bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visual Performance and Perception as a Target of Saccadic Strategies in Patients With Unilateral Vestibular Loss
Authors: Trinidad-Ruiz Gabriel , Rey-Martinez Jorge , Batuecas-Caletrio Angel , Matiño-Soler Eusebi , Perez-Fernandez Nicolas 
Published: March 2018

Objectives:
To evaluate the ability of saccadic strategies developed during vestibular compensation to reduce the effect of an impaired vestibulo-ocular reflex (VOR) on a retinal smear and image motion sensation.

Design:
Twenty patients with unilateral vestibular loss were examined with a video head impulse test before and after vestibular rehabilitation (VR) with the use of gaze stabilization and refixation saccades training. Head and eye velocity functions were processed to infer the retinal eccentricity, and through its correlation with visual acuity (VA), several measurements are proposed to evaluate the influence of VR on saccades behavior and visual performance. To isolate the effect of saccades on the findings and avoid bias because of gain differences, only patients whose VOR gain values remained unchanged after VR were included.

Results:
Improved contribution of covert saccades and reduction of overt saccades latency were measured after VR. We found significant differences when assessing both the interval less than 70% VA (50.25 ms), which is considered the limit of a moderate low vision, and less than 50% VA (39.515 ms), which is the limit for severe low vision. Time to recover a VA of 75% (near normal) was reduced in all the patients (median: 56.472 ms).

Conclusion:
Despite the absence of VOR gain improvement, patients with unilateral vestibular loss are able to develop saccadic strategies that allow the shortening of the interval of retinal smear and image motion. The proposed measurements might be of use to evaluate VR outcomes and visually induced impairment.
The Influence of Concordant Complex Posture and Loading Rate on Motion Segment Failure
Authors: Schollum Meredith L. , Wade Kelly R. , Shan Zhi , Robertson Peter A. , Thambyah Ashvin , Broom Neil D. 
Published: March 2018

Study Design.
Microstructural investigation of compression-induced herniation of a lumbar disc held in a concordant complex posture.

Objective.
To explore the significance of loading rate in a highly asymmetric concordant posture, comparing the mechanisms of failure to an earlier study using a nonconcordant complex posture.

Summary of Background Data.
A recent study with a nonconcordant complex posture (turning in the opposite direction to that which the load is applied) demonstrated the vulnerability of the disc to loading that is borne by one set of oblique-counter oblique fiber sets in the alternating lamellae of the annulus, and aggravated by an elevated loading rate. Given the strain rate–dependent properties of the disc it might be expected that the outcome differs if the posture is reversed.

Methods.
Forty-one motion segments from ovine 16 spines were split into two cohorts; adopting the previously employed low rate (40 mm/min) and surprise rate (400 mm/min) of loading. Both groups of damaged discs were then analyzed microstructurally.

Results.
With the lower rate loading the concordant posture significantly reduced the load required to cause disc failure than earlier described for nonconcordant posture (6.9 vs. 8.4 kN), with more direct tears and alternate lamella damage extending to the anterior disc. Contrary to this result, with a surprise rate, the load at failure was significantly increased with the concordant posture (8.08 vs. 6.96 kN), although remaining significantly less than that from a simple flexed posture (9.6 kN). Analysis of the damage modes and postures suggest facet engagement plays a significant role.

Conclusion.
This study confirms that adding shear to the posture lowers the load at failure, and causes alternate lamella rupture. Load at failure in a complex posture is not determined by loading rate alone. Rather, the strain rate–dependent properties of the disc influence which elements of the system are brought into play.

Level of Evidence: N/A
Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU
Authors: Murphy Patrick B. , Parry Neil G. , Sela Nathalie , Leslie Ken , Vogt Kelly , Ball Ian 
Published: March 2018

Objectives:
To determine the prevalence of intra-abdominal hypertension in mixed medical-surgical critically ill patients using modern definitions and measurement techniques. Secondarily to determine variables associated with intra-abdominal hypertension and ICU mortality.

Design:
A prospective observational study.

Setting:
Single institution trauma, medical and surgical ICU in Canada.

Patients:
Consecutive adult patients admitted to the ICU (n = 285).

