bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Patient Outcomes of Surgeons Who Are US Versus International Medical Graduates
Authors: Tsugawa Yusuke , Dimick Justin B. , Jena Anupam B. , Maggard-Gibbons Melinda , Blumenthal Daniel M. , Gross Nate , Jha Ashish K. 
Published: December 2019

Objective:
The aim of this study was to compare patient outcomes between International Medical Graduate (IMG) versus US medical graduate (USMG) surgeons.

Summary Background Data:
One in 7 surgeons practicing in the US graduated from a foreign medical school. However, it remains unknown whether patient outcomes differ between IMG versus USMG surgeons.

Methods:
Using 20% random sample of Medicare fee-for-service beneficiaries aged 65 to 99 years who underwent 1 of 13 common nonelective surgical procedures (as a “natural experiment” as surgeons are less likely to select patients in this context) in 2011 to 2014 (638,973 patients treated by 37,221 surgeons for the mortality analysis), we compared operative mortality, complications, and length of stay (LOS) between IMG and USMG surgeons, adjusting for patient and surgeon characteristics and hospital-specific fixed effects (effectively comparing IMG and USMG surgeons within the same hospital). We also conducted stratified analyses by patients’ severity of illness and procedure type.

Results:
We found no evidence that patient outcomes differ between IMG and USMG surgeons for operative mortality [adjusted mortality, 7.3% for IMGs vs 7.3% for USMGs; adjusted odds ratio (aOR), 1.01; 95% confidence interval (CI), 0.96–1.05; P = 0.79], complication rate (adjusted complication rate, 0.6% vs 0.6%; aOR, 0.95; 95% CI, 0.85–1.06; P = 0.43), and LOS (adjusted LOS, 6.6 days vs 6.6 days; adjusted difference, +0.02 days; 95% CI, −0.05 to +0.08; P = 0.54). We also found no difference when we stratified by severity of illness and procedures.

Conclusion:
Using national data of Medicare beneficiaries who underwent common surgical procedures, we found no evidence that outcomes differ between IMG and USMG surgeons.
Hospital-level Variation in the Management and Outcomes of Patients With Adhesive Small Bowel Obstruction
Authors: Behman Ramy , Karanicolas Paul J. , Nathens Avery , Gomez David 
Published: December 2019

Objective:
Determine the association between the rate of early operative management for adhesive small bowel obstruction (aSBO) at the hospital-level and the incidence of morbidity and mortality.

Background:
Mounting evidence of the benefits of early operation in patients with aSBO has translated to both an increase in the proportion of patients treated operatively, and the proportion of patients who undergo early operative management. However, variation in practice remains.

Methods:
We identified a population-based cohort of patients (18–80 years) who were admitted with their first episode of aSBO (2005–2014). The exposures of interest were hospital characteristics and the primary outcome measure was 30-day mortality. Hierarchical logistic regression models were used to evaluate hospital-level variation on 30-day mortality, serious complications, and bowel resection.

Results:
A total of 27,026 patients were admitted to 122 hospitals, 23% (n = 6090) were managed operatively, 7% (n = 1845) had a serious complication, and 30-day mortality was 4.2% (n = 1146). The proportion of patients managed with early operation ranged from 0% to 33% [median 10% (interquartile range: 5%–14%)]. There was a 17% lower likelihood of 30-day mortality for every 10% increase in proportion of patients managed with an early operation at the hospital-level (odds ratio: 0.83, 95% confidence interval: 0.70–0.99).

Conclusions:
Hospitals with a higher proportion of aSBO patients treated with an early operation had a lower likelihood of serious complications, bowel resection, and death, independent of hospital type and volume of aSBO admissions. Early operative intervention rates likely are a proxy for additional structures and processes of care focused on aSBO patients that may facilitate patient selection.
Time to Surgery and Colon Cancer Survival in the United States
Authors: Kaltenmeier Christof , Shen Chengli , Medich David S. , Geller David A. , Bartlett David L. , Tsung Allan , Tohme Samer 
Published: December 2019

Purpose:
Time to surgery (TTS) is of concern to patients diagnosed with cancer and their physicians. Controversy surrounds the impact of TTS on colon cancer survival. There are limited national data evaluating the association; thus, our aim was to estimate the overall survival (OS) impact from increasing TTS for patients with colon cancer.

Methods:
Using the National Cancer Data Base (NCDB), we assessed OS as a function of time between diagnosis and surgery by evaluating intervals encompassing <7, 7 to 30, 31 to 60, 61 to 90, 91 to 120, and 121 to 180 days in length. All patients were diagnosed with nonmetastatic colon cancer and underwent surgery as initial treatment. Our main outcome was OS as a function of time between diagnosis and surgery, after adjusting for patient, demographic, and tumor-related factors using Cox regression models and propensity score-based weighting.

