bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitrogen‐Loads to Streams: Importance of Bypass Flow and Nitrate Removal Processes
Authors: Steiness Mads , Jessen Søren , van’t Veen Sofie G. M. , Kofod Tue , Højberg Anker Lajer , Engesgaard Peter
Published: April 2021

N‐loads from subsurface, drains, and groundwater‐fed surface (bypass) flows via two riparian zones (crop field and wetland) to a second order stream were investigated by sampling of shallow and deep groundwater on both sides and monthly measurements of bypass flows from springs, drains, and stream including water quality (nitrate). A push‐pull test in the crop field gave a first‐order denitrification rate (0.23 day–1). Reactive transport modeling evaluated observations of water chemistry and denitrification processes in the groundwater below the crop field showing that nitrate was completely removed by denitrification with pyrite in the aquifer (model rates of 0.6–2.5 mmol NO3 L−1 yr−1). A drain in the crop field routed ∼10% (bypass) of the regional groundwater inflow to the stream. Buffer efficiency was high at 90%. The wetland on the other side of the stream hosts several locations of nitrate‐rich bypass flow from springs, predominantly through a non‐maintained drainage system of drainpipes and ditches with bypass flow accounting for 59% of the regional flow input. Nitrate was completely removed in groundwater by denitrification with dissolved organic matter in shallow groundwater. The regional inflow and N load to the wetland is amongst the highest recorded and data shows that the N load to the stream is very high. The buffer efficiency ranged from 45% to 83% depending on if all bypass flows contributed to the stream or only the two with visible outflow. A conceptual model for nitrate removal efficiency as a function of Damköhler number and percent bypass flow is proposed.
Impact of the 2018 Mars Global Dust Storm on the Ionospheric Peak: A Study Using a Photochemical Model
Authors: Mukundan Vrinda , Thampi Smitha V. , Bhardwaj Anil , Fang Xiaohua
Published: April 2021

We report the impact of the 2018 Mars global dust storm on the ionosphere, in particular, its peak altitude during the onset and growth phases of the event. A one‐dimensional photochemical model is applied to estimate the ionospheric electron densities below 200 km using the measurements of in situ neutral densities and ionizing solar radiation by the NASA Mars Atmosphere and Volatile EvolutioN (MAVEN) mission. Our model results show that while the peak density of the ionosphere on the dawn side during the dust storm is hardly impacted, the altitude of the peak layer may be lifted by ∼10 km. The simulation results support the MAVEN radio occultation observations that there is a time delay in the response of the ionospheric peak altitude in the southern hemisphere (SH), compared with the northern hemisphere (NH) during the dust storm development. Although the 2018 global dust storm developed in the northern Martian mid‐latitudes on 1 June and developed into a global dust event on 17 June, our study suggests that the impact on the ionospheric peak altitude near the equatorial and southern mid‐latitudes became important only after 22 June. This suggests that there was a time‐lag of about 3 weeks in the response of the Martian upper atmosphere of the SH to the dust storm that originated in the NH.
Investigation on the formation mechanism of twinned crystals of hypoxanthine-doped beta-phase anhydrous guanine microplatelets
Authors: Wu Bianbian , Liu Yanan , Chen Fenghua , Li Jiangfeng , Yu Yue , Zhou Yinglin , Li Ling , Xiao Jie , Ma Yurong
Published: April 2021

Herein, hypoxanthine-doped β phase anhydrous guanine (I-doped β-AG) twinned crystals with varying hypoxanthine contents were obtained in formamide. The occlusion of hypoxanthine in β-AG might be a key factor for formation of twinned β-AG crystals.
P- or S-Doped graphdiyne as a superior metal-free electrocatalyst for the hydrogen evolution reaction: a computational study
Authors: Wang Siyao , Jiao Dongxu , Liu Jingwei , Shang Yongchen , Zhao Jingxiang
Published: April 2021

By carefully controlling the type and site of the P or S dopant, graphdiyne can be utilized as a promising electrocatalyst with high efficiency for the hydrogen evolution reaction.
Parental education, parent–child relations and diagnosed mental disorders in childhood: prospective child cohort study
Authors: Holstein Bjørn E , Pant Sofie W , Ammitzbøll Janni , Laursen Bjarne , Madsen Katrine R , Skovgaard Anne Mette , Pedersen Trine P
Published: April 2021

Background

Mental disorder in childhood is an important public health issue. We aimed to examine the prospective association between parental education at childbirth and diagnosed mental disorders in young children and explore whether this association was mediated or modified by parent–child relations in infancy.

Methods

Prospective cohort study of all newborn was from 2002 to 2010 from 16 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 8th birthday, N = 40 762. Baseline data included information from national population registers and from health visitors’ records at child aged 0 to 10 months. Outcome variable: any mental disorder diagnosed at hospital from age 11 months to 8 years.

Results

Low parental education was predictive of diagnosed child mental disorder, adjusted odds ratio (AOR) = 1.83 (95% CI 1.49–2.23). Problematic parent–child relation at age 8–10 months was also predictive of mental disorder, AOR = 2.06 (1.57–2.70) but did not mediate the association between parental education and mental disorder. AOR for mental disorders was 3.24 (2.03–5.16 for the combination vocational training and problematic parent–child relation and 2.49 (1.42–4.38) for the combination primary school and problematic parent–child relation.

