bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Electrocardiograph: Applications and Limitations—An Analysis of 2000 Incident Reports
Authors: Ludbrook G. L. , Russell W. J. , Webb R. K. , Klepper I. D. , Currie M. 
Published: January 2019

The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed with respect to the role of the electrocardiograph (ECG). Of these, 138 (7%) were first detected by the ECG. Of the 1256 incidents which occurred in association with general anaesthesia (GA incidents) 48% were “human detected” and 52% “monitor detected”, the ECG was ranked third and detected 121 (19%) of these monitor detected GA incidents. However over 98% of incidents first detected by the ECG were heart rate changes; they would also have been detected by a pulse meter or pulse oximeter which would have supplied additional information about the adequacy of peripheral perfusion. The ECG is a “first-line” monitor in situations with the potential for myocardial ischaemia, complex dysrhythmias or altered myocardial conduction and should be used in all critically ill patients as well as those at significant risk of these problems. The ECG frequently detects incidents involving minor physiological trespass, such as simple heart rate and rhythm changes associated with anaesthetic agents. These incidents are generally detected relatively early in their evolution. AIMS data has confirmed, however, that the ECG has such poor sensitivity for serious physiological changes such as hypoxia, hypercarbia and hypotension that it cannot even be regarded as a useful “back-up” monitor for these problems. Indeed a “normal” ECG in a dangerous situation may lead to a degree of complacency. Because the anaesthetist cannot differentiate between these minor and serious causes of ECG changes, it was decided, for a theoretical analysis, that although the ECG used on its own would have detected 55% of the 1256 GA incidents, had they been allowed to evolve, it could not be assumed that it would do so without potential for organ damage. The ECG may be regarded as an adjunct to, but does not replace, an oxygen analyser, pulse oximeter, capnograph, or high pressure alarm. An ECG should always be available but need not be used for young fit patients unless specifically indicated.
Incidence of Ventricular Fibrillation after Aortic Cross-Clamp Release using Lignocaine Cardioplegia
Authors: Wallace S. R. , Baker A. B. 
Published: January 2019

The occurrence of ventricular fibrillation after aortic de-clamping during cardiac surgery is common, and if prolonged may contribute to myocardial ischaemia. The use of lignocaine cardioplegia to minimize reperfusion ventricular fibrillation was studied in 141 patients undergoing first time coronary artery surgery in a double blind prospective randomized trial: 71 patients received lignocaine 100 mg/l in their cardioplegia, whereas a control group of 70 patients received cardioplegia without lignocaine. Lignocaine cardioplegia reduced significantly the incidence of reperfusion ventricular fibrillation from 63% to 42%. Of those patients developing reperfusion ventricular fibrillation, a higher proportion receiving lignocaine cardioplegia underwent spontaneous defibrillation (30% vs 11%) though this was not statistically significant. The incidence of atrio-ventricular (A-V) block necessitating ventricular pacing to separate from cardiopulmonary bypass was significantly higher in the lignocaine treated group (44%) than in the control group (20%): this may have been due to the additive effect of procaine in the cardioplegia solution. In the majority of cases this A-V block was transient and had resolved prior to the completion of surgery.
Comparison in Spontaneous Ventilation of the Maxima with the Humphrey ADE Breathing System and between Four Methods for Detecting Rebreathing
Authors: Miller D. M. , Palm A. 
Published: January 2019

