bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced-Dose Apixaban in the Treatment of Left Ventricular Thrombus: A Report of 2 Cases
Authors: Bundrick Adrienne E. , Bowers Riley D. , Perkins Scott L. , Baker Carrie N. 
Published: December 2022

According to the American College of Cardiology and the American Heart Association, warfarin has historically been the standard of care anticoagulant for the treatment of left ventricular thrombus. The use of direct oral anticoagulants (DOACs) has become more prevalent, as they require less frequent laboratory monitoring, offer fixed-dose regimens, are associated with fewer drug-drug and drug-food interactions, and provide more favorable safety profiles when compared to warfarin. However, DOACs are not currently FDA-indicated in the treatment of left ventricular (LV) thrombus. Numerous recent studies have reported and evaluated the use of DOACs for treatment of LV thrombus. Recently, a prospective, open-label, multicenter study evaluated warfarin compared to DOACs for LV thrombus treatment. The AHA recently published a scientific statement regarding the management of patients at risk for and with left ventricular thrombus, which included DOACs as a reasonable alternative to warfarin. This report describes two patients treated with DOACs following LV thrombus diagnosis. The first case is a 71-year-old male admitted for cerebrovascular accident and non-ST-elevation myocardial infarction complicated by a LV thrombus. The second case is an 83-year-old female admitted for acute myocardial infarction complicated with an LV thrombus. Both patients were prescribed apixaban 2.5 mg twice daily. Neither patient has experienced LV thrombus or DOAC treatment related complications. This case series serves as evidence for reduced-dose DOACs as an alternative to warfarin in the treatment of LV thrombus.
Neonatal Transport Facilities and Its Effect on Outcome: An Experience from Tertiary Care Hospital of Central Gujarat
Authors: Rasania Manish , Patel Pooja , Bothra Avinash , Pathak Sunil , Lodaria Binal N , Ranawat Nishi L 
Published: December 2022

Background: This study regarding the transport facilities prevailing in areas surrounding our hospital and the immediate outcome of such transported neonates in terms of morbidity and mortality will provide us an insight into the scope for improvement in the facilities and thus will help in the reduction of mortality of the extramural neonates. Material and method: In this prospective observational study, details of all transported extramural sick neonates were obtained regarding the transport facility availed by the patient. The physiology on arrival and immediate outcome were compared between survived and expired neonates. Results: Out of 82 neonates enrolled in the study, the majority (38 [48.7%]) had sepsis. The majority of neonates were low birth weight (49 [59.8%]) and preterm (47 [57.3%]). In all, 80.5% of the transported neonates were referred from private pediatric hospitals. Free Government ambulance facility (108) was utilized by only 6 (7.3%). Significantly a greater number of moderately hypothermic neonates were there in the expired group versus the survived group (66.7% vs 20%, p =0.013). Capillary refill time of ≥3 seconds on arrival was significantly associated with poor outcomes (66.7% vs 20%, p =0.013). Saturation levels of <70% on arrival are significantly associated with poor outcome (66.7% vs 6%, p <.0001). Conclusion: This study emphasizes the need for appropriate care and management to be provided to critical neonates during transport to maintain hemodynamic stability and improved vitals on arrival to the referred center for a better final outcome.
Efficacy and Safety of Vancomycin Bayesian-Estimated Area Under the Curve Versus Trough-Based Dosing
Authors: Cerenzio John , Truong James 
Published: December 2022

