bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retinal ganglion cell layer thinning within one month of presentation for optic neuritis
Authors: Kupersmith Mark J , Garvin Mona K , Wang Jui-Kai , Durbin Mary , Kardon Randy 
Published: September 2015

Background: Spectral domain optical coherence tomography (SD-OCT) reveals retinal ganglion cell layer plus inner plexiform layer (GCL+IPL) and peripapillary retinal nerve fiber layer (pRNFL) thinning in chronic optic nerve injury. At presentation, swelling of the pRNFL confounds evaluation of early axon loss. Objective: We studied whether the GCL+IPL thins before the pRNFL, the trajectory of GCL+IPL loss and relationship to vision. Methods: We prospectively evaluated 33 eyes (study) with new optic neuritis, using perimetry and SD-OCT with investigative three-dimensional layer segmentation and commercial two-dimensional segmentation to compute the GCL+IPL and pRNFL thickness. Results: At presentation, GCL+IPL thickness (82.4±8.8 µm) did not differ from unaffected fellow eyes (81.2±6.7 µm), via the three-dimensional method, while the two-dimensional method failed in 9% of study eyes. At 1–2 months, there was thinning of the pRNFL in 10% and of the GCL+IPL in 93% of study eyes. GCL+IPL reduction was greatest during the first 2 months. GCL+IPL thinning at 1–2 months correlated with GCL+IPL thinning at 6 months ( r=0.84, P=0.01) and presentation visual acuity ( r=0.48, P=0.006) and perimetric mean deviation ( r=0.52, P=0.003). Conclusion: GGL+IPL is an early biomarker of structural injury in optic neuritis as thinning develops within 1–2 months of onset, prior to pRNFL thinning.
Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression
Authors: Moccia Marcello , Lanzillo Roberta , Palladino Raffaele , Chang Kiara Chu-Mei , Costabile Teresa , Russo Cinzia , De Rosa Anna , Carotenuto Antonio , Saccà Francesco , Maniscalco Giorgia Teresa , Brescia Morra Vincenzo 
Published: September 2015

Background: Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing–remitting (RR). Objective: To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes. Methods: The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded. Results: 67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater ( p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects ( p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period ( p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively). Conclusion: Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.
Efficacy of rituximab in refractory neuromyelitis optica
Authors: Collongues N , Brassat D , Maillart E , Labauge P , Ouallet JC , Carra-Dalliere C , Moreau T , Bourre B , Papeix C , Brochet B , Audoin B , Vukusic S , de Seze J , Marignier R ,   on behalf of the OFSEP and CFSEP
Published: September 2015

Background: Despite a growing use of rituximab (RTX) in neuromyelitis optica (NMO), data are lacking in patients with refractory NMO (RNMO), defined as cases with at least one relapse during immunosuppressive therapy. Objective: The purpose of this study was to assess RTX as a maintenance therapy in RNMO. Methods: Out of a total of 305 NMO cases from a population-based cohort, 21 RNMO patients received RTX during a mean follow-up period of 31 months. Results: After RTX, 11 patients (52.3%) were relapse free, meaning that 47.7% were refractory to RTX. The mean annualized relapse rate decreased from 1.3 to 0.4 ( p<0.001) and median EDSS from 5 to 3 ( p=0.02). Body mass index (BMI) was predictive of EDSS worsening. Conclusions: RTX is an effective and well-tolerated treatment in RNMO. BMI could be a predictive factor for efficacy.
Genetic analysis of the isolated Faroe Islands reveals SORCS3 as a potential multiple sclerosis risk gene
Authors: Binzer S , Stenager E , Binzer M , Kyvik KO , Hillert J , Imrell K 
Published: September 2015

Background: In search of the missing heritability in multiple sclerosis (MS), additional approaches adding to the genetic discoveries of large genome-wide association studies are warranted. Objective: The objective of this research paper is to search for rare genetic MS risk variants in the genetically homogenous population of the isolated Faroe Islands. Methods: Twenty-nine Faroese MS cases and 28 controls were genotyped with the HumanOmniExpressExome-chip. The individuals make up 1596 pair-combinations in which we searched for identical-by-descent shared segments using the PLINK-program. Results: A segment spanning 63 SNPs with excess case-case-pair sharing was identified (0.00173 < p > 0.00212). A haplotype consisting of 42 of the 63 identified SNPs which spanned the entire the Sortilin-related vacuolar protein sorting 10 domain containing receptor 3 ( SORCS3) gene had a carrier frequency of 0.34 in cases but was not present in any controls ( p = 0.0008). Conclusion: This study revealed an oversharing in case-case-pairs of a segment spanning 63 SNPs and the entire SORCS3. While not previously associated with MS, SORCS3 appears to be important in neuronal plasticity through its binding of neurotrophin factors and involvement in glutamate homeostasis. Although additional work is needed to scrutinise the genetic effect of the SORCS3-covering haplotype, this study suggests that SORCS3 may also be important in MS pathogenesis.
Body mass index during adolescence, rather than childhood, is critical in determining MS risk
Authors: Hedström AK , Olsson T , Alfredsson L 
Published: September 2015

