bluuebunny/crossref_metadata_2025_split huggingface dataset:
Normative Values for Word Syllable Duration With Interpretation in a Large Sample of Stroke Survivors With Aphasia
Authors: Haley Katarina L. , Jacks Adam , Kim Soomin , Rodriguez Marcia , Johnson Lorelei P. 
Published: August 2023

Purpose:
Slow speech rate and abnormal temporal prosody are primary diagnostic criteria for differentiating between people with aphasia who do and do not have apraxia of speech. We sought to identify appropriate cutoff values for abnormal word syllable duration (WSD) in a word repetition task, interpret them relative to a data set of people with chronic aphasia, and evaluate the extent to which manually derived measures could be approximated through an automated process that relied on commercial speech recognition technology.

Method:
Fifty neurotypical participants produced 49 multisyllabic words during a repetition task. Audio recordings were submitted to an automated speech recognition (ASR) service (IBM Watson) to measure word duration and generate an orthographic transcription. The transcribed words were compared to a lexical database, and the number of syllables was identified. Automatic and manual measures were compared for 50% of the sample. Results were interpreted relative to WSD scores from an existing data set of 195 people with mostly chronic aphasia.

Results:
ASR correctly identified 83% of target words and 98% of target syllable counts. Automated word duration calculations were longer than manual measures due to imprecise cursor placement. Upon applying regression coefficients to the automated measures and examining the frequency distributions for both manual and estimated measures, a WSD of 303–316 ms was found to indicate longer-than-normal performance (corresponding to the 95th percentile). With this cutoff, 40%–45% of participants with aphasia in our comparison sample had an abnormally long WSD.

Conclusions:
We recommend using a rounded WSD cutoff score between 303 and 316 ms for manual measures. Future research will focus on customizing automated WSD methods to speech samples from people with aphasia, identifying target words that maximize production and measurement reliability, and developing WSD standard scores based on a large participant sample with and without aphasia.
Exploring the Relationship between Infrastructure and Entrepreneurial Development in BRICS Countries “PMGARDL” approach
Authors: Azmi Kamal , Azmi Rida 
Published: August 2023

This article examines the significance of infrastructure in the emergence and development of entrepreneurship, focusing on policies and their interaction with other public support programs. The central issue is to emphasize the importance of considering various types and specificities of infrastructure. The article posits multiple hypotheses regarding the impact of infrastructure on entrepreneurship, with an emphasis on long-term influence. It assumes that incorporating infrastructure into public policies is essential for fostering entrepreneurial growth. Additionally, it suggests that diverse types of infrastructure play a crucial role in the development of an entrepreneurial ecosystem, particularly in technology sectors.The methodology employed in this study is based on the PMG-ARDL method. Researchers used the “TEA” proxy to measure entrepreneurial dynamics and examine the impact of specific infrastructure characteristics. The sample consists of data from BRICS countries, enabling comparisons across institutional contexts and development levels.The main contributions of this study lie in highlighting the importance of infrastructure for entrepreneurship, especially in the long term. Results suggest that public policies should pay special attention to planning and improving infrastructure to energize the entrepreneurial ecosystem. The research also underscores the need for developing new indices to better measure the various specificities of infrastructure.
Centrifugal Pumping: The Patient Outcome Benefits Following Coronary Artery Bypass Surgery
Authors: DeBois William J. , Brennan Robin , Wein Elizabeth , Wayne Isom O. , Gold Jeffrey P. 
Published: August 2023

The increased use of the centrifugal pump during coronary artery bypass surgery has been based primarily on theoretical data related to patient safety. There is minimal evidence suggesting improved outcome when compared to the traditional roller pump technology. We prospectively randomized 200 patients undergoing elective coronary artery bypass grafting into centrifugal pump (100 patients) and roller pump (100 patients) groups to compare differences in blood product usage, complication rate, length of stay and net hospital financial balance.
Moderate hypothermic bypass was employed on all patients. Cardiopulmonary bypass circuits were similar in both groups with the exception of the arterial pump. Both groups were statistically identical in regard to age, sex, surgeon, complications, total pump time, aortic cross clamp time, prebypass hematocrit and platelet count. The twenty-four hour postoperative hematocrits, platelet counts, red blood cell requirements, blood loss and mortality (2%) were identical in both groups. The centrifugal pump patients had less 24 hour weight gain than their peers in the roller pump group (p=0.05) The length of stay and net hospital financial balance were also statistically favored in the centrifugal pump group (p<0.05). These latter findings were significant when studied in all payors and coronary artery bypass diagnostic related group classifications. Although the mechanism for improvement in length of stay and net hospital financial balance cannot fully be explained, the ramifications in an increasingly cost conscious environment are obvious.
Perfusion Techniques for Heparin-Bonded Circuits
Authors: Hollingsed Michael J. , Raley William H. , Hill Ronald C. , Valenzuela Roberto , Vasilakis Alexander , Cruzzavala Jose , Graeber Geoffrey M. , Vance Robert A. , Murray Gordon F. 
Published: August 2023