Conclusions

Low parental education and problematic parent–child relation were independent risk factors for diagnosed mental disorders in the age span of 11 months to 8 years.
The alternative initiation factor eIF2A plays key role in RAN translation of myotonic dystrophy type 2 CCUG•CAGG repeats
Authors: Tusi Solaleh Khoramian , Nguyen Lien , Thangaraju Kiruphagaran , Li Jian , Cleary John D , Zu Tao , Ranum Laura P W
Published: April 2021

Repeat-associated non-ATG (RAN) proteins have been reported in 11 microsatellite expansion disorders but the factors that allow RAN translation to occur and the effects of different repeat motifs and alternative AUG-like initiation codons are unclear. We studied the mechanisms of RAN translation across myotonic dystrophy type 2 (DM2) expansion transcripts with (CCUG) or without (CAGG) efficient alternative AUG-like codons. To better understand how DM2 LPAC and QAGR RAN proteins are expressed, we generated a series of CRISPR/Cas9-edited HEK293T cell lines. We show that LPAC and QAGR RAN protein levels are reduced in protein kinase R (PKR)−/− and PKR-like endoplasmic reticulum kinase (PERK)−/− cells, with more substantial reductions of CAGG-encoded QAGR in PKR−/− cells. Experiments using mutant eIF2α-S51A HEK293T cells show that p-eIF2α is required for QAGR production. In contrast, LPAC levels were only partially reduced in these cells, suggesting that both non-AUG and close-cognate initiation occur across CCUG RNAs. Overexpression of the alternative initiation factor eIF2A increases LPAC and QAGR protein levels but, notably, has a much larger effect on QAGR expressed from CAGG-expansion RNAs that lack efficient close-cognate codons. The effects of eIF2A on increasing LPAC are consistent with previous reports that eIF2A affects CUG-initiation translation. The observation that eIF2A also increases QAGR proteins is novel because CAGG expansion transcripts do not contain CUG or similarly efficient close-cognate AUG-like codons. For QAGR but not LPAC, the eIF2A-dependent increases are not seen when p-eIF2α is blocked. These data highlight the differential regulation of DM2 RAN proteins and eIF2A as a potential therapeutic target for DM2 and other RAN diseases.
A compound deep learning model for long range forecasting in electricity sale.
Authors: Tang Tao , Zhang Yeqing , Feng Wenjiang
Published: April 2021

Accurate prediction of electricity sale has a positive effect on power companies in rationally arranging power supply plans, scientifically optimizing power resource allocation, improving power management efficiency, saving energy and reducing consumption. Predicting future electricity sale based on historical electricity sale data can essentially be summarized as a time series forecasting problem. This paper proposes a fast and memory-efficient method, which adopts the expressive power of deep neural networks and the time characteristics of sequence-to-sequence structure (parallel convolution and recurrent neural network) for long range forecasting in electricity sale. Through a large number of experiments and evaluation of real-world datasets, the effectiveness of the proposed method is proved and verified in terms of prediction accuracy, time consuming and training speed.
Utility of extracorporeal membrane oxygenation (ECMO) in the management of traumatic tracheobronchial injuries: case series
Authors: Al-Thani Hassan , Ahmed Khalid , Rizoli Sandro , Chughtai Talat , Fawzy Ibrahim , El-Menyar Ayman
Published: April 2021

Tracheobronchial injury is a rare, but potentially life-threatening condition, and in most cases requires urgent treatment to restore normal respiratory physiology. Over the past decades, extracorporeal membrane oxygenation (ECMO) has evolved as an important adjunct in airway surgery. We presented three cases of traumatic tracheobronchial injury managed with ECMO support at a level-1 trauma center and emphasized the benefits of anticipation and early institution of ECMO support perioperatively, in these high-risk cases. The management of traumatic tracheobronchial injuries requires early measures to guarantee adequate ventilation. Anticipation and early institution of ECMO in these patients may support respiratory physiology, facilitate repair and improve survival. The time factor and multidisciplinary communication and plan prior to intervention should be considered. ECMO support, whenever available, plays important role in the management of complicated tracheobronchial surgical procedure and thereby reduces risk of mortality.
Natural variation in rice ascorbate peroxidase gene APX9 is associated with a yield-enhancing QTL cluster
Authors: Jeon Yun-A , Lee Hyun-Sook , Kim Sun-Ha , Shim Kyu-Chan , Kang Ju-Won , Kim Hyun-Jung , Tai Thomas H , Ahn Sang-Nag
Published: April 2021

We previously identified a cluster of yield-related quantitative trait loci (QTLs) including plant height in CR4379, a near-isogenic line from a cross between Oryza sativa spp. japonica cultivar ‘Hwaseong’ and the wild relative Oryza rufipogon. Map-based cloning and transgenic approaches revealed that APX9, which encodes an l-ascorbate peroxidase 4, is associated with this cluster. A 3 bp InDel was observed leading to the addition of a valine in Hwaseong compared with O. rufipogon. APX9-overexpressing transgenic plants in the Hwaseong background were taller than Hwaseong. Consistent with these results, APX9 T-DNA insertion mutants in the japonica cultivar Dongjin were shorter. These results confirm that APX9 is the causal gene for the QTL cluster. Sequence analysis of APX9 from 303 rice accessions revealed that the 3 bp InDel clearly differentiates japonica (APX9HS) and O. rufipogon (APX9OR) alleles. indica accessions shared both alleles, suggesting that APX9HS was introgressed into indica followed by crossing. The finding that O. rufipogon accessions with different origins carry APX9OR suggests that the 3 bp insertion was specifically selected in japonica during its domestication. Our findings demonstrate that APX9 acts as a major regulator of plant development by controlling a valuable suite of agronomically important traits in rice.
Evidence of disc reflection in the X-ray spectrum of the neutron star low-mass X-ray binary 4U 1636−536
Authors: Mondal Aditya S , Raychaudhuri B , Dewangan G C
Published: April 2021

