bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional lesional neurosurgery for tremor—a protocol for a systematic review and meta-analysis
Authors: Schreglmann Sebastian R , Krauss Joachim K , Chang Jin Woo , Bhatia Kailash P , Kägi Georg 
Published: May 2017

IntroductionThe recent introduction of incision-less lesional neurosurgery using Gamma Knife and MRI-guided focused ultrasound has revived interest in lesional treatment options for tremor disorders. Preliminary literature researches reveal that the consistency of treatment effects after lesional neurosurgery for tremor has not formally been assessed yet. Similarly, the efficacy of different targets for lesional treatment and incidence of persistent side effects of lesional neurosurgical interventions has not been comprehensively assessed. This work therefore aims to describe a suitable process how to review the existing literature on efficacy and persistent side effects of lesional neurosurgical treatment for tremor due to Parkinson’s disease, essential tremor, multiple sclerosis and midbrain/rubral tremor.Methods and analysisWe will search electronic databases (Medline, Cochrane) and reference lists of included articles for studies reporting lesional interventions for tremor in cohorts homogeneous for tremor aetiology and intervention (technique and target). We will include cohorts with a minimum number of five subjects and follow-up of 2 months. One investigator will perform the initial literature search and two investigators then independently decide which references to include for final efficacy and safety analysis. After settling of disagreement, data will be extracted from articles using a standardised template. We will perform a random-effect meta-analysis calculating standardised mean differences (Hedge’s g) for comparison in Forest plots and subgroup analysis after assessment of heterogeneity using I2statistics.Ethics and disseminationThis study will summarise the available evidence on the efficacy of lesional interventions for the most frequent tremor disorders, as well as for the incidence rate of persisting side effects after unilateral lesional treatment. This data will be useful to guide future work on incision-less lesional interventions for tremor.Systematic review registrationThis study has been registered with the PROSPERO database (no. CRD42016048049).
The impact of duty cycle workflow on sign-out practices: a qualitative study of an internal medicine residency program in Maryland, USA
Authors: Lee Soo-Hoon , Desai Sanjay V , Phan Phillip H 
Published: May 2017

ObjectivesAlthough JCAHO requires a standardised approach to handoffs, and while many standardised protocols have been tested, sign-out practices continue to vary. We believe this is due to the variability in workflow during inpatient duty cycle. We investigate the impact of such workflows on intern sign-out practices.DesignWe employed a prospective, grounded theory mixed-method design.SettingThe study was conducted at a residency programme in the mid-Atlantic USA. Two observers randomly evaluated three types of daily sign-outs for 1 week every 3 months from September 2013 to March 2014. The compliance of each observed behaviour to JCAHO’s Handoff Communication Checklist was recorded.ParticipantsThirty one interns conducting 134 patient sign-outs were observed randomly among the 52 in the programme.ResultsIn the 06:00 to 07:00 sign-back, the night-cover focused on providing information on overnight events to the day interns. In the 11:00 to 12:00 sign-out, the night-cover focused on transferring task accountability to a day-cover intern before departure. In the 20:00 to 21:00 sign-out, the day interns focused on transferring responsibility of their patients to a night-cover.ConclusionDifferent sign-out periods had different emphases regarding information exchange, personal responsibility and task accountability. Sign-outs are context-specific, implying that across-the-board standardised sign-out protocols are likely to have limited efficacy and compliance. Standardisation may need to be relative to the specific type and purpose of each sign-out to be supported by interns.
Mountain rescue cardiopulmonary resuscitation: a comparison between manual and mechanical chest compressions during manikin cardio resuscitation
Authors: Thomassen Oyvind , Skaiaa Sven Christjar , Assmuss Jorg , Østerås Øyvind , Heltne Jon Kenneth , Wik Lars , Brattebo Guttorm 
Published: May 2017

AimChest compression devices are useful during mountain rescue but may cause a delay in transport if not immediately available. The aims of this prospective observational study were to compare manual and mechanical cardiopulmonary resuscitation (CPR) during transport on a sledge connected to a snowmobile with a non-moving setting and to compare CPR quality between manual and two mechanical chest compression devices.MethodsSixteen healthcare providers simulated four different combined CPR scenarios on a sledge in a non-moving setting and during transport and two mechanical chest compression devices during transport on the sledge. The study was conducted in May 2015 in a mountain in Norway. The primary outcome measures were compression rate (compressions per minute), compression depth in millimetres, leaning (incomplete chest wall release after compression in millimetres) and chest compression fraction (fraction of total time were compression were performed). The results were analysed by descriptive and graphical methods and paired t-tests were used to compare the differences between techniques.ResultsWe did not observe a significant difference between moving and non-moving conditions with respect to manual compression rate (p=0.34), compression depth (p=0.50) or leaning (p=0.92). However, both the manual compression depth (p<0.001) and the leaning (p=0.04) showed a significantly larger variance during the moving runs.ConclusionManual chest compression is possible on a snowmobile during transport even in challenging terrain. This experimental study shows that high-quality chest compressions and manual ventilation can be performed in an intubated patient during a short-term transportation on a sledge.
Security of Cyber-Physical Systems in the Presence of Transient Sensor Faults
Authors: Park Junkil , Ivanov Radoslav , Weimer James , Pajic Miroslav , Son Sang Hyuk , Lee Insup 
Published: May 2017

