bluuebunny/crossref_metadata_2025_split huggingface dataset:
RSW Modons and their Surprising Properties: RSW Turbulence
Authors: Zeitlin Vladimir 
Published: April 2018

AbstractBy using quasi-geostrophic modons constructed in Chapter 6 as initial conditions, rotating-shallow-water modons are obtained through the process of ageostrophic adjustment, both in one- and in two-layer configurations. Scatter plots show that they are solutions of the rotating shallow-water equations. A special class of modons with an internal front (shock) is shown to exist. A panorama of collision processes of the modons, leading to formation of tripoles, nonlinear modons, or elastic scattering is presented. The modon solutions are then used for initialisations of numerical simulations of decaying rotating shallow-water turbulence. The results are analysed and compared to those obtained with standard in 2D turbulence initializations, and differences are detected, showing non-universality of decaying 2D turbulence. The obtained energy spectra are steeper than theoretical predictions for ‘pure’ 2D turbulence, and pronounced cyclone–anticyclone asymmetry and dynamical separation of waves and vortices are observed.
Rotating Shallow-Water Models with Moist Convection
Authors: Zeitlin Vladimir 
Published: April 2018

AbstractIt is shown how the standard RSW can be ’augmented’ to include phase transitions of water. This chapter explains how to incorporate extra (convective) vertical fluxes in the model. By using Lagrangian conservation of equivalent potential temperature condensation of the water vapour, which is otherwise a passive tracer, is included in the model and linked to convective fluxes. Simple relaxational parameterisation of condensation permits the closure of the system, and surface evaporation can be easily included. Physical and mathematical properties of thus obtained model are explained, and illustrated on the example of wave scattering on the moisture front. The model is applied to ’moist’ baroclinic instability of jets and vortices. Condensation is shown to produce a transient increase of the growth rate. Special attention is paid to the moist instabilities of hurricane-like vortices, which are shown to enhance intensification of the hurricane, increase gravity wave emission, and generate convection-coupled waves.
Effects of Vitamin B Complex and Vitamin C on Human Skin Cells: Is the Perceived Effect Measurable?
Authors: Rembe Julian-Dario , Fromm-Dornieden Carolin , Stuermer Ewa Klara 
Published: April 2018

ABSTRACT

OBJECTIVE:
Vitamins are essential for human health. In terms of local application for wound healing, vitamins’ positive effect remains unclear. However, because of the regular appearance of nutritional deficiency in chronic wound patients, a favorable impact of locally applied vitamins can be hypothesized.

METHODS:
Vitamins B3, B5, B6, B7, B9, B10, B12, and C individually as well as different combinations of B vitamins were investigated regarding their ability to promote proliferation and migration of human skin fibroblasts and keratinocytes. Proliferation assays with and without bacterial challenge, immunocytochemical staining, and scratch assay were used to determine the most effective combination(s).

MAIN RESULTS:
Some vitamin combinations showed a positive impact on proliferation, especially for keratinocytes after 72 hours. In terms of wound closure, the combinations B9 and B12; B3, B5, B6, and B10; and B3, B5, and B7 improved closure rates by 25% to 30%. The improved closure rates are also reflected by immunocytochemically detected upregulation of the migration marker CXCR4 for several combinations.

CONCLUSIONS:
Certain combinations of B vitamins demonstrate a positive influence on human keratinocytes and fibroblasts. Vitamins especially promoted fibroblast migration, and a statistically significant induction of keratinocyte proliferation was observed. Therefore, local vitamin application could benefit the physiologic wound healing process.
Cost-benefit Analysis of Maintaining a Fully Stocked Malignant Hyperthermia Cart versus an Initial Dantrolene Treatment Dose for Maternity Units
Authors: Ho Phi T. , Carvalho Brendan , Sun Eric C. , Macario Alex , Riley Edward T. 
Published: April 2018

Abstract

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
The Malignant Hyperthermia Association of the United States recommends that dantrolene be available for administration within 10 min. One approach to dantrolene availability is a malignant hyperthermia cart, stocked with dantrolene, other drugs, and supplies. However, this may not be of cost benefit for maternity units, where triggering agents are rarely used.

