bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain development in children with new onset epilepsy: A prospective controlled cohort investigation
Authors: Hermann Bruce P. , Dabbs Kevin , Becker Tara , Jones Jana E. , Myers y Gutierrez Adan , Wendt Gary , Koehn Monica A. , Sheth Raj , Seidenberg Michael 
Published: April 2010

SummaryPurpose:  To characterize prospective neurodevelopmental changes in brain structure in children with new and recent‐onset epilepsy compared to healthy controls.Methods:  Thirty‐four healthy controls (mean age 12.9 years) and 38 children with new/recent‐onset idiopathic epilepsy (mean age 12.9 years) underwent 1.5 T magnetic resonance imaging (MRI) at baseline and 2 years later. Prospective changes in total cerebral and lobar gray and white matter volumes were compared within and between groups.Results:  Prospective changes in gray matter volume were comparable for the epilepsy and control groups, with significant (p < 0.0001) reduction in total cerebral gray matter, due primarily to significant (p < 0.001) reductions in frontal and parietal gray matter. Prospective white matter volume changes differed between groups. Controls exhibited a significant (p = 0.0012) increase in total cerebral white matter volume due to significant (p < 0.001) volume increases in the frontal, parietal, and temporal lobes. In contrast, the epilepsy group exhibited nonsignificant white matter volume change in the total cerebrum (p = 0.51) as well as across all lobes (all p’s > 0.06). The group by white matter volume change interactions were significant for total cerebrum (p = 0.04) and frontal lobe (p = 0.04).Discussion:  Children with new and recent‐onset epilepsy exhibit an altered pattern of brain development characterized by delayed age‐appropriate increase in white matter volume. These findings may affect cognitive development through reduced brain connectivity and may also be related to the impairments in executive function commonly reported in this population.
Scalp‐recorded high‐frequency oscillations in childhood sleep‐induced electrical status epilepticus
Authors: Kobayashi Katsuhiro , Watanabe Yoshiaki , Inoue Takushi , Oka Makio , Yoshinaga Harumi , Ohtsuka Yoko 
Published: April 2010

SummaryBecause high‐frequency oscillations (HFOs) may affect normal brain functions, we examined them using electroencephalography (EEG) in epilepsy with continuous spike‐waves during slow‐wave sleep (CSWS), a condition that can cause neuropsychological regression. In 10 children between 6 and 9 years of age with epilepsy with CSWS or related disorders, we investigated HFOs in scalp EEG spikes during slow‐wave sleep through temporal expansion of the EEG traces with a low‐cut frequency filter at 70 Hz as well as through time‐frequency power spectral analysis. HFOs (ripples) concurrent with spikes were detected in the temporally expanded traces, and the frequency of the high‐frequency peak with the greatest power in each patient’s spectra ranged from 97.7 to 140.6 Hz. This is the first report on the detection of HFOs from scalp EEG recordings in epileptic patients. We speculate that epileptic HFOs may interfere with higher brain functions in epilepsy with CSWS.
Epilepsy surgery, antiepileptic drug trials, and the role of evidence
Authors: Janszky Jozsef , Kovacs Norbert , Gyimesi Csilla , Fogarasi Andras , Doczi Tamás , Wiebe Samuel 
Published: April 2010

SummaryObjective:  We assessed whether recent randomized controlled trials (RCTs) of antiepileptic drugs (AEDs) are informed by evidence about surgical effectiveness. We explored whether RCTs of AEDs consider the patients’ candidacy for surgery in their eligibility criteria, and whether the necessary investigations are requested in participating patients to determine their potential eligibility for surgery.Methods:  We systematically analyzed RCTs published in the last 2 years investigating the efficacy of new AEDs in localization‐related epilepsy. Results from a surgical RCT and recommendations from an epilepsy surgery practice parameter were used to assess the degree to which surgical evidence informed the drug study design.Results:  Eleven RCTs were analyzed. All were conducted in countries with access to epilepsy surgery. None of the studies required magnetic resonance imaging (MRI) with an epilepsy protocol or explicit statement of the epilepsy syndrome, which could lead to the identification of surgical candidates. Having temporal lobe epilepsy or being a potential surgical candidate were not exclusion criteria in any of the trials. The primary efficacy end point was the reduction in seizure frequency or responder rate. Seizure freedom was never the primary outcome, and it was reported in only seven studies. The pooled data analysis of these trials revealed that 1.9% of patients became seizure‐free on placebo and 4.4% on the study drug (p < 0.01).Conclusions:  Important aspects of patient selection for new AED trials are not informed by the evidence about surgical effectiveness. Investigations that could lead to identification of patients for presurgical evaluation were not required in any of the studies.
Calibrating CAT Bonds for Mexican Earthquakes
Authors: Härdle Wolfgang Karl , Cabrera Brenda López 
Published: April 2010

