bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation and Impact of the “Advanced Pediatric Life Support” Course in the Care of Pediatric Emergencies in Spain
Authors: Benito Javier , Luaces-Cubells Carlos , Mintegi Santiago , Manrique Martínez Ignacio , De la Torre Espí Mercedes , Miguez Navarro Concepción , Vazquez López Paula , Campos Calleja Carmen , Ferres Serrat Francesc , Alonso Salas María Teresa , González del Rey Javier 
Published: June 2017

Introduction
The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005.

Objective
To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs.

Methods
The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice.

Results
In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9–87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28–37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6–60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8–85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3–82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more frequently than pre-hospital professionals (68.5% vs 55.4%; p <0.01) and consider PAT useful in the management of patients (60.2% vs 51.1%; p <0.05). Neither the time elapsed since the completion of the course, nor category and years of professional experience had any influence on the views expressed about the impact of the APLS course in clinical practice.

Conclusions
Most health professionals who have received the APLS course, especially those working in the hospital setting, think that the application of the systematic methods learned, the PAT and ABCDE, has a major impact on clinical practice.
The Use of Intranasal Dexmedetomidine and Midazolam for Sedated Magnetic Resonance Imaging in Children
Authors: Sulton Carmen , Kamat Pradip , Mallory Michael , Reynolds Jason 
Published: June 2017

Objective
The objective of this study was to describe the use of intranasal dexmedetomidine (IN DEX) for sedated magnetic resonance imaging (MRI) examinations in children. The use of IN DEX for MRI in children has not been well described in the literature.

Materials and Methods
The Pediatric Sedation Research Consortium (PSRC) is a collaborative and multidisciplinary group of sedation practitioners dedicated to understanding and improving the process of pediatric sedation. We searched the 2007 version of the PSRC database solely for instances in which IN DEX was used for MRI diagnostic studies. Patients receiving intravenous medications were excluded. Patient demographics, IN DEX dose, adjunct medications and dose, as well as procedure completion, complications, interventions, and monitoring providers were analyzed.

Results
A total of 224 sedation encounters were included in our primary analysis. There were no major adverse events. Most sedations (88%) required no intervention. Registered nurses were the monitoring provider in over 99% of cases. The median (interquartile range) dose of dexmedetomidine was 3 (2.5–3) mcg/kg. Adjunctive midazolam was used in 219/224 (98%) of the cases. All procedures were completed.

Conclusions
This report from the PSRC shows that IN DEX in combination with midazolam is an effective medication regimen for children who require an MRI with sedation.
Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels
Authors: Yamamoto Takumi , Yamamoto Nana , Yoshimatsu Hidehiko , Narushima Mitsunaga , Koshima Isao 
Published: June 2017

Background:
Lymphaticovenular anastomosis is a useful treatment option for compression-refractory lower extremity lymphedema, but its efficacy depends largely on the severity of lymphosclerosis. To maximize lymphaticovenular anastomosis efficacy, it is important to elucidate factors associated with severe lymphosclerosis.

Methods:
Medical charts of 134 lower extremity lymphedema patients who underwent preoperative indocyanine green lymphography and lymphaticovenular anastomosis were reviewed to obtain data of clinical demographics, indocyanine green lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis was classified into s0, s1, s2, and s3. Severe lymphosclerosis was defined as lymphatic vessels with s3 sclerosis. Logistic regression analysis was used to identify independent factors associated with severe lymphosclerosis.

Results:
In total, 962 lymphatic vessels were analyzed, among which severe lymphosclerosis was observed in 97 (10.1 percent). Multivariate analysis revealed that independent factors associated with severe lymphosclerosis were higher body mass index (OR, 1.803; 95 percent CI, 1.041 to 3.123; p = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95 percent CI, 1.201 to 4.617/2.135 to 9.362; p = 0.013/p < 0.001), and S-region/D-region on indocyanine green lymphography compared with L-region (OR, 83.134/1441.126; 95 percent CI, 11.296 to 611.843/146.782 to 14149.195; p < 0.001/p < 0.001). Inverse associations were observed in positive history of radiation therapy (OR, 0.461; 95 percent CI, 0.269 to 0.788; p = 0.005).

Conclusions:
Independent factors associated with severe lymphosclerosis were clarified. Indocyanine green lymphography pattern had the strongest association with severe lymphosclerosis. D-region on indocyanine green lymphography should be avoided for lymphaticovenular anastomosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Safety and Indications of Laparoscopic Surgery for Postoperative Small-bowel Obstruction: A Single-center Study of 121 Patients
Authors: Nakamura Takatoshi , Ishii Yoshiyuki , Tsutsui Atsuko , Kaneda Munehisa , Sato Takeo , Watanabe Masahiko 
Published: June 2017

Background/Aims:
The purpose of this study was to evaluate the safety and effectiveness of laparoscopic surgery for the treatment of small-bowel obstruction.