Methods
The authors performed a cost-benefit analysis of maintaining a malignant hyperthermia cart versus a malignant hyperthermia cart readily available within the hospital versus an initial dantrolene dose of 250 mg, on every maternity unit in the United States. A decision-tree model was used to estimate the expected number of lives saved, and this benefit was compared against the expected costs of the policy.

Results
We found that maintaining a malignant hyperthermia cart in every maternity unit in the United States would reduce morbidity and mortality costs by $3,304,641 per year nationally but would cost $5,927,040 annually. Sensitivity analyses showed that our results were largely driven by the extremely low incidence of general anesthesia. If cesarean delivery rates in the United States remained at 32% of all births, the general anesthetic rate would have to be greater than 11% to achieve cost benefit. The only cost-effective strategy is to keep a 250-mg dose of dantrolene on the unit for starting therapy.

Conclusions
It is not of cost benefit to maintain a fully stocked malignant hyperthermia cart with a full supply of dantrolene within 10 min of maternity units. We recommend that hospitals institute alternative strategies (e.g., maintain a small supply of dantrolene on the maternity unit for starting treatment).
EOS Micro-dose Protocol: First Full-spine Radiation Dose Measurements in Anthropomorphic Phantoms and Comparisons with EOS Standard-dose and Conventional Digital Radiology
Authors: Pedersen Peter Heide , Petersen Asger Greval , Østgaard Svend Erik , Tvedebrink Torben , Eiskjær Søren P. 
Published: April 2018

Study Design.
A comparative study of radiation dose measured in anthropomorphic phantoms.

Objectives.
The aim of this study was to first report the first organ dose and effective dose measurements in anthropomorphic phantoms using the new EOS imaging micro-dose protocol in full-spine examinations, and to compare these measurements of radiation dose to measurements in the EOS standard-dose protocol and conventional digital radiology (CR).

Summary of Background Data.
Few studies evaluating organ dose and effective dose for the EOS low-dose scanner exist, and mainly for the standard-dose protocol. To the best of our knowledge, no studies of effective dose based on anthropomorphic phantom measurements exist for the new micro-dose protocol.

Methods.
Two anthropomorphic phantoms, representing a 5-year-old (pediatric) and a 15-year-old (adolescent). The phantoms were exposed to EOS micro-dose and standard-dose protocols during full-spine imaging. Additionally, CR in scoliosis settings was performed. For all modalities, organ doses were measured and effective doses were calculated using thermoluminescent dosimeters.

Results.
We found a 17-fold reduction (94%) of effective dose in micro-dose protocol compared with our CR system in the adolescent phantom. Micro-dose versus standard-dose protocol, showed a 6-fold reduction (83%), and for standard-dose versus our CR system a 2.8-fold reduction (64%) reduction of effective dose was observed.
For the pediatric phantom, a 5-fold reduction (81%) of effective dose in micro-dose protocol compared to our CR system was observed. Micro-dose versus standard-dose protocol, showed a seven-fold (86%) reduction. However, we observed an increase in absorbed dose of 38% when comparing the EOS standard-dose protocol with our CR system.

Conclusion.
The EOS imaging micro-dose option exposes patients to lower radiation doses than any currently available modality for full-spine examination. Expected reduction of dose was established for the adolescent phantom when comparing CR and standard-dose protocol. However, no reduction of effective dose with EOS standard-dose protocol compared to our reference CR system was observed in the pediatric phantom.

Level of Evidence: N/A
Effects of a Care Coordination Intervention with Children with Neurodevelopmental Disabilities and Their Families
Authors: McAllister Jeanne W. , McNally Keehn Rebecca , Rodgers Rylin , Mpofu Philani Brian , Monahan Patrick O. , Lock Thomas M. 
Published: April 2018

ABSTRACT:

Care coordination is integral to improving the health of children and families. Using a Shared Plan of Care (SPoC) as a care coordination activity is recommended, but related research on outcomes in pediatric populations with complex medical conditions is scarce.

Objective:
This study explores family outcomes associated with implementation of a care coordination/SPoC intervention with a population of children with neurodevelopmental disabilities and their families.