Recent advances in cardiopulmonary bypass techniques include the development of durable, covalently bonded heparin coated surfaces using end-point attachment techniques. Advantages of heparin-coated cardiopulmonary bypass include reduced systemic heparin, avoidance of protamine sulfate at the completion of the procedure, enhanced biocompatibility of the circuit, successful application of cardiopulmonary bypass in cases where bleeding may become a problem, and in application of assist devices.
Our experience with this technology has led to the development of guidelines and management strategies. We generally consider application fortwo categories: 1) pharmacotoxicity, i.e., allergic reaction to heparin or protamine; and 2) progression of problems, such as prolonged bleeding tendencies (aspirin) or hemorrhage from cerebral vascular accident. Applications of this technology require tip to tip heparin-bonding, "streamlining" the circuit, meticulous attention to fluid mechanics, crystalloid cardioplegia, precise heparin management, and reversed Trendelenburg position for post-cardiopulmonary bypass volume.
Comparison of Celite and Kaolin Based Heparin and Protamine Dosing Assays During Cardiac Surgery: The In Vitro Effect of Aprotinin
Authors: Zucker Marcia L. , Walker Charles , Jobes David , LaDuca Frank M. 
Published: August 2023

Both aprotinin and in vitro heparin and protamine dosing assays (RxDx System) have been shown to reduce postoperative bleeding in the cardiac surgery patient. While celite activated clotting time tests in the presence of heparin are artificially prolonged by aprotinin, the kaolin based ACT is not. In order to optimize heparin anticoagulation management during cardiac surgery when aprotinin is used, we have evaluated the utility of kaolin based heparin and protamine dosing assays in the presence of aprotinin. In vitro studies were performed using normal donor blood after the addition of heparin and/or aprotinin. Clinical evaluations compared anticoagulation management based upon the two activators (celite and kaolin) in 21 patients requiring cardiopulmonary bypass (CPB) who were not receiving aprotinin.
The kaolin heparin and protamine assays were unaffected by aprotinin using in vitro aprotinin supplemented normal donor blood samples. The amounts of aprotinin used were equivalent to the calculated plasma concentration in an average size patient (6 liter blood volume) receiving either full ( 1 H) or half ( 1/2 H) Hammersmith doses. Heparin and protamine doses, based on the kaolin assays, were not significantly different between aprotinin (apr) treated and control samples (p>0.20).
In a clinical evaluation of CPB patients, the C-ACT and K-ACT showed good correlation (r= 0.97, n = 213), as did the respective dose determination based on the celite and kaolin RxDx assays: heparin dose (r = 0.88, n = 69) and protamine dose (r = 0.88 , n = 19). These studies illustrate comparable heparin and protamine dosing using either celite or kaolin based RxDx assays during cardiac surgery. These findings also suggest that the kaolin based ACT and dosing assays may be useful in monitoring heparin anticoagulation in cardiac surgery patients receiving aprotinin with the potential of combining these two blood conservation methods.
Reduction in Homologous Blood Transfusions Using a Low Prime Circuit
Authors: DeBois William J. , Sukhram Youram , McVey James , Helm Robert E. , Gold Jeffrey P. , Rosengart Todd , lsom O.W. , Krieger Karl H. 
Published: August 2023

