bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Pilot Study Evaluating the Effect of Cooler Dialysate Temperature on Hemodynamic Stability During Prolonged Intermittent Renal Replacement Therapy in Acute Kidney Injury*
Authors: Edrees Fahad Y. , Katari Sreelatha , Baty Jack D. , Vijayan Anitha 
Published: November 2018

Objectives:
Acute kidney injury requiring renal replacement therapy is associated with high morbidity and mortality. Complications of renal replacement therapy include hemodynamic instability with ensuing shortened treatments, inadequate ultrafiltration, and delay in renal recovery. Studies have shown that lowering dialysate temperature in patients with end-stage renal disease is associated with a decrease in the frequency of intradialytic hypotension. However, data regarding mitigation of hypotension by lowering dialysate temperature in patients with acute kidney injury are scarce. We conducted a prospective, randomized, cross-over pilot study to evaluate the effect of lower dialysate temperature on hemodynamic status of critically ill patients with acute kidney injury during prolonged intermittent renal replacement therapy.

Design:
Single-center prospective, randomized, cross-over study.

Setting:
ICUs and a step down unit in a tertiary referral center.

Patients:
Acute kidney injury patients undergoing prolonged intermittent renal replacement therapy.

Interventions:
Participants were randomized to start prolonged intermittent renal replacement therapy with dialysate temperature of 35°C or dialysate temperature of 37°C.

Measurements and Main Results:
The primary endpoint was the number of hypotensive events, as defined by any of the following: decrease in systolic blood pressure greater than or equal to 20 mm Hg, decrease in mean arterial pressure greater than or equal to 10 mm Hg, decrease in ultrafiltration, or increase in vasopressor requirements. The number of events was analyzed by Poisson regression and other outcomes with repeated-measures analysis of variance. Twenty-one patients underwent a total of 78 prolonged intermittent renal replacement therapy sessions, 39 in each arm. The number of hypotensive events was twice as high during treatments with dialysate temperature of 37°C, compared with treatments with the cooler dialysate (1.49 ± 1.12 vs 0.72 ± 0.69; incidence rate ratio, 2.06; p ≤ 0.0001). Treatment sessions with cooler dialysate were more likely to reach prescribed ultrafiltration targets.

Conclusions:
Patients with acute kidney injury undergoing prolonged intermittent renal replacement therapy with cooler dialysate experienced significantly less hypotension during treatment. Prevention of hemodynamic instability during renal replacement therapy helped to achieve ultrafiltration goals and may help to prevent volume overload in critically ill patients.
Platelet Reactivity in Patients on Aspirin and Clopidogrel Therapy Measured by a New Bedside Whole-Blood Assay
Authors: Polzin Amin , Helten Carolin , Dannenberg Lisa , Mourikis Philipp , Naguib David , Achilles Alina , Knoop Betül , Zako Saif , Rehder Susanne , Görlinger Klaus , Levkau Bodo , Zeus Tobias , Kelm Malte , Hohlfeld Thomas , Hoffmann Till 
Published: November 2018

Abstract:
Various tests are available for measuring on-treatment platelet reactivity. The pharmacologically most specific assays are time-consuming and elaborate. A highly specific and convenient assay would be desirable for clinical routine. In this pilot study, we aimed to examine the ability of a novel bedside whole-blood assay—ROTEM platelet—to evaluate platelet inhibition compared with established assays. Platelet reactivity was investigated in 93 patients. Forty-Seven patients were on permanent aspirin therapy and 46 on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. We used ROTEM platelet impedance aggregometry (ROTEM-PTL), light transmission aggregometry (LTA), Multiplate electrode aggregometry (MEA) and vasodilator-stimulated phosphoprotein flow cytometry. Receiver operating characteristic (ROC) analyses showed ROTEM-PTL differentiates well between patients on medication and healthy individuals: aspirin: ROCAUC 0.99 (95% confidence interval, 0.97–1.01); P < 0.0001; DAPT treatment: ROCAUC 0.80 (95% confidence interval, 0.69–0.91); P < 0.001. Pearson regression analyses showed moderate correlations between assays. Aspirin: MEA versus ROTEM-PTL r2 = 0.435, P ≤ 0.001; LTA versus ROTEM-PTL r2 = 0.048, P = 0.180. DAPT: MEA versus ROTEM-PTL r2 = 0.398, P = 0.001; LTA versus ROTEM-PTL r2 = 0.409, P = 0.001; vasodilator-stimulated phosphoprotein versus ROTEM-PTL r2 = 0.164, P = 0.055. ROTEM platelet distinguished well between treated and healthy individuals but correlated moderately with other assays. Clinical trials are needed to investigate the ability of this new assay to identify patients at risk of adverse events.
Assessment of Covert Consciousness in the Intensive Care Unit: Clinical and Ethical Considerations
Authors: Edlow Brian L. , Fins Joseph J. 
Published: November 2018

