bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are Opioids Overprescribed to Pediatric Neurosurgery Patients? A Prospective Study on Prescribing Practices and Patient Use
Authors: Burroughs Leah , Ash Denise , Ackerman Laurie 
Published: December 2021

Background and Hypothesis: The opioid crisis continues to worsen in the United States with opioid overdose deaths reaching record highs in 2020. While a large body of literature exists surrounding the risks of opioids in adults, opioids also pose unique risks to pediatric patients, including accidental ingestion, nonmedical use, and acute cerebellitis causing death. Opioid medications prescribed in the medical setting are often an unwitting source of excess opioids, with half of pediatric overdoses in those under 2 years of age. Although legislative efforts have significantly limited opioid prescribing, recent studies suggest these medications may still be overprescribed. We hypothesized opioid medications are overprescribed to pediatric neurosurgery patients upon hospital discharge.
Methods: Pediatric patients undergoing neurosurgical procedures at Riley Hospital for Children were identified prospectively. Surgery type, length of stay, and inpatient use of opioid medications were collected. Patients prescribed an opioid medication upon hospital discharge were contacted 7 days after discharge and asked to report the number of doses of opioid medication used.
Results: Thirty patients were successfully contacted 7 days after hospital discharge. Patients underwent a variety of cranial and spinal procedures and the mean length of hospital stay was 3.9 days. An average of 24.9 doses of opioid medication were prescribed at hospital discharge, while an average of 3.8 doses were used by patients in the 7 days following hospital discharge. Twelve patients (40%) had used zero doses of the prescribed opioid medication at 7-day follow-up.
Conclusions: Pediatric neurosurgery patients used only 15.3% of prescribed opioids in 7 days after hospital discharge. This creates an excess of leftover opioid medication that may increase the risk of accidental ingestion and misuse. The present study highlights the need for educational initiatives for providers to minimize excess opioids prescribed and for parents to safely dispose of leftover opioid medication.
Determining the Mechanism of Propofol-induced Neurotoxicity
Authors: Burton Kyle , Canfield Scott 
Published: December 2021

Background and Hypothesis: Propofol is an IV anesthetic agent with many clinical applications, including general anesthesia, sedation, delirium, and palliative care. Despite its versatility and effectiveness, Propofol has been shown to have detrimental effects on the vascular interface between the brain and circulation. The Blood-Brain Barrier (BBB) acts as a selective interface that serves to protect the brain from its cerebrovascular network. BBB dysfunction can have lethal complications such as cerebral edema and stroke. Matrix Metalloproteinases (MMP’s), specifically MMP-2 and MMP-9 have been linked to BBB breakdown. Using human induced pluripotent stem cell (IPSC) derived brain microvascular endothelial cells (BMECs), we evaluated the impact of inhibiting MMP-2 on restoring BBB integrity following exposure to Propofol with the intent to reveal the mechanism by which Propofol disrupts the BBB.
We hypothesized that inhibiting MMP-2 would lead to phenotype recovery after exposure to Propofol.
Methods: IPSC-differentiated BMECs were treated with MMP inhibitors at varying time points and concentrations relative to exposure to Propofol for 3 hours. Trans-endothelial electrical resistance (TEER) and sodium fluorescein permeability was used to assess BBB structural integrity. A MTT assay was conducted to assess cell viability.
Results: Inhibiting MMP-2 did not result in in recovery of BBB integrity following exposure to Propofol as no significant differences were observed in TEER and sodium fluorescein permeability between the Propofol control and Propofol + MMP-2 inhibitor groups.
Conclusions & Future Directions: Propofol-induced disruption of BBB integrity does not appear to be through MMP-2 activity. High concentrations of MMP-inhibitor compounds result in increased disruption of BBB tightness and permeability. It is plausible to suspect that Propofol may act through other MMP’s to facilitate BBB break-down, thus future studies should investigate the effects of the other selective MMP inhibitors in their ability to achieve phenotype recovery following exposure to Propofol.
Automated Angiographic Labeling Pipeline
Authors: Cantrell Jacob , Kersey Kolten , Motaganahalli Anush , Li Amy , Maxwell Hunter , Dev Shantanu , Gonzalez Andrew A. 
Published: December 2021