Due to a low estimated blood volume, small adults (weight less than 70 kg) undergoing cardiopulmonary bypass (CPB) are at highest risk for low hematocrit and homologous blood transfusion (HBT). To determine whether reductions in HBT could be achieved we compared the use of a low prime circuit (1400 ml) with our standard (2200 ml) cardiopulmonary bypass (CPB) circuit.
Eighty consecutive adult patients (>age 18, <70 kg) undergoing non-emergent CPB were randomly divided into two groups. Group LP (n=40) was the low prime group and group SP (n=40) was the standard prime group. In Group LP, either of two “low prime” hollow fiber membrane oxygenators with a 3/8 X 3/8 inch A-V loop were utilized. Alternately, in Group SP, a larger membrane oxygenator with a 3/8 X 1/2 A-V loop was utilized. Circuits and CPB management were otherwise identical. Excluded from the study were those patients who had bleeding disorders, reoperations, ejection fractions of less than 30% and history of cerebral vascular insufficiency.
Patients were closely matched for age, BSA, gender, preoperative risk and procedure. Mean weight (kg) was less in Group LP (59.2 vs 62.2, P<0.02). Pre-CPB hematocrits (HCT) were similar in both groups. Initial on CPB HCT was higher in Group LP (19.8 vs 18.4, P<0.04). Group LP had a higher frequency of initial on CPB HCTs of 20% or greater (55% vs 33% , P<0.04). Group LP had a lower packed red blood cell (PRBC) transfusion rate on CPB (0.4 vs 0.9 units, P<0.03). Group LP had higher percentage of patients that did not require transfusion on CPB (78% vs 55%, P<0.03). Despite fewer transfusions, Group LP had a higher post CPB HCT (20.6 vs 19.3, P<0.04). A trend was noted with a lower total PRBC transfusion rate in Group LP (1.9 vs 2.4, P=.10). During the entire length of stay, fewer Group LP patients required any homologous transfusion (26/40 versus 34/40, P <0.04). Chest drainage, 24 hour HCT and discharge HCT were similar in both groups. Transfusion of platelets, fresh frozen plasma and cryoprecipitate was similar in both groups. There were no deaths in either group.
Patients with low blood volume are at high risk of homologous transfusion when undergoing CPB. A significant reduction in prime volume appears to be safe, simple and reduces HBTs in these individuals. Prime reduction should be part of a comprehensive multi-modality blood conservation program.
Comparison of Three Methods to Estimate Heparin Loading Dose for Cardiopulmonary Bypass
Authors: Clark T. Dale , Ecklund Jodie M. , McCall Mary M. , Wolk Dennis R. , Riley Jeffrey B. 
Published: August 2023

Three available methods used to determine heparin loading dose were studied to determine the most reliable method for reaching a target pre-bypass activated clotting time (ACT) of 510 seconds. One hundred and seven patients were randomly assigned to one of three treatment methods: A) 300 units/kg; B) Hemostasis Management System (HMS); C) RX/DX. Five different lots of heparin were assigned to Groups A and B, and Group C had one heparin lot. Different lots were used to account for possible variations in heparin activity.
Post-skin incision ACTs, post-heparin pre-bypass ACTs, and heparin loading doses were compared. The mean and standard deviation of the post-heparin pre-bypass ACTs were used to determine which method was most reliable to obtain a desired ACT.
There was no statistical difference between different heparin lots. There was no difference in the post-heparin ACTs for the three methods (A:487±135 vs. B:474±105 vs. C:474±111 sec). There was a statistically significant difference between the standard deviation for the HMS and 300 u/kg standard deviations (p<0.05). The HMS has the smallest deviation which makes it the most reliable predictor of heparin loading doses to reach a target ACT for cardiopulmonary bypass.
Hemochron vs. Hemotec Kaolin ACT Comparison with Aprotinin Use in Congenital Heart Surgery
Authors: Ecklund Jodie M. , McCall Mary M. , Southworth Rhonda S. , Blackwell Mindy M. , Riley Jeffrey B. 
Published: August 2023

