bluuebunny/crossref_metadata_2025 huggingface dataset:
Barley grain supplementation in late gestation to twin-bearing Merino ewes grazing high-biomass and high-quality pasture does not increase lamb survival
Authors: Kopp K. J. , Robertson S. M. , Friend M. A.
Published: February 2018

Survival of lambs affects the profitability of Merino enterprises, with mortality from birth to marking the most prominent factor leading to poor reproductive performance. Survival of lambs following parturition is dependent on the ability to access colostrum and milk, which can be altered by the provision of barley grain to promote lactogenesis and colostrum production when feed availability is suboptimal. The present study evaluated whether the survival of lambs could be improved by supplementing ewes grazing abundant quality pasture with barley grain. Naturally joined Merino ewes (n = 240, 65.5 kg, body condition score (CS) 3) bearing twin fetuses grazing spring pastures (1712 kg DM/ha green, 12.3 MJ ME/kgDM, and 18.5% crude protein at the commencement of the experiment) were allocated to a supplemented or a control diet, with two replicates of each. Ewes were supplemented with 550 g/ewe.day barley grain (12.6 MJ ME/kgDM, 10% crude protein) for 20 days before and 2 weeks following the commencement of lambing (supplemented), or were unsupplemented (control). Ewes gained 0.5 CS and 10.6 kg liveweight from pre-lambing to lamb marking age in both treatments, indicating that their energy intake was high. The proportion of lambs surviving from birth to marking was 0.79 for control and supplemented treatments. Lamb survival was affected by the interaction (P = 0.039) between treatment and sex, with control female lambs having a significantly higher survival than control male lambs. Supplemented lambs reared as singles (17.1 ± 0.95 kg) had significantly (P < 0.05) heavier marking weights thanthe control lambs reared as singles (14.8 ± 1.1 kg), supplemented lambs reared as twins (14.7 ± 0.71 kg) and control lambs reared as twins (15.5 ± 0.70 kg). Lamb survival was not increased by provision of barley grain in the final weeks before lambing and the first 2 weeks of lambing when ewes were in good CS and grazed ample high-quality pastures.
The Polymorphs of ROY: A Computational Study of Lattice Energies and Conformational Energy Differences
Authors: Thomas Sajesh P. , Spackman Mark A.
Published: February 2018

The remarkable structural diversity observed in polymorphs of 5-methyl-2-[(2-nitrophenyl)amino]-3-thiophenecarbonitrile (commonly known as ROY) challenges computational attempts to predict or rationalize their relative stability. This modest study explores the applicability of CE-B3LYP model energy calculation of lattice energies (using experimental crystal structures), supplemented by a systematic approach to account for conformational energy differences. The CE-B3LYP model provides sensible estimates of absolute and relative lattice energies for the polymorphs, provided care is taken to achieve convergence in the summation of pairwise terms. Conformational energy differences based on density functional theory (DFT) energies are shown to be unreliable, but MP2 energies based on DFT-optimized structures show considerable promise.
Translation description for assessment and post-editing
Authors: Ramón Noelia , Gutiérrez-Lanza Camino
Published: February 2018

This paper presents a corpus-based descriptive research procedure for the identification of significant divergences between original Spanish and Spanish translated from English. When considering the language pair English-Spanish, personal pronouns seem to be good markers of significant differences (anchor phenomena), since they must obligatorily occur in English, but not in Spanish. To test this hypothesis, empirical data have been extracted from a large reference corpus in Spanish (CREA) and from an English-Spanish parallel corpus (P-ACTRES), in both cases from the fiction subcorpora. Statistically significant differences have been found in some of the uses of personal pronouns, having textual and pragmatic implications in the target texts. The aim is to use the results obtained in the case of personal pronouns, together with results from other linguistic areas, to build a semi-automated tool for the post-editing of Spanish translations of texts written originally in English.
Myeloid-targeted immunotherapies act in synergy to induce inflammation and antitumor immunity
Authors: Perry Curtis J. , Muñoz-Rojas Andrés R. , Meeth Katrina M. , Kellman Laura N. , Amezquita Robert A. , Thakral Durga , Du Victor Y. , Wang Jake Xiao , Damsky William , Kuhlmann Alexandra L. , Sher Joel W. , Bosenberg Marcus , Miller-Jensen Kathryn , Kaech Susan M.
Published: February 2018

Eliciting effective antitumor immune responses in patients who fail checkpoint inhibitor therapy is a critical challenge in cancer immunotherapy, and in such patients, tumor-associated myeloid cells and macrophages (TAMs) are promising therapeutic targets. We demonstrate in an autochthonous, poorly immunogenic mouse model of melanoma that combination therapy with an agonistic anti-CD40 mAb and CSF-1R inhibitor potently suppressed tumor growth. Microwell assays to measure multiplex protein secretion by single cells identified that untreated tumors have distinct TAM subpopulations secreting MMP9 or cosecreting CCL17/22, characteristic of an M2-like state. Combination therapy reduced the frequency of these subsets, while simultaneously inducing a separate polyfunctional inflammatory TAM subset cosecreting TNF-α, IL-6, and IL-12. Tumor suppression by this combined therapy was partially dependent on T cells, and on TNF-α and IFN-γ. Together, this study demonstrates the potential for targeting TAMs to convert a “cold” into an “inflamed” tumor microenvironment capable of eliciting protective T cell responses.
Gap and rigidity theorems of 𝜆-hypersurfaces
Authors: Guang Qiang
Published: February 2018

