bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Hybrid Simulation-Based Pre-Professional Physical Therapist Intensive Care Unit Course
Authors: Bishop Kathy Lee , Sharp Jennifer , Ohtake Patricia J. 
Published: March 2017

Background and Purpose:
There is demand for physical therapists to practice in intensive care units (ICUs); however, many physical therapists lack the specialized knowledge and skills to provide these services. Immersive simulation is an ideal instructional design strategy for learning ICU rehabilitation skills because simulation provides safe, low-risk environments to master high-risk interventions. This case report describes an elective hybrid pre-professional physical therapist course that incorporates simulation-based learning experiences (SBLEs) with clinical mentoring to prepare students for formal ICU internships.

Case Description:
Eight final-year physical therapist students participated in this course. The goal of this course was to facilitate the development of students interested in specializing in ICU practice. Course objectives included acquiring the knowledge, communication skills, and clinical skills essential for participating in mentored clinical ICU internships. Educational strategies included lectures, SBLEs, and clinical ICU experiences.

Outcomes:
All students successfully completed the course, earned the American Heart Association Advance Cardiac Life Support certification, and were identified by ICU physical therapist clinical instructors as ready for formal ICU internships. Stakeholders positively reviewed the course. One year following the course, 4 of 8 students were employed in acute care and/or ICU settings.

Discussion:
This elective course used a combination of lectures, SBLEs, and clinical experiences to successfully prepare physical therapist students for mentored ICU internships and employment in acute and critical care practice settings. More research is required to evaluate the simulation pedagogy (structure, types of cases, and time in simulation) and criteria for determining student competence level for ICU practice.
Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma
Authors: Glikson Eran , Yousovich Ruth , Mansour Jobran , Wolf Michael , Migirov Lela , Shapira Yisgav 
Published: March 2017

Objective:
To evaluate the clinical parameters, outcomes, and complications of transcanal endoscopic ear surgeries for middle ear cholesteatoma.

Study Design:
Retrospective study.

Setting:
Tertiary university-affiliated medical center.

Patients:
Adult patients (age >18) who underwent transcanal endoscopic ear surgeries for cholesteatoma, between March 2009 and March 2015.

Intervention:
Transcanal endoscopic surgery was indicated when the cholesteatoma did not extend posterior to the anterior limb of the lateral semicircular canal. Rigid endoscopes 4 and 2.7 mm in diameter, 0, 30, 45, and 70 degrees were used with angled picks, suction, and forceps.
Preoperative assessment included high-resolution computed tomography of the temporal bones and/or non echo-planar diffusion-weighted magnetic resonance imaging and pure-tone audiometry.

Main Outcome Measures:
Residual or recurrent disease was diagnosed by clinical examination and/or magnetic resonance imaging findings consistent with cholesteatoma. Intra- and postoperative complications, pre- and postoperative audiometric results were recorded.

Results:
Sixty operations (56 patients, mean age = 43.6) were included.
Six operations (10%) were performed under local anesthesia. The most common sites of cholesteatoma involvement were: posterior epitympanum (n = 51, 91%), anterior epitympanum (n = 19, 33.9%), posterior mesotympanum (n = 13, 23.2%), and sinus tympani (n = 11, 19.6%). Intraoperative ossicular chain reconstruction was performed in 18 (30%) cases.
Our overall residual and recurrence rates were 10% (n = 6) and 8.3% (n = 5), respectively, with mean duration of follow up of 35 months. The most common sites of residual disease were the mastoid cavity/antrum (n = 3, 50%), tympanic cavity, and posterior mesotympanum. Overall minor and major complication rates were 16.6 and 6%, respectively.

Conclusions:
Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.
Cochlear Implant in Severe Impaired Psychiatric Patients: A Case Series
Authors: Herisanu Ioana T. , Praetorius Mark , Mattern Margarete 
Published: March 2017

Objective:
Psychotic disorders and intelligence deficiencies are no longer contraindications for cochlear implantation regarding the revised German guidelines from May 2012. This article aims to evaluate the outcome of patients with severe psychiatric comorbidities. Therefore the database of the Cochlear Implant Center of the University Hospital of Heidelberg was investigated.

