bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlating data from different sensors to increase the positive predictive value of alarms: an empiric assessment
Authors: Bitan Yuval , O’Connor Michael F 
Published: May 2013

Objectives: Alarm fatigue from high false alarm rate is a well described phenomenon in the intensive care unit (ICU). Progress to further reduce false alarms must employ a new strategy. Highly sensitive alarms invariably have a very high false alarm rate. Clinically useful alarms have a high Positive-Predictive Value. Our goal is to demonstrate one approach to suppressing false alarms using an algorithm that correlates information across sensors and replicates the ways that human evaluators discriminate artifact from real signal.Methods: After obtaining IRB approval and waiver of informed consent, a set of definitions, (hypovolemia, left ventricular shock, tamponade, hemodynamically significant ventricular tachycardia, and hemodynamically significant supraventricular tachycardia), were installed in the monitors in a 10 bed cardiothoracic ICU and evaluated over an 85 day study period. The logic of the algorithms was intended to replicate the logic of practitioners, and correlated information across sensors in a way similar to that used by practitioners. The performance of the alarms was evaluated via a daily interview with the ICU attending and review of the tracings recorded over the previous 24 hours in the monitor. True alarms and false alarms were identified by an expert clinician, and the performance of the algorithms evaluated using the standard definitions of sensitivity, specificity, positive predictive value, and negative predictive value.Results: Between 1 and 221 instances of defined events occurred over the duration of the study, and the positive predictive value of the definitions varied between 4.1% and 84%.Conclusions: Correlation of information across alarms can suppress artifact, increase the positive predictive value of alarms, and can employ more sophisticated definitions of alarm events than present single-sensor based systems.
Student feedback about the use of role plays in Sparshanam, a medical humanities module
Authors: Shankar P Ravi , Piryani Rano M , Singh Kundan K , Karki Bal Man S 
Published: May 2013

Background:At KIST Medical College, Lalitpur, Nepal, a Medical Humanities module for first year medical students has been conducted. Role plays are used to explore social, medical and sexual issues in the Nepalese context. The present study obtained student feedback about the role plays used in the module, the difficulties faced, and obtained suggestions for further improvement.Method:The module was conducted from January to August 2011 using a total of 15 role plays. Student feedback was obtained using a semi-structured questionnaire. Informal discussions were held and a questionnaire was circulated among the first year students who had participated in the module.Results:Ninety-eight of the 100 students in the module participated in the study. The overall opinion regarding the role plays was positive. Students stated role plays helped to make module objectives concrete and interesting, made students identify with the problem being investigated and improved communication skills. Role plays were designed to address important health issues in Nepal and prepare students for addressing these issues in future practice. A lack of sufficient time for preparing the role plays and initial problems with group dynamics were mentioned by the respondents during the study.Conclusions:Student feedback about the use of role plays during the module was positive. Role plays helped in making module objectives more concrete and interesting, improved communication skills and addressed important health issues in Nepal. Role plays are not resource intensive and can be considered for use in medical schools in developing nations.
Moving beyond Type I and Type II neuron types
Authors: Skinner Frances K 
Published: May 2013

In 1948, Hodgkin delineated different classes of axonal firing. This has been mathematically translated allowing insight and understanding to emerge. As such, the terminology of ‘Type I’ and ‘Type II’ neurons is commonplace in the Neuroscience literature today. Theoretical insights have helped us realize that, for example, network synchronization depends on whether neurons are Type I or Type II. Mathematical models are precise with analyses (considering Type I/II aspects), but experimentally, the distinction can be less clear. On the other hand, experiments are becoming more sophisticated in terms of distinguishing and manipulating particular cell types but are limited in terms of being able to consider network aspects simultaneously. Although there is much work going on mathematically and experimentally, in my opinion it is becoming common that models are either superficially linked with experiment or not described in enough detail to appreciate the biological context. Overall, we all suffer in terms of impeding our understanding of brain networks and applying our understanding to neurological disease. I suggest that more modelers become familiar with experimental details and that more experimentalists appreciate modeling assumptions. In other words, we need to move beyond our comfort zones.
Correlation between miRNA-targeting-specific promotermethylation and miRNA regulation of target genes
Authors: Taguchi Y-h 
Published: May 2013

