bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Trauma Patient Intensive Care Resource Utilization in U.S. Military Operations in Iraq and Afghanistan
Authors: Gale Hannah L. , Borgman Matthew A. , April Michael D. , Schauer Steven G. 
Published: December 2019

Objectives:
Children represent a unique patient population treated by military personnel during wartime, as seen in the recent conflicts in Iraq and Afghanistan. We sought to describe ICU resource utilization by U.S. military personnel treating pediatric trauma patients in Iraq and Afghanistan.

Design:
This is a retrospective review of prospectively collected data within Department of Defense Trauma Registry.

Setting:
We studied pediatric casualties treated in U.S. and coalition military hospitals in Iraq and Afghanistan between January 2007 and January 2016.

Patients:
We queried the Department of Defense Trauma Registry for patients less than 18 years with one documented day within an ICU.

Interventions:
We used descriptive statistics to analyze injuries patterns and interventions. We defined prolonged length of stay as ICU stay four days or greater. Regression methodology was utilized to identify factors associated with prolonged length of stay.

Measurements and Main Results:
There were 1955 (56.8%) pediatric patients that met our inclusion criteria. The most common mechanism of injury was explosive (45.2%) followed by gunshot wounds (20.8%). The median composite ISS was 14. The median length of stay was 3 days with 90.2% surviving to hospital discharge. Mechanical ventilation was the most frequent intervention (67.6%) followed by arterial access (21.8%). Prolonged length of stay was associated with all serious injuries, ventilator management, blood product administration, wound dressing, bronchoscopy, imaging, and central venous access.

Conclusions:
Pediatric casualties accounted for nearly one in 10 admissions with the majority requiring intensive care. The most commonly performed interventions were mechanical ventilation, vascular access, and imaging, each of which requires a specialized skill set to provide optimal patient management. All serious injuries by body region except facial were associated with a prolonged length of ICU stay, as well as blood product administration, ventilator management, intracranial pressure monitoring, wound care, bronchoscopy, imaging, and central venous access. The epidemiology of this unique population may be useful in planning future pre-deployment training and resource management in ICUs in deployed environments.
Optimizing Tele-ICU Operational Efficiency Through Workflow Process Modeling and Restructuring
Authors: Becker Christian D. , Yang Muer , Fusaro Mario , Fry Michael , Scurlock Corey S. 
Published: December 2019

Objectives/Design:
Little is known on how to best prioritize various tele-ICU specific tasks and workflows to maximize operational efficiency. We set out to: 1) develop an operational model that accurately reflects tele-ICU workflows at baseline, 2) identify workflow changes that optimize operational efficiency through discrete-event simulation and multi-class priority queuing modeling, and 3) implement the predicted favorable workflow changes and validate the simulation model through prospective correlation of actual-to-predicted change in performance measures linked to patient outcomes.

Setting:
Tele-ICU of a large healthcare system in New York State covering nine ICUs across the spectrum of adult critical care.

Patients:
Seven-thousand three-hundred eighty-seven adult critically ill patients admitted to a system ICU (1,155 patients pre-intervention in 2016Q1 and 6,232 patients post-intervention 2016Q3 to 2017Q2)

Interventions:
Change in tele-ICU workflow process structure and hierarchical process priority based on discrete-event simulation.

Measurements and Main Results:
Our discrete-event simulation model accurately reflected the actual baseline average time to first video assessment by both the tele-ICU intensivist (simulated 132.8 ± 6.7 min vs 132 ± 12.2 min actual) and the tele-ICU nurse (simulated 128.4 ± 7.6 min vs 123 ± 9.8 min actual). For a simultaneous priority and process change, the model simulated a reduction in average TVFA to 51.3 ± 1.6 min (tele-ICU intensivist) and 50.7 ± 2.1 min (tele-ICU nurse), less than the added simulated reductions for each change alone, suggesting correlation of the changes to some degree. Subsequently implementing both changes simultaneously resulted in actual reductions in average time to first video assessment to values within the 95% CIs of the simulations (50 ± 5.5 min for tele-intensivists and 49 ± 3.9 min for tele-nurses).

