bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Energy Burdens Contribute to Economic Poverty in the United States? A Panel Analysis
Authors: Bohr Jeremiah , McCreery Anna C
Published: August 2019

For many households, energy consumption represents a non-discretionary portion of their budget and directly relates to quality of life. As researchers continue to study the environmental impacts of energy behavior, it is important to explore how energy consumption relates to socio-economic wellbeing. This paper examines the economic impacts of being energy-burdened in the United States, defined as spending at least 10% of household income on heating and electricity services; energy burdens are partially, but not entirely, driven by income, since energy needs and costs can vary substantially due to housing characteristics, utility rates, and other factors. Using panel data of US household income and energy expenditures during 1999–2017, this analysis demonstrates that energy-burdened households were at about 150%–200% greater risk of transitioning into or extending the duration of economic poverty over a two-year timeframe relative to non-burdened households. This analysis indicates that dedicating inordinate amounts of income to energy services can threaten a household’s economic well-being over time, possibly by preventing a household from engaging in other economic activities or compounding existing economic hardship. These results emphasize the importance of energy assistance and energy efficiency for low-income households, drawing attention to how structures of energy consumption, the welfare state, and social stratification intertwine.
A new genus of Pycnodontidae (Actinopterygii) from the Upper Jurassic of France and Germany, included in a phylogeny of Pycnodontiformes
Authors: Ebert Martin
Published: August 2019

The new genus Thiollierepycnodus is erected here to accommodate ‘Gyrodus’ wagneri or ‘Proscinetes’ wagneri, a taxon known since the 19th century from the marine Kimmeridgian Plattenkalk of Cerin (France) and since 2014 at the excavation site of the Naturkunde-Museum Bamberg in Wattendorf (Germany). Thiollierepycnodus is placed in Pycnodontidae (Upper Jurassic to Eocene), which is the most advanced family of Pycnodontiformes. With 154–152 Myr (Upper Jurassic), Thiollierepycnodus belongs to the stratigraphically oldest Pycnodontidae, still possessing some primitive features such as four incisiform teeth in the dentary, a crown of bifurcated anterior dentary teeth, reduced scale bars posterior to the dorsal fin origin, but the area of pterygiophores without scales and nine to 10 postanal ventral keel scales and approximately 10 complete scale rows posterior to the cloaca. A phylogenetic analysis leads to the placement of this taxon in Proscinetinae. This and the introduction of two additional taxa from the Cretaceous of Lebanon in the phylogeny are further steps to enlighten the broader evolutionary patterns of Pycnodontidae.
Selection of Lowest Instrumented Vertebra Using Fulcrum Bending Radiographs Achieved Shorter Fusion Safely Compared With the Last “Substantially” Touching Vertebra in Lenke Type 1A and 2A Curves
Authors: Kwan Kenny Yat Hong , Wong Cheuk Pang , Koh Hui Yu , Cheung Kenneth Man Chee
Published: August 2019

Study Design.

Retrospective study with prospective radiographic data collection.

Objective.

To compare fusion level determination criteria using the fulcrum bending radiograph (FBR) and the last substantially touched vertebra (STV) as the lowest instrumented vertebra (LIV) in the radiographic outcomes of correction surgery for Lenke 1A and 2A scoliosis patients with a minimum of 2-year follow-up.

Summary of Background Data.

The STV has been proposed as the LIV in Lenke 1A and 2A curves to avoid postoperative distal adding-on. However, the influence of the inherent flexibility of the curves on selecting the LIV in relation to the STV is not known.

Methods.

A total of 65 consecutive Lenke 1A and 2A patients who underwent posterior selective thoracic fusion were included in this study with a minimum of 2-year follow-up. LIV determination was compared with the FBR and STV methods. The curve correction, trunk shift, radiographic shoulder height, list, and the incidence of distal adding-on were documented.

Results.

Mean preoperative, postoperative, and final follow-up standing coronal Cobb angles of primary curves were 59.37°, 15.58°, and 16.62° respectively. Using the FBR to determine the LIV, STV was selected in 16 patients (25%), STV-1 in 34 (52%), STV-2 in 11 (17%), and STV-3 in three (5%). Fusion level difference between using FBR and STV method was statistically significantly larger (P = 0.019) in patients with more than 70% fulcrum flexibility (mean: 1.18 levels, range: 0–3 levels) than those with less than or equal to 70% flexibility (mean: 0.70 level, range: –1 to 3 levels). Mean fulcrum flexibility was 73.9% in patients who achieved a shorter fusion by FBR method and 66.3% in patients who did not achieve a shorter fusion. Adding-on was observed in three patients (4.6%).

Conclusion.

By considering the curve flexibility, LIV determination using FBR method achieved a shorter fusion than STV method in over 70% of Lenke 1A and 2A patients, while being safe and effective at 2-year follow-up.

Level of Evidence: 3.
Intraoperative Ischemic Stroke in Elective Spine Surgery
Authors: Ishak Basem , Abdul-Jabbar Amir , Singla Amit , Yilmaz Emre , von Glinski Alexander , Ramey Wyatt L. , Blecher Ronen , Tymchak Zane , Oskouian Rod , Chapman Jens R.
Published: August 2019

Study Design.