Objective: Obesity in childhood and during adolescence has repeatedly been associated with increased risk of developing multiple sclerosis (MS). We aimed to investigate whether the most critical period occurs during childhood or later, during adolescence. Methods: Using a population-based case-control study (1586 cases and 2800 controls), individuals with different body sizes at age 10 and different body mass indices at age 20 were compared regarding MS risk, by calculating odds ratios with 95% confidence intervals. Potential interactions between HLA-DRB1*15 and absence of HLA-A*02, respectively, and both childhood and adolescent obesity were evaluated by calculating the attributable proportion due to interaction. Results: Regardless of body size at age 10, individuals with adolescent obesity had a 90% increased risk of MS. Among participants who were not obese at age 20, no association was observed between body size at age 10 and subsequent MS risk. An interaction was observed between the HLA MS risk genes and adolescent, but not childhood, obesity. Conclusions: Our results suggest that BMI during adolescence, rather than childhood, is critical in determining MS risk.
Effect of fingolimod on cardiac autonomic regulation in patients with multiple sclerosis
Authors: Simula Sakari , Laitinen Tomi , Laitinen Tiina M , Tarkiainen Tuula , Hartikainen Päivi , Hartikainen Juha EK 
Published: September 2015

Background: Fingolimod modulates sphingosine-1-phosphate receptors that are also found in cardiovascular tissue. Objective: To investigate the effects of fingolimod on cardiac autonomic regulation prospectively. Methods: Twenty-seven relapsing–remitting multiple sclerosis patients underwent 24-hour electrocardiogram recording before, at the first day of fingolimod treatment (1d) and after three months of continuous dosing (3mo). The time interval between two consecutive R-peaks (RR-interval) was measured. Cardiac autonomic regulation was assessed by the various parameters of heart rate variability. Parasympathetic stimulation prolongs the RR-interval and increases heart rate variability while the effects of sympathetic stimulation are mainly the opposite. The low frequency/high frequency ratio reflects sympathovagal balance. Results: From baseline to 1d, a prolongation of the RR-interval ( P<0.001), an increase in the values of various heart rate variability parameters ( P<0.05 to P<0.001) and a decrease in the low frequency/high frequency ratio ( P<0.05) were demonstrated. At 3mo, although the RR-interval remained longer ( P<0.01), the values of various heart rate variability parameters were lower ( P<0.01 to P<0.001) as compared to baseline. At 3mo, the low frequency/high frequency ratio ( P<0.05) was higher in men than in women although no such difference was found at baseline or at 1d. Conclusions: After an initial increase in parasympathetic regulation, continuous fingolimod dosing shifts cardiac autonomic regulation towards sympathetic predominance, especially in men. Careful follow-up of fingolimod-treated relapsing–remitting multiple sclerosis patients is warranted as sympathetic predominance associates generally with impaired outcome. ClinicalTrials.cov: NCT01704183
A randomized controlled proof-of-concept trial of early sedation management using Responsiveness Index monitoring in mechanically ventilated critically ill patients
Authors: Kaila Markus , Everingham Kirsty , Lapinlampi Petteri , Peltola Petra , Särkelä Mika O K , Uutela Kimmo , Walsh Timothy S. 
Published: September 2015

Abstract
Introduction
Deep sedation is associated with adverse patient outcomes. We recently described a novel sedation-monitoring technology, the Responsiveness Index (RI), which quantifies patient arousal using processed frontal facial EMG data. We explored the potential effectiveness and safety of continuous RI monitoring during early intensive care unit (ICU) care as a nurse decision-support tool.

Methods
In a parallel-group controlled single centre proof of concept trial, patients requiring mechanical ventilation and sedation were randomized via sequential sealed envelopes following ICU admission. Control group patients received hourly clinical sedation assessment and daily sedation holds; the RI monitor was connected but data were concealed from clinical staff. The intervention group received control group care, but RI monitoring was visible and nurses were asked to adjust sedation to maintain patients with an RI>20 whenever possible. Traffic-light colour coding (RI<20, Red; 20–40, Amber; >40, Green) simplified decision-making. The intervention lasted up to 48 hours. Sixteen nurses were interviewed to explore their views of the novel technology.