Objective:
To propose a practical ethical framework for how task-based functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) may be used in the intensive care unit (ICU) to identify covert consciousness in patients with acute severe traumatic brain injury (TBI).

Methods:
We present 2 clinical scenarios in which investigational task-based fMRI and EEG were performed in critically ill patients with acute severe TBI who appeared unconscious on the bedside behavioral assessment. From these cases, we consider the clinical and ethical challenges that emerge and suggest how to reconcile them. We also provide recommendations regarding communication with families about ICU patients with covert consciousness.

Results:
Covert consciousness was detected acutely in a patient who died in the ICU due to withdrawal of life-sustaining therapy, whereas covert consciousness was not detected in a patient who subsequently recovered consciousness, communication, and functional independence. These cases raise ethical challenges about how assessment of covert consciousness in the ICU might inform treatment decisions, prognostication, and perceptions about the benefits and burdens of ongoing care.

Conclusions:
Given that covert consciousness can be detected acutely in the ICU, we recommend that clinicians reconsider evaluative norms for ICU patients. As our clinical appreciation of covert consciousness evolves and its ethical import unfolds, we urge prognostic humility and transparency when clinicians communicate with families in the ICU about goals of care.
Tear Meniscus and Corneal Sub-basal Nerve Plexus Assessment in Primary Sjögren Syndrome and Sicca Syndrome Patients
Authors: Cardigos Joana , Barcelos Filipe , Carvalho Helena , Hipólito Diogo , Crisóstomo Sara , Vaz-Patto José , Alves Nuno 
Published: November 2018

Purpose:
To evaluate lower tear meniscus and corneal sub-basal nerve plexus in primary Sjögren's syndrome (pSS) and Sicca syndrome patients.

Methods:
Cross-sectional study of 116 patients with Sicca syndrome associated with pSS and not associated with Sjögren's syndrome (non-SS Sicca) and 20 normal control subjects. Tear meniscus height and area were measured using anterior segment optical coherence tomography; corneal sub-basal nerve plexus density, length, and tortuosity were evaluated using in vivo confocal microscopy. Data analysis was performed using IBM-SPSS Statistics 24.0.

Results:
Corneal sub-basal nerve plexus density and length were significantly lower, and tortuosity was significantly higher in pSS and non-SS Sicca groups than in normal control subjects (P < 0.001; P = 0.018, respectively). Corneal sub-basal nerve plexus presented a strong association with Schirmer test I and tear breakup time. Cutoff values of sub-basal nerve plexus density (36.5 nerve/mm2) and length (12.5 mm/mm2) presented 80.2% to 81.9% sensitivity and 85% specificity for detecting Sicca syndrome patients. No significant differences were found between the 3 groups regarding tear meniscus height and area.

Conclusions:
Corneal sub-basal nerve plexus in vivo confocal microscopy may be a useful tool in the assessment of dry eye disease in Sicca syndrome, complementing the information provided by the conventional modalities used in dry eye disease evaluation.
Perfusion Monitoring Shows Minimal Blood Flow From the Flap Pedicle to the Tarsoconjunctival Flap
Authors: Tenland Kajsa , Memarzadeh Khashayar , Berggren Johanna , Nguyen Cu Dinh , Dahlstrand Ulf , Hult Jenny , Engelsberg Karl , Lindstedt Sandra , Sheikh Rafi , Malmsjö Malin 
Published: November 2018

Background:
A previous study in pigs has shown that the pedicle of the tarsoconjunctival flap does not appear to have adequate blood perfusion. The aim of this study was to monitor perfusion in tarsoconjunctival flaps in patients with large lower eyelid defects resulting from tumor surgery.