. Retrospective study.

Objective.

. To determine incidence, risk factors, complications, and early postoperative outcome in patients with intraoperative ischemic stroke during elective spine surgery.

Summary of Background Data.

. Overall, stroke is the fifth leading cause of death in the United States and the second leading cause of death worldwide. It can be a catastrophic event and the main cause of neurological disability in adults.

Methods.

. A retrospective review of the electronic medical records of patients who underwent elective spine surgery between January 2016 and November 2018 at a larger tertiary referral center was conducted. Patients with infection and neoplastic disease were excluded. Patient demographics, pre- and postoperative neurological status, surgical treatment, surgical time, blood loss, intraoperative abnormalities, risk factors, history of stroke, medical treatment, diagnostics, hospital stay, complications, and mortality were collected.

Results.

. Out of 5029 surgically treated patients receiving elective spine surgery, a total of seven patients (0.15%) were identified who developed an ischemic stroke during the surgical procedure. Patients were predominantly females (n = 6). Ischemic pontine stroke occurred in two patients. Further distributions of ischemic stroke were: left caudate nucleus, left posterior inferior cerebellar artery, left external capsule, left middle cerebral artery, and acute ischemic supratentorial spots. The main risk factors identified for intraoperative ischemic stroke include hypertension, diabetes, smoking, dyslipidemia, and possibly major intraoperative CSF leak. Three patients (43%) had neurological deficits which did not improve during hospital stay. Two patients recovered fully and two patients died. Therefore, in-hospital mortality rate of this subset of patients was 29%.

Conclusion.

. With the increase of spinal procedures, it is important to identify patients at risk for having an ischemic stroke and to optimize their comorbidities preoperatively. Patients with intraoperative ischemic stroke carry a higher risk for morbidity and mortality during the index hospitalization.

Level of Evidence: 4
Effect of Perioperative Mental Status on Health-related Quality of Life in Patients With Adult Spinal Deformities
Authors: Watanabe Yuh , Yoshida Go , Hasegawa Tomohiko , Yamato Yu , Togawa Daisuke , Banno Tomohiro , Oe Shin , Arima Hideyuki , Ushirozako Hiroki , Yamada Tomohiro , Murata Hideyuki , Matsuyama Yukihiro
Published: August 2019

Study Design.

A retrospective study.

Objective.

We aimed to evaluate the impact of mental status on the clinical outcomes of patients with adult spinal deformity (ASD).

Summary of Background Data.

Limited information is currently available on how preoperative mental status affects postoperative health-related quality of life (HRQOL) in patients with ASD.

Methods.

We enrolled 165 patients with ASD who underwent corrective surgery at a single university hospital between March 2010 and September 2015. We compared Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index (ODI) scores using various x-ray parameters at these time points: preoperative period and postoperative 2 years. Additionally, to determine the associations between perioperative complications and mental health disorders, we examined these x-ray parameters: lumbar lordosis, thoracic kyphosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis (SVA), and T1 pelvic angle (TPA).

Results.

We found correlations between the preoperative SRS-22r total score and preoperative ODI (r = −0.692, P < 0.01) and postoperative ODI (r = –0.443, P < 0.01). Preoperative SRS-22r mental domain correlated with preoperative ODI (r = −0.561, P ≤ 0.01) and postoperative ODI (r = −0.315, P ≤ 0.01). Perioperative (preoperative and postoperative) SRS-22r mental domain did not correlate with the postoperative x-ray parameters except for SVA and TPA. Postoperative mental health correlated with early infection (P < 0.05), hematoma (P < 0.05), deep vein thrombosis (P < 0.05), and delirium (P < 0.05). Regression analysis revealed that preoperative SRS-22r mental health score correlated with preoperative ODI (P < 0.001) and postoperative ODI (P < 0.001). The regression coefficient number between preoperative SRS-22r mental health score and perioperative (preoperative and postoperative) ODI improved from −17.3 to −10.2 from preoperative to postoperative periods.

Conclusion.

Diminished preoperative mental health worsened postoperative HRQOL. Perioperative complications influence postoperative mental status and HRQOL; hence, screening preoperative mental health is important.

Level of Evidence: 3
A Machine Learning Algorithm to Predict Severe Sepsis and Septic Shock: Development, Implementation, and Impact on Clinical Practice*
Authors: Giannini Heather M. , Ginestra Jennifer C. , Chivers Corey , Draugelis Michael , Hanish Asaf , Schweickert William D. , Fuchs Barry D. , Meadows Laurie , Lynch Michael , Donnelly Patrick J. , Pavan Kimberly , Fishman Neil O. , Hanson C. William , Umscheid Craig A.
Published: August 2019

Objectives:

Develop and implement a machine learning algorithm to predict severe sepsis and septic shock and evaluate the impact on clinical practice and patient outcomes.

Design:

Retrospective cohort for algorithm derivation and validation, pre-post impact evaluation.

Setting:

Tertiary teaching hospital system in Philadelphia, PA.

Patients:

All non-ICU admissions; algorithm derivation July 2011 to June 2014 (n = 162,212); algorithm validation October to December 2015 (n = 10,448); silent versus alert comparison January 2016 to February 2017 (silent n = 22,280; alert n = 32,184).

