bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bayesian Networks and Boundedly Rational Expectations *
Authors: Spiegler Ran 
Published: March 2016

AbstractI present a framework for analyzing decision making under imperfect understanding of correlation structures and causal relations. A decision maker (DM) faces an objective long-run probability distribution p over several variables (including the action taken by previous DMs). The DM is characterized by a subjective causal model, represented by a directed acyclic graph over the set of variable labels. The DM attempts to fit this model to p , resulting in a subjective belief that distorts p by factorizing it according to the graph via the standard Bayesian network formula. As a result of this belief distortion, the DM’s evaluation of actions can vary with their long-run frequencies. Accordingly, I define a ”personal equilibrium” notion of individual behavior. The framework enables simple graphical representations of causal-attribution errors (such as coarseness or reverse causation), and provides tools for checking rationality properties of the DM’s behavior. I demonstrate the framework’s scope of applications with examples covering diverse areas, from demand for education to public policy.
Prognostic Significance of Hyponatremia in Acute Intracerebral Hemorrhage: Pooled Analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial Studies*
Authors: Carcel Cheryl , Sato Shoichiro , Zheng Danni , Heeley Emma , Arima Hisatomi , Yang Jie , Wu Guojun , Chen Guofang , Zhang Shihong , Delcourt Candice , Lavados Pablo , Robinson Thompson , Lindley Richard I. , Wang Xia , Chalmers John , Anderson Craig S. 
Published: March 2016

Objectives:
To determine the association of hyponatremia at presentation with clinical and imaging outcomes in patients with acute intracerebral hemorrhage.

Design:
Retrospective pooled analysis of prospectively collected data from 3,243 participants of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials 1 and 2 (international, multicenter, open, blinded endpoint, randomized controlled trials designed to assess the effects of early intensive blood pressure lowering in patients with acute intracerebral hemorrhage).

Setting:
Clinical hospital sites in 21 countries.

Patients:
Patients with predominantly mild-moderate severity of spontaneous intracerebral hemorrhage within 6 hours of onset and elevated systolic blood pressure (150–220 mm Hg) were included in the study.

Interventions:
Patients were assigned to receive intensive (target systolic blood pressure, < 140 mm Hg within 1 hr) or guideline-recommended (target systolic blood pressure, < 180 mm Hg) blood pressure–lowering therapy.

Measurements and Main Results:
Presentation hyponatremia was defined as serum sodium less than 135 mEq/L. The primary outcome was death at 90 days. Multivariable logistic regression was used to assess the association of hyponatremia with important clinical events. Of 3,002 patients with available data, 349 (12%) had hyponatremia. Hyponatremia was associated with death (18% vs 11%; multivariable-adjusted odds ratio, 1.81; 95% CI, 1.28–2.57; p < 0.001) and larger baseline intracerebral hemorrhage volume (multivariable adjusted, p = 0.046) but not with baseline perihematomal edema volume nor with growth of intracerebral hemorrhage or perihematomal edema during the initial 24 hours.

Conclusions:
Hyponatremia at presentation is associated with increased mortality in patients with predominantly deep and modest volume intracerebral hemorrhage through mechanisms that seem independent of growth in intracerebral hemorrhage or perihematomal edema.
A Review of the Perceptions of Healthcare Providers and Family Members Toward Family Involvement in Active Adult Patient Care in the ICU
Authors: Liput Shea A. , Kane-Gill Sandra L. , Seybert Amy L. , Smithburger Pamela L. 
Published: March 2016

Objective:
The objective of this article is to provide a summary of the perceptions of healthcare providers and family members toward their role in active patient care in the ICU and compare the views of healthcare providers with those of relatives of critically ill patients.

Data Sources:
The search was conducted using PubMed as the primary search engine and EMBASE as a secondary search engine.

Study Selection:
Studies were included if they were conducted in the ICU, had an adult patient population, and contained a discussion of active patient care, including perspective or actions of family members or healthcare providers about the active participation.

Data Extraction:
Titles and abstracts of articles identified through PubMed and EMBASE were assessed for relevancy of family involvement. The full article was reviewed of titles and abstracts involving family involvement of care in the ICU to assess if the topic was active care and if the article involved perceptions of healthcare providers or family members. The references of all selected articles were then evaluated for the inclusion of additional studies.

