bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medizinische Notwendigkeit: Ein entbehrlicher, da notorisch
unscharfer Begriff?
Authors: Schoene-Seifert Bettina , Huster Stefan , Harney Anke , Friedrich Daniel R. 
Published: June 2022

ZusammenfassungDie ,medizinische Notwendigkeit‘ (medN) von Behandlungsmaßnahmen
wird diesen in verschiedenen Zusammenhängen als steuerndes oder
orientierendes dichotomes Attribut attestiert oder abgesprochen, ohne dass sie
präzise definiert wäre. Wir sehen in dieser Not eine
mögliche Tugend, solange medN als dynamisches Ergebnis transparenter und
vertrauenswürdiger Überlegungsprozesse verstanden wird, in das
Normen wie Fakten einen möglichst kohärenten Eingang finden. Wir
plädieren dafür, den medN-Begriff relativ zum Versorgungssystem,
aber unabhängig von ökonomischen Rahmenbedingungen zu
verwenden.
Insufficient Closing Forces of Yasargil Titanium Clips in Two Small Aneurysms Detected with Intraoperative Indocyanine Green Videoangiography
Authors: Scheller Christian , Prell Julian , Simmermacher Sebastian , Strauss Christian , Doenitz Christian , Schmidt Nils Ole , Schebesch Karl-Michael 
Published: June 2022

Abstract
Background and Study Aims Aneurysm clips must have adequate closing forces because residual blood flow in clipped aneurysms may result in aneurysm recurrence. Such flow can be intraoperatively detected by visual inspection, microvascular Doppler sonography, indocyanine green videoangiography (ICG-V), angiography, and puncture.
Patients We present two patients with ruptured very small middle cerebral artery aneurysms (3 and 2.9 mm). The necks of both aneurysms were microsurgically clipped with Yasargil aneurysm clips without any complications.
Results In both aneurysms, visual inspection suggested complete occlusion, but ICG-V showed persistent residual blood flow between the middle parts of the clip blades.The first patient was treated with a 5.4-mm FT744T clip (closing force of 1.47 N). After the ICG-V finding, a second 3.9-mm FT714T clip (closing force of 1.08 N) was placed on the tips of the already implanted clip to increase the closing forces. Subsequent ICG-V did not show any further residual blood flow. In the second patient, the aneurysm was clipped with an 8.0-mm FE764K clip (closing force of 1.77 N). Intraoperative ICG-V showed persistent residual blood flow within the aneurysmal dome despite complete closure of the clip. The clip was repositioned closer to the parent vessel. Consecutive ICG-V did not show any residual blood flow.
Conclusion Visually undetected incomplete aneurysm occlusion can be revealed with ICG-V. In very small aneurysms, standard closing forces of clips may not be sufficient and complete closure of the clip branches should be intraoperatively validated with ICG-V.
Implementing a Neurotrauma Registry in Latin America and the Caribbean
Authors: Rolle Myron L. , Garba Deen L. , Griswold Dylan P. , Fernández Laura L. , Sánchez Diana M. , Clavijo Angelica , Rubiano Andrés M. 
Published: June 2022

Abstract

Background Traumatic brain injury (TBI) has a disproportionately greater impact in low- and middle-income countries (LMICs). One strategy to reduce the burden of disease in LMICs is through the implementation of a trauma registry that standardizes the assessment of each patient's management of care.

Objective This study aims to ascertain the interest of Latin America and the Caribbean (LAC) nations in establishing a shared neurotrauma registry in the regional block, based on an existing framework for collaboration.

Methods A descriptive review was performed regarding the interests of LAC nations in implementing a shared neurotrauma registry in their region. We convened a meeting with seven Caribbean and five Latin American nations.

Results One hundred percent (n = 12) of the LAC representatives including neurosurgeons, neurointensivists, ministers of health, and chief medical officers/emergency medical technicians (EMTs) agreed to adopt the registry for tracking the burden of TBI and associated pathologies within the region.

