bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coupling of EIT with computational lung modeling for predicting patient-specific ventilatory responses
Authors: Roth Christian J. , Becher Tobias , Frerichs Inéz , Weiler Norbert , Wall Wolfgang A. 
Published: December 2016

Providing optimal personalized mechanical ventilation for patients with acute or chronic respiratory failure is still a challenge within a clinical setting for each case anew. In this article, we integrate electrical impedance tomography (EIT) monitoring into a powerful patient-specific computational lung model to create an approach for personalizing protective ventilatory treatment. The underlying computational lung model is based on a single computed tomography scan and able to predict global airflow quantities, as well as local tissue aeration and strains for any ventilation maneuver. For validation, a novel “virtual EIT” module is added to our computational lung model, allowing to simulate EIT images based on the patient's thorax geometry and the results of our numerically predicted tissue aeration. Clinically measured EIT images are not used to calibrate the computational model. Thus they provide an independent method to validate the computational predictions at high temporal resolution. The performance of this coupling approach has been tested in an example patient with acute respiratory distress syndrome. The method shows good agreement between computationally predicted and clinically measured airflow data and EIT images. These results imply that the proposed framework can be used for numerical prediction of patient-specific responses to certain therapeutic measures before applying them to an actual patient. In the long run, definition of patient-specific optimal ventilation protocols might be assisted by computational modeling. NEW & NOTEWORTHY In this work, we present a patient-specific computational lung model that is able to predict global and local ventilatory quantities for a given patient and any selected ventilation protocol. For the first time, such a predictive lung model is equipped with a virtual electrical impedance tomography module allowing real-time validation of the computed results with the patient measurements. First promising results obtained in an acute respiratory distress syndrome patient show the potential of this approach for personalized computationally guided optimization of mechanical ventilation in future.
Real-time dose adjustment using point-of-care platelet reactivity testing in a double-blind study of prasugrel in children with sickle cell anaemia
Authors: Hoppe Carolyn C. , Zhou Chunmei , Smith Brendan E. , Brown Patricia B. , Heath Lori E. , Inusa Baba , Rees David C. , Small David S. , Gupta Neehar , Yao Suqin , Heeney Matthew M. , Kanter Julie , Jakubowski Joseph A. 
Published: December 2016

SummaryPatients with sickle cell anaemia (SCA) have vaso-occlusive crises resulting from occlusive hypoxic-ischaemic injury. Prasugrel inhibits platelet activation and aggregation involved in SCA pathophysiology. Determining Effects of Platelet Inhibition on Vaso-Occlusive Events (DOVE) was a phase 3, double-blind, randomised, placebo-controlled trial assessing prasugrel efficacy. DOVE sought to bring patients’ P2Y12 reaction unit (PRU) value within a targeted range via prasugrel dose adjustments using encrypted VerifyNow P2Y12® (VN-P2Y12) point-of-care testing and an interactive voice-response system (IVRS). After PRU determination, randomised patients received 0.08 mg/kg/day prasugrel or placebo. Encrypted PRUs and IVRS provided double-blind dose adjustments to achieve a defined PRU target range of 136–231; placebo patients had mock titrations. Of 341 randomised patients, 166 placebo and 160 prasugrel patients reached the fully titrated dose (FTD). Most prasugrel patients (n=104, 65 %) remained on the initial 0.08 mg/kg dose; doses escalations occurred in 23 % of patients (n=36). Mean PRUs for the pharmacodynamic population at baseline were similar in the prasugrel (273 ± 44.9) and placebo groups (273 ± 51.7), with significant reductions in PRU (p<0.001) for prasugrel patients at the FTD and at 9 months. Concomitant use of hydroxyurea did not affect platelet reactivity at any time. The majority of prasugrel patients (n=135, 84.4 %) at the FTD were within the target range of 136–231 PRUs. Mean VN-P2Y12 percentage inhibition at baseline was similar in the prasugrel (2.8 ± 5.4 %) and placebo groups (2.0 ± 4.7 %); prasugrel patients had significant increases in inhibition (p<0.001) at FTD and at 9 months. Patients with higher PRU values at baseline required higher prasugrel doses to bring PRU within the prespecified range. DOVE is the first study to successfully employ double-blind, real-time, encrypted, point-of-care platelet testing and IVRS to dose-adjust antiplatelet therapy to a targeted range of platelet inhibition.
Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation
Authors: Baratto Francesca , Pappalardo Federico , Oloriz Teresa , Bisceglia Caterina , Vergara Pasquale , Silberbauer John , Albanese Nicolò , Cireddu Manuela , D’Angelo Giuseppe , Di Prima Ambra Licia , Monaco Fabrizio , Paglino Gabriele , Radinovic Andrea , Regazzoli Damiano , Silvetti Simona , Trevisi Nicola , Zangrillo Alberto , Della Bella Paolo 
Published: December 2016