Results:
A total of 514,103 patients diagnosed between 1998 and 2012 were included. Individuals having <7, 7 to 30, 31 to 60, 61 to 90, 91 to 120, and 121 to 180 days between diagnosis and surgery comprised 35.4%, 45%, 15.1%, 2.9%, 1%, and 0.6% of the patients, respectively. There was a steady increase in median TTS across the years. On multivariable analysis, TTS >30 days or within the first week independently increased mortality risk. There was a significant increase in mortality with TTS 31 to 60 [hazard ratio (HR) 1.13], 61 to 90 (HR 1.49), <7 (HR 1.56), 91 to 120 (HR 2.28), and 121 to 180 (HR 2.46) compared to surgery performed 7 to 30 days after diagnosis (P < 0.001).

Conclusions:
TTS is independently associated with OS and this represents a public health issue that should be addressed at a national level. Although time is required for evaluation before surgery, efforts to reduce TTS should be pursued.
Planning sEEG implantation using automated lesion detection: retrospective feasibility study
Authors: Wagstyl Konrad , Adler Sophie , Pimpel Birgit , Chari Aswin , Seunarine Kiran , Lorio Sara , Thornton Rachel , Baldeweg Torsten , Tisdall Martin 
Published: December 2019

AbstractObjectiveA retrospective, cross-sectional study to evaluate the feasibility and potential benefits of incorporating deep-learning on structural MRI into planning stereoelectroencephalography (sEEG) implantation in paediatric patients with diagnostically complex drug-resistant epilepsy. This study aims to assess the degree of co-localisation between automated lesion detection and the seizure onset zone (SOZ) as assessed by sEEG.MethodsA neural network classifier was applied to cortical features from MRI data from three cohorts. 1) The network was trained and cross-validated using 34 patients with visible focal cortical dysplasias (FCDs). 2) Specificity was assessed in 20 paediatric healthy controls. 3) Feasibility for incorporation into sEEG implantation plans was evaluated in 38 sEEG patients. Coordinates of sEEG contacts were coregistered with classifier-predicted lesions. sEEG contacts in seizure onset and irritative tissue were identified by clinical neurophysiologists. A distance of <10mm between SOZ contacts and classifier-predicted lesions was considered co-localisation.ResultsIn patients with radiologically-defined lesions, classifier sensitivity was 74% (25/34 lesions detected). No clusters were detected in the controls (specificity 100%). Of 34 sEEG patients, 21 patients had a focal cortical SOZ. Of these there was co-localisation between classifier output and SOZ contacts in 62%. The algorithm detected 7/8 histopathologically-confirmed FCDs (86%).ConclusionsThere was a high degree of co-localisation between automated lesion detection and sEEG. We have created a framework for incorporation of deep-learning based MRI lesion detection into sEEG implantation planning. Our findings demonstrate that automated MRI analysis could be used to plan optimal electrode trajectories.
Imagination exercises improve language in younger but not in older children with autism suggesting a strong critical period
Authors: Vyshedskiy Andrey , Khokhlovich Edward , Dunn Rita , Faisman Alexander , Elgart Jonah , Lokshina Lisa , Gankin Yuriy , Ostrovsky Simone , deTorres Lauren , Edelson Stephen M , Ilyinskii Petr O 
Published: December 2019

AbstractImagination exercises administered by caregivers were investigated in a three-year-long observational trial of 3,540 children with autism aged 2-12 years. Tablet-based verbal and nonverbal exercises modeled on language therapy and emphasizing mental-juxtaposition-of-objects were organized into an application called Mental Imagery Therapy for Autism (MITA). MITA-exposed children were matched to the ‘Treatment-as-Usual’ participants (TaU, N=5,222) by age, gender, language, sociability, cognitive awareness, health, and ASD severity at baseline. Both younger (2-5 years-of-age) and older children (5-12 YOA) in MITA and TaU groups improved their symptoms over time, but younger MITA-exposed children showed 2.3-fold improvement in language score at the end of the trial vs. TaU group. There was no difference between MITA and TaU in the older children group, supporting Lenneberg’s critical period hypothesis.
Industry ties and evidence in public comments on the FDA framework for modifications to artificial intelligence/machine learning-based medical devices: a cross sectional study
Authors: Smith James A , Abhari Roxanna E , Hussain Zain U , Heneghan Carl , Collins Gary S , Carr Andrew J 
Published: December 2019

