bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid Flow as a Surrogate for Cardiac Output Measurement in Hemodynamically Stable Participants
Authors: Sidor Marian , Premachandra Lalith , Hanna Bishoy , Nair Nanda , Misra Amit 
Published: May 2018

Objective: Evaluation of common carotid artery (CCA) blood flow can provide valuable information regarding the hemodynamic status of a patient. Utilizing ultrasound, we aimed to evaluate the correlation between cardiac output and different hemodynamic parameters in the CCA, namely systolic carotid flow (SCF), corrected flow time (CFT), and total carotid flow (TCF). Methods: We studied a pilot sample of 20 healthy volunteers. Hemodynamic parameters were collected in the right CCA and the heart at rest (baseline), 1-leg compression, 2-leg compression, and passive leg raise. Nonparametric Spearman correlation was calculated using STATA 13 software. Results: This study demonstrated the feasibility and safety of the leg compression testing as a hemodynamic maneuver to simulate volume depletion status. We demonstrated a direct correlation between cardiac output and SCF of 0.67 with a P value < 0.001. Interestingly, TCF calculated based on volume–time integral (VTI) in the carotid artery showed positive correlation of only 0.41, with P < 0.06, and it did not reach statistical significance. We also found a positive correlation between CFT and cardiac output at baseline 0.57, with P < 0.001. Conclusion: Variations in cardiac preload and the subsequent alterations in cardiac output were directly translatable into variations in the carotid blood flow. This supports the potential for using carotid flow as a surrogate for cardiac output. The most promising parameters were SCF, CFT, and carotid systolic VTI. Further work is needed to validate these correlations and utilize these acquired carotid parameters to guide fluid management and predict fluid responsiveness.
Challenges MNCs Face in Emerging Markets: The Nestlé Experience
Authors: Pai V.S. 
Published: May 2018

Maggi was the most popular instant noodles brand in India, which children in particular loved to snack on. The brand had a dominant position until suddenly in mid-2015 it got engulfed in controversy. Several state food regulators found that Maggi contained monosodium glutamate as well as lead well above the prescribed limits. Both these substances were harmful especially for children. When Nestlé India was confronted with lab test results it stuck to its position that they had a world class quality control process in place and that their products were safe for consumption. Finally, the national food regulator FSSAI, ordered a ban on the sale of Maggi including product recall. Consequently, several state governments imposed temporary ban on the sale of Maggi noodles in their respective states. The future of the company suddenly looked very bleak. Nestlé India was slow to respond to this fast unfolding crisis. Further, their responses were very brief and not adequately culture-sensitive. This led to the feeling in several quarters that the company was probably guilty of wrongdoing. To set right things Nestlé's worldwide CEO flew into India to douse the flames of the controversy and draw up an appropriate strategy to bail out the brand. He address the media, put in place a new CEO for Nestlé India and set brand Maggi on the path of recovery. However, Nestlé India was still facing a number of critical issues. What should be done to win over the trust of its customers? How should it recover market share lost to competitors both old rivals and new entrants? What strategy should it develop to succeed with the new products, especially hot heads, launched along with the comeback strategy? Should it change its approach to dealing with government health officials to prevent confrontations in future? How should it shorten the response time and make it effective in the face of a media backed public outcry in future?
Psychosocial Functioning of Children in a Craniofacial Support Group
Authors: Johns Alexis L. , Bava Laura 
Published: May 2018

Objective: To describe psychosocial functioning before and after participation in support groups for pediatric patients with craniofacial diagnoses and their families. Design: Baseline and postgroup outcomes and comparison to test norms. Setting: Urban children’s hospital. Participants: Patients (N = 138) were 54% female, primarily Latino (83%), aged 7 to 18 years (mean = 10.4, standard deviation = 2.8), and had public insurance (72%). Patients had isolated cleft lip/palate (54%), craniofacial syndromes (19%), craniofacial microsomia/microtia (14%), or other diagnoses (12%). Caregivers (n = 138) were mostly mothers (80%). Intervention: Support groups focused on peer normalization, social skills, and coping for patients with craniofacial diagnoses. Main Outcome Measure: Selected scales of the Behavior Assessment System for Children–Second Edition completed by patients and caregivers (51% Spanish; 49% English). Results: While in the average range, caregivers reported significantly higher baseline clinical concerns and patients and caregivers reported lower positive scales compared to test norms. Postgroup, patients reported significantly lower social stress than peer norms. Caregivers reported higher postgroup clinical scales, but no differences from test norms in the positive scales. In comparing pre to postgroup means, all but one scale showed significant improvement. The largest effect sizes were for higher self-reported self-esteem ( d = 0.49) and lower caregiver-reported depression ( d = 0.54) in their children. Conclusions: Although greater clinical concerns were reported compared to test norms, baseline and postgroup functioning was in the average range. Patients and caregivers reported significantly improved psychosocial functioning following group participation, particularly for adaptive skills and self-esteem.
Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer’s Disease
Authors: Lancioni Giulio E. , Singh Nirbhay N. , O’Reilly Mark F. , Sigafoos Jeff , D’Amico Fiora , Laporta Dominga , Cattaneo Maria Giovanna , Scordamaglia Antonella , Pinto Katia 
Published: May 2018