Conclusion The implementation of a neurotrauma registry can benefit the region through a shared database to track disease, improve outcomes, build research, and ultimately influence policy.
Dynamic guidance performance of GdBaCuO and YBaCuO bulk single grain superconductors under a varying external magnetic field
Authors: Huang Zhichuan , Hong Ye , Lei Wuyang , Liu Jianxin , Deng Zigang , Shi Yunhua , Cardwell David A 
Published: June 2022

Abstract
High temperature superconducting (HTS) maglev technology has attracted considerable attention from researchers around the world. It provides a new direction of development for urban rail and high-speed rail transit due to its considerable advantages of frictionless transportation, low noise, and environmental protection. HTS bulk materials are able to provide a significant performance advantage to maglev technology and are a key component to achieving both levitation and vehicle guidance. HTS bulk samples with enhanced flux pinning characteristics can enable improved curve negotiating ability and lateral stability for the maglev vehicle. This paper reports the results of experiments on the dynamic guidance force of single grain Y–Ba–Cu–O (YBCO) and Gd–Ba–Cu–O (GdBCO) bulk HTS single grains in order to explore their potential for enhanced maglev guidance performance. A customized HTS maglev dynamic measurement system (SCML-03) with a rotating, circular permanent magnet guideway (PMG) was employed to simulate the dynamic operation of the HTS vehicle above the PMG at different translational speeds. It was observed from the experimental results that the GdBCO bulk superconductor is more able to resist the attenuation of the dynamic guidance force compared to YBCO under the same operational conditions. In addition, the GdBCO bulk single grain is more able to return to the original equilibrium position following exposure to an external displacement. It is concluded that the GdBCO bulk single grain offers greater potential than YBCO for practical application in HTS maglev given its enhanced guidance performance. The results of these tests provide an important benchmark for the future design of HTS maglev transportation systems.
Ultra-wideband efficient polarization conversion of terahertz wave in a planar metamaterial
Authors: Sarkar Rakesh , Punjal Ajinkya , Prabhu S S , Kumar Gagan 
Published: June 2022

Abstract
We have investigated numerically and experimentally an ultra-wideband efficient polarization conversion of a linearly polarized terahertz wave in a planar metamaterial (MM) geometry comprising an array of C-shaped resonators. Both the co- and cross-polarization transmission spectra of the proposed MM configuration have been studied for numerous polarizations of incident terahertz starting from 0∘ to 90∘ in steps of 15∘. Our design promises a cross-polarization conversion of 40% from 1.22 to 2.75 THz with a maximum of 45% when the MM design is rotated by 45∘ with respect to the incident light. The change in rotation angle excites an electric dipole in the C resonator, which radiates an electric field in the co-and cross-polarization. The polarization conversion has been explained with induced electric field profiles as well as surface current profiles. It is shown that the change in dimension of the C-shaped resonator causes a shift in the transmission spectrum. Numerically simulated results are in good agreement with the experimental results. Our design eliminates the complexity of the fabrication of multilayer structures and opens avenues to design ultra-wideband and efficient polarization rotation devices in the terahertz frequency regime.
Chronoamperometric deposition of transparent WO3 film for application as power efficient electrochromic auxiliary electrode
Authors: Ghosh Tanushree , Rani Chanchal , Kandpal Suchita , Tanwar Manushree , Bansal Love , Kumar Rajesh 
Published: June 2022

Abstract
Inorganic oxide electrochromic electrodes can be made more robust by adopting suitable deposition techniques. Electrochemically deposited tungsten oxide (WO3) film through chronoamperometry has been studied here for application as electrochromic auxiliary electrode. Thoroughly characterized film using electron microscopy, x-ray diffraction and Raman spectroscopy has been used for electrochromic measurements. The electrode shows reversible transparent to blue color switching when biased with a very small bias of 1 V. Bias dependent in-situ spectroelectrochemistry measurements have been performed which shows excellent results in terms of reversibility, cyclability, color contrast, appreciable switching time and good current stability at low working potential. The results thus pave the way to an excellent deposition technique designed particularly for electrochromic applications.
Ultimate low leakage and EOT of high-κ dielectric using transferred metal electrode
Authors: Dang Weiqi , Lu Zheyi , Zhao Bei , Li Bo , Li Jia , Zhang Hongmei , Song Rong , Hossain Mongur , Le Zhikai , Liu Yuan , Duan Xidong 
Published: June 2022

