bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units
Authors: Nussenblatt Veronique , Avdic Edina , Berenholtz Sean , Daugherty Elizabeth , Hadhazy Eric , Lipsett Pamela A. , Maragakis Lisa L. , Perl Trish M. , Speck Kathleen , Swoboda Sandra M. , Ziai Wendy , Cosgrove Sara E. 
Published: February 2014

Objective.Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days.Methods.Patients suspected of having VAP were identified in 6 adult intensive care units (ICUs) over 1 year. A multidisciplinary adjudication committee determined whether the ICU team's VAP diagnosis and therapy were justified, using clinical, microbiologic, and radiographic data at diagnosis and on day 3. Outcomes included the proportion of VAP events misdiagnosed as and treated for VAP on days 1 and 3 and risk factors for the continuation of antibiotics in patients without VAP after day 3.Results.Two hundred thirty-one events were identified as possible VAP by the ICUs. On day 1, 135 (58.4%) of them were determined to not have VAP by the committee. Antibiotics were continued for 120 (76%) of 158 events without VAP on day 3. After adjusting for acute physiology and chronic health evaluation II score and requiring vasopressors on day 1, sputum culture collection on day 3 was significantly associated with antibiotic continuation in patients without VAP. Patients without VAP or other infection received 1,183 excess days of antibiotics during the study.Conclusions.Overdiagnosis and treatment of VAP was common in this study and led to 1,183 excess days of antibiotics in patients with no indication for antibiotics. Clinical differences between non-VAP patients who had antibiotics continued or discontinued were minimal, suggesting that clinician preferences and behaviors contribute to unnecessary prescribing.
Contact Precautions More Is Not Necessarily Better
Authors: Dhar Sorabh , Marchaim Dror , Tansek Ryan , Chopra Teena , Yousuf Adnan , Bhargava Ashish , Martin Emily T. , Talbot Thomas R. , Johnson Laura E. , Hingwe Ameet , Zuckerman Jerry M. , Bono Bartholomew R. , Shuman Emily K. , Poblete Jose , Tran MaryAnn , Kulhanek Grace , Thyagarajan Rama , Nagappan Vijayalakshmi , Herzke Carrie , Perl Trish M. , Kaye Keith S. 
Published: February 2014

Objective.To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs).Design.Prospective cohort study from February 2009 to October 2009.Setting.Eleven teaching hospitals.Participants.HCWs.Methods.One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation.Results.Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%—4.9%) and with all 5 components (31.5%—6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44];P= .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84—55.54];P= .008) associated with increasing burden of isolation.Conclusions.As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
Preclinical Toxicity Screening of Intrathecal Oxytocin in Rats and Dogs
Authors: Yaksh Tony L. , Hobo Shotaro , Peters Christopher , Osborn Kent G. , Richter Philip J. , Rossi Steven S. , Grafe Marjorie R. , Eisenach James C. 
Published: February 2014

Abstract

Background
Anatomic, physiologic, and behavioral studies in animals suggest that spinally released oxytocin should produce analgesia in humans and may also protect from chronic pain after injury. In this article, the authors report preclinical toxicity screening of oxytocin for intrathecal delivery.

Methods
Intrathecal oxytocin, 11 μg (6 U) or vehicle, was injected intrathecally in 24 rats, followed by frequent behavioral assessment and histologic examination of spinal contents 2 or 14 days after injection. In three dogs, a range of intrathecal oxytocin doses (18 to 550 μg in 0.5 ml) was injected followed by physiologic, biochemical, and behavioral assessments. Ten dogs were then randomized to receive five daily injections of intrathecal oxytocin, 550 μg in 0.5 ml, or vehicle with similar assessments and, necropsy and histologic analysis were conducted 2 days later.

Results
In rats, intrathecal oxytocin resulted in transient scratching and itching behaviors, without other differences from vehicle. There was no behavioral, gross anatomic, or histologic evidence of neurotoxicity. Dose ranging in dogs suggested mild effects on motor tone, blood pressure, and heart rate at the 550 μg dose. Repeated boluses in dogs did not produce behavioral, biochemical, neurological, gross anatomic, or histologic evidence of neurotoxicity.