Data Synthesis:
Articles including perceptions of healthcare providers were grouped separately from articles including attitudes of family members. Articles that contained the perceptions of both healthcare providers and family members were considered in both groups but were evaluated with each perspective separately. Examples of specific patient care tasks that were mentioned in each article were identified.

Conclusions:
A positive attitude exists among both family members and providers toward the involvement of family members in active care tasks. Providers and family members share the attitude that a partnership is necessary and that encouragement for family members to participate is essential. The findings in this review support the need for more objective research regarding how families are caring for their loved ones and how family involvement in care is affecting patient and family outcomes.
Admission Hyperglycemia in Critically Ill Sepsis Patients: Association With Outcome and Host Response*
Authors: van Vught Lonneke A. , Wiewel Maryse A. , Klein Klouwenberg Peter M. C. , Hoogendijk Arie J. , Scicluna Brendon P. , Ong David S. Y. , Cremer Olaf L. , Horn Janneke , Bonten Marc M. J. , Schultz Marcus J. , van der Poll Tom 
Published: March 2016

Objectives:
To investigate whether admission hyperglycemia is associated with the presentation and/or outcome of sepsis, what the influence of hyperglycemia is on key host responses to sepsis, and whether hyperglycemia differentially affects patients with diabetes mellitus.

Design and Setting:
A substudy of a prospective observational cohort study was conducted in the intensive care of two tertiary hospitals between January 2011 and July 2013.

Patients:
Of all consecutive critically ill sepsis patients, admission glucose was used to stratify patients in euglycemia (71–140 mg/dL), mild hyperglycemia (141–199 mg/dL), and severe hyperglycemia (≥ 200 mg/dL), and patients with hypoglycemia were excluded. Fifteen plasma biomarkers providing insight in key host responses implicated in sepsis pathogenesis were measured on admission.

Measurements and Main Results:
Of 987 sepsis patients with admission glucose levels greater than 70 mg/dL, 519 (52.6%) had normal glucose levels, 267 (27.1%) had mild, and 201 (20.4%) severe hyperglycemia. Admission hyperglycemia was accompanied by mitigated alterations in plasma host response biomarker levels indicative of activation of the cytokine network, the vascular endothelium, and the coagulation system in patients without a history of diabetes. Severe, but not mild, admission hyperglycemia was associated with increased 30-day mortality (adjusted hazard ratio, 1.66 [95% CI, 1.24–2.23]), in both patients without diabetes (adjusted hazard ratio, 1.65 [95% CI, 1.12–2.42]) and with diabetes (adjusted hazard ratio, 1.91 [95% CI, 1.01–3.62]).

Conclusion:
Admission hyperglycemia is associated with adverse outcome of sepsis irrespective of the presence or absence of preexisting diabetes by a mechanism unrelated to exaggerated inflammation or coagulation.
Pharmacological Therapy for the Prevention and Treatment of Weakness After Critical Illness: A Systematic Review*
Authors: Shepherd Stephen J. , Newman Richard , Brett Stephen J. , Griffith David M. 
Published: March 2016

Objectives:
ICU-acquired weakness is a common complication of critical illness and can have significant effects upon functional status and quality of life. As part of preliminary work to inform the design of a randomized trial of a complex intervention to improve recovery from critical illness, we sought to identify pharmacological interventions that may play a role in this area.

Data Sources:
We systematically reviewed the published literature relating to pharmacological intervention for the treatment and prevention of ICU-acquired weakness.

Study Selection:
We searched MEDLINE, EMBASE, CINAHL+, Web of Science, and both U.S. and European trial registries up to July 2014 alongside reviews and reference lists from populations with no age or language restrictions. We included studies that reported a measure of muscle structure or physical function as an outcome measure.

Data Extraction:
We estimated pooled odds ratios and 95% CI using data extracted from published articles or where available, original data provided by the authors. Assessment of bias was performed using the Cochrane Collaboration’s risk of bias tool.

Data Synthesis:
Ten studies met the inclusion criteria. The current body of evidence does not support the use of any pharmacological agent in this setting, although maintaining euglycemia may reduce the prevalence of critical illness polyneuropathy.

