bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Rapid Respiratory Panel Test on Patient Outcomes
Authors: Rogers Beverly B. , Shankar Prabhu , Jerris Robert C. , Kotzbauer David , Anderson Evan J. , Watson J. Renee , O'Brien Lauren A. , Uwindatwa Francine , McNamara Kelly , Bost James E. 
Published: August 2014

Context
Evolution of polymerase chain reaction testing for infectious pathogens has occurred concurrent with a focus on value-based medicine.

Objective
To determine if implementation of the FilmArray rapid respiratory panel (BioFire Diagnostics, Salt Lake City, Utah) (hereafter RRP), with a shorter time to the test result and expanded panel, results in different outcomes for children admitted to the hospital with an acute respiratory tract illness.

Design
Patient outcomes were compared before implementation of the RRP (November 1, 2011, to January 31, 2012) versus after implementation of the RRP (November 1, 2012, to January 31, 2013). The study included inpatients 3 months or older with an acute respiratory tract illness, most admitted through the emergency department. Testing before RRP implementation used batched polymerase chain reaction analysis for respiratory syncytial virus and influenza A and B, with additional testing for parainfluenza 1 through 3 in approximately 11% of patients and for human metapneumovirus in less than 1% of patients. The RRP tested for respiratory syncytial virus, influenza A and B, parainfluenza 1 through 4, human metapneumovirus, adenovirus, rhinovirus/enterovirus, and coronavirus NL62.

Results
The pre-RRP group had 365 patients, and the post-RRP group had 771 patients. After RRP implementation, the mean time to the test result was shorter (383 minutes versus 1119 minutes, P &lt; .001), and the percentage of patients with a result in the emergency department was greater (51.6% versus 13.4%, P &lt; .001). There was no difference in whether antibiotics were prescribed, but the duration of antibiotic use was shorter after RRP implementation (P = .003) and was dependent on receiving test results within 4 hours. If the test result was positive, the inpatient length of stay (P = .03) and the time in isolation (P = .03) were decreased after RRP implementation compared with before RRP implementation.

Conclusions
The RRP decreases the duration of antibiotic use, the length of inpatient stay, and the time in isolation.
La préservation de l’essentiel dans l’espace clinique
Authors: Zaloum Terry 
Published: August 2014

L’auteure présente ici le texte remanié de la conférence qu’elle a donnée dans le cadre du Colloque organisé par la revue Filigrane, le 16 novembre 2013 : « Qu’est la psychanalyse devenue ? ». En référence à son expérience de près de 30 ans de travail comme psychologue, puis psychanalyste, oeuvrant dans un hôpital psychiatrique pour enfants et adolescents, elle aborde la difficulté, partagée par bon nombre de cliniciens, de pratiquer avec une orientation psychanalytique dans une institution qui ne fait que peu ou pas de place à cette approche. Sa réflexion l’amène à entrevoir ce qui lui semble le plus important de préserver pour continuer à faire un travail psychanalytique dans les milieux institutionnels. Sa réponse à la question posée par Filigrane se décline ainsi en six points particuliers : la perspective temporelle, l’écoute de la réalité psychique, la menace faite à la langue psychanalytique, l’investissement du clinicien, la question de la résistance et de la survivance, et enfin, la transformation du pessimisme.
« Le Coin féminin » de Magali : une rubrique féminine pas comme les autres
Authors: Rao Sathya 
Published: August 2014

C’est en 1905 que Magali Michelet débarque au Canada avec sa famille. Rien ne pouvait laisser imaginer que cette jeune femme, issue d’un milieu modeste, gagnerait un jour sa place au panthéon des lettres canadiennes-françaises. À peine quelques mois après son installation dans un « homestead » situé aux environs de la colonie francophone de Legal en Alberta, Magali prend la charge de la rubrique féminine du quotidien francophone Le courrier de l’Ouest dont son frère, Alex, est le rédacteur en chef. Cette charge, Magali l’assumera pendant presque une dizaine d’années avec talent puisque « Le Coin féminin » comptera parmi ses admiratrices nulle autre que Robertine Barry [Françoise] tout en accueillant parmi ses correspondantes quelques journalistes québécoises de renom. Au fil des années, la rubrique féminine de Magali s’est imposée comme un espace littéraire singulier au sein du paysage de la francophonie albertaine. Véritable carrefour entre l’est et l’ouest du Canada, « Le Coin féminin » a permis également à Magali d’affûter sa plume et d’acquérir une notoriété littéraire nationale.
Clinical Utility of Ductus Venosus Flow in Fetuses With Right‐Sided Congenital Heart Disease
Authors: Arya Bhawna , Krishnan Anita , Donofrio Mary T. 
Published: August 2014