BackgroundmiRNA regulation of target genes and promoter methylation were known to be the primary mechanisms underlying the epigenetic regulation of gene expression. However, how these two processes cooperatively regulate gene expression has not been extensively studied.MethodsGene expression and promoter methylation profiles of 271 distinct human cell lines were obtained from gene expression omnibus. P-values that describe both miRNA-targeting-specific promoter methylation and miRNA regulation of target genes were computed with the MiRaGE method proposed recently by the author.ResultsWe found that promoter methylation was miRNA-targeting-specific. In other words, changes in promoter methylation were associated with miRNA binding at target genes. It was also found that miRNA-targeting-specific promoter hypomethylation was related to miRNA regulation; the genes with miRNA-targeting-specific promoter hypomethylation were downregulated during cell senescence and upregulated during cellulardierentiation. Promoter hypomethylation was especially enhanced for genes targeted by miR-548 miRNAs, which are non-conserved, and primate-specific miRNAs that are typically expressed at lower levels than the frequently investigated conserved miRNAs.ConclusionsIt was found that promoter methylation was affected by miRNA targeting. Furthermore, miRNA-targeting-specific promoter hypomethylation was suggested to facilitate gene regulation by miRNAs that are not strongly expressed (e.g., miR-548 miRNAs).
Association of spirochetal infection with Morgellons disease
Authors: Middelveen Marianne J , Burugu Divya , Poruri Akhila , Burke Jennie , Mayne Peter J , Sapi Eva , Kahn Douglas G , Stricker Raphael B 
Published: May 2013

Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of Borrelia spirochetes in dermatological tissue of four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the Borrelia spirochetes found in MD patients is warranted.
Pharmacist-Physician Collaboration for Diabetes Care: The Diabetes Initiative Program
Authors: Farland Michelle Zingone , Byrd Debbie C , McFarland M Shawn , Thomas Jeremy , Franks Andrea S , George Christa M , Gross Benjamin N , Guirguis Alexander B , Suda Katie J 
Published: May 2013

BACKGROUND: Multiple complications can arise secondary to poor control of glucose, blood pressure, and cholesterol in a patient with diabetes. OBJECTIVE: To evaluate the effect of a pharmacist-physician collaboration on attainment of diabetes-related measures of control. METHODS: This was a prospective, multicenter, cohort study. Patients were enrolled from 7 practice sites throughout Tennessee if they had been diagnosed with type 2 diabetes, were aged 18 years or older with a life expectancy greater than 1 year, and were English speaking. Pregnant women were excluded. Patients were followed for 12 months following enrollment by informed consent. The pharmacist-physician collaboration method was established prior to study initiation. Primary outcomes included hemoglobin A1c (A1C), number of patients with A1C less than 7%, and percentage of patients with A1C greater than 9%. RESULTS: Of the 206 patients enrolled, the mean age was 59.73 years, and most were male (59.71%) and white (66.02%). The A1C was reduced by an average of 1.16% (p < 0.0001). The proportion of patients with A1C less than 7% increased from 12.75% at baseline to 36.76% at study conclusion (p = 0.0002). The proportion of patients with A1C greater than 9% decreased from 34.15% to 16.50%, (p < 0.0001). CONCLUSIONS: Pharmacist-physician collaborative management at multiple practice locations and types of setting (eg, private, academic, Veterans Affairs medical center) has a positive impact on glycemic control and diabetes-related health maintenance. This was accomplished without increasing the total number of antihyperglycemic agents prescribed and without an increase in patient-reported episodes of hypoglycemia.
Increased plasma β-hydroxybutyrate levels during the fasting test in patients with endogenous hyperinsulinaemic hypoglycaemia
Authors: Buffet Alexandre , Vezzosi Delphine , Maiza Jean Christophe , Grunenwald Solange , Bennet Antoine , Caron Philippe 
Published: May 2013

