bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of heart rate variability response in children undergoing elective endotracheal intubation with and without neuromuscular blockade: a randomized controlled trial
Authors: Janda Matthias , Bajorat Jörn , Kudlik Christiana , Pohl Birgit , Schubert Agnes , Nöldge‐Schomburg Gabriele , Hofmockel Rainer 
Published: August 2013

SummaryBackgroundThe routine use of neuromuscular blocking drugs (NMBD) for endotracheal intubation in children is the subject of much controversy. The analysis of heart rate variability (HRV) can reveal information about the functional state of the autonomic nervous system (ANS).AimThe purpose of this study was to determine if HRV elucidates differences in the sympathovagal balance of children undergoing elective endo‐tracheal intubation with and without neuromuscular blockade (NMB).MethodsIn this prospective study, 38 children (2–6 years) scheduled for adenotonsillectomy were randomized into two groups to receive fentanyl 2 μg·kg−1 and propofol 4 mg·kg−1, with either mivacurium 0.25 mg·kg−1 (NMB group) or saline solution (NoNMB group) for anesthesia induction. The same experienced, blinded anesthesiologist performed endotracheal intubation. Heart rate variability, RR intervals, ECG as well as an electroencephalogram were recorded with HRV and BIS XP monitors, respectively. Heart rate variability was analyzed in the frequency domain.ResultsThere was no significant difference in HRV changes immediately after mivacurium administration compared with an administration of saline. The groups were comparable for the bispectral index value (NMB 35 [33–41] vs NoNMB 34 [32–42]) during endotracheal intubation. Changes in both the low‐frequency power and the low‐/high‐frequency ratio immediately after endotracheal intubation compared with the unstimulated state before laryngoscopy were significantly higher without NMB (P = 0.015 and P = 0.006, respectively), whereas there was no significant difference with respect to the high‐frequency power.ConclusionsThe stress response during endotracheal intubation in pediatric patients represented by the frequency domain analysis of HRV was found to be higher without NMB. When mivacurium was added to a propofol–fent‐anyl induction regimen, the ANS alterations during endotracheal intubation decreased significantly.
An Open‐Label Pilot Study Evaluating the Effectiveness of the Heated Lidocaine/Tetracaine Patch for the Treatment of Pain Associated with Carpal Tunnel Syndrome
Authors: Nalamachu Srinivas , Nalamasu Rohit , Jenkins Julie , Marriott Thomas 
Published: August 2013

AbstractObjectivesCarpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve at the wrist that is characterized by pain, paresthesias, weakness, and loss of dexterity. This pilot study was conducted to evaluate the heated lidocaine/tetracaine patch (HLT patch) as a conservative treatment for pain of CTS.MethodsTwenty adult patients (mean age = 44 ± 12 years) with pain secondary to unilateral CTS and electrodiagnostic evidence of mild‐to‐moderate CTS enrolled in this open‐label study. Patients were treated with a single HLT patch placed over the junction of forearm and wrist on the palmar aspect of the wrist twice daily (morning and evening at 12‐hour intervals) for 2 hours. At baseline and during the 2‐week study, patients graded their pain intensity with an 11‐point numerical rating scale (0 = no pain, 10 = worst imaginable pain). Pain interference with general activity, work, and sleep was evaluated with a similar 0‐to‐10‐point scale.ResultsFifteen patients completed the 14‐day treatment period. Mean average pain intensity score decreased from 5.1 ± 1.5 at baseline to 2.5 ± 1.6 at end of study in the per‐protocol population (P < 0.001). Two‐thirds of the patients demonstrated clinically meaningful pain relief (≥ 30% reduction in average pain score), with 40% of the patients reaching this threshold by the third treatment day. Similar improvements were observed for pain interference scores. The HLT patch was generally well tolerated.ConclusionThe HLT patch resulted in clinically meaningful reduction in pain intensity in the majority of patients with mild‐to‐moderate CTS and may represent a targeted nonsurgical treatment for pain associated with CTS.
Factors predicting health‐related quality of life in pediatric liver transplant recipients in the functional outcomes group
Authors: Alonso Estella M. , Martz Karen , Wang Deli , Yi Michael S. , Neighbors Katie , Varni James W. , Bucuvalas John C. ,   The Studies of Pediatric Liver Transplantation (SPLIT) Functional Outcomes Group (FOG)
Published: August 2013