Background:Vancomycin guidelines by the Infectious Diseases Society of America and American Society of Health-System Pharmacists endorse Bayesian-software-assisted area under the curve (AUC24h) in their 2020 update. At this time, there are limited clinical data that support its use.Objectives:The purpose of this study is to evaluate the safety benefits and efficacy outcomes of using Bayesian-assisted AUC24hdosing compared to trough dosing.Methods:Hospitalized patients from before February 1, 2020, (preimplementation of AUC24hdosing) and after August 1, 2020, (postimplementation) were reviewed. Patients with confirmed or suspected methicillin-resistant Staphylococcus aureus (MRSA) infection of the lungs, heart, bones, prosthetic joint, or blood receiving vancomycin for at least 72 hours were included. The primary endpoint was the percentage of patients experiencing an acute kidney injury (AKI) in the trough-based group versus those experiencing AKI in the AUC24hgroup. The composite of all-cause mortality, 30-day readmission, or change in antibiotic therapy due to clinical worsening in patients with confirmed MRSA infections was included as a secondary endpoint. Data were analyzed with statistical testing methods as appropriate.Results:There was a significant reduction in AKI between the AUC24hdosing and trough dosing groups (3% vs 12%; P < 0.01). The efficacy for MRSA infections was also similar between groups (11% vs 14%; P = 0.72).Conclusion and Relevance:Bayesian-assisted AUC24hdosing was associated with a significant reduction in incidence of AKI when compared to trough-based dosing. There was no difference in the composite efficacy endpoint for patients with confirmed MRSA infection, although the study was not powered for this analysis. These data may provide evidence for more institutions to adopt the Bayesian software to assist in dosing of vancomycin.
Incidence of acute haemolysis in cats receiving canine packed red blood cells (xenotransfusions)
Authors: Tinson Erica , Talbot Charles T , Humm Karen 
Published: December 2022

Objectives The aim of this study was to report the incidence of transfusion reactions in cats, including acute haemolysis (AH), occurring within 24 h of receiving a xenotransfusion. An additional aim was to determine whether cases with AH could be classified as having an acute haemolytic transfusion reaction (AHTR) as per the definition provided by the Association of Veterinary Haematology and Transfusion Medicine’s Transfusion Reaction Small Animal Consensus Statement. Methods Medical records of cats that received canine packed red blood cells (PRBCs) between July 2018 and September 2020 at a veterinary hospital were reviewed. The incidence of AH, AHTRs, febrile non-haemolytic transfusion reactions (FNHTRs), transfusion-associated circulatory overload and septic transfusion reactions were recorded. Results The medical records of 53 cats were retrospectively evaluated. Twenty-three (43%) cats had transfusion reactions. Thirteen (25%) cats had AH; however, only four (8%) met the definition of an AHTR. Ten (19%) cats were determined to have FNHTRs. Survival to discharge of cats affected by AH was 50% (25% for cases that met the definition of an AHTR). Survival to discharge of cats not suffering from AHTR was 40%. Conclusions and relevance This report indicates that a higher proportion of cats undergo AH (25%) when administered canine PRBCs than previously reported, although many could not be classed as having an AHTR due to an apparently adequate packed cell volume rise. Challenges with sourcing feline blood in emergency situations occasionally necessitates the use of xenotransfusion in transfusion medicine. Clinicians should be aware that haemolysis after xenotransfusion can occur within 24 h and that a repeat feline transfusion may be required sooner than anticipated in some cases.
Subfoveal choroidal thickness following pars plana vitrectomy in tractional diabetic macular edema
Authors: Dourandeesh Maryam , Moeini Mahdieh , Shaye Zahra Abbasi , Shoeibi Nasser , Hosseini Seyedeh Maryam , Banaee Touka 
Published: December 2022

Purpose To evaluate changes in subfoveal choroidal thickness (SCT) in cases of tractional diabetic macular edema (DME) after pars plana vitrectomy (PPV). Methods This prospective study included 31 eyes of 31 patients who underwent PPV for the management of tractional DME. Best-corrected visual acuity (BCVA), SCT, and central macular thickness (CMT) were measured before the operation, as well as one, three, and six months following the surgery in the operated eyes and at baseline, as well as six months in the fellow eyes. Results The SCT decline in eyes with tractional DME was statistically significant six months postoperatively (P = 0.009). A statistically significant decline was observed in the CMT values one, three, and six months postoperatively in eyes with tractional DME (P = 0.02, P < 0.001, and P < 0.001, respectively). There was a statistically significant improvement in the visual acuity of the affected eyes three (P = 0.047) and six months (P = 0.017) postoperatively. Conclusion After PPV for the treatment of tractional DME, a statistically significant decrease in the CMT values is detectable from the first month after surgery, followed by the improvement of BCVA from the third month. It is worth mentioning that a decrease was found in the SCT six months postoperatively.
Family environment of youth with first episode Mania
Authors: Klein Christina C , Bruns Kaitlyn M , McLaughlin Laura E , Blom Thomas J , Patino Duran Luis Rodrigo , DelBello Melissa P 
Published: December 2022