We study

λ
\lambda

-hypersurfaces that are critical points of a Gaussian weighted area functional

∫

Σ

e

−

|

x

|

2

4

d
A

\int _{\Sigma } e^{-\frac {|x|^2}{4}}dA

for compact variations that preserve weighted volume. First, we prove various gap and rigidity theorems for complete

λ
\lambda

-hypersurfaces in terms of the norm of the second fundamental form

|

A

|

|A|

. Second, we show that in one dimension, the only smooth complete and embedded

λ
\lambda

-hypersurfaces in

R

2

\mathbb {R}^2

with

λ
≥
0

\lambda \geq 0

are lines and round circles. Moreover, we establish a Bernstein-type theorem for

λ
\lambda

-hypersurfaces which states that smooth

λ
\lambda

-hypersurfaces that are entire graphs with polynomial volume growth are hyperplanes. All the results can be viewed as generalizations of results for self-shrinkers.
Cortical Afferents of Area 10 in Cebus Monkeys: Implications for the Evolution of the Frontal Pole
Authors: Rosa Marcello G P , Soares Juliana G M , Chaplin Tristan A , Majka Piotr , Bakola Sophia , Phillips Kimberley A , Reser David H , Gattass Ricardo
Published: February 2018

Area 10, located in the frontal pole, is a unique specialization of the primate cortex. We studied the cortical connections of area 10 in the New World Cebus monkey, using injections of retrograde tracers in different parts of this area. We found that injections throughout area 10 labeled neurons in a consistent set of areas in the dorsolateral, ventrolateral, orbital, and medial parts of the frontal cortex, superior temporal association cortex, and posterior cingulate/retrosplenial region. However, sites on the midline surface of area 10 received more substantial projections from the temporal lobe, including clear auditory connections, whereas those in more lateral parts received >90% of their afferents from other frontal areas. This difference in anatomical connectivity reflects functional connectivity findings in the human brain. The pattern of connections in Cebus is very similar to that observed in the Old World macaque monkey, despite >40 million years of evolutionary separation, but lacks some of the connections reported in the more closely related but smaller marmoset monkey. These findings suggest that the clearer segregation observed in the human frontal pole reflects regional differences already present in early simian primates, and that overall brain mass influences the pattern of cortico-cortical connectivity.
GeneSeqToFamily: a Galaxy workflow to find gene families based on the Ensembl Compara GeneTrees pipeline
Authors: Thanki Anil S , Soranzo Nicola , Haerty Wilfried , Davey Robert P
Published: February 2018

Background

Gene duplication is a major factor contributing to evolutionary novelty, and the contraction or expansion of gene families has often been associated with morphological, physiological, and environmental adaptations. The study of homologous genes helps us to understand the evolution of gene families. It plays a vital role in finding ancestral gene duplication events as well as identifying genes that have diverged from a common ancestor under positive selection. There are various tools available, such as MSOAR, OrthoMCL, and HomoloGene, to identify gene families and visualize syntenic information between species, providing an overview of syntenic regions evolution at the family level. Unfortunately, none of them provide information about structural changes within genes, such as the conservation of ancestral exon boundaries among multiple genomes. The Ensembl GeneTrees computational pipeline generates gene trees based on coding sequences, provides details about exon conservation, and is used in the Ensembl Compara project to discover gene families.

Findings

A certain amount of expertise is required to configure and run the Ensembl Compara GeneTrees pipeline via command line. Therefore, we converted this pipeline into a Galaxy workflow, called GeneSeqToFamily, and provided additional functionality. This workflow uses existing tools from the Galaxy ToolShed, as well as providing additional wrappers and tools that are required to run the workflow.

Conclusions

GeneSeqToFamily represents the Ensembl GeneTrees pipeline as a set of interconnected Galaxy tools, so they can be run interactively within the Galaxy's user-friendly workflow environment while still providing the flexibility to tailor the analysis by changing configurations and tools if necessary. Additional tools allow users to subsequently visualize the gene families produced by the workflow, using the Aequatus.js interactive tool, which has been developed as part of the Aequatus software project.
On the time growth of the error of the DG method for advective problems
Authors: Kučera Václav , Shu Chi-Wang
Published: February 2018