We present a broad-band spectral analysis of the atoll source 4U 1636−536 observed for ∼92 ks with NuSTAR. The source was found to be in a low-luminosity state during this observation with 3–79 keV X-ray luminosity of L3–79 keV = (1.03 ± 0.01) × 1037 erg s−1, assuming a distance of 6 kpc. We have identified and removed 12 type-I X-ray bursts during this observation to study the persistent emission. The continuum is well described by a thermal Comptonization model nthcomp with Γ ∼ 1.9, kTe ∼ 28 keV, and kTs ∼ 0.9 keV. The NuSTAR data reveal a clear signature of disc reflection, a significantly broad Fe–K emission line (around 5–8 keV), and the corresponding reflection hump (around 15–30 keV). We have modelled the data with two relativistically blurred reflection models. Both families of reflection models prefer truncated inner disc radii prior to the ISCO. We find that the inner disc is truncated with an inner radius of Rin = 3.2–4.7 RISCO ($\simeq 16\!-\!24\, R_{\mathrm{ g}}\: \text{or}\: 36\!-\!54$ km). This inner disc radius suggests that the neutron star magnetic field strength is B ≤ 2.0 × 109 G.
Motion Characteristics of the Functional Spinal Unit During Lumbar Disc Injection (Discography) Including Comparison Between Normal and Degenerative Levels
Authors: Bartynski Walter S , Agarwal Vikas , Khan Abdullah S , Bandos Andriy I
Published: April 2021

Objective

While provocation lumbar discography has been used to identify discs responsible for low back pain, the biomechanical effects of disc injection have received little attention. The purpose of this study was to assess the motion of the functional spinal unit including the endplate and facet/pedicle region during disc injection including comparison between normal and degenerative discs.

Subjects

Subjects represent 91 consecutive patients referred for discography with chronic low back pain.

Methods

Lateral projection vertebral motion was retrospectively analyzed at 232 levels (normal: 76 [32.8%], degenerative: 156 [67.2%]). Pre- and postinjection fluoroscopic images were size scaled, and lower endplates were superimposed on separate PowerPoint images. Upper endplate and facet/pedicle motion was separately and independently analyzed on toggled PowerPoint images, subjectively graded as prominent, intermediate, questionable/uncertain, or no motion. Disc morphology was graded using the anteroposterior/lateral postinjection disc appearance (Adams criteria).

Results

Prominent or intermediate endplate and facet/pedicle motion was identified at most lumbar levels with substantial overall agreement (degenerative: κ = 0.93, 95% confidence intervals [CI] = 0.87–1.00; normal: κ = 0.80, 95% CI = 0.61–1.00). Degenerative levels were strongly associated with a lower degree of endplate and facet/pedicle motion compared with normal: (“prominent” motion grade: endplate: 61% [95/156] vs 89% [68/76], P < 0.001; facet/pedicle: 60% [93/156] vs 88% [67/76], P < 0.001).

Conclusion

Disc injection expands the disc space inducing endplate motion, pedicle motion, and facet translation in almost all normal and most degenerate levels. Disc injection therefore biomechanically “provokes” the entire functional spinal unit. When provoked pain is encountered during lumbar discography, contribution from the associated facet joint and myotendinous insertions should be considered.
Parliamentary Intention: Deciphering Its Role in Statutory Interpretation in the Australian Constitutional Context
Authors: Wong Ki On Alex
Published: April 2021

Parliamentary intention is a central aspect of statutory interpretation despite the many questions that exist concerning its normative role and desirability. In Lacey v. Attorney-General (Qld) and Zheng v. Cai, the High Court of Australia sought to diminish the role of objective parliamentary intention in statutory interpretation by alluding to a need for interpretive principles to be based on an understanding of the broader constitutional framework. This article argues that parliamentary intention has an important role to play within the modern statutory interpretation approach as adopted in Australia. Particularly, it is argued that an over-reliance upon statutory interpretation presumptions as a proxy for interpreting the legal meaning of statutes as opposed to an inquiry to discern parliamentary intention as informed by text, context, and purpose, leads to questionable interpretive results. Parliamentary intention is also consistent with the broader constitutional constraints as alluded by the High Court with respect to constitutional values such as the separation of powers between the judicial and legislative branch, and statutes being a product of an exercise of legislative power by democratically elected members of Parliament.
An Innovative Distance-Based Mentorship Program for Nurse Practitioner Student-Alumni Pairs
Authors: Faraz Covelli Asefeh , Flaherty Serena , McNelis Angela M.
Published: April 2021

Little research exists on mentoring programs for nurse practitioner (NP) students. This pilot project aimed to develop, implement, and evaluate a distance program with NP alumni mentoring NP students across the United States. Mentor-mentee pairs (113) were hand-matched and surveyed at six months to collect program data. Most mentees wanted more job-hunting and resume-writing tips; mentors were interested in receiving strategies for mentoring and calendar reminders of important school events. Alumni were interested in helping prepare future NPs by serving as mentors but needed training. Distance mentorship programs may require additional structured guidelines and resources to facilitate success.
Learning and Transfer Effects of an Unfolding Case Study in an Adult Health Nursing Course
Authors: Hobbs Jill R. , Robinson Cecil
Published: April 2021