Conclusions
Substances, including natural neurotransmitters, may be toxic when administered in pharmacologic doses in the spinal cord. This preclinical toxicity screen in two species suggests that bolus injections of oxytocin in concentrations up to 1,100 μg/ml are unlikely to cause neurotoxicity. The authors also support cautious clinical application of intrathecal oxytocin under regulatory supervision.
Apple Peel and Carboxymethylcellulose‐Based Nanocomposite Films Containing Different Nanoclays
Authors: Shin So‐Hyang , Kim Sung‐Jin , Lee Soo‐Hyun , Park Ki‐Moon , Han Jaejoon 
Published: February 2014

AbstractBiodegradable packaging films were developed from polymeric blends of apple peel powder (APP) and carboxymethylcellulose (CMC), into which different nanoclays were incorporated to produce a nanocomposite film. After first estimating the barrier and mechanical properties of 4 different biopolymer films (CMC, methylcellulose, gelatin, and polylactide), CMC was chosen as the best film‐forming solution. Three different nanoclays (Cloisite Na+, 30B, and 20A) were subsequently dispersed in a CMC film solution to improve the barrier and physical properties of the final CMC nanocomposite films. The structures of the exfoliated CMC nanocomposite films were characterized using X‐ray diffraction (XRD) to determine the most efficient nanoclay type, with Cloisite Na+ addition being found to demonstrate the greatest improvement in the barrier and mechanical properties of the film. Finally, the CMC and Cloisite Na+ solution were thoroughly blended with APP using a high‐pressure homogenization (HPH) process to develop biopolymer nanocomposite films, which were then characterized using XRD and Fourier transform infrared spectroscopy. The HPH treatment significantly improved the film‐forming ability by increasing the dispersity of APP in the CMC nanocomposites, as well as having various other effects on the physical properties. These nanocomposite films can be viewed as an alternative solution for the use of agricultural biomass in developing environmentally friendly packaging materials.Practical ApplicationCloisite Na+ nanoclay noticeably improved the barrier and elongation properties of a biopolymer film. High‐pressure homogenization successfully blended apple peel powder with carboxymethylcellulose to develop a nanocomposite film. The apple peel and CMC‐based nanocomposite films that were developed could be used as a novel biodegradable packaging material.
Analysis of As‐ and Hg‐Species in Metal‐Resistant Oral Bacteria, by Imaging ToF‐SIMS
Authors: Nygren Håkan , Dahlén Gunnar , Malmberg Per 
Published: February 2014

AbstractBacterial strains were isolated from the oral cavity of healthy volunteers and grown in the presence of Hg‐ions (1–10 ppm) or arsenate ions at concentrations of 0.1–1.0%. To elucidate how bacteria take up and transform toxic metals inside the cells, we performed ion imaging and depth profiling with time‐of‐flight secondary ion mass spectrometry (ToF‐SIMS). This analysis relies on the use of a pulsed ion beam to ionize surface molecules that can be extracted into a time‐of‐flight mass spectrometer. By combining the pulsed ion beam with another ion beam in direct current (DC) mode, depth profiles are obtained as a result of consecutive removal of surface layers. The spatial resolution of the depth profile along the y‐axis is in the range of a few nanometres, and the spatial resolution along the x‐ and z‐axes is in the μm range. The ToF‐SIMS analysis was performed on crude biofilms of bacteria air‐dried at aluminium foil surfaces, allowing subcellular resolution along the y‐axis. The mercury ions were found transformed to methylmercury preferably in the periplasmic space, and the arsenate ions were found reduced to arsenite inside the cells, close to the cell membrane. The data are discussed in relation to current concepts in bacterial resistance to metals and antibiotics.
An Outbreak of Pyrimethamine Toxicity in Patients with Ischaemic Heart Disease in Pakistan
Authors: Khan Assir Muhammad Zaman , Ahmad Hafiz Ijaz , Akram Javed , Yusuf Noshin Wasim , Kamran Umair 
Published: February 2014

