bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Ventilator Dyssynchrony, Delivered Tidal Volume, and Sedation Using a Novel Automated Ventilator Dyssynchrony Detection Algorithm*
Authors: Sottile Peter D. , Albers David , Higgins Carrie , Mckeehan Jeffery , Moss Marc M. 
Published: January 2018

Objective:
Ventilator dyssynchrony is potentially harmful to patients with or at risk for the acute respiratory distress syndrome. Automated detection of ventilator dyssynchrony from ventilator waveforms has been difficult. It is unclear if certain types of ventilator dyssynchrony deliver large tidal volumes and whether levels of sedation alter the frequency of ventilator dyssynchrony.

Design:
A prospective observational study.

Setting:
A university medical ICU.

Patients:
Patients with or at risk for acute respiratory distress syndrome.

Interventions:
Continuous pressure-time, flow-time, and volume-time data were directly obtained from the ventilator. The level of sedation and the use of neuromuscular blockade was extracted from the medical record. Machine learning algorithms that incorporate clinical insight were developed and trained to detect four previously described and clinically relevant forms of ventilator dyssynchrony. The association between normalized tidal volume and ventilator dyssynchrony and the association between sedation and the frequency of ventilator dyssynchrony were determined.

Measurements and Main Results:
A total of 4.26 million breaths were recorded from 62 ventilated patients. Our algorithm detected three types of ventilator dyssynchrony with an area under the receiver operator curve of greater than 0.89. Ventilator dyssynchrony occurred in 34.4% (95% CI, 34.41–34.49%) of breaths. When compared with synchronous breaths, double-triggered and flow-limited breaths were more likely to deliver tidal volumes greater than 10 mL/kg (40% and 11% compared with 0.2%; p < 0.001 for both comparisons). Deep sedation reduced but did not eliminate the frequency of all ventilator dyssynchrony breaths (p < 0.05). Ventilator dyssynchrony was eliminated with neuromuscular blockade (p < 0.001).

Conclusion:
We developed a computerized algorithm that accurately detects three types of ventilator dyssynchrony. Double-triggered and flow-limited breaths are associated with the frequent delivery of tidal volumes of greater than 10 mL/kg. Although ventilator dyssynchrony is reduced by deep sedation, potentially deleterious tidal volumes may still be delivered. However, neuromuscular blockade effectively eliminates ventilator dyssynchrony.
Use of Nitrous Oxide in Dermatology: A Systematic Review
Authors: Brotzman Erica A. , Sandoval Laura F. , Crane Jonathan 
Published: January 2018

BACKGROUND
Many dermatologic procedures are painful and can be distressing to patients.

OBJECTIVE
To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures.

METHODS
A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology.

RESULTS
Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures.

CONCLUSION
Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.
A Prospective Study of the Safety and Efficacy of a Microneedle Fractional Radiofrequency System for Global Facial Photoaging in Chinese Patients
Authors: Zhang Mengli , Fang Jing , Wu Qiuju , Lin Tong 
Published: January 2018

BACKGROUND
Facial photoaging has become a major cosmetic concern, and the microneedle fractional radiofrequency system (MFRS) is a novel method for rejuvenation that combines radiofrequency and microneedles.

OBJECTIVE
This study prospectively evaluated the efficacy and safety of an MFRS in the treatment of facial photoaged skin in Chinese patients.

MATERIALS AND METHODS
Twenty-seven patients with moderate facial photoaging were recruited and received 3 treatments at 4-week intervals. Blinded clinical assessment was performed by 2 independent dermatologists on a 5-point global photoaging scale (GPS). Patients were also questioned on the extent of improvement of rhytides, skin tightening, and complexion with a 4-point global aesthetic improvement scale (GAIS) and satisfaction based on a 5-point scale. Adverse events and pain scores were also evaluated.

RESULTS
Compared with the baseline, there was a significant improvement in facial photoaged skin after 3 treatments, and these positive outcomes were maintained up to the 6-month follow-up, according to the GPS and GAIS scores. Most patients were satisfied with the treatment and reported mild to moderate pain and adverse effects.