ObjectiveThe objective of the present study was to determine whether a plasma β-hydroxybutyrate (BOHB) level >2700 μmol/l during the 72-h fasting test is sufficient to rule out the diagnosis of endogenous hyperinsulinaemic hypoglycaemia (EHH).Research design and methodsWe retrospectively studied BOHB levels in 39 patients with EHH who had undergone a 72-h fasting test to make the diagnosis of EHH, and we compared EHH patients with BOHB levels >2700 μmol/l (group 1), EHH patients with BOHB levels <2700 μmol/l (group 2) and 59 controls (median glycaemia: 3.2 mmol/l and median BOHB: 6095 μmol/l).ResultsDuring a 72-h fasting test, nine patients (group 1) had BOHB levels >2700 μmol/l (median 6140 and range 2957–7824) and 30 patients (group 2) had BOHB levels <2700 μmol/l (median 542 and range 0–2607). In group 1, four patients had undergone partial pancreatectomy previously and were evaluated for the recurrence of hypoglycaemia, whereas none of the group 2 patients had been operated. The duration of the fasting test was longer in group 1 than in group 2 (P<0.0001), and at the end of the fasting test, plasma glucose concentrations were not significantly different (P=0.0617), but insulin (P=0.004), C-peptide (P=0.0015) and proinsulin (P=0.0038) levels were significantly lower in group 1 patients than in group 2 patients, suggesting lower insulin secretion and/or impaired glycaemic counter-regulation.ConclusionDuring a fasting test, a BOHB level >2700 μmol/l is observed in some EHH patients, suggesting that BOHB levels cannot rule out the recurrence of EHH, in particular, after partial pancreatectomy.
Differences in Peri‐Implant Microflora Between Fully and Partially Edentulous Patients: A Systematic Review
Authors: de Waal Yvonne C. , Winkel Edwin G. , Meijer Henny J. , Raghoebar Gerry M. , van Winkelhoff Arie J. 
Published: May 2013

Background: The current evidence suggests that the oral microflora differs between individuals who are fully edentulous (FES) and those who are partially edentulous (PES). It is unknown whether this leads to differences in peri‐implant microflora when implants are installed. The aim of the study is to compare the submucosal peri‐implant microflora between FES and PES.Methods: A systematic review was conducted. The MEDLINE, Embase, and Cochrane databases were searched for publications up to September 1, 2012. To reduce methodologic variations, only studies reporting in the same article about the submucosal peri‐implant microflora of FES and PES were selected.Results: Eleven publications describing 10 studies were selected. Because of numerous differences among the selected studies, no meta‐analysis could be performed. Six of 10 studies showed a significant difference in the composition of the submucosal peri‐implant microflora in healthy and peri‐implant mucositis conditions between FES and PES, with the latter showing a potentially more pathogenic composition. However, microbiologic results were not unanimous among the studies.Conclusions: In healthy and peri‐implant mucositis conditions, PES harbor a potentially more pathogenic peri‐implant microflora than FES. The current data are insufficient for a clear conclusion regarding peri‐implantitis cases. Overall, because of the lack of a meta‐analysis, the variability in microbiologic outcomes and the limited number of studies available, the current evidence seems not to be robust.
Validation of Antibiotic Efficacy on In Vitro Subgingival Biofilms
Authors: Belibasakis Georgios N. , Thurnheer Thomas 
Published: May 2013

Background: Systemic antibiotics are often used as adjunctive treatment modalities for periodontal diseases. Testing of antimicrobial efficacy can be relevant only if the bacteria are in the form of biofilms rather than the planktonic state, and at concentrations of physiologic relevance, i.e., reachable in the periodontal pocket. The aim of the present study is to test the antimicrobial efficacy of five common antibiotic schemes at physiologically relevant concentrations on a multispecies in vitro biofilm model.Methods: A 10‐species in vitro subgingival biofilm model was exposed to metronidazole (15 μg/mL), amoxicillin (15 μg/mL), metronidazole and amoxicillin in combination, doxycycline (2 μg/mL), and azithromycin (10 μg/mL) over 24 hours. Species‐specific bacterial numbers were determined by culture on selective agar media or by epifluorescence microscopy.Results: Metronidazole alone did not affect biofilm composition. Total bacterial counts were significantly reduced by doxycycline, azithromycin, and amoxicillin alone or in combination with metronidazole, albeit by less than 1 log. On the species‐specific level, these regimens significantly reduced the numbers of Streptococcus anginosus, Porphyromonas gingivalis, and Fusobacterium nucleatum, as well as Campylobacter rectus (except for amoxicillin alone). The strongest effects were displayed by the combination of amoxicillin and metronidazole.Conclusion: Antibiotics at concentrations detectable in gingival crevicular fluid do not dramatically reduce total bacterial loads in this in vitro biofilm model, but cause species‐specific reductions, which may disrupt the biofilm unity.
Characteristics Associated With Maintenance of Mean A1C &lt;6.5% in People With Dysglycemia in the ORIGIN Trial
Authors:   The ORIGIN Trial Investigators
Published: May 2013

