bluuebunny/crossref_metadata_2025_split huggingface dataset:
The “Off-Hour Effect” in Urgent Laparoscopic Cholecystectomy for Acute Cholecystitis
Authors: Yoshioka Ryo , Tomimaru Yoshito , Noguchi Kozo , Noura Shingo , Imamura Hiroshi , Dono Keizo 
Published: October 2019

Background:
The observation that patients may have worse outcomes after urgent therapeutic interventions performed during off-hours compared with on-hours is termed the “off-hour effect.” This phenomenon has not been examined in urgent laparoscopic cholecystectomy (LC). Here we aimed to investigate the off-hour effect in urgent LC for acute cholecystitis.

Patients and Methods:
This study enrolled patients who underwent urgent LC for acute cholecystitis at our institution. On-hour LC was defined as a weekday operation starting between 9 am and 9 pm; and off-hour LC as an operation on a weekend, or starting between 9 pm and 9 am on a weekday. Patients were divided into on-hour and off-hour groups, and the operative outcomes of LC were compared between these groups.

Results:
The study included 371 patients, with 270 (72.8%) on-hour, and 101 (27.2%) off-hour operations. The 2 groups did not significantly differ in operation time, intraoperative blood loss, conversion rate to open surgery, incidence of postoperative complications, or duration of postoperative hospital stay.

Discussion:
Operative outcomes of urgent LC were comparable between the on-hour and off-hour groups, suggesting that there was no significant off-hour effect in urgent LC.
Epidemiology and Comorbidity Burden of Organ Donor Referrals in Australia: Cohort Study 2010–2015
Authors: Thomson Imogen K. , Rosales Brenda M. , Kelly Patrick J. , Wyburn Kate , Waller Karen M.J. , Hirsch Daniel , O’Leary Michael J. , Webster Angela C. 
Published: October 2019

Background.
Increasing organ donation rates in Australia have been exceeded by a rise in potential donor referrals not proceeding to donate. Referral evaluation is resource-intensive. We sought to characterize organ donor referrals in New South Wales, Australia, and identify predictors of referrals not proceeding to donation.

Methods.
We performed a cohort study of NSW Organ and Tissue Donation Service logs 2010–2015, describing the prevalence and impact of comorbidities on referral outcome. Logistic regression was used to identify comorbidities influencing outcome and predict probability of donation.

Results.
Of 2977 referrals, 669 (22%) donated and 2308 (78%) did not. Despite increasing donation rates, the proportion proceeding to donate declined 2010–2015. Among referrals, the prevalence of all comorbidities except cerebrovascular disease increased and was higher among nondonors. History of cardiac disease, ≥65 years of age, chronic kidney or liver disease, malignancy, and absence of cerebrovascular disease were all significantly (P < 0.01) associated with non donation. Hypertension and diabetes did not significantly impact outcome. Predicted probability of donation varied from <1% to 54% depending on comorbidity burden of the referral.

Conclusions.
Comorbidity burden among donor referrals is increasing. The presence of particular comorbidities may significantly impact referral outcome. A better understanding of referral characteristics associated with non donation may improve the efficiency of the referral process in the context of encouraging routine referrals.
Subjective Memory Complaints Are an Important Surrogate for Objective Cognitive Performance in African Americans
Authors: Boggess M. Bailee , Barber Justin M. , Jicha Gregory A. , Caban-Holt Allison 
Published: October 2019

Purpose:
Subjective memory complaints (SMCs) have been shown to be associated with lower neuropsychological test scores cross-sectionally. However, it remains unclear whether such findings hold true for African American (AA) older adults.

Methods:
Baseline visit data from the National Alzheimer’s Coordinating Center database collected from September 2005 to March 2018 were used. Generalized linear mixed models specifying binomial distributions were used to examine how neuropsychological test scores affect the likelihood of reporting SMCs.

Patients:
Inclusion criteria were participants who reported AA as their primary race, 60 to 80 years of age, were cognitively unimpaired, and had a Mini-Mental Status Examination score ≥26. A total of 1021 older AA adults without missing data met the criteria.