Background—
We report the experience in a cohort of consecutive patients receiving extracorporeal membrane oxygenation during catheter ablation of unstable ventricular tachycardia (VT) at our center.

Methods and Results—

From 2010 to 2015, extracorporeal membrane oxygenation was initiated in 64 patients (average age: 63±15 years; left ventricular ejection fraction in 27±9%; cardiogenic shock in 23%, and electrical storm in 62% of patients) undergoing 74 unstable VT catheter ablation procedures. At least one VT was terminated in 81% of procedures with baseline inducible VT, and VT noninducibility was achieved in 69%. Acute heart failure occurred in 5 patients: 3 underwent emergency heart transplantation, 1 had left ventricular assist device (LVAD) implantation, and 1 patient eventually died because of subsequent mesenteric ischemia. All other patients were discharged alive. After a median follow-up of 21 months (13–28 months), VT recurrence was 33%; overall survival was 56 out of 64 patients (88%). Extracorporeal membrane oxygenation–supported ablation was the bridge to LVAD in 6.9% and to heart transplantation in 3.5% of patients. VT recurrence was related to ablation success (after 180 days of follow up: 19% when VT was noninducible, 42% if nonclinical VT was inducible, 75% when clinical VT was inducible, and 75% in untested patients,
P
<0.001). Incidence of all-cause death, heart transplantation, and LVAD was independently related to ablation outcome (at 180 days of follow-up: 9% when noninducibility was achieved, 50% in case of inducible VT, and 75% in untested patients,
P
<0.001). At multivariable analyses, noninducibility (hazard ratio 0.198;
P
=0.001) and left ventricular ejection fraction (hazard ratio 0.916;
P
=0.008) correlated with all-cause death, LVAD, and heart transplantation.

Conclusions—
Ablation of unstable VTs can be safely supported by extracorporeal membrane oxygenation, which allows rhythm stabilization with low procedure mortality, bridging decompensated patients to permanent LVAD or heart transplantation. Successful ablation is associated with better outcomes than unsuccessful ablation.
Retrieval of the Leadless Cardiac Pacemaker
Authors: Reddy Vivek Y. , Miller Marc A. , Knops Reinoud E. , Neuzil Petr , Defaye Pascal , Jung Werner , Doshi Rahul , Castellani Mark , Strickberger Adam , Mead R. Hardwin , Doppalapudi Harish , Lakkireddy Dhanunjaya , Bennett Matthew , Sperzel Johannes 
Published: December 2016

Background—
Leadless cardiac pacemakers have emerged as a safe and effective alternative to conventional transvenous single-chamber ventricular pacemakers. Herein, we report a multicenter experience on the feasibility and safety of acute retrieval (<6 weeks) and chronic retrieval (>6 weeks) of the leadless cardiac pacemaker in humans.

Methods and Results—
This study included patients enrolled in 3 multicenter trials, who received a leadless cardiac pacemaker implant and who subsequently underwent a device removal attempt. The overall leadless pacemaker retrieval success rate was 94%: for patients whose leadless cardiac pacemaker had been implanted for <6 weeks (acute retrieval cohort), complete retrieval was achieved in 100% (n=5/5); for those implanted for ≥ 6 weeks (chronic retrieval cohort), retrieval was achieved in 91% (n=10/11) of patients. The mean duration of time from implant to retrieval attempt was 346 days (range, 88–1188 days) in the chronic retrieval cohort, and nearly two thirds (n=7; 63%) had been implanted for >6 months before the retrieval attempt. There were no procedure-related adverse events at 30 days post retrieval procedure.