AbstractData from 997 pediatric LT recipients were used to model demographic and medical variables as predictors of lower levels of HRQOL. Data were collected through SPLIT FOG project. Patients were between 2 and 18 yr of age and survived LT by at least 12 months. Parents and children (age ≥ 8 yr) completed PedsQL™ 4.0 Generic Core and CF Scales at one time point. Demographic and medical variables were obtained from SPLIT. HRQOL scores were categorized as “poor” based on lower 25% of scores for each measure. Logistic regression models were generated. Single‐parent households (OR 1.94, CI 1.13–3.33, p = 0.017), anti‐seizure medications (OR 3.99, CI 1.26–12.70, p = 0.019), and number of days hospitalized (OR 1.03, CI 1.01–1.06, p = 0.0067) were associated with lower self‐reported HRQOL. Parent data identified increasing age at transplant, age 5–12 yr at survey, hospitalization >21 days at LT, re‐operations, diabetes, and growth failure at LT as additional predictors of generic HRQOL. Male gender, single‐parent households, higher bilirubin levels at LT, and use of anti‐seizure medication predicted lower cognitive function scores. HRQOL following pediatric LT is related to medical and demographic variables.
Adolescent transplant recipients as peer mentors: A program to improve self‐management and health‐related quality of life
Authors: Jerson Bradley , D'Urso Christine , Arnon Ronen , Miloh Tamir , Iyer Kishore , Kerkar Nanda , Annunziato Rachel A. 
Published: August 2013

AbstractThe purpose of this study was to examine the safety, feasibility, acceptability, and preliminary efficacy of a cross‐age peer mentoring program created to improve adherence and psychosocial outcomes for pediatric liver transplant recipients. Twenty‐two participants were assigned to a “mentor now” or “mentor later” waitlist control group. Tacrolimus SD, a validated measure of adherence, was assessed for six months pre‐ and post‐intervention for both groups. Self‐report measures of self‐management and HRQOL were completed at recruitment and three months after training. Participant report indicated the acceptability of the intervention. Clinically significant improvement in adherence was detected. No significant changes on the psychosocial outcome measures at follow‐up were observed. This study demonstrated that an outpatient‐based mentoring program is a safe, feasible, and acceptable option to incorporate within a pediatric liver transplant program with potential for promising application in other transplantation populations as well. These results also suggest that the program may have been associated with meaningful improvement in adherence, although further evaluation is warranted.
Non‐invasive biological quantification of acute gastrointestinal graft‐versus‐host disease in children by plasma citrulline
Authors: Merlin E. , Minet‐Quinard R. , Pereira B. , Rochette E. , Auvrignon A. , Oudot C. , Sapin V. , Deméocq F. , Kanold J. 
Published: August 2013

AbstractClinical grading of GI involvement during acute GVHD remains a challenging issue, especially in children. Plasma citrulline, a non‐protein amino acid selectively produced and released by enterocytes, is a suitable surrogate endpoint for small intestinal epithelial cell mass, irrespective of the underlying cause of cell loss. Children referred for allogeneic bone marrow transplantation who were free from chronic malabsorption or constitutional disease involving the GI tract were consecutively included in this prospective study. Plasma citrulline and albumin concentration was measured every week between day 7 and day 28 of BMT until resolution of the aGVHD or occurrence of chronic GVHD. In total, 31 children were included between 2008 and 2011. After a CR, citrulline levels fell to a minimum level on day 7 and then increased to reach the initial value on day 28. After day 28, plasma citrulline but not albumin was strongly linked to the occurrence of GI GVHD, the threshold being set at 10 μmol/L. The correlation with clinical grade of GI‐aGVHD now needs to be assessed in larger populations. In pediatric patients, citrulline is valuable as a suitable non‐invasive marker of GI involvement in acute GVHD.
Widespread overspill from a saline density‐current channel and its interaction with topography on the south‐west Black Sea shelf
Authors: Hiscott Richard N. , Aksu Ali E. , Flood Roger D. , Kostylev Vladimir , Yaşar Doğan 
Published: August 2013