ObjectivesAbnormal ductus venosus flow is associated with fetal compromise and can be present in right‐sided congenital heart disease. We hypothesized that the ductus venosus flow pattern in fetuses with obstructive right‐sided congenital heart disease will have abnormal flow at baseline. Those with nonobstructive disease will have normal flow at baseline. We further hypothesized that abnormal ductus venosus flow will predict fetal compromise.MethodsWe conducted a retrospective review of fetuses with right‐sided congenital heart disease. Ductus venosus measurements included the presence of atrial reversal, velocity time integral, and peak velocity index. Fetuses were separated into those with obstructive (group 1) and nonobstructive (group 2) lesions. Compromise was defined as fetal distress (pericardial effusion, hydrops, or left ventricular dilatation/dysfunction) or death (fetal/neonatal mortality).ResultsSixty fetuses with right‐sided congenital heart disease were identified (mean gestational age ± SD, 24.2 ± 5.4 weeks; group 1, n = 45; group 2, n = 15). Ductus venosus reversal was more often present (49% versus 13%; P = .017), and the peak velocity index was significantly higher (1.39 ± 0.67 versus 0.98 ± 0.33; P= .026) in group 1. In group 1,duc‐tus venosus reversal was more often present (93% versus 32%; P < .001), and the peak velocity index was significantly higher (1.87 ± 0.67 versus 1.12 ± 0.53; P< .001) in compromised fetuses. In this group, a peak velocity index higher than 1.57 predicted compromise with 93% sensitivity and 81% specificity. In group 2, ductus venosus reversal was rarely present (n = 2) and was not found in any fetuses who died.ConclusionsFetuses with obstructive right‐sided congenital heart disease have ductus venosus reversal at baseline; an abnormal peak velocity index can be used to predict compromise. Fetuses with nonobstructive disease rarely have ductus venosus reversal; the peak velocity index cannot be used to predict outcomes in this group.
Does Early Second‐Trimester Sonography Predict Adverse Perinatal Outcomes in Monochorionic Diamniotic Twin Pregnancies?
Authors: Allaf M. Baraa , Campbell Winston A. , Vintzileos Anthony M. , Haeri Sina , Javadian Pouya , Shamshirsaz Amir A. , Ogburn Paul , Figueroa Reinaldo , Wax Joseph , Markenson Glenn , Chavez Martin R. , Ravangard Samadh F. , Ruano Rodrigo , Sangi-Haghpeykar Haleh , Salmanian Bahram , Meyer Marjorie , Johnson Jeffery , Ozhand Ali , Davis Sarah , Borgida Adam , Belfort Michael A. , Shamshirsaz Alireza A. 
Published: August 2014

ObjectivesTo determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second‐trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.MethodsWe conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16‐ to 18‐week sonographic examination who had serial follow‐up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16‐ to 18‐week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin‐twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5‐minute Apgar score less than 7, necrotizing enterocolitis, culture‐proven early‐onset sepsis, and neonatal death. Receiver operating characteristic and logistic regression–with–generalized estimating equation analyses were constructed.ResultsAmong the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin‐twin transfusion syndrome or adverse neonatal outcomes.ConclusionsIn our cohort, only second‐trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin‐twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.
Sonographic Diagnosis of Tuberculous Lymphadenitis in the Neck
Authors: Park Jun Ho , Kim Dong Wook 
Published: August 2014