AbstractObjectivesTo determine the extent and disclosure of financial ties to industry and use of scientific evidence in comments on a US Food and Drug Administration (FDA) regulatory framework for modifications to artificial intelligence/machine Learning (AI/ML)-based software as a medical device (SaMD).DesignCross-sectional study.SettingWe searched all publicly available comments on the FDA “Proposed Regulatory Framework for Modifications to Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD) - Discussion Paper and Request for Feedback” from April 2nd 2019 to August 8th 2019.Main outcome measuresThe proportion of articles submitted by parties with financial ties to industry, disclosing those ties, citing scientific articles, citing systematic reviews and meta-analyses, and using a systematic process to identify relevant literature.ResultsWe analysed 125 comments submitted on the proposed framework. 79 (63%) comments came from parties with financial ties; for 36 (29%) comments it was not clear and the absence of financial ties could only be confirmed for 10 (8%) comments. No financial ties were disclosed in any of the comments that were not from industry submitters. The vast majority of submitted comments (86%) did not cite any scientific literature, just 4% cited a systematic review or meta-analysis, and no comments indicated that a systematic process was used to identify relevant literature.ConclusionsFinancial ties to industry were common and undisclosed and scientific evidence, including systematic reviews and meta-analyses, were rarely cited. To ensure regulatory frameworks best serve patient interests, the FDA should mandate disclosure of potential conflicts of interest (including financial ties), in comments, encourage the use of scientific evidence and encourage engagement from non-conflicted parties.Strengths and limitations of this study-We analysed the extent of financial ties to industry and the use of scientific evidence in comments on the proposed FDA framework-We used a comprehensive strategy to attempt to identify financial ties to industry-Readers may be able to contribute higher quality comments to subsequent drafts of this framework-There is heterogeneity in the degree of conflict with respect to the framework that the recorded financial ties may represent; some ties will be more likely than others to result in biased commenting-Because the framework could not be classified as pro-industry or not, we did not classify the direction of opinions expressed in comments with respect to the framework and their association with financial ties-We do not know how information submitted to FDA is used internally in the rule-making process
Novel Variants in COL4A3 and COL4A4 are Causes of Alport Syndrome in Rio Grande do Norte, Brazil
Authors: de Araújo Washington Candeia , Falcão Raul Maia , Uchoa Raquel , Garcia Carlos Alexandre , de Souza Jorge Estefano S. , Jeronimo Selma M. B. 
Published: December 2019

AbstractBackgroundAlport syndrome is a progressive and hereditary nephropathy, characterized by hematuria and proteinuria, and extrarenal manifestations as hearing loss and eye abnormalities. The disease can be expressed as autosomal recessive or dominant, caused by variants in COL4A3 and COL4A4 loci, respectively, or X-linked caused by variants in COL4A5 locus.MethodsTwo unrelated families with Alport Syndrome from northeast of Brazil were studied and whole exome sequencing were performed. DNA sequences were mapped against the human genome (GRCh38/hg38 build) to identify associated mutations.ResultsVariant analysis showed deleterious variants in COL4A3 and COL4A4 loci in chromosome 2. Two variants were detected with alternative alleles in a homozygous state in the probands. One novel premature stop codon at position 481 of COL4A3 protein is present in one family and one frameshift mutation leading to a premature stop codon at position 786 of COL4A4 protein in the other family. Both Alport cases presented their variants surrounded by a broad runs of homozygosity (ROH).ConclusionsThe autosome recessive inheritance coupled with the runs of homozygosity in both families suggest inbreeding.
A review of factors associated with patterns of drinking during pregnancy
Authors: McKeague Mark , Norton Sam , Canfield Martha 
Published: December 2019

Purpose
The purpose of this paper is to identify factors associated with drinking patterns during pregnancy.

Design/methodology/approach
A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge.

Findings
In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking.

Research limitations/implications
Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context.

Originality/value
The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.
Millennial generation preferences for rosé wine
Authors: Iazzi Antonio , Scorrano Paola , Rosato Pierfelice , Grandhi Balakrishna 
Published: December 2019

Purpose
The purpose of this paper is to verify the preferences for the purchase of rosé wine by Italian and French Millennials, with the aim of allowing Italian companies to acquire knowledge in improving the positioning of this product in both the Italian and French markets.

Design/methodology/approach
The study involved a descriptive survey conducted between December 2018 and January 2019 on Millennials residing in Italy and France, intercepted via Facebook. In total, 500 valid responses to a highly structured self-administered questionnaire were collected. Descriptive and multivariate analysis techniques were used to examine the responses.

Findings
The two groups of Millennials show different preferences in the purchase of rosé wine. French Millennials rarely buy the product, and perhaps only for reasonable prices. Their purchasing process involves no characteristics of particular importance. On the other hand, Italian Millennials buy the product with a higher frequency and show a greater propensity to spend. In general, they attribute greater importance (though not a great deal of importance) to the characteristics of the product, paying attention to both its intrinsic aspects and its territorial origin and the quality certifications.

Research limitations/implications
The main limitation of the research is the small sample size. Future insights into the consumption of rosé wine will be sought in other significant European markets.

Practical implications
This study is of value to academic researchers, wine industry practitioners and other members of the wine distribution channel, as it provides insights into consumer behavior differences.

