bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 13-Year Global Climatology of Tropical Cyclone Warm-Core Structures from AIRS Data
Authors: Wang Xiang , Jiang Haiyan 
Published: January 2019

Abstract
There is uncertainty as to whether the typical warm-core structure of tropical cyclones (TCs) is featured as an upper-level warm core or not. It has been hypothesized that data from the satellite-borne Advanced Microwave Sounding Unit (AMSU) are inadequate to resolve a realistic TC warm-core structure. This study first evaluates 13 years of Atmospheric Infrared Sounder (AIRS) temperature retrieval against recent dropsonde measurements in TCs. AIRS can resolve the TC warm-core structure well, comparable to the dropsonde observations, although the AMSU-A retrievals fail to do so. Using 13-yr AIRS data in global TCs, a global climatology of the TC warm-core structure is generated in this study. The typical warm-core height is at the upper level around 300–400 hPa for all TCs and increases with TC intensity: 400 hPa (~8 km) for tropical storms, 300 hPa (~10 km) for category 1–3 hurricanes, 250–300 hPa (~10–11 km) for category 4 hurricanes, and 150 hPa (~14 km) for category 5 hurricanes. The range of warm-core height varies with TC intensity as well. A strong correlation between TC intensity and warm-core strength is found. A weaker but still significant correlation between TC intensity and warm-core height is also found.
Local TV News Viewer Reactions to Weathercasters Reporting the Local Impacts of Climate Change
Authors: Engblom Allison , Timm Kristin , Mazzone Raphael , Perkins David , Myers Teresa , Maibach Edward 
Published: January 2019

AbstractMost Americans misperceive climate change as distant risk; TV weathercasters can help correct this misperception by reporting on the current local impacts of climate change. Some weathercasters, however, are concerned that such reporting may alienate skeptical viewers. The goal of this study was to develop a better understanding of how viewers respond to climate change information delivered by weathercasters. Interviews were conducted with 30 local TV news viewers in Virginia with divergent views about climate change, categorized as engaged, disengaged, and unconvinced. During the interview, participants were shown two graphics and two videos about the local impacts of climate change. Most participants in all groups [21/30 (70%)] expressed interest in learning about climate change from weathercasters, particularly local and national impacts. Most participants in all three groups understood the key points and responded positively to both the graphics and the videos. Several unconvinced participants (6/10) were disinterested in seeing climate change information in the weather segment, but they were not opposed to it; they felt the weather segment was too short to adequately explain the information. These preliminary findings suggest that most of the local TV news viewers interviewed in this study—even those unconvinced that human-caused climate change is happening—respond positively to TV weathercasters as local climate educators. These findings are consistent with the reports of TV weathercasters who say that when they report on climate change, they receive far more positive than negative feedback from viewers.
Brief psychosocial interventions improve quality of life of patients receiving palliative care: A systematic review and meta-analysis
Authors: Warth Marco , Kessler Jens , Koehler Friederike , Aguilar-Raab Corina , Bardenheuer Hubert J. , Ditzen Beate 
Published: January 2019

Background: Patients with a terminal disease report a high need for psychosocial and spiritual support. Previous literature reviews on psychosocial interventions in palliative care were restricted to certain subtypes of techniques, included a wide range of patients, conditions, and settings, or required a number of sessions unrealistic to be achieved in patients nearing the end of their lives. Aim: The aim of this study was to review and synthesize the evidence on brief psychosocial interventions (i.e. four sessions or less and less than 21 days) for patients receiving palliative treatment. Design: We performed a systematic review and meta-analysis in accordance with standard guidelines and a pre-registered protocol (PROSPERO: CRD42018082713). Data sources: Electronic databases, journals, and references were searched for controlled clinical trials. We used the Cochrane criteria to assess the risk of bias within studies. Results: In total, 15 studies met the eligibility criteria and reported the effects of 17 interventions and a total of 1248 patients. The most frequently used techniques were life review techniques and music therapy. After exclusion of outliers, psychosocial interventions showed to be superior with regard to the improvement of quality of life (effect size = 0.36, confidence interval = 0.08 to 0.64), and the reduction of emotional (effect size = −0.51, confidence interval = −0.77 to −0.26) and existential distress (effect size = −0.40, confidence interval = −0.71 to −0.07) compared to the control groups. Conclusion: Brief psychosocial interventions can improve clinically relevant health outcomes and should therefore be made available for patients receiving palliative care.
Cricothyroidotomy and Transtracheal High Frequency Jet Ventilation for Elective Laryngeal Surgery. An Audit of 90 Cases
Authors: Russell W. C. , Maguire A. M. , Jones G. W. 
Published: January 2019