Objectives: These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer’s disease, respectively. Methods: Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts. Results: The participants of study 1 succeeded in starting the activities independently and carrying them out accurately. The participants of study 2 largely increased their ambulation levels and also showed signs of positive involvement (eg, smiles and verbalizations). Conclusion: The aforementioned technology-based interventions may represent practical means for supporting people with Alzheimer’s disease.
Adult patients’ experiences of symptom management during pulmonary exacerbations in cystic fibrosis: A thematic synthesis of qualitative research
Authors: Schmid-Mohler Gabriela , Yorke Janelle , Spirig Rebecca , Benden Christian , Caress Ann-Louise 
Published: May 2018

Objective The aim of this review was to describe how patients experience an exacerbation of cystic fibrosis in terms of symptom management. Methods A systematic literature search was performed in MEDLINE, CINAHL, EMBASE, PSYCINFO and ASSIA. Studies were included that contained any direct quotes or summaries of quotes from patients with cystic fibrosis aged 16 or older and were related to symptom experience and management during an exacerbation. Framework analysis, guided by Symptom Management Theory, was used to present the findings. Results The review included 18 qualitative studies. In addition to physiological symptoms, patients highlighted the significant role of psychological symptoms. Delayed help-seeking was a common first response. Participants choose their self-management strategies taking both physiological and psychological symptoms into account. Maintaining normality was an important short-term outcome for patients, leading to conflict with health professionals. Patients’ symptom management during exacerbation was greatly influenced by the structure of cystic fibrosis care. Discussion Our findings provide an initial understanding of factors influencing patient self-management during an exacerbation. The transferal of these findings into clinical practice will provide a basis for shared goal setting and intervention planning. In addition, our findings have implications for future development of patient-reported outcome measures and intervention research.
Prevalence of chronic obstructive pulmonary disease: county-level risk factors based on the Social Ecological Model
Authors: McDaniel JT 
Published: May 2018

Aims: Chronic obstructive pulmonary disease (COPD) was the third leading cause of death among Americans in 2014. Multiple factors, ranging from proximal (i.e. biological characteristics and behaviors) to distal (i.e. environmental characteristics and policies), have been shown to predict COPD outcomes. The Social Ecological Model (SEM), which specifies that five levels of influence (i.e. intrapersonal, interpersonal, institutional, community, and public policy factors) are implicated in the development of ill health, has not been used in epidemiological studies of COPD prevalence. A better understanding of the community-level correlates of COPD prevalence may improve community health practice. Methods: Using several sources of county-level secondary data ( n = 646), changes in COPD prevalence from 2012 to 2014 were predicted from the five levels of the SEM using ordinary least squares (OLS) hierarchical linear regression. The geographic distribution of county-level changes in COPD prevalence was analyzed with a choropleth map. Results: County-level COPD prevalence increased by 4.76% between 2012 and 2014 overall; however, the greatest increases were observed among counties within the Appalachian region (i.e. counties in West Virginia). Results showed that the SEM, with five levels of influence, was a statistically significant framework for examining changes in county-level COPD prevalence, F = 10.21, p < .001, R2 = 0.28. Statistically significant county-level predictors of changes in COPD prevalence included racial composition, ethnic composition, poverty, altitude, air pollution, and smoking policy. Conclusion: COPD prevention may be assisted by the implementation of community-based programs rooted in a multilevel approach.
Disruption of a GATA1-binding motif upstream of XG/PBDX abolishes Xga expression and resolves the Xg blood group system
Authors: Möller Mattias , Lee Yan Quan , Vidovic Karina , Kjellström Sven , Björkman Linda , Storry Jill R. , Olsson Martin L. 
Published: May 2018

Key Points
Expression of the Xg blood group protein is governed by rs311103, and its minor allele disrupts a GATA motif to cause the Xg(a−) phenotype. These data elucidate the genetic basis of the last unresolved blood group system and make genotyping for Xga status possible.
Multifaceted Roles of Beige Fat in Energy Homeostasis Beyond UCP1
Authors: Sponton Carlos Henrique , Kajimura Shingo 
Published: May 2018

