bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning
Authors: Lee D , Czech A. J. , Elriedy M. , Nair A. , El‐Boghdadly K. , Ahmad I. 
Published: July 2018

SummaryCricoid pressure is employed during rapid sequence induction to reduce the risk of pulmonary aspiration. Correct application of cricoid pressure depends on knowledge of neck anatomy and precise identification of surface landmarks. Inaccurate localisation of the cricoid cartilage during rapid sequence induction risks incomplete oesophageal occlusion, with potential for pulmonary aspiration of gastric contents. It may also compromise the laryngeal view for the anaesthetist. Accurate localisation of the cricoid cartilage therefore has relevance for the safe conduct of rapid sequence induction. We conducted a multicentre, prospective cohort study to determine the accuracy of cricoid cartilage identification in 100 patients. The cranio‐caudal midpoint of the cricoid cartilage was identified by a qualified anaesthetic assistant using the conventional landmark technique and marked. While maintaining the patient in the same position, a second mark was made by identifying the midpoint of the cricoid cartilage using ultrasound scanning. The mean (SD) distance between the two marks was 2.07 (8.49) mm. In 41% of patients the midpoint was incorrectly identified by a margin greater than 5 mm. This error was uniformly distributed both above and below the midpoint of the cricoid cartilage. The Pearson correlation coefficient of this error with respect to body mass index was 0.062 (p = 0.539) and with age was −0.020 (p = 0.843). There were also no significant differences in error between male and female patients. Identification of cricoid position using a landmark technique has a high degree of variability and has little correlation with age, sex or body mass index. These findings have significant implications for the safe application of cricoid pressure in the context of rapid sequence induction.
BEST Life—“Bringing ECMO Simulation To Life”—How Medical Simulation Improved a Regional ECMO Program
Authors: Puślecki Mateusz , Ligowski Marcin , Dąbrowski Marek , Stefaniak Sebastian , Ładzińska Małgorzata , Ładziński Piotr , Pawlak Aleksander , Zieliński Marcin , Dąbrowska Agata , Artyńska Aniela , Gezela Mariusz , Sobczyński Paweł , Szarpak Łukasz , Perek Bartłomiej , Jemielity Marek 
Published: July 2018

AbstractThe implemented “ECMO for Greater Poland” program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs’ function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high‐fidelity medical simulation to prepare for real‐life implementation. During the first four months, we performed scenarios mimicking “ECMO for DCD,” “ECMO for ECPR (extended cardiopulmonary resuscitation),” “ECMO for RRF” and “ECMO in hypothermia.” It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km‐long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation‐based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional’s skills, but also to promote ECMO therapy in patients with critical/life‐threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region.
Oximetry knowledge in neonatal units in Victoria, Australia: can we do better?
Authors: Jamieson Katharine , Davey Margot J. , Nixon Gillian M. 
Published: July 2018

AbstractAimPulse oximetry has become a widely used technology in medicine and is a standard part of monitoring in neonatal medicine. Knowledge of basic principles, clinical and technical considerations is important to optimise clinical benefit of use, but have been shown to be insufficient in paediatric staff. We aimed to assess knowledge of pulse oximetry in neonatal medical staff, a population not previously studied.MethodsA 21‐item questionnaire (seven demographic, 14 knowledge) was devised and then administered to neonatal medical staff at all postgraduate levels working in the major public neonatal services in the state of Victoria, Australia.ResultsAverage test score was 64.4% (range 30.8–92.3%) with no correlation between years of experience and score. All respondents reported experience with oximetry, but only 57% reported adequate training in practical oximetry skills and only 28% in interpretation of downloaded oximetry data. About 45% reported knowing what an averaging time was but only 29% were able to provide an acceptable definition and only 10% knew what averaging time was used on devices in their units.ConclusionSignificant knowledge deficits regarding oximetry are evident in neonatal staff, supporting the need for targeted and continuous training in oximetry.
Early Holocene sea level in the Canadian Beaufort Sea constrained by radiocarbon dates from a deep borehole in the Mackenzie Trough, Arctic Canada
Authors: O'Regan Matt , Coxall Helen , Hill Philip , Hilton Robert , Muschitiello Francesco , Swärd Henrik 
Published: July 2018