Between July 1994 and January 1995, ten patients underwent reoperative cardiac surgery with cardiopulmonary bypass for correction of various congenital anomalies. The patients' ages ranged from 0.17 to 34 years. Aprotinin was used according to surgeon protocol (200 mg/m2 body surface area initial loading dose and in pump prime, and 50 mg/m2 hourly infusion). The purpose of this study was to compare the simultaneous ACT values obtained from the Hemotec cartridge and the Hemochron kaolin tube.
A 3 ml blood sample was drawn and duplicate ACTs run at four time periods during the procedure: 2 ml in a prewarmed kaolin Hemochron tube and 0.4 ml in each well of a pre-warmed Hemotec cartridge. Information recorded at each time period included: event [pre-CPB, onCPB hypothermia, on-CPB rewarming, post-CPB], temperature, and ACT values from each machine. A total of 74 paired samples were analyzed. Two-way ANOV A was used to compare the values. Multiple comparison tests using the Bonferonni method were performed to maintain the Type I error rate at 0.05. Regression, correlation, and residual analyses were performed. Cohen's kappa statistic was used to assess the degree of agreement between the two devices.
There was a statistically significant difference between the ACT values obtained between the two devices (p<.01); however, the correlation between the values was high and significant (r=0.841, p<.01). The Hemotec was an average of 86 seconds lower than the Hemochron. The kappa statistic was 0.688, which indicates good agreement. The differences between these two devices have been previously reported using the celite Hemochron tubes, and it appears that there is still a difference when both tubes contain kaolin. Differences in the method of clot detection, differences in sample volume, and differences in the adsorption of aprotinin may explain the differences observed in this study. The Hemochron kaolin ACT is an acceptable alternative to the Hemotec ACT for monitoring heparinization when aprotinin is in use in congenital heart surgery.
Cardiopulmonary Bypass Factors Affecting the Development Of Choreoathetosis in Pediatric Patients
Authors: Ecklund Jodie M. , Phelps Vonda K. , Holden Kenton R. , Riley Jeffrey B. , Crawford Fred A. , Sade Robert M. 
Published: August 2023

Choreoathetosis (CHO) in pediatric patients following cardiopulmonary bypass (CPB) has no known etiology, although several causal factors have been suggested. The infrequent occurrence in any one institution and the inability to perform prospective studies have made the etiology of CHO difficult to discover. This paper discusses a retrospective analysis of eleven cases of CHO following CPB. To form a control group for matched comparison, each of the eleven CHO patients was matched with a patient who did not develop CHO. Matching parameters included: age at operation within 10%, diagnosis (cyanotic, not cyanotic), race, gender, operation, and date of operation within 12 months.
Fifteen preoperative and CPB variables were evaluated to determine differences between the CHO patients and the control patients. Statistical analysis included odds ratios for matched pairs and two sample t-tests. A p value of 0.05 was chosen to assess statistical significance. Variables found to be significantly different between the study and control groups were: lowest rectal temperature, cooling and warming rates, and lowest arterial blood temperature. From these results, it is concluded that cooling to rectal temperatures less than 15°C or a cooling rate greater than 0.4°C /min is associated with the development of CHO following CPB in these patients.
An Under-Occluded Roller Pump is Less Hemolytic Than a Centrifugal Pump
Authors: Rawn OJ , Harris HK , Riley JB , Yoda ON , Blackwell MM 
Published: August 2023

The purpose of this study is to measure and compare the hemolysis produced by roller pumps with varied occlusion settings and a centrifugal pump. The null hypothesis is that there is no difference in the Index of Hemolysis (IH=gm Hb/100 L pumped) produced by a roller pump (RP) at four different occlusion settings and a centrifugal pump (CP) at the same blood flow rate (4.5 L/min) and afterload (250 mmHg, ±10 mmHg) over three hours.
Five identical closed-loop circuits were assembled and primed with saline. The pumps were then calibrated and occlusions were set. In three circuits, the occlusion for the RP was opened at 5 RPMs to support 150, 225, or 300 mmHg (±10 mmHg) against a clamped line. In one circuit, a RP was adjusted to a barely non-occlusive setting (1 cm drop/30 inch gradient). The fifth circuit employed a CP. Prior to testing, the saline in each circuit was replaced with one liter of fresh bovine blood (Hct=22±2%). The IH for each treatment was compared in six trials yielding a statistical power> 0.80.
Analysis of variance with multiple comparison (p≤0.05) demonstrated that compared to the barely non-occlusive setting, the IH in the centrifugal pump was not significantly greater. Under-occluded RP settings yielded IHs significantly less than the CP. It appears that opening the occlusion on a roller pump allows a lower IH compared to traditional RP occlusion setting or centrifugal pumping.
A Comparative Review of Crystalloid, Albumin, Pentastarch and Hetastarch as Perfusates for Cardiopulmonary Bypass
Authors: Myers Gerard J. 
Published: August 2023