Abstract
Beige adipocytes are an inducible form of thermogenic adipose cells that emerge within the white adipose tissue in response to a variety of environmental stimuli, such as chronic cold acclimation. Similar to brown adipocytes that reside in brown adipose tissue depots, beige adipocytes are also thermogenic; however, beige adipocytes possess unique, distinguishing characteristics in their developmental regulation and biological function. This review highlights recent advances in our understanding of beige adipocytes, focusing on the diverse roles of beige fat in the regulation of energy homeostasis that are independent of the canonical thermogenic pathway via uncoupling protein 1.
Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses
Authors: Kreienbühl Lukas , Elia Nadia , Pfeil-Beun Elvire , Walder Bernhard , Tramèr Martin R. 
Published: May 2018

BACKGROUND:
Sedation with propofol is frequently used to facilitate diagnostic and therapeutic procedures. Propofol can be administrated by the patient (patient-controlled sedation [PCS]) or by a clinician (clinician-controlled sedation [CCS]). We aimed to compare these 2 techniques.

METHODS:
PubMed, Embase, CENTRAL, and trial registries were searched up to October 2017 for randomized controlled trials comparing PCS with CCS with propofol. The primary end points were the risks of presenting at least 1 episode of oxygen desaturation, arterial hypotension, and bradycardia, and the risk of requiring a rescue intervention (pharmacologic therapies or physical maneuvers) for sedation-related adverse events. Secondary end points were the dose of propofol administrated, operator and patient satisfaction, and the risk of oversedation. A random-effects model and an α level of .02 to adjust for multiple analyses were used throughout. Trial sequential analyses were performed for primary outcomes. Quality of evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation system.

RESULTS:
Thirteen trials (1103 patients; median age, 47 years; American Society of Anesthesiologists physical status I–III) describing various diagnostic and therapeutic procedures with propofol sedation were included. PCS had no impact on the risk of oxygen desaturation (11 trials, 31/448 patients [6.9%] with PCS versus 46/481 [9.6%] with CCS; risk ratio, 0.74 [98% confidence interval, 0.35–1.56]) but decreased the risk of requiring a rescue intervention for adverse events (11 trials, 29/449 patients [6.5%] with PCS versus 74/482 [15.4%] with CCS; risk ratio, 0.45 [98% confidence interval, 0.25–0.81]). For both outcomes, Trial sequential analyses suggested that further trials were unlikely to change the results, although the quality of evidence was graded very low for all primary outcomes. For the risk of arterial hypotension and bradycardia, the required sample size for a definitive conclusion had not been reached. Analysis of secondary outcomes suggested that PCS decreased the risk of oversedation and had no impact on propofol dose administrated, or on operator or patient satisfaction.

CONCLUSIONS:
PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS.
Trainability of Cricoid Pressure Force Application: A Simulation-Based Study
Authors: Noll Eric , Shodhan Shivam , Varshney Arnavi , Gallagher Christopher , Diemunsch Pierre , Florence F. Barry , Romeiser Jamie , Bennett-Guerrero Elliott 
Published: May 2018

BACKGROUND:Aspiration of gastric contents is a leading cause of airway management–related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10–30 N during application of CP.METHODS:Clinicians (attending anesthesiologist, anesthesiology residents, certified registered nurse anesthetists, or operating room nurses) applied CP on a Vernier force plate simulator with measurements taken at 4 time points over 60 seconds, 2 measurements before and 2 measurements after loss of consciousness. A successful cycle required all 4 time points to be within the target range (10 ± 5 and 30 ± 5 N, respectively). After baseline assessment (n = 100 clinicians), a subset of 40 participants volunteered for education on recommended force targets, underwent self-regulated practice, and then performed 30 1-minute cycles of high-frequency simulation analyzed by cumulative sum analysis to assess their change in performance.RESULTS:At baseline, 5 cycles (1.3% [confidence interval {CI}, 0.3%–2.50%]) out of 400 were successful. Performance improved after education and self-regulated practice (16% successful cycles [CI, 7.8%–25%]), and performance during the last 4 of 30 cycles was 45% (CI, 33%–58%). The odds of success increased over time (odds ratio, 1.1;P< .001). By cumulative sum analysis, however, no subject crossed the h0 line, indicating that no one achieved proficiency of the predefined target forces.CONCLUSIONS:At baseline, performance was poor at achieving target forces specified by national guidelines. Simulation-based training improved the success rate, but no participant achieved the predefined threshold for proficiency.
A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children
Authors: Zhang Bin , Gurnaney Harshad G. , Stricker Paul A. , Galvez Jorge A. , Isserman Rebecca S. , Fiadjoe John E. 
Published: May 2018

BACKGROUND:
The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and instruction. Identifying the specific points during tube placement, during which clinicians struggle, would help with targeted education. We conducted this prospective observational study to determine the incidence and location of technical difficulties using the GlideScope, the success rates of various corrective maneuvers used, and the impact of technical difficulty on success rate.

