bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of an Automated Early Treatment Diabetic Retinopathy Study Low-contrast Letter Acuity Test
Authors: Pang Yi , Sparschu Lauren , Nylin Elyse , Wang Jingyun 
Published: May 2020

SIGNIFICANCE
Automated low-contrast letter acuity (LCLA) has several advantages: consistent luminance, reduced chance of individuals memorizing test letters, and convenient and accurate visual acuity reporting functions. Although automated LCLA might report slightly worse acuity than Sloan LCLA chart, considering its advantages, it may be a viable alternative to Sloan LCLA chart in clinical practice and research.

PURPOSE
The purpose of this study was to determine the repeatability of an automated LCLA measurement and its agreement with the Sloan LCLA chart test in normal participants and reduced-vision participants.

METHODS
Adult participants (n = 49) were measured with both automated Early Treatment Diabetic Retinopathy Study and Sloan LCLA tests, including normal and reduced-vision groups. Low-contrast letter acuity at two contrast levels (2.5 and 10%) was measured at 3 m in a random sequence with both LCLA tests. To test repeatability, participants were retested 1 week later. Repeatability of the two tests between two visits and agreement between automated and Sloan LCLA tests were evaluated using 95% limits of agreement.

RESULTS
In terms of the 95% limits of agreement, the repeatability of both tests was as follows: automated LCLA at 2.5%, ±0.26; automated LCLA at 10%, ±0.22; Sloan LCLA at 2.5%, ±0.23, and Sloan LCLA at 10%, ±0.16. The agreement of the two tests was as follows: ±0.19 at 2.5% and ±0.24 at 10%. The automated LCLA at 2.5 and 10% levels was generally reported one-half to one logMAR line lower than Sloan LCLA (mean differences, −0.04 at 2.5% and −0.13 at 10%; paired t test, P < .05).

CONCLUSIONS
The automated LCLA test shows fairly good test-retest repeatability at both 2.5 and 10% contrast levels. The agreement between the automated and the Sloan low-contrast letter acuity tests was comparable with test-retest agreement. Although the automated LCLA test reports slightly worse acuity than the Sloan LCLA test, it could be an appropriate alternative to the Sloan LCLA test.
The CN Lantern Test and Different Viewing Distances
Authors: Almustanyir Ali , Hovis Jeffery K. 
Published: May 2020

SIGNIFICANCE
This research shows that some color-vision–defective patients could identify railway signal lights correctly if they are working in the yard where sighting distances for signal lights are shorter.

PURPOSE
When interpreting railway signal lights, sighting distance can vary depending on the employee's location and job requirements. Individuals with a color-vision-defect may pass railroad employment color vision testing for positions with shorter sighting distances, despite failing to qualify for positions with longer sighting distances. The CN Lantern (CNLan) simulates railway signal lights. We evaluated performance and repeatability on CNLan at different viewing distances in color-normal and color-deficient individuals.

METHODS
Fifty-six subjects with normal color vision and 63 subjects with a red-green color-vision-defect participated. The CNLan test was performed at 4.6-, 2.3-, 1.15-, and 0.57-m viewing distance. The test was repeated after 10 days.

RESULTS
All individuals with normal color vision passed the CNLan at all distances at both visits without errors. For the group with a color-vision-defect, the pass rate increased from 12% at 4.6 m to 62% at 0.57 m. The repeatability of the CNLan between visits for the color-vision–defective group was very good with AC1 agreement values greater than 0.85.

CONCLUSIONS
An increase in retinal illumination was likely responsible for the improved performance as the test distance was decreased. Typical sighting distances in railway yards correspond to the 0.57-m test distance in our study. The results of this study suggest that 62% of the individuals with a red-green color-vision-defect may correctly identify colored signal lights in a railway yard where sighting distances are less than 100 m.
Extracorporeal Membrane Oxygenation for Pediatric Patients With Coronavirus Disease 2019–Related Illness*
Authors: MacGregor Robert M. , Antiel Ryan M. , Najaf Tasnim , Said Ahmed S. , Warner Brad W. , Raval Mehul V. , Shakhsheer Baddr 
Published: May 2020

Objective:
To describe current hospital guidelines and the opinions of extracorporeal membrane oxygenation leaders at U.S. children’s hospitals concerning the use of extracorporeal membrane oxygenation for coronavirus disease 2019–positive pediatric patients.