Interventions:

A random-forest classifier, derived and validated using electronic health record data, was deployed both silently and later with an alert to notify clinical teams of sepsis prediction.

Measurement and Main Result:

Patients identified for training the algorithm were required to have International Classification of Diseases, 9th Edition codes for severe sepsis or septic shock and a positive blood culture during their hospital encounter with either a lactate greater than 2.2 mmol/L or a systolic blood pressure less than 90 mm Hg. The algorithm demonstrated a sensitivity of 26% and specificity of 98%, with a positive predictive value of 29% and positive likelihood ratio of 13. The alert resulted in a small statistically significant increase in lactate testing and IV fluid administration. There was no significant difference in mortality, discharge disposition, or transfer to ICU, although there was a reduction in time-to-ICU transfer.

Conclusions:

Our machine learning algorithm can predict, with low sensitivity but high specificity, the impending occurrence of severe sepsis and septic shock. Algorithm-generated predictive alerts modestly impacted clinical measures. Next steps include describing clinical perception of this tool and optimizing algorithm design and delivery.
Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury
Authors: Jiang Fan , Jaja Blessing N. R. , Kurpad Shekar N. , Badhiwala Jetan H. , Aarabi Bizhan , Grossman Robert G. , Harrop James S. , Guest Jim D. , Schär Ralph T. , Shaffrey Chris I. , Boakye Max , Toups Elizabeth G. , Wilson Jefferson R. , Fehlings Michael G.
Published: August 2019

Objectives:

There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome.

Design:

Multicenter prospective registry.

Setting:

Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network.

Patients:

Eight-hundred one spinal cord injury patients enrolled by participating centers.

Interventions:

Appropriate spinal cord injury treatment at individual centers.

Measurements and Main Results:

A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32–0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17–36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35–13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19–17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31–14.32) measured using the Spinal Cord Independence Measure subscores.

Conclusions:

Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.
Is Spinal Anesthesia Safer than General Anesthesia for Patients Undergoing Revision THA? Analysis of the ACS-NSQIP Database
Authors: Wilson Jacob M. , Farley Kevin X. , Bradbury Thomas L. , Guild George N.
Published: August 2019

Background

The incidence of revision THA continues to increase and there is a need to identify risk factors contributing to postoperative complications. Anesthesia type has been shown to be associated with complication rates in patients who undergo primary THA, but it is not clear whether the same is true among patients undergoing revision THA.

Questions/purposes

(1) After controlling for confounding variables, in the setting of a large-database analysis, is spinal anesthesia associated with a lower risk of death, readmission, reoperation, postoperative transfusion, thromboembolic events, surgical site infection (SSI), and re-intubation among patients undergoing revision THA?

Methods

The American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing aseptic, revision THA with either spinal or general anesthesia. Coarsened exact matching was used to match patients based on several baseline characteristics, including age, sex, body mass index, surgery type (Current Procedural Terminology code), and the modified Frailty Index score. Coarsened exact matching is a statistical method of exact matching that matches on chosen characteristics, in which continuous variables may be temporarily coarsened (such as, into discrete categorical variables) to facilitate matching. This method is an alternate to and requires less estimation than traditional propensity score matching. Then, using a model controlling for baseline patient characteristics and operative time, we performed multivariate logistic and linear regression analyses of matched cohorts to examine differences in mortality, readmission, reoperation, thromboembolic events, transfusion, SSI, and re-intubation.

Results

After statistical matching and controlling for baseline demographic variables, surgery type (one- or two-component revision), surgical time and modified Frailty Index we found that patients receiving general anesthesia had higher odds of mortality (OR 3.72 [95% CI 1.31 to 10.50]; p = 0.013), readmission (OR 1.49 [95% CI 1.24 to 1.80]; p < 0.001), reoperation (OR 1.40 [95% CI 1.13 to 1.73]; p = 0.002), thromboembolic events (OR 2.57 [95% CI 1.37 to 4.84]; p = 0.003), SSI (OR 1.32 [95% CI 1.01 to 1.72]; p = 0.046), postoperative transfusion (OR 1.57 [95%CI 1.39 to 1.78]; p < 0.001) and unplanned intubation or failure to wean off intubation (OR 5.95 [95% CI 1.43 to 24.72]; p = 0.014).

Conclusions

In patients undergoing revision THA, spinal anesthesia is associated with a decreased risk of several complications. The current investigation suggests that, when practical (such as when long surgical times or changes to the surgical plan are not anticipated), spinal anesthesia should be considered for use during revision THA.

Level of Evidence

Level III, therapeutic study.
Dose-Related Concentrations of Neuroactive/Psychoactive Drugs Expected in Blood of Children and Adolescents
Authors: Fekete Stefanie , Hiemke Christoph , Gerlach Manfred
Published: August 2019

Purpose:

Therapeutic drug monitoring is highly recommended for children and adolescents treated with neurotropic/psychotropic drugs. For interpretation of therapeutic drug monitoring results, drug concentrations (C/D) expected in a “normal” population are helpful to identify pharmacokinetic abnormalities or nonadherence. Using dose-related concentration (DRC) factors obtained from pharmacokinetic data, C/D ranges expected under steady state can be easily calculated by multiplication of DRC by the daily dose. DRC factors, however, are defined only for adults so far. Therefore, it was the aim of this study to estimate DRC factors for children and adolescents and compare them with those of adults.