Methods:
Children aged 2 to 10 years with a neurodevelopmental disability (autism spectrum disorder: 60.9%; global developmental delay/intellectual disability: 39.1%) were referred by pediatric subspecialty programs for care coordination. The intervention included previsit assessments, planned care visits, SPoC development, and 6-month care coordination. A single-group, repeated-measures design was used to evaluate model feasibility and effects on care coordination access, SPoC use, family/clinician goals and needs met, family-professional partnerships, family empowerment, and worry. Times 1 and 2 survey data were collected from a total of 70 families.

Results:
Analysis shows significant improvement in care coordination access, SPoC use, goals achieved, needs met, family empowerment, and reduced worry. There was no significant change in family-professional partnerships and reported SPoC use.

Conclusion:
Findings provide preliminary evidence that a care coordination model using a family-centered, goal-oriented SPoC is a feasible and effective approach with a cohort of children with complex neurodevelopmental disorders and is associated with improved family outcomes. Replication studies are warranted and should include a control group, prolonged time period, additional validated outcome measures, and measurement of costs and professional impact.
Devices for Measuring Cervical Dilation During Labor: Systematic Review and Meta-analysis
Authors: Brancadoro Margherita , Tognarelli Selene , Fambrini Franco , Ragusa Antonio , Menciassi Arianna 
Published: April 2018

Importance
Measurement of cervical dilation is one of the major indicators of labor progression. At present, the criterion standard for this evaluation is digital examination, which results are sometimes inaccurate and extremely dependent on the subject (ie, obstetrician or midwife) experience.

Objective
In this systematic and meta-analysis review, the authors have gathered the vast majority of the instruments used for measuring cervical dilation and their clinical application; main features, potentialities, and the most significant constraints are underlined for each device.

Evidence Acquisition
Three of the most popular databases (ie, Web of Science, PubMed, and ClinicalTrials.gov) were used to identify all available cervimeters, by using single or combinations of the following keywords: “cervical,” “dilation or dilatation,” “cervimetry,” “cervix,” “uterine,” “measurement,” “labour or labor,” “birth,” and “monitoring.” Only articles describing the design or a specific clinical application of an instrument for cervical dilation measurement during labor were selected.

Results
Twenty-five articles were deeply investigated by classifying them in 4 different homogenous groups on the basis of the method proposed for measuring cervical dilation. Suitable devices have not been realized yet, and this is the reason why nowadays the gynecologist/obstetrician still evaluates labor progression by digital examination.

Conclusions and Relevance
Based on a critical analysis of the selected devices, ultrasound seems to be the most promising technology for future cervimetry realization; ultrasound is accurate in distance measurement, and the behind technology can be miniaturized. However, additional studies are necessary for optimizing the technology and developing an optimal solution.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to critique the effectiveness of digital examination, evaluate the instruments used for measuring cervical dilation and their clinical application, and choose the best solution for future cervimetry.
Perfluorocarbon Gas Transport: an Overview of Medical History With Yet Unrealized Potentials
Authors: Spiess Bruce D. 
Published: April 2018

ABSTRACT
Perfluorocarbon (PFCs) compounds have been a hereto fore under realized pharmaceutical class of intravenous emulsions and respiratory adjuvants researched extensively since the late 1970. This review represents an introduction for a series of more detailed lectures/manuscripts that were part of a combined United States collaborative Federal agency meeting in early February, 2017 at Ft Detrick, MD, focused upon potential technologies in development to fulfill a perceived need: “When blood transfusion is not available.” As such, PFCs represent a distinctly different class of pharmaceutical artificial oxygen (and other gas) transporters than are hemoglobin-based oxygen carriers (HBOCs). These two classes of agents have contrasting mechanisms for respiratory gases transport; therefore, each has different advantages and side effects. Both PFCs and HBOCs have suffered from a misguided historical research effort to outperform human banked blood. The PFCs should be viewed as pharmaceuticals possessing unique gas solubility and diffusion characteristics such that they may relieve ischemia of tissues with low/flow—no flow states therefore they can enhance tissue salvage while other definitive treatments are being sought. PFCs as short-term enhanced tissue oxygen (and other gas enhancements) delivery vehicles should have varied and potentially game-changing medical potentials.
Investigating the Extent Realistic Moulage Impacts on Immersion and Performance Among Undergraduate Paramedicine Students in a Simulation-based Trauma Scenario
Authors: Mills Brennen W. , Miles Alecka K. , Phan Tina , Dykstra Peggy M.C. , Hansen Sara S. , Walsh Andrew S. , Reid David N. , Langdon Claire 
Published: April 2018