Design:
Confidential, self-administered questionnaire.

Setting:
One hundred twenty-seven U.S. pediatric extracorporeal membrane oxygenation centers.

Subjects:
Extracorporeal membrane oxygenation center program directors and coordinators.

Interventions:
None.

Measurements and Main Results:
In March 2020, a survey was sent to 127 pediatric extracorporeal membrane oxygenation centers asking them to report their current hospital extracorporeal membrane oxygenation guidelines for coronavirus disease 2019–positive patients. Respondents were also asked their opinion on three ethical dilemmas including: prioritization of children over adults for extracorporeal membrane oxygenation use, institution of do-not-resuscitate orders, and the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019–positive patients. Forty-seven extracorporeal membrane oxygenation centers had enacted guidelines including 46 (100%) that offer venovenous-extracorporeal membrane oxygenation and 42 (89%) that offer venoarterial-extracorporeal membrane oxygenation for coronavirus disease 2019–positive pediatric patients. Forty-four centers (94%) stated that the indications for extracorporeal membrane oxygenation candidacy in coronavirus disease 2019 disease were similar to those used in other viral illnesses, such as respiratory syncytial virus or influenza. Most program directors (98%) did not endorse that children hospitalized with coronavirus disease 2019 should be made do-not-resuscitate and had variable opinions on whether children should be given higher priority over adults when rationing extracorporeal membrane oxygenation. Over half of program directors (60%) did not support the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019.

Conclusions:
The majority of pediatric extracorporeal membrane oxygenation centers have proactively established guidelines for the use of extracorporeal membrane oxygenation for coronavirus disease 2019–related illnesses. Further work is needed to help guide the fair allocation of extracorporeal membrane oxygenation resources and to determine the appropriateness of extracorporeal cardiopulmonary resuscitation.
Improving the Timeliness and Safety of Therapeutic Hypothermia for Hypoxic–Ischemic Encephalopathy
Authors: Smith Hannah N. , Hughes Driscoll Colleen A. 
Published: May 2020

Introduction:
Therapeutic hypothermia (TH) is a time-sensitive, efficacious treatment for newborns who experience perinatal hypoxic–ischemic encephalopathy. Optimal management of patient temperatures during TH may improve newborn outcomes and reduce side effects. We noted that patients undergoing TH were often outside of the target temperature range during treatment. This project sought to improve the timely initiation of effective treatment and temperature stability during TH through system-based changes in practice.

Methods:
Measures include the time to target temperature, the percentage of core temperatures outside of the target range, and the absolute difference between core and peripheral temperatures over 41 months. System-based changes in the TH protocol included changing from passive to active hypothermia on transport and utilizing a delivery mode that uses more gradual temperature fluctuations during TH. We compared measures of health status and side effects as balancing measures.

Results:
The TH protocol changes resulted in a significant reduction of time to goal temperature from 1.67 to 0.49 hours, in the percentage of temperature readings outside goal range from 12.6% to 6.3%, and the average absolute difference between core and peripheral temperatures from 1.78°C to 1.47°C. No adverse health outcomes were detected. We observed decreases in vasopressor use with each protocol change.

