bluuebunny/crossref_metadata_2025 huggingface dataset:
Migration of magnetotactic bacteria in porous media
Authors: Rismani Yazdi Saeed , Nosrati Reza , Stevens Corey A. , Vogel David , Escobedo Carlos
Published: February 2018

Magnetotactic bacteria (MTB) migrate in complex porous sediments where fluid flow is ubiquitous. Here, we demonstrate that magnetotaxis enables MTB to migrate effectively through porous micromodels. Directed MTB can circumvent curved obstacles by traveling along the boundaries and pass flat obstacles by repeatedly switching between forward and backward runs. Magnetotaxis enables directed motion of MTB through heterogeneous porous media, overcoming tortuous flow fields with local velocities as high as 250 μm s−1. Our findings bring new insights into the migration behaviour of MTB in their natural habitats and their potential in vivo applications as microbiorobots.
The burrowing bettongs of Barrow Island: demographic and genetic insights into a threatened macropod
Authors: Donaldson Felicity , Bencini Roberta , Morris Keith , Teale Roy , Wale Celeste H. , How Richard A. , Schmitt Lincoln H.
Published: February 2018

Islands provide the last refuge for many Australian species that have succumbed to range contractions since European settlement. These species have heightened vulnerability when developments are planned for the islands. The burrowing bettong (Bettongia lesueur), a threatened macropod, was once widespread across Australia but now occurs naturally only on Barrow Island and two other Western Australian offshore islands. Here, we document the demographic, social and genetic characteristics of the Barrow Island population, using nuclear microsatellites, mtDNA and demographic parameters from 286 individuals trapped around 29 warrens. The Barrow Island population utilises complex warren systems scattered across the landscape and exhibits continuous breeding, even during extensive dry conditions. Males (759 g) were significantly heavier than females (735 g), with the latter reaching sexual maturity at ~600 g. Warrens varied markedly in size and number of individuals, with 20% of females and 25% of males moving between nearby warrens. There were two deep mtDNA haplotype clades that coalesce around 298 000 years ago, indicating that this island population has maintained an effective population size that has permitted the retention of one marked feature of its preisolation genetic diversity. Dispersal and gene flow between warrens was severely constrained. Both mtDNA and 11 nuclear microsatellites showed a strong isolation by distance effect, with genetic differences between warrens increasing linearly with geographic separation. While this was marked in both sexes, it was stronger in females and consistent with shorter dispersal distances for females than for males. The trapping and genetic data are concordant, with between-warren sociality correlated with genetic similarity. Long-term conservation, management and translocation programs will benefit from cognisance of the strong fidelity to natal areas, as evidenced by both recapture data and genetic analyses.
Alien Sightings and OVNI Culture in Argentina
Authors: Sheinin David M. K.
Published: February 2018

During the Cold War, there were thousands of Unidentified Flying Object (UFO) sightings in Argentina (in Spanish, Objeto volador no identificado or OVNI). The mainstream media reported on many of them. In a field termed ufología, some events were explained scientifically or somewhat scientifically; most were not. These sightings and their stories lived on in a culture of thousands of OVNI aficionados and their literatures, frequently spilling into larger popular cultures.

OVNI culture disrupts chronologies. It offers a picture of Cold War Argentina that breaks with longstanding popular and academic chronologies that stress a dictatorship-versus-democracy binary. That binary is real. However, OVNI culture superimposes an often-neglected Cold War chronology on the mid- to late 20th century. OVNI stories and their cultural consumption evolve and vary not with reference to violent Argentine political and historical change, but in the context of a larger transnational Cold War culture in an Argentine context. Hallmarks of OVNI culture in Argentina include the enormous influence of U.S. popular culture, as well as references to apocalyptic nuclear weapons, and unscientific notions of psychoses in explaining late-night sightings of spacecraft and extraterrestrials.
reception in historical novels
Authors: Stevenson Tom
Published: February 2018

Reception in historical novels set in ancient Greece and Rome differs fundamentally between the 19th and the 20th/21st centuries. In the 19th century, reception was governed heavily by imperial attitudes and religious controversies, particularly in regard to claims about the true Christian faith under the Roman Empire. Hence, novels set in Rome or the Roman Empire dominated the field. In the 20th century, attitudes to empire and religion were drastically revised in the wake of World War I. The growing authority of academic history in an age of scientific progress was another factor which helped to produce a decline in the reputation of historical fiction. Other changes, however, were more stimulating in nature, including the use of ancient Greece as a setting, more impressive source analysis, the rise of female novelists, different subjects and perspectives, and new social and sexual attitudes. These and other developments lifted the reputation of historical fiction once more.
Nanopore sequencing technology and tools for genome assembly: computational analysis of the current state, bottlenecks and future directions
Authors: Senol Cali Damla , Kim Jeremie S , Ghose Saugata , Alkan Can , Mutlu Onur
Published: February 2018

