bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency and Implications of Complications in the ICU After Status Epilepticus: No Calm After the Storm*
Authors: Baumann Sira M. , Semmlack Saskia , De Marchis Gian Marco , Hunziker Sabina , Rüegg Stephan , Marsch Stephan , Sutter Raoul 
Published: October 2020

Objectives:
To investigate the frequency, types, and implications of complications during intensive care in patients after status epilepticus has been successfully terminated.

Design:
Retrospective study.

Setting:
ICUs at a Swiss tertiary academic medical care center.

Patients:
Data were collected from the digital patient records of all adult patients with status epilepticus from 2012 to 2018.

Interventions:
None.

Methods:
Primary outcomes were defined as frequency of complications following status epilepticus termination and return to premorbid functional baseline. Univariable analyses regarding the relative risks of complications occurring after status epilepticus termination for no return to premorbid neurologic function were estimated by Poisson regression with robust error variance.

Results:
Of 311 patients with status epilepticus, 224 patients (72%) were treated on the ICU for more than 24 hours following status epilepticus termination. Ninety-six percent of patients remained in a prolonged state of altered consciousness for a median of 2 days (interquartile range, 1–3 d) and 80% had complications during their ICU treatment. Fifty-five percent had new-onset delirium with a median duration of 2 days (interquartile range, 1–3 d). Forty-two percent had mechanical ventilation for a median of 4 days (interquartile range, 2–11 d) and 21% had nosocomial infections diagnosed after status epilepticus. Multivariable analyses revealed that mechanical ventilation for more than 24 hours after status epilepticus, and arterial hypotension requiring vasopressors were independently associated with increased risk of no return to premorbid function (RRfor each additional day = 1.01; 95% CI, 1.02–1.03 and RRfor each additional day = 1.03; 95% CI, 1.01–1.05) and death (RRfor each additional day = 1.11; 95% CI, 1.04–1.19 and RRfor each additional day = 1.15; 95% CI, 1.03–1.28). Delirium was independently associated with a decreased relative risk of death (RRfor each additional day = 0.55; 95% CI, 0.37–0.80), but prolonged ICU- and hospital stays.

Conclusions:
Complications after status epilepticus termination are frequent and associated with no return to premorbid function, death, and prolonged ICU- and hospital stays. These results call for heightened awareness and further studies mainly regarding prediction and preventive strategies in this context.
Early Sepsis Prediction Using Ensemble Learning With Deep Features and Artificial Features Extracted From Clinical Electronic Health Records
Authors: He Zhengling , Du Lidong , Zhang Pengfei , Zhao Rongjian , Chen Xianxiang , Fang Zhen 
Published: October 2020

Objectives:
Sepsis is caused by infection and subsequent overreaction of immune system and will severely threaten human life. The early prediction is important for the treatment of sepsis. This report aims to develop an early prediction method for sepsis 6 hours ahead on the basis of clinical electronic health records.

Data Sources:
Challenge data are released by PhysioNet/Computing in Cardiology Challenge 2019 and obtained from ICU patients in three separate hospital systems. Part of the data from two datasets, including 40,336 subjects, are publicly available, and the remaining are used as hidden test set. A normalized utility score defined by the organizing committee is used for model performance evaluation.

Study Selection:
The supervised machine learning is applied to tackle this challenge. Specifically, we establish the prediction model under the framework of ensemble learning by integrating the artificial features based on clinical prior knowledge of sepsis with deep features automatically extracted by long short-term memory neural network.

Data Extraction:
Forty clinical variables, including eight vital signs, 26 laboratory values, and six demographics, were measured and recorded once an hour for each individual, and the binary label (0 or 1) was simultaneously provided for each item.

Data Synthesis:
The proposed model was evaluated by 30-fold cross-validation. The sensitivity, specificity, and normalized utility score were 0.641 ± 0.022, 0.844 ± 0.007, and 0.401 ± 0.019 on publicly available datasets, respectively. The final normalized utility score our team (UCAS_DataMiner) has obtained was 0.313 on full hidden test set (0.406, 0.373, and –0.215 on test set A, B, and C, respectively).