There are few quantitative studies evaluating the impact of unfolding case studies on understanding and transfer of learning in nursing education. The purpose of this study was to examine the effects of an unfolding case study on undergraduate nursing students' learning outcomes. Teaching with unfolding case studies was compared to slide lecture using a pretest, posttest, and transfer test. The learning outcomes of students in the two groups were found to be not significantly different. Both instructional methods reveal similar learning outcomes.
The Effect of Noninvasive Brain Stimulation to Reduce Nonspecific Low Back Pain
Authors: Patricio Philippe , Roy Jean-Sébastien , Rohel Antoine , Gariépy Cynthia , Émond Camille , Hamel Élodie , Massé-Alarie Hugo
Published: April 2021

Objective:

We conducted a systematic review/meta-analysis to evaluate noninvasive brain stimulation (NIBS) efficacy to alleviate pain and improve disability in low back pain (LBP).

Materials and Methods:

A systematic literature search was performed by a librarian in MEDLINE, Embase, EBM Reviews, CINAHL, and Web of Science databases (last search: January 14, 2021). Data were pooled by the number of sessions and follow-up periods. Independent reviewers performed screening, data extraction, and risk of bias. Pain reduction and disability were used as outcomes.

Results:

Twelve articles were included in the qualitative synthesis and 8 in the meta-analysis. A single session of NIBS reduced pain compared with sham (standardized mean difference: −0.47; P<0.001; very low–quality evidence). Repeated sessions of NIBS did not impact pain at short-term (mean difference [MD]: −0.31; P=0.23) or midterm (MD: −0.56; P=0.33; moderate quality evidence). Combining NIBS with cointerventions did not influence pain (MD: −0.31; P=0.30; moderate quality evidence). NIBS did not have a statistically significant impact on disability.

Discussion:

There is very low-quality evidence suggesting that a single NIBS session reduces LBP intensity. In contrast, there is moderate quality evidence that repeated NIBS sessions or combination with cointervention did not improve pain or disability. Thus, current results do not support NIBS use to treat chronic LBP. Considering that tDCS was tested in 8 of 12 studies with little success, studies focusing on different NIBS techniques or innovative parameters are required to determine their potential to improve pain and disability in chronic LBP.
Establishing Reproducibility and Correlation of Cochlear Microphonic Amplitude to Implant Electrode Position Using Intraoperative Electrocochleography and Postoperative Cone Beam Computed Tomography
Authors: Soulby Andrew , Connor Steve , Jiang Dan , Nunn Terry , Boyle Patrick , Pai Irumee
Published: April 2021

Objectives:

The primary objective of this study was to establish the reproducibility of cochlear microphonic (CM) recordings obtained from a cochlear implant (CI) electrode contact during and immediately after insertion. This was achieved by evaluating the insertion angle and calculating the position of the apical electrode contact during insertion, using postoperative cone beam computed tomography (CBCT). The secondary objective was to create individualized patient maps of electrode contacts located within acoustically sensitive regions by correlating the CM amplitude to the electrode position determined using CBCT.

Methods:

CMs were recorded from a CI electrode contact during and immediately after insertion in 12 patients (n = 14 ears). Intraoperative recordings were made for a 0.5 kHz tone burst stimulus and were recorded from the apical electrode contact. Postinsertion recordings were made from the odd-numbered electrode contacts (1–15) along the array, using a range of stimulus frequencies (from 0.125 to 2 kHz). The time point at which each electrode contact passed through the round window was noted throughout the insertion, and the CM amplitude at this point was correlated to postoperative CBCT. This correlation was then used to estimate the CM amplitude at particular points within the cochlea, which was in turn compared with the amplitudes recorded from each electrode postoperatively to assess the reproducibility of the recordings.

Results:

Significant correlation was shown between intraoperative insertion and postinsertion angles at two amplitude events (maximum amplitude: 29° mean absolute error, r = 0.77, p = 0.006; 10% of maximum amplitude: 52° mean absolute error, r = 0.85, p = 0.002).

Conclusion:

We have developed a novel method to demonstrate the reproducibility of the CM responses recorded from a CI electrode during insertion. By correlating the CM amplitude with the postoperative CBCT, we have also been able to create individualized maps of CM responses, categorizing the cochlea into acoustically responsive and unresponsive regions. If the electrode contacts within the acoustically sensitive regions are shown to be associated with improved loudness discrimination, it could have implications for optimal electrode mapping and placement.
Communicating During COVID-19: The Effect of Transparent Masks for Speech Recognition in Noise
Authors: Thibodeau Linda M. , Thibodeau-Nielsen Rachel B. , Tran Chi Mai Quynh , Jacob Regina Tangerino de Souza
Published: April 2021

Objective:

The purpose of this study was to assess the speech recognition in noise when using a transparent mask that allows greater visibility of the talker’s face compared to an opaque mask in persons with normal and impaired hearing via an online format.

Design:

A repeated-measures design was used to evaluate the auditory-visual recognition of sentences recorded in background noise with transparent and opaque face masks, and without a mask (N = 154). In a smaller follow-up study (N = 29), the same files were presented via auditory-only presentation to determine if differences observed in the transparent and opaque mask conditions were attributable to additional visual cues or to acoustic differences between the recordings of the two mask types. Listeners completed the 40-minute online session on a computer, laptop, or tablet in a quiet room via their personal listening devices (earbuds or hearing assistive device). The adult volunteers who used English as their first language were recruited through social media links and email and categorized into three groups: normal hearing and confirmed or suspected hearing loss either with or without the use of assistive listening devices.