AbstractSeaward of the Bosphorus Strait, the south‐west Black Sea shelf is dominated by the world's largest channel network maintained by a quasi‐continuous saline (ca 35 → 31 psu) underflow. Calculations indicate that >85% of the initial discharge of ca 104 m3s−1 spills overbank before the shelf edge. This paper documents interaction of the overspill with sea bed topography using multibeam bathymetry, echo‐sounder images of the water column, conductivity–temperature–depth profiles and sediment cores. Overbank spill is widespread, particularly through crevasse channels and on the middle shelf where confinement by channel banks is negligible. Towards the outer shelf, the wind‐driven Rim Current advects mud along the shelf, contributing to levée successions and deposition on stoss sides of elongate transverse ridges. Echo‐sounder profiles reveal metre‐scale eddies over megaflutes, and breaking lee waves and internal hydraulic jumps over ridges. Megaflutes reach 600 m long and 7 m deep, yet form where the underflow, outside the flute, is no thicker than ca 2 to 5 m. Two types of elongate seaward‐facing ridges are recognized. Type 1 ridges, 2 to 5 m high, consist of bivalve‐rich muddy sand in low‐angle (3·5° to 6°) cross‐sets created by the underflow. Type 2 ridges, ca 5 m high, have crests up to 2 km long and a buried wedge‐shaped foundation (the ‘ridge‐core’) comprised of facies similar to Type 1 ridges. These ridge‐cores are blanketed on the landward side by stratified muds, and are capped by obliquely oriented ribs supporting a diverse benthic community. This facies distribution is interpreted to result from stoss‐side and lee‐side velocity and turbulence fluctuations induced by internal hydraulic jumps and breaking lee waves in overspilling portions of the underflow. Experimental results published by W.H. Snyder and co‐workers effectively explain ridge evolution and flow across the ridges, and therefore can be applied with confidence to less easily studied deep‐marine settings swept by turbidity currents.
Some Remarks onPutnam's Contributions to Semantics
Authors: Burge Tyler 
Published: August 2013

AbstractAfter a critical discussion of Putnam's early work on the analytic–synthetic distinction, this article discusses seven contributions that Putnam has made to the philosophy of language. These contributions are (1) to understanding the role of definitions in science and in ordinary discourse; (2) to recognizing the role of stereotypes in explaining meaning; (3) to acknowledging the minimal role of explicative understanding in having linguistic competence with natural kind words; (4) to distinguishing sharply between identifying natural kinds and determining their more fundamental natures; (5) to exploring a division of linguistic labour – a role for social interaction in determining reference, especially of natural kind terms; (6) to establishing a broadly unified causal account of the reference of ordinary natural kind terms and scientific physical magnitude terms; and (7) to reviving a conception of scientific language that allows for trans‐theoretical reference and one sort of trans‐theoretical meaning.
Screening recipients of increased‐risk donor organs: a survey of transplant infectious diseases physician practices
Authors: Theodoropoulos N. , Ladner D.P. , Ison M.G. 
Published: August 2013

AbstractBackgroundIn 1994, the Public Health Service published guidelines to minimize the risk of human immunodeficiency virus (HIV) transmission and to monitor recipients following the transplantation of organs from increased‐risk donors. A 2007 survey revealed the post‐transplant surveillance of recipients of organs from increased‐risk donors (ROIRD) is variable.MethodsAn electronic survey was sent to transplant infectious diseases physicians at US solid organ transplant centers.ResultsA total of 126 surveys were sent to infectious diseases physicians, and we received 51 (40%) responses. We found that 22% of respondents obtain only verbal, 69% verbal and written, and 8% do not obtain any special consent from ROIRD, despite an Organ Procurement and Transplantation Network policy requiring such consent. Post‐solid organ transplantation serologies for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) are performed by 6–8% of respondents in all recipients, by 69% of respondents in ROIRD only, and 25% of respondents do not perform them at all. Post‐transplant nucleic acid testing is carried out by 55–64% of respondents in ROIRD, by 0–2% in all recipients, and not performed by 35–43% of respondents.ConclusionScreening RIORD for HIV, HBV, and HCV has increased since 2007, but remains less than optimal and is incomplete when screening for disease transmission at many centers.
Heart transplantation in a patient with heteroresistant vancomycin‐intermediate Staphylococcus aureus ventricular assist device mediastinitis and bacteremia
Authors: Swartz T.H. , Huprikar S. , LaBombardi V. , Pinney S. , Anyanwu A. , Lee M. , Patel G. 
Published: August 2013