Methods:
The modified Hughes procedure was performed in 13 patients. Blood perfusion was monitored using laser Doppler velocimetry and laser speckle-contrast imaging.

Results:
Blood flow decreased gradually from the pedicle base to the end of the flap and was 19% at the flap base, 11% in the middle of the flap, and 4% in the distal end of the flap. The flaps survived, and there was no tissue necrosis.

Conclusions:
Tarsoconjunctival tissue survival does not seem to be dependent on a conjunctival flap. Free tarsoconjunctival grafts or composite grafts might be considered as viable alternatives in reconstruction of major eyelid defects.
Impact of a Resident-Centered Interprofessional Quality Improvement Intervention on Acute Care Length of Stay
Authors: Walker Megan , Gay Lindsey , Raynaldo Glynda , Von Marensdorff Hans , Bates Jeffrey T. , Friedland Joan A. , Park Jung Hyun , Kehl Ekaterina , Sowers Bryan , Bhavani Sivasubramanium , Lan Charlie , Bozkurt Biykem , Stewart Diana E. , Horstman Molly J. 
Published: November 2018

ABSTRACT
Competency in interprofessional quality improvement and performance measurement is required by the Accreditation Council for Graduate Medical Education. We implemented an interprofessional quality improvement project to support trainee involvement in systems-level improvement to reduce hospital length of stay and engage trainees in efforts to improve the validity and reliability of clinical documentation contributing to risk-adjusted performance measures. The intervention had three components: daily interprofessional disposition huddles to discuss discharge needs, medical documentation curriculum to improve clinical data accuracy, and scheduled coding huddles to provide real-time feedback on documentation. Outcome measures included an unadjusted and risk-adjusted measure of hospital length of stay. Case severity index (CSI) served as a process measure. Statistical process control charts were used to measure change over time. The mean unadjusted length of stay decreased from 5.84 to 4.98 days. Both the unadjusted and the risk-adjusted length of stay measures exceeded the lower control limit of the statistical control chart. The CSI increased and exceeded the upper control limit of the statistical control chart. Improvements were sustained in the year following implementation. The intervention offers a model for academic institutions to satisfy new Common Program Requirements by engaging trainees in performance measurement and interprofessional improvement efforts.
Variation in Laboratory Test Naming Conventions in EHRs Within and Between Hospitals
Authors: Wiitala Wyndy L. , Vincent Brenda M. , Burns Jennifer A. , Prescott Hallie C. , Waljee Akbar K. , Cohen Genna R. , Iwashyna Theodore J. 
Published: November 2018

Background:
Electronic health records provide clinically rich data for research and quality improvement work. However, the data are often unstructured text, may be inconsistently recorded and extracted into centralized databases, making them difficult to use for research.

Objectives:
We sought to quantify the variation in how key laboratory measures are recorded in the Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW) across hospitals and over time. We included 6 laboratory tests commonly drawn within the first 24 hours of hospital admission (albumin, bilirubin, creatinine, hemoglobin, sodium, white blood cell count) from fiscal years 2005–2015.

Results:
We assessed laboratory test capture for 5,454,411 acute hospital admissions at 121 sites across the VA. The mapping of standardized laboratory nomenclature (Logical Observation Identifiers Names and Codes, LOINCs) to test results in CDW varied within hospital by laboratory test. The relationship between LOINCs and laboratory test names improved over time; by FY2015, 109 (95.6%) hospitals had >90% of the 6 laboratory tests mapped to an appropriate LOINC. All fields used to classify test results are provided in an Appendix (Supplemental Digital Content 1, http://links.lww.com/MLR/B635).

