bluuebunny/crossref_metadata_2025_split huggingface dataset:
CPR to the Rescue!
Authors: Heath Janie , Walmsley Lee Anne , Aker Rachelle M. , Ferrin Shelley , Stone Dan , Norton James C. 
Published: February 2020

Purpose/Objectives
The hCATS (health Colleges Advancing Team Skills) to CPR (Cultivating Practices for Resilience) Camp was an interprofessional pilot program to promote resilience, introduce strategies for coping with stress, cultivate compassion, and promote work-life balance to prevent burnout among health profession students, faculty, and healthcare professionals who team to provide patient care.

Program Description
The University of Kentucky (UK) College of Nursing received funding to partner with the UK Center for Interprofessional Health Education for immersive weekend activities utilizing KORU and Mindfulness Based Stress Reduction models, conducted by certified UK faculty experts in self-stewardship techniques such as mindfulness practices.

Outcomes
Thirty-nine participants from 7 UK colleges and UK HealthCare participated in 4 distinct CPR Camps, completed program assessments, and created team projects. Mean scores from each cohort significantly increased in a retrospective pre/post analysis of student perception of knowledge in all of the following categories: (1) habits and practices for resilient people, (2) strategies for building resilience and preventing/coping with stress/burnout in self and others, and (3) work-life balance (with the exception of cohort 4, for work-life balance). Students indicated on open-response items specific strategies they were willing to adopt going forward. These outcomes met our objectives for developing participants' understanding of resilience practices and adopting useful stress reduction practices. Planning and implementation of team projects successfully brought different professions together to advance learning in resilience.

Conclusion
The CPR Camp initiative is an effective model for promoting and sustaining resilience-building strategies among health profession students. Similar programming conducted and/or attended by academic and/or health system leaders, such as clinical nurse specialists, can help cultivate practices for resilience among the members of the interprofessional workforce, enabling teams to better cope with stress, prevent burnout, and ultimately improve team-based care delivery for patients and their families.
Classification of Subtypes of Crouzon Syndrome Based on the Type of Vault Suture Synostosis
Authors: Lu Xiaona , Sawh-Martinez Rajendra , Forte Antonio Jorge , Wu Robin , Cabrejo Raysa , Wilson Alexander , Steinbacher Derek M. , Alperovich Michael , Alonso Nivaldo , Persing John A. 
Published: February 2020

Background:
Patients with Crouzon syndrome develop various types of anatomic deformities due to different forms of craniosynostosis, yet they have similar craniofacial characteristics. However, exact homology is not evident. Different pathology then may be best treated by different forms of surgical technique. Therefore, precise classification of Crouzon syndrome, based on individual patterns of cranial suture involvement is needed.

Methods:
Ninety-five computed tomography (CT) scans (Crouzon, n = 33; control, n = 62) were included in this study. All the CT scans are divided into 4 types based on premature closure of sutures: class I = coronal and lambdoidal synostosis; class II = sagittal synostosis; class III = pansynostosis; and class IV = “Others.” The CT scan anatomy was measured by Materialise software.

Results:
The class III, pansynostosis, is the most prevalent (63.6%). The classes I, III, and IV of Crouzon have significantly shortened entire anteroposterior cranial base length, with the shortest base length in class III. The external cranial measurements in class I show primarily a decreased posterior facial skeleton, while the class III presented with holistic facial skeleton reduction. Class II has the least severe craniofacial malformations, while class III had the most severe.

Conclusion:
The morphology of patients with Crouzon syndrome is not identical in both cranial base and facial characteristics, especially when they associated with different subtypes of cranial suture synostosis. The classification of Crouzon syndrome proposed in this study, summarizes the differences among each subgroup of craniosynostosis suture involvement, which, theoretically, may ultimately influence both the timing and type of surgical intervention.
Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion?
Authors: Liu Kai , Wei Hongpu , Dai Jiewen , Wang Xudong 
Published: February 2020

Purpose:
To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes.

Material and Methods:
Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate.

Results:
Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively.

Conclusion:
SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.
Resorbable Versus Titanium Fixation of Le Fort I Osteotomy
Authors: Passeri Luis Augusto , Bento Adriano Mesquita , Vanni Tazio 
Published: February 2020

Abstract
Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] −0.19, 0.30), vertical stability for impaction was −0.43 mm (95% CI −0.94, 0.07), and for inferior repositioning was −1.29 mm (95% CI −2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.
Fentanyl impairs but ketamine preserves the microcirculatory response to hemorrhage
Authors: Xiang Lusha , Calderon Alfredo S. , Klemcke Harold G. , Scott Laura L. , Hinojosa-Laborde Carmen , Ryan Kathy L. 
Published: February 2020

BACKGROUND
Peripheral vasoconstriction is the most critical compensating mechanism following hemorrhage to maintain blood pressure. On the battlefield, ketamine rather than opioids is recommended for pain management in case of hemorrhage, but effects of analgesics on compensatory vasoconstriction are not defined. We hypothesized that fentanyl impairs but ketamine preserves the peripheral vasoconstriction and blood pressure compensation following hemorrhage.