Nanopore sequencing technology has the potential to render other sequencing technologies obsolete with its ability to generate long reads and provide portability. However, high error rates of the technology pose a challenge while generating accurate genome assemblies. The tools used for nanopore sequence analysis are of critical importance, as they should overcome the high error rates of the technology. Our goal in this work is to comprehensively analyze current publicly available tools for nanopore sequence analysis to understand their advantages, disadvantages and performance bottlenecks. It is important to understand where the current tools do not perform well to develop better tools. To this end, we (1) analyze the multiple steps and the associated tools in the genome assembly pipeline using nanopore sequence data, and (2) provide guidelines for determining the appropriate tools for each step. Based on our analyses, we make four key observations: (1) the choice of the tool for basecalling plays a critical role in overcoming the high error rates of nanopore sequencing technology. (2) Read-to-read overlap finding tools, GraphMap and Minimap, perform similarly in terms of accuracy. However, Minimap has a lower memory usage, and it is faster than GraphMap. (3) There is a trade-off between accuracy and performance when deciding on the appropriate tool for the assembly step. The fast but less accurate assembler Miniasm can be used for quick initial assembly, and further polishing can be applied on top of it to increase the accuracy, which leads to faster overall assembly. (4) The state-of-the-art polishing tool, Racon, generates high-quality consensus sequences while providing a significant speedup over another polishing tool, Nanopolish. We analyze various combinations of different tools and expose the trade-offs between accuracy, performance, memory usage and scalability. We conclude that our observations can guide researchers and practitioners in making conscious and effective choices for each step of the genome assembly pipeline using nanopore sequence data. Also, with the help of bottlenecks we have found, developers can improve the current tools or build new ones that are both accurate and fast, to overcome the high error rates of the nanopore sequencing technology.
Extrema-weighted feature extraction for functional data
Authors: van den Boom Willem , Mao Callie , Schroeder Rebecca A , Dunson David B
Published: February 2018

Motivation

Although there is a rich literature on methods for assessing the impact of functional predictors, the focus has been on approaches for dimension reduction that do not suit certain applications. Examples of standard approaches include functional linear models, functional principal components regression and cluster-based approaches, such as latent trajectory analysis. This article is motivated by applications in which the dynamics in a predictor, across times when the value is relatively extreme, are particularly informative about the response. For example, physicians are interested in relating the dynamics of blood pressure changes during surgery to post-surgery adverse outcomes, and it is thought that the dynamics are more important when blood pressure is significantly elevated or lowered.

Results

We propose a novel class of extrema-weighted feature (XWF) extraction models. Key components in defining XWFs include the marginal density of the predictor, a function up-weighting values at extreme quantiles of this marginal, and functionals characterizing local dynamics. Algorithms are proposed for fitting of XWF-based regression and classification models, and are compared with current methods for functional predictors in simulations and a blood pressure during surgery application. XWFs find features of intraoperative blood pressure trajectories that are predictive of postoperative mortality. By their nature, most of these features cannot be found by previous methods.

Availability and implementation

The R package ‘xwf’ is available at the CRAN repository: https://cran.r-project.org/package=xwf.

Supplementary information

Supplementary data are available at Bioinformatics online.
Estimating the Hospital Burden of Norovirus-Associated Gastroenteritis in England and Its Opportunity Costs for Nonadmitted Patients
Authors: Sandmann Frank G , Shallcross Laura , Adams Natalie , Allen David J , Coen Pietro G , Jeanes Annette , Kozlakidis Zisis , Larkin Lesley , Wurie Fatima , Robotham Julie V , Jit Mark , Deeny Sarah R
Published: February 2018

Since the introduction of rotavirus vaccination in England in July 2013, norovirus has become the second-largest contributor of inpatient gastroenteritis, preventing 57800 patients from being admitted annually. Economic costs amount to £297.7 million, which translates into 6300 quality-adjusted life years.
A three-dimensional view on biodiversity changes: spatial, temporal, and functional perspectives on fish communities in the Baltic Sea
Authors: Frelat Romain , Orio Alessandro , Casini Michele , Lehmann Andreas , Mérigot Bastien , Otto Saskia A , Sguotti Camilla , Möllmann Christian
Published: February 2018

Fisheries and marine ecosystem-based management requires a holistic understanding of the dynamics of fish communities and their responses to changes in environmental conditions. Environmental conditions can simultaneously shape the spatial distribution and the temporal dynamics of a population, which together can trigger changes in the functional structure of communities. Here, we developed a comprehensive framework based on complementary multivariate statistical methodologies to simultaneously investigate the effects of environmental conditions on the spatial, temporal and functional dynamics of species assemblages. The framework is tested using survey data collected during more than 4000 fisheries hauls over the Baltic Sea between 2001 and 2016. The approach revealed the Baltic fish community to be structured into three sub-assemblages along a strong and temporally stable salinity gradient decreasing from West to the East. Additionally, we highlight a mismatch between species and functional richness associated with a lower functional redundancy in the Baltic Proper compared with other sub-areas, suggesting an ecosystem more susceptible to external pressures. Based on a large dataset of community data analysed in an innovative and comprehensive way, we could disentangle the effects of environmental changes on the structure of biotic communities—key information for the management and conservation of ecosystems.
Race Characterization of Phytophthora Root Rot on Capsicum in Taiwan as a Basis for Anticipatory Resistance Breeding
Authors: Barchenger Derek W. , Sheu Zong-Ming , Kumar Sanjeet , Lin Shih-Wen , Burlakoti Rishi R. , Bosland Paul W.
Published: February 2018

