bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study
Authors: Downes Kevin J , Fitzgerald Julie C , Schriver Emily , Boge Craig L K , Russo Michael E , Weiss Scott L , Balamuth Fran , Kubis Sherri E , Tolomeo Pam , Bilker Warren B , Han Jennifer H , Lautenbach Ebbing , Coffin Susan E , Gerber Jeffrey S 
Published: October 2018

Abstract

Background
Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection.

Methods
We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein &lt;4 mg/dL and procalcitonin &lt;1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3–9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods.

Results
We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm’s cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30–0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression.

Conclusions
Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Use of Stereotactic Radiosurgery in the Treatment of Adults With Metastatic Brain Tumors
Authors: Graber Jerome J , Cobbs Charles S , Olson Jeffrey J 
Published: October 2018

Abstract

TARGET POPULATION
These recommendations apply to adult patients with new or recurrent solitary or multiple brain metastases from solid tumors as detailed in each section.

QUESTION 1
Should patients with newly diagnosed metastatic brain tumors undergo stereotactic radiosurgery (SRS) compared with other treatment modalities?

RECOMMENDATIONS

Level 3: SRS is recommended as an alternative to surgical resection in solitary metastases when surgical resection is likely to induce new neurological deficits, and tumor volume and location are not likely to be associated with radiation-induced injury to surrounding structures.

Level 3: SRS should be considered as a valid adjunctive therapy to supportive palliative care for some patients with brain metastases when it might be reasonably expected to relieve focal symptoms and improve functional quality of life in the short term if this is consistent with the overall goals of the patient.

QUESTION 2
What is the role of SRS after open surgical resection of brain metastasis?

RECOMMENDATION

Level 3: After open surgical resection of a solitary brain metastasis, SRS should be used to decrease local recurrence rates.

QUESTION 3
What is the role of SRS alone in the management of patients with 1 to 4 brain metastases?

RECOMMENDATIONS

Level 3: For patients with solitary brain metastasis, SRS should be given to decrease the risk of local progression.

Level 3: For patients with 2 to 4 brain metastases, SRS is recommended for local tumor control, instead of whole brain radiotherapy, when their cumulative volume is < 7 mL.

QUESTION 4
What is the role of SRS alone in the management of patients with more than 4 brain metastases?

RECOMMENDATION

Level 3: The use of stereotactic radiosurgery alone is recommended to improve median overall survival for patients with more than 4 metastases having a cumulative volume < 7 mL. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_4
Procedural Variables Influencing Stereotactic Accuracy and Efficiency in Deep Brain Stimulation Surgery
Authors: Mirzadeh Zaman , Chen Tsinsue , Chapple Kristina M , Lambert Margaret , Karis John P , Dhall Rohit , Ponce Francisco A 
Published: October 2018

Abstract

BACKGROUND
Deep brain stimulation (DBS) is well-established, evidence-based therapy for Parkinson disease, essential tremor, and primary dystonia. Clinical outcome studies have recently shown that “asleep” DBS lead placement, performed using intraoperative imaging with stereotactic accuracy as the surgical endpoint, has motor outcomes comparable to traditional “awake” DBS using microelectrode recording (MER), but with shorter case times and improved speech fluency.

OBJECTIVE
To identify procedural variables in DBS surgery associated with improved surgical efficiency and stereotactic accuracy.

METHODS
Retrospective review of 323 cases with 546 leads placed (August 2011-October 2014). In 52% (n = 168) of cases, patients were asleep under general anesthesia without MER. Multivariate regression identified independent predictors of reduced surgery time and improved stereotactic accuracy.

RESULTS
MER was an independent contributor to increased procedure time (+44 min; P = .03). Stereotactic accuracy was better in asleep patients. Accuracy was improved with frame-based stereotaxy at head of bed 0° vs frameless stereotaxy at head of bed 30°. Improved accuracy was also associated with shorter procedures (r = 0.17; P = .049). Vector errors were evenly distributed around the planned target for the globus pallidus internus, but directionally skewed for the subthalamic (medial-posterior) and ventral intermediate nuclei (medial-anterior).