Study Design:
Retrospective case review.

Methods:
We present three patients who received a cochlear implant (CI) despite a serious psychiatric disorder. Two were sent from psychiatrists asking if a CI was possible for their profound hearing loss. One patient had acoustic hallucinations and a recurrent depressive disorder, the other had a schizophrenic psychosis and a minor impairment of intelligence. The third patient had a recurrent depressive disorder, a posttraumatic stress disorder, a chronic pain disorder, and paranoid personality traits. We discuss the preoperative diagnosis, course of diseases, and psychosocial situation.

Results:
All three patients received a CI and rehabilitation in the Cochlear Implant Center of the University Hospital of Heidelberg. All three of them opted for a second implant and developed a good hearing outcome. Free field understanding of words in quite is for all three of them over 60% in the Freiburger monosyllable test with two implants, similar to nonpsychiatric patients’ results. No patient has acceptance problems. In the long run, no aggravation of the psychiatric diseases occurred.

Conclusion:
With interdisciplinary evaluation, a cochlear implantation is possible in severely impaired psychiatric patients. For a good result the indication is to be discussed interdisciplinary.
Diagnostic Yield of Upper and Lower Gastrointestinal Endoscopies in Children in a Tertiary Centre
Authors: Thomson Mike , Sharma Shishu 
Published: March 2017

ABSTRACTIntroduction:Endoscopy is integral to the diagnosis and management of many gastrointestinal problems in children. Recently the number of endoscopic procedures performed has increased considerably worldwide raising questions about their appropriateness and cost‐efficacy.Objectives:The aim of the study was to determine the diagnostic yield (the likelihood that a procedure or test will provide information required to establish a diagnosis) of endoscopy in a paediatric population in a large tertiary referral centre and to determine the terminal ileum intubation (TII) rate of paediatric ileocolonosocopy (IC) in an active training environment and compare with previously calculated rates.Methods:Random selection of cases from a theatre electronic database from a 30‐month period covering April 2012 to October 2014. The data were collected for initial presenting symptoms; age at diagnosis; indications for endoscopy; endoscopic findings; histopathological findings; and any change in management postendoscopic procedure. The diagnostic yield of the endoscopies and the TII rate of IC were calculated. Change in and contribution to management was assessed.Results:Median age 9.58 (0.5–16.5) years and M:F ratio 1:1.42. The positive diagnostic yield was 18.9% for oesophago‐gastro‐duodenoscopy alone, 32.6% for IC alone, and 39.2% when both occurred. In 45% management was actively changed due to endoscopy/histopathology findings and a significant management contribution occurred in all patients. TII was achieved in 98% of cases, which compares favourably to a TII rate of 89% at the same centre during the period 2009 to 2011.Conclusions:Diagnostic yield was 32.6% for IC and 39.2% when oesophago‐gastro‐duodenoscopy also occurred. A TII rate of 98% should be achievable in children. A change in management occurred in 45% and as a significant negative finding may be as important as a positive diagnosis for exclusion of suspected disorders, with consequent reassurance and change in management. Contribution to management was therefore identified in all cases.
Early Presence of Sleep Spindles on Electroencephalography Is Associated With Good Outcome After Pediatric Cardiac Arrest
Authors: Ducharme-Crevier Laurence , Press Craig A. , Kurz Jonathan E. , Mills Michele G. , Goldstein Joshua L. , Wainwright Mark S. 
Published: March 2017

Objectives:
The role of sleep architecture as a biomarker for prognostication after resuscitation from cardiac arrest in children hospitalized in an ICU remains poorly defined. We sought to investigate the association between features of normal sleep architecture in children after cardiac arrest and a favorable neurologic outcome at 6 months.

Design:
Retrospective review of medical records and continuous electroencephalography monitoring.

Setting:
Cardiac and PICU of a tertiary children’s hospital.