Results
We analysed 74 patients treated per protocol (36 intervention; 38 control). The proportion of patients with RI<20 was identical at the start of monitoring (54 % both groups). Overall, the proportion of time with RI<20 trended to lower values for the intervention group (median 16 % (1–3rd quartile 8–30 %) versus 33 % (10–54 %); P = 0.08); sedation and analgesic use was similar. A post hoc analysis restricted to patients with RI<20 when monitoring started, found intervention patients spent less time with low RI value (16 % (11–45 %) versus 51 % (33–72 %); P = 0.02), cumulative propofol use trended to lower values (median 1090 mg versus 2390 mg; P = 0.14), and cumulative alfentanil use was lower (21.2 mg versus 32.3 mg; P = 0.01). RASS scores were similar for both groups. Sedation related adverse event rates were similar (7/36 versus 5/38). Similar proportions of patients had sedation holds (83 % versus 87 %) and were extubated (47 % versus 44 %) during the intervention period. Nurses valued the objective visible data trends and simple colour prompts, and found RI monitoring a useful adjunct to existing practice.

Conclusions
RI monitoring was safe and acceptable. Data suggested potential to modify sedation decision-making. Larger trials are justified to explore effects on patient-centred outcomes.

Trial registration
NCT01361230 (registered April 19, 2010)
How HCAs and APs contribute to postoperative care
Authors: Peate Ian 
Published: September 2015

The typical surgical care journey concludes with postoperative care. While this is the last phase of the journey or surgical pathway, for the patient the impact of surgery may not end here. For the patient, the journey may continue and they may have to endure other interventions that aim to return them to full health, or to as near full health as possible. This article provides insight into and understanding of some of the key issues that are associated with postoperative care. If the healthcare assistant and assistant practitioner (HCA and AP) understand these issues, then it can help them offer care that is safe, effective and patient-centred.
1/3. Hope and despair: the community health assistant role in Zambia
Authors: Zulu Joseph Mumba , Michelo Charles , Kinsman John , Hurtig Anna-Karin , Zulu Joseph Mumba 
Published: September 2015

Background: In order to address the challenges facing the community-based health workforce in Zambia, its Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called ‘community health assistants’ (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. Methods: A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district, Zambia, and observations were analysed using a thematic analysis approach. Results: Personal characteristics, such as previous experience and knowledge, passion to serve the community and a desire to improve skills, motivated people to become CHAs. Health systems characteristics, such as an inclusive work culture in some health posts, motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure that constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected some CHAs' self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs, which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers, due to their exclusion from the government payroll, inhibited CHAs' ability to deliver services. Conclusions: Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.
Walkable scores for selected three east Texas counties: physical activity and policy implications
Authors: Njororai Simiyu Wycliffe W. , Njororai Fletcher , Jivetti Billystrom Aronya 
Published: September 2015

<p><strong>Introduction:</strong> Physical activity has become an important intervention against overweight and obesity cases in the USA and worldwide. One key aspect of physical activity is walking, which has been identified as a component that can easily be incorporated into one’s lifestyle. Recent studies on physical activity have focused on promoting walking as a health enhancing endeavor. In 2010, the proportion of Texas adults who reported no participation in leisure time activity (26.7%) was significantly higher than the national average (24.4%). However, many Texans, like most Americans, are sedentary.</p><p><strong>Purpose:</strong> This study examined the walkability of the environments in selected counties in east Texas including Wood, Van Zandt and Smith counties.</p><p><strong>Methods and material:</strong> The data was drawn from the Walkscore.com and was based on all the zip codes in the three counties in east Texas. The community capitals were used a framework for analysis. </p><p><strong>Results:</strong> Only three (8.82%) zip codes had walkable scores between 70 and 89; five (14.71%) had scores between 50 and 69; four (11.76%) between 25 and 49 and 22 (64.71%) had a score below 24.</p><p><strong>Discussion:</strong> The vast majority (26, 76.47%) of zip codes are highly dependent on vehicle transport.</p><p><strong>Conclusions and recommendations:</strong> Stakeholders need therefore to focus on causes for the minimal walkability so that practical interventions are generated to enhance the physical activity friendly infrastructure so as to enhance the well-being of the residents in these three east Texas counties.</p>
New type of fluxgate magnetometer for the heart’s magnetic fields detection
Authors: Rybalko Ruslan , Haueisen Jens , Hofmann Christian 
Published: September 2015

