenty pediatric intensive care professionals responded from 57 countries; 477 of 920 nurses (52%), 407 of 920 physicians (44%), and 36 of 920 dieticians (4%). Sixty-two percent had more than 5 years PICU experience and 49% worked in general PICUs, with 35% working in combined cardiac and general PICUs. The top three perceived barriers across all professional groups were as follows: 1) enteral feeds being withheld in advance of procedures or operating department visits, 2) none or not enough dietitian coverage on weekends or evenings, and 3) not enough time dedicated to education and training on how to optimally feed patients.

Conclusions:
This is the largest survey that has explored perceived barriers to the delivery of enteral nutrition across the world by physicians, nurses, and dietitians. There were some similarities with adult intensive care barriers. In all professional groups, the perception of barriers reduced with years PICU experience. This survey highlights implications for PICU practice around more focused nutrition education for all PICU professional groups.
Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock
Authors: Murphy Lexa K. , Palermo Tonya M. , Meert Kathleen L. , Reeder Ron , Dean J. Michael , Banks Russell , Berg Robert A. , Carcillo Joseph A. , Chima Ranjit , McGalliard Julie , Haaland Wren , Holubkov Richard , Mourani Peter M. , Pollack Murray M. , Sapru Anil , Sorenson Samuel , Varni James W. , Zimmerman Jerry 
Published: June 2020

Objectives:
To identify trajectories and correlates of caregiver distress and family functioning in families of children who survived community-acquired septic shock. We hypothesized that: 1) a substantial subset of families would demonstrate trajectories of persistent elevated caregiver distress and impaired family functioning 12 months after hospitalization and 2) sociodemographic and clinical risk factors would be associated with trajectories of persistent distress and family dysfunction.

Design:
Prospective cohort.

Setting:
Fourteen PICUs in the United States.

Patients:
Caregivers of 260 children who survived community-acquired septic shock.

Interventions:
None.

Measurements and Main Results:
Caregivers completed ratings of distress on the Brief Symptom Inventory and of family functioning on the Family Assessment Device at baseline, 1, 3, 6, and 12 months after hospitalization. Results from group-based trajectory modeling indicated that 67% of the current sample was characterized by persistent low caregiver distress, 26% by persistent moderate to high distress that remained stable across 12 months (high-risk caregiver distress group), and 8% by initial high distress followed by gradual recovery. Forty percent of the sample was characterized by stable high family functioning, 15% by persistent high dysfunction across 12 months (high-risk family functioning group), 12% by gradually improving functioning, and 32% by deteriorating function over time. Independently of age, child race was associated with membership in the high-risk caregiver distress group (non-white/Hispanic; effect size, –0.12; p = 0.010). There were no significant sociodemographic or clinical correlates of the high-risk family functioning group in multivariable analyses.

Conclusions:
Although the majority of families whose children survived community-acquired septic shock were characterized by resilience, a subgroup demonstrated trajectories of persistently elevated distress and family dysfunction during the 12 months after hospitalization. Results suggest a need for family-based psychosocial screening after pediatric septic shock to identify and support at-risk families.
Effects of the Non-Neutralizing Humanized Monoclonal Anti-Adrenomedullin Antibody Adrecizumab on Hemodynamic and Renal Injury in a Porcine Two-Hit Model
Authors: Thiele Christoph , Simon Tim-Philipp , Szymanski Jeanine , Daniel Christoph , Golias Christos , Hartmann Oliver , Struck Joachim , Martin Lukas , Marx Gernot , Schuerholz Tobias 
Published: June 2020

ABSTRACT
Adrenomedullin is a vasoactive peptide that improves endothelial barrier function in sepsis, but may also cause hypotension and organ failure. Treatment with a non-neutralizing monoclonal anti-adrenomedullin antibody showed improvement in murine sepsis models. We tested the effects of the humanized monoclonal anti-adrenomedullin antibody Adrecizumab in a porcine two-hit model of hemorrhagic and septic shock.
In this randomized, blinded study 12 German Landrace pigs were bled to half of baseline mean arterial pressure for 45 min. Sepsis was induced using an Escherichia coli clot placed into the abdominal cavity 6 h after hemorrhagic shock. Animals received either 2 mg/kg BW anti-adrenomedullin antibody or vehicle solution immediately after sepsis induction. After 4 h, resuscitation was initiated using balanced crystalloids and noradrenalin to maintain a central venous pressure of 8 to 12 mm Hg, a mean arterial pressure ≥ 65 mm Hg, and a ScvO2 ≥70% for another 8 h. Hemodynamic parameters, laboratory parameters, and kidney histology were assessed.
The amount of volume resuscitation was significantly lower and significantly less animals developed a septic shock in the antibody-treated group, compared with the vehicle group. Kidney histology showed significantly lower granulocytes in both cortex and medulla in antibody-treated animals, while the remaining four kidney measures (serum creatinine and urine output and cortical and medullary injury in histopathology) did not reach the significance levels. After induction of sepsis, plasma adrenomedullin increased immediately in both the groups, but increased quicker and more pronounced in the antibody group.
In this two-hit shock model, treatment with an anti-adrenomedullin antibody significantly increased plasma adrenomedullin levels, while significantly less animals developed septic shock and renal granulocyte extravasation was significantly reduced. Thus, therapy with Adrecizumab may provide benefit in sepsis, and clinical investigation of this drug candidate is warranted.
A Comparative Study of Target Reconstruction of Ultra-High-Resolution CT for Patients with Corona-Virus Disease 2019 (COVID-19)
Authors: Lv Shao-mao , Lin Yu , Kang Jiang-he , Duan Shao-yin , Zhang Wei-guo , Wang Jin-an 
Published: June 2020