METHOD
Sprague-Dawley rats (11–13 weeks) were randomly assigned to control (saline vehicle), fentanyl, or ketamine-treated groups with or without hemorrhage (n = 8 or 9 for each group). Rats were anesthetized with Inactin (i.p. 10 mg/100 g), and the spinotrapezius muscles were prepared for microcirculatory observation. Arteriolar arcades were observed with a Nikon microscope, and vessel images and arteriolar diameters were recorded by using Nikon NIS Elements Imaging Software (Nikon Instruments Inc. NY). After baseline perimeters were recorded, the arterioles were topically challenged with saline, fentanyl, or ketamine at concentrations relevant to intravenous analgesic doses to determine direct vasoactive effects. After arteriolar diameters returned to baseline, 30% of total blood volume was removed in 25 minutes. Ten minutes after hemorrhage, rats were intravenously injected with an analgesic dose of fentanyl (0.6 μg/100 g), ketamine (0.3 mg/100 g), or a comparable volume of saline. For each drug or vehicle administration, the total volume injected was 0.1 mL/100 g. Blood pressure, heart rate, and arteriolar responses were monitored for 40 minutes.

RESULTS
Topical fentanyl–induced vasodilation (17 ± 2%), but ketamine caused vasoconstriction (−15 ± 4%, p < 0.01). Following hemorrhage, intravenous ketamine did not affect blood pressure or respiratory rate, while fentanyl induced a slight and transient (<5 minutes, p = 0.03 vs. saline group) decrease in blood pressure, with a profound and prolonged suppression in respiratory rate (>10 minutes, with a peak inhibition of 57 ± 8% of baseline, p < 0.01). The compensatory vasoconstriction observed after hemorrhage was not affected by ketamine treatment. However, after fentanyl injection, although changes in blood pressure were transiently present, arteriolar constriction to hemorrhage was absent and replaced with a sustained vasodilation (78 ± 25% to 36 ± 22% of baseline during the 40 minutes after injection, p < 0.01).

CONCLUSION
Ketamine affects neither systemic nor microcirculatory compensatory responses to hemorrhage, providing preclinical evidence that ketamine may help attenuate adverse physiological consequences associated with opioids following traumatic hemorrhage. Microcirculatory responses are more sensitive than systemic response for evaluation of hemodynamic stability during procedures associated with pain management.
Predictors of hemodynamic decompensation in progressive hypovolemia: Compensatory reserve versus heart rate variability
Authors: Schlotman Taylor E. , Suresh Mithun R. , Koons Natalie J. , Howard Jeffrey T. , Schiller Alicia M. , Cardin Sylvain , Convertino Victor A. 
Published: February 2020

BACKGROUND
Hemorrhage remains the leading cause of death following traumatic injury in both civilian and military settings. Heart rate variability (HRV) and heart rate complexity (HRC) have been proposed as potential “new vital signs” for monitoring trauma patients; however, the added benefit of HRV or HRC for decision support remains unclear. Another new paradigm, the compensatory reserve measurement (CRM), represents the integration of all cardiopulmonary mechanisms responsible for compensation during relative blood loss and was developed to identify current physiologic status by estimating the progression toward hemodynamic decompensation. In the present study, we hypothesized that CRM would provide greater sensitivity and specificity to detect progressive reductions in central circulating blood volume and onset of decompensation as compared with measurements of HRV and HRC.

METHODS
Continuous, noninvasive measurements of compensatory reserve and electrocardiogram signals were made on 101 healthy volunteers during lower-body negative pressure (LBNP) to the point of decompensation. Measures of HRV and HRC were taken from electrocardiogram signal data.

RESULTS
Compensatory reserve measurement demonstrated a superior sensitivity and specificity (receiver operator characteristic area under the curve [ROC AUC] = 0.93) compared with all HRV measures (ROC AUC ≤ 0.84) and all HRC measures (ROC AUC ≤ 0.86). Sensitivity and specificity values at the ROC optimal thresholds were greater for CRM (sensitivity = 0.84; specificity = 0.84) than HRV (sensitivity, ≤0.78; specificity, ≤0.77), and HRC (sensitivity, ≤0.79; specificity, ≤0.77). With standardized values across all levels of LBNP, CRM had a steeper decline, less variability, and explained a greater proportion of the variation in the data than both HRV and HRC during progressive hypovolemia.