Abstract
The application area of fluxgate sensors is limited by their sensitivity. Medical researches create high demand on the magnetometers with the characteristics of high accuracy and sensibility for measuring weak magnetic fields produced by the human body, such as the heart‘s magnetic field. Due to the insufficient sensitivity of fluxgate sensors, superconducting magnetometers (SQUID) take the dominant position for the cardiomagnetic measurements. They have to be cooled by liquefied gases and it leads to high service costs. Therefore an idea of creating a high sensitive sensor based on fluxgate principles and known methods of measurement is attractive and up to date. This paper is dedicated to the modified flux-gate sensors based on Racetrack technology with a new approach of signal demodulation. The improved fluxgate sensor system provides detection of the heart‘s magnetic field without additional expenditures for use.
Development of a new homecare sleep monitor using body sounds and motion tracking
Authors: Kalkbrenner Christoph , Eichenlaub Manuel , Brucher Rainer 
Published: September 2015

Abstract
This paper presents the development of a sleep monitor to provide a comfortable way of detecting sleep-related breathing disorders like the obstructive sleep apnea syndrome (OSAS). OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital with multiple electrodes and sensors attached to the patient’s body. However, body sound and motion tracking also provide extensive information about sleep course. A unique recording device offering a good body sound extraction, noise suppression and a small size is developed. Using this device a reliable detection of breathing and heart beat is possible. In addition sleeping positions and the activity of the patient will be evaluated using an inertial measurement unit (IMU). The device is easy to set up and offers the possibility to use it independently at home.
Initial experiments have shown that volunteers were able to set up the device on their own. Furthermore several overnight recordings revealed the capability to monitor breathing, heart rate, sleeping position as well as movements of the patient.
Separating the effect of respiration from the heart rate variability for cases of constant harmonic breathing
Authors: Kircher Michael , Lenis Gustavo , Dössel Olaf 
Published: September 2015

Abstract
Heart Rate Variability studies are a known measure for the autonomous control of the heart rate. In special situations, its interpretation can be ambiguous, since the respiration has a major influence on the heart rate variability. For this reason it has often been proposed to measure Heart Rate Variability, while the subjects are breathing at a constant respiration rate. That way the spectral influence of the respiration is known. In this work we propose to remove this constant respiratory influence from the heart rate and the Heart Rate Variability parameters to gain respiration free autonomous controlled heart rate signal. The spectral respiratory component in the heart rate signal is detected and characterized. Subsequently the respiratory effect on Heart Rate Variability is removed using spectral filtering approaches, such as the Notch filter or the Raised Cosine filter. As a result new decoupled Heart Variability parameters are gained, which could lead to new additional interpretations of the autonomous control of the heart rate.
Processing of membranes for oxygenation using the Bellhouse-effect
Authors: Neußer C. , Bach C. , Doeringer J. , Jockenhoevel S. 
Published: September 2015

Abstract
State-of-the-art lung support systems are limited to short time application because of a lack of long term hemocompatibility and protein absorption on the membrane surfaces. In a highly interdisciplinary project at RWTH Aachen University a biohybrid lung assist system with endothelialised gas exchange flat membranes is developed to improve long term compatibility of oxygenators. To increase the gas exchange performance of flat membranes hollows are imprinted in the membrane surfaces. This approach is based on the research of B. J. Bell-house et al. [1], who discovered this effect, now known as Bellhouse-effect, around 1960. In this paper a processes to manufacture membrane assemblies for oxygenation with imprinted hollows on the flat membrane surfaces is reviewed.
“Hands free for intervention”, a new approach for transoral endoscopic surgery
Authors: Boese A. , Detert M. , Stibbe Chr. , Thiele M. , Arens Chr. 
Published: September 2015

Abstract
A standard method for transoral diagnostic and dissection of tumour is the endoscopic examination plus microscopic and laser supported surgery. For endoscopic examination a set of rigid endoscopes with different angles of view are on the market and in use. To simplify the diagnostic examination, a first idea was to use an endoscope with flexible angles of view. A further step of this approach is the electrical angulation of the endoscopic view to enable an adaption on the surgery site without using the hands. Thus the hands are free for intervention. This paper shows a first implementation of a prototype of an electrical operated endoscope for a free hand imaging in transoral interventions.
Using smart glasses for ultrasound diagnostics
Authors: Maas Stefan , Ingler Marvin , Overhoff Heinrich Martin 
Published: September 2015

Abstract
Ultrasound has been established as a diagnostic tool in a wide range of applications. Especially for beginners, the alignment of sectional images to patient’s spatial anatomy can be cumbersome. A direct view onto the patient’s anatomy while regarding ultrasound images may help to overcome unergonomic examination.
To solve these issues an affordable augmented reality system using smart glasses was created, that displays a (virtual) ultrasound image beneath a (real) ultrasound transducer.