AbstractWe investigated an outbreak of darkening of skin, bleeding from multiple sites, leucopenia and thrombocytopenia in ischaemic heart disease patients. Case patients were defined as patients who had received medicines from the pharmacy of Punjab Institute of Cardiology between 1 December 2011 and 12 January 2012 and who developed any one of the following: darkening of skin, bleeding from any site, thrombocytopenia and leucopenia. Clinical and drug‐related data were abstracted. All 664 case patients had received iso‐sorbide‐mono‐nitrate contaminated with about 50 mg of pyrimethamine, and 151 (23%) died. The median age of 117 patients admitted at Jinnah Hospital Lahore was 57 years (range, 37–100) and 92 (79%) were male. The median time from intake of medicine to presentation was 37 days (range 13–72). Symptoms and signs included bleeding (in 95% of the patients), skin hyperpigmentation (in 61%), diarrhoea (in 53%) and abdominal pain (in 48%). At presentation, the median white cell count was 2.3 × 109/L (range, 0.1 × 109–16.0 × 109), the median hemoglobin concentration was 109 g/L (range 58–169) and the median platelet count was 18 × 109/L (range, 0 × 109–318 × 109). Bone marrow examination revealed trileneage dysplasia and severe megaloblastosis. The predictors of mortality included presentation prior to 15 January 2012, age more than 57 years, hypotension and leukocyte count less than 1.5 × 109/L. None of the patients who died received Calcium folinate because all deaths occurred prior to contaminant identification. We describe an outbreak of pyrimethamine toxicity in ischaemic heart disease patients receiving medicines from a single pharmacy due to accidental contamination of iso‐sorbide mono‐nitrate tablets at industrial level. Late recognition of illness resulted in high mortality.
Predicting survival in heart failure: validation of the MAGGIC heart failure risk score in 51 043 patients from the Swedish Heart Failure Registry
Authors: Sartipy Ulrik , Dahlström Ulf , Edner Magnus , Lund Lars H. 
Published: February 2014

AimsThe aim of this study was to evaluate the performance of a recently developed risk score for mortality in heart failure by external validation in a national heart failure registry.Methods and resultsFrom 13 routinely available patient characteristics, the Meta‐analysis Global Group in Chronic Heart Failure (MAGGIC) constructed a risk score for prediction of mortality in heart failure. We included 51 043 patients from the national Swedish Heart Failure Registry and calculated the MAGGIC risk score for each patient. The outcome measure was 3‐year mortality. The predicted probability of death obtained from the calculated risk score was compared with the observed 3‐year mortality, and model discrimination and calibration were assessed by formal tests and graphical means. The overall 3‐year mortality in the study population was 39.4% and the MAGGIC project heart failure risk score predicted mortality was 36.4% (observed to expected ratio: 1.08). Discrimination was excellent overall (C index = 0.741). The difference between the model‐predicted and the observed 3‐year mortality in the six risk groups varied between 5% and −12%. Calibration plots demonstrated slight overprediction for the lowest risk patients, and underprediction in high risk patients.ConclusionThe MAGGIC project heart failure risk score demonstrated an excellent ability to categorize patients in separate risk strata. Although the predicted 3‐year mortality risk was higher in low risk groups and lower in high risk groups compared with the observed 3‐year mortality in the Swedish Heart Failure Registry, the MAGGIC project heart failure risk score performed well in a large nationwide contemporary external validation cohort.
Cardiorespiratory fitness and risk of heart failure: a population‐based follow‐up study
Authors: Khan Hassan , Kunutsor Setor , Rauramaa Rainer , Savonen Kai , Kalogeropoulos Andreas P. , Georgiopoulou Vasiliki V. , Butler Javed , Laukkanen Jari A. 
Published: February 2014