ObjectivesThe aim of this study was to assess the diagnostic accuracy of individual sonographic features and sonographic diagnosis for patients with a clinical suspicion of tuberculous lymphadenitis in the neck.MethodsFrom January 2010 to December 2011, 79 patients who underwent neck sonography and sonographically guided fine‐needle aspiration with tuberculosis polymerase chain reaction analysis for clinical suspicion of tuberculous lymphadenitis in the neck were enrolled in the study. The sonographic features of each patient were retrospectively investigated by a single radiologist using a picture archiving and communication system, and a sonographic diagnosis according to the number of sonographic features was developed. Follow‐up sonography, polymerase chain reaction, core needle biopsy, or excision biopsy of lymph nodes from the neck was used for the final diagnosis.ResultsThe diagnoses of the 79 patients were finally confirmed as tuberculous lymphadenitis (n = 40), suppurative lymphadenitis (n = 2), Kikuchi disease (n = 12), metastatic lymph nodes (n = 9), and nonspecific lymphadenitis (n = 16). No sonographic features with both high sensitivity and specificity were found. In a receiver operating characteristic analysis of sonographic diagnosis, the category of 2 or more sonographic features showed the highest area under the curve. When the “2 or more” category was selected, the sensitivity, specificity, positive and negative predictive values, and accuracy of sonography for diagnosis of tuberculous lymphadenitis were 95.0%, 79.5%, 82.6%, 93.9%, and 87.3%, respectively.ConclusionsAlthough no sonographic feature had both high sensitivity and specificity for detection of tuberculous lymphadenitis, the diagnostic accuracy of the “2 or more” category was higher than those of other categories.
Sonography for Diagnosis of Benign and Malignant Tumors of the Nose and Paranasal Sinuses
Authors: Liu Jun-jie , Gao Yong , Wu Ya-Fei , Zhu Shang-Yong 
Published: August 2014

ObjectivesThe purpose of this study was to demonstrate the reliability of sonography for diagnosis of nose and paranasal sinus tumors.MethodsNinety‐six consecutive patients with tumors underwent sonography and computed tomography (CT) before surgical treatment. Tumor detectability and imaging findings were evaluated independently and then compared with pathologic findings.ResultsOf 96 tumors, 75 were detected by sonography, for a detectability rate of 78.1%; 93 tumors were detected by CT, for a detectability rate of 96.9%. By comparison, sonography showed a trend toward higher detectability of nasal vestibular tumors than CT (87.5% for sonography versus 50.0% for CT) and small lumps on the wing of the nose (78.8% for sonography versus 33.3% for CT). Among the sonographic features, boundary, shape, internal echo, calcification, bone invasion, vascular pattern, and cervical lymph node metastasis all had significantly positive correlations with malignancy (P < .05), but size did not (P = .324). In addition, the vascular resistive index for malignant tumors was significantly higher (mean ± SD, 0.66 ± 0.20) than the index for benign lesions (0.24 ± 0.30; P < .001). Moreover, the detection rate for grade 1–3 (small–large) blood flow in benign lesions was only 43.8%, whereas the rate for malignant tumors was 97.7% (P < .001).ConclusionsThe vascular pattern may be a promising predictive indicator for distinguishing benign and malignant tumors of the nose and paranasal sinuses. Consequently, sonography has high value for diagnosis of benign and malignant tumors of the nose and paranasal sinuses, especially for nasal vestibular tumors and small lumps on the wing of the nose.
A New Assessment Tool for Parkinson Disease
Authors: Sanzaro Enzo , Iemolo Francesco , Duro Giovanni , Malferrari Giovanni 
Published: August 2014