CONCLUSION
Distinct procedural variables in DBS surgery are associated with reduced case times and improved stereotactic accuracy.
Optimum frequency of Faraday tomography to explore the intergalactic magnetic field in filaments of galaxies
Authors: Akahori Takuya , Ideguchi Shinsuke , Aoki Takahiro , Takefuji Kazuhiro , Ujihara Hideki , Takahashi Keitaro 
Published: October 2018

Abstract
Faraday tomography is thought to be a powerful tool to explore the cosmic magnetic field. Broadband radio polarimetric data are essential to ensuring the quality of Faraday tomography, but such data are not easy to obtain because of radio frequency interferences. In this paper, we investigate optimum frequency coverage of Faraday tomography so as to explore the Faraday rotation measure (RM) due to the intergalactic magnetic field (IGMF) in filaments of galaxies. We adopt a simple model of the IGMF and estimate confidence intervals of the model parameters using the Fisher information matrix. We find that meaningful constraints on RM due to the IGMF are available with data at multiple narrowbands which are scattered over the ultra-high frequency (UHF, 300–3000 MHz). The optimum frequency depends on the Faraday thickness of the Milky Way foreground. These results are obtained for a wide brightness range of the background source including fast radio bursts. We discuss the relation between the polarized-intensity spectrum and the optimum frequency.
Intravenous vs Oral Acetaminophen for Analgesia After Cesarean Delivery: A Randomized Trial
Authors: Wilson Sylvia H , Wolf Bethany J , Robinson Stefanie M , Nelson Cecil , Hebbar Latha 
Published: October 2018

Abstract

Objective
Examination of postoperative analgesia with intravenous and oral acetaminophen.

Design
Prospective, three-arm, nonblinded, randomized clinical trial.

Setting
A single academic medical center.

Subjects
Parturients scheduled for elective cesarean delivery.

Methods
This trial randomized 141 parturients to receive intravenous acetaminophen (1 g every eight hours, three doses), oral acetaminophen (1 g every eight hours, three doses), or no acetaminophen. All patients received a standardized neuraxial anesthetic with intrathecal opioids and scheduled postoperative ketorolac. The primary outcome, 24-hour opioid consumption, was evaluated using the Kruskal-Wallace test and Tukey-Kramer adjustment for multiple comparisons. Secondary outcomes included 48-hour opioid consumption, first opioid rescue, pain scores, patient satisfaction, times to ambulation and discharge, and side effects.

Results
Over 18 months, 141 parturients with similar demographic variables completed the study. Median (interquartile range) opioid consumption in intravenous morphine milligram equivalents at 24 hours was 0 (5), 0 (7), and 5 (7) for the intravenous, oral, and no groups, respectively, and differed between groups (global P = 0.017). Opioid consumption and other secondary outcomes did not differ between the intravenous vs oral or oral vs no groups. Opioid consumption was reduced at 24 hours with intravenous vs no acetaminophen (P = 0.015). Patients receiving no acetaminophen had 5.8 times the odds of consuming opioids (P = 0.036), consumed 40% more opioids controlling for time (P = 0.041), and had higher pain scores with ambulation (P = 0.004) compared with the intravenous group.

Conclusions
Intravenous acetaminophen did not reduce 24-hour opioid consumption or other outcomes compared with oral acetaminophen. Intravenous acetaminophen did decrease opioid consumption and pain scores compared with no acetaminophen.
THE COMPARISON OF THE EXTERNAL DOSE RATE MEASUREMENT OF CHILDREN AND ADOLESCENT PATIENTS WITH ADULT PATIENTS TREATED WITH RADIOIODINE THERAPY
Authors: Edis Nurcan , Tamam Muge Oner 
Published: October 2018