An enclosed efferent, afferent reservoir breathing system (Maxima, Life Air Pty Ltd), being valveless, was compared to a simple afferent reservoir system (Humphrey ADE, A mode), having a valve, by assessing fresh gas flow (V̇F) requirements, with respect to ventilation (V̇E), that prevents rebreathing in volunteers, awake and breathing spontaneously. The results are recorded in terms of the quotient V̇F/V̇E associated with the onset of rebreathing. At the same time four clinical methods for assessing rebreathing were evaluated from the perspective of suitability for practical application during anaesthesia. No significant difference was found in the VF requirements between the ADE and Maxima breathing systems with respective values obtained for the quotient VF/VE of 0.80 and 0.77. Our findings showed that the method of sampling carbon dioxide (CO2) at the outflow of the efferent limb of the patient connector (eliminated CO2 method) in both afferent reservoir systems provided the highest flow rate and most reliable indication for detecting potential or actual rebreathing, when attempting to minimize VF. It provides no additional deadspace or resistance to gas flow, and has the advantage of being the only qualitative method that is reliable for the purpose of detecting the onset of rebreathing.
Central Venous Catheters Revisited— Infection Rates and an Assessment of the New Fibrin Analysing System Brush
Authors: van Heerden P. V. , Webb S. A. R. , Fong S. , Golledge C. L. , Roberts B. L. , Thompson W. R. 
Published: January 2019

Sixty-one consecutive patients in the Intensive Care Unit requiring central venous lines (CVC) for five or more days were randomized to receive either a standard triple lumen CVC (STD/CVC) or a silver sulphadiazine and chlorhexidine impregnated CVC (SSD/CVC). Data from the 54 patients who completed the trial show a reduced infection rate (positive tip culture) in the SSD/CVC group (4 out of 28) compared to the STD/CVC group (10 out of 26) (P<0.05). In addition, the new Fibrin Analysing System (FAS) brush was evaluated and used to determine the presence of infection in all the CVCs (STD/CVC and SSD/CVC combined, n=54) at day 3 (i.e. early warning of CVC colonization/infection) and at the time of removal of the CVC. The FAS brush was able to detect an infected CVC on only one occasion on day 3 out of the 14 CVC tips which were later found to be colonized/infected at the time of removal. The sensitivity of the FAS brush in detecting colonized/infected CVCs at the time of CVC removal compared with CVC tip culture was 21% with a specificity of 100%. These findings would currently not support the routine use of the FAS brush in determining CVC infection/colonization.
Positive Serology to Legionella Longbeachae in Patients with Adult Respiratory Distress Syndrome
Authors: Konecny P. , Bell A. J. 
Published: January 2019

In an observational study we measured the Legionella longbeachae antibody titre rise in patients mechanically ventilated for more than eight days during a two-month period. The patients were divided into two groups on the basis of the presence or absence of the adult respiratory distress syndrome (ARDS). In nine patients with ARDS all showed an antibody rise consistent with recent infection with Legionella long-beachae with a rise in titre (six patients) or a high titre after eight to ten days of ventilation (three patients). Three patients without ARDS did not show a rise in titre. Culture of the environment, ventilator circuits, humidifiers and humidification water did not reveal an environmental source of Legionella longbeachae in the Intensive Care Unit. Legionella longbeachae may be implicated as a pathogenic organism in ARDS, or as a secondary nosocomial infection. Alternatively the antibody titre rise may represent an epiphenomenon and may not be related to Legionella longbeachae infection.
Ventilator-CPAP with the Siemens Servo 900C Compared with Continuous Flow-CPAP in Intubated Patients: Effect on Work of Breathing
Authors: Aerts J. G. J. V. , Van Den Berg B. , Bogaard J. M. 
Published: January 2019

The effects of continuous positive airway pressure (CPAP) provided by the Siemens Servo 900C ventilator were compared with a continuous flow system (CF-CPAP) in patients weaning from the ventilator. Thirteen patients were studied using both systems at a CPAP level of 0.5 kPa. Additional work of breathing (Wapp) and derived variables were determined in relation to the minute volumes of the patients. The Wapp imposed by the ventilator exceeded the Wapp of CF-CPAP in all patients. The difference in Wapp between ventilator- and CF-CPAP was greater at higher ventilatory needs. The increments in Wapp imposed by the ventilator were positively correlated with the actual end-expiratory pressures (EEP). The EEP increasingly exceeded the preset CPAP level of the ventilator at higher minute volumes. An inspiratory threshold due to a gradient between EEP and preset CPAP greatly increased the Wapp imposed by the ventilator. As this threshold was attributed to the resistance of the PEEP device of the ventilator, it indicates that the additional work related to the expiratory valve should be taken into account when the Siemens Servo 900C ventilator is used for weaning purposes.
Perioperative Management of Intra-Partum Seizure
Authors: Cheng A. Y. , Kwan A. 
Published: January 2019