CONCLUSION
This MFRS is effective for facial skin rejuvenation in Chinese patients. The therapy also seems safe and well tolerated.
Serratia marcescens Infectious Endocarditis
Authors: Schechter Marcos C. , Spicer Jennifer O. , del Mar Aldrete Sol , Kraft Colleen S. 
Published: January 2018

Background

Serratia marcescens infectious endocarditis (SMIE) is an uncommon disease, and the largest case series were reported from California in the 1970s. We aimed to identify risk factors and outcomes of SMIE in our institution.

Methods
Retrospective cohort study of all cases of Serratia marcescens bacteremia (SMB) diagnosed between January 2003 and December 2013.

Results
A total of 298 cases of SMB were reviewed, and 5 cases of SMIE were found. Clinical characteristics between SMB and SMIE cases were similar, except for more frequent history of injection drug use among cases of SMIE. Serratia marcescens infectious endocarditis cases had large vegetations, frequent embolic events, and poor outcomes.

Conclusions
We confirm the stereotypical description of SMIE as a cause left-sided heart disease in injection drug users with frequent embolic events. Poor outcomes prevailed despite advances in medical care.
“Product” Versus “Process” Measures in Assessing Speech Recognition Outcomes in Adults With Cochlear Implants
Authors: Moberly Aaron C. , Castellanos Irina , Vasil Kara J. , Adunka Oliver F. , Pisoni David B. 
Published: January 2018

Hypotheses:
1) When controlling for age in postlingual adult cochlear implant (CI) users, information-processing functions, as assessed using “process” measures of working memory capacity, inhibitory control, information-processing speed, and fluid reasoning, will predict traditional “product” outcome measures of speech recognition. 2) Demographic/audiologic factors, particularly duration of deafness, duration of CI use, degree of residual hearing, and socioeconomic status, will impact performance on underlying information-processing functions, as assessed using process measures.

Background:
Clinicians and researchers rely heavily on endpoint product measures of accuracy in speech recognition to gauge patient outcomes postoperatively. However, these measures are primarily descriptive and were not designed to assess the underlying core information-processing operations that are used during speech recognition. In contrast, process measures reflect the integrity of elementary core subprocesses that are operative during behavioral tests using complex speech signals.

Methods:
Forty-two experienced adult CI users were tested using three product measures of speech recognition, along with four process measures of working memory capacity, inhibitory control, speed of lexical/phonological access, and nonverbal fluid reasoning. Demographic and audiologic factors were also assessed.

Results:
Scores on product measures were associated with core process measures of speed of lexical/phonological access and nonverbal fluid reasoning. After controlling for participant age, demographic and audiologic factors did not correlate with process measure scores.

Conclusion:
Findings provide support for the important foundational roles of information processing operations in speech recognition outcomes of postlingually deaf patients who have received CIs.
Utility of Noncontrast Magnetic Resonance Imaging for Detection of Recurrent Vestibular Schwannoma
Authors: Williams Jamie C. , Carr Carrie M. , Eckel Laurence J. , Kotsenas Amy L. , Hunt Christopher H. , Carlson Matthew L. , Lane John I. 
Published: January 2018

Background:
Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) (T1WI) is the conventional imaging technique of choice to detect vestibular schwannoma (VS) recurrence or regrowth, despite suboptimal specificity secondary to enhancing postoperative changes. Furthermore, recent concerns regarding the accumulation of gadolinium in body tissues have led for a call to reduce the number of contrast-enhanced examinations. The objective of the current study is to evaluate the diagnostic accuracy of high-resolution noncontrast (three-dimensional [3D] T2) MRI relative to gadolinium-enhanced T1WI in the detection of VS recurrence after resection.

Methods:
Following Institutional Review Board approval, 13 consecutive postoperative patients with VS recurrence or regrowth were identified from a prospectively maintained clinical database in which recurrence was determined by progression on serial postoperative MRI examination. Three blinded neuroradiologists retrospectively evaluated a total of 41 postoperative MRI examinations from these patients using only gadolinium-enhanced T1WI and 3D T2 MRI for recurrence or regrowth. Interobserver agreement, differences in detection between the two sequences, and the sensitivity and specificity of 3D T2 MRI were assessed.