METHODS:
We conducted this observational study at our quaternary pediatric hospital between February 2014 and August 2014. We observed 200 GlideScope-guided intubations and documented key intubation–related outcomes. Inclusion criteria for patients were <6 years of age and elective surgery requiring endotracheal intubation. We documented the number of advancement maneuvers required to intubate the trachea, the location where technical difficulty occurred, the types of maneuvers used to address difficulties, and the tracheal intubation success rate. We used a bias-corrected bootstrapping method with 300 replicates to determine the 95% confidence interval (CI) around the rate of difficulty with an intubation attempt.

RESULTS:
After excluding attempts by inexperienced clinicians, there were 225 attempts in 187 patients, 58% (131 of 225; bootstrap CI, 51.6%–64.6%]) of the attempts had technical difficulties. Technical difficulty was most likely to occur when inserting the tracheal tube between the plane of the arytenoid cartilages to just beyond the vocal cords: “zone 3.” Clockwise rotation of the tube was the most common successful corrective maneuver in zone 3. The overall tracheal intubation success rate was 98% (CI, 95%–99%); however, the first attempt success rate was only 80% (CI, 74%–86%). Patients with technical difficulty had more attempts (median [interquartile range], 2 [1–3] than those without technical difficulty median (interquartile range, 1 [1–1; P value <.01]).

CONCLUSIONS:
A variety of clinicians experience technical difficulties with the GlideScope Cobalt videolaryngoscope in children. These difficulties result in more tracheal intubation attempts, an important risk factor for intubation-associated complications. Targeted education of clinicians may reduce the incidence of technical difficulties.
Proximal Versus Distal Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Analgesia? A Randomized, Subject-Masked, Controlled Clinical Trial
Authors: Sztain Jacklynn F. , Khatibi Bahareh , Monahan Amanda M. , Said Engy T. , Abramson Wendy B. , Gabriel Rodney A. , Finneran John J. , Bellars Richard H. , Nguyen Patrick L. , Ball Scott T. , Gonzales Francis B. , Ahmed Sonya S. , Donohue Michael C. , Padwal Jennifer A. , Ilfeld Brian M. 
Published: May 2018

BACKGROUND:A continuous adductor canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the adductor hiatus would provide superior analgesia compared to a more proximal catheter location. We therefore tested the hypothesis that during a continuous adductor canal nerve block, postoperative analgesia would be improved by placing the perineural catheter tip 2–3 cm cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal location) compared to a more proximal location at the midpoint between the anterior superior iliac spine and the superior border of the patella (proximal location).METHODS:Preoperatively, subjects undergoing total knee arthroplasty received an ultrasound-guided perineural catheter inserted either in the proximal or distal location within the adductor canal in a randomized, subject-masked fashion. Subjects received a single injection of lidocaine 2% via the catheter preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus, 30 minutes lockout) for the study duration. After joint closure, the surgeon infiltrated the entire joint using 30 mL of ropivacaine (0.5%), ketorolac (30 mg), epinephrine (5 μg/mL), and tranexamic acid (2 g). The primary end point was the median level of pain as measured on a numeric rating scale (NRS) during the time period of 8:00amto 12:00Pmthe day after surgery.RESULTS:For the primary end point, the NRS of subjects with a catheter inserted at the proximal location (n = 24) was a median (10th, 25th–75th, 90th quartiles) of 0.5 (0.0, 0.0–3.2, 5.0) vs 3.0 (0.0, 2.0–5.4, 7.8) for subjects with a catheter inserted in the distal location (n = 26;P= .011). Median and maximum NRSs were lower in the proximal group at all other time points, but these differences did not reach statistical significance. There were no clinically relevant or statistically significant differences between the treatment groups for any other secondary end point, including opioid consumption and ambulation distance.CONCLUSIONS:For continuous adductor canal blocks accompanied by intraoperative periarticular local anesthetic infiltration, analgesia the day after knee arthroplasty is improved with a catheter inserted at the level of the midpoint between the anterior superior iliac spine and the superior border of the patella compared with a more distal insertion closer to the adductor hiatus.