Results:

Auditory-visual recognition of sentences recorded with the transparent mask was significantly better (M = 68.9%) than for sentences recorded with the opaque mask (M = 58.9%) for all participants. There was a trend for those who used hearing assistive technology to score lower than the other two groups who had similar performance across all conditions regardless of the mask type. Subjective ratings of confidence and concentration followed the expected pattern based on objective scores. Results of the auditory-only presentation of the sentences to listeners with normal hearing suggested that the transparent mask benefits were not attributable to an acoustic advantage but rather to the addition of the visual cues of the talker’s face available through the transparent mask. In fact, performance in the auditory-only presentation was significantly lower with the transparent mask (M = 40.7%) compared to the opaque mask (M = 58.2%).

Conclusions:

Use of transparent masks can significantly facilitate speech recognition in noise even for persons with normal hearing and thus may reduce stressful communication challenges experienced in medical, employment, and educational settings during the global pandemic. To mitigate the spread of COVID-19 and facilitate communication, safety-approved transparent masks are strongly encouraged over opaque masks.
Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion
Authors: Shahrestani Shane , Chen Xiao T. , Ballatori Alexander M. , Ton Andy , Bakhsheshian Joshua , Hah Raymond J. , Wang Jeffrey C. , Buser Zorica
Published: April 2021

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to compare different aspects of fusion surgery in patients with osteoporosis with regard to graft subtype and surgical approach.

Summary of Background Data.

Osteoporosis and chronic lower back pain are common in elderly populations and significantly increase the risk of compression fractures within the spine.

Methods.

Using the 2016–2017 National Readmission Database we identified 11,086 osteoporotic patients who received lumbar fusion using ICD-10 coding. Information regarding biologic graft type and surgical approach was collected. Patients were stratified by number of levels fused. Perioperative complications were collected at 30-, 90-, and 180-day follow-up intervals. Statistical analysis included univariate testing and multivariate regression modeling, controlling for patient demographics and comorbidities.

Results.

Patients receiving single-level fusion with autologous grafts had higher rates of hardware failure (P = 0.00014) at 30-day follow-up and 90-day follow-up (P < 0.0001) and higher rates of lumbar vertebral fractures at 90-day follow-up (P = 0.045) compared to those treated with nonautologous grafts. Patients receiving lumbar fusion with anterior and posterior approaches had no difference in readmission or infection rates, but the anterior approach was associated with a higher cost.

Conclusion.

In this study, osteoporotic patients treated with autologous grafts had higher rates of complications compared to those treated with nonautologous grafts. Anterior and posterior approaches had similar complication rates; however, the anterior approach was associated with a higher total cost.

Level of Evidence: 4
Comparison of Short-Term Clinical Results and Radiologic Changes Between Two Different Minimally Invasive Decompressive Surgical Methods for Lumbar Canal Stenosis
Authors: Tanaka Sunao , Wada Kanichiro , Kumagai Gentaro , Asari Toru , Aburakawa Shuichi , Yamasaki Yoshihito , Yokoyama Toru , Takeuchi Kazunari , Ishibashi Yasuyuki
Published: April 2021

Study Design.

A multicenter, retrospective study.

Objective.

To clarify the clinical and radiological effects of removing interspinous contextures in lumbar decompression surgery for patients with lumbar spinal stenosis.

Summary of Background Data.

There have seldom been reports that have compared both clinical results and radiological changes among minimally invasive decompression methods.

Methods.

Consecutive 52 patients underwent lumbar spinous process-splitting laminectomy (LSPSL), following which 50 patients underwent trans-interspinous lumbar decompression (TISLD). All patients presented with cauda equina type of lumbar spinal stenosis and underwent a minimum 1-year follow-up. The Japanese Orthopaedic Association (JOA) score and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score were evaluated to determine the extent of daily living activities. Propensity score (PS)-matched analysis was used to match patients’ age and preoperative JOA scores between the two groups. Lumbar lordosis (LL), disc height (DH), segmental range of motion (ROM), and vertebral anterior translation were measured by functional lumbar lateral x-ray, and changes between preoperative and 1-year postoperative values were evaluated.

Results.

Twenty-nine pairs of patients were selected by PS-matching. Mean JOA scores increased from 14.4 to 23.5 (mean recovery rate was 62.3%) in the LSPSL group and from 14.0 to 23.2 (61.3%) in the TISLD group at preoperative and 1-year follow-up, respectively. There were no significant differences in clinical results and changes in LL, ROM, and vertebral anterior translation in each group. The DH at L4/5 level at 1-year after surgery revealed significant decrease in the TISLD group compared with the LSPSL group. There was a correlation between preoperative DH and DH decrease in the LSPSL group, but not in TISLD group.

Conclusion.

Removal of interspinous contextures did not influence clinical outcomes at 1 year after surgery, but it may be likely to cause disc height loss when it applied at the L4/5 level.

Level of Evidence: 3
Early Trauma Predictors of Mobility in People with Spinal Cord Injury
Authors: Engel-Haber Einat , Radomislensky Irina , Peleg Kobi , Bodas Moran , Bondi Moshe , Noy Shlomo , Zeilig Gabi
Published: April 2021

Study Design.

A retrospective cohort study.

Objective.

This study aims to assess the potential value of very early trauma variables such as Abbreviated Injury Scale (AIS) and the Injury Severity Score for predicting independent ambulation following a traumatic spinal cord injury (TSCI).