Originality/value
This research is the first to compare rosé wine preferences of Millennials in France and Italy.
Sustainability reporting and firm’s performance
Authors: Buallay Amina 
Published: December 2019

PurposeThe purpose of this paper is to provide a comparison between manufacturing and banking sectors with regards to the level of sustainability reporting (environmental, social and governance (ESG)) and its impact on operational, financial and market performance.Design/methodology/approachThe research is quantitative, based on pooled data analysis of 932 manufactures and 530 banks listed on 80 countries for ten years from 2008 to 2017 ending up with 11,705 observations. A multivariate model is used to investigate the impact of sustainability reporting (ESG) on a firm’s performance. The theoretical model is built on agency, legitimacy, resources and stakeholders’ theories. The practical model is built on independent variable (ESG) and the dependent variables (return on assets, return on equity and Tobin’sQ).FindingsThe findings deduced from the empirical results on one hand demonstrated that ESG positively affect the operational, financial and market performance in the manufacturing sector. However, on the other hand, the ESG negatively affect the operational, financial and market performance in the banking sector.Originality/valueThis research makes a contribution to the scarce literature and compares the level of sustainability reporting and its impact on performance in both the manufacturing and banking sector which are two of the major and important sectors in the global financial markets.
Risk management integration and supply chain performance in ISO 9001-certified and non-certified firms
Authors: Dellana Scott , Kros John F. , Falasca Mauro , Rowe William J. 
Published: December 2019

PurposeThe purpose of this paper is to explore the mediating effect of supply chain risk management integration (RMI) on the relationship between supply chain logistics performance (LP) and supply chain cost performance (CP), as well as on the relationship between LP and supply chain service performance (SP). The impact of CP and SP on overall firm performance (FP) is also explored. ISO 9001-certified firms and non-certified firms are assessed to determine whether superior risk-based thinking, as required in the latest ISO 9001 standard, has a positive impact on the different relationships.Design/methodology/approachA theoretical model is developed and tested based on the participation of 140 supply chain managers. The proposed structural equation model positively relates LP, RMI, CP and SP. RMI is positively linked to CP and SP, while CP and SP are positively related to overall FP. Two subsamples (a group of 63 ISO 9001-certified firms and a group of 77 non-certified firms) are used to evaluate the model.FindingsFor certified and non-certified firms, LP is positively related to RMI, CP and SP, and SP and CP are positively related to FP. However, for certified firms, RMI partially mediates the relationship of LP with both CP and SP, while for non-certified firms, RMI does not mediate these relationships. The findings suggest that ISO 9001-certified firms are able to leverage RMI efforts to impact positively on supply chain performance, whereas non-certified firms are not.Research limitations/implicationsThe study findings are based on the perceptions of managers. Even though the majority of the 63 certified firms included in this study were ISO 9001:2015 certified, the model results do not differentiate between companies certified to the 2008 version of the standard and the 2015 version (which specifically requires demonstration of risk-based thinking).Practical implicationsThis study suggests that ISO 9001 provides a framework for risk management processes and collaboration with supply chain partners to positively impact the relationship of LP with cost and SP.Originality/valueThis is one of the first studies to characterize the benefits of using a structured approach for risk-based thinking that is associated with ISO 9001.
Effect of probiotic consumption on increasing the CD4+ T cell counts among Iranian patients living with HIV
Authors: Emadi-Koochak Hamid , Siami Zeinab , zebardast Jayran , SeyedAlinaghi SeyedAhmad , Asadollahi-Amin Ali 
Published: December 2019

PurposeDuring the ART era, persistent immune activation remains a significant challenge in people living with HIV (PLWH). Microbial translocation play an essential role in this setting. Probiotics have several immunological benefits which can reverse this process. The purpose of this paper is to investigate the safety and efficacy of probiotics on CD4 counts among Iranian PLWH.Design/methodology/approachIn total, 50 PLWH with CD4 counts above 350 cells/mm3did not receive ART participated in a randomized, double-blind trial and underwent 24 weeks of treatment with either LactoCare® or placebo twice daily. CD4 counts of the patients were measured at baseline, 12 weeks and 24 later in the two groups. Side effects were measured monthly using a specific checklist.FindingsThe mean CD4 count of the patients showed a significant difference between the two groups after six months. Through six months follow up, the mean CD4 count of the patients showed a significant reduction as compared to the baseline in the placebo group; however, it did not show a significant difference in the probiotic group. Repeated Measures Anova test showed a significant effect for time × treatment interaction on the CD4 count during the trial course. No significant difference between the two groups concerning adverse events was reported.Originality/valueIt seems the use of probiotics in PLWH with a CD4 count above 350 cells/mm3who are not receiving antiretroviral drugs is safe and can reduce the devastating process of CD4+ T cells in these patients.