Background The purpose is to compare youth- and caregiver-reported characteristics of family environment, within and between families with a child experiencing a first manic episode of bipolar disorder (BPD), and families without a child with BPD or familial history of psychiatric disorders (HF). Methods Family environment of 61 families with a child with BPD and 44 HF were assessed with Family Environment Scale (FES). We compared FES subscale scores between families with BPD and HF, and caregiver- and youth-rated scores. Results Families with BPD differed significantly from HF on 8/10 FES subscales scores. Youth differed significantly from their caregivers on 7/10 subscales. An interaction effect was observed such that youth with BPD reported lower cohesion and organization, and higher conflict than their caregivers; however, HF did not differ significantly on these domains. Conclusions Our results suggest that families with BPD have higher conflict and lower cohesion and organization compared to HF. Results also indicate differences between youth and caregiver perspectives in both groups, which may contribute to family discord. Interventions targeting areas of cohesion, organization, and conflict may be beneficial for youth with BPD and their families, specifically those that identify and bridge perceptual divides.
Sleep and psychiatric symptoms in young child psychiatric outpatients – a Follow-up study
Authors: Kuha Tiia , Saarelainen Taru , Huhdanpää Hanna , Maasalo Katri , Paavonen E Juulia , Aronen Eeva T 
Published: December 2022

Background Knowledge of the continuity of sleep problems and the associations between sleep and psychiatric symptoms in child psychiatric patients is scarce. Objectives To investigate the persistency of sleep problems and how sleep at preschool age predicts sleep problems and psychiatric symptoms at school age in child psychiatric patients. Methods Participants ( n = 68) were child psychiatry outpatients at Helsinki University Hospital in 2015–2017. Caregivers evaluated sleep with the Sleep Disturbance Scale for Children (SDSC) and psychiatric symptoms with the Child Behavior Checklist (CBCL) at baseline (age 4–7 years) and again at follow-up (age 8–13 years). Family background information was collected at both time points. Results Sleep problems at preschool age predicted sleep problems at school age (R2Adjusted = .48, p < .001). Persistent sleep problems associated strongly with the intensity of psychiatric symptoms ( p = .001). Internalizing symptoms were predicted by sleep problems ( p = .038) even after controlling for age, sex, and psychiatric symptoms at preschool age. Conclusion Sleep problems are prevalent and persistent and relate to psychiatric symptoms in children treated at child psychiatry clinics. These results emphasize the need for identification and treatment of sleep problems in these children.
In-plane shear strengthening of reinforced concrete diaphragms using fiber reinforced polymer composites
Authors: Aryan Hadi , Gencturk Bora , Alkhrdaji Tarek 
Published: December 2022

Reinforced concrete (RC) diaphragms play a fundamental role in seismic resistance of RC buildings. In addition to transferring the gravity loads to the beams and columns, diaphragms need to be sufficiently rigid with high shear capacity to resist and distribute the earthquake loads to the lateral force resisting system. Despite the large building inventory with under designed diaphragms to resist the shear loads from earthquakes, the number of studies investigating possible approaches to increase the in-plane shear capacity of diaphragms is limited. External equally distributed narrow strips of fiber-reinforced polymers (FRP) providing additional shear strength for RC diaphragms is proposed in this study. Five full scale RC diaphragms with overall dimensions of 4.5 m long by 1.5 m wide by 0.1 m thick were built and tested under cyclic shear loading. One out of the five specimens was tested as a reference with no strengthening, while the remaining four were strengthened with external glass or carbon fiber-reinforced polymer (GFRP or CFRP) composites. The test results showed that the FRP strengthening system effectively enhances the in-plane shear capacity of the RC diaphragms. Compared to the reference specimen, the FRP layout used for testing increased the shear capacity by up to 40%. This paper presents the test specimens, strengthening systems, and in-plane shear response of tested diaphragms in terms of failure modes, strength, and deformation. The experimental results were also compared to theoretical values determined according to the evaluation criteria in the International Code Council (ICC)-Evaluation Services (ES), Acceptance Criteria (AC) 125.
High Thoracic Tortuosity Is Associated With CT-Markers of Degeneration of the Descending Thoracic Aortic Wall
Authors: Gross Benjamin D. , Cho Logan D. , Taubenfeld Ella , Tadros Rami O. , Faries Peter L. , Marin Michael L. , Miner Grace H. 
Published: December 2022