We carried out an audit of needle cricothyroidotomy and transtracheal ventilation used during anaesthesia for elective endolaryngeal surgery. The data on 90 consecutive procedures was collected over two years. Patients were anaesthetized using a total intravenous technique. An intravenous cannula or Tuohy needle was placed through the cricothyroid membrane and the patient was ventilated via the cannula using high frequency jet ventilation. Technical details of the procedure and any perioperative complications were recorded. There were 12 complications in total. Only three of these were clearly related to the cricothyroid puncture, i.e., one minor bleed and two cases of limited local surgical emphysema. All complications were minor and resolved without sequelae.
A Comparative Study of Three Different Methods of Administering Metaraminol during Spinal Anaesthesia in the Elderly
Authors: Critchley L. A. H. , Yu S. C. 
Published: January 2019

We compared three methods of administering metaraminol during spinal (subarachnoid) anaesthesia. Fifty-two elderly patients with fractured hips were studied. Blood pressure was maintained by either intramuscular (IM) metaraminol (0.1 mg.kg-1), intravenous (IV) boluses (0.01 mg.kg-1) or an infusion (0.05 mg.kg-1.h-1). Non-invasive blood pressure was recorded every one-minute. Spinal anaesthesia initially decreased the systolic arterial pressure by 15 (14)% compared to 35 (15)% for diastolic pressure (P<0.001). IM metaraminol restored the systolic arterial pressure back to baseline values (-3%), but there was significant between-subject variability resulting in a very unpredictable effect. IV boluses and infusion had a more predictable effect and maintained systolic arterial pressure at about 20% below baseline. Range of effect, measured by inter-quartile range and variance, was greatest in the IM group and least in the infusion group (P<0.003). IM metaraminol during spinal anaesthesia has a very unpredictable effect. Infusions of metaraminol provided the best blood pressure control. Diastolic blood pressure fell significantly after spinal anaesthesia and this merits further investigation.
Propofol Alone, Sevoflurane Alone, and Combined Propofol-sevoflurane Anaesthesia in Electroconvulsive Therapy
Authors: Wajima Z. , Shiga T. , Yoshikawa T. , Ogura A. , Inoue T. , Ogawa R. 
Published: January 2019

Electroconvulsive therapy is an effective treatment for severe and medication-resistant depression. There have been no reports describing how a volatile anaesthetic affects haemodynamic responses, seizure duration, and recovery characteristics during electroconvulsive therapy. We carried out a repeated-measure crossover study to compare the effects on haemodynamic responses, seizure duration, and recovery characteristics of the following types of anaesthesia in electroconvulsive therapy: propofol alone, sevoflurane alone, and propofol combined with sevoflurane. We recruited 50 patients requiring electroconvulsive therapy for depression. For anaesthesia induction, 1.5 mg/kg propofol (condition P), 5% sevoflurane in oxygen following a vital capacity rapid inhalation induction (condition S), or 1.5 mg/kg propofol followed by 5% sevoflurane in oxygen (condition PS) was administered. Succinylcholine 1.5 mg/kg was then given. Electrical stimulation was administered after fasciculation. Measurements were obtained before anaesthesia induction (baseline), prior to succinylcholine administration, prior to electroconvulsive therapy, and at the peak after electroconvulsive therapy. After electroconvulsive therapy, peak heart rate and peak mean arterial pressure were highest in condition S. Whereas recovery time was longest in condition PS, motor seizure duration was significantly shorter than in either condition P or S. Electroencephalographic seizure duration was significantly shorter in condition PS than in condition P and significantly shorter in condition S than in condition P. Sevoflurane anaesthesia alone is most disadvantageous in terms of haemodynamics. Propofol-sevoflurane anaesthesia is advantageous in terms of haemodynamics, but disadvantageous in terms of seizure duration and recovery time. Propofol alone is most advantageous in terms of seizure duration.
The Influence of the Univent® Endotracheal Tube on Internal Jugular Vein Cannulation
Authors: Schummer W. , Schummer C. , Frober R. , Fuchs J. , Simon M. , Huttemann E. 
Published: January 2019

