bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation
Authors: Downing Norman Lance , Rolnick Joshua , Poole Sarah F , Hall Evan , Wessels Alexander J , Heidenreich Paul , Shieh Lisa 
Published: March 2019

BackgroundSepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions.ObjectivesTo determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis.DesignPatient-level randomisation, single blinded.SettingMedical and surgical inpatient units of an academic, tertiary care medical centre.Patients1123 adults over the age of 18 admitted to inpatient wards (intensive care units (ICU) excluded) at an academic teaching hospital between November 2014 and March 2015.InterventionsPatients were randomised to either usual care or the addition of an EHR-generated alert in response to a set of modified severe sepsis criteria that included vital signs, laboratory values and physician orders.Measurements and main resultsThere was no significant difference between the intervention and control groups in primary outcome of the percentage of patients with new antibiotic orders at 3 hours after the alert (35% vs 37%, p=0.53). There was no difference in secondary outcomes of in-hospital mortality at 30 days, length of stay greater than 72 hours, rate of transfer to ICU within 48 hours of alert, or proportion of patients receiving at least 30 mL/kg of intravenous fluids.ConclusionsAn EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures.
Open Problems Column
Authors: Gasarch William 
Published: March 2019

There have been two polls asking theorists (and others) what they thought of P vs NP and related questions [5, 6]. Both were written by me (William Gasarch) and appeared in the Complexity Column of SIGACT News, edited by Lane A. Hemaspaandra.
I have conducted a third poll. The results of that poll will appear in Lane's column in this issue (Volume 50, Number 1, March 2019). In the article I did not give my own answers [though I commented on other people's answers in square brackets]. By contrast, this column contains my answers about the status of P vs. NP. For information on what is the status of P vs NP see Scott Aaronson's article [1], Lance Fortnow's article [3], or (for the layperson) Lance Fortnow's book [4].
Liquid Biopsy of Extracellular Microvesicles Maps Coronary Calcification and Atherosclerotic Plaque in Asymptomatic Patients With Familial Hypercholesterolemia
Authors: Chiva-Blanch Gemma , Padró Teresa , Alonso Rodrigo , Crespo Javier , Perez de Isla Leopoldo , Mata Pedro , Badimon Lina 
Published: March 2019

Objective—
Heterozygous familial hypercholesterolemia (FH) is the most common genetic disorder associated with premature atherosclerotic cardiovascular disease. Circulating microvesicles (cMV) are released when cells are activated. We investigated whether cMV could provide information on coronary calcification and atherosclerosis in FH patients.

Approach and Results—

Eighty-two patients (mean of 44±9 years old) with molecular diagnosis of heterozygous FH and asymptomatic cardiovascular disease were investigated. Atherosclerotic plaque characterization was performed by computed tomography angiography, and Agatston coronary calcium score and plaque composition sum were calculated. cMV were quantified by flow cytometry using AV (annexin V) and cell surface-specific antibodies. Of the 82 FH patients, 48 presented atherosclerotic plaque. Patients with atherosclerosis were men and older in a higher percentage than patients without atherosclerotic plaque. FH patients with atherosclerotic plaque showed higher levels of total AV
+
cMV, cMV AV
+
from platelet origin, from granulocytes and neutrophils, and cMV AV
+/−
from endothelial cells than FH-patients without atherosclerotic plaque. Plaque composition sum correlated with platelet- and endothelial-derived cMV, and Agatston coronary calcium score correlated with granulocyte-, platelet-, and endothelial-derived cMV. Receiver operating characteristic curve analyses indicated that the cluster of platelet-, granulocyte-, neutrophil, and endothelial-derived cMV considered together, added significant predictive value to the specific SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) risk equation for plaque presence (area under the curve=0.866, 95% CI, 0.775–0.958;
P
<0.0001,
P
=0.030 for the increment of the area under the curve).

Conclusions—
Endothelial-, granulocyte-, neutrophil- and platelet-derived cMV discriminate and map coronary atherosclerotic plaque and calcification in asymptomatic patients with FH. Liquid biopsy of cMV may be a surrogate biomarker of coronary atherosclerotic plaque burden in FH patients.
Cortical Superficial Siderosis Evolution
Authors: Charidimou Andreas , Boulouis Gregoire , Xiong Li , Pasi Marco , Roongpiboonsopit Duangnapa , Ayres Alison , Schwab Kristin M. , Rosand Jonathan , Gurol M. Edip , Viswanathan Anand , Greenberg Steven M. 
Published: March 2019

Background and Purpose—
We investigated cortical superficial siderosis (cSS) progression and its clinical relevance for incident lobar intracerebral hemorrhage (ICH) risk, in probable cerebral amyloid angiopathy presenting with neurological symptoms and without ICH at baseline.