Results:
A total of 258 participants reported a SMC. SMCs were more likely with lower scores on measures of episodic memory and processing; however, SMCs were also more likely with higher scores on a measure of working memory. Working memory appeared to mediate reporting of SMC among participants with lower episodic memory scores.

Discussion:
These findings demonstrate that SMCs are associated with lower scores on objective neuropsychological measures among older AAs. Additional work is needed to determine whether SMCs are further associated with a risk for clinical transition to mild cognitive impairment or dementia among AA older adults.
High Prevalence of Social Cognition Disorders and Mild Cognitive Impairment Long Term After Stroke
Authors: Sensenbrenner Bénédicte , Rouaud Olivier , Graule-Petot Anny , Guillemin Sophie , Piver Ariane , Giroud Maurice , Béjot Yannick , Jacquin-Piques Agnès 
Published: October 2019

Purpose:
Social cognition disorders after stroke are poorly described. Yet, rehabilitation difficulties are frequent after stroke. This study aimed to evaluate the frequency of social cognition disorders 3 years after a first-ever stroke and to assess the factors associated with this condition. The second aim was to describe all the cognitive domains altered in the same population.

Methods:
Patients who suffered from a first-ever ischemic or hemorrhagic stroke underwent clinical and neuropsychological assessment, which included the mini-Social cognition and Emotional Assessment (SEA) for evaluating social cognition.

Results:
The 43 included patients were 67±15 years old, with a median Neurological Institute of Health Stroke Scale (NIHSS) (± interquartile range) at 0±1, and a median modified Rankin Scale (± interquartile range) at 1±1. Twenty patients (46.5%) had poor results in the facial emotions subtest; this factor was associated with a low educational grade (P=0.001). Fourteen patients (34.2%) had poor results on the “faux-pas” recognition subtest; this factor was associated with nonverbal episodic memory disorders (P=0.01). Thirty four patients (79.1%) had cognitive impairment, with at least 1 cognitive domain affected.

Conclusions:
The study demonstrates the high frequency of social cognition impairment 3 years after the first-ever stroke in young patients. Doctors and nurses should be sensitized to cognitive handicap after stroke because of difficulties for rehabilitation and returning to work.
Origins of Cerebral Edema: Implications for Spaceflight-Associated Neuro-Ocular Syndrome
Authors: Galdamez Laura A. , Brunstetter Tyson J. , Lee Andrew G. , Tarver William J. 
Published: October 2019

Background:
Spaceflight-associated neuro-ocular syndrome (SANS) was first described in 2011 and is associated with structural ocular changes found to occur in astronauts after long-duration missions. Despite multiple insufficient potential terrestrial models, an understanding of the etiology has yet to be described.

Evidence Acquisition:
A systematic review was conducted on literature published about the pathophysiology of cerebral edema. Databases searched include PubMed, Scopus, and the Texas Medical Center Online Library. This information was then applied to create theories on mechanisms on SANS etiology.

Results:
Cerebral edema occurs through 2 general mechanisms: redistribution of ions and water intracellularly and displacement of ions and water from the vascular compartment to the brain parenchyma. These processes occur through interconnected endocrine and inflammatory pathways and involve mediators such as cytokines, matrix metalloproteases, nitric oxide, and free radicals. The pathways ultimately lead to a violation of cellular membrane ionic gradients and blood–brain barrier degradation. By applying the principles of cerebral edema pathophysiology to the optic disc edema (ODE) see in SANS, several theories regarding its etiology can be formed. Venous stasis may lead to ODE through venous and capillary distension and leak, as well as relative hypoxia and insufficient ATP substrate delivery causing axoplasmic flow stasis and local oxidative stress.