A young nulliparous woman previously diagnosed with pregnancy-induced hypertension suffered a seizure during active first stage labour. Pre-seizure blood pressure was borderline high but she did not fulfill other criteria for pre-eclampsia. She underwent emergency caesarean section for presumed eclampsia. Postoperatively, she deteriorated neurologically. CT scan showed an intracranial haemorrhage requiring neurosurgical intervention. The similarities of presentation of a primary cerebrovascular event and eclampsia following an intra-partum seizure made the differential diagnosis difficult.
Opioid Requirements and Responses in Asians
Authors: Lee A. , Gin T. , Oh T. E. 
Published: January 2019

The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. Much of the pharmacogenetic work has focused on the metabolism of codeine, morphine and pethidine, and there are some differences between Chinese and Caucasians. Asians may receive less analgesia because they are more likely to experience, or are less tolerant of the adverse effects of opioids. Despite this, ethnic factors are probably only a small contributor to the inter-individual variation in opioid requirements. Unlike earlier studies, recent larger studies using patient-controlled analgesia have shown similar opioid usage between Asians and Caucasians in the postoperative period. An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
Elevated procalcitonin levels in anaphylaxis
Authors: Joo Shiang Ang 
Published: January 2019

Background: The most common role procalcitonin play in current-day medicine is in the diagnosis and management of sepsis. Aside from sepsis, there are other known causes of elevated procalcitonin, for example, trauma and severe pancreatitis. We herein present a case of markedly elevated procalcitonin levels with an unusual cause, that is, anaphylaxis. Case report: A young lady presented to our hospital consecutively for anaphylaxis. Both presentations were associated with a markedly elevated procalcitonin level. She was discharged with an epinephrine autoinjector after the second visit. Recognition of anaphylaxis as a cause of elevated procalcitonin level can potentially change management as shown in this case report. This case report also highlights the importance of history taking and not to over rely on investigation results for patient management.
The impact of body mass index on resource utilization and outcomes of children admitted to a pediatric intensive care unit
Authors: Sharma Kamal , Raszynski Andre , Totapally Balagangadhar R 
Published: January 2019

Introduction: Obesity is associated with poor health outcomes but may be protective in intensive care unit patients. The objective of this study is to describe the characteristics of underweight, normal weight, and obese children, and to compare their length of stay, resource utilization, and mortality. Methods: The charts of 1447 patients who were admitted to a tertiary-level pediatric intensive care unit during 1 calendar year were reviewed. Patients were divided into three groups: underweight (<5th percentile), normal (5th–95th percentiles), and obese (>95th percentile). Body mass index for age percentile was used for children older than age 2 years, and weight-for-height percentile was used for children younger than age 2 years. Demographic data, Pediatric Index of Mortality 2 score, Pediatric Index of Mortality 2 risk of mortality, hospital mortality, hospital length of stay, the use and duration of ventilator support, hemodynamic support, and dialysis were determined. Results: Fifteen percent of children were underweight, while 61.5% were normal weight and 23.5% were obese; 54.9% of the patients were male. The overall mortality was 1.87%, with no significant difference between the three weight groups. The racial distribution, prevalence, and duration of invasive and noninvasive ventilation, and the use of vasopressors, central venous lines, and dialysis were similar between three groups. Tube feeding and parenteral nutrition were used more often in the underweight group. Pediatric intensive care unit and hospital lengths of stays were higher in underweight children. Underweight children were younger when compared to normal or obese children. Pediatric Index of Mortality 2 scores and Pediatric Index of Mortality 2 risk of mortality scores were higher in underweight children. Conclusion: There were no significant differences between the three weight groups in mortality. Underweight children were younger and sicker, and received tube feeding and parenteral nutrition more frequently.
Development and Evaluation of an Integrated Digital Patient Platform During Oncology Treatment
Authors: De Regge Melissa , Decoene Elsie , Eeckloo Kristof , Van Hecke Ann 
Published: January 2019