Materials and Methods:
The study group comprised 121 patients who underwent laparoscopic surgery for small-bowel obstruction.

Results:
Previous operations were open surgery in 107 patients and laparoscopic surgery in 14. On univariate analysis, 4 risk factors were related to conversion to open surgery: radiotherapy (P=0.0002), previous episode of intestinal obstruction (P=0.0064), bleeding volume of ≥50 mL (P=0.0059), and the presence or absence of previous bowel resection (P=0.0269). On multivariate analysis, only radiotherapy was an independent risk factor for conversion to open surgery (odds ratio, 5.5141; P=0.0091).

Conclusions:
Laparoscopic surgery can be safely performed in patients with postoperative small-bowel obstruction and is considered an effective treatment with a low rate of recurrent bowel obstruction.
Pharmacology of cough in palliative care
Authors: Morice Alyn H. , Shanks Gabriella 
Published: June 2017

Purpose of review
Cough is a common and distressing symptom. It has a marked decrement on quality-of-life particularly in the arena of palliative care where coexisting symptoms such as pain may be exacerbated. Whilst local definitive treatment may alleviate coughing it usually requires general measures. The purpose of the review is to assess the current evidence relating to the pharmacological management of cough.

Recent findings
Key to understanding cough is the realization that most cough is because of a hypersensitivity of the afferent vagus nerve. Cough suppression with opioids and first-generation antihistamines may produce relief. However, much cough in palliative medicine is caused by unrecognized nonacid reflux and aspiration. Promotility agents may be dramatically effective at both preventing cough and recurrent aspiration.

Summary
The implications of this review will aid practitioners understanding of cough in a variety of settings, including palliative care.
Clean energy and the hydrogen economy
Authors: Brandon N. P. , Kurban Z. 
Published: June 2017

In recent years, new-found interest in the hydrogen economy from both industry and academia has helped to shed light on its potential. Hydrogen can enable an energy revolution by providing much needed flexibility in renewable energy systems. As a clean energy carrier, hydrogen offers a range of benefits for simultaneously decarbonizing the transport, residential, commercial and industrial sectors. Hydrogen is shown here to have synergies with other low-carbon alternatives, and can enable a more cost-effective transition to de-carbonized and cleaner energy systems. This paper presents the opportunities for the use of hydrogen in key sectors of the economy and identifies the benefits and challenges within the hydrogen supply chain for power-to-gas, power-to-power and gas-to-gas supply pathways. While industry players have already started the market introduction of hydrogen fuel cell systems, including fuel cell electric vehicles and micro-combined heat and power devices, the use of hydrogen at grid scale requires the challenges of clean hydrogen production, bulk storage and distribution to be resolved. Ultimately, greater government support, in partnership with industry and academia, is still needed to realize hydrogen's potential across all economic sectors.This article is part of the themed issue ‘The challenges of hydrogen and metals’.
A kinetic Monte Carlo approach to diffusion-controlled thermal desorption spectroscopy
Authors: Schablitzki T. , Rogal J. , Drautz R. 
Published: June 2017

Atomistic simulations of thermal desorption spectra for effusion from bulk materials to characterize binding or trapping sites are a challenging task as large system sizes as well as extended time scales are required. Here, we introduce an approach where we combine kinetic Monte Carlo with an analytic approximation of the superbasins within the framework of absorbing Markov chains. We apply our approach to the effusion of hydrogen from BCC iron, where the diffusion within bulk grains is coarse grained using absorbing Markov chains, which provide an exact solution of the dynamics within a superbasin. Our analytic approximation to the superbasin is transferable with respect to grain size and elliptical shapes and can be applied in simulations with constant temperature as well as constant heating rate. The resulting thermal desorption spectra are in close agreement with direct kinetic Monte Carlo simulations, but the calculations are computationally much more efficient. Our approach is thus applicable to much larger system sizes and provides a first step towards an atomistic understanding of the influence of structural features on the position and shape of peaks in thermal desorption spectra.
This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Isotopic tracing of hydrogen transport and trapping in nuclear materials
Authors: Chêne Jacques , Martin Frantz 
Published: June 2017