Methods:

To obtain pharmacokinetic data (apparent total clearance of drugs from plasma after oral administration, elimination half-life, area under the curve, and minimum serum drug concentration) from children and adolescents treated with psychotropic drugs, a systematic review of published literature was performed, and the pharmaceutical companies that market these drugs were contacted. Available information was used for the calculation of DRC factors.

Results:

Fourteen of 26 drugs had similar DRC factors to those reported for adults; 8 and 4 had higher and lower factors, respectively. The antidepressants citalopram, clomipramine, fluvoxamine, and imipramine and the antipsychotics haloperidol and olanzapine showed higher DRC factors than those calculated for adults. The DRC factors of amphetamine and methylphenidate were higher in children (6–12 years) but not in adolescents (13–17 years). On the contrary, the antipsychotic quetiapine and the mood-stabilizing antiepileptics lamotrigine, oxcarbazepine, and topiramate showed lower DRC factors than those calculated for adults.

Conclusions:

It was concluded that concentrations of neuroactive/psychoactive drugs to be expected in blood for a given dose may differ between adults and children or adolescents, most probably owing to age-dependent differences in the elimination of these drugs.
Clearing the air: adolescent smoking trends
Authors: Solecki Susan , Adegite Enitan , Turchi Renee
Published: August 2019

Purpose of review

The purpose of this review is to highlight the emerging smoking behaviors and varied tobacco products elevating public health concerns related to the exposure of these potentially harmful substances in the adolescent population.

Recent findings

Although adolescent smoking of traditional cigarettes has declined in the last 40 years, the inhalation of other nicotine-containing products using alternative methods and devices, such as smoking electronic cigarettes, using hookahs, vaping, and JUULing are dramatically on the rise in the adolescent population. Regardless of the novel delivery devices or methods, use of nicotine-containing products in any form is hazardous and unsafe.

If adolescent smoking trends continue at the current rate in the United States, 5.6 million of today's American youth under the age of 18 will die early from a smoking-related illness. With the emerging high-risk smoking behaviors resulting in detrimental exposure to nicotine and other harmful substances available to adolescents, pediatric healthcare providers will have an increasing responsibility to screen, to manage, and to educate patients and families to combat this imminent threat to the public health of our next generation.
The ins and outs of engineering functional tissues and organs: evaluating the in-vitro and in-situ processes
Authors: Kurniawan Nicholas A.
Published: August 2019

Purpose of review

For many disorders that result in loss of organ function, the only curative treatment is organ transplantation. However, this approach is severely limited by the shortage of donor organs. Tissue engineering has emerged as an alternative solution to this issue. This review discusses the concept of tissue engineering from a technical viewpoint and summarizes the state of the art as well as the current shortcomings, with the aim of identifying the key lessons that we can learn to further advance the engineering of functional tissues and organs.

Recent findings

A plethora of tissue-engineering strategies have been recently developed. Notably, these strategies put different emphases on the in-vitro and in-situ processes (i.e. preimplantation and postimplantation) that take place during tissue formation. Biophysical and biomechanical interactions between the cells and the scaffold/biomaterial play a crucial role in all steps and have started to be exploited to steer tissue regeneration.

Recent works have demonstrated the need to better understand the in-vitro and in-situ processes during tissue formation, in order to regenerate complex, functional organs with desired cellular organization and tissue architecture. A concerted effort from both fundamental and tissue-specific research has the potential to accelerate progress in the field.
Back Pain in Adolescents: Characteristics, Quality of Life, and Drug Self-Management
Authors: Iacovelli Chiara , Germanotta Marco , Coraci Daniele , Mosca Rita , Vincenzi Maria Teresa , Gilardi Alessandro , Padua Luca , Aprile Irene
Published: August 2019

Objectives

Back pain is one of the major problems for the public health system in the western world. The purposes of this study were to assess back pain in a large cohort of adolescents; to evaluate the prevalence, intensity, and features; and obtain information about drug management of this symptom.

Methods

One thousand four hundred seventy-one healthy students aged 14 to 19 years were enrolled in the study. The subjects underwent a face-to-face interview using an ad hoc questionnaire, the Numeric Rating Scale, the Neuropathic Pain Symptom Inventory, and the Short-Form 36 questionnaire.

Results

Sixty-eight percent of adolescents reported moderate to severe pain, with a higher prevalence of moderate/severe pain in female. The intensity of pain was higher (P < 0.001) in females than in men. A correlation was found between pain and quality of life. Considering the adolescents with severe pain, 21.6% requested a doctor's opinion, and 18% used analgesics (63.2% of them without a doctor's prescription), with a frequency of about 2 times per month.

Conclusions

We found that the prevalence of back pain in adolescents is very high, with the consequences on quality of life, and it becomes frequently a self-managed symptom. This should encourage research on the causes of pain in order to limit the risk factors underlying the pain development and obtain a good prevention strategy.
Business Leaders' Attitudes About Value of Employee and Community Health
Authors: Heffernan Megan , Meit Michael , Powers Molly , Castrucci Brian C. , Sellers Katie
Published: August 2019

Objective:

This study uses qualitative methodology to describe a range of business leaders' attitudes about health.