This prospective clinical investigation assessed the effect of placement of a Univent® tube on the anatomy of the internal jugular veins and the success of cannulation of the left internal jugular vein. After obtaining informed consent, 48 adult patients were enrolled. Of these, 42 patients were eligible and were divided into two groups: Univent® tube (group U, n=21) and wire enforced endotracheal tube (group C, n=21). The Univent® tube group were having a left thoracotomy. Using horizontal ultrasound scans just above the thyroid gland, the internal jugular vein was visualized and measured before and after Univent® placement. The number of needle passes necessary to cannulate the left internal jugular vein in the two groups was also compared. Univent® tubes were associated with lateral displacement of the right carotid artery and internal jugular vein on the convex side of the Univent® tube, with compression of the right internal jugular vein by the artery, resulting in a kidney-shaped cross-section of the vein. On the left (concave side of the tube), the neck was indented, the sheath of the left carotid artery was displaced medially, and the left internal jugular vein distorted to an ellipse. There was a significant increase in the lateral diameter and a decrease in the cross-sectional area of the left internal jugular vein (t-test, P<0.05). The first attempt at cannulation of the left internal jugular vein failed significantly more often in the Univent® group (13/21 vs 5/21 in group C, Chi-square 6.22, P=0.025). Cannulation of the internal jugular vein before placement of the Univent® tube, or placement with ultrasound guidance is suggested.
The Spectrum of Practice in the Diagnosis and Management of Pneumonia in Patients Requiring Mechanical Ventilation. Australian and New Zealand Practice in Intensive Care (ANZPIC II)
Authors: Boots R. J. , Lipman J. , Bellomo R. , Stephens D. , Heller R. F. 
Published: January 2019

This study of ventilated patients investigated current clinical practice in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units (ICUs) within Australia and New Zealand. Diagnostic methods and confidence, disease severity, microbiology and antibiotic use were assessed. All pneumonia types had similar mortality (community-acquired pneumonia 33%, hospital-acquired pneumonia 37% and ventilator-associated pneumonia 24%, P=0.15) with no inter-hospital differences (P=0.08–0.91). Bronchoscopy was performed in 26%, its use predicted by admission hospital (one tertiary: OR 9.98, CI 95% 5.11–19.49, P<0.001; one regional: OR 6.29, CI 95% 3.24–12.20, P<0.001), clinical signs of consolidation (OR 3.72, CI 95% 2.09–6.62, P<0.001) and diagnostic confidence (OR 2.19, CI 95% 1.29–3.72, P=0.004). Bronchoscopy did not predict outcome (P=0.11) or appropriate antibiotic selection (P=0.69). Inappropriate antibiotic prescription was similar for all pneumonia types (11–13%, P=0.12) and hospitals (0–16%, P=0.25). Blood cultures were taken in 51% of cases. For community-acquired pneumonia, 70% received a third generation cephalosporin and 65% a macrolide. Third generation cephalosporins were less frequently used for mild infections (OR 0.38, CI 95% 0.16–0.90, P=0.03), hospital-acquired pneumonia (OR 0.40, CI 95% 0.23–0.72, P<0.01), ventilator-associated pneumonia (OR 0.04, CI 95% 0.02–0.13, P<0.001), suspected aspiration (OR 0.20, CI 95% 0.04–0.92, P=0.04), in one regional (OR 0.26, CI 95% 0.07–0.97, P=0.05) and one tertiary hospital (OR 0.14, CI 95% 0.03–0.73, P=0.02) but were more commonly used in older patients (OR 1.02, CI 95% 1.01–1.03, P=0.01). There is practice variability in bronchoscopy and antibiotic use for pneumonia in Australian and New Zealand ICUs without significant impact on patient outcome, as the prevalence of inappropriate antibiotic prescription is low. There are opportunities for improving microbiological diagnostic work-up for isolation of aetiological pathogens.
Disease Risk and Mortality Prediction in Intensive Care Patients with Pneumonia. Australian and New Zealand Practice in Intensive Care (ANZPIC II)
Authors: Boots R. J. , Lipman J. , Bellomo R. , Stephens D. , Heller R. F. 
Published: January 2019