A comparative review is made of the four most common asanguineous solutions used for the priming of cardiopulmonary bypass equipment. Increasing health care costs and concerns over the administration of blood derived products has cardiac programs examining their practice of using albumin as a routine part of the priming solution for bypass. Emphasis is being placed on the use of crystalloids with synthetic colloids, or crystalloids alone, as the priming agents for extracorporeal circulation.
However new evidence has shown that the use of these solutions, without the addition of albumin, may be associated with the development of a cold induced agglutination. The data reviewed suggests that the ideal priming fluid may still not be available and recommendations are made.
Blood Anion Gaps and Venoarterial Carbon Dioxide Gradients as Risk Factors in Long-Term Extra corporeal Support
Authors: Grist Gary , Thomas Don 
Published: August 2023

Increases in the blood anion gap (AG) and venoarterial carbon dioxide gradients [p(VA) CO2 ] may indicate changes in intracellular acid concentration not demonstrated by blood gas measurements. This prospective study examines these two physiologic markers to determine their relationship to extracorporeal membrane oxygenation (ECMO) survival and duration in 100 patients.
Serum electrolytes were drawn every 6 hours and the AG calculated. Simultaneous arterial blood gases and venous blood gases were drawn every 4 hours and the p(V-A)CO2 calculated. Cumulative averages were then calculated from all the AG and p(V-A)CO2 values during each ECMO treatment. The average AG was 11 mEq/L. The average p(V-A)CO2 was 9 mm of mercury (mmHg).
Patients with an AG of 11 mEq/L or less had a 12% mortality and those with a higher AG had a 43% mortality (p=0.0005). Patients with a p(V-A)CO2 of less than 9 mmHg had a 13% mortality and those with a 9 mmHg or higher gradient had a 35% mortality (p=0.0126). Patients with both a low AG and a low p(V-A)CO2 had a 7% mortality and survivors were on ECMO 100 (± 37) hours. Patients with both a high AG and a high p(V-A)CO2 had a 56% mortality and survivors were on ECMO 190 (± 1 05) hours.
Both mortality and survivors’ ECMO time increase as one or both risk factors increase. Patients with increases in both risk factors have a mortality rate 8 times greater and survivors remain on ECMO almost twice as long as those without increased risk factors. Patients may benefit from a perfusion strategy that seeks to minimize the AG and p(V-A)CO2.
Hemostatic Assessment of Patients Undergoing lntraaortic Balloon Pump Therapy
Authors: Ficek Suzanne J. , Stammers Alfred , Deligonul Ubeydullah , Shurmur Scott W. , Alonso Anselmo , Galbraith Timothy 
Published: August 2023

Patients undergoing intraaortic balloon pump (IABP) therapy are at risk for developing coagulopathies due to the adverse effects of prolonged exposure of the synthetic surface of the polyurethane balloon to blood components. Hemorrhagic risk has been attributed to a number of factors including thrombocytopenia, vascular injury, and/or platelet degranulation which increase the potential of receiving autogeneic blood transfusions. The present study is a prospective evaluation of coagulation using a viscoelastic monitor (Thrombelastograph- TEG) that measures functional aspects of clot development and stabilization in patients being treated with IABP therapy.
Following Institutional Review Board approval, six patients undergoing IABP therapy for hemodynamic instability were enrolled in this study. Blood samples were taken prior to balloon insertion, at 8, 16, 24, 48, 72, and 96 hours on IABP therapy, and 24 hours following the removal of the balloon when applicable. Samples were incubated with heparinase to degrade heparin and TEG profiles were subsequently determined in duplicate. Measured parameters on the TEG included Rtime, K-time, maximum amplitude, alpha angle, and lysis at 30 and 60 minutes with calculation of the TEG index.
Mortality was 33% following IABP discontinuation. Transfusion of packed red blood cells occurred in 50% of the patients during their balloon pump therapy. Patients demonstrated a significant deviance in fibrinolytic potential from pre-IABP lysis (1.6% ± 1.8) at both 24 hours (18.8% ± 22.9) and 48 hours (21.9% ± 28.5) of therapy (p<0.05) which returned to baseline shortly after balloon removal. Activation of coagulation factors appeared evident by a steadily increasing alpha angle from pre-IABP data (31.1 ± 9.2) throughout the duration of therapy and 24 hour recovery (53 ± 14; p<.005), and by a steadily trending increase in the TEG index pre-IABP (.251 ± 1.4) to post-IABP (2.6 ± 1.7; p<0.05).
The results indicate that IABP therapy induces an increase in fibrinolytic potential at 24 to 48 hours of balloon pump therapy with a paradoxical trend toward increased coagulability, potentially predisposing the patient to hemorrhagic risk.