Conclusions:
We realized a 6-hour ahead early-onset prediction of sepsis on the basis of clinical electronic health record by ensemble learning. The results indicated the proposed model functioned well in the early prediction of sepsis. In particular, ensemble learning had a significant (p < 0.01) improvement than any single model in performance.
Concurrent β-blocker Use is Associated With Improved Outcome in Esophageal Cancer Patients Who Undergo Chemoradiation
Authors: Farrugia Mark K. , Ma Sung Jun , Mattson David M. , Flaherty Leayn , Repasky Elizabeth A. , Singh Anurag K. 
Published: October 2020

Background:
β-blocker use has been associated with improved outcomes in a number of different malignancies; however, the impact of β-blockade in esophageal cancer is not been well characterized. We compared the outcomes of esophageal cancer patients based on β-blocker usage.

Methods:
The charts of all 418 patients treated with radiation for esophageal cancer at our institution from April 2010 to October 2018 were analyzed. Patients who underwent treatment with palliative intent or did not finish treatment were excluded. β-blocker use was determined from the medication list at time of pretreatment consultation.

Results:
There were 291 esophageal cancer patients who received neoadjuvant/definitive chemoradiation therapy. The median follow-up for the cohort was 22.5 months (interquartile range: 9.6 to 41.0 mo). Within the cohort, 27.8% (n=81) of patients were taking β-blockers at the time of treatment. Those taking β-blockers had significantly improved distant control (22.2% vs. 37.9%; P=0.035). Concomitant β-blocker use was significantly associated with improved progression-free survival (P<0.001, hazard ratio=0.42 [0.27-0.66]) and overall survival (P=0.002, hazard ratio=0.55 [0.38-0.81]) on Cox regression analysis. Propensity score–matched pairs were created using tumor stage, nodal stage, sex, neoadjuvant versus definitive therapy, Karnofsky Performance Status, and aspirin use. This matched-pair analysis showed a significant progression-free survival (P=0.005) benefit in esophageal cancer patients taking β-blockers.

Conclusions:
Concurrent β-blocker use is common within patients receiving concurrent chemoradiation for esophageal cancer. Esophageal cancer patients who received chemoradiation while taking β-blockers demonstrated significant benefits in survival-based outcomes.
Effectiveness of Containment Measures Against COVID-19 in Singapore
Authors: Pung Rachael , Cook Alex R. , Chiew Calvin J. , Clapham Hannah E. , Sun Yinxiaohe , Li Zongbin , Dickens Borame L. , Ma Stefan , Mak Kenneth , Tan Chorh Chuan , Heng Derrick , Chen Mark I-Cheng , Lee Vernon J. 
Published: October 2020

Background:
We hypothesize that comprehensive surveillance of COVID-19 in Singapore has facilitated early case detection and prompt contact tracing and, with community-based measures, contained spread. We assessed the effectiveness of containment measures by estimating transmissibility (effective reproduction number,

JOURNAL/epide/04.03/00001648-202101000-00011/inline-graphic1/v/2023-09-08T094005Z/r/image-tiff

) over the course of the outbreak.

Methods:
We used a Bayesian data augmentation framework to allocate infectors to infectees with no known infectors and determine serial interval distribution parameters via Markov chain Monte Carlo sampling. We fitted a smoothing spline to the number of secondary cases generated by each infector by respective onset dates to estimate

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and evaluated increase in mean number of secondary cases per individual for each day’s delay in starting isolation or quarantine.

Results:
As of April 1, 2020, 1000 COVID-19 cases were reported in Singapore. We estimated a mean serial interval of 4.6 days [95% credible interval (CI) = 4.2, 5.1] with a SD of 3.5 days (95% CI = 3.1, 4.0). The posterior mean

JOURNAL/epide/04.03/00001648-202101000-00011/inline-graphic3/v/2023-09-08T094005Z/r/image-tiff

was below one for most of the time, peaking at 1.1 (95% CI = 1.0, 1.3) on week 9 of 2020 due to a spreading event in one of the clusters. Eight hundred twenty-seven (82.7%) of cases infected less than one person on average. Over an interval of 7 days, the incremental mean number of cases generated per individual for each day’s delay in starting isolation or quarantine was 0.03 cases (95% CI = 0.02, 0.05).