Peppers (Capsicum sp.) are an increasingly important crop because of their use as a vegetable, spice, and food colorant. The oomycete Phytophthora capsici is one of the most devastating pathogens to pepper production worldwide, causing more than $100 million in losses annually. Developing cultivars resistant to P. capsici is challenging because of the many physiological races that exist and new races that are continuously evolving. This problem is confounded by the lack of a universal system of race characterization. As a basis to develop a global anticipatory breeding program, New Mexico recombinant inbred lines (NMRILs) functioned as a host differential for Phytophthora root rot to characterize the race structure of P. capsici populations in Taiwan. Using the NMRILs, 24 new races were identified, illustrating the utility and usefulness of the NMRILs for anticipatory breeding. Virulence of P. capsici was observed to be geographically specific and in two virulence clusters. Interestingly, all but two isolates collected in 2016 were the A2 mating type, which is a shift from the predominantly A1 mating type isolates collected prior to 2008. The NMRILs host differential provides an approach for scientists to work together on a global scale when breeding for resistance as well as on a local level for regional gene deployment. Additionally, we propose that the current race numbering system, which has no biological meaning, be supplemented with the virulence phenotype, based on the susceptible NMRILs to a given isolate. This work provides insights into the population dynamics of P. capsici and interactions within the highly complex Capsicum−Phytophthora pathosystem, and offers a basis for similar research in other crops.
Etiology of Acute Coronary Syndrome after Noncardiac Surgery
Authors: Helwani Mohammad A. , Amin Amit , Lavigne Paul , Rao Srikar , Oesterreich Shari , Samaha Eslam , Brown Jamie C. , Nagele Peter
Published: February 2018

Background

The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia.

Methods

In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes. Acute coronary syndrome was classified as ST–elevation myocardial infarction, non–ST–elevation myocardial infarction, or unstable angina; myocardial infarctions were adjudicated as type 1 (plaque rupture), type 2 (demand ischemia), or type 4b (stent thrombosis).

Results

Among 215,077 patients screened, 146 patients were identified who developed acute coronary syndrome: 117 were classified as non–ST–elevation myocardial infarction (80.1%); 21 (14.4%) were classified as ST–elevation myocardial infarction, and 8 (5.5%) were classified as unstable angina. After coronary angiography, most events were adjudicated as demand ischemia (type 2 myocardial infarction, n = 106, 72.6%) compared to acute coronary thrombosis (type 1 myocardial infarction, n = 37, 25.3%) and stent thrombosis (type 4B, n = 3, 2.1%). Absent or only mild, nonobstructive coronary artery disease was found in 39 patients (26.7%). In 14 patients (9.6%), acute coronary syndrome was likely due to stress-induced cardiomyopathy. Aggregate 30-day and 1-yr mortality rates were 7 and 14%, respectively.

Conclusions

The dominant mechanism of perioperative acute coronary syndrome in our cohort was demand ischemia. A subset of patients had no evidence of obstructive coronary artery disease, but findings were consistent with stress-induced cardiomyopathy.
Can Mathematical Modeling Explain the Measured Magnitude of the Second Gas Effect?
Authors: Korman Ben , Dash Ranjan K. , Peyton Philip J.
Published: February 2018

Background

Recent clinical studies suggest that the magnitude of the second gas effect is considerably greater on arterial blood partial pressures of volatile agents than on end-expired partial pressures, and a significant second gas effect on blood partial pressures of oxygen and volatile agents occurs even at relatively low rates of nitrous oxide uptake. We set out to further investigate the mechanism of this phenomenon with the help of mathematical modeling.

Methods

Log-normal distributions of ventilation and blood flow were generated representing the range of ventilation-perfusion scatter seen in patients during general anesthesia. Mixtures of nominal delivered concentrations of volatile agents (desflurane, isoflurane and diethyl ether) with and without 70% nitrous oxide were mathematically modeled using steady state mass-balance principles, and the magnitude of the second gas effect calculated as an augmentation ratio for the volatile agent, defined as the partial pressure in the presence to that in the absence of nitrous oxide.

Results

Increasing the degree of mismatch increased the second gas effect in blood. Simultaneously, the second gas effect decreased in the gas phase. The increase in blood was greatest for the least soluble gas, desflurane, and least for the most soluble gas, diethyl ether, while opposite results applied in the gas phase.