Intervention:
Intra-abdominal pressure measurements twice a day during admission to the ICU.

Measurements and Main Results:
In 285 patients who met inclusion criteria, 30% were diagnosed with intra-abdominal hypertension at admission and a further 15% developed intra-abdominal hypertension during admission. The prevalence of abdominal compartment syndrome was 3%. Obesity, sepsis, mechanical ventilation, and 24-hour fluid balance (> 3 L) were all independent predictors for intra-abdominal hypertension. Intra-abdominal hypertension occurred in 28% of nonventilated patients. Admission type (medical vs surgical vs trauma) was not a significant predictor of intra-abdominal hypertension. Overall ICU mortality was 20% and was significantly higher for patients with intra-abdominal hypertension (30%) compared with patients without intra-abdominal hypertension (11%). Intra-abdominal hypertension of any grade was an independent predictor of mortality (odds ratio, 3.33; 95% CI, 1.46–7.57).

Conclusions:
Intra-abdominal hypertension is common in both surgical and nonsurgical patients in the intensive care setting and was found to be independently associated with mortality. Despite prior reports to the contrary, intra-abdominal hypertension develops in nonventilated patients and in patients who do not have intra-abdominal hypertension at admission. Intra-abdominal pressure monitoring is inexpensive, provides valuable clinical information, and there may be a role for its routine measurement in the ICU. Future work should evaluate the impact of early interventions for patients with intra-abdominal hypertension.
Elective Stoma Reversal Has a Higher Incidence of Postoperative Clostridium Difficile Infection Compared With Elective Colectomy: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program and Targeted Colectomy Databases
Authors: Skancke Matthew , Vaziri Khashayar , Umapathi Bindu , Amdur Richard , Radomski Michal , Obias Vincent 
Published: March 2018

BACKGROUND:

Clostridium difficile infection is caused by the proliferation of a gram-positive anaerobic bacteria after medical or surgical intervention and can result in toxic complications, emergent surgery, and death.

OBJECTIVE:
This analysis evaluates the incidence of C difficile infection in elective restoration of intestinal continuity compared with elective colon resection.

DESIGN:
This was a retrospective database review of the 2015 American College of Surgeons National Surgical Quality Improvement Project and targeted colectomy database.

SETTINGS:
The intervention cohort was defined as the primary Current Procedural Terminology codes for ileostomy/colostomy reversal (44227, 44620, 44625, and 44626) and International Classification of Diseases codes for ileostomy/colostomy status (VV44.2, VV44.3, VV55.2, VV55.3, Z93.2, Z93.3, Z43.3, and Z43.2).

PATIENTS:
A total of 2235 patients underwent elective stoma reversal compared with 10403 patients who underwent elective colon resection.

INTERVENTION:
Multivariate regression modeling of the impact of stoma reversal on postoperative C difficile infection risk was used as the study intervention.

MAIN OUTCOME MEASURES:
The incidence of C difficile infection in the 30 days after surgery was measured.

RESULTS:
The incidence of C difficile infection in the 30-day postoperative period was significantly higher (3.04% vs 1.25%; p < 0.001) in patients undergoing stoma reversal. After controlling for differences in cohorts, regression analysis suggested that stoma reversal (OR = 2.701 (95% CI, 1.966–3.711); p < 0.001), smoking (OR = 1.520 (95% CI, 1.063–2.174); p = 0.022), steroids (OR = 1.677 (95% CI, 1.005–2.779); p = 0.048), and disseminated cancer (OR = 2.312 (95% CI, 1.437–3.719); p = 0.001) were associated with C difficile infection incidence in the 30-day postoperative period.

LIMITATIONS:
The study was limited because it was a retrospective database review with observational bias.

CONCLUSIONS:
Patients who undergo elective stoma reversal have a higher incidence of postoperative C difficile infection compared with patients who undergo an elective colectomy. Given the impact of postoperative C difficile infection, a heightened sense of suspicion should be given to symptomatic patients after stoma reversal. See at Video Abstract at http://links.lww.com/DCR/A553.
Open Surgical Incisions After Colorectal Surgery Improve Quality Metrics, But Do Patients Benefit?
Authors: Mullen Matthew G. , Hawkins Robert B. , Johnston Lily E. , Shah Puja M. , Turrentine Florence E. , Hedrick Traci L. , Friel Charles M. 
Published: March 2018

BACKGROUND:
Surgical site infection is a frequent cause of morbidity after colorectal resection and is a quality measure for hospitals and surgeons. In an effort to reduce the risk of postoperative infections, many wounds are left open at the time of surgery for secondary or delayed primary wound closure.