AbstractThis article examines the calibration of a real parametric catastrophe bond (CAT bond) for earthquakes sponsored by the Mexican government, which is of a high interest as it delivers several policy‐relevant findings. The results demonstrate that a combination of reinsurance and CAT bond is optimal in the sense that it provides coverage for a lower cost and lower exposure at default than reinsurance itself. A hybrid CAT bond for earthquakes is also priced in order to reduce the basis and moral risk borne by the sponsor and to reflect the value of the loss by several variables.
Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis
Authors: Glickman Seth W. , Cairns Charles B. , Otero Ronny M. , Woods Christopher W. , Tsalik Ephraim L. , Langley Raymond J. , Van Velkinburgh Jennifer C. , Park Lawrence P. , Glickman Lawrence T. , Fowler Vance G. , Kingsmore Stephen F. , Rivers Emanuel P. 
Published: April 2010

AbstractBackground:  Aggressive diagnosis and treatment of patients presenting to the emergency department (ED) with septic shock has been shown to reduce mortality. To enhance the ability to intervene in patients with lesser illness severity, a better understanding of the natural history of the early progression from simple infection to more severe illness is needed.Objectives:  The objectives were to 1) describe the clinical presentation of ED sepsis, including types of infection and causative microorganisms, and 2) determine the incidence, patient characteristics, and mortality associated with early progression to septic shock among ED patients with infection.Methods:  This was a multicenter study of adult ED patients with sepsis but no evidence of shock. Multivariable logistic regression was used to identify patient factors for early progression to shock and its association with 30‐day mortality.Results:  Of 472 patients not in shock at ED presentation (systolic blood pressure > 90 mm Hg and lactate < 4 mmol/L), 84 (17.8%) progressed to shock within 72 hours. Independent factors associated with early progression to shock included older age, female sex, hyperthermia, anemia, comorbid lung disease, and vascular access device infection. Early progression to shock (vs. no progression) was associated with higher 30‐day mortality (13.1% vs. 3.1%, odds ratio [OR] = 4.72, 95% confidence interval [CI] = 2.01 to 11.1; p ≤ 0.001). Among 379 patients with uncomplicated sepsis (i.e., no evidence of shock or any end‐organ dysfunction), 86 (22.7%) progressed to severe sepsis or shock within 72 hours of hospital admission.Conclusions:  A significant portion of ED patients with less severe sepsis progress to severe sepsis or shock within 72 hours. Additional diagnostic approaches are needed to risk stratify and more effectively treat ED patients with sepsis.ACADEMIC EMERGENCY MEDICINE 2010; 17:383–390 © 2010 by the Society for Academic Emergency Medicine
Can Computed Tomography Angiography of the Brain Replace Lumbar Puncture in the Evaluation of Acute‐onset Headache After a Negative Noncontrast Cranial Computed Tomography Scan?
Authors: McCormack Robert F. , Hutson Alan 
Published: April 2010