Patients:
All patients from 6 months to 18 years old resuscitated from cardiac arrest who underwent continuous electroencephalography monitoring in the first 24 hours after in- or out-of-hospital cardiac arrest from January 2010 to June 2015.

Interventions:
None.

Measurements and Main Results:
Thirty-four patients underwent continuous electroencephalography monitoring after cardiac arrest. The median age was 6.1 years (interquartile range, 1.5–12.5 yr), 20 patients were male (59%). Most cases (n = 23, 68%) suffered from in-hospital cardiac arrest. Electroencephalography monitoring was initiated a median of 9.3 hours (5.8–14.9 hr) after return of spontaneous circulation, for a median duration of 14.3 hours (6.0–16.0 hr) within the first 24-hour period after the cardiac arrest. Five patients had normal spindles, five had abnormal spindles, and 24 patients did not have any sleep architecture. The presence of spindles was associated with a favorable neurologic outcome at 6-month postcardiac arrest (p = 0.001).

Conclusions:
Continuous electroencephalography monitoring can be used in children to assess spindles in the ICU. The presence of spindles on continuous electroencephalography monitoring in the first 24 hours after resuscitation from cardiac arrest is associated with a favorable neurologic outcome. Assessment of sleep architecture on continuous electroencephalography after cardiac arrest could improve outcome prediction.
Prone Positioning Improves Ventilation Homogeneity in Children With Acute Respiratory Distress Syndrome
Authors: Lupton-Smith Alison , Argent Andrew , Rimensberger Peter , Frerichs Inez , Morrow Brenda 
Published: March 2017

Objectives:
To determine the effect of prone positioning on ventilation distribution in children with acute respiratory distress syndrome.

Design:
Prospective observational study.

Setting:
Paediatric Intensive Care at Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

Patients:
Mechanically ventilated children with acute respiratory distress syndrome.

Interventions:
Electrical impedance tomography measures were taken in the supine position, after which the child was turned into the prone position, and subsequent electrical impedance tomography measurements were taken.

Measurements and Main Results:
Thoracic electrical impedance tomography measures were taken at baseline and after 5, 20, and 60 minutes in the prone position. The proportion of ventilation, regional filling characteristics, and global inhomogeneity index were calculated for the ventral and dorsal lung regions. Arterial blood gas measurements were taken before and after the intervention. A responder was defined as having an improvement of more than 10% in the oxygenation index after 60 minutes in prone position. Twelve children (nine male, 65%) were studied. Four children were responders, three were nonresponders, and five showed no change to prone positioning. Ventilation in ventral and dorsal lung regions was no different in the supine or prone positions between response groups. The proportion of ventilation in the dorsal lung increased from 49% to 57% in responders, while it became more equal between ventral and dorsal lung regions in the prone position in nonresponders. Responders showed greater improvements in ventilation homogeneity with R
2 improving from 0.86 ± 0.24 to 0.98 ± 0.02 in the ventral lung and 0.91 ± 0.15 to 0.99 ± 0.01 in the dorsal lung region with time in the prone position.

Conclusions:
The response to prone position was variable in children with acute respiratory distress syndrome. Prone positioning improves homogeneity of ventilation and may result in recruitment of the dorsal lung regions.
Medication Reconciliation During Hospitalization and in Hospital-Home Interface: An Observational Retrospective Study
Authors: Volpi Elisabetta , Giannelli Alessandro , Toccafondi Giulio , Baroni Monica , Tonazzini Sara , Alduini Stefania , Biagini Stefania , Gini Rosa , Bellandi Tommaso , Emdin Michele 
Published: March 2017

Objective
Medication errors are one of the leading causes of patient harms. Medication reconciliation is a fundamental process that to be effective, it should be embraced during each single care transition. Our objectives were to investigate current medication reconciliation practices in the 2 Fondazione Toscana Gabriele Monasterio hospitals and comprehensively assess the quality of medication reconciliation practices between inpatient and outpatient care by analyzing the medication patterns 6 months before admission, during hospitalization, and 9 months after discharge for a selected group of patients with cardiovascular diseases.