Summary of Background Data.

Several models for prediction of ambulation early after TSCI have been published and validated. The vast majority rely on the initial examination of American Spinal Injury Association (ASIA) impairment scale and level of injury; however, in many locations and clinical situations this examination is not feasible early after the injury.

Methods.

Patient characteristics, trauma data, and ASIA scores on admission to rehabilitation were collected for each of the 144 individuals in the study. Outcome measure was the indoor mobility item of the Spinal Cord Independence Measure taken upon discharge from rehabilitation. Univariate and multivariable models were created for each predictor, Odds ratios (ORs) were obtained by a multivariable logistic regression analysis, and area under the receiver operator curve was calculated for each model.

Results.

We observed a significant correlation between the trauma variables and independent ambulation upon discharge from rehabilitation. Of the early variables, the AIS for the spine region showed the strongest correlation.

Conclusion.

These findings support using preliminary trauma variables for early prognostication of ambulation following a TSCI, allowing for tailored individual interventions.

Level of Evidence: 3
The Range of Cardiogenic Shock Survival by Clinical Stage: Data From the Critical Care Cardiology Trials Network Registry
Authors: Lawler Patrick R. , Berg David D. , Park Jeong-Gun , Katz Jason N. , Baird-Zars Vivian M. , Barsness Gregory W. , Bohula Erin A. , Carnicelli Anthony P. , Chaudhry Sunit-Preet , Jentzer Jacob C. , Menon Venu , Metkus Thomas , Nativi-Nicolau Jose , Phreaner Nicholas , Sinha Shashank S. , Teuteberg Jeffrey J. , van Diepen Sean , Morrow David A.
Published: April 2021

OBJECTIVES:

Cardiogenic shock presents with variable severity. Categorizing cardiogenic shock into clinical stages may improve risk stratification and patient selection for therapies. We sought to determine whether a structured implementation of the 2019 Society for Cardiovascular Angiography and Interventions clinical cardiogenic shock staging criteria that is ascertainable in clinical registries discriminates mortality in a contemporary population with or at-risk for cardiogenic shock.

DESIGN:

We developed a pragmatic application of the Society for Cardiovascular Angiography and Interventions cardiogenic shock staging criteria—A (at-risk), B (beginning), C (classic cardiogenic shock), D (deteriorating), or E (extremis)—and examined outcomes by stage.

SETTING:

The Critical Care Cardiology Trials Network is an investigator-initiated multicenter research collaboration coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions with or at-risk for cardiogenic shock during two annual 2-month collection periods (2017–2019) were analyzed.

PATIENTS:

Patients with or at-risk for cardiogenic shock.

MEASUREMENTS AND MAIN RESULTS:

Of 8,240 CICU admissions reviewed, 1,991 (24%) had or were at-risk for cardiogenic shock. Distributions across the five stages were as follows: A: 33%; B: 7%; C: 16%; D: 23%; and E: 21%. Overall in-hospital mortality among patients with established cardiogenic shock was 39%; however, mortality varied from only 15.8% to 32.1% to 62.5% across stages C, D, and E (Cochran-Armitage p
trend < 0.0001). The Society for Cardiovascular Angiography and Interventions stages improved mortality prediction beyond the Sequential Organ Failure Assessment and Intra-Aortic Balloon Pumpin Cardiogenic Shock II scores.

CONCLUSIONS:

Although overall mortality in cardiogenic shock remains high, it varies considerably based on clinical stage, identifying stage C as relatively lower risk. We demonstrate a pragmatic adaptation of the Society for Cardiovascular Angiography and Interventions cardiogenic shock stages that effectively stratifies mortality risk and could be leveraged for future clinical research.
Determining the Electronic Signature of Infection in Electronic Health Record Data
Authors: Churpek Matthew M. , Dumanian Jay , Dussault Nicole , Bhavani Sivasubramanium V. , Carey Kyle A. , Gilbert Emily R. , Arain Erum , Ye Chen , Winslow Christopher J. , Shah Nirav S. , Afshar Majid , Edelson Dana P.
Published: April 2021

OBJECTIVES:

Recent sepsis studies have defined patients as “infected” using a combination of culture and antibiotic orders rather than billing data. However, the accuracy of these definitions is unclear. We aimed to compare the accuracy of different established criteria for identifying infected patients using detailed chart review.

DESIGN:

Retrospective observational study.

SETTING:

Six hospitals from three health systems in Illinois.

PATIENTS:

Adult admissions with blood culture or antibiotic orders, or Angus International Classification of Diseases infection codes and death were eligible for study inclusion as potentially infected patients. Nine-hundred to 1,000 of these admissions were randomly selected from each health system for chart review, and a proportional number of patients who did not meet chart review eligibility criteria were also included and deemed not infected.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The accuracy of published billing code criteria by Angus et al and electronic health record criteria by Rhee et al and Seymour et al (Sepsis-3) was determined using the manual chart review results as the gold standard. A total of 5,215 patients were included, with 2,874 encounters analyzed via chart review and a proportional 2,341 added who did not meet chart review eligibility criteria. In the study cohort, 27.5% of admissions had at least one infection. This was most similar to the percentage of admissions with blood culture orders (26.8%), Angus infection criteria (28.7%), and the Sepsis-3 criteria (30.4%). Sepsis-3 criteria was the most sensitive (81%), followed by Angus (77%) and Rhee (52%), while Rhee (97%) and Angus (90%) were more specific than the Sepsis-3 criteria (89%). Results were similar for patients with organ dysfunction during their admission.