OBJECTIVE:
The purpose of this study was to evaluate the impact of delayed wound closure on the rate of surgical infections and resource use.

DESIGN:
This retrospective propensity-matched study compared colorectal surgery patients with wounds left open with a cohort of patients with primary skin closure.

SETTINGS:
The American College of Surgeons National Quality Improvement Program Participant Use file for 2014 was queried.

PATIENTS:
A total of 50,212 patients who underwent elective or emergent colectomy, proctectomy, and stoma creation were included.

MAIN OUTCOME MEASURES:
Rates of postoperative infections and discharge to medical facilities were measured.

RESULTS:
Surgical wounds were left open in 2.9% of colorectal cases (n = 1466). Patients with skin left open were broadly higher risk, as evidenced by a significantly higher median estimated probability of 30-day mortality (3.40% vs 0.45%; p < 0.0001). After propensity matching (n = 1382 per group), there were no significant differences between baseline characteristics. Within the matched cohort, there were no differences in the rates of 30-day mortality, deep or organ space infection, or sepsis (all p > 0.05). Resource use was higher for patients with incisions left open, including longer length of stay (11 vs 10 d; p = 0.006) and higher rates of discharge to a facility (34% vs 27%; p < 0.001).

LIMITATIONS:
This study was limited by its retrospective design and a large data set with a bias toward academic institutions.

CONCLUSIONS:
In a well-matched colorectal cohort, secondary or delayed wound closure eliminates superficial surgical infections, but there was no decrease in deep or organ space infections. In addition, attention should be given to the possibility for increased resource use associated with open surgical incisions. See Video Abstract at http://links.lww.com/DCR/A560.
Determination of Tacrolimus Concentration and Protein Expression of P-Glycoprotein in Single Human Renal Core Biopsies
Authors: Krogstad Veronica , Vethe Nils T. , Robertsen Ida , Hasvold Grete , Ose Anne-Marthe D. , Hermann Monica , Andersen Anders M. , Chan Joe , Skauby Morten , Svensson My H. S. , Åsberg Anders , Christensen Hege 
Published: March 2018

Background:
Tacrolimus (TAC) is currently the cornerstone of immunosuppressive protocols for renal transplant recipients. Despite therapeutic whole blood monitoring, TAC is associated with nephrotoxicity, and it has been hypothesized that intrarenal accumulation of TAC and/or its metabolites are involved. As TAC is a substrate of P-glycoprotein (P-gp), the expression and activity of this efflux transporter could influence the levels of TAC in renal tissue. The primary aim of this study was to develop and validate a method for quantification of TAC in tissue homogenates from single human renal core biopsies. The secondary aim was to provide measures of P-gp expression and of the demethylated metabolites of TAC in the same renal biopsy.

Methods:
Human renal tissue, with and without clinical TAC exposure, was used for method development and validation. Homogenates were prepared with bead-beating, and concentrations of TAC and its demethylated metabolites were analyzed with liquid chromatography tandem mass spectrometry after protein precipitation. A Western blot method was used for semiquantification of P-gp expression in the homogenates. The final methods were applied to renal core biopsies from 2 transplant patients.

Results:
The TAC assay showed within- and between-run mean accuracy between 99.7% and 107% and coefficients of variation ≤6.7%. Matrix effects were nonsignificant, and samples were stable for 3 months preanalytically when stored at −80°C. TAC concentrations in the renal core biopsies were 62.6 and 43.7 pg/mg tissue. The methods for measurement of desmethyl-TAC and P-gp expression were suitable for semiquantification in homogenates from renal core biopsies.