Conclusions:
We estimate that robust surveillance, active case detection, prompt contact tracing, and quarantine of close contacts kept

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below one.
Simultaneous Quantification of BCR-ABL and Bruton Tyrosine Kinase Inhibitors in Dried Plasma Spots and Its Application to Clinical Sample Analysis
Authors: Mukai Yuji , Yoshida Yuka , Yoshida Tatsunari , Kondo Takeshi , Inotsume Nobuo , Toda Takaki 
Published: October 2020

Background:
Recent reports highlight the importance of therapeutic drug monitoring (TDM) of BCR-ABL and Bruton tyrosine kinase inhibitors (TKIs); thus, large-scale studies are needed to determine the target concentrations of these drugs. TDM using dried plasma spots (DPS) instead of conventional plasma samples is a promising approach. This study aimed to develop and validate a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of BCR-ABL and Bruton TKIs for further TDM studies.

Methods:
A 20-μL aliquot of plasma was spotted onto a filter paper and dried completely. Analytes were extracted from 2 DPS using 250 μL of solvent. After cleanup by supported liquid extraction, the sample was analyzed by LC-MS/MS. Applicability of the method was examined using samples of patients' DPS transported by regular mail as a proof-of-concept study. The constant bias and proportional error between plasma and DPS concentrations were assessed by Passing–Bablok regression analysis, and systematic errors were evaluated by Bland–Altman analysis.

Results:
The method was successfully validated over the following calibration ranges: 1–200 ng/mL for dasatinib and ponatinib, 2–400 ng/mL for ibrutinib, 5–1000 ng/mL for bosutinib, and 20–4000 ng/mL for imatinib and nilotinib. TKI concentrations were successfully determined for 93 of 96 DPS from clinical samples. No constant bias between plasma and DPS concentrations was observed for bosutinib, dasatinib, nilotinib, and ponatinib, whereas there were proportional errors between the plasma and DPS concentrations of nilotinib and ponatinib. Bland–Altman plots revealed that significant systematic errors existed between both methods for bosutinib, nilotinib, and ponatinib.

Conclusions:
An LC-MS/MS method for the simultaneous quantification of 6 TKIs in DPS was developed and validated. Further large-scale studies should be conducted to assess the consistency of concentration measurements obtained from plasma and DPS.
Temporal Attenuation of Gamma Dose Rate in Air Due to Radiocesium Downward Mobility in Soil
Authors: Velasco Hugo 
Published: October 2020

Abstract
The Chernobyl and Fukushima Dai-ichi Nuclear Power Plant accidents have demonstrated that radiocesium deposited on the ground was one of most important pathway contributions to the air dose rate. Cesium-134 contributes more significantly in the first period of 2–3 y. However, 137Cs external exposure may remain relevant for decades. The contribution to the air dose rate attributable to these radionuclides is maximum at the deposition time and then usually decreases over time. The dose rate temporal reduction is a consequence of both the radionuclide physical decay and the radionuclide downward mobility in soil. In this investigation, this decreasing behavior of the air dose rate is approached using an empirical attenuation function, and its coefficients are computed in terms of the effective diffusion coefficient and downward migration rates of radiocesium in soil. The methodology is tested for different hypothetical scenarios and in real situations, including areas affected by the two major accidents at nuclear power plants.
Least Significant Changes and Reproducibility of 131I Uptake Test
Authors: Şahmaran Turan , Gültekin Salih Sinan 
Published: October 2020