Conclusions:
This study demonstrates that detailed attention to the method of delivery of TH has an impact on ensuring effective delivery of therapy and minimizing the risks of treatment. The protocol changes were not associated with an increase in adverse events and were associated with a reduction in vasopressor use.
Reducing Antacid Use in a Level IV NICU: A QI Project to Reduce Morbidity
Authors: Reinhart Richelle M. , McClary Jacquelyn D. , Zhang Mengqi , Marasch Jaime L. , Hibbs Anna Maria , Nock Mary L. 
Published: May 2020

Introduction:
Gastroesophageal reflux is a physiologic occurrence in infants. Clinicians caring for neonates use histamine-2 receptor antagonists (H2As) or proton pump inhibitors (PPIs) for symptomatic reflux, apnea/bradycardia/desaturations, or irritability. Recent studies have shown that there is an increased incidence of infection, fracture, and mortality in neonates who receive antacids.

Methods:
A multidisciplinary team aimed to decrease nonindicated antacid use in the NICU by 50% by April 2019. Outcome measures include the median number of inappropriate antacid prescriptions and patient-days on acid-suppressants. Interventions include education regarding use and risks of antacids, development of a list of indications deemed “appropriate” for starting an H2A or PPI, mandatory discussion on rounds when considering antacids, documentation of treatment goal, and indication, and an automatic drop-off in the electronic medical record.

Results:
Baseline data (June–December 2017) showed 19 prescriptions of H2As or PPIs. Of those, 10 orders were deemed “inappropriate,” according to our indicated uses. There were 407 total patient-days of medication-use (median: 51 patient-days). After the implementation of the interventions (October 2018–May 2019), there were 11 prescriptions of antacid medications, 3 of which were deemed “inappropriate.” There were 206 total days of medication-use (median: 18.5 patient-days).

Conclusions:
A multidisciplinary agreement on indications for antacid use in neonates stimulates discussion and creates more purposeful use. Overall, we successfully decreased nonindicated antacid prescriptions in the NICU. For the next steps, we hope to educate physicians on the risks of antacid use and reduce prescriptions in other areas of the hospital and the outpatient setting.
Ethnic Differences in Resting Total Peripheral Resistance: A Systematic Review and Meta-Analysis
Authors: Brownlow Briana N. , Williams DeWayne P. , Kapuku Gaston , Vasey Michael W. , Anderson Norman B. , Koenig Julian , Thayer Julian F. , Hill LaBarron K. 
Published: May 2020

ABSTRACTObjectiveDecades of research suggest that there may be important ethnic differences in the hemodynamic mechanisms that co-determine arterial blood pressure, the primary diagnostic index of hypertension. In general, studies have observed that, compared with European Americans (EAs), African Americans (AAs) exhibit higher total peripheral resistance (TPR), an important summative index of peripheral vascular constriction. In contrast, EAs have been reliably shown to exhibit greater cardiac output (CO), which is directly linked to left ventricle and overall cardiac blood flow. We have previously proposed that elevated basal TPR, in particular, represents one component of the cardiovascular conundrum, characterized, paradoxically, by elevated resting heart rate variability among AAs relative to EAs. The present meta-analysis and systematic review of the literature sought to extend this previous work by establishing the magnitude of the empirically implied ethnic differences in resting TPR and CO.MethodsA search of the literature yielded 140 abstracts on differences in TPR between AAs and EAs; 40 were included. Sample sizes, means, and standard deviations for baseline TPR with samples that included EAs and AAs were collected, and Hedgesgwas computed.ResultsFindings indicated that AAs had higher baseline TPR than did EAs (Hedgesg= 0.307, SE = 0.043, confidence interval= 0.224 to 0.391,p< .001). In addition, EAs had higher resting CO than did AAs (Hedgesg= −0.214, SE = 0.056, confidence interval = −0.324 to −0.104,p< .001).ConclusionsWe discuss the present findings in the context of the role of elevated TPR in the deleterious effects of high blood pressure specifically for AAs.
The Effect of Pain Resilience on Experimental Pain Experience Across Different Stimuli
Authors: Ankawi Brett , Slepian P. Maxwell , Himawan Lina , France Christopher R. 
Published: May 2020