Methods:

Five Chambers of Commerce executives and 10 business leaders shared their opinions on the value they place on health in their business and the larger community.

Results:

Employee health was highlighted as a top priority among business leaders. The importance of business investment in community health more broadly was not discussed as frequently among business leaders. While attitudes may vary across industries and company sizes, many business executives recognized the direct role health plays in their business productivity and revenue. Compared with employee health, community health was not as salient to these business leaders; however, they do recognize the link between community health and economic development.

Conclusions:

Increasing business leaders' engagement in improving community health may require additional education and resources. Further research is needed to gather representative data on business leaders' attitudes about health.
Lessons Learned From Breast Implant Registries
Authors: Wurzer Paul , Hundeshagen Gabriel , Cambiaso-Daniel Janos , Fischer Sebastian , Hoflehner Helmut , Spendel Stephan , Lumenta David B. , Kamolz Lars P. , Kneser Ulrich , Hirche Christoph
Published: August 2019

Objective

Over several decades, numerous national and international registries on breast implants went online, aiming to collect prospective data to provide increased safety for patients and surgeons. We performed a review of all published data on breast implant registries to assess availability and quality of data and determine its usefulness and impact.

Materials and Methods

PubMed, Ovid, and Web of Science were searched to identify all articles containing breast implant registries in English language. The review was registered at PROSPERO (CRD42016041255) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There was no limitation by publication date.

Results

Eight hundred ninety-five articles were identified; after removal of duplicates, 536 abstracts were screened on breast implant registries in plastic and reconstructive surgery. Unrelated articles, non-English articles, and not breast implant–related studies were excluded. Twenty breast implant registry–related articles met the inclusion criteria; 7 articles contained actual data on breast implants. Compared with international trends, only a minimal percentage of performed surgical breast augmentations is documented in registries, and the overall data quality and availability were low.

Conclusions

Only a fraction of performed breast augmentations is documented properly in a registry. Currently, there are no published data based on a clinical quality registry. Sustained funding and reliable administrative governmental structures remain crucial to establish an adequate clinical quality registry for breast implants as currently launched in Australia to analyze outcomes and risk factors for an increased patient safety.
Antithrombin III Contributes to the Protective Effects of Fresh Frozen Plasma Following Hemorrhagic Shock by Preventing Syndecan-1 Shedding and Endothelial Barrier Disruption
Authors: Lopez Ernesto , Peng Zhanglong , Kozar Rosemary A. , Cao Yanna , Ko Tien C. , Wade Charles E. , Cardenas Jessica C.
Published: August 2019

Background:

Endothelial dysfunction during hemorrhagic shock (HS) is associated with loss of cell-associated syndecan-1 (Sdc1) and hyperpermeability. Fresh frozen plasma (FFP) preserves Sdc1 and reduces permeability following HS, although the key mediators remain unknown. Antithrombin III (ATIII) is a plasma protein with potent anti-inflammatory and endothelial protective activity. We hypothesized that the protective effects of FFP on endothelial Sdc1 and permeability are mediated, in part, through ATIII.

Methods:

ATIII and Sdc1 were measured in severely injured patients upon admission (N = 125) and hospital day 3 (N = 90) for correlation analysis. In vitro effects of ATIII on human lung microvascular endothelial cells (HLMVECs) were determined by pretreating cells with vehicle, FFP, ATIII-deficient FFP, or purified ATIII followed by TNFα stimulation. Sdc1 expression was measured by immunostaining and permeability by electrical impedance. To determine the role of ATIII in vivo, male mice were subjected to a fixed pressure exsanguination model of HS, followed by resuscitation with FFP, ATIII-deficient FFP, or ATIII-deficient FFP with ATIII repletion. Lung Sdc1 expression was assessed by immunostaining.

Results:

Pearson correlation analysis showed a significant negative correlation between plasma levels of Sdc1 and ATIII (R = −0.62; P < 0.0001) in injured patients on hospital day 3. Also, in vitro, FFP and ATIII prevented TNFα-induced permeability (P < 0.05 vs TNFα) in HLMVECs. ATIII-deficient FFP had no effect; however, ATIII restoration reestablished its protective effects in a dose-dependent manner. Similarly, FFP and ATIII prevented TNFα-induced Sdc1 shedding in HLMVECs; however, ATIII-deficient FFP did not. In mice, Sdc1 expression was increased following FFP resuscitation (1.7 ± 0.5, P < 0.01) vs. HS alone (1.0 ± 0.3); however, no improvement was seen following ATIII-deficient FFP treatment (1.3 ± 0.4, P = 0.3). ATIII restoration improved Sdc1 expression (1.5 ± 0.9, P < 0.05) similar to that of FFP resuscitation.