Conclusions:
Using the pathophysiology of cerebral edema as a model, hypotheses can be inferred as to the etiology of ODE in SANS. Further studies are needed to determine the presence and contribution of local vascular stasis and resulting inflammation and oxidative stress to the pathophysiology of SANS.
Community gender systems and daughter’s risk of female genital mutilation/cutting: New theory and application to Egypt
Authors: Yount Kathryn M. , Cheong Yuk Fai , James-Hawkins Laurie , Grose Rose Grace , Hayford Sarah R. 
Published: October 2019

AbstractWe proposed and tested a feminist social-ecological theory about daughters’ experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15–49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. Contextual factors are important determinants of FGMC, but an integrated theory is lacking, and quantitative multilevel research is limited. We theorized that more favorable community-level gender systems, including gender norms opposing FGMCandexpanded opportunities for women outside of the family, would be associated with a daughter’s lower risk of FGMC and would strengthen the negative association of a mother’s opposition to FGMC with her daughter’s risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women’s opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems theory of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters may be needed for sustainable declines in the practice.
Targeting the centromedian thalamic nucleus for deep brain stimulation
Authors: Warren Aaron E.L , Dalic Linda J. , Thevathasan Wesley , Roten Annie , Bulluss Kristian J. , Archer John S. 
Published: October 2019

ABSTRACTObjectivesDeep brain stimulation (DBS) of the centromedian thalamic nucleus (CM) is an emerging treatment for multiple brain diseases, including the drug-resistant epilepsy Lennox-Gastaut syndrome (LGS). We aimed to improve neurosurgical targeting of the CM by (i) developing a structural MRI approach for CM visualisation, (ii) identifying the CM’s neurophysiological characteristics, and (iii) mapping connectivity from CM-DBS sites using functional MRI (fMRI).MethodsNineteen patients with LGS (mean age=28 years) underwent pre-surgical 3 tesla MRI using magnetisation-prepared 2 rapid acquisition gradient echoes (MP2RAGE) and fMRI sequences; 16 proceeded to bilateral CM-DBS implantation and intraoperative microelectrode recordings (MERs) from the thalamus. CM visualisation was achieved by highlighting intrathalamic borders on MP2RAGE using Sobel edge-detection. Mixed-effects analysis compared two MER features (spike firing rate, background noise) between ventrolateral, CM, and parafasicular nuclei. Resting-state fMRI connectivity was assessed using implanted CM-DBS electrode positions as regions-of-interest.ResultsThe CM appeared as a hyperintense region bordering the comparatively hypointense pulvinar, mediodorsal, and parafasicular nuclei. At the group-level, reduced spike firing and background noise distinguished CM from the ventrolateral nucleus; however, these trends were not found in 20-25% of individual MER trajectories. Areas of fMRI connectivity included basal ganglia, brainstem, cerebellum, sensorimotor/premotor and limbic cortex.ConclusionsIn the largest clinical trial cohort of LGS patients undergoing CM-DBS reported to date, we show that accurate targeting of the CM is achievable using 3 tesla MP2RAGE MRI. MERs may provide additional localising features in some cases, however their utility is limited by inter-patient variability. Therapeutic effects of CM-DBS may be mediated via connectivity with brain networks that support diverse arousal, cognitive, and sensorimotor processes.
An Environment-Wide Study of Adult Cognitive Performance in the 23andMe Cohort
Authors: Huang Yunru , Filshtein Teresa ,   the 23andMe Research Team, Gentleman Robert , Aslibekyan Stella 
Published: October 2019