Some illustrations of the use of deuterium or tritium for isotopic tracing of hydrogen absorption, transport and trapping in nuclear materials are presented. Isotopic tracing of hydrogen has been shown to be successful for the determination of the boundaries conditions for hydrogen desorption or absorption in a material exposed to a hydrogen source. Also, the unique capabilities of isotopic tracing and related techniques to characterize H interactions with point defects and dislocations acting as moving traps has been demonstrated. Such transport mechanisms are considered to play a major role in some stress corrosion cracking and hydrogen embrittlement mechanisms.
This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Alloy and composition dependence of hydrogen embrittlement susceptibility in high-strength steel fasteners
Authors: Brahimi S. V. , Yue S. , Sriraman K. R. 
Published: June 2017

High-strength steel fasteners characterized by tensile strengths above 1100 MPa are often used in critical applications where a failure can have catastrophic consequences. Preventing hydrogen embrittlement (HE) failure is a fundamental concern implicating the entire fastener supply chain. Research is typically conducted under idealized conditions that cannot be translated into know-how prescribed in fastener industry standards and practices. Additionally, inconsistencies and even contradictions in fastener industry standards have led to much confusion and many preventable or misdiagnosed fastener failures. HE susceptibility is a function of the material condition, which is comprehensively described by the metallurgical and mechanical properties. Material strength has a first-order effect on HE susceptibility, which increases significantly above 1200 MPa and is characterized by a ductile--brittle transition. For a given concentration of hydrogen and at equal strength, the critical strength above which the ductile–brittle transition begins can vary due to second-order effects of chemistry, tempering temperature and sub-microstructure. Additionally, non-homogeneity of the metallurgical structure resulting from poorly controlled heat treatment, impurities and non-metallic inclusions can increase HE susceptibility of steel in ways that are measurable but unpredictable. Below 1200 MPa, non-conforming quality is often the root cause of real-life failures.This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Hydrogen-related challenges for the steelmaker: the search for proper testing
Authors: Thiessen R. G. 
Published: June 2017

The modern steelmaker of advanced high-strength steels has always been challenged with the conflicting targets of increased strength while maintaining or improving ductility. These new steels help the transportation sector, including the automotive sector, to achieve the goals of increased passenger safety and reduced emissions. With increasing tensile strengths, certain steels exhibit an increased sensitivity towards hydrogen embrittlement (HE). The ability to characterize the material's sensitivity in an as-delivered condition has been developed and accepted (SEP1970), but the complexity of the stress states that can induce an embrittlement together with the wide range of applications for high-strength steels make the development of a standardized test for HE under in-service conditions extremely challenging. Some proposals for evaluating the material's sensitivity give an advantage to materials with a low starting ductility. Despite this, newly developed materials can have a higher original elongation with only a moderate reduction in elongation due to hydrogen. This work presents a characterization of new materials and their sensitivity towards HE.
This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Analysis of electro-permeation of hydrogen in metallic alloys
Authors: Raina A. , Deshpande V. S. , Fleck N. A. 
Published: June 2017

A reaction–diffusion type modelling framework is presented to analyse both electro-permeation (EP) and thermal desorption spectrometry (TDS) measurements of hydrogen in metallic alloys. It is assumed that the kinetics of hydrogen motion is governed by diffusion through the lattice, along with trapping/detrapping at specific sites such as dislocations, grain boundaries, etc. It is shown that the trapping and detrapping rates are typically much faster than the diffusion rate, and consequently a simplification of the governing equations suffices such that local equilibrium exists between lattice and trapped hydrogen. Using this local equilibrium assumption, we then present an asymptotic analysis of the governing kinetic equation for the EP test. This asymptotic analysis reveals that four regimes of behaviour exist, ranging from negligible trapping to the complete filling of deep traps. The analysis suggests that EP tests should be so-arranged that three regimes of behaviour are spanned, in order to extract the relevant material properties associated with hydrogen transport. The numerical solutions presented in this study support the asymptotic analysis. The hydrogen kinetics framework is also deployed to analyse both EP and TDS tests on the same martensitic steel. The EP measurements all lie in regime I and are thus insufficient to uniquely determine both the trap density and binding energy. Reasonable agreement is obtained between measurements and numerical predictions of TDS tests using parameters estimated from the EP tests. Further improvements in measurements are required to confirm the fidelity of this modelling approach.
This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Solute hydrogen and hydride phase implications on the plasticity of zirconium and titanium alloys: a review and some recent advances
Authors: Conforto E. , Guillot I. , Feaugas X. 
Published: June 2017