Methods—
Consecutive patients meeting modified Boston criteria for probable cerebral amyloid angiopathy from a single-center cohort who underwent magnetic resonance imaging (MRI) at baseline and during follow-up were analyzed. cSS progression was assessed by comparison of the baseline and follow-up images. Patients were followed prospectively for incident symptomatic ICH. cSS progression and first-ever ICH risk were investigated in Cox proportional hazard models adjusting for confounders.

Results—

The cohort included 118 probable cerebral amyloid angiopathy patients: 72 (61%) presented with transient focal neurological episodes and 46 (39%) with cognitive complaints prompting the baseline MRI investigation. Fifty-two patients (44.1%) had cSS at baseline. During a median scan interval of 2.2 years (interquartile range, 1.2–4.4 years) between the baseline (ie, first) MRI and the latest MRI, cSS progression was detected in 33 (28%) patients. In multivariable logistic regression, baseline cSS presence (odds ratio, 4.04; 95% CI, 1.53–10.70;
P
=0.005), especially disseminated cSS (odds ratio, 9.12; 95% CI, 2.85–29.18;
P
<0.0001) and appearance of new lobar microbleeds (odds ratio, 4.24; 95% CI, 1.29–13.9;
P
=0.017) were independent predictors of cSS progression. For patients without an ICH during the interscan interval (n=105) and subsequent follow-up (median postfinal MRI time, 1.34; interquartile range, 0.3–3 years), cSS progression independently predicted increased symptomatic ICH risk (hazard ratio, 3.76; 95% CI, 1.37–10.35;
P
=0.010).

Conclusions—
Our results suggest that cSS evolution may be a useful biomarker for assessing disease progression and ICH risk in cerebral amyloid angiopathy patients and a candidate biomarker for clinical studies and trials.
Impacts of robotic arm use on individuals with upper extremity disabilities: A scoping review
Authors: Beaudoin Maude , Lettre Josiane , Routhier François , Archambault Philippe S. , Lemay Martin , Gélinas Isabelle 
Published: March 2019

Background. Robotic arms may help users perform various activities. Even though robotic arms are commercially available, their impacts are still poorly understood. Purpose. This scoping review aimed to identify the potential impacts of using robotic arms for individuals with upper-extremity disabilities and appraise the scientific quality of the selected studies. Method. A search for studies published between 1970 and 2016 was conducted in PubMed, Embase, Compendex, and Scopus. The Canadian Model of Occupational Performance and Engagement was used to classify activities in which impacts were evaluated. The quality of each study was rated using McMaster University’s critical review form for quantitative studies. Findings. Thirty-six studies were reviewed, which evaluated self-care (21), productivity (33), and leisure (8). The short-term impacts were more commonly documented than long-term impacts. The impacts identified were mostly positive. The studies’ mean quality score was 8.8/15. Implications. Additional studies with more rigorous conditions are needed to produce higher-quality scientific evidence of the long-term impacts of robotic arm use.
A 6-Week Transition to Maximal Running Shoes Does Not Change Running Biomechanics
Authors: Hannigan J.J. , Pollard Christine D. 
Published: March 2019

Background: A recent study suggested that maximal running shoes may increase the impact force and loading rate of the vertical ground-reaction force during running. It is currently unknown whether runners will adapt to decrease the impact force and loading rate over time. Purpose: To compare the vertical ground-reaction force and ankle kinematics between maximal and traditional shoes before and after a 6-week acclimation period to the maximal shoe. Study Design: Controlled laboratory study. Methods: Participants ran in a traditional running shoe and a maximal running shoe during 2 testing sessions 6 weeks apart. During each session, 3-dimensional kinematics and kinetics were collected during overground running. Variables of interest included the loading rate, impact peak, and active peak of the vertical ground-reaction force, as well as eversion and dorsiflexion kinematics. Two-way repeated measures analyses of variance compared data within participants. Results: No significant differences were observed in any biomechanical variable between time points. The loading rate and impact peak were higher in the maximal shoe. Runners were still everted at toe-off and landed with less dorsiflexion, on average, in the maximal shoe. Conclusion: Greater loading rates and impact forces were previously found in maximal running shoes, which may indicate an increased risk of injury. The eversion mechanics observed in the maximal shoes may also increase the risk of injury. A 6-week transition to maximal shoes did not significantly change any of these measures. Clinical Relevance: Maximal running shoes are becoming very popular and may be considered a treatment option for some injuries. The biomechanical results of this study do not support the use of maximal running shoes. However, the effect of these shoes on pain and injury rates is unknown.
The clinical application of combination suprapubic prostatectomy with transurethral resection of the prostate (TURP) in patients with large volume benign prostatic hyperplasia (BPH)
Authors: Wei Shiping , Cheng Fan , Yu Weiming 
Published: March 2019