AbstractBackgroundThe corona-virus disease 2019 (COVID-19) pandemic has caused a serious public health risk. Compared with conventional high-resolution CT (C-HRCT, matrix 512), ultra-high resolution CT (U-HRCT, matrix 1024) can increase the effective pixel per unit volume by about 4 times. Our study is to evaluate the value of target reconstruction of U-HRCT in the accurate diagnosis of COVID-19.MethodsA total of 13 COVID-19 cases, 44 cases of other pneumonias, and 6 cases of ground-glass nodules were retrospectively analyzed. The data were categorized into groups A (C-HRCT) and B (U-HRCT), following which iDose4-3 and iDose4-5 were used for target reconstruction, respectively. CT value, noise, and signal-to-noise ratio (SNR) in different reconstructed images were measured. Two senior imaging doctors scored the image quality and the structure of the lesions on a 5-point scale. Chi-square test, variance analysis, and binarylogistic regression analysis were used for statistical analysis.ResultsU-HRCT image can reduce noise and improve SNR with an increase of the iterative reconstruction level. The SNR of U-HRCT image was lower than that of the C-HRCT image of the same iDose4level, and the noise of U-HRCT was higher than that of C-HRCT image; the difference was statistically significant (P< 0.05). Logistic regression analysis showed thatperipleural distribution, thickening of blood vessels and interlobular septum, and crazy-paving pattern were independent indictors of the COVID-19 on U-HRCT. U-HRCT was superior to C-HRCT in showing the blood vessels, bronchial wall, and interlobular septum in the ground-glass opacities; the difference was statistically significant (P < 0.05).ConclusionsPeripleural distribution, thickening of blood vessels and interlobular septum, and crazy-paving pattern on U-HRCT are favorable signs for COVID-19. U-HRCT is superior to C-HRCT in displaying the blood vessels, bronchial walls, and interlobular septum for evaluating COVID-19.
Burnout in radiation therapists in Portugal
Authors: Guerra Jéssica , Caramelo Francisco , Patrício Miguel 
Published: June 2020

AbstractBackgroundBurnout syndrome has adverse consequences for individuals, causing a variety of cognitive, affective, physical, behavioural and motivational problems. We aim to assess burnout in Portuguese radiation therapists, for who high levels of contact with patients may potentially lead to burnout.MethodsRadiation therapists working in Portugal were invited via e-mail to participate in the study by filling in a survey. The latter had two components: a social-demographic questionnaire and the Maslach Burnout Inventory – Human Services Survey.ResultsA total of 103 people responded to the survey, 95 of which employed as radiation therapists. The mean burnout scores were 20.60 ± 11.21, 7.43 ± 5.34 and 35.02 ± 6.02, for the emotional exhaustion, depersonalisation and personal accomplishment subscales, respectively. In the same order, the total of radiation therapists presenting high levels of burnout were 29%, 14.9% and 29.3% for the different dimensions. The mean scores of burnout did not differ significantly regarding gender, civil status, working in the public or private sector and years of service. Radiation therapists aged 40 years or older presented greater scores of burnout, though with no statistical significance.ConclusionRadiation therapists working in Portugal were seen to have average scores of burnout in the emotional exhaustion, depersonalisation and personal accomplishment subscales.
Structural characterization of the essential cell division protein FtsE and its interaction with FtsX inStreptococcus pneumoniae
Authors: Alcorlo Martin , Straume Daniel , Lutkenhaus Joe , Håvarstein Leiv Sigve , Hermoso Juan A. 
Published: June 2020

ABSTRACTFtsEX is a membrane complex widely conserved across diverse bacterial genera and involved in critical processes such as recruitment of division proteins and in spatial and temporal regulation of muralytic activity during cell division or sporulation. FtsEX is a member of the ABC transporter superfamily, where FtsX is an integral membrane protein and FtsE is an ATPase, required for mechanotransmission of the signal from the cytosol through the membrane, to regulate the activity of cell-wall hydrolases in the periplasm. Both proteins are essential in the major human respiratory pathogenic bacterium,Streptococcus pneumoniaeand interact with the modular peptidoglycan hydrolase PcsB at the septum. Here, we report the high-resolution structures of pneumococcal FtsE in complex with different nucleotides. Structural analysis reveals that FtsE contains all the conserved structural motifs associated with ATPase activity, and allowed interpretation of thein vivodimeric arrangement in both ADP and ATP states. Interestingly, three specific FtsE regions were identified with high structural plasticity that shape the cavity in which the cytosolic region of FtsX would be inserted. The residues corresponding to the FtsX coupling helix, responsible for FtsE contact, were identified and validated byin vivomutagenesis studies showing that this interaction is essential for cell growth and proper morphology.IMPORTANCEBacterial cell division is a central process that requires exquisite orchestration of both the cell wall biosynthetic and lytic machineries. The essential membrane complex FtsEX, widely conserved across bacteria, play a central role by recruiting proteins to the divisome apparatus and by regulating periplasmic muralytic activity from the cytosol. FtsEX is a member of the Type VII family of the ABC-superfamily but instead transporter, couple ATP hydrolysis by FtsE to mechanically transduce a conformational signal to activate PG hydrolases. So far, no structural information is available for FtsE. Here we provide the structural characterization of FtsE confirming its ATPase nature and revealing regions with high structural plasticity key for FtsX binding. The complementary region in FtsX has been also identified and validatedin vivo. Our results provide evidences on how difference between ATP and ADP states in FtsE would dramatically alter FtsEX interaction with PG hydrolase PcsB in pneumococcal division.