Objective/Introduction Increased vascular tortuosity may be an independent marker of generalized aortic pathology. This study investigates the association between descending thoracic aortic tortuosity, aneurysm pathophysiology, and outcomes following EVAR in AAA patients. Methods Patients who underwent elective EVAR between 2004 and 2018 were reviewed. Thoracic tortuosity index (TTI) was measured using 3D reconstruction software. Patients were dichotomized across the median TTI into high tortuosity [HT] (TTI >1.27, Figure1(a) ) and low tortuosity [LT] (TTI ≤1.27, Figure 1(b) ) groups. Perioperative complications, postoperative outcomes, and CT-based features of thoracic aortic wall degeneration ( Figure 1(c)-(e) ) were collected and analyzed. Results 136 patients underwent treatment: 70 HT patients, including 54 males and 16 females (mean age: 77 years), and 66 LT patients, including 62 males and 4 females (mean age: 70 years) (age; P < .001). LT patients exhibited greater prevalence of hypercholesterolemia and diabetes (P = .045, P = .01). Presence of degenerative aortic wall markers was greater in HT patients (P = .045). HT patients had higher incidence of multiple aneurysms concurrently present in their aorta compared to LT (32.8% vs 11.3%; P = .002). Frequency of AAA rupture/dissection was 4.3% for HT and 1.5% for LT (P = .339). A trend was observed in all cause 30-day mortality in the HT group (P = .061). Other perioperative complications and postoperative outcomes were similar between groups. Conclusion High TTI was associated with older age at time of EVAR, greater prevalence of degenerative markers in the descending thoracic aortic wall, and widespread aorto-iliac dilation. While not predictive of EVAR outcomes, TTI can provide valuable information regarding aneurysm pathophysiology.
Postpartum contraceptive initiation and use: Evidence from Accra, Ghana
Authors: Agula Caesar , Henry Elizabeth G , Asuming Patrick O , Obeng-Dwamena Akua , Toprah Theophilus , Agyekum Martin Wiredu , Shah Iqbal , Bawah Ayaga A 
Published: December 2022

Background: Postpartum contraceptive use reduces unintended pregnancies and results in better health outcomes for children and women. However, there is a dearth of knowledge on postpartum contraceptive use in Ghana, particularly among women in low-income urban settings. To shed light on strategies that might enhance access to postpartum family planning services in low-income urban settings, we examined contraceptive use among postpartum women in Accra, Ghana, at 1, 3, 6, and 12 months following the birth and the methods used. The predictors of modern contraceptive use in the 12-month postpartum period were also examined. Methods: Data come from a cross-sectional survey conducted in 2018 among 624 women aged 16–44 years who reported giving birth in the past 13–31 months prior to the interview. We generated descriptive statistics to examine the prevalence of contraceptive use among postpartum women at 1, 3, 6, and 12 months after birth. We further estimated a binary logistic regression to examine the predictors of modern contraceptive use at 12 months postpartum. Results: Forty percent of postpartum women never used any contraceptive method during 1 year after birth and of those who used a method, 40% relied on traditional methods. Moreover, 29% of women started using a method the immediate 1 month post-birth. Results further show that postpartum modern contraceptive uptake was positively associated with higher education, having more live births, and being currently in a union. Conclusions: Findings highlight that there may be opportunities to improve the quality of counseling during antenatal and postnatal care visits by clients to ensure fully informed choices regarding postpartum contraception. Community outreach by health providers/promoters or similar models should be promoted in low-income population settings to educate postpartum women on modern contraceptive use. Women who plan to use traditional methods should be provided with information on the consistent and correct use of these methods.
Safety of User-Initiated Intensification of Insulin Delivery Using Cambridge Hybrid Closed-Loop Algorithm
Authors: Ware Julia , Wilinska Malgorzata E. , Ruan Yue , Allen Janet M. , Boughton Charlotte K. , Hartnell Sara , Bally Lia , de Beaufort Carine , Besser Rachel E. J. , Campbell Fiona M. , Draxlbauer Katharine , Elleri Daniela , Evans Mark L. , Fröhlich-Reiterer Elke , Ghatak Atrayee , Hofer Sabine E. , Kapellen Thomas M. , Leelarathna Lalantha , Mader Julia K. , Mubita Womba M. , Narendran Parth , Poettler Tina , Rami-Merhar Birgit , Tauschmann Martin , Randell Tabitha , Thabit Hood , Thankamony Ajay , Trevelyan Nicola , Hovorka Roman 
Published: December 2022