ABSTRACTObjectivePain resilience, one’s ability to maintain behavioral engagement and adaptively regulate cognitions and emotions despite intense or prolonged pain, has been shown to protect against negative pain-related outcomes in experimental settings. A weakness of this research, and much of experimental pain research in general, has been the lack of rationale behind the selection of noxious stimuli, which can activate different nociceptive fibers. The present study sought to determine if the relationship between pain resilience and pain ratings differed across stimuli based on the stimulated nociceptors.MethodsHealthy undergraduate students (N= 100; mean [SD] age = 19.4 [1.2] years; 60% female) completed the Pain Resilience Scale and provided continuous pain ratings during exposure to three different tasks, each selected based on their ability to stimulate specific combinations of nociceptive fibers: pinprick (Aδ fibers), cold water immersion (Aδ and C fibers), and ischemic tourniquet (C fibers).ResultsParticipants with high pain resilience reported lower pain ratings over time during cold water immersion than did those with low pain resilience (F(1, 39) = 8.526,p= .006); however, there was no relationship between pain resilience and pain ratings during either of the pinprick or ischemic tourniquet stimuli.ConclusionsThis study provides further support for the use of multiple pain stimuli for pain assessment given their unique characteristics and concludes that outcome variables aside from pain ratings may provide additional insight into the role of resilience on pain adaptation.
Recent Trends of Infectious Complications Following Heart Transplantation
Authors: Multani Ashrit , Moayedi Yasbanoo , Puing Alfredo , Henricksen Erik , Garvert Donn W. , Gomez Carlos A. , Tremblay-Gravel Maxime , Bunce Paul E. , Luikart Helen , Ross Heather J. , Khush Kiran K. , Montoya Jose G. , Teuteberg Jeffrey J. 
Published: May 2020

Background.
Heart transplantation is a life-saving procedure that has seen improvements in transplant and patient outcomes due to advances in immunosuppression and prevention of posttransplantation infectious episodes (IEps). This study systematically evaluates IEps in the modern era of heart transplantation at Stanford University Medical Center.

Methods.
This is a single-center retrospective review that includes 279 consecutive adult heart transplantation recipients from January 2008 to September 2017. Baseline demographic, clinical, serological, and outcomes information were collected. Kaplan-Meier estimator was used to assess survival stratified by IEp occurrence within the first year.

Results.
A total of 600 IEps occurred in 279 patients (2.15 IEps per patient) during a median follow-up period of 3 years. Overall survival was 83.3% (95% confidence interval [CI], 76.2-88.4) at 1 year posttransplantation for those with any IEp compared with 93.0% (95% CI, 87.2-96.4) in those without IEp (P = 0.07). Bacterial IEps were the most common (n = 375; 62.5%), followed by viral (n = 180; 30.0%), fungal (n = 40; 6.7%), and parasitic (n = 5; 0.8%). IEps by Gram-negative bacteria (n = 210) outnumbered those by Gram-positive bacteria (n = 142). Compared with prior studies from our center, there was a decreased proportion of viral (including cytomegalovirus), fungal (including Aspergillus spp. and non-Aspergillus spp. molds), and Nocardia infections. There were no IEps due to Mycobacterium tuberculosis, Pneumocystis jirovecii, or Toxoplasma gondii.

Conclusions.
A significant reduction in viral, fungal, and Nocardia IEps after heart transplantation was observed, most likely due to advancements in immunosuppression and preventive strategies, including pretransplant infectious diseases screening and antimicrobial prophylaxis.
Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score
Authors: Levenfus Ian , Ullmann Enrico , Battegay Edouard , Schuurmans Macé M. 
Published: May 2020