CONCLUSIONS:

Published criteria have a wide range of accuracy for identifying infected patients, with the Sepsis-3 criteria being the most sensitive and Rhee criteria being the most specific. These findings have important implications for studies investigating the burden of sepsis on a local and national level.
Skeletal Muscle Changes, Function, and Health-Related Quality of Life in Survivors of Pediatric Critical Illness
Authors: Ong Chengsi , Lee Jan Hau , Wong Judith J. M. , Leow Melvin K. S. , Puthucheary Zudin A.
Published: April 2021

OBJECTIVES:

To describe functional and skeletal muscle changes observed during pediatric critical illness and recovery and their association with health-related quality of life.

DESIGN:

Prospective cohort study.

SETTING:

Single multidisciplinary PICU.

PATIENTS:

Children with greater than or equal to 1 organ dysfunction, expected PICU stay greater than or equal to 48 hours, expected survival to discharge, and without progressive neuromuscular disease or malignancies were followed from admission to approximately 6.7 months postdischarge.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Functional status was measured using the Functional Status Scale score and Pediatric Evaluation of Disability Inventory—Computer Adaptive Test. Patient and parental health-related quality of life were measured using the Pediatric Quality of Life Inventory and Short Form-36 questionnaires, respectively. Quadriceps muscle size, echogenicity, and fat thickness were measured using ultrasonography during PICU stay, at hospital discharge, and follow-up. Factors affecting change in muscle were explored. Associations between functional, muscle, and health-related quality of life changes were compared using regression analysis. Seventy-three survivors were recruited, of which 44 completed follow-ups. Functional impairment persisted in four of 44 (9.1%) at 6.7 months (interquartile range, 6–7.7 mo) after discharge. Muscle size decreased during PICU stay and was associated with inadequate energy intake (adjusted β, 0.15; 95% CI, 0.02–0.28; p = 0.030). No change in echogenicity or fat thickness was observed. Muscle growth postdischarge correlated with mobility function scores (adjusted β, 0.05; 95% CI, 0.01–0.09; p = 0.046). Improvements in mobility scores were associated with improved physical health-related quality of life at follow-up (adjusted β, 1.02; 95% CI, 0.23–1.81; p = 0.013). Child physical health-related quality of life at hospital discharge was associated with parental physical health-related quality of life (adjusted β, 0.09; 95% CI, 0.01–0.17; p = 0.027).

CONCLUSIONS:

Muscle decreased in critically ill children, which was associated with energy inadequacy and impaired muscle growth postdischarge. Muscle changes correlated with change in mobility, which was associated with child health-related quality of life. Mobility, child health-related quality of life, and parental health-related quality of life appeared to be interlinked.
A Comparison of Thrombosis and Hemorrhage Rates in Patients With Severe Respiratory Failure Due to Coronavirus Disease 2019 and Influenza Requiring Extracorporeal Membrane Oxygenation
Authors: Doyle Andrew J. , Hunt Beverley J. , Sanderson Barnaby , Zhang Joseph , Mak Sze M. , Benedetti Guilia , Breen Karen A. , Camporota Luigi , Barrett Nicholas A. , Retter Andrew
Published: April 2021

OBJECTIVES:

Extracorporeal membrane oxygenation is a lifesaving therapy for patients with severe acute respiratory distress syndrome refractory to conventional mechanical ventilation. It is frequently complicated by both thrombosis and hemorrhage. A markedly prothrombotic state associated with high rates of venous thromboembolism has been described in patients with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) infection. These rates have currently not been described during extracorporeal membrane oxygenation in comparison to other viral pneumonias.

DESIGN:

Retrospective observational study.

SETTING:

Single high-volume tertiary critical care department at a university hospital.

PATIENTS:

Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between March 1, 2020, and May 31, 2020, with coronavirus disease 2019 were compared with a cohort of patients with influenza pneumonia between June 1, 2012, and May 31, 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The rates of venous thromboembolism and hemorrhage were compared in patients with coronavirus disease 2019 against a historic population of patients with influenza pneumonia who required extracorporeal membrane oxygenation. There were 51 patients who received extracorporeal membrane oxygenation due to coronavirus disease 2019 and 80 patients with influenza. At cannulation for extracorporeal membrane oxygenation, 37% of patients with coronavirus disease 2019 compared with 8% of patients with influenza had filling defects on CT pulmonary angiography (p = 0.0001). Catheter-associated deep vein thrombosis shown on ultrasound Doppler after decannulation was present in 53% with coronavirus disease 2019 versus 25% with influenza (p = 0.01). The rates of intracranial hemorrhage at the time of cannulation were 16% with coronavirus disease 2019 and 14% with influenza (p = 0.8). Elevated d-dimer levels were seen in both conditions and were significantly higher in those with pulmonary thromboembolism than those without in coronavirus disease 2019 (p = 0.02). Fibrinogen and C-reactive protein levels were significantly higher in those with coronavirus disease 2019 than influenza (p < 0.01).

CONCLUSIONS:

Significant rates of pulmonary thromboembolism and of catheter-associated deep vein thrombosis were seen in both viral infections but were greater in those requiring the use of extracorporeal membrane oxygenation in coronavirus disease 2019 than for influenza.
Surge and Mortality in ICUs in New York City’s Public Healthcare System
Authors: Toth Alexander T. , Tatem Kathleen S. , Hosseinipour Nicole , Wong Taylor , Newton-Dame Remle , Cohen Gabriel M. , George Annie , Sessa Thomas , Postelnicu Radu , Uppal Amit , Davis Nichola J. , Mukherjee Vikramjit
Published: April 2021

OBJECTIVES:

To evaluate the impact of ICU surge on mortality and to explore clinical and sociodemographic predictors of mortality.