Abstract
Radioactive iodine uptake (RAIU) is one of the important tests performed in the departments of nuclear medicine, testing thyroid function by measuring the amount of 131I uptake after oral administration. A RAIU value measured 4 and 24 h after administration has been widely used for differential diagnosis of thyroid function and for the calculation of treatment dose. This study was performed to define practical methods for reproducibility and least significant change (LSC) values replicating thyroid measurements. In the study were 119 patients referred to the nuclear medicine department for examination of thyroid gland function with the diagnosis of Graves' disease (60), toxic multinodular goiter (29), thyroiditis (10), thyroid cancer (6), and unknown etiology (14). The level of thyroid stimulating hormone (TSH) among the patients was 2.07 ± 6.74 μIU mL−1. RAIU measurements were carried out by two different technicians, who have performed an equal number of measurements from each diagnosis in reference to the clinical diagnosis. Measurement of each patient was performed twice at 4 and 24 h after the administration under stable geometry and counting conditions using a standard procedure. Data were evaluated using statistical methods. For assessment of the reproducibility, three parameters were used: reproducibility coefficient (RC), the root-mean-square standard deviation (SDRMS), and the least significant change values. The average RAIU values of the first and second measurements were found as 23.71 ± 16.52% and 23.94 ± 16.64% at 4 h (p >0.05), and 35.33 ± 19.22% and 35.49 ± 19.19% at 24 h (p >0.05), respectively. For thyroid uptake values repeated at 4 and 24 h after radioiodine administration, the mean difference was found to be −0.24 ± 0.62% [limits of agreement (%); −1.44 to 0.97] at 4 h and −0.16 ± 0.44% [limits of agreement (%); −1.02 to 0.70] at 24 h. Confidence intervals were within the limits of agreement (d̅−1.96 SD and d̅+1.96 SD). When the correlation between the repeated RAIU measurements was examined taking the differences and averages into account, there was a negative correlation between 4-h measurement pairs (r=−0.203, p <0.05). On the other hand, a significant correlation was not found between the 24-h measurement pairs (r=0.074, p >0.05). RC, SDRMS, and LSC were calculated as 0.70%, 0.46%, and 1.29% for the 4 h measurements and 0.54%, 0.33%, and 0.91% for the 24-h measurements, respectively. Although there was a minor difference between measurement pairs at 4 and 24 h post-administration, the difference appeared to be insignificant without an apparent effect in the clinical settings.
Exposure to Short Wavelength-Enriched White Light and Exercise Improves Alertness and Performance in Operational NASA Flight Controllers Working Overnight Shifts
Authors: Barger Laura K. , Sullivan Jason P. , Lockley Steven W. , Czeisler Charles A. 
Published: October 2020

Objective:
We evaluated the efficacy of a combined short-wavelength-enriched white light and exercise fatigue countermeasure during breaks for flight controllers working overnight shifts.

Methods:
Twenty NASA flight controllers were studied for two blocks of nightshifts in ISS mission control, randomized to either the control or countermeasure condition. The countermeasure constituted passive exposure to blue-enriched polychromatic lighting for three 20-minute intervals, which included 10 minutes of exercise and occurred before and twice during their shifts. Alertness, performance, and mood were evaluated.

Results:
Flight controllers reported being significantly more alert (P < 0.0001) and happy (P = 0.003) and had faster reaction times (10% slowest responses; P < 0.05) during the countermeasure condition compared to control.

Conclusions:
The combined light and exercise countermeasure improved alertness, performance, and mood in shift workers overnight. Further research is necessary to determine their relative contribution.
Doctor of Physical Therapy Students' Developing Understanding of Physical Therapy Practice: A Longitudinal Study
Authors: Gilliland Sarah J. , Brown Teressa F. 
Published: October 2020

Introduction.
Clinical reasoning is a complex real-world practice that requires problem framing prior to problem solving. Clinicians and students demonstrate qualitative differences in their approaches to clinical reasoning that are influenced by their beliefs about practice. The purpose of this study was to examine the development of Doctor of Physical Therapy (DPT) students' perspectives on physical therapy practice throughout their entry-level education.

Methods.
A total of 44 students completed semistructured interviews that included both general and specific descriptions of their perceptions of physical therapy practice at 3 points during their DPT education: first, third, and eighth semester. The qualitative process of thematic analysis was used to identify patterns in the interview data. Patterns of change at both the group and individual levels within each coding dimension were identified.

