bluuebunny/crossref_metadata_2025_split huggingface dataset:
To tube or not to tube: a skeptic's guide to nonintubated thoracic surgery
Authors: Schieren Mark , Defosse Jerome 
Published: December 2020

Purpose of review
The aim of this review is to provide an overview of the rationale and evidence for nonintubated thoracic surgery and guide clinicians, considering the implementation of nonintubated thoracic surgery, to find an anesthetic approach suitable for their department.

Recent findings
Based on physiologic considerations alone, nonintubated thoracic surgery would be expected to be an advantageous concept in thoracic anesthesia, especially in patients at high risk for pulmonary complications. Currently existing evidence, however, does not support these claims. Although the feasibility and safety have been repeatedly demonstrated, high-quality evidence showing a significant benefit regarding clinically relevant patient-centered outcomes is not available.
Anesthetic approaches to nonintubated thoracic surgery differ significantly; however, they usually concentrate on six main aspects: maintenance of airway patency, respiratory support, analgesia, patient comfort, cough suppression, and conversion techniques. Given the lack of high-quality studies comparing different techniques, evidence-based guidance of clinical decision-making is currently not possible. Until further evidence is available, anesthetic management will depend mostly on local availability and expertise.

Summary
In select patients and with experienced teams, nonintubated thoracic surgery can be a suitable alternative to intubated thoracic surgery. Until more evidence is available, however, a general change in anesthetic management in thoracic surgery is not justified.
Doppler Echocardiographic Indices Are Specific But Not Sensitive to Predict Pulmonary Artery Occlusion Pressure in Critically Ill Patients Under Mechanical Ventilation
Authors: Mercado Pablo , Maizel Julien , Marc Julien , Beyls Christophe , Zerbib Yoann , Zogheib Elie , Titeca-Beauport Dimitri , Joris Magalie , Kontar Loay , Riviere Antoine , Bonef Olivier , Soupison Thierry , Tribouilloy Christophe , de Cagny Bertrand , Slama Michel 
Published: December 2020

OBJECTIVES:
The objective of this study was to prospectively evaluate the ability of transthoracic echocardiography to assess pulmonary artery occlusion pressure in mechanically ventilated critically ill patients.

DESIGN:
In a prospective observational study.

SETTING:
Amiens University Hospital Medical ICU.

PATIENTS:
Fifty-three mechanically ventilated patients in sinus rhythm admitted to our ICU.

INTERVENTION:
Transthoracic echocardiography was performed simultaneously to pulmonary artery catheter.

MEASUREMENTS AND MAIN RESULTS:
Transmitral early velocity wave recorded using pulsed wave Doppler (E), late transmitral velocity wave recorded using pulsed wave Doppler (A), and deceleration time of E wave were recorded using pulsed Doppler as well as early mitral annulus velocity wave recorded using tissue Doppler imaging (E′). Pulmonary artery occlusion pressure was measured simultaneously using pulmonary artery catheter. There was a significant correlation between pulmonary artery occlusion pressure and lateral ratio between E wave and E′ (E/E′ ratio) (r = 0.35; p < 0.01), ratio between E wave and A wave (E/A ratio) (r = 0.41; p < 0.002), and deceleration time of E wave (r = –0.34; p < 0.02). E/E′ greater than 15 was predictive of pulmonary artery occlusion pressure greater than or equal to 18 mm Hg with a sensitivity of 25% and a specificity of 95%, whereas E/E′ less than 7 was predictive of pulmonary artery occlusion pressure less than 18 mm Hg with a sensitivity of 32% and a specificity of 81%. E/A greater than 1.8 yielded a sensitivity of 44% and a specificity of 95% to predict pulmonary artery occlusion pressure greater than or equal to 18 mm Hg, whereas E/A less than 0.7 was predictive of pulmonary artery occlusion pressure less than 18 mm Hg with a sensitivity of 19% and a specificity of 94%. A similar predictive capacity was observed when the analysis was confined to patients with EF less than 50%. A large proportion of E/E′ measurements 32 (60%) were situated between the two cut-off values obtained by the receiver operating characteristic curves: E/E′ greater than 15 and E/E′ less than 7.

CONCLUSIONS:
In mechanically ventilated critically ill patients, Doppler transthoracic echocardiography indices are highly specific but not sensitive to estimate pulmonary artery occlusion pressure.
Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque
Authors: Wang Yonghuai , Zhao Cuiting , Meng Pingping , Yu Yao , Li Guangyuan , Kong Fanxin , Mu Lixin , Yang Jun , Ma Chunyan 
Published: December 2020

Background:
Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD.

Materials and methods:
We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured.