Conclusions:

ATIII plays a role in FFP-mediated protection of endothelial Sdc1 expression and barrier function, making it a potential therapeutic target to mitigate HS-induced endothelial dysfunction. Further studies are needed to elucidate the mechanisms by which ATIII protects the endothelium.
Predictive survival factors of the traumatically injured on venovenous extracorporeal membrane oxygenation: A Bayesian model
Authors: Huang James E. , Holland Seth R. , Patrick Joshua , Piper Lydia C. , Sams Valerie G.
Published: August 2019

BACKGROUND

Venovenous extracorporeal membrane oxygenation (ECMO) has had encouraging evidence suggesting efficacy and acceptable safety in trauma patients with refractory respiratory failure. Given the obstacles of accruing adequate quality prospective data for a resource-intensive modality, it is unclear what is indicative of survival to discharge. We investigate pre-ECMO characteristics (age, Injury Severity Score [ISS], time from admission to cannulation, P:F ratio) in trauma patients to determine correlation with survival.

METHODS

To address these challenges, we use Bayesian inference and patients from a level I trauma center and Extracorporeal Life Support Organization–designated Gold Center of Excellence (N = 12), published literature, and Markov chain Monte Carlo simulation to determine if there is strong predictive probability regarding survival to discharge.

RESULTS

Bayesian inference probabilities expressed as odds ratios with 95% credible intervals (CrIs) were as follows: age (e
βage = 0.981; CrI, 0.976–0.985), ISS (e
βISS = 0.996; CrI, 0.980–1.012), P:F ratio (e
βpf = 1.000; CrI, 0.996–1.003), and time from admission to ECMO (e
βtime = 0.988; CrI, 0.974–1.004). Bayes factors (BF) were as follows: BFage = 3.151, BFISS = 3.564 × 1013, BFpf = 0.463, and BFtime = 913.758.

CONCLUSION

Age was the only pre-ECMO factor that demonstrated the most certain effect on hospital mortality for trauma patients placed on venovenous ECMO. The ISS and time to ECMO initiation had some appreciable impact on survival although less certain than age; P:F ratio likely had none. However, the pre-ECMO factors that were found to have any impact on mortality were relatively diminutive. More studies are necessary to update prior distributions and enhance accuracy.

LEVEL OF EVIDENCE

Prognostic, Level IV.
Disproportionally low funding for trauma research by the National Institutes of Health: A call for a National Institute of Trauma
Authors: Glass Nina E. , Riccardi Julia , Farber Nicole I. , Bonne Stephanie L. , Livingston David H.
Published: August 2019

BACKGROUND

Trauma is a major cause of death and disability in all ages. Previous reviews have suggested that National Institutes of Health (NIH) funding for trauma is not commensurate with its burden of disease, but a detailed analysis has been lacking. We postulated that NIH spending on trauma research was lower than previously thought and was distributed widely, preventing a comprehensive research strategy that could decrease trauma morbidity and mortality.

METHODS

The NIH Research Portfolio Online Reporting Tool was initially screened using a search of over 20 terms including “trauma,” “injury,” “shock,” “MVC,” and excluding clearly unrelated conditions, for example, “cancer.” The details of all grants that screened positive underwent manual review to identify true trauma-related grants. An expert panel was used to adjudicate any ambiguity.

RESULTS

In FY2016, NIH awarded 50,137 grants, of which 6,401 (13%) were captured by our initial screen. Following review, 1,888 (28%) were identified as trauma-related; 3.7% of all NIH grants. These grants (US $720 million) represent only 2.9% of the NIH extramural budget. In addition, the grants were funded and administered by 24 of the institutes and centers across the NIH ranging from 0.01% (National Cancer Institute) to 11% (National Institute of Neurological Disorders and Stroke and National Institute of Arthritis and Musculoskeletal and Skin Diseases) of their extramural portfolios.

CONCLUSION

Given the extreme burden of trauma-related disability and years of life lost, this review of extramural NIH funding definitively demonstrates that trauma is severely underfunded. The lack of a dedicated home for trauma research at NIH leads to a diffusion of grants across many institutes and makes it impossible to direct a focused and effective national research endeavor to improve outcomes. These data demonstrate the need for a National Institute of Trauma at the NIH to help set an agenda to reach the national goal of Zero Preventable Deaths.
Location, location, location: Utilizing Needs-Based Assessment of Trauma Systems-2 in trauma system planning
Authors: Dooley Jennings H. , Ozdenerol Esra , Sharpe John P. , Magnotti Louis J. , Croce Martin A. , Fischer Peter E.
Published: August 2019

BACKGROUND

In 2015, the American College of Surgeons Committee on Trauma introduced the Needs-Based Assessment of Trauma Systems (NBATS) tool to quantify the optimal number of trauma centers for a region. While useful, more focus was required on injury population, distribution, and transportation systems. Therefore, NBATS-2 was developed utilizing advanced geographical modeling. The purpose of this study was to evaluate NBATS-2 in a large regional trauma system.

METHODS

Data from all injured patients from 2016 to 2017 with an Injury Severity Score greater than 15 was collected from the trauma registry of the existing (legacy) center. Injury location and demographics were analyzed by zip code. A regional map was built using US census data to include hospital and population demographic data by zip code. Spatial modeling was conducted using ArcGIS to estimate an area within a 45-minute drive to a trauma center.