Deglacial and Holocene relative sea level (RSL) in the Canadian Beaufort Sea was influenced by the timing and extent of glacial ice in the Mackenzie River corridor and adjacent coastal plains. Considerable evidence indicates extensive ice cover in this region of northwestern Canada during the Late Wisconsinan. However, no absolute ages exist to constrain maximum RSL lowering before the late Holocene (4.2–0 ka). In 1984, the Geological Survey of Canada drilled an 81.5‐m‐deep borehole in the western Mackenzie Trough at 45 m water depth (MTW01). The lower 52.5 m of the borehole was interpreted as a deltaic progradational sequence deposited during a period of rising sea level. The upper 29 m was described as foraminifer‐bearing marine sediments deposited after transgression of the site, when RSL rose above ~−74 m. Here, we present radiocarbon measurements from MTW01, acquired from benthic foraminifera, mollusc fragments and particulate organic carbon in the >63 μm fraction (POC>63 μm) in an attempt to constrain the chronology of sediments within this borehole and date the timing of transgression. The deepest carbonate macrofossil was acquired from 8 m above the transgressive surface (equivalent to 21 m b.s.l.), where mollusc fragments returned a date of 9400 +180–260 cal. a BP (2σ). This provides the oldest constraint on Holocene sea‐level lowering in the region, and implies that transgression at this site occurred prior to the early Holocene. Ages obtained from the lower 52.5 m of the borehole are limited to POC>63 μm samples. These indicate that progradational sediments were deposited rapidly after 24 820 +390–380 cal. a BP (2σ). Due to the incorporation of older reworked organic matter, the actual age of progradation is likely to be younger, occurring after Late Wisconsinan glacial ice retreated from the coast.
Sensitization to Hymenoptera venom marker allergens: Prevalence, predisposing factors, and clinical implications
Authors: Stoevesandt Johanna , Hosp Christine , Kerstan Andreas , Trautmann Axel 
Published: July 2018

SummaryBackgroundThe prevalence and predisposing factors of asymptomatic sensitization to Hymenoptera venom marker allergens are largely unknown.ObjectiveTo evaluate sensitization profiles in a group of 490 dermatologic patients without a history of sting‐induced anaphylaxis.MethodsClinical data were collected using a structured questionnaire; sera were tested for total IgE and specific IgE to venom preparations, recombinant venom marker allergens, inhalative allergens, and cross‐reactive carbohydrate determinants.ResultsThe lifetime prevalence of Hymenoptera stings was 85.3%. IgE rates exceeding cut‐off values of 0.35 kUA/L were 17.3% for rVes v 1, 18.0% for rVes v 5, and 3.5% for rApi m 1. Median specific/total IgE ratios for the above mentioned marker allergens were 0.05%, 0.02%, and 0.00%, respectively. Marker allergen‐directed sensitization was detectable in 85.5% of 138 Vespula venom‐reactive sera. Of 68 bee venom‐reactive participants, 23.5% were sensitized to rApi m 1 and 64.7% to any one or several of five commercially available bee venom allergens. Although double reactivity to bee and Vespula venom was clearly associated with sensitization to cross‐reactive carbohydrate determinants (P < 0.001), sensitization to marker allergens of both species was detectable in most double‐reactive sera (56.5%). Vespula venom marker allergen‐directed sensitization was associated with recent stings (P = 0.010), large local reactions (P = 0.009), total IgE elevation (P < 0.001), and sensitization to cross‐reactive carbohydrate determinants (P = 0.008).Conclusions and Clinical RelevanceThe high sensitization rates observed in individuals without a history of sting‐induced anaphylaxis as well as total IgE levels and cross‐reactive carbohydrate determinant‐directed reactivity as potential confounders need to be considered in any interpretation of positive test results for Hymenoptera venom marker allergens.
Immunogenicity and predictors of response to a single dose trivalent seasonal influenza vaccine in multiple sclerosis patients receiving disease‐modifying therapies
Authors: Metze Christoph , Winkelmann Alexander , Loebermann Micha , Hecker Michael , Schweiger Brunhilde , Reisinger Emil Christian , Zettl Uwe Klaus 
Published: July 2018

SummaryAimsTo evaluate the immunogenicity and safety of a seasonal influenza vaccine in a cohort of multiple sclerosis (MS) patients receiving different immunomodulating/immunosuppressive therapies and assess predictors of immune response.MethodsA prospective, multicenter, non‐randomized observational study including 108 patients receiving a trivalent seasonal influenza vaccination was conducted. Influenza‐specific antibody titers (H1N1, H3N2, and influenza B) were measured to evaluate rates of seroprotection and seroconversion/significant titer increase. Univariable and multivariable analyses were performed to identify prognostic factors of vaccination outcomes.ResultsRegarding the whole cohort, seroprotection rates >70% were achieved for each influenza strain. Interferon‐treated patients reached high seroprotection rates (>84%). Good seroprotection rates were seen in patients treated with glatiramer acetate. In particular for H3N2, response rates were low in natalizumab‐treated patients and in the small subgroup of fingolimod‐treated patients. Patients with a previous disease‐modifying therapy and a longer disease duration were less likely to respond sufficiently. No severe adverse events were reported. MS disease activity was not increased after a one‐year follow‐up period.ConclusionVaccination led to good immunogenicity, especially in MS patients treated with interferons and glatiramer acetate. At least for the H1N1 strain, rates of seroprotection and seroconversion/significant titer increase were high (>70% and >60%, respectively) for all therapeutic subgroups. Patients with a longer duration of the disease are exposed to an increased risk of insufficient immune response to vaccination.
Efficiency of species survey networks can be improved by integrating different monitoring approaches in a spatial prioritization design
Authors: Morán‐Ordóñez Alejandra , Canessa Stefano , Bota Gerard , Brotons Lluis , Herrando Sergi , Hermoso Virgilio 
Published: July 2018