AimTo examine the relationship between cardiorespiratory fitness (CRF) and risk of incident heart failure (HF).Methods and resultsCardiorespiratory fitness, as measured by maximal oxygen uptake (VO2max), was assessed at baseline in a prospective cohort of 1873 men aged 42–61 years without HF or chronic respiratory disease. During a mean follow‐up of 20.4 years, 152 incident HF events were recorded. Within‐person variability was calculated using data from repeat measurements taken 11 years apart. The age‐adjusted hazard ratio (HR) per unit increase (1 mL/kg/min of VO2max) in CRF was 0.89 [95% confidence interval (CI) 0.86–0.93], which was minimally attenuated to 0.94 (95% CI 0.90–0.98) after further adjustment for established HF risk factors (body mass index, systolic blood pressure, history of cardiovascular disease, diabetes, heart rate, and LV hypertrophy) and incident coronary events as a time‐varying covariate. In a comparison of extreme quartiles of CRF levels (VO2max ≥35.4 vs. ≤25.7 mL/kg/min), the corresponding HRs were 0.27 (0.15–0.50) and 0.48 (0.25–0.92), respectively. Each 1 MET (metabolic equivalent of oxygen consumption) increment in CRF was associated with a 21% (7–33%) reduction in multivariable adjusted risk of HF. Addition of CRF to a HF risk prediction model containing established risk factors did not significantly improve risk discrimination (C‐index change = 0.0164, P = 0.07).ConclusionsIn this Finnish population, there is a strong, inverse, and independent association between long‐term CRF and HF risk, consistent with a dose–response relationship. The protective effect of CRF on HF risk warrants further evaluation.
A centurial development of the North Sea fish megafauna as reflected by the historical Swedish longlining fisheries
Authors: Cardinale M , Bartolino V , Svedäng H , Sundelöf A , Poulsen R T , Casini M 
Published: February 2014

AbstractHistorically, to compensate for declining catches, fishers have usually shifted from species characterized by high catch rate onto less easily caught species or have moved into new fishing grounds. Such shifts are poorly documented for areas with a long history of exploitation (i.e. North Sea) as they occurred long time before the start of the regular assessments of the marine resources. The Swedish longline fisheries in the Kattegat‐Skagerrak and North Sea have a long history that spans over several centuries. These fisheries have historically targeted large demersal predator fish as ling (Molva molva), cod (Gadus morhua), Atlantic halibut (Hippoglossus hippoglossus) and skates (mainly Dipturus spp.). In this study, data from the Swedish longline fisheries from 1859 to 1960 have been collated. The data show that the geographical expansion of the fishery was extensive. At the turn of the 20th century, offshore longlining became concentrated north and west of the Shetlands and Hebrides, and after the WWII, the fishery expanded to Iceland and Rockall. In the offshore fishery, CPUE for the main target species, ling, remained stable, whereas for the other species, with the exception of tusk (Brosme brosme), CPUE showed a dramatic decline over time. In contrast, in the coastal longlining fishery, severe declines were revealed for all major target species except cod. We argue that the constant search for new fishing grounds in the Northeast Atlantic reflects a dwindling resource, where the fishermen kept the catch rates of ling high by travelling to more and more distant fishing grounds.
Mechanical Properties of Canine Patella‐Ligament‐Tibia Segment
Authors: Biskup Jeffery , Freeman Andy , Camisa Will , Innes John , Conzemius Michael 
Published: February 2014

ObjectiveTo test the ex vivo mechanical properties of canine patella‐ligament‐tibia (PLT) segment and establish the relationship between donor size and PLT dimensions to the mechanical properties of PLT grafts.Study DesignEx vivo mechanical testing study.Sample PopulationCanine PLT segments (n = 21 dogs; 42 PLT).MethodsMorphometric measurements of PLT segments were taken from computed tomography (CT) images and compared with results obtained using calipers. PLT were tested to failure at a rate of 100% length/s. Mechanical properties and failure mode were recorded.ResultsPLT width and thickness (P < .001 for both) measured by calipers were significantly lower than those taken from CT images. Thirty‐five (83%) specimens failed by avulsion fracture from the patella, 1 failed mid‐ligament, and 6 failed by tibial fracture. Dog weight and PLT length had the strongest Pearson's r value when correlated with load at failure (r = 0.73, 0.81, respectively).ConclusionDog weight and PLT length were the best predictors of load at failure. PLT failure load of dogs weighing >25 kg were similar to those reported for the cranial cruciate ligament (CCL) suggesting that the PLT may be a suitable allograft for CCL replacement.
Surgical Technique and Short‐Term Outcome for Experimental Laparoscopic Closure of the Epiploic Foramen in 6 Horses
Authors: Munsterman Amelia S. , Hanson Russell Reid , Cattley Russell C. , Barrett Elizabeth J. , Albanese Valeria 
Published: February 2014