Abstract
The aim of this study is to evaluate the radiation safety of caregiving people contacting the child and adolescent patients with thyroid cancer who received radioactive iodine-131 (RIT) treatment by comparison with external dose rate measurements of adult patients according to their administered activities and days of hospitalization. We retrospectively evaluated external dose rate measurement of 158 children and adolescent patients and 158 adult patients. During the RIT, the hospitalization time were grouped as 2, 3 and 4 d, and the administered activities as <3700, 3700 and >3700 MBq. The values of external dose rate measurements of children and adolescents were statistically significantly higher than the adult group. Different approaches in radiation safety rules are required for children and adolescents. In terms of radiation safety, we suggest that more specific regulations for family members and caregivers should be established and informed.
A Meta-analysis of Immune Parameters, Variability, and Assessment of Modal Distribution in Psychosis and Test of the Immune Subgroup Hypothesis
Authors: Pillinger Toby , Osimo Emanuele F , Brugger Stefan , Mondelli Valeria , McCutcheon Robert A , Howes Oliver D 
Published: October 2018

AbstractImmune parameters are elevated in psychosis, but it is unclear whether alterations are homogenous across patients or heterogeneity exists, consistent with the hypothesis that immune alterations are specific to a subgroup of patients. To address this, we examine whether antipsychotic-naïve first-episode psychosis patients exhibit greater variability in blood cytokines, C-reactive protein, and white cell counts compared with controls, and if group mean differences persist after adjusting for skewed data and potential confounds. Databases were searched for studies reporting levels of peripheral immune parameters. Means and variances were extracted and analyzed using multivariate meta-analysis of mean and variability of differences. Outcomes were (1) variability in patients relative to controls, indexed by variability ratio (VR) and coefficient of variation ratio (CVR); (2) mean differences indexed by Hedges g; (3) Modal distribution of raw immune parameter data using Hartigan’s unimodality dip test. Thirty-five studies reporting on 1263 patients and 1470 controls were included. Variability of interleukin-6 (IL6) (VR = 0.19), tumor necrosis factor-α (TNFα) (VR = 0.36), interleukin-1β (VR = 0.35), interleukin-4 (VR = 0.55), and interleukin-8 (VR = 0.28) was reduced in patients. Results persisted for IL6 and IL8 after mean-scaling. Ninety-four percent and one hundred percent of raw data were unimodally distributed in psychosis and controls, respectively. Mean levels of IL6 (g = 0.62), TNFα (g = 0.56), interferon-γ (IFNγ) (g = 0.32), transforming growth factor-β (g = 0.53), and interleukin-17 (IL17) (g = 0.48) were elevated in psychosis. Sensitivity analyses indicated this is unlikely explained by confounders for IL6, IFNγ, and IL17. These findings show elevated cytokines in psychosis after accounting for confounds, and that the hypothesis of an immune subgroup is not supported by the variability or modal distribution.
Cognitive Effects of Perioperative Pregabalin
Authors: Myhre Marianne , Jacobsen Henrik Børsting , Andersson Stein , Stubhaug Audun 
Published: October 2018

Abstract

EDITOR’S PERSPECTIVE

What We Already Know about This Topic
Perioperative administration of pregabalin has been associated with decreased postoperative pain and opioid requirements

What This Article Tells Us That Is New
This secondary analysis of data demonstrating that perioperative administration of pregabalin was associated with a reduction in opioid requirements and incisional hyperalgesia suggests that these benefits may be compromised by an increased risk of developing impaired postoperative cognitive performance

Background
Pregabalin has shown opioid sparing and analgesic effects in the early postoperative period; however, perioperative effects on cognition have not been studied. A randomized, parallel group, placebo-controlled investigation in 80 donor nephrectomy patients was previously performed that evaluated the analgesic, opioid-sparing, and antihyperalgesic effects of pregabalin. This article describes a secondary exploratory analysis that tested the hypothesis that pregabalin would impair cognitive function compared to placebo.