AbstractPublic participation to monitoring programs is increasingly advocated to overcome scarcity of resources and deliver important information for policy‐making. Here, we illustrate the design of optimal monitoring networks for bird species of conservation concern in Catalonia (NE Spain), under different scenarios of combined governmental and citizen‐science monitoring approaches. In our case study, current government efforts, limited to protected areas, were insufficient to cover the whole spectrum of target species and species‐threat levels, reinforcing the assumption that citizen‐science data can greatly assist in achieving monitoring targets. However, simply carrying out both government and citizen‐science monitoringad hocled to inefficiency and duplication of efforts: some species were represented in excess of targets while several features were undersampled. Policy‐making should concentrate on providing an adequate platform for coordination of government and public‐participatory monitoring to minimize duplicated efforts, overcome the biases of each monitoring program and obtain the best from both.
Environmental governance: A practical framework to guide design, evaluation, and analysis
Authors: Bennett Nathan J. , Satterfield Terre 
Published: July 2018

AbstractGovernance is one of the most important factors for ensuring effective environmental management and conservation actions. Yet, there is still a relative paucity of comprehensive and practicable guidance that can be used to frame the evaluation, design, and analysis of systems of environmental governance. This conceptual review and synthesis article seeks to addresses this problem through resituating the broad body of governance literature into a practical framework for environmental governance. Our framework builds on a rich history of governance scholarship to propose that environmental governance has four general aims or objectives – to be effective, to be equitable, to be responsive, and to be robust. Each of these four objectives need to be considered simultaneously across the institutional, structural, and procedural elements of environmental governance. Through a review of the literature, we developed a set of attributes for each of these objectives and relate these to the overall capacity, functioning, and performance of environmental governance. Our aim is to provide a practical and adaptable framework that can be applied to the design, evaluation, and analysis of environmental governance in different social and political contexts, to diverse environmental problems and modes of governance, and at a range of scales.
Interleukin 6 at reperfusion: A potent predictor of hepatic and extrahepatic early complications after liver transplantation
Authors: Faitot Francois , Besch Camille , Lebas Benjamin , Addeo Pietro , Ellero Bernard , Woehl‐Jaegle Marie‐Lorraine , Namer Izzie‐Jacques , Bachellier Philippe , Freys Guy 
Published: July 2018

AbstractBackground and aimsIschemia‐reperfusion injury impacts early liver graft function. Interleukin 6 (IL‐6) as early as at reperfusion has shown to predict in‐hospital complications, but its impact on vascular complications and long‐term outcomes is not ascertained.MethodsA retrospective study was conducted on all consecutive patients transplanted during a 6‐year period to define significant early systemic inflammatory response (ESIR). The main end‐point was 3‐year graft survival. Significant ESIR was defined according to IL‐6 level at reperfusion on an exploratory set of 121 patients and validated on an independent cohort (n = 153).ResultsSignificant ESIR was defined as IL‐6 at reperfusion >1000 ng/mL in the exploratory cohort. Three‐year graft and overall survival were lower in patients with ESIR in the determination set (P = 0.001 and 0.045, respectively). This was confirmed in the validation set (P = 0.045 and 0.027). In patients with high cytolysis, IL‐6 identified patients at risk for arterial thrombosis. The main determinants for IL‐6 level were intragraft lactate level, cold ischemia time, and anhepatic phase duration (P = 0.005). IL‐6 level independently predicted graft survival (P = 0.0003).ConclusionsIL‐6 at reperfusion is a valid biomarker to predict long‐term survival. Furthermore, it helps the interpretation of cytolysis in the prediction of early vascular complications.
Expression and the transparency of belief
Authors: García Rodríguez Ángel 
Published: July 2018