Results:
Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ
2 = 3.74) improved by adding GCCS (χ
2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19.

Conclusion:
Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS.

Video abstract:
Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.
Reconstruction of Enriched Uranium Released to Air from the Former Apollo Facility, Apollo, Pennsylvania
Authors: Caffrey Emily A. , Voillequé Paul G. , Rood Arthur S. , Grogan Helen A. , Mohler H. Justin , Meyer Kathleen R. , Till John E. 
Published: December 2020

Abstract
The former Apollo facility converted enriched uranium hexafluoride into uranium oxide for shipment to nuclear fuel fabrication plants from 1957 to 1983. This paper describes quantification of the source term from the Apollo facility in terms of quantities of uranium released, particle size, and solubility characteristics. Releases occurred through stacks, rooftop vents, and an incinerator that operated from 1964 to 1969. Incidental and accidental releases are addressed as part of this analysis. Atmospheric releases of uranium from plant operations were estimated from stack sampling and production records. Roof vents, both filtered and unfiltered, were the major emission points from the plant. The total estimated release of uranium activity (including 234U, 235U, and 238U) to the air was 28 GBq. Measurements by others found that the releases were primarily associated with large particles and that their solubility was variable but generally low (Class Y). The release estimates presented here and those findings were incorporated into a sophisticated atmospheric transport model to estimate atmospheric concentrations and soil contamination levels due to the releases and to reconstruct historical doses to individuals that lived in the vicinity of the former Apollo facility.
TRENDS IN INTRAVITREAL CORTICOSTEROID AGENT USE BY US OPHTHALMOLOGISTS IN MEDICARE BENEFICIARIES AND ASSOCIATION WITH PHYSICIAN–INDUSTRY INTERACTIONS
Authors: Watane Arjun , Kalavar Meghana , Yannuzzi Nicolas A. , Kuriyan Ajay E. , Sridhar Jayanth 
Published: December 2020

Purpose:
To report trends of intravitreal corticosteroid use and explore the relationship between career experience, reported industry payments, and prescribing habits.

Methods:
A retrospective review of ophthalmologists who administered intravitreal dexamethasone implants (DEX) and triamcinolone acetonide (TA) injections between August 2013 and December 2017.

Results:
A total of 1,070 US ophthalmologists were reimbursed by Medicare for 522,804 DEX injections and 2.6 million TA injections. There was a significant positive trend in the number of DEX (P = 0.01), but not TA, injections per year. Mid-career and late-career physicians performed significantly greater total injections on average compared with early-career physicians (both P < 0.001). Early-career physicians performed a greater proportion of DEX injections than late-career physicians (P = 0.006). Industry payments were positively associated with the proportion of DEX used and inversely correlated with the proportion of TA administered (P < 0.001). On multivariate analysis, years in practice, number of payments, and total value of payments were significantly associated with the number of DEX injections administered (all P < 0.001).

Conclusion:
From 2013 to 2017, the use of DEX increased, whereas TA use remained stable. There was a positive association between DEX use and physician–industry interactions, which may be explained by seniority and experience. This study does not define a causal relationship.
Real-time imaging of airflow patterns and impact of infection control measures in ophthalmic practice: a pandemic perspective
Authors: Srivastava Samaresh , Vasavada Vaishali , Vasavada Abhay R. , Sudhalkar Aditya , Kothari Abhishek , Vasavada Shail A. 
Published: December 2020

Purpose:
To analyze exhaled airflow patterns in a clinical scenario and the impact of infection control practices and room air circulation in context of the COVID-19 pandemic.

Setting:
Raghudeep Eye Hospital, India.

Design:
Experimental study.

Methods:
Ten patients attending ophthalmic outpatient clinic (OPD) and operating room (OR) were included. Using Schlieren imaging, exhaled airflow patterns were documented with/without an N95 mask or face shield during respiratory activities. Recordings were performed with and without room air conditioning turned on. Exhaled airflow patterns in OPD and OR when using vs not using these infection control measures and the impact of room air circulation on these were compared.

Results:
Five patients each in OPD and OR were included. There was a forward stream of exhaled air from the patient's mouth/nose during all respiratory activities. An N95 mask dampened its intensity and forward transmission. Taping the mask around the nasal bridge further reduced airflow leakage. A mechanical barrier in front of the patient's face blocked forward propagation of the exhaled airflow. Turning on a forceful and direct draft of air over the surgeon's working area dampened and diverted the exhaled airflow away from the surgeons' breathing area. This effect was particularly pronounced in the OR, with the overhead laminar airflow.