OBJECTIVE
To assess the success and baseline predictors of maintaining glycemic control for up to 5 years of therapy using basal insulin glargine or standard glycemic care in people with dysglycemia treated with zero or one oral glucose-lowering agents.

RESEARCH DESIGN AND METHODS
Data from 12,537 participants in the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial were examined by baseline glycemic status (with or without type 2 diabetes) and by therapeutic approach (titrated insulin glargine or standard therapy) using an intention-to-treat analysis. Median values for fasting plasma glucose (FPG) and A1C and percentages with A1C &lt;6.5% (48 mmol/mol) during randomized treatment were calculated. Factors independently associated with maintaining updated mean A1C &lt;6.5% were analyzed with linear regression models.

RESULTS
Median A1C in the whole population was 6.4% at baseline; at 5 years, it was 6.2% with glargine treatment and 6.5% with standard care. Of those with diabetes at baseline, 60% using glargine and 45% using standard care had A1C &lt;6.5% at 5 years. Lack of diabetes and lower baseline A1C were independently associated with 5-year mean A1C &lt;6.5%. Maintaining mean A1C &lt;6.5% was more likely with glargine (odds ratio [OR] 2.98 [95% CI 2.67–3.32], P &lt; 0.001) than standard care after adjustment for other independent predictors.

CONCLUSIONS
Systematic intervention with basal insulin glargine or standard care early in the natural history of dysglycemia can maintain glycemic control near baseline levels for at least 5 years, whether diabetes is present at baseline or not. Keeping mean A1C &lt;6.5% is more likely in people with lower baseline A1C and with the glargine-based regimen.
Glucose Metabolism After Renal Transplantation
Authors: Hecking Manfred , Kainz Alexander , Werzowa Johannes , Haidinger Michael , Döller Dominik , Tura Andrea , Karaboyas Angelo , Hörl Walter H. , Wolzt Michael , Sharif Adnan , Roden Michael , Moro Ermanno , Pacini Giovanni , Port Friedrich K. , Säemann Marcus D. 
Published: May 2013

OBJECTIVE
We determined prevalence, risk factors, phenotype, and pathophysiological mechanism of new-onset diabetes after transplantation (NODAT) to generate strategies for optimal pharmacological management of hyperglycemia in NODAT patients.

RESEARCH DESIGN AND METHODS
Retrospective cohort study comparing demographics, laboratory data, and oral glucose tolerance test (OGTT)-derived metabolic parameters from kidney transplant recipients versus subjects not receiving transplants.

RESULTS
Among 1,064 stable kidney transplant recipients (≥6 months posttransplantation), 113 (11%) had a history of NODAT and 132 (12%) had pretransplant diabetes. In the remaining patients, randomly assigned OGTTs showed a high prevalence of abnormal glucose metabolism (11% diabetes; 32% impaired fasting glucose, impaired glucose tolerance, or both), predominantly in older patients who received tacrolimus as the primary immunosuppressant. Compared with 1,357 nontransplant subjects, stable kidney transplant recipients had lower basal glucose, higher glycated hemoglobin, lower insulin secretion, and greater insulin sensitivity in each of the three subgroups, defined by OGTT 2-h glucose (&lt;140, 140–199, ≥200 mg/dL). These findings were reinforced in linear spline interpolation models of insulin secretion and sensitivity (all P &lt; 0.001) and in another regression model in which the estimated oral glucose insulin sensitivity index was substantially higher (by 79–112 mL/min m2) for transplant versus nontransplant subjects despite adjustments for age, sex, and BMI (all P &lt; 0.001).