ObjectivesA sonographic method that provides for the measurement of a single frozen image and ignores the remaining portions of the midbrain has been used recently as a biological marker of Parkinson disease. We propose a new approach to evaluating the midbrain: obtaining the nigral lesion load, with which it is possible to acquire an estimate of the real damage to the substantia nigra.MethodsWe studied 60 patients with Parkinson disease and classified them according to the Hoehn and Yahr scale (Neurology 1967; 17:427–442). Magnetic resonance imaging of the brain, ioflupane‐labeled single‐photon emission computed tomography, and technetium Tc 99m–labeled single‐photon emission computed tomography were performed. Assessment of the midbrain parenchyma was performed with transcranial sonography to quantify the extent of hyperechoic signals on 2 different scans (upper and lower substantia nigra).ResultsIn 90% of patients (54), we found pathologic hyperechoic substantia nigra signals (>0.25 cm2). These data were similar to those described previously by other authors. However, the sum of the values obtained from each measurement (total of 4 per patient) showed that patients with severe disease had larger nigral lesion loads. In most cases, the study showed impairment of the nigrostriatal dopaminergic system when the hyperechoic pattern was more pronounced.ConclusionsTranscranial sonography is a useful tool for Parkinson disease workup. A single measurement of substantia nigra echogenicity may be insufficient for an optimal definition of the stage of the disease. A study of the entire midbrain may deliver more information than a single measurement.
In Vivo Measurement of Rotator Cuff Tendon Strain With Ultrasound Elastography
Authors: Hatta Taku , Yamamoto Nobuyuki , Sano Hirotaka , Itoi Eiji 
Published: August 2014

ObjectivesTo clarify the relationship between the strain ratio measured by ultrasound elastography and the mechanical properties of the tendon measured by a universal testing machine. We also attempted to determine the effect of the type and depth of soft tissue overlying the tendon on the elastographic measurement.MethodsTwelve fresh porcine shoulders were prepared. Elastographic measurement was performed on the infraspinatus tendon by manually applying repetitive compressions from an ultrasound probe with an acoustic coupler consisting of an elastomer with definite elasticity as a reference material. The strain ratio, defined as tendon/reference strain, was obtained by 4 different approaches: with the probe placed on the skin, on the subcutaneous fat after removing the skin, on the muscle after removing the subcutaneous fat, and directly on the tendon. The strain ratios measured by these approaches were compared statistically. The relationship between the depth of the tendon measured on elastography and the strain ratio was also investigated. We also attempted to clarify the relationship between the strain ratio of the tendon and its elastic property. The tendon was mounted on a testing machine, and compressive force was applied. Tendon compliance was calculated as the reciprocal of the Young modulus in the range of 5% to 10% strain, which was compared to its strain ratio.ResultsThe tendon/reference strain ratio significantly correlated with the tendon compliance (r = 0.73; P < .01). The strain ratio was not affected by differences in the measuring approaches (P = .4) or by the depth to the tendon level (P = .8).ConclusionsOur results indicated that the strain ratio of the rotator cuff tendon could be measured with minimal influence by overlying soft tissues if its depth from the skin was less than 22 mm. We believe that ultrasound elastography would be a useful tool for assessment of tendon elasticity in clinical practice.
Risk Factors Associated With Failed Sonographically Guided Saline Hydrostatic Intussusception Reduction in Children
Authors: He Nianan , Zhang Shenglong , Ye Xianjun , Zhu Xiaoqian , Zhao Zhihong , Sui Xiufang 
Published: August 2014

ObjectivesThe aim of this study was to explore the risk factors associated with failed sonographically guided saline hydrostatic intussusception reduction in children.MethodsWe retrospectively reviewed the medical records and sonograms of 288 cases of intussusception over a 3‐year period. Logistic regression was used for the analysis of the clinical data (sex, age, duration of symptoms, and presence or absence of emesis or bloody stool) and sonographic features (initial location and intussusception length, presence or absence of free peritoneal fluid, and trapped fluid in the intussusception).ResultsThe sex, age, and duration of symptoms showed no significant impact on the hydrostatic reducibility. The success rate became significantly lower for the intussusception cases with the presence of bloody stool, free peritoneal fluid, and trapped fluid in the intussusception (P < .05). The success rate was also lower when the intussusceptions were located in the left side of the abdomen (P < .05). For the above risk factors, the odds ratios from multivariate logistic regression analysis were 174.68 for initial intussusception location in the descending colon/rectum, 36.06 for the presence of peritoneal fluid, 13.22 for trapped fluid in the intussusception, and 9.27 for the presence of bloody stool.ConclusionsAn initial intussusception location in the descending colon/rectum, the presence of peritoneal fluid, trapped fluid in the intussusception, and bloody stool are the most important risk factors for failure of sonographically guided saline hydrostatic intussusception reduction.
Relationship Between Isolated Mild Tricuspid Valve Regurgitation in Second‐Trimester Fetuses and Postnatal Congenital Cardiac Disorders
Authors: Zhou Jizi , Zhang Yun , Gui Yonghao , Chu Chen , Zhang Congcong , Zhou Qiongjie , Zhang Ying , Li Xiaotian , Yan Yingliu 
Published: August 2014