Conclusions—
This multicenter experience demonstrated the feasibility and safety of retrieving a chronically implanted single-chamber (right ventricle) active fixation leadless pacemaker.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT02051972, NCT02030418, and NCT01700244.
Associations Between Blood Pressure and Outcomes Among Blacks in the Jackson Heart Study
Authors: Randolph Tiffany C. , Greiner Melissa A. , Egwim Chidiebube , Hernandez Adrian F. , Thomas Kevin L. , Curtis Lesley H. , Muntner Paul , Wang Wei , Mentz Robert J. , O'Brien Emily C. 
Published: December 2016

Background
In 2014, new hypertension guidelines liberalized blood pressure goals for persons 60 years and older. Little is known about the implications for blacks.

Methods and Results

Using data from 2000 through 2011 for 5280 participants in the Jackson Heart Study, a community‐based black cohort in Jackson, Mississippi, we examined whether higher blood pressure was associated with greater risk of mortality and heart failure hospitalization, and whether the risk was the same across age groups. We investigated associations between baseline blood pressure and both mortality and heart failure hospitalization. We also tested for interactions between age and blood pressure in the mortality model. Median systolic and diastolic blood pressures at baseline were 125 mm Hg (25th–75th percentile, 114–137 mm Hg) and 79 mm Hg (72–86 mm Hg), respectively. Median follow‐up was 9 years for mortality and 7 years for heart failure hospitalization. After multivariable adjustment, every 10 mm Hg increase in systolic blood pressure was associated with greater risks of mortality (hazard ratio, 1.12; 95%
CI
, 1.06–1.17) and heart failure hospitalization (1.07; 95%
CI
, 1.00–1.14). The mortality risk per 10 mm Hg increase in systolic blood pressure was greater in participants younger than 60 years (1.26; 95%
CI
, 1.13–1.42) than among participants 60 years and older (1.09; 95%
CI
, 1.03–1.15).

Conclusions
Adults in all age groups were at greater risk of mortality as systolic blood pressure increased. In the context of the 2014 hypertension guidelines, these findings should be considered when determining treatment goals in black patients.
Acute Coronary Syndrome and Suicide: A Case‐Referent Study
Authors: Liu Chao‐Han , Yeh Ming‐Kung , Wang Ji‐Hung , Weng Shu‐Chuan , Bai Meng‐Yi , Chang Jung‐Chen 
Published: December 2016

Background

The high prevalence of acute coronary syndrome (
ACS
) represents a significant burden on healthcare resources. A robust association exists between depression and increased morbidity and mortality after
ACS
. This study examined the relationship between suicide and
ACS
after adjusting for depression and other comorbidities.

Methods and Results

In this case‐referent study conducted in Taiwan, the cases were people aged 35 years or older who died from suicide between 2000 and 2012 and 4 live referents, each matched by age, sex, and area of residence. The covariates adjusted for in the analysis were sociodemographic characteristics, physical comorbidities, and psychiatric disorders. We identified 41 050 persons who committed suicide and 164 200 referents. In the case and referent groups, 1027 (2.5%) and 2412 (1.5%) patients had
ACS
, respectively. After potential confounders were adjusted,
ACS
was significantly associated with increased odds of suicide (
aOR
=1.15, 95% confidence interval [
CI
]=1.05‐1.26). The odds of suicide were highest during the initial 6 months post‐
ACS
diagnosis (
OR
=3.05, 95%
CI
=2.55‐3.65) and remained high for at least 4 years after
ACS
diagnosis.

Conclusions

ACS
patients are at an increased risk of suicide compared with otherwise healthy people. The risk of suicide is particularly high in the 6 months after
ACS
diagnosis. Our results suggest that we need to identify efficacious methods to recognize those at risk for suicide and to develop effective interventions to prevent such deaths.
Community families: A qualitative study of families who volunteer to support persons with severe mental illness
Authors: Jensen Lotte Groth , Lou Stina , Aagaard Jørgen , Væggemose Ulla 
Published: December 2016