AbstractVancomycin‐intermediate Staphylococcus aureus (VISA) infections are an emerging problem and antibiotic options are limited. We report the first case, to our knowledge, of heteroresistant VISA mediastinitis and bacteremia in a patient with a ventricular assist device who underwent orthotopic heart transplantation with clinical cure.
Evaluation of accelerated collagen cross‐linking for the treatment of melting keratitis in eight dogs
Authors: Famose Frank 
Published: August 2013

AbstractObjectiveMelting keratitis is serious condition presenting a high risk of permanent blindness and is caused by infectious or noninfectious factors. In humans, the clinical efficacy of collagen cross‐linking (CXL) has been described in the treatment of refractory infectious keratitis by arresting keratomalacia. The aim of this study was to evaluate the efficacy of acceleratedCXLfor the treatment of melting keratitis in dogs.Animal studied and ProcedureEight dogs were treated for unilateral melting keratitis by accelerated CXL. Corneas were irradiated by UVA (370 nm) at 30 mW/cm² irradiance for 3 min after soaking by 0.1% riboflavin in 20% dextran for 30 min. Follow‐up was conducted 3, 7, 14, and 30 days after treatment.ResultsPain improvement was observed for all cases within 3 days after treatment. Epithelial healing was observed within 15 days for all cases.Disappearance of cellular infiltration was observed for all cases at day 7. The corneal vascularization disappeared for 4 of 8 dogs and was reduced for 4 of 8 dogs within 1 month. At 1 month, all cases presented a variable degree of corneal scarring, but all eyes had visual function. No recurrent infection was observed.ConclusionsThe main observation of this study is that all the cases have presented with the same clinical result regardless of the presence and the sensitivity of the infectious agents and regardless of the duration of the condition prior toCXLtreatment. AcceleratedCXLappears to be a valuable option for the treatment of melting keratitis.
Treatment of immune‐mediated keratitis in horses with episcleral silicone matrix cyclosporine delivery devices
Authors: Gilger Brian C. , Stoppini Riccardo , Wilkie David A. , Clode Alison B. , Pinto Nelson H. , Hempstead Julie , Gerding Joseph , Salmon Jacklyn H. 
Published: August 2013

AbstractPurposeTo describe the use of episcleral silicone matrix cyclosporine (ESMC) drug delivery devices in horses with immune‐mediated keratitis (IMMK) with evaluation of tolerability and efficacy in long‐term control of inflammation.MethodsRetrospective study. ESMC implants (1.2 cm length, 30% wt/wt cyclosporine (CsA) in silicone; with approximately 2 μg/day steady‐state release for at least 400 days) were used.ResultsNineteen horses (20 eyes) received two or more ESMC implants for superficial stromal (n = 9), midstromal (n = 3), or endothelial (n = 5) IMMK. Three additional horses received two or more ESMC implants for pigmentary keratouveitis (PK). Nine eyes of eight horses with superficial and five eyes of five horses with endothelial IMMK were well controlled after placement of ESMC implants (mean follow‐up 176.8 and 207.2 days, respectively). Horses with midstromal IMMK and PK were not controlled with ESMC implants alone, but instead required frequent use of other medications or surgery to control the disease. The mean duration of disease prior to ESMC implantation of horses with midstromal IMMK was 495 ± 203.9 days, compared with 121.6 ± 92.7 days with superficial IMMK. ESMC implants were well tolerated by all horses without documented loss of the device.ConclusionsResults from this preliminary retrospective study suggest that the ESMC implants were well tolerated and associated with treatment success with superficial and endothelial IMMK, especially if placed early in the disease process. Further study is needed to determine the duration of efficacy, number of implants required, and better therapies for chronic midstromal IMMK and pigmentary keratouveitis.
The Effects of a Parametric Variation of the Rim Seal Geometry on the Interaction Between Hub Leakage and Mainstream Flows in HP Turbines
Authors: Popović I. , Hodson H. P. 
Published: August 2013