Conclusions:
These methods may be valuable for the elucidation of the pharmacokinetic mechanisms behind TAC-induced nephrotoxicity in renal transplant recipients.
Saving Lives and Preventing Injuries From Unjustified Protective Actions—Method for Developing a Comprehensive Public Protective Action Strategy for a Severe NPP Emergency
Authors: Callen J. , McKenna T. 
Published: March 2018

Abstract
During the response to the Fukushima Daiichi nuclear power plant (FDNPP) emergency, about 50 patients died during or shortly after an evacuation when they were not provided with the needed medical support. In addition, it has been shown that during the FDNPP emergency there were increases in mortality rates among the elderly due to long-term dislocation as a result of evacuation and relocation orders and an inability to stay in areas where residents were advised to shelter for extended periods. These deaths occurred even though the possible radiation exposure to the public was too low to result in radiation-induced deaths, injuries, or a meaningful increase in the cancer rate, even if no protective actions had been taken. These problems are not unique to the FDNPP emergency and would be expected if the recommendations of many organizations were followed. Neither the International Commission on Radiological Protection (ICRP), the U.S. Nuclear Regulatory Commission (NRC) nor the U.S Environmental Protection Agency (EPA) adequately take into consideration in their recommendations and analysis the non-radiological health impacts, such as deaths and injuries, that could result from protective actions. Furthermore, ICRP, NRC, EPA, and the U.S. Department of Homeland Security (DHS) call for taking protective actions at doses lower than those resulting in meaningful adverse radiation-induced health effects and do not state the doses at which such effects would be seen. Consequently, it would be impossible for decision makers and the public to balance all the hazards both from radiation exposure and protective actions when deciding whether a protective action is justified. What is needed, as is presented in this paper, is a method for developing a comprehensive protective action strategy that allows the public, decision makers, and others who must work together to balance the radiological with the non-radiological health hazards posed by protective actions, and to counter the exaggerated fear of radiation exposure that could lead to taking unjustified protective actions and adverse psychological, sociological, and other effects.
Reassessment of Resuspension Factor Following Radionuclide Dispersal: Toward a General-purpose Rate Constant
Authors: Marshall Shaun , Potter Charles , Medich David 
Published: March 2018

Abstract
A recent analysis of historical radionuclide resuspension datasets confirmed the general applicability of the Anspaugh and modified Anspaugh models of resuspension factors following both controlled and disastrous releases. While observations appear to have larger variance earlier in time, previous studies equally weighted the data for statistical fit calculations; this could induce a positive skewing of resuspension coefficients in the early time-period. A refitting is performed using a relative instrumental weighting of the observations. Measurements within a 3‐d window are grouped into singular sample sets to construct standard deviations. The resulting best-fit equations produce tamer exponentials, which give decreased integrated resuspension factor values relative to those reported by Anspaugh. As expected, the fits attenuate greater error among the data at earlier time. The reevaluation provides a sharper contrast between the empirical models and reaffirms their deficiencies in the short-lived timeframe wherein the dynamics of particulate dispersion dominate the resuspension process.
Development and Validation of the Realistic Anthropomorphic Flexible (RAF) Phantom
Authors: Lombardo Pasquale A. , Vanhavere Filip , Lebacq Anne L. , Struelens Lara , Bogaerts Ria 
Published: March 2018

Abstract
Voxel phantoms developed by segmenting computed tomography images are known to be more anatomically accurate than mathematical phantoms. However, due to their lack of flexibility and the complexity of voxel datasets, the use of voxel phantoms in dosimetry is often impractical. This paper describes the development of the realistic anthropomorphic flexible (RAF) polygonal mesh phantom, a novel phantom based on Boundary Representation (B-Rep) that merges anatomical accuracy and flexibility. Rather than using segmentation of tomography images, the modeling of the phantom’s organs was based on freely and commercially available anatomical atlases, ICRP 89, and recent medical literature. To validate the phantom, a high-resolution voxel version was created for the MCNPx transport code. The voxelized RAF phantom was validated by comparing it with the ICRP 110 male phantom for external irradiations with parallel beams of photons and electrons. Dose coefficients obtained from simulations with the RAF phantom were compared with those from ICRP Publication 116. Relevant differences in organ doses were found.
Joint American Nuclear Society and Health Physics Society Conference: Applicability of Radiation Response Models to Low Dose Protection Standards
Authors: Glines Wayne M. , Markham Anna 
Published: March 2018