Conclusions:
Using high force airflow with the draft facing downward can dampen and divert the exhaled airflow away from healthcare providers. Using masks/mechanical barriers and taping the mask reduces potential dissemination of aerosols and, thereby, human and surface contamination.
Wavefront-guided myopic laser in situ keratomileusis with a high-resolution Hartmann-Shack aberrometer and a new nomogram
Authors: Maloney Robert K. , Kraff Colman R. , Coleman Stephen C. 
Published: December 2020

Purpose:
To evaluate visual, refractive, aberrometric, and patient-reported outcomes of wavefront-guided (WFG) myopic laser in situ keratomileusis (LASIK) using a high-resolution Hartmann-Shack aberrometer (iDesign Advanced WaveScan system) with a new nomogram and to determine whether the new nomogram resolved the mild undercorrection that occurs with the manufacturer's default settings.

Setting:
Three private LASIK practices.

Design:
Prospective, open-label, noncomparative, multicenter study.

Methods:
One hundred ninety eyes of 95 patients underwent bilateral WFG LASIK for the correction of myopia or myopic astigmatism. A new nomogram was used, which effectively adjusted the wavefront-measured refraction sphere up or down to equal the manifest refraction sphere. Patients were followed up for 6 months.

Results:
Eighty-four patients completed the final follow up. At 6 months, 162 (96.4%) of 168 eyes achieved monocular uncorrected distance visual acuity of 20/20 or better. No eye lost 2 or more lines of corrected distance visual acuity. The safety and efficacy indices were 1.12 and 1.09, respectively; 164 (98%) of 168 eyes had manifest refraction spherical equivalent within ±0.50 diopters (D) of emmetropia, and 154 (92%) of 168 eyes had residual manifest refractive astigmatism of 0.50 D or less. Fewer patients experienced burning, stinging, soreness, and irritation postoperatively than preoperatively. Eighty-one (96%) of 84 patients reported improved quality of life.

Conclusions:
WFG myopic LASIK using a high-resolution Hartmann-Shack aberrometer and a new nomogram resolved the undercorrection with the manufacturer’s default settings. The treatment was safe and effective with excellent visual and refractive outcomes, high patient satisfaction, and improved quality of life.
COVID-19 Infections Among Healthcare Personnel in the United States Veterans Health Administration, March to August, 2020
Authors: Oda Gina , Sharma Aditya , Lucero-Obusan Cynthia , Schirmer Patricia , Sohoni Pooja , Holodniy Mark 
Published: December 2020

Objective:
We investigated COVID-19 infection and death among healthcare personnel (HCP) in the United States Veterans Health Administration.

Methods:
HCP with positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction tests between March 1 and August 31, 2020 were included. Risk ratios were calculated for sex, age, race/ethnicity, Veteran status, occupation category, facility of employment by inpatient COVID-19 test percent positivity and death.

Results:
Five thousand nine hundred twenty five HCP were COVID-19-infected out of 131,606 tested (4.5% positivity). Highest risk for COVID-19 infection included: HCP working in hospitals with more than 15% inpatient COVID-19 test positivity, nursing staff, non-Hispanic Black, and Hispanic or Latino HCP and HCP who were Veterans. Among 18 HCP who died after COVID-19 infection, male sex, age more than or equal to 65 years, and Veteran status were significant risk factors.

Conclusions:
Robust national surveillance testing methods are needed to accurately monitor HCP COVID-19 infections and deaths to improve HCP safety.
Determining nurse practitioner core competencies using a Delphi approach
Authors: Chan Tracey Elizabeth , Lockhart Joan Such , Schreiber James B. , Kronk Rebecca 
Published: December 2020

ABSTRACTBackground:Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined.Purpose:This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the currentNP Core Competencies(NONPF, 2017), theEssentials of Doctoral Education for Advanced Nursing Practice(AACN, 2006), and theCommon Advanced Practice Registered Nurse Doctoral-Level Competencies(AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable.Methods:A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data.Results:Consensus was reached after 3 rounds and resulted in 49 final core competencies.Implications for practice:This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.
Core outcomes sets for studies evaluating critical illness and patient recovery
Authors: Dinglas Victor D. , Cherukuri Sai P.S. , Needham Dale M. 
Published: December 2020

Purpose of review
Given the growing body of critical care clinical research publications, core outcome sets (COSs) are important to help mitigate heterogeneity in outcomes assessed and measurement instruments used, and have potential to reduce research waste. This article provides an update on COS projects in critical care medicine, and related resources and tools for COS developers.