Conclusions

Modeling of ventilation-perfusion inhomogeneity confirms that the second gas effect is greater in blood than in expired gas. Gas-based minimum alveolar concentration readings may therefore underestimate the depth of anesthesia during nitrous oxide anesthesia with volatile agents. The effect on minimum alveolar concentration is likely to be most pronounced for the less soluble volatile agents in current use.
Impact of Frailty and Comorbidities on Surgical Outcomes and Complications in Adult Spinal Disorders
Authors: Yagi Mitsuru , Fujita Nobuyuki , Okada Eijiro , Tsuji Osahiko , Nagoshi Narihito , Tsuji Takashi , Asazuma Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: February 2018

Study Design.

Retrospective review of surgically treated 481 adult patients with spinal disorders.

Objective.

The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates.

Summary of Background Data.

Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates.

Methods.

We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65 ± 9 years), 152 degenerative spondylolisthesis (DS: 64 ± 10 years), or 173 lumbar spinal canal stenosis (LSCS: 71 ± 9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates.

Results.

The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09 ± 0.12, DS 0.06 ± 0.06, LSCS 0.04 ± 0.05, P < 0.01. CCI: ASD 2.1 ± 1.6, DS 1.4 ± 0.7, LSCS 1.6 ± 0.9, P < 0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26 ± 11, Scoliosis Research Society Questionnaire [SRS] 3.7 ± 0.7; prefrail: ODI 32 ± 12, SRS 3.6 ± 0.6; frail: ODI 42 ± 15, SRS 3.2 ± 0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36%, 58%, and 81%) in ASD, but not in others.

Conclusion.

ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD.

Level of Evidence: 4
Rheumatoid Arthritis Is Associated With an Increased Risk of Postoperative Infection and Revision Surgery in Elderly Patients Undergoing Anterior Cervical Fusion
Authors: Horowitz Jason A. , Puvanesarajah Varun , Jain Amit , Li Xudong J. , Shimer Adam L. , Shen Francis H. , Hassanzadeh Hamid
Published: February 2018

Study Design.

Retrospective review.

Objective.

To identify the incidence and analyze the risk of postoperative complications amongst elderly patients with rheumatoid arthritis undergoing anterior cervical fusion.

Summary of Background Data.

Previous studies have reported elevated risks of postoperative complications for patients with rheumatoid arthritis undergoing orthopedic procedures. However, little is known about the risk of postoperative complications in rheumatoid arthritis patients after spine surgery.

Methods.

A commercially available database was queried for all Medicare patients 65 years of age and older undergoing one- or two-level primary anterior cervical fusion surgeries from 2005 to 2013. Complications, hospitalization costs, and length of stay were queried. Multivariate logistic regression analyses were performed to estimate the odds ratio for each complication adjusted for age, sex, and Charlson Comorbidity Index.

Results.

A total of 6067 patients with a history of rheumatoid arthritis and 113,187 controls were identified. Significantly higher incidences of major medical complications (7.5% vs. 5.9%, P < 0.001), postoperative infections (2.6% vs. 1.5%, P < 0.001), and revision surgery (1.1% vs. 0.6%, P < 0.001) were observed amongst the rheumatoid arthritis cohort. Significantly greater average cost of hospitalization ($17,622 vs. $12,489, P < 0.001) and average length of stay (3.13 vs. 2.08 days, P < 0.001) were also observed.

Conclusion.

Patients with rheumatoid arthritis undergoing anterior cervical fusion face increased risks of postoperative infection and revision surgery compared to normal controls. This information is valuable for preoperative counseling and risk stratification.

Level of Evidence: 3
Management of Early Deep Wound Infection After Thoracolumbar Instrumentation
Authors: Yuan Wei , Liu Xuan , Zhou Xiaoshu , Pei Lei , Zhu Yue
Published: February 2018

Study Design.

A retrospective study.

Objective.

The aim of this study was to compare the clinical outcomes of continuous irrigation suction systems (CISS) or vacuum-assisted closure system (VACS) in early deep wound infection (DWI) after thoracolumbar instrumentation.

Summary of Background Data.

DWI after thoracolumbar instrumentation is challenging and debridement followed by either CISS or VACS has been proven to be effective. So far, which one of the system has more advantages over the other remains unclear.

Methods.

Patients after thoracolumbar instrumentation were evaluated at our spine surgery center from 2005 to 2015. Patients who were diagnosed with early deep DWI after spinal instrumentation and treated by meticulous debridement in the operating room followed by either CISS or VACS were included. Detailed information was obtained from the medical records, including clinical features, results of laboratory examinations, medical therapies, and outcomes. A follow-up was conducted to observe whether recurrent spinal infection or other complications happened.

Results.

We identified 11 patients in the CISS group and 12 patients in the VACS group. There were no significant differences in terms of age, gender, follow-up duration, symptoms of infection, laboratory examinations, etc. The number of CISS or VACS replacement was 1.3 and 1.6, respectively, before wound healing (P > 0.05). And there were significant differences in terms of hospital stay and extra cost of infection treatment between the two groups. In the follow-up period, we observed sinus tract formation and low back pain in both groups and one patient in the VACS group died of pulmonary infection 4 years after the initial surgery.