This study of ventilated patients investigated pneumonia risk factors and outcome predictors in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units within Australia and New Zealand. For community acquired pneumonia, mortality increased with immunosuppression (OR 5.32, CI 95% 1.58–17.99, P<0.01), clinical signs of consolidation (OR 2.43, CI 95% 1.09–5.44, P=0.03) and Sepsis-Related Organ Failure Assessment (SOFA) scores (OR 1.19, CI 95% 1.08–1.30, P<0.001) but improved if appropriate antibiotic changes were made within three days of intensive care unit admission (OR 0.42, CI 95% 0.20–0.86, P=0.02). For hospital-acquired pneumonia, immunosuppression (OR 6.98, CI 95% 1.16–42.2, P=0.03) and non-metastatic cancer (OR 3.78, CI 95% 1.20–11.93, P=0.02) were the principal mortality predictors. Alcoholism (OR 7.80, CI 95% 1.20–17.50, P<0.001), high SOFA scores (OR 1.44, CI 95% 1.20–1.75, P=0.001) and the isolation of “high risk” organisms including Pseudomonas aeruginosa, Acinetobacter spp, Stenotrophomonas spp and methicillin resistant Staphylococcus aureus (OR 4.79, CI 95% 1.43–16.03, P=0.01), were associated with increased mortality in ventilator-associated pneumonia. The use of non-invasive ventilation was independently protective against mortality for patients with community-acquired and hospital-acquired pneumonia (OR 0.35, CI 95% 0.18–0.68, P=0.002). Mortality was similar for patients requiring both invasive and non-invasive ventilation and non-invasive ventilation alone (21% compared with 20% respectively, P=0.56). Pneumonia risks and mortality predictors in Australian and New Zealand ICUs vary with pneumonia type. A history of alcoholism is a major risk factor for mortality in ventilator-associated pneumonia, greater in magnitude than the mortality effect of immunosuppression in hospital-acquired pneumonia or community-acquired pneumonia. Non-invasive ventilation is associated with reduced ICU mortality. Clinical signs of consolidation worsen, while rationalising antibiotic therapy within three days of ICU admission improves mortality for community-acquired pneumonia patients.
Control of Imported and Acquired Methicillin-resistant Staphylococcus aureus (MRSA) in Mechanically Ventilated Patients: A Dose-response Study of Enteral Vancomycin to Reduce Absolute Carriage and Infection
Authors: Viviani M. , Van Saene H. K. F. , Dezzoni R. , Silvestri L. , Lenarda R. Di , Berlot G. , Gullo A. 
Published: January 2019

This study aimed to quantify the animate source provided by the patients using the concept of “absolute carriage” by multiplying the carrier rate by the level of carriage; and to compare the impact of a low and high dose of an oropha-ryngeal vancomycin gel on the absolute MRSA carriage and infection. In all, 265 patients were included, 126 were MRSA positive. Fifty-five patients received 2% vancomycin gel during the first year whilst 4% vancomycin gel was given to 50 patients during the second year. Surveillance swabs of throat and rectum were obtained from all eligible patients on admission and then twice weekly. The vancomycin protocol was started as soon as the surveillance cultures were positive for MRSA. Those patients received one gram of enteral vancomycin daily, divided into four doses. During the first year 2% vancomycin gel 4 ml (80 mg) was applied in the oropharynx in four doses in addition to the enteral solution (Group A). During the second year 4% vancomycin gel 4 ml (160 mg) was used (Group B). The absolute carriage was high during both periods: 3.6 for Group A, and 3.2 for Group B. The 4% vancomycin protocol significantly reduced the absolute carriage, compared to the 2% vancomycin protocol: 2.6 versus 1.5 (P<0.01). Significant reduction in secondary endogenous infections was found in the second year: seven versus 15 patients (P<0.05). A total of 3,588 microbiological samples were processed. Neither Staphylococcus aureus with intermediate sensitivity to vancomycin (VISA) nor vancomycin-resistant enterococci (VRE) were detected.
A National Survey of Infection Control Practice by New Zealand Anaesthetists
Authors: Ryan A. J. , Webster C. S. , Merry A. F. , Grieve D. J. 
Published: January 2019