RESULTS

A total of 1,795 severely injured patients were identified across 54 counties in the tri-state region. Forty-eight percent of the population and 58% of the injuries were within a 45-minute drive of the legacy trauma center. With the addition of another urban center, injured and total population coverage increased by only 1% while decreasing the volume to the existing center by 40%. However, the addition of two rural trauma centers increased coverage significantly to 62% of the population and 71% of the injured (p < 0.001). The volume of the legacy center was decreased by 25%, but the self-pay rate increased by 16%.

CONCLUSION

The geospatial modeling of NBATS-2 adds a new dimension to trauma system planning. This study demonstrates how geospatial modeling applied in a practical tool can be incorporated into trauma system planning at the local level and used to assess changes in population and injury coverage within a region, as well as potential volume and financial implications to a current system.

LEVEL OF EVIDENCE

Care management/economic, level V.
Comparison of the causes of death and wounding patterns in urban firearm-related violence and civilian public mass shooting events
Authors: Maghami Sam , Hendrix Cheralyn , Matecki Mary , Mahendran Karthika , Amdur Richard , Mitchell Roger , Diaz Francisco , Estroff Jordan , Smith E. Reed , Shapiro Geoff , Sarani Babak
Published: August 2019

BACKGROUND

There are no reports comparing wounding pattern in urban and public mass shooting events (CPMS). Because CPMS receive greater media coverage, there is a connation that the nature of wounding is more grave than daily urban gun violence. We hypothesize that the mechanism of death following urban gunshot wounds (GSWs) is the same as has been reported following CPMS.

METHODS

Autopsy reports of all firearm-related deaths in Washington, DC were reviewed from January 1, 2016, to December 31, 2017. Demographic data, firearm type, number and anatomic location of GSWs, and organ(s) injured were abstracted. The organ injury resulting in death was noted. The results were compared with a previously published study of 19 CPMS events involving 213 victims.

RESULTS

One hundred eighty-six urban autopsy reports were reviewed. There were 171 (92%) homicides and 13 (7%) suicides. Handguns were implicated in 180 (97%) events. One hundred eight (59%) gunshots were to the chest/upper back, 85 (46%) to the head, 77 (42%) to an extremity, and 71 (38%) to the abdomen/lower back. The leading mechanisms of death in both urban firearm violence and CPMS were injury to the brain, lung parenchyma, and heart. Fatal brain injury was more common in CPMS events as compared with urban events involving a handgun.

CONCLUSION

There is little difference in wounding pattern between urban and CPMS firearm events. Based on the organs injured, rapid point of wounding care and transport to a trauma center remain the best options for mitigating death following all GSW events.

LEVEL OF EVIDENCE

Epidemiological, level IV.
Cardiobacterium hominis endocarditis complicated by aortic root abscess: a case report
Authors: Holden Robert , Lewkenbandara Rashmi , Pasztor Monika , Okonkwo Ekene Kenneth
Published: August 2019

The present report describes a case of infective endocarditis complicated with aortic root abscess caused by

Cardiobacterium hominis

in a 56-year-old man.

C. hominis

is a microaerophilic, pleomorphic Gram-negative bacillus and member of the

Haemophilus

species,

Aggregatibacter actinomycetemcomitans

,

C. hominis

,

Eikenella corrodens

and

Kingella kingae

(HACEK) group, a group of bacteria known to be a rare cause of endocarditis. With prompt diagnosis and initiation of antimicrobial and surgical management, a successful outcome was achieved.
Repertoire of morphable proteins in an organism
Authors: Izumi Keisuke , Saho Eitaro , Kutomi Ayuka , Tomoike Fumiaki , Okada Tetsuji
Published: August 2019

All living organisms have evolved to contain a set of proteins with variable physical and chemical properties. Efforts in the field of structural biology have contributed to uncovering the shape and the variability of each component. A set of experimental coordinates for a given protein can be used to define the “morphness/unmorphness”. Here we show the results of global analysis of more than a thousand E. coli proteins, demonstrating that it would be a comprehensive method of understanding the evolved repertoire in an organism. By collecting “UnMorphness Factor” (UMF) determined for each of the proteins, the lowest and the highest boundaries of the experimentally observable structural variation are understood. The distribution of UMFs obtained for an organism is expected to represent how rigid and flexible components are balanced. The present analysis extends to evaluate the growing data from single particle cryo-electron microscopy, providing valuable information on effective interpretation to structural changes of proteins and the supramolecular complexes. The data and the method presented here also conform to FAIR data principles, having potential significance to advance the field of structural and molecular cell biology.
TheMedicago truncatulaHKT family: Ion transport properties and regulation of expression upon abiotic stresses and symbiosis
Authors: Thouin Julien , Guo Man Yuan , Zribi Ikram , Pauly Nicolas , Mouradi Mohammed , Ghoulam Cherki , Sentenac Hervé , Véry Anne-Aliénor
Published: August 2019