Background: Patient platforms are seen as promising technologies in an integrated care approach to involve cancer patients in their own health care and to support them in managing their personal health information. However, few digital platforms have been codesigned with patients and caregivers. Objective: To develop, implement, and evaluate the feasibility and applicability of a digital oncology platform (DOP) for patients with cancer. Method: A mixed-method study was used, employing a survey, interviews, and logged data from caregivers and patients. The DOP was designed in cooperation with Information Technology (IT) staff, caregivers, and patients. Results: The DOP was actively used by half of the patients. These active patients were positive about the DOP. Caregivers acknowledged the added value but also indicate that additional workload was involved. Oncology nurse specialists are the users of the platform. General practitioners have indicated their interest in the platform. Conclusion: Thanks to the codesign process, the DOP could be tailored to the expectations of the end users. This study provides insight into which DOP functionalities the patients were interested in and includes further recommendations for implementation.
Baseline and interim functional imaging with PET effectively risk stratifies patients with peripheral T-cell lymphoma
Authors: Mehta-Shah Neha , Ito Kimiteru , Bantilan Kurt , Moskowitz Alison J. , Sauter Craig , Horwitz Steven M. , Schöder Heiko 
Published: January 2019

Abstract
The prognosis of peripheral T-cell lymphoma (PTCL) is heterogenous. Baseline or interim imaging characteristics may inform risk-adapted treatment paradigms. We identified 112 patients with PTCL who were consecutively treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)/CHOP-like regimens with the intent to consolidate with an autologous transplant. Baseline (n = 93) and interim (after 4 cycles, n = 99) positron emission tomography (PET) images were reevaluated, and we calculated baseline total metabolic tumor volume (TMTV). Interim PET (iPET) responses were graded visually by 5-point score (i5PS) and by percentage change of standardized uptake value. By univariate analysis, predictors of event-free survival (EFS) included Prognostic Index for Peripheral TCL (PIT) higher than 1 (hazard ratio [HR], 1.83; P = .021), International Prognostic Index (IPI) higher than 3 (HR, 2.01; P = .021), high TMTV (&gt;125 cm3; HR, 3.92; P = .003), and positive iPET (HR, 3.57; P &lt; .001). By multivariate analysis, high baseline TMTV predicted worse overall survival (OS; HR, 6.025; P = .022) and EFS (HR, 3.861; P = .005). Patients with i5PS of 1 to 3 had a longer median OS and EFS (104 months, 64 months) than those with i5PS of 4 to 5 (19 months, 11 months; P &lt; .001). Four-year OS and EFS for patients with i5PS of 1 to 3 and PIT of 1 or less were 85% and 62%, respectively. However, 4-year OS and EFS for those with i5PS of 4 to 5 and PIT higher than 1 were both 0% (P &lt; .001). In multivariate analysis, after controlling for IPI and PIT, i5PS was independently prognostic for EFS (HR, 3.400 95% confidence interval, 1.750-6.750; P &lt; .001) and OS (HR, 10.243; 95% confidence interval, 4.052-25.891; P &lt; .001). In conjunction with clinical parameters, iPET helps risk stratify patients with PTCL and could inform risk-adapted treatment strategies. Prospective studies are needed to confirm these findings.
Endothelial signaling by neutrophil-released oncostatin M enhances P-selectin–dependent inflammation and thrombosis
Authors: Setiadi Hendra , Yago Tadayuki , Liu Zhenghui , McEver Rodger P. 
Published: January 2019