Results.
First-semester students demonstrated a biomedical perspective focused on fixing problems related to specific pathologies while prioritizing the physical therapist's medical knowledge. Eighth semester students demonstrated a broader spectrum of perspectives with some retaining a biomedical view and others recognizing a more collaborative approach to practice with an emphasis on patient education and empowerment. There were high levels of variation in student development that became more pronounced as students moved through the curriculum.

Discussion and Conclusions.
Students' perspectives become more divergent over the 3 years in the program suggesting that natural development through classroom and clinical learning may not be sufficient for some students to develop comprehensive, patient-centered perspectives. The inconsistencies in development suggest that programs may need to give more explicit attention to students' development of perspectives/understandings in order to foster comprehensive development of patient-centered clinicians.
Bilateral Sequential Spontaneous Otogenic Pneumocephalus, Lessons in Pathophysiology, and Management of a Rare Case
Authors: Shapiro Scott B. , Lipschitz Noga , Tumlin Parker , Krueger Bryan , Forbes Jonathan , Samy Ravi N. 
Published: October 2020

Objective:
Report the details of an unusual case of initially unilateral intradural spontaneous otogenic pneumocephalus in which the patient developed contralateral pneumocephalus after surgical repair of temporal bone and dural defects on the initial side. Discuss the lessons learned concerning management and pathophysiology of this rare case.

Patient:
A 73-year-old male presenting with bilateral retro-orbital pain and headache was found to have unilateral intradural pneumocephalus in the temporal lobe with an adjacent defect in the temporal bone.

Intervention:
Surgical repair of the initial defect in the temporal bone and dura via a middle cranial fossa approach with obliteration of the mastoid cavity.

Results:
The patient's symptoms and degree of pneumocephalus on first affected side decreased initially after surgery. Two weeks after surgery he developed worsening pneumocephalus on the contralateral side in the temporal and frontal lobes with weakness and mild somnolence. This side was repaired via a similar technique without mastoid obliteration. Two weeks after surgery the patient recovered to normal level of consciousness with mild residual weakness.

Conclusions:
Spontaneous otogenic intradural pneumocephalus is an extremely rare but serious condition related to defects in the temporal bone and dura. The precise mechanism by which this occurs is poorly understood. This unusual case where there were bilateral defects presenting with spontaneous otogenic pneumocephalus in sequence illustrates that it represents a rare sequelae of processes which thin the skull base. These processes should be addressed in addition to acute management of the defect and intracranial air.
Middle Ear Actuator Performance Determined From Intracochlear Pressure Measurements in a Single Cochlear Scala
Authors: Raufer Stefan , Gamm Ute A. , Grossöhmichen Martin , Lenarz Thomas , Maier Hannes 
Published: October 2020

Hypothesis:
Intracochlear pressure measurements in one cochlear scala are sufficient as reference to determine the output of an active middle ear implant (AMEI) in terms of “equivalent sound pressure level” (eqSPL).

Background:
The performance of AMEIs is commonly calculated from stapes velocities or intracochlear pressure differences (PDiff). However, there are scenarios where measuring stapes velocities or PDiff may not be feasible, for example when access to the stapes or one of the scalae is impractical.

Methods:
We reanalyzed data from a previous study of our group that investigated the performance of an AMEI coupled to the incus in 10 human temporal bones. We calculated eqSPL based on stapes velocities according to the ASTM standard F2504-05 and based on intracochlear pressures in scala vestibuli, scala tympani, and PDiff.

Results:
The AMEI produced eqSPL of ∼100 to 120 dB at 1 Vrms. No significant differences were found between using intracochlear pressures in scala vestibuli, scala tympani, or PDiff as a reference. The actuator performance calculated from stapes displacements predicted slightly higher eqSPLs at frequencies above 1000 Hz, but these differences were not statistically significant.

Conclusion:
Our findings show that pressure measurements in one scala can be sufficient to evaluate the performance of an AMEI coupled to the incus. The method may be extended to other stimulation modalities of the middle ear or cochlea when access to the stapes or one of the scalae is not possible.