In this contribution, we propose a review of the possible implications of hydrogen on mechanical behaviour of Zr and Ti alloys with emphasis on the mechanisms of plasticity and strain hardening. Recent advances on the impact of oxygen and hydrogen on the activation volume show that oxygen content hinders creep but hydrogen partially screens this effect. Both aspects are discussed in terms of a locking–unlocking model of the screw dislocation mobility in prismatic slip. Additionally, possible extension of this behaviour is suggested for thepyramidal slip. The low hydrogen solubility in both Zr and Ti leads in many cases to hydride precipitation. The nature of these phases depends on the hydrogen content and can show crystallographic orientation relationships with the hexagonal compact structure of the alloys. Some advances on the thermal stability of these phases are illustrated and discussed in relation with the deepening of the misfit dislocations. Under tensile loading, we showed that hydrides enhance the hardening process in relation with internal stress due to strain incompatibilities between the Zr and Ti matrix and hydride phases. Different plastic yielding processes of hydrides were identified, which progressively reduce these strain incompatibilities.This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Hydrogen in Ti and Zr alloys: industrial perspective, failure modes and mechanistic understanding
Authors: Chapman T. P. , Dye D. , Rugg D. 
Published: June 2017

Titanium is widely used in demanding applications, such as in aerospace. Its strength-to-weight ratio and corrosion resistance make it well suited to highly stressed rotating components. Zirconium has a no less critical application where its low neutron capture cross section and good corrosion resistance in hot water and steam make it well suited to reactor core use, including fuel cladding and structures. The similar metallurgical behaviour of these alloy systems makes it alluring to compare and contrast their behaviour. This is rarely undertaken, mostly because the industrial and academic communities studying these alloys have little overlap. The similarities with respect to hydrogen are remarkable, albeit potentially unsurprising, and so this paper aims to provide an overview of the role hydrogen has to play through the material life cycle. This includes the relationship between alloy design and manufacturing process windows, the role of hydrogen in degradation and failure mechanisms and some of the underpinning metallurgy. The potential role of some advanced experimental and modelling techniques will also be explored to give a tentative view of potential for advances in this field in the next decade or so.This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Hydrogen effects in corrosion: discussion
Authors: Stopher Miles A. , Simpson E. Luke 
Published: June 2017

This session contained talks on the characterization of hydrogen-enhanced corrosion of steels and nickel-based alloys, emphasizing the different observations across length scales, from atomic-scale spectrographic to macro-scale fractographic examinations.
This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Regional missense constraint improves variant deleteriousness prediction
Authors: Samocha Kaitlin E. , Kosmicki Jack A. , Karczewski Konrad J. , O’Donnell-Luria Anne H. , Pierce-Hoffman Emma , MacArthur Daniel G. , Neale Benjamin M. , Daly Mark J. 
Published: June 2017

AbstractGiven increasing numbers of patients who are undergoing exome or genome sequencing, it is critical to establish tools and methods to interpret the impact of genetic variation. While the ability to predict deleteriousness for any given variant is limited, missense variants remain a particularly challenging class of variation to interpret, since they can have drastically different effects depending on both the precise location and specific amino acid substitution of the variant. In order to better evaluate missense variation, we leveraged the exome sequencing data of 60,706 individuals from the Exome Aggregation Consortium (ExAC) dataset to identify sub-genic regions that are depleted of missense variation. We further used this depletion as part of a novel missense deleteriousness metric named MPC. We applied MPC tode novomissense variants and identified a category ofde novomissense variants with the same impact on neurodevelopmental disorders as truncating mutations in intolerant genes, supporting the value of incorporating regional missense constraint in variant interpretation.
A Rational Drug Combination Design to Inhibit Epithelial-Mesenchymal Transition in a Three-Dimensional Microenvironment
Authors: Barneh Farnaz , Mirzaie Mehdi , Nickchi Payman , Tan Tuan Zea , Thiery Jean Paul , Piran Mehran , Salimi Mona , Goshadrou Fatemeh , Aref Amir R. , Jafari Mohieddin 
Published: June 2017

AbstractEpithelial-Mesenchymal Transition (EMT) is a major player of tumor invasiveness whose inhibition is challenged by redundancy of multiple inducing factors. We applied a systems-pharmacology approach by integrating network-based analyses with multiple bioinformatic resources to design a drug combination regimen reversing EMT phenotype in aggressive cancers. We observed that histone deacetylases were critical targets to tune expression of multiple epithelial versus mesenchymal genes. Moreover, SRC and IKBK were the principal intracellular kinases regulating multiple signaling pathways. To validate the anti-EMT efficacy of the target combinations, we inhibited the pinpointed proteins with already prescribed drugs and observed that whereas low dose mono-therapy failed to limit cell dispersion from collagen spheroids in a microfluidic device as a metric of EMT, the combination fully inhibited dissociation and invasion of cancer cells toward co-cultured endothelial cells. Given the approval status and safety profiles of the suggested drugs, the proposed combination set can be considered in clinical trials.