AbstractObjectives:  The primary goal of evaluation for acute‐onset headache is to exclude aneurysmal subarachnoid hemorrhage (SAH). Noncontrast cranial computed tomography (CT), followed by lumbar puncture (LP) if the CT is negative, is the current standard of care. Computed tomography angiography (CTA) of the brain has become more available and more sensitive for the detection of cerebral aneurysms. This study addresses the role of CT/CTA versus CT/LP in the diagnostic workup of acute‐onset headache.Methods:  This article reviews the recent literature for the prevalence of SAH in emergency department (ED) headache patients, the sensitivity of CT for diagnosing acute SAH, and the sensitivity and specificity of CTA for cerebral aneurysms. An equivalence study comparing CT/LP and CT/CTA would require 3,000 +  subjects. As an alternative, the authors constructed a mathematical probability model to determine the posttest probability of excluding aneurysmal or arterial venous malformation (AVM) SAH with a CT/CTA strategy.Results:  SAH prevalence in ED headache patients was conservatively estimated at 15%. Representative studies reported CT sensitivity for SAH to be 91% (95% confidence interval [CI] = 82% to 97%) and sensitivity of CTA for aneurysm to be 97.9% (95% CI = 88.9% to 99.9%). Based on these data, the posttest probability of excluding aneurysmal SAH after a negative CT/CTA was 99.43% (95% CI = 98.86% to 99.81%).Conclusions:  CT followed by CTA can exclude SAH with a greater than 99% posttest probability. In ED patients complaining of acute‐onset headache without significant SAH risk factors, CT/CTA may offer a less invasive and more specific diagnostic paradigm. If one chooses to offer LP after CT/CTA, informed consent for LP should put the pretest risk of a missed aneurysmal SAH at less than 1%.ACADEMIC EMERGENCY MEDICINE 2010; 17:444–451 © 2010 by the Society for Academic Emergency Medicine
Cardiovascular and Metabolic Effects of High‐dose Insulin in a Porcine Septic Shock Model
Authors: Holger Joel S. , Dries David J. , Barringer Kelly W. , Peake Benjamin J. , Flottemesch Thomas J. , Marini John J. 
Published: April 2010

AbstractObjectives:  High‐dose insulin (HDI) has inotropic and vasodilatory properties in various clinical conditions associated with myocardial depression. The authors hypothesized that HDI will improve the myocardial depression produced by severe septic shock and have beneficial effects on metabolic parameters. In an animal model of severe septic shock, this study compared the effects of HDI treatment to normal saline (NS) resuscitation alone.Methods:  Ten pigs were randomized to an insulin (HDI) or NS group. All were anesthetized and instrumented to monitor cardiovascular function. In both arms, Escherichia coli endotoxin lipopolysaccharide (LPS) and NS infusions were begun. LPS was titrated to 20 μg/kg/hour over 30 minutes and continued for 5 hours, and saline was infused at 20 mL/kg/hour throughout the protocol. Dextrose (50%) was infused to maintain glucose in the 60–150 mg/dL range, and potassium was infused to maintain a level greater than 2.8 mmol/L. At 60 minutes, the HDI group received an insulin infusion titrated from 2 to 10 units/kg/hour over 40 minutes and continued at that rate throughout the protocol. Survival, heart rate (HR), mean arterial pressure (MAP), pulmonary artery and central venous pressure, cardiac output, central venous oxygen saturation (SVO2), and lactate were monitored for 5 hours (three pigs each arm) or 7 hours (two pigs each arm) or until death. Cardiac index, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), O2 delivery, and O2 consumption were derived from measured data. Outcomes from the repeated‐measures analysis were modeled using a mixed‐effects linear model that assumed normally distributed errors and a random effect at the subject level.Results:  No significant baseline differences existed between arms at time 0 or 60 minutes. Survival was 100% in the HDI arm and 60% in the NS arm. Cardiovascular variables were significantly better in the HDI arm: cardiac index (p < 0.001), SVR (p < 0.003), and PVR (p < 0.01). The metabolic parameters were also significantly better in the HDI arm: SVO2 (p < 0.01), O2 delivery (p < 0.001), and O2 consumption (p < 0.001). No differences in MAP, HR, or lactate were found.Conclusions:  In this animal model of endotoxemic‐induced septic shock that results in severe myocardial depression, HDI is associated with improved cardiac function compared to NS resuscitation alone. HDI also demonstrated favorable metabolic, pulmonary, and peripheral vascular effects. Further studies may define a potential role for the use of HDI in the resuscitation of septic shock.ACADEMIC EMERGENCY MEDICINE 2010; 17:429–435 © 2010 by the Society for Academic Emergency Medicine
Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter
Authors: Xavier Scheuermeyer Frank , Grafstein Eric , Stenstrom Rob , Innes Grant , Poureslami Iraj , Sighary Maziar 
Published: April 2010