Conclusions:
Discrete-event simulation can accurately predict the effects of contemplated multidisciplinary tele-ICU workflow changes. The value of workflow process and task priority modeling is likely to increase with increasing operational complexities and interdependencies.
Intermittent Hemodialysis for Managing Metabolic Acidosis During Resuscitation of Septic Shock: A Descriptive Study
Authors: Nogi Kazutaka , Shiraishi Atsushi , Yamamoto Ryohei , Sasano Mikio , Matsumoto Takashi , Karumai Toshiyuki , Hayashi Yoshiro 
Published: December 2019

Objectives:
Septic shock is often complicated by severe metabolic acidosis, for which renal replacement therapy may be considered. However, little is known about the use of intermittent hemodialysis to manage this condition. The aim of this study was to compare physiologic and biochemical variables and vasopressor requirements before and after intermittent hemodialysis among patients who received intermittent hemodialysis to manage metabolic acidosis during resuscitation of septic shock.

Design:
This retrospective, cross-sectional study was conducted between April 2014 and September 2015.

Settings:
The ICU of a non-university-affiliated teaching hospital.

Patients:
Patients who were admitted to the ICU with septic shock and underwent intermittent hemodialysis to manage metabolic acidosis within 48 hours after the diagnosis of septic shock.

Measurements and Main Results:
The main outcomes were mean arterial pressure, minute ventilator volume, norepinephrine requirement, bicarbonate and pH before and after intermittent hemodialysis. Of 1,190 patients screened, 34 were included, and 33 accomplished a planned session of intermittent hemodialysis. After intermittent hemodialysis, an increased mean arterial pressure (+9.0 mm Hg; 95% CI, 6–13; p < 0.001), decreased minute ventilatory volume (–2.0 L/min; 95% CI, –3.3 to 0.8; p = 0.002), decreased norepinephrine requirement (–0.07 µg/kg/min; 95% CI, –0.12 to –0.02; p = 0.009), increased bicarbonate level (+7.2 mmol/L; 95% CI, 6.1–8.3; p < 0.001), and increased pH (+0.17; 95% CI, 0.13–0.21; p < 0.001) were observed in comparison to those before intermittent hemodialysis.

Conclusions:
In conclusion, intermittent hemodialysis appeared to be feasible and to stabilize hemodynamic and respiratory conditions in patients with septic shock complicated by metabolic acidosis during resuscitation.
Epigenetic Profiling in Severe Sepsis: A Pilot Study of DNA Methylation Profiles in Critical Illness*
Authors: Binnie Alexandra , Walsh Christopher J. , Hu Pingzhao , Dwivedi Dhruva J. , Fox-Robichaud Alison , Liaw Patricia C. , Tsang Jennifer L. Y. , Batt Jane , Carrasqueiro Gabriela , Gupta Sahil , Marshall John C. , Castelo-Branco Pedro , dos Santos Claudia C. 
Published: December 2019

Objectives:
Epigenetic alterations are an important regulator of gene expression in health and disease; however, epigenetic data in sepsis are lacking. To demonstrate proof of concept and estimate effect size, we performed the first epigenome-wide methylation analysis of whole blood DNA samples from a cohort of septic and nonseptic critically ill patients.

Design:
A nested case-control study using genomic DNA isolated from whole blood from septic (n = 66) and nonseptic (n = 68) critically ill patients on “Day 1” of ICU admission. Methylation patterns were identified using Illumina 450K arrays with percent methylation expressed as β values. After quality control, 134 participants and 414,818 autosomal cytosine-phosphate-guanine sites were used for epigenome-wide methylation analyses.

Setting:
Tertiary care hospitals.

Subjects:
Critically ill septic and nonseptic patients.

Interventions:
Observational study.

Measurements and Main Results:
A total of 668 differentially methylated regions corresponding to 443 genes were identified. Known sepsis-associated genes included complement component 3; angiopoietin 2; myeloperoxidase; lactoperoxidase; major histocompatibility complex, class I, A; major histocompatibility complex, class II, isotype DR β I; major histocompatibility complex, class I, C; and major histocompatibility complex, class II, isotype DQ β I. When compared with whole blood gene expression data from seven external datasets containing septic and nonseptic patients, 81% of the differentially methylated region–associated genes were differentially expressed in one or more datasets and 31% in three or more datasets. Functional analysis showed enrichment for antigen processing and presentation, methyltransferase activity, cell adhesion, and cell junctions. Analysis by weighted gene coexpression network analysis revealed DNA comethylation modules that were associated with clinical traits including severity of illness, need for vasopressors, and length of stay.