Conclusion.

Thorough debridement followed by CISS or VACS are comparable in treating early DWI after thoracolumbar instrumentation. The CISS treatment was statistically significant in comparison to the VACS treatment in terms of hospital stay and cost.

Level of Evidence: 4
Impact of Psychiatric Comorbidities on Short-Term Outcomes Following Intervention for Lumbar Degenerative Disc Disease
Authors: Kalakoti Piyush , Sciubba Daniel M. , Pugely Andrew J. , McGirt Matthew J. , Sharma Kanika , Patra Devi P. , Phan Kevin , Madhavan Karthik , Menger Richard P. , Notarianni Christina , Guthikonda Bharat , Nanda Anil , Sun Hai
Published: February 2018

Study Design.

Retrospective, observational cohort study.

Objective.

To investigate the impact of psychiatric diseases on short-term outcomes in patients undergoing fusion surgery for lumbar degenerative disc disease (LDDD).

Summary of Background Data.

Limited literature exists on the prevalence and impact of psychiatric comorbidities on outcomes in patients undergoing surgery for LDDD.

Methods.

Adult patients (>18 yr) registered in the Nationwide Inpatient Sample database (2002–2011) and undergoing an elective spine fusion for LDDD that met inclusion criteria formed the study population. Defined primary outcome measures were discharge disposition, length of stay, hospitalization cost, and short-term postsurgical complications (neurological, respiratory, cardiac, gastrointestinal, wound complication and infections, venous thromboembolism, and acute renal failure). Multivariable regression techniques were used to explore the association of psychiatric comorbidities on short-term outcomes by adjusting for patient demographics, clinical, and hospital characteristics.

Results.

Of the 126,044 adult patients undergoing fusion surgery for LDDD (mean age: 54.91 yr, 58% female) approximately 18% had a psychiatric disease. Multivariable regression analysis revealed patients with psychiatric disease undergoing fusion surgery have higher likelihood for unfavorable discharge (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.35–1.47; P < 0.001), length of stay (OR 1.03; 95% CI 1.02–1.04; P < 0001), postsurgery neurologic complications (OR 1.25; 95% CI 1.13–1.37; P < 0.001), venous thromboembolic events (OR 1.38 95% CI 1.26–1.52; P < 0.001), and acute renal failure (OR 1.17; 95% CI 1.01–1.37; P = 0.040). Patients with psychiatric disease were also associated to have higher hospitalization cost (6.3% higher; 95% CI: 5.6%–7.1%; P < 0.001) compared to those without it.

Conclusion.

Our study quantifies the estimates for presence of concomitant psychiatric comorbid conditions on short outcomes in patients undergoing fusions for LDDD. The data provide supporting evidence for adequate preoperative planning and postsurgical care including consultation for mental health for favorable outcomes.

Level of Evidence: 4
Lymphocyte Count at 4 Days Postoperatively
Authors: Iwata Eiichiro , Shigematsu Hideki , Yamamoto Yusuke , Tanaka Masato , Okuda Akinori , Morimoto Yasuhiko , Masuda Keisuke , Nakajima Hiroshi , Koizumi Munehisa , Tanaka Yasuhito
Published: February 2018

Study Design.

Case-control study.

Objective.

To identify laboratory markers for surgical site infection (SSI) in posterior lumbar decompression surgery, which are not affected by operative factors, and to determine the diagnostic cutoffs of these markers.

Summary of Background Data.

Numerous laboratory markers are used for the early detection of SSI; however, these markers may be affected by operative factors.

Methods.

The study included 182 participants. They were divided into an SSI group (patients who developed deep SSI; n = 8) and a no-SSI group (n = 174). We reviewed data on the C-reactive protein level and total white blood cell count and differential count before posterior lumbar decompression surgery and 1 and 4 days postoperatively. We determined which markers differed significantly between the groups and identified the markers that were not affected by operative factors (operative time, intraoperative blood loss, and number of operative segments) in the no-SSI group. We then determined the diagnostic cutoffs of these unaffected markers using receiver operating characteristic curves.

Results.

We identified the lymphocyte percentage at 4 days postoperatively (cutoff, <19.4%; sensitivity, 80.0%; specificity, 62.5%; area under the curve, 0.78) and lymphocyte count at 4 days postoperatively (cutoff, <1010/μL; sensitivity, 93.7%; specificity, 62.5%; area under the curve, 0.78) as reliable markers.

Conclusion.

Lymphocyte percentage and count at 4 days postoperatively are reliable markers for SSI after posterior lumbar decompression surgery. Lymphocyte count at 4 days postoperatively can be considered as a superior marker for screening because it has a high sensitivity and can be measured early.