Results:
Fifteen of the 41 postoperative MRIs demonstrated progression, as determined by examiner consensus on the gadolinium-enhanced T1WI. Agreement, measured using Krippendorff's alpha, was 0.82 for the 3D T2 images and 0.83 for the contrast-enhanced T1WI. All the three examiners demonstrated no difference in the detection of progression between the two sequences (McNemar's test p values 0.69 for examiner 1, 0.63 for examiner 2, and 0.99 for examiner 3). The sensitivity of 3D T2 was 0.78 (CI 0.60–0.96), while the specificity was 0.94 (CI 0.86–1.00).

Conclusion:
Noncontrast high-resolution 3D T2 MRI seems sufficient to assess for recurrence or regrowth after VS resection. The results of this study have implications for reducing cost, time, and adverse events associated with gadolinium administration in this population requiring serial follow-up examinations. These promising, yet preliminary findings warrant confirmation with a larger prospective cohort of patients.
Blood biomarkers for evaluation of perinatal encephalopathy: state of the art
Authors: Graham Ernest M. , Everett Allen D. , Delpech Jean-Christophe , Northington Frances J. 
Published: January 2018

Purpose of review
The rapid progress in biomarker science is on the threshold of significantly changing clinical care for infants in the neonatal ICU. Infants with neonatal brain injuries will likely be the first group whose management is dramatically altered with point-of-care, rapidly available brain biomarker analysis. Providing an interim update on progress in this area is the purpose of this review.

Recent findings
Highlighted findings from the past 18 months of publications on biomarkers in neonatal brain injury include; Specific nonbrain markers of cardiac health and global asphyxia continue to provide information on brain injury after hypoxic–ischemic encephalopathy (HIE). Prediction of injury in the piglet hypoxia-ischemia model is improved with the use of a combination score of plasma metabolites. In a neonatal piglet model of perinatal hypoxia–ischemia, a systemic proinflammatory surge of cytokines has been identified after rewarming from therapeutic hypothermia. New biomarkers identified recently include osteopontin, activin A, neutrophil gelatinase-associated lipocalin, secretoneurin, Tau and neurofilament light protein. Brain-based biomarkers differ in their ability to predict short-term in-hospital outcomes and long-term neurologic deficits.

Summary
Neonatal brain biomarker research is currently in its very early development with major advances still to be made.
Hot Spotting as a Strategy to Identify High-Cost Surgical Populations
Authors: Shubeck Sarah P. , Thumma Jyothi R. , Dimick Justin B. , Nathan Hari 
Published: January 2018

Objective:
The aim of this study was to determine the feasibility of “hot spotting” in elective surgical populations.

Background:
Prospective identification of high-cost patients, known as “hot spotting,” is well developed in medical populations, but has not been performed in surgical populations. Population-based management of surgical expenditures requires identification of high-cost surgical patients to allow for effective implementation of cost-saving strategies.

Methods:
Using 100% Medicare claims data for 2010 to 2013, we identified patients aged 65 to 99 years undergoing elective surgical procedures. We calculated price-standardized Medicare payments for the surgical episode from the index admission through 30 days after discharge. Patient-level factors associated with payments were analyzed by multivariable linear regression.

Results:
Medicare patients in the highest decile of spending accounted for a disproportionate share of aggregate costs: 30% in Colectomy (COL), 22% in coronary artery bypass grafting (CABG), 19% in Total Hip Arthroplasty, and 18% in Total Knee Arthroplasty. Medicare expenditure differences between the highest and lowest deciles were because of a 5-fold difference for COL and 3-fold difference for CABG in index hospitalization cost. In contrast, for orthopedic procedures, there were 47- to 80-fold post-acute care expenditures between highest and lowest deciles. In multivariable analyses, patients with ≥3 comorbidities had significantly higher costs than healthier patients.