In this paper we derive a priori $L^{\infty }(L^{2})$ and L2(L2) error estimates for a linear advection–reaction equation with inlet and outlet boundary conditions. The goal is to derive error estimates for the discontinuous Galerkin method that do not blow up exponentially with respect to time, unlike the usual case when Gronwall’s inequality is used. While this is possible in special cases, such as divergence-free advection fields, we take a more general approach using exponential scaling of the exact and discrete solutions. Here we use a special scaling function, which corresponds to time taken along individual pathlines of the flow. For advection fields, where the time that massless particles carried by the flow spend inside the spatial domain is uniformly bounded from above by some $\widehat{T}$, we derive $\mathcal{O}$(hp+1/2) error estimates where the constant factor depends only on $\widehat{T}$, but not on the final time T. This can be interpreted as applying Gronwall’s inequality in the error analysis along individual pathlines (Lagrangian setting), instead of physical time (Eulerian setting).
Timing of Operative Intervention in Traumatic Spine Injuries Without Neurological Deficit
Authors: Kim Elliott J , Wick Joseph B , Stonko David P , Chotai Silky , Freeman Jr Thomas H , Douleh Diana G , Mistry Akshitkumar M , Parker Scott L , Devin Clinton J
Published: February 2018

BACKGROUND

Numerous studies have demonstrated the benefits of early decompression and stabilization in unstable spine injuries with incomplete neurological deficits. However, a clear consensus on timing to operative intervention still does not exist in those with a normal neurological exam and unstable spine.

OBJECTIVE

To determine the optimal timing of operative intervention in traumatic spine injuries without neurological deficit.

METHODS

Retrospective chart review at a single institution was performed including patients with traumatic spine injuries without neurological deficit admitted from December 2001 to August 2012. Estimated intraoperative blood loss (EBL), in-hospital complications, postoperative hospital length of stay (HLOS), intensive care unit length of stay (ICULOS), and ventilator days were recorded. Delayed surgery was defined as surgery 72 h after admission.

RESULTS

A total of 456 patients were included for analysis. There was a trend towards statistical significance between the time to operative intervention and EBL in bivariate analysis (P = .07). In the risk-adjusted multivariable analysis delayed vs early surgery was not associated with increased EBL or complications. Delayed surgery was associated with increased ICULOS (odds ratio [OR] = 2.19; 95% confidence interval [CI]: 1.38-3.51; P = .001), ventilator days (OR = 2.09; 95% CI: 1.28-3.43; P = .004), and increased postoperative HLOS (OR = 1.84; 95% CI: 1.22-2.76; P = .004).

CONCLUSION

Earlier operative intervention was associated with decreased ICULOS, ventilator days, and postoperative HLOS and did not show a statistically significant increase in EBL or complications. Earlier operative intervention for traumatic spine injuries without neurological deficit provides better outcomes compared to delayed surgery.
Alterations in Cortical Thickness and Subcortical Volume are Associated With Neurological Symptoms and Neck Pain in Patients With Cervical Spondylosis
Authors: Woodworth Davis C , Holly Langston T , Mayer Emeran A , Salamon Noriko , Ellingson Benjamin M
Published: February 2018

BACKGROUND

Advanced cervical spondylosis (CS) can cause structural damage to the spinal cord resulting in long-term neurological impairment including neck pain and motor weakness. We hypothesized long-term structural reorganization within the brain in patients with CS.

OBJECTIVE

To explore the associations between cortical thickness, subcortical volumes, neurological symptoms, and pain severity in CS patients with or without myelopathy and healthy controls (HCs).

METHODS

High-resolution T1-weighted structural magnetic resonance imaging (MRI) scans from 26 CS patients and 45 HCs were acquired. Cortical thickness and subcortical volumes were computed and compared to the modified Japanese Orthopedic Association (mJOA) and the Neck Disability Index (NDI) scores.

RESULTS

Cortical thinning within the superior frontal gyrus, anterior cingulate, precuneus, and reduction in putamen volume were associated with worsening neurological and pain symptoms. Among the strongest associations were cortical thickness within the left precuneus (R2 = 0.34) and left and right putamen (R2 = 0.43, 0.47, respectively) vs mJOA, and the left precuneus (R2 = 0.55), insula (R2 = 0.57), and right putamen (R2 = 0.54) vs NDI (P ≤ .0001 for all). Cortical thickness along Brodmann areas 3a, 4a, and 4p were also moderately associated with mJOA. Preliminary evidence also suggests that patients with CS may undergo cortical atrophy at a faster rate than HCs.

CONCLUSION

Patients with CS appear to exhibit cortical thinning and atrophy with worsening neurological and pain symptoms in specific brain regions associated with sensorimotor and pain processing.
Sainsbury family (per. 1869–1956)
Authors: unknown photographer
Published: February 2018

Sainsbury (per. 1869–1956) by unknown photographer [Sainsbury family (per. 1869–1956): John James Sainsbury (1844–1928) and Mary Ann Sainsbury (1849–1927)] Sainsbury's Archives
Carline family (per. c. 1870–c. 1975)
Authors: Carline Richard
Published: February 2018

Carline (per. c. 1870–c. 1975) by Richard Carline, 1923 [Carline family (per. c.1870–c.1975) [left to right]: George Carline (1855-1920), Hilda Carline (1889-1950), Richard Carline (1896-1980), Annie Carline (1862-1945), and Sydney Carline (1888-1929)] © Estate of the Artist. Picture destroyed. Photograph: Photographic Survey, Courtauld Institute of Art, London
Horsey family (per. c. 1500–c. 1640)
Authors: unknown sculptor
Published: February 2018

