bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Hospital Readmissions Through the Perspective of the Returning Emergency Department Patient
Authors: Campbell Denise , Ditkoff Jeffery 
Published: December 2019

Background and Objective:
Hospital readmissions have garnered attention over the last few years. The reasons are myriad, including penalties from the Centers for Medicare & Medicaid Services, as well as acknowledgment from hospitals that readmissions highlight failures in the treatment spectrum. The purpose of this project was to investigate patients' perspective of why they return to the emergency department (ED) within 30 days of discharge from the inpatient setting.

Methods:
A descriptive qualitative study was conducted in an attempt to elucidate causes of readmissions in our patient population. Detailed interviews of 80 patients who returned to the ED within 30 days of discharge were completed to determine patients' health status upon discharge, ability to obtain resources, and health status that prompted return for care.

Results:
Of the 80 patients who returned, 64 were admitted to the hospital. The median time from discharge to return was 13.4 days. Pain was the most common reason for return to the ED. Of the 80 patients, only 19 followed up with a physician prior to return.

Conclusions:
The data show that once patients return to the ED after discharge, it is very likely they will be admitted to the hospital. An intervention prior to the return to the ED is imperative.
Reusable Pulse Oximetry Sensors: A Cost-Saving Quality Improvement Project
Authors: Arciaga Zachary , Ackerman Annemaire , Justice Paula , Temple Angela , Whalen Madeleine 
Published: December 2019

Background:
In the setting of tightening health care budgets and capped payments, new strategies are needed to reduce waste while still providing quality and safe care. Transitioning from disposable supplies to reusable options is a viable approach to save money.

Objective:
To reduce the cost of the largest expense in the Adult Emergency Department's budget by 20% by transiting from disposable to reusable pulse oximetry sensors.

Methods:
We implemented an interdisciplinary quality improvement project using the Plan-Do-Study-Act cycle to reduce supply costs in an urban, academic emergency department with approximately 70 000 patient visits per year.

Results:
By switching to reusable supplies, we reduced the average cost of providing pulse oximetry readings by 56% and decreased budget estimates for supply acquisition by roughly $30 000 per month.

Conclusion:
This project represents a successful interdisciplinary approach to significantly reducing a large budgetary line item with concrete cost savings and highlights potential savings within reusable and disposable supply chains.
Autologous Fat Transplantation to Improve Lip Contour in Secondary Cleft Lip Deformity
Authors: Zheng Danning , Zhou Jia , Yu Li , Zhang Yifan , Wang Jian 
Published: December 2019

Abstract
The insufficient volume of lip is one of the pathological problems of cleft lip, despite that the cleft lip the muscles and skin are repositioned. Autologous fat is an ideal material for soft tissue repair, including correction of contour deformity, restoration of volume insufficient, and even improvement of tissue characteristics. In this study, the authors evaluated the result of fat grafting in improvement of lip contour in secondary cleft lip deformity. The authors performed a retrospective analysis of their series of patients who underwent lip fat grafting. A total of 65 subjects with lip fat grafting for cleft lip revision were recruited for the study. The photographs documented the original malformation and the posttreatment photographs. The authors recruited female and male raters, who were experts in the field or lay persons to form a panel of 12 raters altogether. Symmetry and aesthetics were improved after fat grafting based on vermillion border (P = 0.02), symmetry of lip (P = 0.007), and nasal profile including upper lip (P = 0.04) using a 1- to 5-point scale. After treatment, both sides of the lip are more symmetrical, the thickness of the filling part is significantly increased, the filling area is soft, the appearance is satisfied. Fat grafting is an efficient secondary procedure to improve lip contour after cleft lip repairs.
Submandibular Gland Surgery; Transoral Versus Conventional Transcervical Approach
Authors: Gülşen Secaattin , Ulutaş Saffet 
Published: December 2019

Introduction:
Transcervical approach (TCA) is a widely accepted method of surgery in submandibular gland (SMG) excision. The main purpose of the present study is to compare the surgical and functional outcomes of TCA and transoral approach (TOA) in SMG excision.

Methods:
The participants of this prospective study are 31 consecutive patients in whom SMG excision was performed via TOA (n = 14) and TCA (n = 17). Operative time, complications, hospitalization time, postoperative morbidities, and histopathological results were noted and compared between the groups. The numerical rating scale was used to grade the postoperative morbidities including, pain, eating and swallowing difficulty, and abnormal sense of tongue.

Results:
The number of females (n = 10) was higher than males (n = 4) in the TOA group due to aesthetic concerns. The average operative time of TOA group (85.3 ± 17.8 minutes) was significantly longer than the TCA group (40.8 ± 7.3 minutes), whereas the mean hospitalization time in TOA group (28.5 ± 4.6 hours) was remarkably shorter than TCA group (49.4 ± 6.9 hours). The mean pain scores were significantly less in the TOA group than the TCA group during the first 3 days postoperatively (P < 0.001). The mean numerical rating scale scores of eating and swallowing difficulty and abnormal sense of tongue were significantly higher in the TOA group compared to the TCA group postoperatively. There was no postoperative marginal mandibular nerve (MMN) dysfunction seen in the TAO group, whereas temporary dysfunction of MMN was observed in 3 (17.6%) patients in the TCA group.