Conclusions:
DNA methylation marks may provide important causal and potentially biomarker information in critically ill patients with sepsis.
Targeting human epidermal growth factor receptor 2 (HER2) in gynecologic malignancies
Authors: Erickson Britt K. , Zeybek Burak , Santin Alessandro D. , Fader Amanda N. 
Published: December 2019

Purpose of review
The purpose of this review is to describe the role of the human epidermal growth factor receptor 2 (HER2) as a biomarker and potential target in gynecologic malignancies and to describe contemporary updates in the use of anti-HER2 treatments for these cancers.

Recent findings
Approximately 25–30% of all patients with uterine serous carcinoma overexpress tumoral HER2. The anti-HER2 antibody trastuzumab represents an effective, targeted therapy with significant efficacy in the treatment of HER2-positive breast and gastric cancer. Recently, trastuzumab efficacy has also been demonstrated in a randomized controlled trial of women with advanced or recurrent uterine serous carcinoma. Additionally, trastuzumab may be effective in women with HER2-positive uterine carcinosarcoma. The role of anti-HER2 therapy is unclear in women with other gynecologic malignancies but is being evaluated.

Summary
HER2 amplification/overexpression is an effective therapeutic target in select gynecologic malignancies, and especially in the rare endometrial cancer subtype, uterine serous carcinoma. As anti-HER2-targeted therapies become increasingly available, more treatment options may become available for women with HER2-positive disease.
Speckle tracking echocardiography: imaging insights into the aorta
Authors: Rong Lisa Q. , Kim Jiwon , Gregory Alexander J. 
Published: December 2019

Purpose of review
Pathophysiologic changes of aortic tissue may not always manifest as aneurysms, nor does the size of an aneurysm necessarily represent the severity of tissue abnormality – approximately 40% of patients who present with dissection have aortic diameters below criteria recommended for surgical resection. Noninvasive imaging-based quantification of aortic biomechanics has the potential to improve our knowledge of the pathophysiology of aortic disease, including patient-specific risk-stratification and intraoperative surgical decision-making.

Recent findings
We summarize the current state of clinical utilization of two-dimensional speckle tracking echocardiography (2D-STE) aortic strain to better understand the pathophysiology, clinical implications, and risk stratification of aortic disease.

Summary
2D-STE has demonstrated promising early results as an imaging modality to determine clinically relevant measures of aortic tissue mechanical properties. Further large multinational, multiethnic, age-stratified, and sex-stratified measures of normal aortic strain measurements, as well as comparison studies with alternative imaging techniques, will be needed to properly elucidate the role echocardiography will play in the clinical management of aortic disease.
Choosing the best antithrombotic regimen in patients with ventricular assist devices
Authors: Bader Feras , Mallah Saad , Atallah Bassam 
Published: December 2019

Purpose of review
Two major complications compromise the outcomes and quality of life for left ventricular assist device (LVAD) patients. This review aims to discuss the mechanisms of thrombosis and bleeding, recent literature on the optimal approaches for antithrombotic therapy, and novel approaches to prevent bleeding.

Recent findings
Recent studies with the newly designed LVAD, the fully magnetically levitated rotor, show lower thrombotic risk but sustain similar bleeding risk. Small studies present options for less intense antithrombotic regimens with the newer devices. Bridging anticoagulation when needed in this patient population might require modified regimens and close monitoring to avoid anticoagulation overlap during the bridged periods. The necessity to add an antiplatelet to anticoagulation is particularly being challenged with the recent data. Antiplatelet responsiveness testing is an intriguing approach to customize regimens. In addition, novel approaches that target activation of the angiotensin II receptors and inflammatory responses might offer further protection against bleeding in implanted patients.

Summary
Close monitoring, novel, and patient-tailored approaches may offer the best antithrombotic strategies for LVAD patients. More clinical and long-term data are needed to establish the potential for less intense regimens particularly with the newly designed devices.
End-of-life care in patients with advanced heart failure
Authors: Diamant Michael J. , Keshmiri Hesam , Toma Mustafa 
Published: December 2019

Purpose of review
With an aging population with heart failure, there is a growing need for end-of-life care in this population, including a focus on symptom management and quality-of-life considerations.