CONCLUSION
These findings add to the growing body of literature describing the advantages of CRM for detecting reductions in central blood volume. Most importantly, these results provide further support for the potential use of CRM in the triage and monitoring of patients at highest risk for the onset of shock following blood loss.
French civilian surgical expertise still inadequately prepared for mass casualties 3 years after major terror attacks in Paris (2015) and Nice (2016)
Authors: Destan Clement , De Carbonnière Anne , Moritz Céline , Gaudric Julien , Malgras Brice , Desterke Christophe , Bonnet Stéphane , Hornez Emmanuel 
Published: February 2020

BACKGROUND
Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a nonselected population of practicing French surgeons.

METHODS
A questionnaire was sent between July and December 2017 to French students and practicing surgeons, using the French Surgical Colleges' mailing lists. Items analyzed included education, training, interest and clinical activity in trauma care and damage-control surgery (DCS).

RESULTS
622 questionnaires were analyzed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in Level I trauma centers (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of ‘interest in trauma care’ was 8/10. Factors associated with a higher score were being a resident doctor (p = 0.01), a digestive surgeon (p = 0.0013), in the military (p = 1,71 × 10−6) and working in TC1 (p = 0.034). The mean “DCS techniques knowledge” score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively, p = 0.0007 and p = 0.001) and in the military (respectively p = 1.74 × 10−8 and p = 3.94 × 10−7). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons.

CONCLUSION
French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate.

LEVEL OF EVIDENCE
Level III, Study Type Survey.
Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock
Authors: Moore Hunter B. , Tessmer Matthew T. , Moore Ernest E. , Sperry Jason L. , Cohen Mitchell J. , Chapman Michael P. , Pusateri Anthony E. , Guyette Francis X. , Brown Joshua B. , Neal Matthew D. , Zuckerbraun Brian , Sauaia Angela 
Published: February 2020

BACKGROUND
Randomized clinical trials (RCTs) support the use of prehospital plasma in traumatic hemorrhagic shock, especially in long transports. The citrate added to plasma binds with calcium, yet most prehospital trauma protocols have no guidelines for calcium replacement. We reviewed the experience of two recent prehospital plasma RCTs regarding admission ionized-calcium (i-Ca) blood levels and its impact on survival. We hypothesized that prehospital plasma is associated with hypocalcemia, which in turn is associated with lower survival.

METHODS
We studied patients enrolled in two institutions participating in prehospital plasma RCTs (control, standard of care; experimental, plasma), with i-Ca collected before calcium supplementation. Adults with traumatic hemorrhagic shock (systolic blood pressure ≤70 mm Hg or 71–90 mm Hg + heart rate ≥108 bpm) were eligible. We use generalized linear mixed models with random intercepts and Cox proportional hazards models with robust standard errors to account for clustered data by institution. Hypocalcemia was defined as i-Ca of 1.0 mmol/L or less.

RESULTS
Of 160 subjects (76% men), 48% received prehospital plasma (median age, 40 years [interquartile range, 28–53 years]) and 71% suffered blunt trauma (median Injury Severity Score [ISS], 22 [interquartile range, 17–34]). Prehospital plasma and control patients were similar regarding age, sex, ISS, blunt mechanism, and brain injury. Prehospital plasma recipients had significantly higher rates of hypocalcemia compared with controls (53% vs. 36%; adjusted relative risk, 1.48; 95% confidence interval [CI], 1.03–2.12; p = 0.03). Severe hypocalcemia was significantly associated with decreased survival (adjusted hazard ratio, 1.07; 95% CI, 1.02–1.13; p = 0.01) and massive transfusion (adjusted relative risk, 2.70; 95% CI, 1.13–6.46; p = 0.03), after adjustment for confounders (randomization group, age, ISS, and shock index).

CONCLUSION
Prehospital plasma in civilian trauma is associated with hypocalcemia, which in turn predicts lower survival and massive transfusion. These data underscore the need for explicit calcium supplementation guidelines in prehospital hemotherapy.

LEVEL OF EVIDENCE
Therapeutic, level II.
Resuscitative endovascular balloon occlusion of the aorta in a pediatric swine model: Is 60 minutes too long?
Authors: Yamashiro Kaeli J. , Galganski Laura A. , Grayson J. Kevin , Johnson M. Austin , Beyer Carl A. , Spruce Marguerite W. , Caples Connor M. , Trappey A. Francois , Wishy Andrew M. , Stephenson Jacob T. 
Published: February 2020

BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is recommended in adults with a noncompressible torso hemorrhage with occlusion times of less than 60 minutes. The tolerable duration in children is unknown. We used a pediatric swine controlled hemorrhage model to evaluate the physiologic effects of 30 minutes and 60 minutes of REBOA.