Horsey (per. c. 1500–c. 1640) by unknown sculptor [Horsey family (per. c.1500–c.1640) [left to right]: Sir John Horsey (d. 1546) and Sir John Horsey (d. 1564)] Collection Sherborne Abbey; © reserved in the photograph
Sassoon family (per. c. 1830–1961)
Authors: unknown photographer
Published: February 2018

Sassoon (per. c. 1830–1961) by unknown photographer [Sassoon family (per. c.1830–1961): David Sassoon (1792-1864) [seated], and [left to right]: Elias David Sassoon (1820-1880), Sir Abdullah David Sassoon (1818-1896), and Sassoon David Sassoon] © reserved
Implications for the Dental Care of Vulnerable Populations if Medicaid Is Cut Back
Authors: Valachovic Richard W.
Published: February 2018

Good oral health affects academic performance, employability and annual earnings, military readiness, overall health care costs, and general health status and well-being. The Affordable Care Act (ACA) has enhanced the ability of many Americans to receive dental care through the expansion of Medicaid and the inclusion of pediatric oral health as 1 of the 10 “essential health benefits.” Almost all of the proposals presented by the current Congress and Administration to modify the ACA call for changes to Medicaid that would cut back funding and/or give states more control over programs. Limiting federal support to Medicaid will eventually increase the pressure on states to cut costs, and dental care is usually one of the first benefits on the chopping block. If this happens, all of the gains that have been realized as a result of the Medicaid expansion would be diminished or lost, with a significant impact on the overall health, well-being, and success of those who will suffer the consequences of a lack of access to dental care.
Outcomes and Complications Following Laminectomy Alone for Thoracic Myelopathy due to Ossified Ligamentum Flavum
Authors: Osman Nebiyu S. , Cheung Zoe B. , Hussain Awais K. , Phan Kevin , Arvind Varun , Vig Khushdeep S. , Vargas Luilly , Kim Jun S. , Cho Samuel Kang-Wook
Published: February 2018

Study Design.

Systematic review and meta-analysis.

Objective.

Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF).

Summary of Background Data.

OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF.

Methods.

A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model.

Results.

A total of 137 patients were included. The pooled pre- and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70–7.47; I
2 = 98%) and 8.29 (95% CI, 7.73–8.85; I
2 = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08–4.98; I
2 = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6–26.1; I
2 = 0%), 12.1% (95% CI, 6.6–21.2; I
2 = 0%), 5.8% (95% CI, 2.1–15.4; I
2 = 0%), and 5.7% (95% CI, 2.2–14.3; I
2 = 0%), respectively.

Conclusion.

Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.

Level of Evidence: 3
Exploration of the Inter-Relationships Between Obesity, Physical Inactivity, Inflammation, and Low Back Pain
Authors: Hashem Lukas E. , Roffey Darren M. , Alfasi Abdulghader M. , Papineau Gabrielle D. , Wai Denise C. , Phan Philippe , Kingwell Stephen P. , Wai Eugene K.
Published: February 2018

Study Design.

Retrospective analysis wherein 103 patients were considered, and 76 patients were included: 49 were classified as chronic non-specific low back pain (CNSLBP) (Study group) and 27 had identifiable cases of specific chronic low back pain (LBP) (Control group).

Objective.

Elucidate markers of systemic inflammation in patients with CNSLBP.

Summary of Background Data.

Mechanisms of LBP are poorly understood. Pro-inflammatory cytokines are increased in obesity and involved with pain modulation; we previously proposed a theoretical model of their mediating role in LBP.

Methods.

Demographic information was acquired via questionnaire, chart review, and blood test data. Univariate analysis identified factors associated with CNSLBP and markers of systemic inflammation. A receiver operating curve and Youden Index were used to select optimal cut-off points for elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Multivariable logistic regression analysis calculated the adjusted strength of relationship between factors that were proposed in our theoretical model for CNSLBP.

Results.

Unadjusted CRP was significantly correlated with ESR (R = 0.63, P < 0.0001) and body mass index (BMI) (R = 0.38, P = 0.0015). Physically inactive patients had significantly higher CRP (6.1 vs. 1.2, P = 0.0050). ESR was significantly correlated with number of comorbidities (R = 0.34, P = 0.0047), BMI (R = 0.38, P = 0.0014), and age (R = 0.36, P = 0.0026). Physically inactive patients (10.4 vs. 3.6, P = 0.0001) and females (11.2 vs. 6.4, P = 0.0422) had significantly higher ESR. Adjusted analyses indicated significant relationships between physical inactivity and markers of systemic inflammation (adjusted odds ratios for ESR and CRP: 15.9, P = 0.0380; 15.2, P = 0.0272, respectively), and between elevated CRP and CNSLBP (adjusted odds ratio: 8.0, P = 0.0126).

Conclusion.