Conclusions:
The use of electronic health record data for research requires assessing data consistency and quality. Using laboratory test results requires the use of both unstructured text fields and the identification of appropriate LOINCs. When using data from multiple facilities, the results should be carefully examined by facility and over time to maximize the capture of data fields.
Pregnancy and Infant Outcomes Among Women Using the Dapivirine Vaginal Ring in Early Pregnancy
Authors: Makanani Bonus , Balkus Jennifer E. , Jiao Yuqing , Noguchi Lisa M. , Palanee-Phillips Thesla , Mbilizi Yamikani , Moodley Jothi , Kintu Kenneth , Reddy Krishnaveni , Kabwigu Samuel , Jeenariain Nitesha , Harkoo Ishana , Mgodi Nyaradzo , Piper Jeanna , Rees Helen , Scheckter Rachel , Beigi Richard , Baeten Jared M. ,   on behalf of the MTN-020/ASPIRE Study Team
Published: November 2018

Background:
Monthly use of the dapivirine vaginal ring has been shown to be safe and effective for HIV-1 prevention in nonpregnant reproductive-aged women. The impact of dapivirine on pregnancy outcomes and infant is not known. We compared pregnancy incidence and outcomes by study arm among HIV-1–uninfected women who became pregnant while participating in MTN-020/ASPIRE.

Methods:
ASPIRE was a randomized, double-blind, placebo-controlled phase III safety and effectiveness study of the dapivirine ring for HIV-1 prevention. Sexually active women aged 18–45 years from Malawi, South Africa, Uganda, and Zimbabwe were enrolled. Urine pregnancy tests were performed monthly, and, if positive, study product was withheld during pregnancy and breastfeeding. Pregnancy-related outcomes included the following: pregnancy incidence, pregnancy outcomes (live birth, preterm birth, pregnancy loss, and congenital anomalies), and infant growth.

Results:
Of 2629 women enrolled in ASPIRE, 169 became pregnant during follow-up, resulting in 179 incident pregnancies and 181 pregnancy outcomes. No difference in pregnancy incidence by study arm was observed (hazard ratio = 0.93; 95% confidence interval: 0.68 to 1.26). The distribution of pregnancy outcomes was similar by study arm, and no difference was noted in the frequency or pattern of congenital anomalies or infant growth parameters by study arm.

Conclusions:
Dapivirine use in the periconception period does not seem to be associated with adverse effects on pregnancy or infant outcomes. Our findings provide support for additional safety studies of the dapivirine ring throughout pregnancy.
The Modified Keystone Flap for Pressure Ulcers
Authors: Byun Il Hwan , Kim Chan Woo , Park Tae Hwan 
Published: November 2018

Introduction
The reconstruction of extensive soft tissue defects from pressure ulcers is a great challenge. Resurfacing such defects with like tissues and minimizing morbidities are important. Here we present our surgical experience using a novel modified keystone flap for pressure ulcer patients.

Methods
We retrospectively reviewed the data of 13 consecutive cases reconstructed with the modified keystone flaps between March and December, 2017. The mean dimensions of the reconstructed defect were 7.7 × 6.5 cm, while the mean dimensions of the flap were 12.1 × 8.3 cm.

Results
Time efficient reconstructions with the modified keystone flap were performed without any following major complications. Minor wound dehiscence occurred in only one case, which soon healed with conservative management.

Conclusions
Considering its simple design, reliable flap survival, minimal donor-site morbidity, optimal flap thickness, and evenly distributed surgical tension, our novel technique of the modified keystone flap is as an excellent surgical option for the reconstruction of pressure ulcers in the gluteal region.
Harmonizing Clinical Sequencing And Interpretation For The Emerge III Network
Authors:   The eMERGE Consortium, Gibbs Richard A. , Rehm Heidi L. 
Published: November 2018

ABSTRACTBackgroundThe eMERGE III Network was tasked with harmonizing genetic testing protocols linking multiple sites and investigators.MethodsDNA capture panels targeting 109 genes and 1551 variants were constructed by two clinical sequencing centers for analysis of 25,000 participant DNA samples collected at 11 sites where samples were linked to patients with electronic health records. Each step from sample collection, data generation, interpretation, reporting, delivery and storage, were developed and validated in CAP/CLIA settings and harmonized across sequencing centers.ResultsA compliant and secure network was built and enabled ongoing review and reconciliation of clinical interpretations while maintaining communication and data sharing between investigators. Mechanisms for sustained propagation and growth of the network were established. An interim data freeze representing 15,574 sequenced subjects, informed the assay performance for a range of variant types, the rate of return of results for different phenotypes and the frequency of secondary findings. Practical obstacles for implementation and scaling of clinical and research findings were identified and addressed. The eMERGE protocols and tools established are now available for widespread dissemination.ConclusionsThis study established processes for different sequencing sites to harmonize the technical and interpretive aspects of sequencing tests, a critical achievement towards global standardization of genomic testing. The network established experience in the return of results and the rate of secondary findings across diverse biobank populations. Furthermore, the eMERGE network has accomplished integration of structured genomic results into multiple electronic health record systems, setting the stage for clinical decision support to enable genomic medicine.
Inferring the ancestry of everyone
Authors: Kelleher Jerome , Wong Yan , Albers Patrick K. , Wohns Anthony W. , McVean Gil 
Published: November 2018