Conclusion:
We found that a subset of multimorbid patients was responsible for a disproportionate share of total Medicare spending, but the individual components of spending vary by procedure. These findings suggest that targeting high-cost Medicare patients (ie, hot spotting) for cost containment efforts would be a potentially effective strategy to reduce costs in surgical populations.
Utility of Time and Frequency Domain Parameters of Heart Rate Variability in the Context of Autonomic Disorders Characterized by Orthostatic Dysfunction
Authors: Baker Jacquie , Racosta Juan M. , Balint Brittany , Kimpinski Kurt 
Published: January 2018

Purpose:
The clinical significance of heart rate variability in the context of autonomic dysfunction continues to be a matter of debate. A consensus is lacking on the best heart rate variability measures for clinical purposes. Therefore, the purpose of this study was to investigate the utility of heart rate variability parameters in healthy versus autonomic dysfunction.

Methods:
Healthy young (n = 134), healthy older (n = 32), and patients with mild (postural tachycardia syndrome; n = 25) and severe (neurogenic orthostatic hypotension; n = 34) autonomic dysfunction were included. Time and frequency parameters during baseline, head-up tilt (HUT), and heart rate response to deep breathing (HRDB) were compared.

Results:
Cardiovagal time parameters were significantly reduced during HUT in healthy young and postural tachycardia syndrome (P < 0.001). Healthy young had significantly higher time parameters during baseline, HUT, and HRDB (P < 0.01). This was reflected by a significantly lower resting heart rate (HR) (61.4 ± 9.0 bpm vs. 76.8 ± 13.6 bpm; P < 0.001) and a smaller ∆HR during HUT (32.8 ± 10.5 bpm vs. 44.4 ± 13.3 bpm; P < 0.001). Time parameters increased in young and postural tachycardia syndrome during HRDB, which was characterized by a nonsignificant difference in ∆HR between both groups. Time parameters were significantly higher in healthy old versus neurogenic orthostatic hypotension at rest and during HRDB (P < 0.05). During HUT, only the SD of all normal RR intervals remained significantly higher. Heart rate changes corroborated these findings. Resting HR was significantly lower in healthy older (62.6 ± 11.0 bpm vs. 70.7 ± 12.4 bpm), and ∆HR during HRDB was significantly higher (15.9 ± 9.2 bpm vs. 3.9 ± 4.2 bpm; P < 0.001). During HUT, ∆HR showed no significant differences.

Conclusions:
Time domain parameters of heart rate variability have a greater utility than frequency parameters in clinical autonomic disorders.
Amorphous mesoporous GeO

x

anode for Na-ion batteries with high capacity and long lifespan
Authors: Shen Kangze , Lin Ning , Xu Tianjun , Han Ying , Qian Yitai 
Published: January 2018

It is recently demonstrated that amorphous Ge anode shows higher reversible Na-ion storage capacity (590 mA h g
−1
) than crystallized Ge anode (369 mA h g
−1
). Here, amorphous GeO

x

anode is prepared by a simple wet-chemistry reduction route at room temperature. The obtained amorphous GeO

x

shows a porous hierarchical architecture, accompanied with a Brunauer–Emmett–Teller surface area of 159 m
2
g
−1
and an average pore diameter of 14 nm. This unique structure enables the GeO

x

anode to enhance the Na-ion/electron diffusion rate, and buffer the volume change. As anode for Na-ion battery, high reversible capacity over 400 mA h g
−1
, fine rate capability with a capacity of 200 mA h g
−1
maintained at 3.0 A g
−1
and long-term cycling stability with 270 mA h g
−1
even over 1000 cycles at 1.0 A g
−1
are obtained.
Metatranscriptome analysis of the vaginal microbiota reveals potential mechanisms for protection against metronidazole in bacterial vaginosis
Authors: Deng Zhi-Luo , Gottschick Cornelia , Bhuju Sabin , Masur Clarissa , Abels Christoph , Wagner-Döbler Irene 
Published: January 2018