Abstract
The increase of gate leakage current when the gate dielectric layer is thinned is a key issue for device scalability. For scaling down the integrated circuits, a thin gate dielectric layer with a low leakage current is essential. Currently, changing the dielectric layer material or enhancing the surface contact between the gate dielectric and the channel material is the most common way to reduce gate leakage current in devices. Herein, we report a technique of enhancing the surface contact between the gate dielectric and the metal electrode, that is constructing an Au/Al2O3/Si metal–oxide–semiconductor device by replacing the typical evaporated electrode/dielectric layer contact with a transferred electrode/high-κ dielectric layer contact. The contact with a mild, non-invasive interface can ensure the intrinsic insulation of the dielectric layer. By applying 2–40 nm Al2O3 as the dielectric layer, the current density–electrical field (J–E) measurement reveals that the dielectric leakage generated by the transferred electrode is less than that obtained by the typical evaporated electrode with a ratio of 0.3 × 101 ∼ 5 × 106 at V
bias = 1 V. Furthermore, at J = 1 mA cm−2, the withstand voltage can be raised by 100–102 times over that of an evaporated electrode. The capacitance–voltage (C–V) test shows that the transferred metal electrode can efficiently scale the equivalent oxide layer thickness (EOT) to 1.58 nm, which is a relatively smaller value than the overall reported Si-based device’s EOT. This finding successfully illustrates that the transferred electrode/dielectric layer’s mild contact can balance the scaling of the gate dielectric layer with a minimal leakage current and constantly reduce the EOT. Our enhanced electrode/dielectric contact approach provides a straightforward and effective pathway for further scaling of devices in integrated circuits and significantly decreases the overall integrated circuit’s static power consumption (ICs).
Cross-Linked Hyaluronic Acid for Cleft Lip and Palate Aesthetic Correction: A Preliminary Report
Authors: Ordynowski Łukasz 
Published: June 2022

AbstractBackgroundSurgical treatment of cleft lip and palate is divided into primary and secondary procedures to restore physiological function and appearance of the face, mouth, and nose. Hyaluronic acid (HA) bio-implants have been successfully used for volume loss correction in several medical disciplines. However, there is paucity of information about its use in the management of facial clefting.ObjectivesThe aim of this report is to present the preliminary findings on the feasibility of using a cross-linked HA for aesthetic correction in previously surgical treated cleft lip and palate cases.MethodsThe cross-linked HA STYLAGE L, XL, and XXL (LABORATOIRES VIVACY, Paris, France) were used in this case series. Multiple treatment sessions, 4-6 weeks apart, were performed if required.ResultsA total of 15 patients had undergone the HA injections between May 2018 and December 2021. Of these, 13 had simultaneous correction of the nose, lip, and paranasal scar and the remaining 2 only the lip and scar. The procedures were uneventful and well tolerated by the patients. At follow-up, aesthetic improvement was observed in all patients. Moreover, patients reported overall satisfaction with the outcome of the procedures particularly because of its minimally invasive nature.ConclusionsCross-linked HA is a feasible and promising complimentary option for aesthetic, and potentially functional, correction in cases of cleft lip and palate. Larger clinical trials are needed to validate these preliminary findings.Level of Evidence: 4
Neurodegenerative and Cerebrovascular Brain Pathologies Are Differentially Associated With Declining Grip Strength and Gait In Older Adults
Authors: Oveisgharan Shahram , Yu Lei , Wang Tianhao , Schneider Julie A , Bennett David A , Buchman Aron S 
Published: June 2022