Anaesthetists have an important role in preventing nosocomial infection. Failures in this role have resulted in critical reports in the media. We ascertained the current practices of New Zealand anaesthetists relating to infection control, by distributing a questionnaire to all 450 anaesthetists practising in New Zealand. Sixty-one percent responded. Just over half the respondents had never read their hospital policy on infection control and over a third had never read the Australian and New Zealand College of Anaesthetists policy document on infection control. It was found that 3.4% rarely changed gloves if they became contaminated and 2.2% occasionally used the same syringe to administer drugs to more than one patient. The majority (86.3%) of respondents split one drug ampoule between more than one patient, 41.3% used multidose vials for more than one patient and 2.2% used pre-filled syringes for more than one patient. The majority complied with the College infection control policy for performing arterial cannulation (85.7%)), central venous cannulation (77.4%) and regional blockade (65.1%). Respondents ranked the overall risk of the anaesthetist contributing to the transmission of infectious agents on a scale from 0 to 10 (10=highest risk). The median response was 7, the modal response was 10 and interquartile range was 4 to 8. There was a high level of awareness of the risks of contributing to cross-infection inherent in anaesthesia, most anaesthetists reporting that they followed recommended guidelines in this context. However, these data suggest more effort is required to promote compliance with appropriate guidelines.
Perioperative Pulse Contour Cardiac Output Analysis in a Patient with Severe Cardiac Dysfunction
Authors: Jones D. , Story D. , Peyton P. , Bellomo R. 
Published: January 2019

We describe a patient with severe left ventricular dysfunction simultaneously monitored with pulse contour cardiac output (PiCCO) analysis, a continuous cardiac output pulmonary artery catheter (continuous COPAC) and intraoperative transoesophageal echocardiography (TOE). There was good agreement between cardiac output (CO) measurements obtained by the three techniques prior to cardiopulmonary bypass (CPB). Agreement of CO measurements following CPB was initially poor, but improved following recalibration of PiCCO. PiCCO-derived global end-diastolic volume index (GEDVI) and cardiac function index (CFI), were assessed as markers of left ventricular preload and myocardial contractility, respectively. GEDVI correlated well with CO in the postoperative period. CFI increased more than two -fold following coronary revascularization and milrinone administration, and there was also a temporal relationship between the CFI and the dose of milrinone in the first 24 hours of treatment. Global end-diastolic volume and cardiac function index may be useful additional measures of left ventricular preload and myocardial contractility in patients with severe left ventricular dysfunction.
Vardenafil and Weaning from Inhaled Nitric Oxide: Effect on Pulmonary Hypertension in ARDS
Authors: Giacomini M. , Borotto E. , Bosottl L. , Denkewitz T. , Reali-Forster C. , Carlucci P. , Centanni S. , Mantero A. , Iapichino G. 
Published: January 2019

We report a 66-year-old patient with refractory pulmonary hypertension secondary to ARDS who was being treated with inhaled nitric oxide. Enteral vardenafil (phosphodiesterase-5 inhibitor) was tried at two different doses (10 mg and 5 mg), in order to wean the patient from nitric oxide. The higher dose decreased pulmonary pressure but caused systemic hypotension and the drug was discontinued. Subsequently, a 5 mg dose of vardenafil decreased pulmonary pressure without hypotension. Pulmonary hypertension was controlled using vardenafil 10-15 mg divided in 2-3 daily doses. This therapy allowed nitric oxide withdrawal, weaning from mechanical ventilation and discharge from ICU. Vardenafil acted in synergy with inhaled nitric oxide, permitted nitric oxide reduction and discontinuation and proved to be effective as a single, long-term treatment for pulmonary hypertension.