ObjectiveTo describe a laparoscopic technique for, and short‐term outcome after, closure of the epiploic foramen (EF) in horses.Study DesignDescriptive, experimental study.AnimalsHealthy, adult horses (n = 6).MethodsLaparoscopic portals to approach the EF were identified in standing horses. Under laparoscopic observation, the gastropancreatic fold and right lobe of the pancreas were grasped with Babcock forceps and secured to the caudate hepatic lobe using helical titanium coils to obliterate the EF. Surgical procedure time and intra‐ and postoperative complications were recorded. Serial analysis of select serum enzymes was used as an indication of involvement of the pancreas and liver. Closure was reevaluated at 4 weeks using repeat laparoscopy, and necropsy was performed immediately after.ResultsAt initial surgery, EF closure was successful in all 6 horses; median surgical time was 40.5 minutes (range, 22–110 minutes). Serum gamma‐glutamyl transferase (GGT) and sorbitol dehydrogenase (SDH) were not significantly altered by the surgical procedure; however, aspartate aminotransferase (AST) and amylase (AMY) were transiently increased. At repeat laparoscopic reevaluation, closure was complete in 5 horses, with partial closure of the EF observed in 1 horse. No complications related to the procedure were noted during or after surgery in any horse.ConclusionsEF closure in the standing horse can be accomplished without complications to the surrounding organs and vessels.
Nutrient Management and the Chesapeake Bay
Authors: Beegle Douglas 
Published: February 2014

AbstractThe Chesapeake Bay is the largest estuary in the United States with a very large and diverse watershed. The health of the Bay related to pollution from nutrients and sediment has been in decline for many years. Agriculture in the watershed is one of the major contributors of nutrient and sediment pollution to the Chesapeake. The cause of the nutrient pollution from agriculture has usually been thought to have been the result of mismanagement of nutrients on farms. Consequently, the approaches to solving the problem have focused almost exclusively on changing farm management. As a result, significant progress has been made in improving on‐farm nutrient management but the health of the Bay remains a concern. An analysis of the structure of animal agriculture in the Bay watershed reveals that the problem is much deeper than simply mismanagement on farms. A major underlying cause is a regional nutrient imbalance resulting from an economically driven system of animal production based on importing from outside the watershed a large amount of the animal feed. Therefore, a long‐term, sustainable solution will require much more than just changing on‐farm management. To really solve this problem will require a restructuring of the animal production systems to internalize the environmental costs of this structural imbalance of nutrients in the watershed. The challenge that must be met is how to accomplish this in a way that is sustainable.
Fertilizer Use in Regulated River Basins: Is it What We Think?
Authors: Osmond Deanna L. , Neas Kathy , Johnson Amy M. , Cahill Sheri L. 
Published: February 2014

AbstractLike many impacted coastal water systems, the Tar‐Pamlico River Basin and Jordan Lake watershed in North Carolina have had environmental rules implemented to reduce nitrogen and phosphorus loadings to their waters. Agriculture's contribution to nutrient loading in both basins was based on models, and no agricultural data were collected before rules were designed. A one‐time statistically valid area‐frame sampling was applied to agricultural fields in each of the basins to collect agricultural information, including fertilizer rates. This sampling was much more detailed than current USDA surveys. In both basins, nitrogen fertilizer rates were frequently lower than the recommended rates, and therefore, calculated nitrogen losses were lower than expected; phosphorus application rates were irrespective of soil test information. Generally, the survey found that producers in both basins are often under‐applying fertilizer, especially nitrogen, and minimizing environmental impact of nutrient and soil losses from agricultural fields through appropriate cropping systems and conservation practices.