This article is concerned with the security of modern Cyber-Physical Systems in the presence of transient sensor faults. We consider a system with multiple sensors measuring the same physical variable, where each sensor provides an interval with all possible values of the true state. We note that some sensors might output faulty readings and others may be controlled by a malicious attacker. Differing from previous works, in this article, we aim to distinguish between faults and attacks and develop an attack detection algorithm for the latter only. To do this, we note that there are two kinds of faults—transient and permanent; the former are benign and short-lived, whereas the latter may have dangerous consequences on system performance. We argue that sensors have an underlying transient fault model that quantifies the amount of time in which transient faults can occur. In addition, we provide a framework for developing such a model if it is not provided by manufacturers.
Attacks can manifest as either transient or permanent faults depending on the attacker’s goal. We provide different techniques for handling each kind. For the former, we analyze the worst-case performance of sensor fusion over time given each sensor’s transient fault model and develop a filtered fusion interval that is guaranteed to contain the true value and is bounded in size. To deal with attacks that do not comply with sensors’ transient fault models, we propose a sound attack detection algorithm based on pairwise inconsistencies between sensor measurements. Finally, we provide a real-data case study on an unmanned ground vehicle to evaluate the various aspects of this article.
Characterization and Evaluation of Mobile CrowdSensing Performance and Energy Indicators
Authors: Pinciroli Riccardo , Distefano Salvatore 
Published: May 2017

Mobile Crowdsensing (MCS) is a contribution-based paradigm involving mobiles in pervasive application deployment and operation, pushed by the evergrowing and widespread dissemination of personal devices. Nevertheless, MCS is still lacking of some key features to become a disruptive paradigm. Among others, control on performance and reliability, mainly due to the contribution churning. For mitigating the impact of churning, several policies such as redundancy, over-provisioning and checkpointing can be adopted but, to properly design and evaluate such policies, specific techniques and tools are required.
This paper attempts to fill this gap by proposing a new technique for the evaluation of relevant performance and energy figures of merit for MCS systems. It allows to get insightson them from three different perspectives: end users, contributors and service providers. Based on queuing networks (QN), the proposed technique relaxes the assumptions of existing solutions allowing a stochastic characterization of underlying phenomena through general, non exponential distributions. To cope with the contribution churning it extends the QN semantics of a service station with variablenumber of servers, implementing proper mechanisms to manage the memory issues thus arising in the underlying process. This way, a preliminary validation of the proposed QN model against an analytic one and an in depth investigation also considering checkpointing have been performed through a case study.
Cervical vagus nerve stimulation augments spontaneous discharge in second- and higher-order sensory neurons in the rat nucleus of the solitary tract
Authors: Beaumont Eric , Campbell Regenia P. , Andresen Michael C. , Scofield Stephanie , Singh Krishna , Libbus Imad , KenKnight Bruce H. , Snyder Logan , Cantrell Nathan 
Published: May 2017

Vagus nerve stimulation (VNS) currently treats patients with drug-resistant epilepsy, depression, and heart failure. The mild intensities used in chronic VNS suggest that primary visceral afferents and central nervous system activation are involved. Here, we measured the activity of neurons in the nucleus of the solitary tract (NTS) in anesthetized rats using clinically styled VNS. Our chief findings indicate that VNS at threshold bradycardic intensity activated NTS neuron discharge in one-third of NTS neurons. This VNS directly activated only myelinated vagal afferents projecting to second-order NTS neurons. Most VNS-induced activity in NTS, however, was unsynchronized to vagal stimuli. Thus, VNS activated unsynchronized activity in NTS neurons that were second order to vagal afferent C-fibers as well as higher-order NTS neurons only polysynaptically activated by the vagus. Overall, cardiovascular-sensitive and -insensitive NTS neurons were similarly activated by VNS: 3/4 neurons with monosynaptic vagal A-fiber afferents, 6/42 neurons with monosynaptic vagal C-fiber afferents, and 16/21 polysynaptic NTS neurons. Provocatively, vagal A-fibers indirectly activated C-fiber neurons during VNS. Elevated spontaneous spiking was quantitatively much higher than synchronized activity and extended well into the periods of nonstimulation. Surprisingly, many polysynaptic NTS neurons responded to half the bradycardic intensity used in clinical studies, indicating that a subset of myelinated vagal afferents is sufficient to evoke VNS indirect activation. Our study uncovered a myelinated vagal afferent drive that indirectly activates NTS neurons and thus central pathways beyond NTS and support reconsideration of brain contributions of vagal afferents underpinning of therapeutic impacts.NEW & NOTEWORTHY Acute vagus nerve stimulation elevated activity in neurons located in the medial nucleus of the solitary tract. Such stimuli directly activated only myelinated vagal afferents but indirectly activated a subpopulation of second- and higher-order neurons, suggesting that afferent mechanisms and central neuron activation may be responsible for vagus nerve stimulation efficacy.
Noninvasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension
Authors: Bonnet Benjamin , Jourdan Franck , du Cailar Guilhem , Fesler Pierre 
Published: May 2017