Background & Hypothesis: Treatment decisions for medical management, endovascular therapy, open surgery, and hybrid approaches for peripheral artery disease (PAD) are largely driven by imaging. While catheter-directed angiography remains the gold-standard for endoluminal vessel analysis, currently, there is not widespread clinical use of machine learning to provide automated segmentation. This project aims to develop an active learning pipeline to automate the labeling of vascular structures in angiographic images.
Methods: We queried the picture archiving and communication system (PACS) database for Indiana University Health and Eskenazi Health to identify studies with catheter-directed angiograms of the extremities. From this dataset we randomly selected an initial convenience sample of 50 angiograms to manually label using the 3D Slicer software. We compared three workflow approaches for labeling this training data - (1) human-only single-pass labelling whereby one person labels each image; (2) human-only multi-pass labelling whereby three humans label a vessel with increasing precision; (3) “human-in-the-middle” approach using NVIDIA’s AI-Assisted Annotation client whereby the image is auto-segmented and then manually checked for accuracy.
Results: We are currently evaluating speed and accuracy for each of these approaches. However, our preliminary data suggests that human-only multi-pass labeling is most efficientappreac We will be validating the following three-step process. First, thresholding tool was used to leverage differences in contrast gradations to approximate the location of vascular structure. Second, the eraser tool was utilized to refine the vessel boundaries. Finally, major blood vessels contributing to axial flow to the foot were manually labeled. These labeled angiograms will be used to develop an active learning algorithm to automate future labeling of the remaining dataset.
Conclusion: A machine learning approach to interpreting lower extremity images can dramatically improve the efficiency of triaging patients with PAD. Further work is underway to develop and implement this program clinically.
Medication and its Effect on Safe & Sound Protocol Therapy Outcomes in a Pediatric Population
Authors: Cook Victoria , Hunt Doreen , Kolacz Jacek 
Published: December 2021

Background and Hypothesis: The current study evaluated the effect of different medications on a child’s response to the Safe & Sound Protocol (SSP) therapy. Informed by the Polyvagal Theory and the evidenced relationship between state regulation and autonomic imbalance, the therapy aims to improve state dysregulation which can manifest in children as emotional reactivity, sensory processing issues, and auditory sensitivities. Prior studies have shown a reduction in auditory hypersensitivities after the SSP therapy plus evidence shows SSRIs and stimulants have a positive impact on hearing in the presence of background noise. We hypothesized that a) the SSP could improve treatment response in those taking neurotransmitter-altering medication due to synergistic effects or b) it could show reduce treatment response due to sensitivities already being managed by medication.
Project Methods: Children in the study underwent a month of the SSP therapy with auditory processing standardized parent reports (Brain Body Center Sensory Scale) taken prior to treatment then approximately 1 week and 4 weeks after treatment. The data was then separated into different medication groups: stimulants (n=4), non-stimulant neurotransmitter altering medications (n=4), and other non-neurotransmitter altering medications (n=9) such as albuterol. Non-medication and medication group outcomes were then compared to identify significant differences between the groups using independent and paired samples t-tests.
Results: The results from this study found a significant reduced response to the SSP in children taking non-stimulant neurotransmitter altering medications, which included both sertraline, a selective serotonin reuptake inhibitor, and guanfacine, an a2A-adrenergic agonist. In addition, the non-neurotransmitter altering medication group was the only medication group that showed significant improvement in hypersensitivities while each non-medication group improved in hypersensitivity and hyposensitivity.
Potential Impact: Commonly-used guidelines for SSP are to maintain typical medication use during the intervention. This study, the first to systematically assess treatment response to the SSP by medication use, could inform how clinicians implement both SSP and medication treatments concurrently. However, these results are based on very small medication groups, therefore follow-up studies with larger samples are necessary to inform current clinical practices.
Non-invasive, Spatiotemporal Characterization of Muscle Activation Patterns from Vagus Nerve Stimulation in Human Subjects
Authors: Feucht Maria , Ward Matthew 
Published: December 2021