Conclusions:
At present, no pharmacological intervention can be recommended to prevent or treat ICU-acquired weakness. Further research is required into this field to include more novel agents such as myostatin inhibitors. Challenges in the conduct of research in this area are highlighted.
Vemurafenib-Induced Neutrophilic Panniculitis: A New Case and Review of the Literature
Authors: Vázquez-Osorio Igor , Sánchez-Aguilar María Dolores , García-Rodiño Sara , Suárez-Peñaranda José M. , Aliste Carlos , Vázquez-Veiga Hugo 
Published: March 2016

Abstract:
Vemurafenib has proved to be useful in the treatment of patients with unresectable or metastatic melanoma harboring the BRAF-V600E mutation, with better rates of overall and progression-free survival than previous treatments. Adverse cutaneous effects, such as alopecia, pruritus, photosensitivity reactions, verrucous keratosis, keratoacanthomas, or squamous cell carcinomas, have been described. Thirty cases of vemurafenib-associated panniculitis are available in the literature with variable clinical relevance. Only 9 of them exhibited definitive evidence of neutrophilic panniculitis. They all consist of multiple lesions, usually located in the lower limbs. Histopathologically, they have been described as predominantly neutrophilic, lymphocytic, or mixed, more commonly with lobular location. We report an additional case of neutrophilic panniculitis in a 45-year-old woman treated with vemurafenib for metastatic melanoma, presenting as a single lesion on his right leg. The lesion resolved spontaneously and did not need treatment reduction. The presentation of this condition with a single lesion is particularly challenging. Recognition of this association is important given the increasing use of vemurafenib and the potential implications of treatment withdrawal.
Clear-Cell Atypical Fibroxanthoma: A Combined Immunohistochemistry Analysis
Authors: Brau Javier Cristina N. , Valentín Colón Diana C. , Sánchez Jorge L. , Sánchez Julio E. 
Published: March 2016

Abstract:
Atypical fibroxanthoma is considered to be a low-grade sarcoma, characterized by a proliferation of bizarre spindled cells. A case of a rare variant of this tumor, a clear-cell atypical fibroxanthoma, presenting with rapid growth on a 63-year-old female, is reported. The differential diagnosis of a clear cell proliferation and a review of the immunohistochemistry markers used in the diagnosis of atypical fibroxanthoma are discussed. In particular, the usefulness of markers such as CD10, procollagen 1, CD68, CD163, CD99, and S100A6, and the importance of negative markers such as S100, cytokeratin, and desmin are emphasized. Furthermore, the development of a keratoacanthoma at the site of previous Mohs surgery is recounted.
An Index Case of Cutaneous Hodgkin Lymphoma and Review of the Literature
Authors: Huong Giang , Olson Luke C. , Rippis George E. , Magro Cynthia M. 
Published: March 2016

Abstract:
Hodgkin lymphoma (HL), although a common hematopoietic malignancy, presents as a primary cutaneous form in extraordinarily rare instances. In this study, we present a remarkable case of a 76-year-old woman with a history of bony metastatic breast cancer who developed multiple subcutaneous nodules on the left neck and scalp. A biopsy revealed the histological and immunohistochemical findings of classic HL. She was treated with systemic chemotherapy and quickly achieved disease remission. Five months later, she was alive and without evidence of lymphoma, consistent with our understanding of primary cutaneous HL as an indolent variant of HL.
Symptomatic Dry Eye and Its Associated Factors: A Study of University Undergraduate Students in Ghana
Authors: Asiedu Kofi , Kyei Samuel , Boampong Frank , Ocansey Stephen 
Published: March 2016

Background:
To estimate the prevalence and risk factors of symptomatic dry eye disease (DED) among undergraduate students in a Ghanaian university.

Methods:
This cross-sectional study included 700 undergraduate students of the University of Cape Coast, aged 18 to 34 years. Participants completed questionnaires delivered directly to randomly and systematically selected subjects to detect symptomatic dry eye and its predictive factors. Symptomatic dry eye was defined as any reported symptom on the Standard Patient Evaluation Eye Dryness (SPEED) questionnaire reported as often or constant or if any symptom on the Ocular Surface Disease Index (OSDI) was reported as most of the time or all of the time. Furthermore, OSDI ≥13 and SPEED ≥6 were used to defined symptomatic dry eye and prevalence were also estimated with these criteria as secondary measures. Current symptoms of dry eye and possible risk factors such as age, gender, current alcohol drinking, use of oral contraceptives, use of computer more than an hour daily, environmental conditions, allergies, and self-medication with over-the-counter eye drops were the main outcome measures. We used logistic regression analysis to examine the associations between dry eye and its predictive factors.