End-systolic left ventricular (LV) elastance ( Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection (“ejection P-V curve” method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship ( r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance ( Ea) was compensated by a parallel increase in Ees without change in Ea/ Ees. In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states. NEW & NOTEWORTHY The use of real-time three-dimensional echocardiography-derived left ventricular volumes in conjunction with carotid tonometry was found to be reproducible and sensitive enough to detect expected differences in left ventricular elastance in arterial hypertension. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.
Disease Stage–Dependent Changes in Cardiac Contractile Performance and Oxygen Utilization Underlie Reduced Myocardial Efficiency in Human Inherited Hypertrophic Cardiomyopathy
Authors: Güçlü Ahmet , Knaapen Paul , Harms Hendrik J. , Parbhudayal Rahana Y. , Michels Michelle , Lammertsma Adriaan A. , van Rossum Albert C. , Germans Tjeerd , van der Velden Jolanda 
Published: May 2017

Background—
Reduced myocardial efficiency represents a target for therapy in hypertrophic cardiomyopathy although therapeutic benefit may depend on disease stage. Here, we determined disease stage–dependent changes in myocardial efficiency and effects of myectomy surgery.

Methods and Results—

Myocardial external efficiency (MEE) was determined in 27 asymptomatic mutation carriers (genotype positive/phenotype negative), 10 patients with hypertrophic obstructive cardiomyopathy (HOCM), 10 patients with aortic valve stenosis, and 14 healthy individuals using [
11
C]-acetate positron emission tomography and cardiovascular magnetic resonance imaging. Follow-up measurements were performed in HOCM and aortic valve stenosis patients 4 months after surgery. External work did not differ in HOCM compared with controls, whereas myocardial oxygen consumption was lower in HOCM. Because of a higher cardiac mass, total cardiac oxygen consumption was significantly higher in HOCM than in controls and genotype positive/phenotype negative. MEE was significantly lower in genotype positive/phenotype negative than in controls (28±6% versus 42±6%) and was further decreased in HOCM (22±5%). In contrast to patients with aortic valve stenosis, MEE was not improved in patients with HOCM after surgery, which was explained by opposite changes in the septum (decrease) and lateral (increase) wall.

Conclusions—
Different mechanisms underlie reduced MEE at the early and advanced stage of hypertrophic cardiomyopathy. The initial increase and subsequent reduction in myocardial oxygen consumption during disease progression indicates that energy deficiency is a primary mutation-related event, whereas mechanisms secondary to disease remodeling underlie low MEE in HOCM. Our data highlight that the benefit of therapies to improve energetic status of the heart may vary depending on the disease stage and that treatment should be initiated before cardiac remodeling.
Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium
Authors: Goldberg Ronald B. , Aroda Vanita R. , Bluemke David A. , Barrett-Connor Elizabeth , Budoff Matthew , Crandall Jill P. , Dabelea Dana , Horton Edward S. , Mather Kieren J. , Orchard Trevor J. , Schade David , Watson Karol , Temprosa Marinella 
Published: May 2017

Background:
Despite the reduced incidence of coronary heart disease with intensive risk factor management, people with diabetes mellitus and prediabetes remain at increased coronary heart disease risk. Diabetes prevention interventions may be needed to reduce coronary heart disease risk. This approach was examined in the DPP (Diabetes Prevention Program) and the DPPOS (Diabetes Prevention Program Outcome Study), a long-term intervention study in 3234 subjects with prediabetes (mean±SD age, 64±10 years) that showed reduced diabetes risk with lifestyle and metformin compared with placebo over 3.2 years.

Methods:
The DPPOS offered periodic group lifestyle sessions to all participants and continued metformin in the originally randomized metformin group. Subclinical atherosclerosis was assessed in 2029 participants with coronary artery calcium (CAC) measurements after an average of 14 years of follow-up. The CAC scores were analyzed continuously as CAC severity and categorically as CAC presence (CAC score >0) and reported separately in men and women.