AbstractBACKGROUNDWith the emergence of web-based data collection methods, large digital health cohorts offer the opportunity to conduct behavioral and epidemiologic research at an unprecedented scale. The size and breadth of such data sets enable discovery of novel associations across the phenotypic spectrum.METHODSWe deployed the digital symbol substitution test (DSST) online to consented 23andMe research participants 50-85 years of age. We tested cross-sectional associations between DSST performance and 824 phenotypes using linear regression models adjusted for age, sex, age*sex interaction, device, time of cohort entry, and ancestry, separately among discovery (n=144,786) and replication (n=93,428) samples; additional analyses further adjusted for education. We post-stratified association estimates on age, sex, and education to adjust for discrepancies across subsamples. Leveraging the rich genetic and phenotypic data available at 23andMe, we also estimated genetic and environmental correlations between DSST and its top correlates using linkage disequilibrium score regression.RESULTS97 phenotypes were significantly (false discovery rate < 0.05) and strongly (standardized effect size > |0.5|) associated with DSST performance in the discovery phase. Of those, 60 (38 with additional adjustment for education) demonstrated both statistical significance and consistent direction of association in the replication sample. The significantly associated phenotypes largely clustered into the following categories: psychiatric traits (e.g. anxiety, β per 1 SD = −0.74, P-value=3.9×10−169), education (e.g. highest math class completed, β per 1 SD = 2.11, P-value<1 × 10−300), leisure activities (e.g. solitary activities like puzzles, β per 1 SD = 1.85, P-value<1.0×10−300), social determinants (e.g. household income, β per 1 SD = 1.20, P-value= 8.9×10−245, and lifestyle (e.g. years smoked, β per 1 SD = −0.98, P-value= 2.2×10−78). We identified several reproducible genetic correlations between DSST and its top associated exposures (e.g. 0.48 for leisure activities like puzzles, 0.28 for years of education, and −0.24 for anxiety; all P ≤ 7.9×10−26). For almost all exposures, genetic correlations with DSST were considerably stronger than environmental correlations.CONCLUSIONSWe have conducted the largest study of cognitive performance to date, building evidence supporting its correlations with many social, lifestyle, and clinical exposures. We established that the observed associations are in part underpinned by shared genetic architecture. Our study illustrates the potential of large-scale digital cohorts to contribute to epidemiologic discovery.
Increasing Firearm Deaths in The Youngest Americans: Ecologic Correlation with Firearm Prevalence
Authors: Bleyer Archie , Siegel Stuart , Thomas Charles R. 
Published: October 2019

ABSTRACTBackgroundIn the United States (U.S.), the overall death rate in 1-4 year-olds had been steadily declining until 2011, after which it ceased to improve. To understand this trend reversal, we investigated trends in the causes of their deaths.MethodsMortality data were obtained from the U.S. Centers for Disease Control and Institute for Health Metrics and Evaluation, firearm background check data from the National Instant Criminal Background Check System, and civilian firearm prevalence from the Small Arms Survey.FindingsIn 1-4 year-olds, the rate of fatal firearm accidents during 2002-2017 increased exponentially at an average rate of 6.0%/year (p=0.0003). The rate of increase was the greatest of all evaluable causes of death in the age group. Both the rate increase and most recent absolute rate in firearm accidental deaths in young children were correlated with the concurrent corresponding rate of firearm background checks (p = 0.0002 and 0.003, respectively). Also, the firearm accidental death rate in countries with high civilian firearm prevalence was correlated with the number of guns per civilian population (p=0.002).InterpretationPrior to 2004, the childhood firearm death rate did not increase during the Federal Assault Weapons Ban. Since 2004 when the Ban ended, the steadily increasing rate of sales and concomitant availability of, and access to, firearms in the U.S. has been associated with an increase in fatal firearm accidents in its youngest children. The acceleration of firearm deaths and injuries among young Americans requires urgent, definitive solutions that address firearm prevalence.FundingNo external funding.KEY POINTSQuestionIn the U.S., how has the escalation of both firearm sales and firearm death rates affected the country’s youngest population?FindingsWhile the steadily increasing rate of sales and concomitant availability of, and access to, firearms in the U.S. has increased since 2004, fatal firearm accidents in 1 to 4 year-olds increased exponentially and at a rate greater than all other evaluable causes of death in the age group.InterpretationThe ominous acceleration of firearm deaths and injuries among young Americans requires urgent, definitive solutions from multiple stakeholders to effectively reduce firearm access.
Legionella pneumophilainfection and antibiotic treatment engenders a highly disturbed pulmonary microbiome with decreased microbial diversity
Authors: Pérez-Cobas Ana Elena , Ginevra Christophe , Rusniok Christophe , Jarraud Sophie , Buchrieser Carmen 
Published: October 2019