METHODS
Pediatric swine weighing 20 kg to 30 kg underwent a splenectomy and a controlled 60% total blood volume hemorrhage over 30 minutes, followed by either zone 1 REBOA for 30 minutes (30R) or 60 minutes (60R). Swine were then resuscitated with shed blood and received critical care for 240 minutes.

RESULTS
During critical care, the 30R group's (n = 3) pH, bicarbonate, base excess, and lactate were no different than baseline, while at the end of critical care, these variables continued to differ from baseline in the 60R group (n = 5) and were worsening (7.4 vs. 7.2, p < 0.001, 30.4 mmol/L vs. 18.4 mmol/L, p < 0.0001, 5.6 mmol/L vs. −8.5 mmol/L, p < 0.0001, 2.4 mmol/L vs. 5.7 mmol/L, p < 0.001, respectively). Compared with baseline, end creatinine and creatinine kinase were elevated in 60R swine (1.0 mg/dL vs. 1.7 mg/dL, p < 0.01 and 335.4 U/L vs. 961.0 U/L, p < 0.001, respectively), but not 30R swine (0.9 mg/dL vs. 1.2 mg/dL, p = 0.06 and 423.7 U/L vs. 769.5 U/L, p = 0.15, respectively). There was no difference in survival time between the 30R and 60R pediatric swine, p = 0.99.

CONCLUSION
The physiologic effects of 30 minutes of zone 1 REBOA in pediatric swine mostly resolved during the subsequent 4 hours of critical care, whereas the effects of 60 minutes of REBOA persisted and worsened after 4 hours of critical care. Sixty minutes of zone 1 REBOA may create an irreversible physiologic insult in a pediatric population.
Proneness, urbanicity, trauma, and cannabis triggering psychotic states in large urban centers
Authors: Machado-de-Sousa João Paulo , Crippa José A.S. , Hallak Jaime 
Published: February 2020

Purpose of review
The two past decades have seen the production of a vast amount of evidence about the genetic and nongenetic factors that contribute to the onset of psychosis from various fields of research. The present article reviews recent evidence from four of these fields that were shown to be strongly associated with psychosis: proneness, urbanicity, trauma, and cannabis use.

Recent findings
The evidence reviewed shows that all four sets of factors investigated here are implicated in the occurrence of psychosis. The specificity and complexity of these associations, however, are not yet clear and recent findings show that the directions of the associations described may be different than we first thought.

Summary
It is clear that psychosis is strongly affected by a number of environmental determinants that act in concert with genetic determinants to cause psychotic disorders; however, these influences are complex and their actual impact may be difficult to establish because of poor definitions and specificity. Urbanicity in special is a poorly defined concept that seems to encompass different sets of factors in each study, which hinders discussions and conclusions regarding its impact.
Integrating blue-green and grey infrastructure through an adaptation pathways approach to surface water flooding
Authors: Kapetas Leon , Fenner Richard 
Published: February 2020

A range of solutions to future flood risk are available ranging from blue-green infrastructure (BGI) as commonly incorporated in sustainable drainage systems (SuDS) to traditional grey infrastructure (e.g. pipe networks, storage tanks, flood walls). Each offers a different profile with respect to costs, flexibility of implementation and the ability to deliver a range of wider benefits beyond their flood protection function. An important question that must be addressed when considering these approaches is what is the most suitable mix of grey and blue-green solutions to urban flooding at any location and at any future time? This paper uses an adaptation pathways approach to compare a range of alternative options to deal with current and expected future flood risk in part of a London borough. Solutions considered separately and in combination include grey pipe expansion, bioretention cells, permeable pavements and storage ponds. A methodological framework combines a range of existing tools to develop, assess and characterize each pathway, including a storm water management model (SWMM), a SuDs opportunity selection tool, an adaptation pathway generator and the CIRIA B£ST tool for monetizing multiple benefits. Climate change is represented by the UK Water Industry Research method for establishing future rainfall intensities for sewer and BGI design. The results showed that by extending the way in which adaptation pathways are compared and evaluated through the wider consideration of multiple benefits there is a trade-off between deferring interventions until they are needed for flood risk mitigation and delivering the multiple benefits associated with interventions so that performance thresholds do not need to be met before introducing new options. The relative contribution of each option's capital and operation and maintenance costs has implications on when the option is implemented as well as the rate of implementation. The monetization of the multiple benefits associated with each pathway shows that their economic co-evaluation alongside infrastructure costs can change the preference for one pathway over another.
This article is part of the theme issue ‘Urban flood resilience’.