Systemic inflammation may act as a mediator for physical inactivity and obesity in the pathogenesis of CNSLBP.

Level of Evidence: 2
Authorship Trends in Spine Publications From 2000 to 2015
Authors: Haws Brittany E. , Khechen Benjamin , Movassaghi Kamran , Yom Kelly H. , Guntin Jordan A. , Cardinal Kaitlyn L. , Shoshana Noah B. , Singh Kern
Published: February 2018

Study Design.

Literature review.

Objective.

To examine changes in authorship characteristics for Spine publications from the year 2000 to 2015.

Summary of Background Data.

Scientific publications are considered an indication of academic achievement for physicians. Recently, authorship trends have been investigated; however, limited information is available on this topic within spine-specific literature.

Methods.

Original research articles published in Spine in the years 2000, 2005, 2010, and 2015 were evaluated. Authorship characteristics were collected for each article, including the number of authors and institutions per publication, first and last authors’ sex, publication origin, and highest degree held by the first and last author. Trends over time were analyzed using numeric and visual descriptive analyses including percentages, means, standard deviations, and graphs.

Results.

An average of 506 articles per year was published in Spine during the years 2000, 2005, 2010, and 2015. The number of articles written by 10 or more authors increased during this time (0.9%–14.4%). There was a substantial increase in the number of multiple institutional affiliations (33.6%–68.7%) and articles originating from outside North America (47.6%–55.7%) from 2000 to 2015. The percentage of first authors with bachelor's degrees was higher in 2015 (6.6%) as compared to 2000 (1.4%), and more last authors were identified as MD/PhDs in 2015 (19.2%) than in 2000 (10.0%). Similar female representation was noted for first and last authorship for all years evaluated.

Conclusion.

The results of this study demonstrate increases in authors per article published in Spine from 2000 to 2015. In addition, first authors were more likely to hold bachelor's degrees over time. This may be attributed to increasing competition in spine-related fields, necessitating earlier research exposure to aid in academic achievement. Interestingly, the percentage of female authorship has not changed significantly over time, in contrast with much of the previous literature.

Level of Evidence: 2
The Efficacy of Brace Treatment for Thoracolumbar Kyphosis in Patients With Achondroplasia
Authors: Xu Leilei , Li Yetian , Sheng Fei , Xia Chao , Qiu Yong , Zhu Zezhang
Published: February 2018

Study Design.

A retrospective study.

Objectives.

The aim of this study was to evaluate the outcome of brace treatment in the correction of thoracolumbar kyphosis (TLK) for patients with achondroplasia and to determine the factors associated with bracing efficacy.

Summary of Background Data.

Brace treatment has been used to correct TLK in patients with achondroplasia. However, there was a paucity of knowledge concerning its effectiveness.

Methods.

A total of 33 achondroplasic patients treated by bracing were included in this study. Radiographic parameters including TLK, lumbar lordosis, curve magnitude, apical vertebral translation (AVT), percentage of apical vertebral wedging, pelvic tilt (PT), and pelvic incidence were recorded for each patient at the visit. Comparison of these parameters between the initial visit and the final visit was performed using the Student t test. Factors associated with the correction of TLK were evaluated using the logistic regression analysis.

Results.

The mean age at presentation was 27.5 ± 13.4 months. The mean period of treatment was 32.2 ± 15.7 months, and the mean period of follow-up was 25.7 ± 11.3 months. At the initial visit, the mean value of TLK and the percentage of apical vertebral wedging were 41.7 ± 15.4° and 61.4% ± 16.2%, respectively. At the final visit, the TLK and apical vertebral wedging were remarkably reduced to 29.5 ± 20.8° and 52.1% ± 18.7%, respectively. The logistic regression analysis showed that initial TLK, AVT, percentage of apical vertebral wedging, and PT were independent factors associated with the correction of TLK.

Conclusion.

Brace treatment can effectively correct TLK and restore the morphology of apical vertebral body for patients with achondroplasia. Large TLK, severe apical vertebral wedging, presence of AVT, and low PT may be indicative of an unfavorable outcome, which should be taken into account at the initiation of bracing.

Level of Evidence: 4
Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients*
Authors: Delahanty Ryan J. , Kaufman David , Jones Spencer S.
Published: February 2018

Objectives:

Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes.

Setting:

One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare.

Patients:

A cohort of 237,173 ICU patients discharged between January 2014 and December 2016.

Design:

The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set.

Measurements and Main Results:

Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms.