Objective: To investigate the safety and efficacy of the combination of suprapubic prostatectomy with transurethral resection of the prostate (TURP) for the treatment of large volume benign prostatic hyperplasia (BPH). Methods: We retrospectively analyzed the clinical data of two methods of treatment with 60 cases of a large volume BPH (>100 g) from January 2011 to 2017; the methods were suprapubic prostatectomy and suprapubic prostatectomy combination with TURP, in which the single open group comprised 30 cases, treated using the former method, and the combined open group comprised the other 30 cases, treated using the latter method. In the combined open group, the residual prostate gland was removed by TURP. We compared both the groups of patients using age, prostate volume, international prostate symptom score (IPSS), prostate-specific antigen (PSA), maximum flow rate, residual urine, operation time, hospitalization time, postoperative washing time, blood transfusion rate, and decreased amount of intraoperative hemoglobin in operation, and compared the preoperative and postoperative IPSS, maximum flow rate, and residual urine volume. Results: There was no significant difference between the two groups in age, prostate volume, IPSS, PSA, maximum flow rate, residual urine, and other clinical data ( P > 0.05); the single group operation time, postoperative bladder irrigation time, hospitalization time, blood transfusion rate, and decreased amount of intraoperative hemoglobin were significantly greater in the single open group than in the combined open group, and statistically significant differences were observed between both the groups ( P < 0.05). Postoperative voiding function improved significantly compared with the preoperative, and a statistically significant difference was observed ( P < 0.05). Conclusion: The combination of suprapubic prostatectomy with TURP is an effective and a safe surgical method for the treatment of patients with large volume BPH. It is certainly worthy of clinical application.
Safe vincristine use in Switzerland: Still a long way to go?
Authors: Brühwiler Lea D , Schwappach David LB 
Published: March 2019

Background Different international organizations recommend safety measures for the use of vincristine to prevent wrong route administrations. A central recommendation is to use infusion bags instead of syringes to prevent confusion with intrathecal chemotherapy. This study aimed to investigate the implementation of safety measures for vincristine and intrathecal chemotherapies in Switzerland. Method We conducted a written survey among hospital pharmacies of all general care and pediatric hospitals in Switzerland (n = 102). A responsible person of each hospital pharmacy was invited by email to participate in the online survey in May 2018. Results Of 66 responding hospitals (response rate 65%), 27 have a hospital pharmacy preparing parenteral chemotherapy. All of these hospitals prepared vincristine in 2017, while 21 also prepared intrathecal chemotherapy. Of these 21, 16 hospitals prepared vincristine as syringes, with small volume syringes being the most widely distributed dosage form. A switch from syringes to infusion bags was discussed in seven hospitals, and discussions led to plans for switch in two. The most prevalent safety measures were labeling for vincristine and special delivery for intrathecal drugs. Of hospitals preparing both vincristine syringes and intrathecal chemotherapy, four reported to have no safety measures implemented neither for vincristine nor for intrathecal chemotherapy. Conclusion International recommendations are not widely implemented in Swiss hospitals. Syringes are still in use and other safety measures are sparsely disseminated. Thus, Swiss vincristine patients are still at an increased risk for wrong route application. Recommendations have to be further disseminated and implementation could be enhanced.
Central perpendicular line in macular spectral-domain optical coherence tomography in five eyes
Authors: Guixeres Esteve María Carmen , Postelmans Laurence 
Published: March 2019