Methods
Eighty patients scheduled for donor nephrectomy participated in this randomized, placebo-controlled study. Pregabalin (150 mg twice daily, n = 40) or placebo (n = 40) was administered on the day of surgery and the first postoperative day, in addition to a pain regimen consisting of opioids, steroids, local anesthetics, and acetaminophen. Specific cognitive tests measuring inhibition, sustained attention, psychomotor speed, visual memory, and strategy were performed at baseline, 24 h, and 3 to 5 days after surgery, using tests from the Cambridge Neuropsychological Test Automated Battery.

Results
In the spatial working memory within errors test, the number of errors increased with pregabalin compared to placebo 24 h after surgery; median (25th, 75th percentile) values were 1 (0, 6) versus 0 (0, 1; rate ratio [95% CI], 3.20 [1.55 to 6.62]; P = 0.002). Furthermore, pregabalin significantly increased the number of errors in the stop-signal task stop-go test compared with placebo; median (25th, 75th percentile) values were 3 (1, 6) versus 1 (0, 2; rate ratio, 2.14 [1.13 to 4.07]; P = 0.020). There were no significant differences between groups in the paired associated learning, reaction time, rapid visual processing, or spatial working memory strategy tests.

Conclusions
Perioperative pregabalin significantly negatively affected subdomains of executive functioning, including inhibition, and working memory compared to placebo, whereas psychomotor speed was not changed.
Data and Lifelong Learning Protocol: Understanding Cultural Barriers and Facilitators to Using Clinical Performance Data to Support Continuing Professional Development
Authors: Wiljer David , Tavares Walter , Mylopoulos Maria , Campbell Craig , Charow Rebecca , Davis Dave , Okrainec Allan , Silver Ivan , Sockalingam Sanjeev 
Published: October 2018

Abstract:
Continuing professional development (CPD) can support delivery of high-quality care, but may not be optimized until we can understand cultural barriers and facilitators, especially as innovations emerge. Lifelong learning (LLL), linked with quality improvement, competence, and professionalism, is a core competency in medical education. The purpose of this study is to examine cultural factors (individual, organizational, and systemic) that influence CPD and specifically the use of clinical data to inform LLL and CPD activities. This mixed-method study will examine the perceptions of two learner groups (psychiatrists and general surgeons) in three phases: (1) a survey to understand the relationship between data-informed learning and orientation to LLL; (2) semistructured interviews using purposive and maximum variation sampling techniques to identify individual-, organizational-, and system-level barriers and facilitators to engaging in data-informed LLL to support practice change; and (3) a document analysis of legislation, policies, and procedures related to the access and the use of clinical data for performance improvement in CPD. We obtained research ethics approval from the University Health Network in Toronto, Ontario, Canada. By exploring two distinct learner groups, we will identify contextual features that may inform what educators should consider when conceptualizing and designing CPD activities and what initial actions need to be taken before CPD activities can be optimized. This study will lead to the development of a framework reflective of barriers and facilitators that can be implemented when planning to use data in CPD activities to support data adoption for LLL.
Evaluation of Aqueous Endocan and Endostatin Levels in Patients With Pseudoexfoliation Syndrome
Authors: Yağci Ramazan , Dervişoğullari Serdar , Güler Emre , Totan Yüksel , Hepşen İbrahim F. 
Published: October 2018

Purpose:
The purpose of the present study was to evaluate the aqueous humor endocan and endostatin levels in patients with pseudoexfoliation (PEX) syndrome and to compare the results with healthy individuals.

Materials and Methods:
Twenty nine cataract patients with PEX syndrome (PEX group) and 32 cataract patients without PEX syndrome (control group) were enrolled in the study. Endocan and endostatin were measured in the aqueous humor of the PEX and control groups by enzyme-linked immunosorbent assay.

Results:
There was no difference between the PEX and control groups in terms of age (P=0.721) and sex (P=0.902). The aqueous levels of endocan in patients with PEX (26.39±5.80 pg/mL) was significantly higher than in the control group (11.42±2.44 pg/mL) (P=0.039). The aqueous levels of endostatin was 12.00±1.35 ng/mL in the PEX group and 14.22±3.31 ng/mL in the control group, however, the difference was not statistically significant (P=0.41).