CONCLUSIONS
Glucose metabolism differs substantially between kidney transplant recipients and nontransplant controls. Because impaired insulin secretion appears to be the predominant pathophysiological feature after renal transplantation, early therapeutic interventions that preserve, maintain, or improve β-cell function are potentially beneficial in this population.
Grounding-line migration in plan-view marine ice-sheet models: results of the ice2sea MISMIP3d intercomparison
Authors: Pattyn Frank , Perichon Laura , Durand Gaël , Favier Lionel , Gagliardini Olivier , Hindmarsh Richard C.A. , Zwinger Thomas , Albrecht Torsten , Cornford Stephen , Docquier David , Fürst Johannes J. , Goldberg Daniel , Gudmundsson G. Hilmar , Humbert Angelika , Hütten Moritz , Huybrechts Philippe , Jouvet Guillaume , Kleiner Thomas , Larour Eric , Martin Daniel , Morlighem Mathieu , Payne Anthony J. , Pollard David , Rückamp Martin , Rybak Oleg , Seroussi Hélène , Thoma Malte , Wilkens Nina 
Published: May 2013

AbstractPredictions of marine ice-sheet behaviour require models able to simulate grounding-line migration. We present results of an intercomparison experiment for plan-view marine ice-sheet models. Verification is effected by comparison with approximate analytical solutions for flux across the grounding line using simplified geometrical configurations (no lateral variations, no buttressing effects from lateral drag). Perturbation experiments specifying spatial variation in basal sliding parameters permitted the evolution of curved grounding lines, generating buttressing effects. The experiments showed regions of compression and extensional flow across the grounding line, thereby invalidating the boundary layer theory. Steady-state grounding-line positions were found to be dependent on the level of physical model approximation. Resolving grounding lines requires inclusion of membrane stresses, a sufficiently small grid size (<500 m), or subgrid interpolation of the grounding line. The latter still requires nominal grid sizes of <5 km. For larger grid spacings, appropriate parameterizations for ice flux may be imposed at the grounding line, but the short-time transient behaviour is then incorrect and different from models that do not incorporate grounding-line parameterizations. The numerical error associated with predicting grounding-line motion can be reduced significantly below the errors associated with parameter ignorance and uncertainties in future scenarios.
Computing the volume response of the Antarctic Peninsula ice sheet to warming scenarios to 2200
Authors: Barrand Nicholas E. , Hindmarsh Richard C.A. , Arthern Robert J. , Rosie Williams C. , Mouginot Jérémie , Scheuchl Bernd , Rignot Eric , Ligtenberg Stefan R.M. , Van Den Broeke Michiel R. , Edwards Tamsin L. , Cook Alison J. , Simonsen Sebastian B. 
Published: May 2013

AbstractThe contribution to sea level to 2200 from the grounded, mainland Antarctic Peninsula ice sheet (APIS) was calculated using an ice-sheet model initialized with a new technique computing ice fluxes based on observed surface velocities, altimetry and surface mass balance, and computing volume response using a linearized method. Volume change estimates of the APIS resulting from surface mass-balance anomalies calculated by the regional model RACMO2, forced by A1B and E1 scenarios of the global models ECHAM5 and HadCM3, predicted net negative sea-level contributions between −0.5 and −12 mm sea-level equivalent (SLE) by 2200. Increased glacier flow due to ice thickening returned ∼15% of the increased accumulation to the sea by 2100 and ∼30% by 2200. The likely change in volume of the APIS by 2200 in response to imposed 10 and 20 km retreats of the grounding line at individual large outlet glaciers in Palmer Land, southern Antarctic Peninsula, ranged between 0.5 and 3.5 mm SLE per drainage basin. Ensemble calculations of APIS volume change resulting from imposed grounding-line retreat due to ice-shelf break-up scenarios applied to all 20 of the largest drainage basins in Palmer Land (covering ∼40% of the total area of APIS) resulted in net sea-level contributions of 7–16 mm SLE by 2100, and 10–25 mm SLE by 2200. Inclusion of basins in the northern peninsula and realistic simulation of grounding-line movement for AP outlet glaciers will improve future projections.