Level of Evidence: 4
Diffuse Idiopathic Skeletal Hyperostosis Extended to the Lumbar Segment Is a Risk Factor of Reoperation in Patients Treated Surgically for Lumbar Stenosis
Authors: Yamada Kentaro , Satoh Shigenobu , Abe Yuichiro , Yanagibashi Yasushi , Hyakumachi Takahiko , Masuda Takeshi
Published: February 2018

Study Design.

Retrospective longitudinal cohort study.

Objective.

To investigate the association between diffuse idiopathic skeletal hyperostosis (DISH) and reoperation in patients treated surgically for lumbar spinal stenosis (LSS) in long-term results.

Summary of Background Data.

Few studies have evaluated DISH as a potential risk factor of poor surgical results for LSS.

Methods.

This study included 1063 responders to a postoperative postal survey out of 2363 consecutive patients who underwent surgery for LSS between 2002 and 2010. The survey included questions about reoperations performed at another hospital and the patient-reported outcomes. DISH was evaluated by preoperative standing whole-spine radiographs. We investigated DISH as a predictor of reoperation and characteristics of poor outcomes in patients with DISH. We also assessed selection bias by examining the differences between responders and nonresponders to a postal survey.

Results.

Reoperations were performed in a total of 115 patients (10.8%) within an average of 8.6 years after the initial surgeries. Patients who only had DISH were not associated with reoperation; however, reoperations were performed significantly more often in patients with DISH extended to the lumbar segment (L-DISH) than in patients without (22% and 7.3%, respectively; P < 0.001). Cox analysis showed that L-DISH was one of the significant independent predictors for reoperation (hazard ratio 2.05, P = 0.009). Surgery-free survival was significantly shorter in patients with L-DISH than in those without (P = 0.005). The cause of reoperation did not differ between the patients with and without L-DISH. Several factors, but not L-DISH, were significantly associated with responders to the survey.

Conclusion.

L-DISH was independently associated with reoperation for LSS. The decreased number of lumbar mobile segments due to L-DISH might lead to unfavorable outcomes. Careful follow-up of patients is needed after surgery for LSS with L-DISH.

Level of Evidence: 3
The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying
Authors: Vranas Kelly C. , Jopling Jeffrey K. , Scott Jennifer Y. , Badawi Omar , Harhay Michael O. , Slatore Christopher G. , Ramsey Meghan C. , Breslow Michael J. , Milstein Arnold S. , Kerlin Meeta Prasad
Published: February 2018

Objective:

Many ICU patients do not require critical care interventions. Whether aggressive care environments increase risks to low-acuity patients is unknown. We evaluated whether ICU acuity was associated with outcomes of low mortality-risk patients. We hypothesized that admission to high-acuity ICUs would be associated with worse outcomes. This hypothesis was based on two possibilities: 1) high-acuity ICUs may have a culture of aggressive therapy that could lead to potentially avoidable complications and 2) high-acuity ICUs may focus attention toward the many sicker patients and away from the fewer low-risk patients.

Design:

Retrospective cohort study.

Setting:

Three hundred twenty-two ICUs in 199 hospitals in the Philips eICU database between 2010 and 2015.

Patients:

Adult ICU patients at low risk of dying, defined as an Acute Physiology and Chronic Health Evaluation-IVa–predicted mortality of 3% or less.

Exposure:

ICU acuity, defined as the mean Acute Physiology and Chronic Health Evaluation IVa score of all admitted patients in a calendar year, stratified into quartiles.

Measurements and Main Results:

We used generalized estimating equations to test whether ICU acuity is independently associated with a primary outcome of ICU length of stay and secondary outcomes of hospital length of stay, hospital mortality, and discharge destination. The study included 381,997 low-risk patients. Mean ICU and hospital length of stay were 1.8 ± 2.1 and 5.2 ± 5.0 days, respectively. Mean Acute Physiology and Chronic Health Evaluation IVa–predicted hospital mortality was 1.6% ± 0.8%; actual hospital mortality was 0.7%. In adjusted analyses, admission to low-acuity ICUs was associated with worse outcomes compared with higher-acuity ICUs. Specifically, compared with the highest-acuity quartile, ICU length of stay in low-acuity ICUs was increased by 0.24 days; in medium-acuity ICUs by 0.16 days; and in high-acuity ICUs by 0.09 days (all p < 0.001). Similar patterns existed for hospital length of stay. Patients in lower-acuity ICUs had significantly higher hospital mortality (odds ratio, 1.28 [95% CI, 1.10–1.49] for low-; 1.24 [95% CI, 1.07–1.42] for medium-, and 1.14 [95% CI, 0.99–1.31] for high-acuity ICUs) and lower likelihood of discharge home (odds ratio, 0.86 [95% CI, 0.82–0.90] for low-, 0.88 [95% CI, 0.85–0.92] for medium-, and 0.95 [95% CI, 0.92–0.99] for high-acuity ICUs).