Soil salinity is one of the most important abiotic stresses affecting plant growth. In legumes, symbiotic nitrogen fixation in nodules is affected by salt stress, and salinity tolerance is variable among species. Genes from the High affinity K+Transporter (HKT) family are known to play crucial roles in salt stress tolerance in different plant species. In legumes these transporters are still very poorly characterized.. Here we study the HKT transporter family from the model legumeMedicago trunacatula, which is moderately tolerant to salinity. The genome of this species comprises fiveHKTgenes, hereafter namedMtHKT1;1toMtHKT1;5. Phylogenetic analysis indicated that the MtHKT polypeptides belong to HKT subfamily 1. Three members (MtHKT1;2, MtHKT1;4andMtHKT1;5) of theMedicago truncatulafamily were cloned and expressed inXenopusoocytes. Their electrophysiological properties revealed a permeability 10 times higher for Na+than for K+and varying rectification properties. Expression analyses of the threeMtHKTgenes under different biotic and abiotic conditions suggested that MtHKT1;5 is the main transporter from this family in the root, the three genes sharing a decrease of expression in drought and salt stress conditions in non inoculated plants as well as plants inoculated with rhizobia. In the shoot, the three MtHKT would be present at similar levels independently on the applied stresses. Based on biomass and ion content analysis, the nodule appeared as the most sensitive organ to the applied salt and drought stresses. The level of expression of the threeMtHKTgenes was strongly decreased by both stresses in the nodule.
Time-lapse single-cell transcriptomics reveals modulation of histone H3 for dormancy breaking
Authors: Tsuyuzaki Hayato , Hosokawa Masahito , Arikawa Koji , Yoda Takuya , Okada Naoyuki , Takeyama Haruko , Sato Masamitsu
Published: August 2019

How quiescent cells break dormancy is a key issue in eukaryotic cells including cancer. Fungal spores, for example, remain quiescent for long periods until nourished, although the mechanisms by which dormancy is broken remain enigmatic. Transcriptome analysis could provide a clue, but methods to synchronously germinate large numbers of spores are lacking, and thus it remains a challenge to analyse gene expression upon germination. Hence, we developed methods to assemble transcriptomes from individual, asynchronous spore cells of fission yeast undergoing germination to assess transcriptomic changes over time. The virtual time-lapse analyses highlighted one of three copies of histone H3 genes for which transcription fluctuates during the initial stage of germination. Disruption of this temporal fluctuation caused defects in spore germination despite no visible defects in other stages of the life cycle. We conclude that modulation of histone H3 expression is a crucial ‘wake-up’ trigger at dormancy breaking.
Supervised-learning is an accurate method for network-based gene classification
Authors: Liu Renming , Mancuso Christopher A , Yannakopoulos Anna , Johnson Kayla A , Krishnan Arjun
Published: August 2019

Background

Assigning every human gene to specific functions, diseases, and traits is a grand challenge in modern genetics. Key to addressing this challenge are computational methods such as supervised-learning and label-propagation that can leverage molecular interaction networks to predict gene attributes. In spite of being a popular machine learning technique across fields, supervised-learning has been applied only in a few network-based studies for predicting pathway-, phenotype-, or disease-associated genes. It is unknown how supervised-learning broadly performs across different networks and diverse gene classification tasks, and how it compares to label-propagation, the widely-benchmarked canonical approach for this problem.

Results

In this study, we present a comprehensive benchmarking of supervised-learning for network-based gene classification, evaluating this approach and a state-of-the-art label-propagation technique on hundreds of diverse prediction tasks and multiple networks using stringent evaluation schemes. We demonstrate that supervised-learning on a gene’s full network connectivity outperforms label-propagation and achieves high prediction accuracy by efficiently capturing local network properties, rivaling label-propagation’s appeal for naturally using network topology. We further show that supervised-learning on the full network is also superior to learning on node-embeddings (derived using node2vec), an increasingly popular approach for concisely representing network connectivity.

Conclusion

These results show that supervised-learning is an accurate approach for prioritizing genes associated with diverse functions, diseases, and traits and should be considered a staple of network-based gene classification workflows. The datasets and the code used to reproduce the results and add new gene classification methods have been made freely available.

Contact

arjun@msu.edu
Brain-wide visual habituation networks in wild type and fmr1 zebrafish
Authors: Marquez-Legorreta Emmanuel , Constantin Lena , Piber Marielle , Favre-Bulle Itia A. , Taylor Michael A. , Vanwalleghem Gilles C. , Scott Ethan
Published: August 2019

Habituation is a form of learning during which animals stop responding to repetitive stimuli, and deficits in habituation are characteristics of several psychiatric disorders. Due to the technical challenges of measuring brain activity comprehensively and at cellular resolution, the brain-wide networks mediating habituation are poorly understood. Here we report brain-wide calcium imaging during visual learning in larval zebrafish as they habituate to repeated threatening loom stimuli. We show that different functional categories of loom-sensitive neurons are located in characteristic locations throughout the brain, and that both the functional properties of their networks and the resulting behavior can be modulated by stimulus saliency and timing. Using graph theory, we identify a principally visual circuit that habituates minimally, a moderately habituating midbrain population proposed to mediate the sensorimotor transformation, and downstream circuit elements responsible for higher order representations and the delivery of behavior. Zebrafish larvae carrying a mutation in the fmr1 gene have a systematic shift towards sustained premotor activity in this network, and show slower behavioral habituation. This represents the first description of a visual learning network across the brain at cellular resolution, and provides insights into the circuit-level changes that may occur in people with Fragile X syndrome and related psychiatric conditions.