Background and Hypothesis: Vagus nerve stimulation (VNS) is used for treatment of epilepsy in over 100,000 patients worldwide and is a potential treatment for many inflammatory disorders. VNS-evoked compound nerve action potentials (CNAPs) may have applications as a biomarker of VNS treatment efficacy, but transcutaneous measurement of this activity is obscured by muscle artifacts. A more precise understanding of muscle activation patterns could improve recording and analysis protocols for isolating the vagus nerve (VN) CNAP. We hypothesize that analyzing multi-electrode array (MEA) surface recordings overlying the VN will allow us to characterize this muscle artifact.
Project Methods: Five patients undergoing VNS therapy for epilepsy were enrolled in a clinical study at Indiana University School of Medicine (IRB #2006075899). A custom-made MEA with a grid of 32 soft foam electrodes was placed on the skin overlying the VN on each side of the neck. Surface potentials were recorded for approximately 20 minutes at the patient’s established device settings.
Results: VNS-evoked potentials were visualized in all five patients. Two probable muscle artifacts were identified, defined as non-propagating features in the mean response to n > 600 pulses of VNS. The first had an onset latency of ~1-3 ms, and the second had a latency of ~7-10 ms. Both artifacts appeared primarily in the electrodes overlying the laryngeal muscles.
Conclusion and Potential Impact: The short latency of the first muscle artifact suggests stimulus signal leakage activating the superior laryngeal nerve. The second artifact with longer latency is likely caused by the recurrent laryngeal nerve. Previous analyses may have mischaracterized the first muscle artifact as nerve activity. The use of MEA-based recordings clarifies our understanding of the VN’s response to VNS, which may lead to better treatment efficacy and the eventual development of personalized VNS therapies for epilepsy and a range of inflammatory disorders.
Role of MicroRNA-134-5p in Metabolic Syndrome-Associated Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction
Authors: Hannon Aidan , Jheng Jia-Rong , Halliday Gunner , Lai Yen-Chun 
Published: December 2021

Background: Pulmonary hypertension in heart failure with preserved ejection fraction (PH-HFpEF) is the most common cause of PH worldwide. It is closely linked to risk factors for metabolic syndrome, including obesity and diabetes - factors known to increase proliferation and migration of pulmonary artery smooth muscle cells (PASMCs), leading to pulmonary vascular remodeling. Qualitative studies have shown that patients with progressive vascular abnormalities develop more severe symptoms and suffer frequent hospitalization. However, underlying mechanisms involved in the regulation of pulmonary vascular remodeling in metabolic syndrome-associated PH-HFpEF are still unclear.
Aim: We have recently observed decreased levels of the tumor suppressor WW domain-containing oxidoreductase (WWOX), which plays a housekeeping role in repressing cellular proliferation, in PASMCs isolated from rats with experimental PH-HFpEF and human subjects with obesity and diabetes. As microRNAs (miRNAs) have been shown to regulate WWOX expression in cancers, here we aimed at examining the involvement of miRNAs in WWOX-associated pulmonary vasculature regulation in metabolic syndrome-associated PH-HFpEF.
Methods and Results: Among miRNAs that have been associated with reduced WWOX expression, including miR -134-5p, -153-3p, -29a-3b, -29b-3p and -187-5p, we found that miR-134-5p was significantly increased in PASMCs of obese and diabetic subjects. To determine the role of miR-134-5p in the regulation of WWOX in the pulmonary vasculature, we applied exogenous miR-134-5p to human PASMCs. Treatment with miR-134-5p decreased WWOX expression, increased PCNA expression (a cell proliferation marker) and enhanced cellular proliferation. Additionally, human PASMCs challenged with high concentration of glucose, palmitic acid and insulin, which mimic hyperglycemic, hyperlipidemic and hyperinsulinemic conditions, exhibited increased miR-134-5p, accompanied by elevated cellular proliferation.
Conclusions: These studies suggest that miR-134-5p may have a potential role in metabolic syndrome-associated PH-HFpEF through regulating WWOX in the pulmonary vasculature. These studies identify miR-134-5p as a potential therapeutic target for the treatment of metabolic syndrome-associated PH-HFpEF.
This project was funded, in part, with support from the NIH NHLBI Short-Term Training Program in Biomedical Sciences Grant funded, in part by T35HL110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Racial and Ethnic Variations in Mortality Associated with Common Pediatric Gastrointestinal Disorders in Children's Hospitals in the US
Authors: Kanu Kadija , Molleston Jean P. , Bennett, Jr. William E. 
Published: December 2021

Background: The objective of this study is to determine the mortality, risk factors, and disease associations of eight common pediatric gastrointestinal (GI) disorders: cystic fibrosis (CF), cirrhosis, gastrointestinal bleeding (GIB), inflammatory bowel disease (IBD), liver failure (LF), liver transplant, acute pancreatitis, and short bowel syndrome (SBS).