Recent findings
Targeted therapies focusing on symptom control and improving quality of life is the cornerstone of providing care in patients with heart failure near the end of life. Such therapies, including the use of inotropes for palliative purposes, have been shown to improve symptoms without an increase in mortality. In addition, recent evidence shows that implementing certain strategies in planning for end of life, including advance care planning and palliative care involvement, can significantly improve symptoms and quality of life, reduce hospitalizations, and ensure care respects patient values and preferences.

Summary
Shifting focus from prolonging life to enhancing quality of life in heart failure patients approaching the end of life can be achieved by recognizing and managing end-stage heart failure-related symptoms, advanced care planning, and a multidisciplinary care approach.
Valve sparing root replacement: an update
Authors: De Paulis Ruggero , Scaffa Raffaele , Chirichilli Ilaria 
Published: December 2019

Purpose of review
Until the year 2000, the publications concerning aortic valve sparing (AVS) did not exceed 20 articles; in the following years almost 300 publications have appeared. Over 35 years from the introduction of valve sparing techniques and 500 years after the death of Leonardo da Vinci, this review highlights the significant steps in modern imaging techniques and the excellent clinical results in the field of reconstructive aortic root surgery.

Recent findings
AVS operations underwent significant modifications over the last few years making it reproducible with satisfactory outcomes. The extraordinary potential of imaging opens new boundless horizons in the perspective of an increasingly patient-tailored surgical planning. The basic surgical concepts include the preservation and resuspension of the aortic valve in a near-normal environment (with the creation of functionally suited neo-aortic sinuses) and the re-establishment of a normal relationship of the aortic root components.

Summary
Today is possible to perform a reimplantation procedure with the creation of neo-sinuses or a remodeling procedure with the addition of annular support. Both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. AVS operations have become established alternatives to Bentall procedures for patients with aortic root pathology, especially in young patients.
EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY
Authors: Baumann Carmen , Kaye Stephen , Iannetta Danilo , Sultan Ziyaad , Dwivedi Rahul , Pearce Ian 
Published: December 2019

Purpose:
To investigate the role of an internal limiting membrane (ILM) flap in macular hole (MH) surgery on closure rate, visual acuity, and integrity of the outer retinal layers.

Methods:
Retrospective, nonrandomized interventional analysis in which 117 eyes of 117 patients were included who had undergone pars-plana vitrectomy (PPV) and gas tamponade for primary idiopathic MH >400 µm with either conventional ILM peeling or with inverted ILM flap technique at The Royal Liverpool University Hospital between January 2016 and April 2018. Main outcome measures were closure of MH, best-corrected visual acuity (BCVA) at 3, 6, and 12 months, and restoration of external limiting membrane and ellipsoid zone (EZ) using optical coherence tomography.

Results:
Macular hole closure rate was significantly higher in patients with an ILM flap (67/68; 98.53%) than in those with conventional ILM peeling (43/49; 87.76%) (P = 0.02). Both groups showed significant improvements in their preoperative to postoperative BCVA at 3 months from 1.07 (0.43) logarithm of the minimum angle of resolution (logMAR) (20/235 Snellen) to 0.71 (0.34) logMAR (20/103 Snellen) (P <0.001), but there was no significant difference between the two groups (P = 0.45, P = 0.71). We found significant associations between postoperative BCVA and preoperative BCVA (P < 0.01) and the integrity of the EZ (P < 0.01). In 35 patients who had follow-up to 12 months, there was a significant improvement in BCVA between 3, 6, and 12 months from 0.73 (0.45) logMAR (20/107 Snellen) to 0.53 (0.24) logMAR (20/68 Snellen) and to 0.35 (0.18) logMAR (20/45 Snellen), respectively (P < 0.01). There was no significant difference at these time periods between the two groups (P = 0.62, P = 0.21, P = 0.31). The integrity of the EZ also improved significantly between 3, 6, and 12 months (P = 0.01), irrespective of the presence of an ILM flap (P = 0.58), but with a trend toward delay in restoration in those patients with an ILM flap. The improvement in BCVA at 12 months, taking into account the age of the patient, size and duration of the MH, presence of an ILM flap, and preoperative BCVA was dependent on the state of the EZ (P = 0.01).