Introduction
Many healthcare education commentators suggest that moulage can be used in simulation to enhance scenario realism. However, few studies investigate to what extent using moulage in simulation impacts learners. We undertook a mixed-methods pilot study investigating how moulage influences student immersion and performance in simulation.

Methods
Fifty undergraduate paramedicine students were randomized into two groups completing a trauma-based scenario with or without patient moulage. Task immersion was determined via a self-report questionnaire (National Aeronautics and Space Administration Task Load Index), eye-tracking, and postsimulation interviews. Performance was measured via independent observation of video by two paramedic clinical educators and time-to-action—when students first applied pressure to the primary wound.

Results
Eye-tracking suggested that students attended to the thigh wound more often with the inclusion of moulage than without. National Aeronautics and Space Administration Task Load Index data suggested that the inclusion of moulage heightened students' feeling of being rushed throughout the scenario. This elicited an expedited performance of tasks with moulage present compared with not. Students experienced greater immersion with the inclusion of moulage. However, including moulage enhanced scenario difficulty to the extent that overall clinical performance was negatively affected. However, no differences were found when more heavily weighting items felt to contribute most to the survivability of the patient.

Conclusions
Including moulage engendered immersion and a greater sense of urgency and did not sacrifice performance of key life-saving interventions. As a result of undertaking this pilot project, we suggest that a large-scale randomized controlled trial is feasible and should be undertaken before implementing change to curricula.
The Weekend Effect in AAA Repair
Authors: O’Donnell Thomas F. X. , Li Chun , Swerdlow Nicholas J. , Liang Patric , Pothof Alexander B. , Patel Virendra I. , Giles Kristina A. , Malas Mahmoud B. , Schermerhorn Marc L. 
Published: April 2018

Background:
Conflicting reports exist regarding whether patients undergoing surgery on the weekend or later in the week experience worse outcomes.

Methods:
We identified patients undergoing abdominal aortic aneurysm (AAA) repair in the Vascular Quality Initiative between 2009 and 2017 [n = 38,498; 30,537 endovascular aneurysm repair (EVAR) and 7961 open repair]. We utilized mixed effects logistic regression to compare adjusted rates of perioperative mortality based on the day of repair.

Results:
Tuesday was the most common day for elective repair (22%), Friday for symptomatic repairs (20%), and ruptured aneurysms were evenly distributed. Patients with ruptured aneurysms experienced similar adjusted mortality whether they underwent repair during the week or on weekends. Transfers of ruptured AAA were more common over the weekend. However, patients transferred on the weekend experienced higher adjusted mortality than those transferred during the week (28% vs 21%, P = 0.02), despite the fact that during the week, transferred patients actually experienced lower adjusted mortality than patients treated at the index hospital (21% vs 31%, P < 0.01). Among symptomatic patients, adjusted mortality was higher for those undergoing repair over the weekend than those whose surgeries were delayed until a weekday (7.9% vs 3.1%, P = 0.02). Adjusted mortality in elective cases did not vary across the days of the week. Results were consistent between open and EVAR patients.

Conclusion:
We found no evidence of a weekend effect for ruptured or symptomatic AAA repair. However, patients with ruptured AAA transferred on the weekend experienced higher mortality than those transferred during the week, suggesting a need for improvement in weekend transfer processes.
Plasma coadministration improves resuscitation with tranexamic acid or prothrombin complex in a porcine hemorrhagic shock model
Authors: Kuckelman John , Barron Morgan , Moe Donald , Lallemand Michael , McClellan John , Marko Shannon , Eckert Matthew , Martin Matthew J. 
Published: April 2018

BACKGROUND
Traumatic coagulopathy has now been well characterized and carries high rates of mortality owing to bleeding. A "factor-based" resuscitation strategy using procoagulant drugs and factor concentrates in lieu of plasma is being used by some, but with little evidentiary support. We sought to evaluate and compare resuscitation strategies using combinations of tranexamic acid (TXA), prothrombin complex concentrate (PCC), and fresh frozen plasma (FFP).