Objective: Many hybrid closed-loop (HCL) systems struggle to manage unusually high glucose levels as experienced with intercurrent illness or pre-menstrually. Manual correction boluses may be needed, increasing hypoglycemia risk with overcorrection. The Cambridge HCL system includes a user-initiated algorithm intensification mode (“Boost”), activation of which increases automated insulin delivery by approximately 35%, while remaining glucose-responsive. In this analysis, we assessed the safety of “Boost” mode. Methods: We retrospectively analyzed data from closed-loop studies involving young children (1-7 years, n = 24), children and adolescents (10-17 years, n = 19), adults (≥24 years, n = 13), and older adults (≥60 years, n = 20) with type 1 diabetes. Outcomes were calculated per participant for days with ≥30 minutes of “Boost” use versus days with no “Boost” use. Participants with <10 “Boost” days were excluded. The main outcome was time spent in hypoglycemia <70 and <54 mg/dL. Results: Eight weeks of data for 76 participants were analyzed. There was no difference in time spent <70 and <54 mg/dL between “Boost” days and “non-Boost” days; mean difference: –0.10% (95% confidence interval [CI] –0.28 to 0.07; P = .249) time <70 mg/dL, and 0.03 (–0.04 to 0.09; P = .416) time < 54 mg/dL. Time in significant hyperglycemia >300 mg/dL was 1.39 percentage points (1.01 to 1.77; P < .001) higher on “Boost” days, with higher mean glucose and lower time in target range ( P < .001). Conclusions: Use of an algorithm intensification mode in HCL therapy is safe across all age groups with type 1 diabetes. The higher time in hyperglycemia observed on “Boost” days suggests that users are more likely to use algorithm intensification on days with extreme hyperglycemic excursions.
Foot and Shank Coordination During Walking in Copers Compared With Patients With Chronic Ankle Instability and Controls
Authors: Kweon Sang Jin , Harrison Kathryn , Williams D.S. Blaise , Kwon Yong Ung 
Published: December 2022

Background: Chronic ankle instability (CAI) alters sensorimotor function and joint coordination, but ankle coordination during walking in copers (patients with a history of ankle sprain without any residual symptoms of CAI) remains unknown. Purpose: To identify foot and shank coordination patterns that discriminate among individuals with CAI, copers, and healthy controls and to investigate whether copers display a different strategy to overcome altered sensorimotor function after a lateral ankle sprain compared with individuals with CAI and healthy controls. Study Design: Controlled laboratory study. Methods: A total of 51 participants (17 participants with CAI, 17 copers, 17 healthy controls) walked on an instrumented treadmill at a fixed speed of 1.20 m/s for a 10-second trial, from which 8 consecutive gait cycles were extracted for analysis. Heel strike and toe-off were identified for each stance phase, and each stance phase was normalized to 100 time frames. A curve analysis was performed to detect group mean differences in vector coding coupling angles and coordination variabilities for sagittal plane ankle motion/transverse plane tibial plane motion (SAK/TT) and frontal plane ankle motion/transverse plane tibial motion (FAK/TT) with 90% CIs. Results: During the terminal stance, CAI and coper groups demonstrated an inversion–tibial external rotation coupling, while controls displayed a dorsiflexion–tibial internal rotation strategy. During midstance, there were no differences between the coper, CAI, or control groups. At 0% to 20% of stance, the CAI group showed the most variability, while copers showed the least. During midstance, both copers and controls displayed an increase in variability earlier than the CAI group. The CAI group displayed a peak in variability from 39% to 43% of stance, which was greater than copers. During the propulsive phase (from heel-off to toe-off), the CAI group showed greater SAK/TT variability than both copers and controls. Similar to SAK/TT variability, the CAI group showed an earlier peak in FAK/TT variability compared with controls. Conclusion: The CAI, coper, and control groups displayed different ankle joint coupling patterns and coordination variability during a walking gait cycle. Clinical Relevance: Copers may have the ability to alter their coordination during walking, which may help us understand the underlying mechanism of CAI.