Results:

There were no CAC differences between lifestyle and placebo intervention groups in either sex. CAC severity and presence were significantly lower among men in the metformin versus the placebo group (age-adjusted mean CAC severity, 39.5 versus 66.9 Agatston units,
P
=0.04; CAC presence, 75% versus 84%,
P
=0.02), but no metformin effect was seen in women. In multivariate analysis, the metformin effect in men was not influenced by demographic, anthropometric, or metabolic factors; by the development of diabetes mellitus; or by use/nonuse of statin therapy.

Conclusions:
Metformin may protect against coronary atherosclerosis in prediabetes and early diabetes mellitus among men.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00038727.
Long‐Term Outcomes of Patients With Mediastinal Radiation–Associated Severe Aortic Stenosis and Subsequent Surgical Aortic Valve Replacement: A Matched Cohort Study
Authors: Donnellan Eoin , Masri Ahmad , Johnston Douglas R. , Pettersson Gosta B. , Rodriguez L. Leonardo , Popovic Zoran B. , Roselli Eric E. , Smedira Nicholas G. , Svensson Lars G. , Griffin Brian P. , Desai Milind Y. 
Published: May 2017

Background

Cardiac disease after mediastinal radiotherapy for thoracic malignancy (
chest radiotherapy [XRT]
) often manifests as progressive aortic stenosis. In patients with
XRT
‐induced severe
aortic stenosis
undergoing surgical aortic valve replacement (
SAVR
), we sought to: (1) study long‐term survival and compare these patients with a matched cohort undergoing
SAVR
during the same time frame; and (2) identify potential predictors of long‐term mortality.

Methods and Results

We studied patients with symptomatic severe
aortic stenosis
undergoing
SAVR
at our institution, of which there were 172 mediastinal
XRT
patients (63±13 years, 62% women) matched in a 1:1 fashion (based on age, sex, time of surgery, and
aortic valve
area) with 172 non‐
XRT
patients (comparison group). Baseline clinical and postoperative data were obtained. Society of Thoracic Surgeons score was calculated and mortality was recorded. In the
XRT
group, the median
Society of Thoracic Surgeons
score was 4% (interquartile range 2–13), while mean left ventricular ejection fraction, left ventricular stroke volume index, and mean
aortic valve
gradient were 54±11%, 38±14 mL/m
2
, and 39±11 mm Hg, respectively. In the entire cohort, 27% and 34% of patients underwent concomitant coronary artery bypass grafting and aortic surgery at the time of
SAVR
, respectively. Thirty‐day/in‐hospital deaths occurred in 4 (2%)
patients in the XRT
group and 0 patients in the comparison group. At 6±3 years of follow‐up, on matched group analysis, there were 95 (28%) deaths (83 [48%] in
the XRT
group versus 12 [7%] in the comparison group (log‐rank 89,
P
<0.001). On multivariable Cox survival analysis, in the whole cohort, higher
Society of Thoracic Surgeons
score (hazard ratio, 1.14; 95% CI, 1.03–1.26) and mediastinal
XRT
(
hazard ratio,
8.12; 95% CI, 4.26–15.64) were associated with increased longer‐term mortality (both
P
<0.01).

Conclusions

In patients with severe
aortic stenosis
undergoing
SAVR
, patients with prior mediastinal
XRT
have significantly worse longer‐term survival versus a matched cohort.
Resistant Atherosclerosis
Authors: Spence J. David , Solo Karla 
Published: May 2017

Background and Purpose—
Recent studies indicate that patients with lower levels of low-density lipoprotein cholesterol (LDL-C) have greater regression of coronary plaque. In 2002, we found that carotid plaque progression doubled cardiovascular risk. In 2003, we therefore implemented a new approach, treating arteries instead of risk factors. Since then, we have seen many patients with carotid plaque progression despite very low levels of LDL-C, suggesting other causes of atherosclerosis. We studied the relationship of achieved LDL-C and change in LDL-C to progression/regression of atherosclerosis, before and after 2003.

Methods—
All 4512 patients in our clinic database with at least 2 measurements of LDL-C and carotid total plaque area approximately a year apart and complete data for analyses (n=2025 before and 2487 after December 31, 2003) were included in the study.

Results—

Baseline total plaque area was significantly higher after 2003 (129.56±134.32 versus 113.33±121.52 mm
2
;
P
<0.0001), and plaque progression was significantly less after 2003 (2.94±37.11 versus 12.62±43.24 mm
2
;
P
<0.0001). Many patients with LDL-C <1.8 mm had plaque progression (47.5%), and change in LDL-C was not correlated with plaque progression/regression. Increasing age and serum creatinine contributed to resistant atherosclerosis.

Conclusions—
Many patients have Resistant Atherosclerosis, failing to achieve regression of atherosclerosis despite low levels of LDL-C. Instead of relying on LDL-C, measuring plaque burden may be a more useful way of assessing individual response to therapy, particularly in resistant atherosclerosis.