Conclusions:

Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death score has many attractive attributes that address the key barriers to adoption of ICU risk adjustment algorithms and performs comparably to existing human-intensive algorithms. Automated risk adjustment algorithms have the potential to obviate known barriers to adoption such as cost-prohibitive licensing fees and significant direct labor costs. Further evaluation is needed to ensure that the level of performance observed in this study could be achieved at independent sites.
Impact of Improved Survival in Congenital Heart Disease on Incidence of Disease
Authors: Bregman Stacey , Frishman William H.
Published: February 2018

Survival rates and life expectancies for patients with congenital heart disease (CHD) have dramatically increased, and these patients are now reaching reproductive age. As they reproduce, questions pertaining to recurrent risk of disease and the impact on incidence rates have emerged. Recurrence rates for CHD have been estimated at 3% to 5%, although, due to the complex genetics underlying CHD, this range may represent an underestimation of the true risk. Debate still exists on whether the impact of recurrence of disease has been reflected in incidence rates. Although incidence rates have undoubtedly increased, the mechanism underlying this remains unclear; improved detection likely accounts for the majority of the observed increase; however, a true increase may be present simultaneously. Concurrently, certain factors, including improved fetal detection and elective terminations, infertility, increased rates of spontaneous abortion and intrauterine fetal demise in women with CHD, and folic acid supplementation, are leading to decreases in the incidence of CHD. It is likely that the full impact of improved survival and heritability of CHD on incidence rates remains to be seen and will likely be attenuated by other factors acting to decrease incidence.
Evaluation of MITF, SOX10, MART-1, and R21 Immunostaining for the Diagnosis of Residual Melanoma In Situ on Chronically Sun-Damaged Skin
Authors: Mu Euphemia W. , Quatrano Nicola A. , Yagerman Sarah E. , Ratner Desiree , Meehan Shane A.
Published: February 2018

BACKGROUND

Melanocytic immunostains can assist in margin evaluation of melanoma in situ (MIS) excisions; however, their accuracy and reliability relative to hematoxylin & eosin (H&E) is yet to be determined.

OBJECTIVE

The objective of this study was to evaluate the sensitivity, specificity, and concordance of 4 melanocyte-specific immunostains for diagnosing MIS occurring on chronically sun-damaged skin.

MATERIALS AND METHODS

Serial permanent sections from representative areas of negative margin and residual tumor were stained using H&E, MITF, MART-1, SOX10, and R21 and examined in a blinded fashion. The study set included 100 digital microscopy images from 10 cases of MIS excisions from the face. Two board-certified dermatopathologists, 4 fellowship-trained Mohs surgeons, 2 Mohs fellows, and 2 dermatology residents independently reviewed the 100 images.

RESULTS

The average melanocyte density was 11 versus 28 melanocytes per 0.5 mm for chronically sun-damaged skin versus residual MIS on H&E, respectively. Statistically significantly higher melanocyte densities were observed using MITF, MART-1, and SOX10 on negative margins. The sensitivity and interobserver concordance was highest using MITF and SOX10. The intraobserver agreement on 4 duplicate images was 85%.

CONCLUSION

In conclusion, the nuclear immunostains (MITF and SOX10) show the most promise for improving the diagnosis of MIS in chronically sun-damaged skin.
Detection of Drug-Exposed Newborns
Authors: Wabuyele Simuli L. , Colby Jennifer M. , McMillin Gwendolyn A.
Published: February 2018

Maternal substance abuse during pregnancy is a growing problem with major public health and legal concerns. In utero substance exposure may adversely affect neonatal development; pregnancy outcome; and the long-term behavioral, cognitive, and developmental abilities of the child. Also, serious legal implications are associated with substance abuse during pregnancy, including charges of child abuse and neglect that may result in the removal of the neonate from parental care and loss of custodial rights. Timely detection of in utero drug exposure is necessary for early identification and effective management of exposed newborns. Accurate identification of drug-exposed newborns relies on maternal history; clinical presentation of the newborn; and laboratory testing of biological maternal matrices (ie, urine, blood, oral fluid, sweat, hair, and breast milk), neonatal matrices (ie, urine, meconium, hair, and umbilical cord blood and tissue), and/or matrices from both the mother and neonate (ie, placenta and amniotic fluid). Evaluation of biological matrices can account for in utero exposure at various stages of gestation and approximate the period (recent versus chronic use) of substance exposure. Each matrix has its own unique advantages and limitations in terms of ease of collection, the window of gestational exposure represented, and sensitivity for different parent drug analytes and metabolites, which must be carefully considered for accurate interpretation of results. Analytical approaches to sample preparation and analysis vary based on the complexity of these biological matrices. Immunoassays are routinely used for screening, and chromatographic separation coupled to mass spectrometry detection method is commonly used for definitive (confirmatory) testing. Some laboratories use a single technology for all testing. This review provides a discussion on approaches used to detect drug-exposed newborns, biological specimens that have been studied to identify and characterize drug exposures, example analytical methods for meconium and umbilical cord tissue as well as considerations surrounding the interpretation of results. A possible algorithm for testing is also proposed.
Percutaneous Mechanical Circulation Support Combined with Extracorporeal Membrane Oxygenation (oxyRVAD) in Secondary Right Heart Failure
Authors: Lepper Philipp M. , Hörsch Sabrina I. , Seiler Frederik , Kamp Annegret , Becker Sören L. , Lensch Christian , Conzelmann Lars O. , Haake Hendrik , Muellenbach Ralf M. , Bals Robert , Kredel Markus , Langer Frank , Wilkens Heinrike , Trudzinski Franziska C.
Published: February 2018