METHODS
Sixty adult swine underwent 35% blood volume hemorrhage combined with a truncal ischemia-reperfusion injury to produce uniform shock and coagulopathy. Animals were randomized to control (n = 12), a single-agent group (TXA, n = 10; PCC, n = 8; or FFP, n = 6) or combination groups (TXA-FFP, n = 10; PCC-FFP, n = 8; TXA-PCC, n = 6). Resuscitation was continued to 6 hours. Key outcomes included hemodynamics, laboratory values, and rotational thromboelastometry. Results were compared between all groups, with additional comparisons between FFP and non-FFP groups.

RESULTS
All 60 animals survived to 6 hours. Shock was seen in all animals, with hypotension (mean arterial pressure, 44 mm Hg), tachycardia (heart rate, 145), acidosis (pH 7.18; lactate, 11), anemia (hematocrit, 17), and coagulopathy (fibrinogen, 107). There were clear differences between groups for mean pH (p = 0.02), international normalized ratio (p < 0.01), clotting time (CT; p < 0.01), lactate (p = 0.01), creatinine (p < 0.01), and fibrinogen (p = 0.02). Fresh frozen plasma groups had significantly improved resuscitation and clotting parameters (Figures), with lower lactate at 6.5 versus 8.4 (p = 0.04), and increased fibrinogen at 126 versus 95 (p < 0.01). Rotational thromboelastometry also demonstrated shortened CT at 60 seconds in the FFP group vs 65 seconds in the non-FFP group (p = 0.04).

CONCLUSION
When used to correct traumatic coagulopathy, combinations of FFP with TXA or PCC were superior in improving acidosis, coagulopathy, and CT than when these agents are given alone or in combination without plasma. Further validation of pure factor-based strategies is needed.
Antioxidant treatment after injury suppresses second hit immune priming
Authors: Hoth J. Jason , Smith Lane M. , Furdui Cristina M. , Wells Jonathan D. , Yoza Barbara K. , McCall Charles E. 
Published: April 2018

BACKGROUND
Pulmonary contusion (PC) is a common injury that often results in priming for exaggerated inflammatory responses to a second hit. Previous studies used a mouse model of pulmonary contusion and showed an early and sustained reduction of SIRT1 protein and activity in the lung and bronchoalveolar lavage (BAL) cells of injured mice. Sustained decrease in SIRT1 was associated with a primed phenotype in injured mice challenged with an inflammatory stimulus. This study tests the hypothesis that pulmonary contusion induces oxidant production that modifies and decreases SIRT1 and primes the lung for the second-hit response.

METHODS
A mouse model of pulmonary contusion was used to investigate injury-induced oxidant changes in SIRT1. Second-hit responses were evaluated by infection (Streptococcus pneumoniae) and inflammatory challenge using bacterial lipopolysaccharide. BAL, lung tissue, and blood were collected and used to evaluate inflammatory responses and SIRT1 levels, oxidant modification, and activity. Levels of NO in the BAL from mice and patients with PC were also assessed.

RESULTS
We found that oxidants produced as a result of pulmonary contusion resulted in modification of SIRT1. S-Nitrosylation was observed and correlated with increased inducible nitric oxide synthase expression after injury. Anti-oxidant treatment of injured mice preserved SIRT1 activity, decreased second hit responses and improved lung function. Elevated NO levels in the BAL of PC patients was associated with acute respiratory distress syndrome or diagnosis of pneumonia.

CONCLUSIONS
We conclude that oxidative stress in the lung after injury induces redox modification of SIRT1 and contributes to priming of the lung for a second-hit response. Antioxidant treatment suggests that SIRT1 activity after injury may be beneficial in suppressing second-hit responses.