AbstractQuestions like “Do you believe that p?” can be meant deliberatively (i.e., the question whether to believe that p) or self‐ascriptively (i.e., the question whether the addressee already believes that p). Therefore, an utterance of “I believe that p” can be a proper answer either to a deliberative or to a self‐ascriptive question. In the latter case, an utterance of “I believe that p” is a self‐ascription of belief, but in the former case, it is not. Instead, it is an episode of the belief formed by deliberation. In failing to make these distinctions, contemporary discussions of the transparency of belief mistakenly assume that a proper answer to questions like “Do you believe that p?” is always a self‐ascription of belief. Adhering to the distinctions results in a better account of the transparency of belief.
Intravenous brivaracetam in status epilepticus: A retrospective single‐center study
Authors: Kalss Gudrun , Rohracher Alexandra , Leitinger Markus , Pilz Georg , Novak Helmut F. , Neuray Caroline , Kreidenhuber Rudolf , Höfler Julia , Kuchukhidze Giorgi , Trinka Eugen 
Published: July 2018

SummaryBrivaracetam (BRV) is a high‐affinity synaptic vesicle glycoprotein 2A ligand that is structurally related to levetiracetam (LEV). Compared to LEV, its affinity to the ligand is >10%‐30% higher. Due to its more lipophilic characteristics, it might have a quicker penetration across the blood‐brain barrier and potentially also a stronger anticonvulsant effect. Thus, we aimed to explore its usefulness in the treatment of status epilepticus (SE). We retrospectively assessed treatment response and adverse events in adjunctive treatment with intravenous BRV in patients with SE from January 2016 to July 2017 at our institution. Seven patients aged median 68 years (range = 29‐79) were treated with intravenous BRV. Three patients had SE with coma and four without. SE arose de novo in two patients; etiology was remote symptomatic in four patients and progressive symptomatic in one patient. The most frequent etiology was remote vascular in two patients. BRV was administered after median four antiepileptic drugs (range = 2‐11). Time of treatment initiation ranged from 0.5 hours to 105 days (median = 10.5 hours). Immediate clinical and electrophysiological improvement was observed in two patients (29%). Median loading dose was 100 mg intravenously over 15 minutes (range = 50‐200 mg), titrated up to a median dose of 100 mg/d (range = 100‐300). Median Glasgow Outcome Scale score was 3 (range = 3‐5), with an improvement in 86% of patients compared to admission. We observed no adverse events regarding cardiorespiratory function. BRV might have potential as a novel antiepileptic drug in early stages of SE. Its potential may lie its ability to cross the blood‐brain barrier more quickly than LEV and its favorable safety profile. Prospective studies for the use of BRV in SE are required.
Biotic interactions in species distribution modelling: 10 questions to guide interpretation and avoid false conclusions
Authors: Dormann Carsten F. , Bobrowski Maria , Dehling D. Matthias , Harris David J. , Hartig Florian , Lischke Heike , Moretti Marco D. , Pagel Jörn , Pinkert Stefan , Schleuning Matthias , Schmidt Susanne I. , Sheppard Christine S. , Steinbauer Manuel J. , Zeuss Dirk , Kraan Casper 
Published: July 2018

AbstractAimRecent studies increasingly use statistical methods to infer biotic interactions from co‐occurrence information at a large spatial scale. However, disentangling biotic interactions from other factors that can affect co‐occurrence patterns at the macroscale is a major challenge.ApproachWe present a set of questions that analysts and reviewers should ask to avoid erroneously attributing species association patterns to biotic interactions. Our questions relate to the appropriateness of data and models, the causality behind a correlative signal, and the problems associated with static data from dynamic systems. We summarize caveats reported by macroecological studies of biotic interactions and examine whether conclusions on the presence of biotic interactions are supported by the modelling approaches used.FindingsIrrespective of the method used, studies that set out to test for biotic interactions find statistical associations in species’ co‐occurrences. Yet, when compared with our list of questions, few purported interpretations of such associations as biotic interactions hold up to scrutiny. This does not dismiss the presence or importance of biotic interactions, but it highlights the risk of too lenient interpretation of the data. Combining model results with information from experiments and functional traits that are relevant for the biotic interaction of interest might strengthen conclusions.Main conclusionsMoving from species‐ to community‐level models, including biotic interactions among species, is of great importance for process‐based understanding and forecasting ecological responses. We hope that our questions will help to improve these models and facilitate the interpretation of their results. In essence, we conclude that ecologists have to recognize that a species association pattern in joint species distribution models will be driven not only by real biotic interactions, but also by shared habitat preferences, common migration history, phylogenetic history and shared response to missing environmental drivers, which specifically need to be discussed and, if possible, integrated into models.