Abstract
Seventy-five years after the Hanford Site was initially created as the primary plutonium production site for atomic weapons development under the Manhattan Project, the American Nuclear Society and the Health Physics Society are sponsoring a conference from 30 September through 3 October 2018, in Pasco, Washington, titled “Applicability of Radiation Response Models to Low Dose Protection Standards.” The goal of this conference is to use current scientific data to update the approach to regulating low-level radiation doses; i.e., to answer a quintessential question of radiation protection—how to best develop radiation protection standards that protect human populations against detrimental effects while allowing the beneficial uses of radiation and radioactive materials. Previous conferences (e.g., “Wingspread Conference,” “Arlie Conference”) have attempted to address this question; but now, almost 20 y later, the key issues, goals, conclusions, and recommendations of those two conferences remain and are as relevant as they were then. Despite the best efforts of the conference participants and increased knowledge and understanding of the science underlying radiation effects in human populations, the bases of current radiation protection standards have evolved little. This 2018 conference seeks to provide a basis and path forward for evolving radiation protection standards to be more reflective of current knowledge and understanding of low dose response models.
The use of National Weather Service Data to Compute the Dose to the MEOI
Authors: Vickers Linda 
Published: March 2018

Abstract
The Turner method is the “benchmark method” for computing the stability class that is used to compute the X/Q (s m−3). The Turner method should be used to ascertain the validity of X/Q results determined by other methods. This paper used site-specific meteorological data obtained from the National Weather Service. The Turner method described herein is simple, quick, accurate, and transparent because all of the data, calculations, and results are visible for verification and validation with published literature.
A Phase 3 Study of Micafungin Versus Amphotericin B Deoxycholate in Infants With Invasive Candidiasis
Authors: Benjamin Daniel K. , Kaufman David A. , Hope William W. , Smith P. Brian , Arrieta Antonio , Manzoni Paolo , Kovanda Laura L. , Lademacher Christopher , Isaacson Brigit , Jednachowski Deborah , Wu Chunzhang , Kaibara Atsunori , Walsh Thomas J. 
Published: March 2018

Background:
Amphotericin B deoxycholate (AmB-D) is standard of care treatment for neonatal invasive candidiasis (IC). Micafungin (MCA) has broad-spectrum fungicidal activity against Candida spp. We compared the efficacy and safety of intravenous MCA with intravenous AmB-D and assessed the pharmacokinetics of MCA in infants >2–120 days of age with proven IC in a phase 3, randomized, double-blind, multicenter, parallel-group, noninferiority study (NCT00815516).

Methods:
Infants were randomized 2:1 to MCA (10 mg/kg/d) or AmB-D (1 mg/kg/d) for ≥21 days. Primary efficacy endpoint was fungal-free survival (FFS) 1 week after last study drug dose. MCA population pharmacokinetics included simulated area under the curve (AUC) at steady state and maximum plasma concentration after 2-hour infusion. AUC pharmacodynamic target exposure was 170 µg·h/mL.

Results:
Thirty infants received MCA (n = 20) or AmB-D (n = 10). The trial was terminated early because of slow recruitment. FFS was observed in 12 of 20 [60%; 95% confidence interval (CI): 36%–81%] MCA-group infants and in 7 of 10 (70%; 95% CI: 35%–93%) AmB-D-group infants. The most common treatment-emergent adverse events were anemia [MCA: n = 9 (45%); AmB-D: n = 3 (30%)] and thrombocytopenia [n = 2 (10%) and n = 3 (30%), respectively]. Model-derived mean AUC at steady state for MCA was 399.3 ± 163.9 µg·h/mL (95% prediction interval: 190.3–742.3 µg/mL); steady state and maximum plasma concentration after 2-hour infusion was 31.1 ± 10.5 µg/mL (95% prediction interval: 17.0–49.7 µg/mL). MCA exposures were above the AUC pharmacodynamic target exposure.

Conclusions:
Within the study limitations, infants with IC treated with MCA achieved similar FFS compared with AmB-D. Both agents were safe and well tolerated.