ObjectivesIn most cases, the clinical importance of fetal isolated mild tricuspid valve regurgitation is not known. This study evaluated the relationship between fetal isolated mild tricuspid regurgitation in the general obstetric population and postnatal congenital cardiac disorders.MethodsDetailed fetal echocardiography was done between 18 and 24 weeks' gestation to detect tricuspid regurgitation and to exclude complicated cardiac defects. Routine second‐trimester targeted organ scans were also performed to exclude extracardiac defects. Follow‐up was done until birth. After birth, the cardiac anatomy of the neonates was examined by echocardiography. The association between fetal isolated mild tricuspid regurgitation and postnatal congenital cardiac disorders was assessed by logistic regression analysis.ResultsNo major cardiac disorders were found postnatally. Some minor disorders were found, including a patent foramen ovale, atrial septal defects, a patent ductus arteriosus, and small ventricular septal defects. Fetuses with isolated mild tricuspid regurgitation had a significantly higher likelihood of having ventricular septal defects (odds ratio, 5.80; P = .027) or a patent foramen ovale with atrial septal defects and a patent ductus arteriosus (odds ratio, 11.61; P = .007). There was no significant association between tricuspid regurgitation and an isolated patent foramen ovale or a patent foramen ovale with atrial septal defects in neonates.ConclusionsFetuses with isolated mild tricuspid regurgitation in the second trimester did not have a higher incidence of major cardiac disorders after birth. The presence of isolated mild tricuspid regurgitation may be an indication of minor postnatal congenital cardiac disorders.
Spreading depression in continuous electroencephalography of brain trauma
Authors: Hartings Jed A. , Wilson J. Adam , Hinzman Jason M. , Pollandt Sebastian , Dreier Jens P. , DiNapoli Vince , Ficker David M. , Shutter Lori A. , Andaluz Norberto 
Published: August 2014

ObjectiveCortical spreading depolarizations are a pathophysiological mechanism and candidate target for advanced monitoring in acute brain injury. Here we investigated manifestations of spreading depolarization in continuous electroencephalography (EEG) as a broadly applicable, noninvasive method for neuromonitoring.MethodsEighteen patients requiring surgical treatment of traumatic brain injury were monitored by invasive electrocorticography (ECoG; subdural electrodes) and noninvasive scalp EEG during intensive care. Spreading depolarizations were first identified in subdural recordings, and EEG was then examined visually and quantitatively to identify correlates.ResultsA total of 455 spreading depolarizations occurred during 65.9 days of simultaneous ECoG/EEG monitoring. For 179 of 455 events (39%), depolarizations caused temporally isolated, transient depressions of spontaneous EEG amplitudes to 57% (median) of baseline power. Depressions lasted 21 minutes (median) and occurred as suppressions of high‐amplitude delta activity present as a baseline pattern in the injured hemisphere. For 62 of 179 (35%) events, isolated depressions showed a clear spread of depression between EEG channels with delays of 17 minutes (median), sometimes spanning the entire hemisphere. A further 188 of 455 (41%) depolarizations were associated with continuous EEG depression that lasted hours to days due to ongoing depolarizations. Depolarizations were also evidenced in EEG as shifts in direct current potentials.InterpretationLeão's spreading depression can be observed in clinically standard, continuous scalp EEG, and underlying depolarizations can spread widely across the injured cerebral hemisphere. These results open the possibility of monitoring noninvasively a neuronal pathophysiological mechanism in a wide range of disorders including ischemic stroke, subarachnoid hemorrhage, and brain trauma, and suggest a novel application for continuous EEG. Ann Neurol 2014;76:681–694