DESIGN:

Retrospective cohort analysis.

SETTING:

NYC Health + Hospitals ICUs.

PATIENTS:

Adult ICU patients with coronavirus disease 2019 admitted between March 24, and May 12, 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Hospitals reported surge levels daily. Uni- and multivariable analyses were conducted to assess factors impacting in-hospital mortality. Mortality in Hispanic patients was higher for high/very high surge compared with low/medium surge (69.6% vs 56.4%; p = 0.0011). Patients 65 years old and older had similar mortality across surge levels. Mortality decreased from high/very high surge to low/medium surge in, patients 18–44 years old and 45–64 (18–44 yr: 46.4% vs 27.3%; p = 0.0017 and 45–64 yr: 64.9% vs 53.2%; p = 0.002), and for medium, high, and very high poverty neighborhoods (medium: 69.5% vs 60.7%; p = 0.019 and high: 71.2% vs 59.7%; p = 0.0078 and very high: 66.6% vs 50.7%; p = 0.0003). In the multivariable model high surge (high/very high vs low/medium odds ratio, 1.4; 95% CI, 1.2–1.8), race/ethnicity (Black vs White odds ratio, 1.5; 95% CI, 1.1–2.0 and Asian vs White odds ratio 1.5; 95% CI, 1.0–2.3; other vs White odds ratio 1.5, 95% CI, 1.0–2.3), age (45–64 vs 18–44 odds ratio, 2.0; 95% CI, 1.6–2.5 and 65–74 vs 18–44 odds ratio, 5.1; 95% CI, 3.3–8.0 and 75+ vs 18–44 odds ratio, 6.8; 95% CI, 4.7–10.1), payer type (uninsured vs commercial/other odds ratio, 1.7; 95% CI, 1.2–2.3; medicaid vs commercial/other odds ratio, 1.3; 95% CI, 1.1–1.5), neighborhood poverty (medium vs low odds ratio 1.6, 95% CI, 1.0–2.4 and high vs low odds ratio, 1.8; 95% CI, 1.3–2.5), comorbidities (diabetes odds ratio, 1.6; 95% CI, 1.2–2.0 and asthma odds ratio, 1.4; 95% CI, 1.1–1.8 and heart disease odds ratio, 2.5; 95% CI, 2.0–3.3), and interventions (mechanical ventilation odds ratio, 8.8; 95% CI, 6.1–12.9 and dialysis odds ratio, 3.0; 95% CI, 1.9–4.7) were significant predictors for mortality.

CONCLUSIONS:

Patients admitted to ICUs with higher surge scores were at greater risk of death. Impact of surge levels on mortality varied across sociodemographic groups.
Association Between Incident Delirium Treatment With Haloperidol and Mortality in Critically Ill Adults*
Authors: Duprey Matthew S. , Devlin John W. , van der Hoeven Johannes G. , Pickkers Peter , Briesacher Becky A. , Saczynski Jane S. , Griffith John L. , van den Boogaard Mark
Published: April 2021

OBJECTIVES:

Haloperidol is commonly administered in the ICU to reduce the burden of delirium and its related symptoms despite no clear evidence showing haloperidol helps to resolve delirium or improve survival. We evaluated the association between haloperidol, when used to treat incident ICU delirium and its symptoms, and mortality.

DESIGN:

Post hoc cohort analysis of a randomized, double-blind, placebo-controlled, delirium prevention trial.

SETTING:

Fourteen Dutch ICUs between July 2013 and December 2016.

PATIENTS:

One-thousand four-hundred ninety-five critically ill adults free from delirium at ICU admission having an expected ICU stay greater than or equal to 2 days.

INTERVENTIONS:

Patients received preventive haloperidol or placebo for up to 28 days until delirium occurrence, death, or ICU discharge. If delirium occurred, treatment with open-label IV haloperidol 2 mg tid (up to 5 mg tid per delirium symptoms) was administered at clinician discretion.

MEASUREMENTS AND MAIN RESULTS:

Patients were evaluated tid for delirium and coma for 28 days. Time-varying Cox hazards models were constructed for 28-day and 90-day mortality, controlling for study-arm, delirium and coma days, age, Acute Physiology and Chronic Health Evaluation-II score, sepsis, mechanical ventilation, and ICU length of stay. Among the 1,495 patients, 542 (36%) developed delirium within 28 days (median [interquartile range] with delirium 4 d [2–7 d]). A total of 477 of 542 (88%) received treatment haloperidol (2.1 mg [1.0–3.8 mg] daily) for 6 days (3–11 d). Each milligram of treatment haloperidol administered daily was associated with decreased mortality at 28 days (hazard ratio, 0.93; 95% CI, 0.91–0.95) and 90 days (hazard ratio, 0.97; 95% CI, 0.96–0.98). Treatment haloperidol administered later in the ICU course was less protective of death. Results were stable by prevention study-arm, predelirium haloperidol exposure, and haloperidol treatment protocol adherence.

CONCLUSIONS:

Treatment of incident delirium and its symptoms with haloperidol may be associated with a dose-dependent improvement in survival. Future randomized trials need to confirm these results.