AbstractBackgroundUnderstanding the pathological bases underlying the heterogeneity of motor decline in old age may lead to targeted treatments. We examined whether different brain pathologies are related to declining grip strength and gait function.MethodsWe examined postmortem brains of older adults who underwent annual motor testing. Postmortem exam measured 6 neurodegenerative and 5 cerebrovascular disease (CVD) pathologies. Grip strength was measured twice bilaterally using a hand-held dynamometer, and gait function was a composite measure based on time and steps taken to walk 8 ft and perform a 360° turn twice.ResultsIn separate linear mixed-effects models including all autopsied adults (N = 1 217), neurodegenerative pathologies including tau tangles, TDP-43, and nigral neuronal loss were associated with declining grip strength, but not CVD pathologies. In contrast, although both CVD and neurodegenerative pathologies were associated with declining gait function, CVD pathologies accounted for 75% of the variance of declining rate of gait function explained by brain pathologies and neurodegenerative pathologies accounted for 25%. These findings were unchanged in adults (n = 970) without a history of stroke. Restricting analyses to only adults without dementia (n = 661), CVD pathologies continued to account for the majority of the variance of declining gait. However, we failed to detect in this subgroup the variance of declining grip strength explained by neurodegenerative or CVD pathologies.ConclusionDifferent pathologies accumulating in aging brains may contribute to the phenotypic heterogeneity of motor decline. Larger studies are needed in older adults without dementia to assess differences in the motor consequences of varied brain pathologies.
An eco-evo-devo genetic network model of stress response
Authors: Feng Li , Dong Tianyu , Jiang Peng , Yang Zhenyu , Dong Ang , Xie Shang-Qian , Griffin Christopher H , Wu Rongling 
Published: June 2022

AbstractThe capacity of plants to resist abiotic stresses is of great importance to agricultural, ecological and environmental sustainability, but little is known about its genetic underpinnings. Existing genetic tools can identify individual genetic variants mediating biochemical, physiological, and cellular defenses, but fail to chart an overall genetic atlas behind stress resistance. We view stress response as an eco-evo-devo process by which plants adaptively respond to stress through complex interactions of developmental canalization, phenotypic plasticity, and phenotypic integration. As such, we define and quantify stress response as the developmental change of adaptive traits from stress-free to stress-exposed environments. We integrate composite functional mapping and evolutionary game theory to reconstruct omnigenic, information-flow interaction networks for stress response. Using desert-adapted Euphrates poplar as an example, we infer salt resistance-related genome-wide interactome networks and trace the roadmap of how each SNP acts and interacts with any other possible SNPs to mediate salt resistance. We characterize the previously unknown regulatory mechanisms driving trait variation; i.e. the significance of a SNP may be due to the promotion of positive regulators, whereas the insignificance of a SNP may result from the inhibition of negative regulators. The regulator-regulatee interactions detected are not only experimentally validated by two complementary experiments, but also biologically interpreted by their encoded protein–protein interactions. Our eco-evo-devo model of genetic interactome networks provides an approach to interrogate the genetic architecture of stress response and informs precise gene editing for improving plants’ capacity to live in stress environments.
Diagnosis and management of type 2 diabetes in children
Authors: Garvick Sarah , Altenburg Lilli , Dunlap Bailey , Fisher Abby , Watson Amanda , Gregory Tanya 
Published: June 2022

ABSTRACT
The incidence of type 2 diabetes in children has risen 4.8% over the past decade, correlating with steadily rising obesity rates in children. Updated guidelines from the American Academy of Pediatrics and the American Diabetes Association encourage early identification and pharmacologic intervention for children with type 2 diabetes. Because of the aggressive disease course in children, comprehensive treatment must include prevention of complications such as diabetic nephropathy and neuropathy as well as management of comorbidities such as cardiovascular disease and dyslipidemia. Because the highest incidence of type 2 diabetes is reported in patients from racial or ethnic minority groups and those of low socioeconomic status, clinicians must work with patients and families to identify socioeconomic disparities that could affect adherence to diabetes management plans and to connect patients with community resources.
Lower Respiratory Tract Coinfection in the ICU: Prevalence and Clinical Significance of Coinfection Detected via Microbiological Analysis of Bronchoalveolar Lavage Fluid With a Comparison of Invasive Methodologies
Authors: Zelus Casey S. , Blaha Michael A. , Samson Kaeli K. , Kalil Andre C. , Van Schooneveld Trevor C. , Marcelin Jasmine R. , Cawcutt Kelly A. 
Published: June 2022

OBJECTIVES:
Pneumonia remains a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of coinfection. Further investigation into the impact of bronchoalveolar lavage (BAL) sampling methodology and efficient clinical utilization of microbiological analyses is needed to guide the management of lower respiratory tract infection in the ICU.