Methods: Diagnoses were found using the International Classification of Disease (ICD) codes from 2004 through 2020. We performed a retrospective cohort study using the Pediatric Health Information System (PHIS) database from 50 children’s hospitals in the US. We analyzed all encounters with ICD codes for these disorders, then determined the per-encounter mortality rate for each. We performed a mixed-effects logistic regression modeling hospital as a random effect, mortality as the dependent variable, and patient demographics and medical history as independent variables. We hypothesized that demographic factors such as Black race, Hispanic ethnicity, and markers of socioeconomic status would be associated with increased mortality.

Results: The per-encounter mortality for each diagnosis was: cirrhosis (2.19%), CF (0.66%), GIB (4.22%), IBD (0.21%), LF (7.03%), liver transplant (0.37%), acute pancreatitis (2.23%), and SBS (1.13%). There was a higher (p<0.05) mortality for those of Asian race and mixed-race populations in GIB (OR 1.76 and 1.37, respectively) and acute pancreatitis (OR 1.94 and 1.34, respectively). For those of Black race, there was a higher mortality in liver transplant and liver failure (OR 1.31 and 1.65 respectively). Additionally, mortality was increased in Hispanic/Latino patients with CF, GIB, and SBS (OR 2.34, 1.39, and 1.41, respectively). Coincident cardiovascular, renal/urologic, and neurologic/neuromuscular abnormalities were also associated with a significant higher mortality.

Conclusion: The degree of variation associated with race and ethnicity is unlikely to be accounted for by variation in clinical features, thus the impact of social determinants of health should be the focus of future study.

Cirrhosis

CF

GIB

IBD

LF

Liver Transplant

Acute Pancreatitis

SBS

Mortality Rate

2.19%

0.66%

4.22%

0.21%

7.03%

0.37%

2.23%

1.13%

Asian Race OR

1.10

3.77

1.76*

1.71

1.08

0.89

1.94*

1.35

Black Race
OR

0.90

0.48

1.03

1.55

1.31*

1.65*

1.15

1.14

Mixed Race OR

1.16

1.12

1.37*

1.44

1.23

0.85

1.34*

1.16

Hispanic/Latino OR

1.13

2.34*

1.39*

1.53

1.16

1.65

1.13

1.41*

*Significant OR numbers with an associated p<0.05
Conceitos e práticas inclusivas no contexto da Educação Física escolar
Authors: Ranzan Mayara Erbes , Lavinscky Pereira Taylor Brian , Dos Santos Tarcísio Bitencourt 
Published: December 2021

RESUMO Objetivo. Apresentar propostas de conceitos e práticas encontradas na literatura que buscam auxiliar professores de Educação Física no processo de inclusão de estudantes com deficiências.Desenvolvimento. O artigo perpassa por conceitos e práticas que buscam auxiliar professores de Educação Física em sua prática docente, ofertando um acervo de informações dispostas na literatura sobre o tema e exemplificando com ações práticas do cotidiano.Implicações. Considerando a proposta do trabalho, espera-se que os professores reflitam sobre o escopo apresentado, absorvam o necessário e reproduzam o essencial em suas aulas, implicando em aplicabilidade das legislações no que concerne a inclusão de alunos com deficiência.
Minimizing the risk of fracture of definitive casts for removable partial dentures: A dental technique
Authors: Neppelenbroek Karin Hermana , Porto Vinicius Carvalho , Sugio Carolina Campos , Gomes Anna Clara Gurgel , Garcia Amanda Aparecida Maia Neves 
Published: December 2021