Results:
Of the 700 participants, 650 completed the questionnaire. The prevalence of symptomatic dry eye was 44.3% (95% confidence interval [CI], 40.6%–48.2%). There was a significant association between symptomatic dry eye and discomfort with eyes in windy conditions (χ2=110.1; df=4; P<0.001), areas with low humidity (χ2=91.6; df=4; P<0.001), and air-conditioned rooms (χ2=89.0; df=4; P<0.001). Self-medication with over-the-counter eye drops (OR 4.20; 95% CI, 2.61–6.74; P<0.001), any allergies (OR 2.46; 95% CI, 1.42–4.29; P=0.001), and use of oral contraceptives (OR 4.04; 95% CI, 1.02–16.01; P=0.047) were predictive factors of symptomatic dry eye. Sex was predictive in univariate analysis but was not significantly associated in multivariate analysis.

Conclusions:
The prevalence of symptomatic dry eye among undergraduate students in Ghana is high and it is associated with self-medication with over-the-counter eye drops, allergies, use of oral contraceptive, windy conditions, very low humid areas, air-conditioned rooms, and sex. Relevant input directed against modifiable risks factors may have a positive impact on the well-being of undergraduate students in Ghana.
Autologous Serum Eye Drops Combined With Silicone Hydrogen Lenses for the Treatment of Postinfectious Corneal Persistent Epithelial Defects
Authors: Wang Wei-Yu , Lee Yu-Kuei , Tsai Shih-Hao , Lin Yen-Chun , Chen Yan-Ming 
Published: March 2016

Objective:
To evaluate the clinical effect of combined topical autologous serum eye drops (ASEs) and silicone hydrogel contact lens (CLs) for the treatment of corneal persistent epithelial defects (PEDs) after infectious corneal ulcers.

Methods:
We conducted a retrospective chart review of 12 patients with postinfectious corneal PEDs who were unsuccessfully treated with conventional medical management and were then treated with combined topical 20% (v/v) ASEs and silicone hydrogel CLs from July 1, 2011, to June 30, 2014. The corneal ulcers were all initially managed with antibiotic eye drops until the infiltrates resolved but the lesions failed to epithelialize. The clinical effects of the combined treatment were evaluated.

Results:
The PEDs healed in all 12 patients within 2 weeks. The combined treatment was associated with an improvement of best-corrected visual acuity (BCVA) at the final 3-month follow-up examination. All patients responded well to the combined treatment and no adverse events were noted in any patient.

Conclusions:
The combined use of silicone hydrogel CLs and ASEs can successfully treat postinfectious corneal PEDs and prevent continuous corneal melting during acute disease.
Epac–protein kinase C alpha signaling in purinergic P2X3R-mediated hyperalgesia after inflammation
Authors: Gu Yanping , Li Guangwen , Chen Yong , Huang Li-Yen Mae 
Published: March 2016

Abstract
Sensitization of purinergic P2X3 receptors (P2X3Rs) is a major mechanism contributing to injury-induced exaggerated pain responses. We showed in a previous study that cyclic adenosine monophosphate (cAMP)–dependent guanine nucleotide exchange factor 1 (Epac1) in rat sensory dorsal root ganglia (DRGs) is upregulated after inflammatory injury, and it plays a critical role in P2X3R sensitization by activating protein kinase C epsilon (PKCε) inside the cells. protein kinase C epsilon has been established as the major PKC isoform mediating injury-induced hyperalgesic responses. On the other hand, the role of PKCα in receptor sensitization was seldom considered. Here, we studied the participation of PKCα in Epac signaling in P2X3R-mediated hyperalgesia. The expression of both Epac1 and Epac2 and the level of cAMP in DRGs are greatly enhanced after complete Freund adjuvant (CFA)–induced inflammation. The expression of phosphorylated PKCα is also upregulated. Complete Freund adjuvant (CFA)–induced P2X3R-mediated hyperalgesia is not only blocked by Epac antagonists but also by the classical PKC isoform inhibitors, Go6976, and PKCα-siRNA. These CFA effects are mimicked by the application of the Epac agonist, 8-(4-chlorophenylthio)-2 -O-methyl-cAMP (CPT), in control rats, further confirming the involvement of Epacs. Because the application of Go6976 prior to CPT still reduces CPT-induced hyperalgesia, PKCα is downstream of Epacs to mediate the enhancement of P2X3R responses in DRGs. The pattern of translocation of PKCα inside DRG neurons in response to CPT or CFA stimulation is distinct from that of PKCε. Thus, in contrast to prevalent view, PKCα also plays an essential role in producing complex inflammation-induced receptor-mediated hyperalgesia.
Strain Echocardiography Parameters Correlate With Disease Severity in Children and Infants With Sepsis*
Authors: Haileselassie Bereketeab , Su Erik , Pozios Iraklis , Fiskum Teresa , Thompson Reid , Abraham Theodore 
Published: March 2016