Background: Social interventions targeted at people with severe mental illness (SMI) often include volunteers. Volunteers’ perspectives are important for these interventions to work. This article investigates the experiences of volunteer families who befriend a person with SMI. Material: Qualitative interviews with members of volunteer families. Discussion: The families were motivated by helping a vulnerable person and by engaging in a rewarding relationship. However, the families often doubted their personal judgement and relied on mental health workers to act as safety net. Conclusion: The volunteer involvement is meaningful but also challenging. The families value professional support.
Lower limb venous diameters and haemodynamics during pregnancy and postpartum period in healthy primigravidae
Authors: Gardenghi Leandro Augusto , Dezotti Nei Rodrigues Alves , Dalio Marcelo Bellini , Martins Wellington de Paula , Joviliano Edwaldo Edner , Piccinato Carlos Eli 
Published: December 2016

Objective Analyse venous haemodynamics in healthy primigravidae during pregnancy and in the postpartum. Methods Cohort with primigravidae evaluated in the three trimesters of pregnancy and postpartum. Duplex evaluated venous diameters and reflux; air plethysmography evaluated venous filling index, ejection fraction, residual volume fraction and outflow fraction in both limbs. Results During pregnancy, diameters increased in bilateral common femoral and right infravalvar great saphenous, but returned to first trimester values after delivery. Reflux developed in one woman (5%) in the second trimester and in two more women (15%) in the third trimester. No reflux was detected in postpartum. Bilateral venous filling index was higher during pregnancy. Bilateral ejection fraction and residual volume fraction did not change. Bilateral outflow fraction increased progressively. The right limb outflow fraction in left lateral decubitus was similar. All changes returned to first trimester values after delivery. Conclusions Healthy primigravidae presented changes in lower limbs’ veins during pregnancy: diameters in bilateral common femoral and infravalvar great saphenous veins increased; new reflux was developed in 15% of women, but there was no venous hypertension. Calf muscular pump function did not change. All changes returned to first trimester values after delivery.
Integrating Lean Exploration Loops Into Healthcare Facility Design
Authors: Mazur Lukasz M. , Johnson Kendra , Pooya Pegah , Chadwick Janet , McCreery John 
Published: December 2016

Purpose: To explore what, when, and how Lean methods and tools can add value during the programming phase of design through providing additional resources and support to project leadership and the architectural design team. Background: This case study–based research took place at one large academic hospital during design efforts of a surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and postop, central processing and distribution, and materials management. Surgical services project leadership asked for support from Lean practitioners during the design process. Methods: Lean exploration loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs were primarily focused on the relative advantages of a large footprint with few floors or a smaller footprint with more floors and support spaces not collocated adjacent to ORs on the same floor. Results: LELs resulted in quantifications of key operational and design features (e.g., design preferences of employees and patients, horizontal distance travel, and elevator utilization studies), which in turn complemented the architectural design process and created an opportunities to gain buy-in and consensus from stakeholders through their active participation in many of the analyses. Conclusions: We found Lean tools and methods to be of most value during programming phase when focused on the high-level operational and design issues to help establish buy-in and consensus among stakeholders, while acknowledging that there is often not enough design detail to perform accurate analysis.
Acculturation and the labor market in Mexico
Authors: Cano-Urbina Javier , Mason Patrick L. 
Published: December 2016

AbstractThis paper empirically examines the relationship between the self-identity as Indigenous and earnings inequality in the Mexican labor market. Using Mexican Census data and a large set of wage covariates reveals the existence of an earnings penalty for self-identification as Indigenous. There is an additional and larger penalty for Indigenous persons who are fluent in an Indigenous language, regardless of Spanish language fluency. Further analyses using the Mexican Family Life Survey reveal that these earnings gaps persist after we also control for an individual’s cognitive ability. Ethno-linguistic inequality is particularly strong in smaller cities and among self-employed workers.JEL Classification:J10, J15, J31, J71, O15
A Novel Approach for the Control of Inflammatory Pain: Prostaglandin E2 Complexation by Randomly Methylated β-Cyclodextrins
Authors: Sauer Reine-Solange , Rittner Heike Lydia , Roewer Norbert , Sohajda Tamás , Shityakov Sergey , Brack Alexander , Broscheit Jens-Albert 
Published: December 2016

BACKGROUND:
Inhibitors of cyclooxygenase, which block the formation of prostaglandin (PG) E2, are the standard treatment of inflammatory pain. These drugs, however, have serious gastrointestinal, renal, and cardiovascular side effects that limit their clinical use. Cyclodextrins are neutral glucose oligomers that form a hydrophilic outer and a hydrophobic interior cavity used to carry hydrophilic substances. Methyl-β-cyclodextrins are used currently in several drugs as enhancers and also to deliver PGs. We therefore hypothesized that randomly methylated β-cyclodextrins (RAMEB) could be used for pain treatment.