The objective of this work was to assess and understand the effects of parametric variation performed on a typical overlapping rim seal geometry. The datum geometry has been focus of a detailed experimental investigation employing a large-scale linear cascade subjected to a range of the mass flow rates and swirl velocities of the leakage air. The parametric variations described in this paper were examined using validated CFD. As a part of the parametric studies, both the axial and the radial seal clearance between the rotor fin (angel wing) and stator platform were varied as well as the length of the overlap between stator and rotor platforms. In addition, the effects of forward and backward facing annulus steps were also investigated.
It has been found that a backward facing annulus step was detrimental for all conditions considered, while a forward facing step offered improvements for smaller step heights and/or lower leakage fractions. Tightening of the seal clearances closer to the annulus line improved the sealing effectiveness, but often at the expense of increased losses. On the other hand, increasing the overlap length led to improvements in the sealing effectiveness with very small effects on the overall losses. Moving the rim seal away from the blade leading edges reduced the pressure asymmetry at the rim seal and increased the flow uniformity of the leakage air. However, this led to an increased cross-passage flow (more negative skew) and higher losses at all but lowest leakage fractions.
The results presented in this paper highlight the fact that there may not be an optimum rim seal solution that would offer an improvement for the full range of leakage fractions and that for different rim sealing flows there may be a different optimum geometry. In addition, rotor disc movements in radial and axial directions at various off-design conditions should be considered as a part of the design process. Based on the presented results it may be of a benefit to the turbine designer to consider rotor disc designs which would be more biased towards the upstream and outward disc movements that would result in tightening of the seal clearances and avoidance of a backward facing annulus step.
Impact of the 3D Flow Effects on the Silo Combustor Thermal State
Authors: Vassiliev Vladimir , Magni Fulvio , Chernyshev Sergey , Kostege Valery 
Published: August 2013

Many Alstom heavy-duty gas turbines with a silo combustor are in service and moreover undergoing upgrades for performance augmentation, lifetime extension, and emission reduction. Several structural parts of the combustor are exposed to high gas temperatures, and therefore their lifetime depends mainly on the metal temperatures, which must be kept within the acceptable limits. This paper describes methodology based on the state of the art methods of 3D CFD and finite element (FE) computations, which are combined into the computational process for the reliable silo combustor thermal analyses.
In the first part of the paper the computational model of the silo combustor is discussed. The model comprises CFD models simulating the hot gas path and the cooling air supply system, as well as the FE model of the structural parts. The CFD models predict the gas temperatures and heat transfer coefficients that are used by the FE model for calculating the metal temperatures.
In the second part of the paper the computational results are presented and several 3D flow phenomena are analysed in details. One effect is the interaction of dilution jets in swirled cross flow. At different operation conditions, pairing of those jets occurs, which generates the periodic metal temperature distribution, as recorded in the field. This analysis also revealed factors, which influence on the temperature distribution. The combustor simulation delivers an insight into non-homogeneous temperature profiles in front of the turbine behind the transition channel of the silo-combustor. Finally, by adding leakages into the flow model, the interesting example of the non-homogeneous leakage of cold air, which can lead to local increase of material temperature, was simulated. All these simulations led to reliable silo-combustor upgrades.
Simulations of Multi-Phase Particle Deposition on a Non-Axisymmetric Contoured Endwall With Film-Cooling
Authors: Lawson Seth A. , Lynch Stephen P. , Thole Karen A. 
Published: August 2013

Designing turbine components for maximum aerodynamic performance with adequate cooling is a critical challenge for gas turbine engineers, particularly at the endwall of a turbine due to complex secondary flows. To complicate matters, impurities from the fuel and intake air can deposit on film-cooled components downstream of the combustor. Deposition induced roughness can reduce cooling effectiveness and aerodynamic performance dramatically. One method commonly used for reducing the effects of secondary flows on aerodynamic performance is endwall contouring. The current study evaluates deposition effects on endwall contouring given the change to the secondary flow pattern.
For the current study, deposition was dynamically simulated in a turbine cascade to determine its effects on film-cooling with and without endwall contouring. Computationally predicted impactions were in qualitative agreement with experimental deposition simulations showing that contouring reduced deposition around strategically placed film-cooling holes. Deposition reduced cooling effectiveness by 50% on a flat endwall and 40% on an identically cooled contoured endwall. Although 40% is still a dramatic reduction in effectiveness, the method of using the endwall contouring to alter deposition effects shows promise.