Conclusions:

Admission to high-acuity ICUs is associated with better outcomes among low mortality-risk patients. Future research should aim to understand factors that confer benefit to patients with different risk profiles.
Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis
Authors: Meyer Nathaniel , Harhay Michael O. , Small Dylan S. , Prescott Hallie C. , Bowles Kathryn H. , Gaieski David F. , Mikkelsen Mark E.
Published: February 2018

Objectives:

A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia.

Design and Setting:

Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015.

Patients:

We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis.

Interventions:

None.

Measurements and Main Results:

From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014.

Conclusions:

Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits.
Transport Time and Preoperating Room Hemostatic Interventions Are Important: Improving Outcomes After Severe Truncal Injury
Authors: Holcomb John B.
Published: February 2018

Objectives:

Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock. Outcomes of patients with hemorrhagic shock and extremity bleeding have improved with widespread use of tourniquets and early balanced transfusion therapy. Conversely, civilian patients suffering truncal bleeding and shock have the same mortality (46%) over the last 20 years. To understand how to decrease this substantial mortality, one must first critically evaluate all phases of care from point of injury to definitive hemorrhage control in the operating room.

Data Sources:

Limited literature review.

Data Synthesis:

The peak time to death after severe truncal injury is within 30 minutes of injury. However, when adding prehospital transport time, time spent in the emergency department, followed by the time in the operating room, it currently takes 2.1 hours to achieve definitive truncal hemorrhage control. This disparity in uncontrolled truncal bleeding and time to hemorrhage control needs to be reconciled. Prehospital and emergency department whole blood transfusion and temporary truncal hemorrhage control are now possible.

Conclusions:

The importance of rapid transport, early truncal hemorrhage control and whole blood transfusion is now widely recognized. Prehospital temporary truncal hemorrhage control and whole blood transfusion should offer the best possibility of improving patient outcomes after severe truncal injury.
Endothelial Cell-Specific Molecule-1 in Critically Ill Patients With Hematologic Malignancy
Authors: Zafrani Lara , Resche-Rigon Matthieu , De Freitas Caires Nathalie , Gaudet Alexandre , Mathieu Daniel , Parmentier-decrucq Erika , Lemiale Virginie , Mokart Djamel , Pène Frédéric , Kouatchet Achille , Mayaux Julien , Vincent François , N’yunga Martine , Bruneel Fabrice , Rabbat Antoine , Lebert Christine , Perez Pierre , Meert Anne-Pascale , Benoit Dominique , Darmon Michael , Azoulay Elie
Published: February 2018

Objectives:

To assess whether serum concentration of endothelial cell-specific molecule-1 (Endocan) at ICU admission is associated with the use of ICU resources and outcomes in critically ill hematology patients.

Design:

Prospective multicenter cohort study.

Setting:

Seventeen ICUs in France and Belgium.

Patients:

Seven hundred forty-four consecutive critically ill hematology patients; 72 critically ill septic patients without hematologic malignancy; 276 healthy subjects.

Intervention:

None.

Measurements and Main Results:

Median total endocan concentrations were 4.46 (2.7–7.8) ng/mL. Endocan concentrations were higher in patients who had received chemotherapy before ICU admission (4.7 [2.8–8.1] ng/mL vs. 3.7 [2.5–6.3] ng/mL [p = 0.002]). In patients with acute respiratory failure, endocan levels were increased in patients with drug-induced pulmonary toxicity compared with other etiologies (p = 0.038). Total endocan levels higher than 4.46 ng/mL were associated with a higher cumulative probability of renal replacement therapy requirement (p = 0.006), a higher requirement of mechanical ventilation (p = 0.01) and a higher requirement of vasopressors throughout ICU stay (p < 0.0001). By multivariate analysis, total endocan levels at admission were independently associated with ICU mortality (odds ratios, 1.39; 95% CI, 1.06–1.83; p = 0.018). The predictive value of endocan peptide fragments of 14 kDa in terms of mortality and life-sustaining therapies requirement was inferior to that of total endocan. Endocan levels were higher in critically ill hematology patients compared with healthy subjects (p < 0.0001) but lower than endocan values in critically ill septic patients without hematologic malignancy (p = 0.005)

Conclusions:

Serum concentrations of endocan at admission are associated with the use of ICU resources and mortality in critically ill hematology patients. Studies to risk-stratify patients in the emergency department or in the hematology wards based on endocan concentrations to identify those likely to benefit from early ICU management are warranted.
Prognostic Value of Secretoneurin in Patients With Severe Sepsis and Septic Shock: Data From the Albumin Italian Outcome Sepsis Study
Authors: Røsjø Helge , Masson Serge , Caironi Pietro , Stridsberg Mats , Magnoli Michela , Christensen Geir , Moise Gabriella , Urbano Maria Cristina , Gattinoni Luciano , Pesenti Antonio , Latini Roberto , Omland Torbjørn
Published: February 2018

Objectives:

Secretoneurin directly influences cardiomyocyte calcium handling, and circulating secretoneurin levels seem to improve risk prediction in patients with myocardial dysfunction by integrating information on systemic stress, myocardial function, and renal function. Accordingly, in this study, we hypothesized that secretoneurin would improve risk prediction in patients with sepsis and especially in patients with septic shock as these patients are more hemodynamically unstable.