METHODS:
An in silico screening for important inflammatory mediators (eg, PGE2, substance P, bradykinin, and calcitonin gene-related peptide) was performed to predict the probability of these molecules binding to RAMEB. Thereafter, a comprehensive in vitro study investigated the complexation affinity of the best target toward RAMEB or its RAMEB-fraction L (FL) using capillary electrophoresis.
Wistar rats were injected intraplantarly with complete Freund’s adjuvant (CFA) for 96 hours to induce inflammatory hyperalgesia. Subsequently, rats were treated intraplantarly or intravenously either with RAMEB or RAMEB FL and compared with the respective controls. Parecoxib was used as positive control. Mechanical (paw pressure threshold, PPT) and thermal (paw withdrawal latency) nociceptive thresholds were determined before injection and at the indicated time points thereafter. Paw tissue was collected after treatments, and PGE2 and PGD2 contents were measured. Analysis of variance was used for data analysis followed by appropriate post hoc comparisons.

RESULTS:
In silico screening indicated that PGE2, with the highest affinity, was the best candidate for RAMEB binding. Likewise, in capillary electrophoresis experiments, RAMEB had a high affinity to form inclusion complexes with the PGE2 (stability constant [K], 360 1/M; 95% confidence interval [C]: 347.58–372.42 M−1). Local treatment with RAMEB alleviated CFA-induced mechanical (PPT: 76.25 g; 95% CI: 56.24–96.25 g) and thermal hyperalgesia (PPT: 8.50 seconds; 95% CI: 6.76–10.23 seconds). Moreover, a systemic administration of RAMEB decreased CFA-induced mechanical (PPT: 126.66 g; 95% CI: 114.54–138.77 g) and thermal hyperalgesia (paw withdrawal latency: 11.47 seconds; 95% CI: 9.26–13.68 seconds). RAMEB FL resulted in greater in vitro PGE2-binding capacity and decreased PG content as well as hyperalgesia in vivo to a similar extent. Motor activity of the rats was not altered by RAMEB or RAMEB FL.

CONCLUSIONS:
Capture of PGs by cyclodextrins could be a novel and innovative tool for the treatment of inflammatory pain and bypassing some unwanted side effects of cyclooxygenase inhibitors.
The evolution of afro‐montaneDelphinium(Ranunculaceae): Morphospecies, phylogenetics and biogeography
Authors: Chartier Marion , Dressler Stefan , Schönenberger Jürg , Mora Alfonso Rojas , Sarthou Corinne , Wang Wei , Jabbour Florian 
Published: December 2016

AbstractThe genus Delphinium (Ranunculaceae) consists of ca. 300 species and has a mainly holarctic distribution. Few species have been described from high‐altitude areas in West and East Tropical Africa, where the environmental conditions are mostly temperate‐like. We aim to clarify the taxonomy of these afro‐montane Delphinium species and to understand their evolutionary history in terms of their floral morphology and their phylogenetic and biogeographic relationships. Based on herbarium specimens, we analyze flower shape variation, map the geographic distribution of the morphologically defined taxa and reconstruct the molecular phylogeny of the group. Our quantitative analyses of flower shapes indicate that three species can be defined based on floral morphological traits, hence confirming the latest taxonomic treatment of the group where D. dasycaulon, D. leroyi and D. macrocentrum were described. The examination of herbarium specimens indicates that these three species are almost parapatric. However, their respective monophyly is not supported by molecular data. Considering their relatively young age, the non‐monophyly of each of the three morphospecies could be due to incomplete lineage sorting and/or hybridization events. Alternatively, the transition to the D. leroyi floral morph could be the result of evolutionary convergence in the two main groups of afro‐montane Delphinium driven by similar pollinators in different sky islands of the East African Rift System. We hypothesize that the main branches of the East African Rift System, as physical barriers to dispersal, may have prevented genetic exchange among geographic clusters.