AbstractA central problem in evolutionary biology is to infer the full genealogical history of a set of DNA sequences. This history contains rich information about the forces that have influenced a sexually reproducing species. However, existing methods are limited: the most accurate is unable to cope with more than a few dozen samples. With modern genetic data sets rapidly approaching millions of genomes, there is an urgent need for efficient inference methods to exploit such rich resources. We introduce an algorithm to infer whole-genome history which has comparable accuracy to the state-of-the-art but can process around four orders of magnitude more sequences. Additionally, our method results in an “evolutionary encoding” of the original sequence data, enabling efficient access to genealogies and calculation of genetic statistics over the data. We apply this technique to human data from the 1000 Genomes Project, Simons Genome Diversity Project and UK Biobank, showing that the genealogies we estimate are both rich in biological signal and efficient to process.
Landscape genomics of an obligate mutualism: discordant population structures between a leafcutter-ant and its fungal cultivars
Authors: Smith Chad C. , Weber Jesse N. , Mikheyev Alexander S. , Roces Flavio , Bollazzi Martin , Kellner Katrin , Seal Jon N. , Mueller Ulrich G. 
Published: November 2018

AbstractTo explore landscape genomics at the range limit of an obligate mutualism, we used genotyping-by-sequencing (ddRADseq) to quantify population structure and the effect of hostsymbiont interactions between the northernmost fungus-farming leafcutter antAtta texanaand its two main types of cultivated fungus. At local scales, genome-wide differentiation between ants associated with either of the two fungal types is greater than the differentiation associated with the abiotic factors temperature and precipitation, suggesting that specific ant-fungus genome-genome combinations may have been favored by selection. For the ant hosts, we found a broad cline of genetic structure across the range, and a reduction of genetic diversity along the axis of range expansion towards the range margin. In contrast, genetic structure was patchy in the cultivated fungi, with no consistent reduction of fungal genetic diversity at the range margins. This discordance in population-genetic structure between ant hosts and fungal symbionts is surprising because the ant farmers co-disperse with their vertically-transmitted fungal symbionts, but apparently the fungi disperse occasionally also through between-nest horizontal transfer or other unknown dispersal mechanisms. The discordance in populationgenetic structure indicates that genetic drift and gene flow differ in magnitude between each partner in this leafcutter mutualism. Together, these findings imply that variation in the strength of drift and gene flow experienced by each mutualistic partner affects adaptation to environmental stress at the range margin, and genome-genome interactions between host and symbiont influences adaptive genetic differentiation of the host during range evolution in this obligate mutualism.
Domain organization and conformational change of dynactin p150
Authors: Saito Kei , Murayama Takashi , Hata Tomone , Kobayashi Takuya , Shibata Keitaro , Kazuno Saiko , Fujimura Tsutomu , Sakurai Takashi , Toyoshima Yoko Y. 
Published: November 2018

AbstractDynactin is a principal regulator of the minus-end directed microtubule motor dynein. The sidearm of dynactin is essential for binding to microtubules and regulation of dynein activity. Although our understanding of the structure of the dynactin backbone (Arp1 rod) has greatly improved recently, structural details of the sidearm part remain elusive. Here, electron microscopy of individual molecules of the dynactin complex revealed that the sidearm was highly flexible and exhibited diverse morphologies. Utilizing mutants for nanogold labeling and deletion analysis, we determined the domain organization of the largest subunit p150 and identified a filamentous structure protruding from the head domain of the sidearm as the coiled-coil 1 (CC1), the dynein-binding domain, in p150. Furthermore, the protrusion formed by CC1 exhibited either a folded or an extended form, suggesting that CC1 works as an extending “arm”. These findings provide clues to understand how dynactin binds to microtubules and regulates dynein.