AbstractObjectives:  While the short‐term (<7‐day) safety and efficiency of electrical cardioversion for emergency department (ED) patients with atrial fibrillation or flutter have been established, the 30‐day outcomes with respect to stroke, thromboembolic events, or death have not been investigated.Methods:  A two‐center cohort of consecutive ED patients undergoing cardioversion for atrial fibrillation or flutter between January 1, 2000, and September 30, 2007, was retrospectively investigated. This cohort was probabilistically linked with both a regional ED database and the provincial health registry to determine which patients had a subsequent ED visit or hospital admission, stroke, or thromboembolic event or died within 30 days. In addition, trained reviewers performed a detailed chart abstraction on 150 randomly selected patients, with emphasis on demographics, vital signs, medical treatment, and predefined adverse events. Hemodynamically unstable patients or those whose condition was the result of an underlying acute medical diagnosis were excluded. Data were analyzed by descriptive methods.Results:  During the study period, 1,233 patients made 1,820 visits for atrial fibrillation or flutter to the ED. Of the 400 eligible patients undergoing direct‐current cardioversion (DCCV), no patients died, had a stroke, or had a thromboembolic event in the following 30 days (95% confidence interval [CI] = 0.0 to 0.8% for all outcomes). A total of 141 patients were included in the formal chart review, with five patients (3.5%, 95% CI = 0.5% to 6.6%) failing cardioversion, six patients (4.3%, 95% CI = 0.9% to 7.6%) having a minor adverse event that did not change disposition, and five patients (3.5%, 95% CI = 0.5% to 6.6%) admitted to hospital at the index visit.Conclusions:  Cardioversion of patients with atrial fibrillation or flutter in the ED appears to have a very low rate of long‐term complications.ACADEMIC EMERGENCY MEDICINE 2010; 17:408–415 © 2010 by the Society for Academic Emergency Medicine
Prospective Multicenter Study of Bronchiolitis: Predictors of an Unscheduled Visit After Discharge From the Emergency Department
Authors: Norwood Agatha , Mansbach Jonathan M. , Clark Sunday , Waseem Muhammad , Camargo Carlos A. 
Published: April 2010

AbstractObjectives:  There is little evidence about which children with bronchiolitis will have worsened disease after discharge from the emergency department (ED). The objective of this study was to determine predictors of post‐ED unscheduled visits.Methods:  The authors conducted a prospective cohort study of patients discharged from 2004 to 2006 at 30 EDs in 15 U.S. states. Inclusion criteria were diagnosis of bronchiolitis, age <2 years, and discharge home; the exclusion criterion was previous enrollment. Unscheduled visits were defined as urgent visits to an ED/clinic for worsened bronchiolitis within 2 weeks.Results:  Of 722 patients eligible for the current analysis, 717 (99%) had unscheduled visit data, of whom 121 (17%; 95% confidence interval [CI] = 14% to 20%) had unscheduled visits. Unscheduled visits were more likely for children age <2 months (11% vs. 6%; p = 0.04), males (70% vs. 57%; p = 0.007), and those with history of hospitalization (27% vs. 18%; p = 0.01). The two groups were similar in other demographic and clinical factors (all p > 0.10). Using multivariable logistic regression, independent predictors of unscheduled visits were age <2 months, male, and history of hospitalization.Conclusions:  In this study of children age younger than 2 years with bronchiolitis, one of six children had unscheduled visits within 2 weeks of ED discharge. The three predictors of unscheduled visits were age under 2 months, male sex, and previous hospitalization.ACADEMIC EMERGENCY MEDICINE 2010; 17:376–382 © 2010 by the Society for Academic Emergency Medicine
Surface Cooling for Rapid Induction of Mild Hypothermia After Cardiac Arrest: Design Determines Efficacy
Authors: Uray Thomas , Haugk Moritz , Sterz Fritz , Arrich Jasmin , Richling Nina , Janata Andreas , Holzer Michael , Behringer Wilhelm 
Published: April 2010