Conclusion:
In patients undergoing primary pars-plana vitrectomy for MH >400 µm, the presence of an inverted ILM flap was associated with a significantly higher closure rate than a conventional ILM peeling. Best-corrected visual acuity showed a strong correlation with the integrity of the EZ and both improved significantly between 3, 6, and 12 months, irrespective of the presence of an ILM flap.
AUTOMATED RETINAL LAYER SEGMENTATION AND THEIR THICKNESS PROFILES IN HEALTHY SUBJECTS
Authors: Giannakaki-Zimmermann Helena , Munk Marion R. , Ebneter Andreas , Wolf Sebastian , Zinkernagel Martin 
Published: December 2019

Purpose:
To assess whether retinal thickness measurements with a standard 30° spectral domain optical coherence tomography (SD-OCT) are comparable with wide-field 55° SD-OCT.

Methods:
Thirty-three healthy individuals were scanned using 55° as well as 30° SD-OCT according to a standardized protocol. Automated retinal layer segmentation of standard and wide-field SD-OCTs was assessed using customized software.

Results:
Both lenses showed a high correlation when analyzing total retinal thickness within the central, the inner, and the outer retinal ring (r = > 0.9). Automated thickness measurements with the 55° system were marginally higher compared with the 30° lens. The thickness of each separate retinal layer using automated segmentation showed excellent correlations within the inner and outer rings (range: r = 0.6—r = 0.9 for the inner ring and range: r = 0.9—r = 1.0 for the outer ring).

Conclusion:
Fifty-five degree wide-field SD-OCT provides a good overview of the posterior pole and presents similar quantitative values as a standard 30° OCT lens. Therefore, thickness values are comparable when switching between these two lenses.
Antegrade Continence Enema
Authors: Holder Monica , Desjarlais Marie , Harrington Anne , Kern Patricia 
Published: December 2019

Abstract
The broad term “ACE” refers to an antegrade continence enema that allows you to flush or empty the colon starting from the beginning of the colon (cecum) and flushing to the end (rectum) for patients with true fecal incontinence or constipation with the inability to empty the bowel with oral therapy. The terms “cecostomy,” “MACE,” “ACE,” and “Malone” have often been used interchangeably; however, they do have technical differences. The purpose of this article is to describe and compare specifically Malone/appendicostomy, neo-Malone/neo-appendicostomy, and cecostomy. The contents of this publication are compiled of both expert opinions and literature review.
Influences of Two-Year Professional Education Delivered in English on Japanese Undergraduate Physiotherapy Students’ English Vocabulary and International Perspectives: A Retrospective Cohort Study
Authors: Mine Koya , Girdwood Michael , Toyoda Hiroko , Nakayama Takashi 
Published: December 2019

Introduction.
Low levels of English proficiency among Japanese physiotherapists pose serious barriers to implement evidence-based practice and think about their careers in global terms. This retrospective cohort study aimed to investigate the influences of a series of lectures regarding various physiotherapy topics conducted in English, on Japanese undergraduate physiotherapy students’ English vocabulary and international perspectives.

Methods.
Twelve students from Tokyo University of Technology participated in a total of 60 lectures throughout 2 years. On a weekly basis, 90-minute physiotherapy lectures were conducted in English. Another 12 students who did not participate in lectures were randomly chosen and served as a control group. English vocabulary regarding physiotherapy was assessed through a word translation test. Furthermore, students’ subjective interests in learning English, studying and working abroad, awareness toward the importance of learning English and physiotherapy from foreign countries, and the level of physiotherapy in Japan compared with that in other countries were also evaluated using 11-point numerical rating scale.

Results.
English vocabulary scores were significantly higher in the experimental group (P < .01). The effect size was large (3.09). Interest levels in learning English, and studying and working abroad were significantly higher in the experimental group (P < .01). Effect sizes were large (1.89 and 1.11, respectively). However, levels of awareness toward the importance of learning English and physiotherapy from other countries and the level of physiotherapy in Japan were not significantly different between the two groups.

Discussion and Conclusions.
Two-year professional education in English may lead to benefits in English vocabulary related to physiotherapy and motivating students to think about their careers in global perspectives. Based on these findings, educational staff in Japanese physiotherapy schools are encouraged to consider to introduce professional education using English for undergraduate students.