ABSTRACTBackgroundLung microbiome analyses have shown that the healthy lung is not sterile but it is colonized like other body sites by bacteria, fungi and viruses. However, little is known about the microbial composition of the lung microbiome during infectious diseases such as pneumonia and how it evolves during antibiotic therapy. To better understand the impact of the composition of the pulmonary microbiome on severity and outcome of pneumonia we analysed the composition and evolution of the human lung microbiome during pneumonia caused by the bacteriumLegionella pneumophila.ResultsWe collected 10 bronchoalveolar lavage (BAL) samples from three patients during long-term hospitalisation due to severe pneumonia and performed a longitudinal in-depth study of the composition of their lung microbiome by high-throughput Illumina sequencing of the 16S rRNA gene (bacteria and archaea), ITS region (fungi) and 18S rRNA gene (eukaryotes). We found that the composition of the bacterial lung microbiome during pneumonia is hugely disturbed containing a very high percentage of the pathogen, a very low bacterial diversity, and an increased presence of opportunistic microorganisms such as species belonging to Staphylococcaceae and Streptococcaceae. The microbiome of antibiotic treated patients cured from pneumonia represented a different perturbation state with a higher abundance of resistant bacteria (mainly Firmicutes) and a significantly different bacterial composition as that found in healthy individuals. In contrast, the mycobiome remains more stable during pneumonia and antimicrobial therapy. Interestingly we identified possible cooperation within and between both communities. Furthermore, archaea (Methanobrevibacter) and protozoa (AcanthamoebaandTrichomonas) were detected.ConclusionsBacterial pneumonia leads to a collapse of the healthy microbiome and a strongly disturbed bacterial composition of the pulmonary microbiome that is dominated by the pathogen. Antibiotic treatment allows some bacteria to regrow or recolonize the lungs but the restoration of a healthy lung microbiome composition is only regained a certain time after the antibiotic treatment. Archaea and protozoa should also be considered, as they might be important but yet overseen members of the lung microbiome. Interactions between the micro- and the mycobiome might play a role in the restoration of the microbiome and the clinical evolution of the disease.
The itch-scratch reflex generates protective immunity
Authors: Radjavi Ali , Lebeau Anna-Marie , Mcoy Henry P. 
Published: October 2019

AbstractItch: its complex neurobiology, its exquisite evolutionary conservation, and even the undeniably euphoric sensation of the scratch it evokes, are all suggestive of a productive physiological function. Nevertheless, we still struggle to answer (or altogether overlook) the basic question of why we itch in the first place. Here, we propose a simple hypothesis: the purpose of itch sensation is to evoke scratching behavior, which in turn boosts protective immunity against the broad range of pathogenic challenges that enter at the skin. We propose that the key function of itch induced scratching is to physically disrupt the skin, serving as a “mechanical adjuvant” that amplifies and directs immune responses to the precise site of potential pathogen entry. As proof of principle, we show that the potent adjuvanticity of itch inducing Compound 48/80 is dependent on this agent’s ability to elicit scratching behavior.
Topological inference from spontaneous activity structures in FMRI videos with peristence barcodes
Authors: Don Arjuna P.H. , Peters James F. , Ramanna Sheela , Tozzi Arturo 
Published: October 2019

AbstractSpatio-temporal brain activities with variable delay detectable in resting-state functional magnetic resonance imaging (rs-fMRI) give rise to highly reproducible structures, termed cortical lag threads, that can propagate from one brain region to another. Using a computational topology of data approach, we found that Betti numbers that are cycle counts and the areas of vortex cycles covering brain activation regions in triangulated rs-fMRI video frames make it possible to track persistent, recurring blood oxygen level dependent (BOLD) signals. Our findings have been codified and visualized in what are known as persistent barcodes. Importantly, a topology of data offers a practical approach in coping with and sidestepping massive noise in neuro data, such as unwanted dark (low intensity) regions in the neighbourhood of non-zero BOLD signals. A natural outcome of a topology of data approach is the tracking of persistent, non-trivial BOLD signals that appear intermittently in a sequence of rs-fMRI video frames. The end result of this tracking of changing lag structures is a persistent barcode, which is a pictograph that offers a convenient visual means of exhibiting, comparing and classifying brain activation patterns.