Right heart failure (RHF) because of pulmonary hypertension (PH) is a frequently encountered clinical problem with high mortality. The last resort, if pharmacological therapy fails, is mechanical circulatory support. There is a lack of percutaneous systems to support the right ventricle (RV). Venoarterial extracorporeal membrane oxygenation is widely used as a bailout in acute RHF in non-left ventricular assist device patients. Venoarterial extracorporeal membrane oxygenation does not unload the left ventricle and may cause failure of the left ventricle if used for a longer period of time. We report the long-term use of an ECMO-based percutaneous right ventricular assist system (oxyRVAD) capable to deliver up to 6 L/min of blood flow with a returning cannula placed in the main pulmonary artery used in RHF originating from PH with poor oxygenation. We present a series of four patients on oxyRVAD (mean treatment duration 15 ± 7.6 days). Patients benefited from the system clinically; however, two patients eventually died while on oxyRVAD. Nevertheless, we provide a proof-of-concept of this system in PH patients, which is feasible and might provide a useful “bridge-to-recovery” or “bridge-to-transplant” option in the management of patients with severe RHF because of PH.
Short article: Endoscopic ultrasound-guided fine-needle aspiration of portal vein thrombosis in patients with chronic liver disease and suspicion of hepatocellular carcinoma
Authors: Gimeno Garcia Antonio Z. , Aparicio Jose R. , Barturen Angel , Moreno Miguel , Nicolas-Perez David , Quintero Enrique
Published: February 2018

Background

Differentiation between benign and malignant portal vein thrombosis (PVT) in the setting of a hepatocellular carcinoma (HCC) is of paramount importance. Histological analysis is usually not carried out because of potential severe side effects of the percutaneous approach. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) may be safer and may guide the clinical management of patients with HCC.

Objective

To describe the feasibility of the EUS-FNA in a series of patients with HCC and PVT.

Materials and methods

A chart review of patients with PVT was performed from 2014 to 2016 in three tertiary care hospitals of Spain. Patients with chronic liver disease and PVT with a suspicion of HCC referred for EUS-FNA were included. The impact of the EUS-FNA was assessed by comparing staging following the Barcelona Clinic Liver Cancer algorithm (BCLC) before and after EUS-FNA.

Results

Of 104 patients with PVT and chronic liver disease, 23 were considered candidates for EUS-FNA. Eight patients were referred for EUS-FNA. The technique was feasible in seven patients and FNA was positive in six patients. No side effects were reported. EUS-FNA upstaged six out of seven (85.7%) patients: one patient BCLC stage B, two patients BCLC stage A, and three patients in whom the HCC was not diagnosed before EUS-FNA of the PVT. A benign PVT was found in the explant of the only patient with a negative PVT.

Conclusion

EUS-FNA is a valuable technique in selected patients with chronic liver disease with PVT. It is feasible, safe, and may alter the clinical management in these patients.
The Zinc and Copper Levels in Thalassemia Major Patients, Receiving Iron Chelation Therapy
Authors: Zekavat Omid R. , Bahmanjahromi Ayda , Haghpanah Sezaneh , Ebrahimi Sara , Cohan Nader
Published: February 2018

Essential trace elements deficiency including zinc and copper are frequently reported in the literature, but the results are controversial. The aim of this study was to evaluate zinc and copper levels in thalassemia major (TM) patients who were on regular transfusion and iron chelation therapy. In a case-control cross-sectional study 43 TM patients and 43 age-matched and sex-matched healthy controls were examined. Patients were selected by convenience sampling method from TM patients who were registered in Thalassemia Clinic during 6 months. Serum zinc and copper levels were evaluated in all subjects. Zinc and copper dietary intake were also assessed. The median zinc level in the participants was significantly lower than the control group (35 [6.3 to 298] vs. 173 [3.1 to 584] μg/dL; P<0.05), but the mean copper level was significantly higher in the patients in comparison with the control group (260±118 vs. 201±69 μg/dL; P<0.05). In contrast, the mean zinc and copper dietary intake in the patient’s group were significantly lower than the control group. The mean serum zinc and copper levels in the patient’s group were not different according to iron chelation therapy type. Also, zinc and copper levels in the patient’s group were not statistically significant based on ferritin level, age, and duration of therapy. Essential trace elements level change and deficiency might occur in TM patients. Hence, routine assessment of these elements is recommended for better management.
The Development of Defense Mechanisms During the Latency Period
Authors: Cramer Phebe
Published: February 2018

The developmental period of latency, during middle childhood, has not been previously studied for possible change in the use of defense mechanisms. Using a validated narrative method to assess defenses, the present research examines change in children's defense use during this period. As predicted from theory, there was a significant increase in the use of the defense of Identification. This finding is consistent with theory that posits a shift at this time from defense against anxiety that is based on lack of impulse control to defense that is based on anxiety due to violation of conscience.
Outcomes of Clinical Nurse Specialist Practice in the Implementation of Video Monitoring at an Academic Medical Center
Authors: Purvis Suzanne , Kaun Alazda , McKenna Andrea , Weber Viste Jessica , Fedorov Emilie
Published: February 2018

Purpose/Objectives:

The purpose of this project was to design and implement a program that utilizes video cameras with the goal of monitoring for and preventing unsafe patient events that can lead to poor outcomes.