Purpose: The aim of this study is to report a rare spectral-domain optical coherence tomography finding in the macula. Methods: This is a descriptive consecutive case series. Patients diagnosed with hyperreflective central perpendicular line in the macular spectral-domain optical coherence tomography were included. Best-corrected visual acuity assessment, standard Amsler grid test, biomicroscopic examination and macular spectral-domain optical coherence tomography were performed. Results: We examined three men and one woman, aged 56 to 91 years (average age: 75.25 years). Spectral-domain optical coherence tomography showed a hyperreflective central perpendicular line in five eyes accompanied by vitreofoveal adhesion in all of them. In two eyes, we observed a lifting of the ellipsoid zone, and in one eye the external limiting membrane was also pulled. In one eye, a subtle lifting of the interdigitation zone was revealed. In another eye, we also found a triangular foveolar detachment of the interdigitation zone. Snellen’s best-corrected visual acuity ranged from 0.2 to −0.1 logMAR (average of 0.006 logMAR). Amsler grid test was unremarkable in four eyes and metamorphopsia was detected in one eye. One eye developed a full-thickness macular hole several weeks after the phacoemulsification cataract surgery. Conclusion: The presence of a central perpendicular line can be revealed by the macular spectral-domain optical coherence tomography. We hypothesize that this finding could be considered as a sign of vitreomacular traction. In our patients, best-corrected visual acuity was only mildly reduced, and Amsler grid test was affected in only one eye.
Estimation of Gastric Volume Before Anesthesia in Term-Pregnant Women Undergoing Elective Cesarean Section, Compared With Non-pregnant or First-Trimester Women Undergoing Minor Gynecological Surgical Procedures
Authors: Gal Oren , Rotshtein Mark , Feldman Dan , Mari Amir , Hallak Motti , Kopelman Yael 
Published: March 2019

Background: Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events. Aims: Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Methods: In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure. Results: Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm2 vs 3.2 ± 0.79 cm2;  P = .97). Gastric volume was small in the two groups. Conclusion: Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.
Risk Factors for Unplanned Dialysis Initiation: A Systematic Review of the Literature
Authors: Hassan Rana , Akbari Ayub , Brown Pierre A. , Hiremath Swapnil , Brimble K. Scott , Molnar Amber O. 
Published: March 2019

Background: Unplanned dialysis initiation is common in patients with chronic kidney disease (CKD). Objective: To determine common definitions and patient risk factors for unplanned dialysis. Design: Systematic review. Setting: MEDLINE, EMBASE, and the Cochrane Library were searched from inception to February 2018. Patients: Studies that included incident chronic dialysis patients or patients with CKD that cited a definition or examined risk factors for unplanned dialysis were included. Measurements: Definitions and criteria for unplanned dialysis reported across studies. Patient characteristics associated with unplanned dialysis. Methods: Two reviewers independently extracted data using a standardized data abstraction form and assessed study quality using a modified New Castle Ottawa Scale. Results: From 2797 citations, 48 met eligibility criteria. Reported definitions for unplanned dialysis were variable. Most publications cited dialysis initiation under emergency conditions and/or with a central venous catheter. The association of patient characteristics with unplanned dialysis was reported in 26 studies, 18 were retrospective and 21 included incident dialysis patients. The most common risk factors in univariate analyses were (number of studies) increased age (n = 7), cause of kidney disease (n = 6), presence of cardiovascular disease (n = 7), lower serum hemoglobin (n = 9), lower serum albumin (n = 10), higher serum phosphate (n = 6), higher serum creatinine or lower estimated glomerular filtration rate (eGFR) at dialysis initiation (n = 7), late referral (n = 5), lack of dialysis education (n = 6), and lack of follow-up in a predialysis clinic prior to dialysis initiation (n = 5). A minority of studies performed multivariable analyses (n = 10); the most common risk factors were increased age (n = 4), increased comorbidity score (n = 3), late referral (n = 5), and lower eGFR at dialysis initiation (n = 3). Limitations: Comparison of results across studies was limited by inconsistent definitions for unplanned dialysis. High-quality data on patient risk factors for unplanned dialysis are lacking. Conclusions: Well-designed prospective studies to determine modifiable risk factors are needed. The lack of a consensus definition for unplanned dialysis makes research and quality improvement initiatives in this area more challenging.
Calibrating and validating a combined accumulation and mobilisation model for water distribution system discolouration using particle swarm optimisation
Authors: Furnass William R. , Mounce Stephen R. , Husband Stewart , Collins Richard P. , Boxall Joby B. 
Published: March 2019

AbstractA discolouration concept is proposed describing simultaneous pipe wall material accumulation and mobilisation processes that define discolouration in drinking water distribution systems, one of the biggest causes of customer dissatisfaction. Validation of these mathematical forms is presented. The model formulation was shown to maintain the mobilisation functionality of previous validated shear-stress-dependant modelling tool, but requiring only two empirical parameters. Two distinct operational datasets are then analysed and robust empirical model parameter calibration is obtained utilising a refined particle swarm optimisation technique. The model is shown to make usefully accurate simulations for flow mediated events, providing evidence of predictive capabilities. The combined tracking of accumulation and mobilisation behaviour enables assessment of the current and future discolouration risk posed by any pipe irrespective of age or material, allowing pro-active, risk based planning and prioritisation of maintenance interventions to protect the quality of delivered water.