Recent findings
We identified 28 unique COS projects, of which 15 have published results as of May 2020. COS topics relevant to critical care medicine include mechanical ventilation, cardiology, stroke, rehabilitation, and long-term outcomes (LTOs) after critical illness. There are four COS projects for coronavirus disease 2019 (COVID-19), with a ‘meta-COS’ summarizing common outcomes across these projects. To help facilitate COS development, there are existing resources, standards, guidelines, and tools available from the Core Outcome Measures in Effectiveness Trials Initiative (www.comet-initiative.org/) and the National Institutes of Health-funded Improve LTO project (www.improvelto.com/).

Summary
Many COS projects have been completed in critical care, with more on-going COS projects, including foci from across the spectrum of acute critical care, COVID-19, critical care rehabilitation, and patient recovery and LTOs. Extensive resources are accessible to help facilitate rigorous COS development.
Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors
Authors: Wischmeyer Paul E. , Suman Oscar E. , Kozar Rosemary , Wolf Steven E. , Molinger Jeroen , Pastva Amy M. 
Published: December 2020

Purpose of review
ICU survivors frequently suffer significant, prolonged physical disability. ‘ICU Survivorship’, or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest addressing persistent catabolism by treatment with testosterone analogues combined with structured exercise is a promising novel intervention to improve ‘ICU Survivorship’.

Recent findings
One explanation for lack of success in addressing post-ICU physical disability is most ICU patients exhibit severe testosterone deficiencies early in ICU that drives persistent catabolism despite rehabilitation efforts. Oxandrolone is an FDA-approved testosterone analogue for treating muscle weakness in ICU patients. A growing number of trials with this agent combined with structured exercise show clinical benefit, including improved physical function and safety in burns and other catabolic states. However, no trials of oxandrolone/testosterone and exercise in nonburn ICU populations have been conducted.

Summary
Critical illness leads to a catabolic state, including severe testosterone deficiency that persists throughout hospital stay, and results in persistent muscle weakness and physical dysfunction. The combination of an anabolic agent with adequate nutrition and structured exercise is likely essential to optimize muscle mass/strength and physical function in ICU survivors. Further research in ICU populations is needed.
Postcritical illness vulnerability
Authors: Prescott Hallie C. , Sussman Jeremy B. , Wiersinga W. Joost 
Published: December 2020

Purpose of review
Critical illness survivorship is associated with new and worsening physical, cognitive, and emotional status. Survivors are vulnerable to further health set-backs, most commonly because of infection and exacerbation of chronic medical conditions. Awareness of survivors’ challenges are important given the anticipated rise in critical illness survivors because of SARS-CoV-2 viral sepsis.

Recent findings
Studies continue to document challenges of critical illness survivorship. Beyond the cognitive, physical, and mental health sequelae encompassed by postintensive case syndrome, patients commonly experience persistent immunosuppression, re-hospitalization, inability to resume prior employment, and reduced quality of life. Although recommended practices for enhancing recovery from sepsis are associated with better outcomes, only a minority of patients receive all recommended practices. ICU follow-up programs or peer support groups remain important interventions to learn about and address the multifaceted challenges of critical illness survivorship, but there is little evidence of benefit to date.

Summary
Survivors of sepsis and critical illness commonly experience impaired health status, reduced quality of life, and inability to return to prior employment. Although the challenges of critical illness survivorship are increasingly well documented, there are relatively few studies on enhancing recovery. Future studies must focus on identifying best practices for optimizing recovery and strategies to promote their implementation.
Noninvasive ventilation and high-flow nasal oxygen for acute respiratory failure: is less more?
Authors: Thille Arnaud W. , Coudroy Rémi , Frat Jean-Pierre 
Published: December 2020

Purpose of review
High-flow nasal oxygen and noninvasive ventilation (NIV) are two strategies representing an alternative to standard oxygen in the management of respiratory failure.

Recent findings
Although high-flow nasal oxygen has shown promising results in patients with de-novo acute respiratory failure, further large clinical trials are needed to determine the best oxygenation strategy. As NIV may have deleterious effects, especially in patients generating strong inspiratory efforts, protective NIV using higher levels of positive-end expiratory pressure, more prolonged sessions and additional interfaces such as helmets should be assessed in the future. Whereas NIV is the first-line ventilation strategy in patients with acute exacerbation of chronic lung diseases, high-flow nasal oxygen could be an alternative to NIV after partial reversal of respiratory acidosis. To prevent severe hypoxemia during intubation of hypoxemic patients or to prevent postextubation respiratory failure in patients at high-risk of reintubation, NIV is the best strategy for preoxygenation or immediately after extubation in ICUs.

Summary
New large-scale clinical trials are needed to compare high-flow nasal oxygen with standard oxygen in patients with de-novo acute respiratory failure to determine the reference treatment. After which, more protective NIV could be assessed among the more severe patients.