Description of the Project:

The Concerns-Based Adoption Model was utilized to address users’ concerns in different stages of diffusion of the new technology. Clinical nurse specialists, as part of a Constant Observation Workgroup, addressed these concerns during initial development and subsequent implementation of video monitoring on adult inpatient units. Establishing initiation criteria for video monitoring and documentation in the electronic health record was critical to success of the project.

Outcomes:

Video monitoring was successfully implemented on 8 inpatient units. A decline in full-time employment numbers for 1:1 sitters was demonstrated with no increase in fall numbers.

Conclusions:

Clinical nurse specialists were successful in collaborating with interdisciplinary colleagues to support the development of a Constant Observation Program that included video monitoring. In addition, clinical nurse specialists developed documentation, policies, and procedures to support this new technology. Success was evidenced by support of and growth of the program over time.
Brief Report: Statin Effects on Myocardial Fibrosis Markers in People Living With HIV
Authors: deFilippi Christopher , Christenson Robert , Joyce Jessica , Park Elli A. , Wu Ashley , Fitch Kathleen V. , Looby Sara E. , Lu Michael T. , Hoffmann Udo , Grinspoon Steven K. , Lo Janet
Published: February 2018

Background:

In observational studies, patients with HIV have higher levels of soluble ST2 (sST2), galectin-3, and growth differentiation factor-15 (GDF-15) than non-HIV controls. As statins exert pleiotropic immunomodulatory effects that may affect markers of myocardial fibrosis, the objective of the current study is to determine whether biomarkers of myocardial fibrosis reflecting subclinical pathology may be modified by statin therapy in patients with HIV.

Setting and Methods:

Forty HIV+ men and women participated in a single center 12-month randomized, double-blind placebo-controlled trial of atorvastatin 40 mg every day vs. placebo. At baseline and 12-months, sST2, GDF-15, galectin-3 were measured.

Results:

The changes in sST2 were −0.310 (−4.195, 2.075) vs. 1.163 (0.624, 4.715) ng/mL, median (interquartile range) atorvastatin vs. placebo (P = 0.04). The change in sST2 was significantly related to changes in monocyte activation marker sCD14 (r = 0.63, P < 0.0001) and MCP (r = 0.52, P = 0.0009), markers of generalized inflammation hs-IL-6 (r = 0.58, P = 0.0002), oxLDL (r = 0.49, P = 0.002), and GDF-15 (r = 0.54, P = 0.0008).

Conclusions:

sST2, a member of the IL-1 receptor family and a marker of fibrosis and inflammation increases over time among patients with HIV and this increase is attenuated by statin therapy in HIV. This effect may relate to immunomodulatory mechanisms of statins.
Recurrence of Giant Cell Tumor of The Larynx
Authors: Acikalin Resit Murat , Özsan Ayşe Vildan , Alimoglu Yalcin , Gezginadam Zafer , Yanik Huseyin Tarik , Coskun Samet Cagri , Kaya Hasan
Published: February 2018

Giant cell tumor of the larynx is a rare tumor. It was first reported by Wessely et al in 1940. Thirty-nine cases have been reported until now and together with the current case 2 recurrences were encountered. In this case report, our aim was to discuss conservative management because of the suspicion of recurrence. A 70-year-old male patient was admitted to our clinic with the complaint of hoarseness. A tumor measuring 1 × 1 cm located in the anterior half right vocal fold and extending to the anterior comissure was found on laryngeal endoscopy. Direct laryngoscopy and biopsy of the mass revealed giant cell tumor on histopathological examination. Tumor resection with cordectomy through laryngofissure and subsequently medialization thyroplasty were performed. Horaseness of the patient improved. On 2-year follow-up, a tumoral lesion suggesting recurrence was found on the vocal cord. Direct laryngoscopy and biopsy confirmed recurrence. Total laryngectomy was performed. This is the second case of recurrent giant cell tumor of the larynx. The therapy of choice should be selected considering the possibility of recurrence.
Orbital Cavernous Hemangioma Causing Spontaneous Compressive Hemorrhage
Authors: Bachelet Jean-Thomas , Berhouma Moncef , Shipkov Hristo , Kodjikian Laurent , Jouanneau Emmanuel , Gleizal Arnaud
Published: February 2018

Cavernous hemangiomas are the most common tumors of the posterior cone of the orbit in adults. They are discovered in a fortuitous manner or in front of the appearance of a progressive exophthalmia.

The authors report through a complete literature review (PubMed) patients of retro-orbital cavernous hemangioma revealed by spontaneous compressional hemorrhage from 1984 to 2017.

This review is illustrated by a case of sharp decrease in visual acuity secondary to orbital cavernous hemangioma hemorrhage.

The authors detail the management and the evolution of all these patients.