Methods
A retrospective observational study was conducted in the Cardiothoracic Department of the Fondazione Toscana Gabriele Monasterio hospitals. Medication history was reviewed for all the patients admitted from and discharged to the community, from January to March 2013. Patients were excluded if they had less than 4 drugs or less than 2 drugs for cardiovascular system in their prescription list at admission or if they died during follow-up. We selected 714 patients, and we obtained the clinical charts and all drug prescriptions collected during patients’ hospitalization by the electronic clinical recording system. We also analyzed the list of prescriptions of this sample of patients, from 6 months before admission to 9 months after discharge, extracted from the regional prescription registry. In the resulting sample, prescriptions were analyzed to assess unintentional discrepancies.

Results
The study included 298 patients (mean age, 71.2 years), according to the inclusion and exclusion criteria. Among 14,573 prescriptions analyzed, we found 4363 discrepancies (14.6 discrepancies per patient). Among these discrepancies, 1310 were classified as unintentional (4.4 discrepancies per patient). Among unintentional discrepancies, only 63 (4.8%) took place during hospitalization. Although at the hospital-home interface, 33.1% of unintentional discrepancies were detected through the comparison between the patients’ declared therapy and the previous medication consumption and 62.1% were identified in the comparison between the prescription at the discharge and the following medication pattern at home.

Conclusions
Medication errors have important implications for patient safety, and their identification is a main target for improving clinical practice. The comparison between the medication patterns acquired through the regional prescription registry before and after hospitalization outlined critical touchpoint in the current medication reconciliation process, calling for the definition of shared medication reconciliation standards between hospitals and primary care services to minimize medication discrepancies and enhance patient safety.
Clinical application of perioperative multimodal analgesia
Authors: Bruhn Jörgen , Scheffer Gert J. , van Geffen Geert-Jan 
Published: March 2017

Purpose of review
The experience of intense postoperative pain remains a significant problem in perioperative medicine. The mainstay of postoperative analgetic therapy is the combination of nonopioid agents (e.g. paracetamol and NSAIDs) with strong opioids (e.g. morphine) according to the WHO analgesic ladder. But as the incidence and intensity of postoperative pain remains high, the search for and evaluation of additional concepts is ongoing. This review highlights the current trends of perioperative multimodal analgesia concepts.

Recent findings
Gabapentinoids, ketamine, dexamethasone and magnesium are effective parts of a multimodal analgesia concept without absolute contraindications and nearly without major negative side effects. Recent publications further define the role of these substances for perioperative use in terms of optimal dosing, positive side effects, relative potency and interaction.

Summary
Components of well tolerated and simple advanced multimodal analgesia concepts in the perioperative period are now easy to apply and ready to become a standard in the daily clinical practice.
Decomposing leaf mass into metabolic and structural components explains divergent patterns of trait variation within and among plant species
Authors: Katabuchi Masatoshi , Kitajima Kaoru , Wright S. Joseph , Van Bael Sunshine A. , Osnas Jeanne L. D. , Lichstein Jeremy W. 
Published: March 2017

AbstractAcross the global flora, interspecific variation in photosynthetic and metabolic rates depends more strongly on leaf area than leaf mass. In contrast, intraspecific variation in these rates is strongly mass-dependent. These contrasting patterns suggest that the causes of variation in leaf mass per area (LMA) may be fundamentally different within vs. among species.We developed a statistical modeling framework to decompose LMA into two conceptual components – metabolic LMAm (which determines photosynthetic capacity and dark respiration) and structural LMAs (which determines leaf toughness and potential leaf lifespan) - using leaf trait data from tropical forests in Panama and a global leaf-trait database.Decomposing LMA into LMAm and LMAs improves predictions of leaf trait variation (photosynthesis, respiration, and lifespan). We show that strong area-dependence of metabolic traits across species can result from multiple factors, including high LMAs variance and/or a slow increase in photosynthetic capacity with increasing LMAm. In contrast, strong mass-dependence of metabolic traits within species results from LMAm increasing from sunny to shady conditions. LMAm and LMAs were nearly independent of each other in both global and Panama datasets.Synthesis: Our results suggest that leaf functional variation is multi-dimensional and that biogeochemical models should treat metabolic and structural leaf components separately.
CRISPulator: a discrete simulation tool for pooled genetic screens
Authors: Nagy Tamas , Kampmann Martin 
Published: March 2017