Design:

Multicenter, interventional randomized clinical trial.

Setting:

Multicenter, pragmatic, open-label, randomized, prospective clinical trial testing fluid administration with either 20% human albumin and crystalloids or crystalloid solutions alone in patients with severe sepsis or septic shock (The Albumin Italian Outcome Sepsis).

Patients or Subjects:

In total, 540 patients with septic shock and 418 patients with severe sepsis.

Interventions:

Either 20% human albumin and crystalloids or crystalloid solutions alone.

Measurements and Main Results:

We measured secretoneurin on days 1, 2, and 7 after randomization and compared the prognostic value of secretoneurin for ICU and 90-day mortality with established risk indices and cardiac biomarkers in septic shock and severe sepsis. High secretoneurin levels on day 1 were associated with age and serum concentrations of lactate, bilirubin, creatinine, and N-terminal pro-B-type natriuretic peptide. Adjusting for established risk factors and cardiovascular biomarkers, secretoneurin levels on day 1 were associated with ICU (odds ratio, 2.27 [95% CI, 1.05–4.93]; p = 0.04) and 90-day mortality (2.04 [1.02–4.10]; p = 0.04) in patients with septic shock, but not severe sepsis without shock. Secretoneurin levels on day 2 were also associated with ICU (3.11 [1.34–7.20]; p = 0.008) and 90-day mortality (2.69 [1.26–5.78]; p = 0.01) in multivariate regression analyses and improved reclassification in patients with septic shock, as assessed by the net reclassification index. Randomized albumin administration did not influence the associations between secretoneurin and outcomes.

Conclusions:

Secretoneurin provides early and potent prognostic information in septic patients with cardiovascular instability.
STAT5 expression correlates with recurrence and survival in melanoma patients treated with interferon-α
Authors: Machiraju Devayani , Moll Iris , Gebhardt Christoffer , Sucker Antje , Buder-Bakhaya Kristina , Schadendorf Dirk , Hassel Jessica C.
Published: February 2018

Interferons (IFN) have a direct growth-inhibiting effect on tumor cells through Janus kinase-dependent activation of the transcription factor signal transducer and activator of transcription (STAT1). In vitro, signaling through STAT5 has been demonstrated to counteract this effect and lead to IFN resistance of melanoma cell lines. In 32 patients treated with IFN-α in an adjuvant setting, we investigated paraffin-embedded tumor tissue from primary melanomas and melanoma metastases for expression of STAT3 and STAT5, by immunohistochemistry, and for expression of phosphorylated signaling transduction activating transcription factor (pSTAT)3 and pSTAT5, by immunofluorescence. Tumor cell expression levels of these proteins were correlated with patient characteristics and clinical outcomes. The patient cohort consisted of 12 (37.5%) patients at AJCC stage I/II (primary melanoma) and 20 (62.5%) at stage III/IV (metastatic melanoma). Recurrence was observed for 25 (78.1%) either during or after IFN-α therapy. χ
2 Correlation of staining intensities with clinical data revealed association of pSTAT3 and STAT5 expression with sex (P=0.003 and 0.016, respectively) and of STAT3 with tumor stage (P=0.019). Recurrence of melanoma was found to be associated with high STAT5 expression (P=0.017). Multivariable regression analysis revealed STAT5 expression as an independent factor for predicting progression-free survival (P<0.0001) and overall survival (P=0.022). In summary, high expression of STAT5 correlated with melanoma recurrence and survival of patients treated with IFN-α in the adjuvant setting. Recently, it has been suggested that mutations of Janus kinases are involved in resistance to immune checkpoint blocker treatments implying a possible role of STAT5 for immune checkpoint resistance.
Teacher Decision Factors That Lead to Preschool Expulsion
Authors: Gilliam Walter S. , Reyes Chin R.
Published: February 2018

Preschool expulsion is a trending social problem. To date, this is the first study that examines the teacher decision factors behind preschool expulsions. This article presents results of the development and validation of the Preschool Expulsion Risk Measure (PERM). In a 2-phase analysis of the study, we provide evidence for the PERM's reliability and validity in a sample of 352 preschoolers from 88 sites in a New England state. The PERM yielded 4 factors (classroom disruption, fear of accountability, hopelessness, and teacher stress) and demonstrated good internal consistency. The PERM correlated with standardized assessments of children's behavior problems and predicted intervention status (target child vs. random peer) and the probability of expulsion (child considered for expulsion vs. child never considered for expulsion). Classroom disruption predicted intervention status whereas accountability predicted consideration for expulsion. Results support the PERM as a viable tool for assessing the propensity to be expelled. Findings shed light into the decision factors that propel teachers to consider expulsion of a child, which can inform early education programs and policies to address this issue.