Objectives:
In the progression of severe sepsis, sepsis-induced myocardial dysfunction contributes to severity of illness and ultimate mortality. Identification of sepsis-induced myocardial dysfunction causing depressed cardiac function during critical illness has implications for ongoing patient management. However, assessing pediatric cardiac function traditionally relies on echocardiographic qualitative assessment and measurement of left ventricular ejection fraction or fractional shortening. These metrics are often insensitive for detecting early or regional myocardial dysfunction. Strain echocardiography is a contemporary echocardiographic modality that may be more sensitive to perturbations in cardiac function. This investigation hypothesizes that strain echocardiography metrics correlate with severity of illness in pediatric sepsis despite normal fractional shortening.

Design:
Single-center retrospective observational study.

Setting:
Tertiary 36-bed medical/surgical PICU.

Patients:
Pediatric patients admitted with sepsis.

Interventions:
None.

Measurements and Main Results:
Twenty-three children with sepsis received an echocardiogram in the study period. Patients with sepsis demonstrated abnormal peak systolic longitudinal strain for age (mean = –0.13 ± 0.07; p < 0.01) and low normal peak systolic circumferential strain (mean = –0.17 ± 0.14; p = 0.02) compared with internal controls as well as previously published normal values. Depressed strain was demonstrated in the septic patients despite having normal fractional shortening (mean = 0.41; 95% CI, 0.38–0.43). On initial echocardiographic imaging, worsening peak systolic longitudinal strain was associated with increasing lactate (p = 0.04).

Conclusions:
Pediatric patients with sepsis demonstrate evidence of depressed strain echocardiography parameters not shown by fractional shortening that correlate with clinical indices of sepsis severity. Whether strain echocardiography could eventually assist in grading pediatric sepsis severity and affect management is an area for potential future investigation.
Epidemiology of Polypharmacy and Potential Drug–Drug Interactions Among Pediatric Patients in ICUs of U.S. Children’s Hospitals*
Authors: Dai Dingwei , Feinstein James A. , Morrison Wynne , Zuppa Athena F. , Feudtner Chris 
Published: March 2016

Objectives:
Polypharmacy is common in hospitalized children in the United States and has been identified as a major risk factor for exposure to potential drug–drug interactions. Little is known about the characteristics and prevalence of exposure of pediatric patients to polypharmacy and potential drug–drug interactions in PICUs.

Design:
Retrospective cohort study using the Pediatric Health Information System database.

Setting:
Forty-two freestanding children’s hospitals throughout the United States.

Patients:
A total of 54,549 patients less than 18 years old cared for in PICUs in 2011. Patients in neonatal ICUs were not included.

Measurements and Main Results:
PICU patients were on average exposed to 10 distinct drugs each hospital day and to 20 drugs cumulatively during their hospitalization. Seventy-five percent of patients were exposed to greater than or equal to one potential drug–drug interaction regardless of severity level, 6% to greater than or equal to one contraindicated potential drug–drug interaction, 69% to greater than or equal to one major potential drug–drug interaction, 57% to greater than or equal to one moderate potential drug–drug interaction, 19% to greater than or equal to one minor potential drug–drug interaction. Potential drug–drug interaction exposures were significantly associated with specific diagnoses (p < 0.001), presence of complex chronic conditions (p < 0.001), increasing number of total distinct drugs used (p < 0.001), increasing length of stay in PICU (p < 0.001), and white race (p < 0.001).

Conclusions:
Many PICU patients are exposed to substantial polypharmacy and potential drug–drug interactions. Future research should identify the risk of adverse drug events following specific potential drug–drug interaction exposures, especially the risk of adverse drug events due to multiple potential drug–drug interaction exposures, and determine the probability and magnitude of the actual harm (if any) for each specific potential drug–drug interaction, especially for multiple potential drug–drug interaction exposures.