AbstractObjectives:  Recently, a novel cooling pad was developed for rapid induction of mild hypothermia after cardiac arrest. The aim of this study was to evaluate the cooling efficacy of three different pad designs for in‐hospital cooling.Methods:  Included in this prospective interventional study were patients with esophageal temperature (Tes) > 34°C on admission. The cooling pad consists of multiple cooling units, filled with a combination of graphite and water, which is precooled to –18°C (design A) or to –9°C (designs B and C) before use. The designs of the cooling pad differed in number, shape, and thickness of the cooling units, with weights of 9.7 kg (design A), 5.3 kg (design B), and 6.2 kg (design C). All three designs were tested in sequential order and were changed according to the results found in the previous trial. Cooling was started after admission until Tes = 34°C, when the cooling pad was removed. The target temperature of Tes = 32–34°C was maintained for 24 hours. Data are presented as medians and interquartile ranges (IQRs = 25%–75%) or proportions.Results:  Cooling rates were 3.4°C/hour (IQR = 2.5–3.7) with design A (n = 12), 2.8°C/hour (IQR = 1.6–3.3) with design B (n = 7), and 2.9°C/hour (IQR = 1.9–3.6) with design C (n = 10; p = 0.5). To reach 34°C, the cooling pad had to be exchanged with a new one due to melting and therefore depleting cooling capacity in three patients with design A, in five patients with design B, and in no patient with design C (p = 0.004).Conclusions:  With adequate design and storage temperature, the cooling pad proved to be efficient for rapid in‐hospital cooling of patients resuscitated from cardiac arrest.ACADEMIC EMERGENCY MEDICINE 2010; 17:360–367 © 2010 by the Society for Academic Emergency Medicine
Tissue Oxygenation Does Not Predict Central Venous Oxygenation in Emergency Department Patients With Severe Sepsis and Septic Shock
Authors: Napoli Anthony M. , Machan Jason T. , Forcada Ahteri , Corl Keith , Gardiner Fenwick 
Published: April 2010

AbstractObjectives:  This study sought to determine whether tissue oxygenation (StO2) could be used as a surrogate for central venous oxygenation (ScVO2) in early goal‐directed therapy (EGDT).Methods:  The study enrolled a prospective convenience sample of patients aged ≥18 years with sepsis and systolic blood pressure <90 mm Hg after 2 L of normal saline or lactate >4 mmol, who received a continuous central venous oximetry catheter. StO2 and ScVO2 were measured at 15‐minute intervals. Data were analyzed using a random coefficients model, correlations, and Bland‐Altman plots.Results:  There were 284 measurements in 40 patients. While a statistically significant relationship existed between StO2 and ScVO2 (F(1,37) = 10.23, p = 0.002), StO2 appears to systematically overestimate at lower ScVO2 and underestimate at higher ScVO2. This was reflected in the fixed effect slope of 0.49 (95% confidence interval [CI] = 0.266 to 0.720) and intercept of 34 (95% CI = 14.681 to 50.830), which were significantly different from 1 and 0, respectively. The initial point correlation (r = 0.5) was fair, but there was poor overall agreement (bias = 4.3, limits of agreement = −20.8 to 29.4).Conclusions:  Correlation between StO2 and ScVO2 was fair. The two measures trend in the same direction, but clinical use of StO2 in lieu of ScVO2 is unsubstantiated due to large and systematic biases. However, these biases may reflect real physiologic states. Further research may investigate if these measures could be used in concert as prognostic indicators.ACADEMIC EMERGENCY MEDICINE 2010; 17:349–352 © 2010 by the Society for Academic Emergency Medicine
The Association Between Hypothermia, Prehospital Cooling, and Mortality in Burn Victims
Authors: Singer Adam J. , Taira Breena R. , Thode Jr Henry C. , McCormack Jane E. , Shapiro Mark , Aydin Ani , Lee Christopher 
Published: April 2010

AbstractObjectives:  Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients.Methods:  This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35°C. Data analysis consisted of univariate associations between patient characteristics and hypothermia.Results:  There were 1,215 burn patients from 1994 to 2007. Mean age (±standard deviation [±SD]) was 29 (±24) years, 67% were male, 248 (26.7%) had full‐thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6°C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling.Conclusions:  Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia.ACADEMIC EMERGENCY MEDICINE 2010; 17:456–459 © 2010 by the Society for Academic Emergency Medicine