DESIGN:
Retrospective observational study.

SETTING:
ICUs at a single center between August 1, 2012, and January 1, 2018.

PATIENTS:
Mechanically ventilated adult patients who underwent BAL testing during an ICU admission were included.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
BAL methodology (bronchoscopic vs nonbronchoscopic), microbiological diagnostic testing, and clinical outcomes measures were obtained. Chi-square or Fisher exact tests assessed associations between categorical variables, whereas Kruskal-Wallis tests analyzed differences in distributions of measures. BAL samples from 803 patients met inclusion criteria. Coinfection was detected more frequently via bronchoscopic BAL compared with nonbronchoscopic BAL (26% vs 9%; p < 0.001). Viruses were detected more frequently in bronchoscopic (42% vs 13%; p < 0.001) and bacteria in nonbronchoscopic (42% vs 33%; p = 0.011) BALs. A positive correlation between mortality and the number of organisms isolated was identified, with 43%, 48%, and 58% 30-day mortality among those with 0, 1, and more than 2 organisms, respectively (p = 0.003). Viral organism detection was associated with increased 30-day mortality (56% vs 46%; p = 0.033).

CONCLUSIONS:
Even in the setting of standardized institutional techniques, retrospective evaluation of bronchoscopic and nonbronchoscopic BAL methodologies did not reveal similar microbiologic yield in critically ill patients, though bronchoscopic BAL overall yielded more organisms, and occurrence of multiple organisms in BAL was associated with worse outcome. Prospective data are needed for direct comparison of both methods to develop more standardized approaches for use in different patient groups.
Dysphagia Post-Extubation Affects Long-Term Mortality in Mixed Adult ICU Patients—Data From a Large Prospective Observational Study With Systematic Dysphagia Screening
Authors: Zuercher Patrick , Moser Michel , Waskowski Jan , Pfortmueller Carmen A. , Schefold Joerg C. 
Published: June 2022

OBJECTIVES:
Data on long-term effects of post-extubation dysphagia is lacking. We investigate mid- and long-term clinical outcomes in a large sample of ICU patients with systematic dysphagia screening.

DESIGN:
Outcome analysis with a follow-up of 6 years or death (whichever occurred earlier) of ICU patients from a prospective observational trial (Dysphagia in Mechanically Ventilated ICU Patients study) with systematic dysphagia screening.

SETTING:
ICU of a tertiary care academic center.

PATIENTS:
Nine-hundred thirty-three mixed medical-surgical ICU patients (median age, 66 yr; interquartile range [IQR], 54–74, Acute Physiology and Chronic Health Evaluation II score 19 [IQR, 14–24], 71% male).

INTERVENTIONS:
ICU patients were followed up for a mean follow-up period of 1,731 ± 772 days (4.7 ± 2.1 yr). Primary outcome measures were 180-day and 360-day all-cause mortality in ICU patients with versus without dysphagia.

MEASUREMENTS AND MAIN RESULTS:
Two-hundred seventy-three patients died (29.3%) during the observational interval (n = 76 lost to follow-up). In dysphagia screening positive versus negative ICU patients, mortality at 180 days was 16% versus 5.8% (excess mortality 10.2%), whereas mortality at 360 days was 25% versus 9.1% (excess mortality 15.9%). Adjustment for confounders in a Cox model revealed a significant association of dysphagia with all-cause mortality in a time-dependent manner. The risk of death in ICU patients with versus without post-extubation dysphagia declined from about 2.5 times higher to about equal risk for both groups over the first year (i.e. 1.03 yr) post-ICU admission (at 360 d: hazard ratio [HR], 1.03; 95% CI, 0.42–3.70). The mean mortality HR for the first year post-ICU admission was HR 2.09 (95% CI, 1.34–3.24; p = 0.0009).

CONCLUSIONS:
Long-term follow-up of a large cohort of medical-surgical adult ICU patients systematically screened for dysphagia showed that dysphagia is associated with increased hazards for death for up to 1 year after ICU admission. Our data underline effects of post-extubation dysphagia on long-term clinical outcomes in affected critically ill patients.