AbstractClinical prediction scores support the assessment of patients in the emergency setting to determine the need for further diagnostic and therapeutic steps. During the current COVID-19 pandemic, physicians in emergency rooms (ER) of many hospitals have a considerably higher patient load and need to decide within a short time frame whom to hospitalize. Based on our clinical experiences in dealing with COVID-19 patients at the University Hospital Zurich, we created a triage score with the acronym AIFELL consisting of clinical, radiological and laboratory findings.The score was then evaluated in a retrospective analysis of 122 consecutive patients with suspected COVID-19 from March until mid-April 2020. Descriptive statistics, Student’s t-test, ANOVA and Scheffe’s post hoc analysis confirmed the diagnostic power of the score. The results suggest that the AIFELL score has potential as a triage tool in the ER setting intended to select probable COVID-19 cases for hospitalization in spontaneously presenting or referred patients with acute respiratory symptoms.
The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students
Authors: Gallo Linda A. , Gallo Tania F. , Young Sophia L. , Moritz Karen M. , Akison Lisa K. 
Published: May 2020

AbstractBackgroundThe pandemic inflicted by coronavirus disease 2019 (COVID-19) resulted in physical isolation measures in many parts of the world. In Australia, nationwide restrictions included staying at home, unless seeking medical care, providing care, purchasing food, undertaking exercise, or attending work in an essential service. All undergraduate university classes transitioned to online, mostly home-based learning. This disruption to daily life may have consequences for eating and physical activity patterns.MethodsIn this observational study, we examined the effect of isolation measures, during the early phase of the COVID-19 pandemic in Australia (March/April), on diet (24-hour diet recall, ASA-24) and physical activity (Active Australia Survey) patterns among third-year biomedical students in Brisbane, Australia. Findings were compared to students enrolled in the same course in the previous two years.ResultsIn females, energy intake was ~20% greater in 2020 compared with 2018 and 2019, and the frequency of snacking and energy density of consumed snacks were also increased. In males, there was no difference in energy intake or snacking behaviour. Physical activity was impacted for both sexes, whereby fewer students undertook any walking activity and, of those that did, time spent doing so was less compared with 2018 and 2019. The proportion of students reporting any vigorous activity was not different for males or females but, among males who participated in this level of activity, the duration was less in 2020 compared with previous years. The proportion of male and female students achieving ‘sufficient’ levels of activity, defined by at least 150 mins over at least 5 sessions, was ~30% less in 2020. Indeed, the majority of students reported as having undertaken less physical activity than usual.ConclusionsIncreased energy intake for females and reduced physical activity for males and females demonstrate impacts of isolation measures that may have deleterious consequences for physical and mental wellbeing, with the potential to affect long-term nutrition and activity patterns.
Modeling COVID 19 in the Basque Country: from introduction to control measure response
Authors: Aguiar Maíra , Millán Ortuondo Eduardo , Van-Dierdonck Joseba Bidaurrazaga , Mar Javier , Stollenwerk Nico 
Published: May 2020

AbstractIn March 2020, a multidisciplinary task force (so-called Basque Modelling Task Force, BMTF) was created to assist the Basque Health managers and the Basque Government during the COVID-19 responses. BMTF is a modeling team, working on different approaches, including stochastic processes, statistical methods and artificial intelligence. In this paper we describe and present the results obtained by a new stochastic SHARUCD model framework which was able to describe the disease incidence data provided by the Basque Health Services. Our models differentiate mild and asymptomatic from severe infections prone to be hospitalized and were able to predict the course of the epidemic, from introduction to control measure response, providing important projections on the national health system necessities during the increased population demand on hospital ad-missions. Short and longer-term predictions were tested with good results adjusted to the current epidemiological data, showing that the partial lockdown measures were effective and enough to slow down disease transmission in the Basque Country. The growth rate λ Is calculated from the model and from the data and the implications for the reproduction ratio r are shown. At the moment, the reproduction ratio r is estimated to be below the threshold behavior of r = 1, but still close to 1, meaning that although the number of new cases are decelerating, a careful monitoring of the development of the outbreak is required. This framework is now being used to monitor disease transmission while the country lock-down is gradually lifted, with insights to specific programs for a general policy of “social distancing” and home quarantining. These are the first publicly available modeling results for the Basque Country and the efforts will be continued taking into consideration the updated data and new information that are generated over time.