AbstractBacterial vaginosis (BV) is a prevalent multifactorial disease of women in their reproductive years characterized by a shift from the Lactobacillus spp. dominated microbial community towards a taxonomically diverse anaerobic community. For unknown reasons, some women do not respond to therapy. In our recent clinical study, out of 37 women diagnosed with BV, 31 were successfully treated with metronidazole, while 6 still had BV after treatment. To discover possible reasons for the lack of response in those patients, we performed a metatranscriptome analysis of their vaginal microbiota, comparing them to patients who responded. Seven out of 8 Cas genes of Gardnerella vaginalis were highly up-regulated in non-responding patients. Cas genes, in addition to protecting against phages, might be involved in DNA repair thus mitigating the bactericidal effect of DNA damaging agents like metronidazole. In the second part of our study, we analyzed the vaginal metatranscriptomes of four patients over three months and showed high in vivo expression of genes for pore-forming toxins in L. iners and of genes encoding enzymes for the production of hydrogen peroxide and D-lactate in L. crispatus.
Reimplementation of the Potjans-Diesmann cortical microcircuit model: from NEST to Brian
Authors: Shimoura Renan Oliveira , Kamiji Nilton Liuji , de Oliveira Pena Rodrigo Felipe , Cordeiro Vinicius Lima , Ceballos Cesar Celis , Romaro Cecilia , Roque Antonio Carlos 
Published: January 2018

1AbstractThis work targets the replicability of computational models to provide the community with tested and proven open-source models to be used in new studies and implementations. The Potjans-Diesmann model describes a cortical microcircuit containing two cell types (excitatory and inhibitory) distributed in four layers, and represents the cortical network below a surface of 1 mm2. The original implementation of the Potjans-Diesmann model was based on the NEST simulator and our goal here was to re-implement the model in the Brian 2 simulator and obtain the same results presented in the reference article. We did not replicate analyses that involve changes in the network structure. Our replicated network model presents activity dynamic patterns very similar to the ones observed in the original model, with comparisons made in terms of firing rates and synchrony and irregularity measures. In conclusion, the Potjans-Diesmann model was successfully replicated in a different platform than the one in which it was originally implemented.
Utility of the SWAN Scale for ADHD Trait-Based Genetic Research: A Validity and Polygenic Risk Study
Authors: Burton Christie L. , Wright Leah , Shan Janet , Xiao Bowei , Dupuis Annie , Goodale Tara , Shaheen S-M , Corfield Elizabeth C. , Arnold Paul D. , Schachar Russell J. , Crosbie Jennifer 
Published: January 2018

AbstractBackgroundValid and genetically-informative trait measures of psychopathology collected in the general population would provide a powerful complement to case/control genetic designs. We report the convergent, predictive and discriminant validity of the parent- and the self-report versions of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scale (SWAN) for attention-deficit/hyperactivity disorder (ADHD) traits. We tested if SWAN ADHD scores were associated with ADHD diagnosis, ADHD polygenic risk, as well as with traits and polygenic risk for co-occurring disorders such as anxiety and obsessive-compulsive disorder (OCD).MethodsWe collected parent- and self-report SWAN scores in a community sample (n=15,560; 6-18 years of age) and created norms. Sensitivity-specificity analyses determined SWAN cut-points that discriminated those with a community ADHD diagnosis (n=972) from those without a community diagnosis. We validated cut-points from the community sample in a clinical sample (266 ADHD cases; 36 controls). We tested if SWAN scores were associated with anxiety and obsessive-compulsive (OC) traits and polygenic risk for ADHD, OCD and anxiety disorders.ResultsBoth the parent- and the self-report SWAN measures showed high convergent validity with established ADHD measures and distinguished ADHD participants with high sensitivity and specificity in the community sample. Cut-points established in the community sample discriminated ADHD clinic cases from controls with a sensitivity of 86% and specificity of 94%. High parent- and self-report SWAN scores and scores above the community-based cut-points were associated with polygenic risk for ADHD. High ADHD traits were associated with high anxiety traits, but not OC traits. SWAN scores were not associated with OCD or anxiety disorder polygenic risk.ConclusionThe parent- and self-report SWAN are potentially useful in genetic research because they predict ADHD diagnoses and are associated with ADHD polygenic risk.