Conclusions:
The findings of the present study could suggest that the increased levels of aqueous endocan may be related to pathogenesis of PEX. However, levels of aqueous endostatin did not show any significant difference in PEX.
Higher Body Mass Index Adversely Affects Knee Function After Anterior Cruciate Ligament Reconstruction in Individuals Who Are Recreationally Active
Authors: Harput Gulcan , Guney-Deniz Hande , Ozer Hamza , Baltaci Gul , Mattacola Carl 
Published: October 2018

Objective:
Our aim was to investigate the effect of body mass index (BMI) levels on quadriceps and hamstring strength and functional outcomes up to 6 months after anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft (HTG).

Design:
Prospective, controlled study.

Setting:
University clinical laboratory.

Patients:
Ninety-one participants who had undergone unilateral ACLR with HTG were divided into 2 groups according to their BMI. The participants whose BMI were between 18.5 and 24.9 kg/m2 were included in group 1 (n = 50, age: 27.2 ± 6.7 years, BMI: 22.3 ± 1.6 kg/m2) and those whose BMI > 24.9 kg/m2 were included in group 2 (n = 41, age: 30.2 ± 6.9 years, BMI: 28.0 ± 2.4 kg/m2).

Interventions:
Quadriceps and hamstring strength, functional performance including hop, jump, and balance performance, and IKDC score.

Main Outcome Measures:
Maximum voluntary isometric contraction of the quadriceps and hamstring muscles and the body mass were measured at 1, 3, and 6 months after surgery. Absolute peak torques and normalized peak torques to body weight for both limbs were recorded. Functional outcomes were evaluated at 6 months after surgery.

Results:
Normalized quadriceps strength improvement was lower in group 2 when compared with group 1 (F
(2,178) = 6.23, P = 0.003). Group 2 also demonstrated lower scores in functional performance (P < 0.05). Normalized hamstring and absolute quadriceps and hamstring strength improvement was not affected by higher BMI level (P > 0.05).

Conclusions:
Higher BMI levels adversely affect quadriceps strength capacity and performance in patients who have undergone ACLR with HTG. Clinicians should consider BMI levels of patients when assessing and targeting muscle recovery because it could negatively affect the success of the ACLR rehabilitation.
Do Normative Composite Scores on the Functional Movement Screen Differ Across High School, Collegiate, and Professional Athletes? A Critical Review
Authors: Pollen Travis R. , Keitt Frazier , Trojian Thomas H. 
Published: October 2018

Objective:
The Functional Movement Screen (FMS) is a battery of 7 unloaded tests designed to rate human movement competency. Injury rates vary across the different level of a sport. The purpose of this critical review was to determine whether normative FMS composite scores differ across high school, collegiate, and professional athletic populations and to determine whether normative composite scores correlate with rates of severe injury across different collegiate sports.

Data Sources:
PubMed, Web of Science, and EBSCO databases from inception to September 2017 with the following syntax: “functional movement screen*” OR “movement screen*”. Additional records were identified by citation tracking and hand search of articles.

Study Selection:
A total of 708 records identified, of which 36 were included. Studies were included if they reported a FMS composite score for one of the groups.

Data Extraction:
Two reviewers (T.R.P. and F.K.) screened records for the author and year; sample size; study design; sport(s); number, age, and sex of participants; testing conditions; methodological quality; and mean or median composite score(s).

Data Synthesis:
Normative FMS composite scores were invariant to level of play, with 61% of reported scores falling between 14 and 16, despite injury rates increasing by level of play. Scores for high school, college, and professional athletes were 14.1, 14.8, and 15.7, respectively. There was a significant positive relationship between composite scores and rate of severe injury in college sports (r(11) = 0.66, P = 0.014).

Conclusions:
Our findings potentially undermine the FMS's predictive validity. Although the FMS may have other applications, this critical review provides further evidence against the composite score for injury prediction in competitive athletes.