AbstractIn the earliest phase of inflammation, histamine and other agonists rapidly mobilize P-selectin to the apical membranes of endothelial cells, where it initiates rolling adhesion of flowing neutrophils. Clustering of P-selectin in clathrin-coated pits facilitates rolling. Inflammatory cytokines typically signal by regulating gene transcription over a period of hours. We found that neutrophils rolling on P-selectin secreted the cytokine oncostatin M (OSM). The released OSM triggered signals through glycoprotein 130 (gp130)–containing receptors on endothelial cells that, within minutes, further clustered P-selectin and markedly enhanced its adhesive function. Antibodies to OSM or gp130, deletion of the gene encoding OSM in hematopoietic cells, or conditional deletion of the gene encoding gp130 in endothelial cells inhibited neutrophil rolling on P-selectin in trauma-stimulated venules of the mouse cremaster muscle. In a mouse model of P-selectin–dependent deep vein thrombosis, deletion of OSM in hematopoietic cells or of gp130 in endothelial cells markedly inhibited adhesion of neutrophils and monocytes and the rate and extent of thrombus formation. Our results reveal a paracrine-signaling mechanism by which neutrophil-released OSM rapidly influences endothelial cell function during physiological and pathological inflammation.
A moderate role for cognitive models in agent-based modeling of cultural change
Authors: Abrams Marshall 
Published: January 2019

AbstractPurposeAgent-based models are typically “simple-agent” models, in which agents behave according to simple rules, or “complex-agent” models which incorporate complex models of cognitive processes. I argue that there is also an important role for agent-based computer models in which agents incorporate cognitive models of moderate complexity. In particular, I argue that such models have the potential to bring insights from the humanistic study of culture into population-level modeling of cultural change.MethodsI motivate my proposal in part by describing an agent-based modeling framework, POPCO, in which agents’ communication of their simulated beliefs depends on a model of analogy processing implemented by artificial neural networks within each agent. I use POPCO to model a hypothesis about causal relations between cultural patterns proposed by Peggy Sanday.ResultsIn model 1, empirical patterns like those reported by Sanday emerge from the influence of analogies on agents’ communication with each other. Model 2 extends model 1 by allowing the components of a new analogy to diffuse through the population for reasons unrelated to later effects of the analogy. This illustrates a process by which novel cultural features might arise.ConclusionsThe inclusion of relatively simple cognitive models in agents allows modeling population-level effects of inferential and cultural coherence relations, including symbolic cultural relationships. I argue that such models of moderate complexity can illuminate various causal relationships involving cultural patterns and cognitive processes.
In situ non-invasive multianalytical methodology to characterize mosaic tesserae from the House of Gilded Cupids, Pompeii
Authors: Marcaida Iker , Maguregui Maite , Morillas Héctor , Prieto-Taboada Nagore , Veneranda Marco , Fdez-Ortiz de Vallejuelo Silvia , Martellone Alberta , De Nigris Bruno , Osanna Massimo , Madariaga Juan Manuel 
Published: January 2019

Abstract
Mosaics, one of the most important decorative artworks in the Roman culture, were usually elaborated with a set of tesserae joined with lime or others binders to form geometric or figurative decorations. The identification of both substrate and colored compounds of the tesserae is a challenge for chemists and archaeologists. In this work, two mosaics present in the House of Gilded Cupids from the Archaeological Park of Pompeii were analyzed in situ by non destructive techniques. Raman and Diffuse Reflectance Infrared Fourier Transform (DRIFT) spectroscopies were used for the molecular and mineralogical characterization, and hand-held energy dispersive X-ray fluorescence (HH-EDXRF) spectrometry and Laser Induced Breakdown Spectroscopy (LIBS) for the elemental analysis. LIBS in-depth analysis was performed to obtain insights about the thickness of the pictorial layer determining that the thickness of red and orange pictorial layers was higher than 140 μm. The results showed that white tesserae were mainly composed by calcite, while local black colored volcanic rocks were used to manufacture black tesserae. Red and orange tesserae were composed by a calcite-based matrix with a hematite pictorial layer applied over it. Orange color was obtained by diluting hematite in the calcite matrix. Principal component analysis (PCA) of the XRF data was performed to observe differences and/or similarities between the analyzed mosaics; the samples projection of the PCA showed clear groupings.