AbstractThe rapid adoption of CRISPR technology has enabled biomedical researchers to conduct CRISPR-based genetic screens in a pooled format. The quality of results from such screens is heavily dependent on optimal screen design, which also affects cost and scalability. We present CRISPulator, a computational tool that simulates the impact of screen parameters on the robustness of screen results, thereby enabling users to build intuition and insights that will inform their experimental strategy. We illustrate its power by deriving non-obvious rules for optimal screen design.
Emergence of an adaptive command for orienting behavior in premotor brainstem neurons of barn owls
Authors: Cazettes Fanny , Fischer Brian J. , Beckert Michael V. , Pena Jose L. 
Published: March 2017

AbstractThe midbrain map of auditory space commands sound-orienting responses in barn owls. Owls precisely localize sounds in frontal space but underestimate the direction of peripheral sound sources. This bias for central locations was proposed to be adaptive to the decreased reliability in the periphery of sensory cues used for sound localization by the owl. Understanding the neural pathway supporting this biased behavior provides a means to address how adaptive motor commands are implemented by neurons. Here we find that the sensory input for sound direction is weighted by its reliability in premotor neurons of the owl’s midbrain tegmentum such that the mean population firing rate approximates the head-orienting behavior. We provide evidence that this coding may emerge through convergence of upstream projections from the midbrain map of auditory space. We further show that manipulating the sensory input yields changes predicted by the convergent network in both premotor neural responses and behavior. This work demonstrates how a topographic sensory representation can be linearly read out to adjust behavioral responses by the reliability of the sensory input.Significance statementThis research shows how statistics of the sensory input can be integrated into a behavioral command by readout of a sensory representation. The firing rate of midbrain premotor neurons receiving sensory information from a topographic representation of auditory space is weighted by the reliability of sensory cues. We show that these premotor responses are consistent with a weighted convergence from the topographic sensory representation. This convergence was also tested behaviorally, where manipulation of stimulus properties led to bidirectional changes in sound localization errors. Thus a topographic representation of auditory space is translated into a premotor command for sound localization that is modulated by sensory reliability.
clusterTools: proximity searches for functional elements to identify putative biosynthetic gene clusters
Authors: de los Santos Emmanuel LC , Challis Gregory L. 
Published: March 2017

AbstractMotivation:The low cost of DNA sequencing has accelerated research in natural product biosynthesis allowing us to rapidly link small molecules to the clusters that produce them. However, the large amount of data means that the number of putative biosynthetic gene clusters (BGCs) far exceeds our ability to experimentally characterize them. This necessitates the need for development of further tools to analyze putative BGCs to flag those of interest for further characterization.Results:Clustertools implements a framework to aid in the characterization of putative BGCs. It does this by or-ganizing genomic information on coding sequences in a way that enables directed, hypothesis-driven queries for functional elements in close physical proximity of each other. Genomic sequence databases can be constructed in clusterTools with an interface to the NCBI Genbank and Genomes databases, or from private sequence databases. clusterTools can be used either to identify interesting BGCs from a database of putative BGCs, or on databases of genomic sequences to identify and download regions of interest in the DNA for further processing and annotation in programs such as antiSMASH. We have used clusterTools to identify putative and known biosynthetic gene clus-ters involved in bacterial polyketide alkaoloid and tetronate biosynthesis.Availability and Implementation:Clustertools is implemented in Python and is available via the AGPL. Stand-alone versions of clusterTools are available for Macintosh, Windows, and Linux upon registration (https://goo.gl/forms/QRKTkpqiA0g31IWp1). The source-code is available athttps://www.github.com/emzodls/clusterArch.Supplementary information:A manual describing the Python toolkit that powers clusterTools, as well as the HMMs constructed for the tetronate search is available online.