A technique is described to facilitate impression making and safely obtain the definitive cast for removable partial dentures with long, retentive, or lone-standing abutment teeth. Firstly, the individualized stock tray receives a coating of melted wax. Next, the prepared teeth are impressed with irreversible hydrocolloid, and the set impression is removed from mouth. The mold is then poured conventionally and, after the gypsum has set, is immersed in hot water to soften the wax and allow removal of the tray. The impression material is carefully cut away with a scalpel blade to expose the cast. With these straightforward and easily made changes compared with the conventional technique, the risk of fracturing the definitive cast is minimized, especially when reproducing long retentive teeth. A dental technique is presented that uses wax to coat the impression tray to facilitate the passive displacement of the cast. This results in a straightforward and precise definitive cast for removable partial dentures.
Modified simplified algorithm of the method of group consideration of arguments in simulation processes
Authors: Ravska Nataliia , Korbut Eugene , Ivanovskyi Oleksiy , Rodin Radion , Parnenko Valeria , Zakovorotnyi Oleksandr , Klochko Oleksandr , Sapon Serhiy , Loroch Rolahd 
Published: December 2021

There are many types and methods of simulation, but among them special attention should be paid to methods based on the theory of heuristic self-organization. All algorithms of the method of group argumentation (MGVA) are characterized by structural commonality on the principle of self-organization, which require insignificant requirements for a priori information to search for an infinite number of options. The advantage of the algorithm of the method of group
consideration of arguments in comparison with other algorithms of this class is the presence of possibilities of expansion of the vector of initial data and the device for elimination of collinearity - reception of orthogonalization. MGVA consists of two blocks: pre-processing of observations taking into account the system of selected reference functions and calculation of selection applicants. As a result of the algorithm, models capable of controlling the process taking into account the phenomena accompanying a certain process are obtained. Given the commonality of the main provisions of the theory of self-organization of artificial neural networks and MGVA, the network variables are added to the model as a variable Z. As a result, we obtain a neural network that describes the physical phenomena accompanying the process. This will significantly increase the efficiency and accuracy of process management.
Method for determining the actual group of classification (mode of operation) of load-lifting cranes
Authors: Nyezhentsev Oleksiy 
Published: December 2021

The problems which arise during the period of expert inspection of the load-lifting cranes which have fulfilled regulatory lifetime, at definition of their actual group of classification (operating mode) are analyzed. It is established that the actual group of classification (mode of operation) of operated cranes, which is determined by the regulations on labor protection (NPAOP), often does not coincide with the passport modes of operation of cranes. A new method of diagnosing the actual classification group (operating mode) of operated cranes has been developed, which allows taking into account the real modes of their loading and classes of use using the value of specific energy consumption of cranes. The proposed method allows to reliably determining the actual group of classification of cranes that have served the regulatory lifetime, taking into account the real operating conditions of all crane mechanisms and their technical condition for the entire period of
operation. This makes it possible to reasonably and qualitatively establish the terms and conditions of further safe operation of cranes.
Loi Évin, marketing du vin et protectionnisme
Authors: Duquesnois Franck , Cheriet Foued 
Published: December 2021

Dans cet article, nous discutons l'éventuel rôle positif de la loi Évin comme barrière protectionniste face à l’agressivité concurrentielle de marques de vin étrangères souhaitant pénétrer le marché français du vin.
Nous nous interrogeons à savoir si ce rempart que constitue la loi Évin est soutenable dans le temps. La dissonance entre la loi française et la loi européenne offre un vide juridique dont pourraient tirer parti les groupes internationaux des vins étrangers mais aussi français. En outre, les stratégies de contournement de la loi Évin mobilisées par les acteurs du vin, nous montrent que cette loi n’est pas l’unique rempart à l’arrivée de vins étrangers en France. Le faible succès de ces derniers relèverait davantage des spécificités des comportements d’achat des Français que d’échecs ou de difficultés de communication de ces marques. La loi Évin devra donc s’adapter aux nouvelles stratégies des entreprises et aux contextes de consommation en France et à l’étranger. De même, une trop grande focalisation par les acteurs nationaux sur la nécessité d’assouplir davantage encore la loi Évin ne doit pas occulter les stratégies des grands groupes internationaux ni le protectionnisme économique dont témoignent d’autres pays.
affaire Bordeaux Magnum ou la vente en primeur et la rupture brutale des relations commerciales établies
Authors: Raffray Ronan 
Published: December 2021

La rupture brutale des relations commerciales régit-elle les relations commerciales qui se nouent à Bordeaux lors de la campagne des primeurs ? La rencontre d’un système de vente construit sur les usages de place et d’une règlementation nationale soucieuse de normer la fin des relations commerciales s’annonce particulièrement instructive.