Conclusion:
In selected patients, transoral SMG excision is an indisputable superior method in terms of MMN inadvertent injury risk, cosmetic results and postoperative pain compared to the conventional method of TCA in selected cases. Especially in young female patients with serious aesthetic concerns, excision of SMG via a TOA without any visible incision provides cosmetically excellent satisfactory results.
Surgical Site Infection Caused by Mycobacterium Septicum Following Blepharoplasty
Authors: Shin Hyojeong , Song Jong Keun , Hong Jeong-geun , Yoo Gyeol , Baek Sang Oon , Lee Jun Yong 
Published: December 2019

Background:

M fortuitum and M chelonae are commonly reported in surgical site infections caused by nontuberculous mycobacterium, but M septicum is rarely known. Herein, the authors report the first case of surgical site infection caused by M septicum in an immunocompetent patient after blepharoplasty.

Methods:
A 37-year-old woman had persisting bilateral masses on the upper eyelids at 3 months after a blepharoplasty. The excision and revision were performed in a local clinic with the administration of the empirical antibiotic (clarithromycin) for 2 months, but the masses recurred. The patient was referred to the authors’ hospital after the steroid was injected. As the right eyelid skin was very thin with the pus pocket, curettage was performed, while the mass on the left eyelid was completely excised. A bacterial, Acid Fast Bacilli culture with antibiotic susceptibility testing, and a DNA-polymerase chain reaction test were performed.

Results:
The polymerase chain reaction test identified M septicum. The antibiotic treatment was delayed to identify the susceptibility to antibiotics, but the Acid Fast Bacilli culture result showed no growth. In the meantime, the mass on the right eyelid recurred. Levofloxacin and clarithromycin were administered for 6 months in consultation with the Division of Infectious Diseases. Then the mass was excised. There was no recurrence after 1 year of follow-up.

Conclusion:
There are a few reports of M septicum catheter-related infection and pulmonary disease, but surgical site infection has not been reported. When a localized mass on a surgical site is found, surgeons should consider M septicum infection and find out the pathogen with its antibiotics susceptibility.
At what geographic scales does agricultural alienation amplify foodborne disease outbreaks? A statistical test for 25 U.S. states, 1970-2000
Authors: Okamoto Kenichi W. , Liebman Alex , Wallace Robert G. 
Published: December 2019

AbstractThe modern economy is driving multiple environmental and social crises across the globe. Capital accumulation externalizes the myriad damage associated with commodity production to ecosystems, labor, public health, and governments across jurisdictions. A growing literature shows multinational agriculture, a major sector of the economy, plays a fundamental role in disrupting the ecological cycles upon which communities across the globe depend. We report here one of the first statistical tests of such an ecosocial rift. We used geometric morphometrics to characterize a parameter space in agricultural alienation across nature, human welfare, and industrial appropriation for 25 U.S. states, at five-year increments between 1970 and 2000. The first two relative warps of the analysis reproduce the long-documented shift in and out of the 1980s farming crisis. We found the crisis left the U.S. food system in a new configuration, with commodity crops replacing cropland pasture, greater farm debt load, overcapitalized inputs, and a relative decline in on-farm wages. To determine if such a shift had an epidemiological impact, we tested whether salmonellosis and shigellosis—two foodborne pathogens for which national incidence data across the study period were available—regressed against historical changes in this alienation space across geographic scale. The second relative warp for shigellosis showed a multivariate relationship with the alienation space, but significance failed to withstand a Bonferroni correction. The partial warps and Procrustes residuals of temporal trends in the alienation space likewise exhibited limited predictive capacity for outbreak size. In part these results may reflect sampling artifacts. Data availability limits both the number of years sampled and the variety of diseases tested. Nevertheless, our analyses demonstrate that metabolic rifts associated with specific modes of production can be rigorously investigated.
A tool for browsing the Cancer Dependency Map reveals functional connections between genes and helps predict the efficacy and selectivity of candidate cancer drugs
Authors: Shimada Kenichi , Muhlich Jeremy L , Mitchison Timothy J 
Published: December 2019

SummaryIndividual cancers rely on distinct essential genes for their survival. The Cancer Dependency Map (DepMap) is an ongoing project to uncover gene dependency in hundreds of cancer cell lines. DepMap is a powerful drug discovery tool, but can be challenging to use without professional bioinformatics assistance. We combined CRISPR and shRNA screening data from DepMap and built a non-programmer-friendly browser (https://labsyspharm.shinyapps.io/depmap)that reports, for each gene, the growth reduction that can be expected on loss of a gene or inhibition of its action (efficacy) and the selectivity of this effect across cell lines. Cluster analysis revealed proteins that work together in pathways or complexes. This tool can be used to 1) predict the efficacy and selectivity of candidate drugs; 2) identify targets for highly selective drugs; 3) identify maximally sensitive cell lines for testing a drug; 4) target hop,i.e., navigate from an undruggable protein with the desired selectively profile, such as an activated oncogene, to more druggable targets with a similar profile; and 5) identify novel pathways needed for cancer cell growth and survival.
Public Perceptions of Artificial Intelligence and Robotics in Medicine
Authors: Stai Bethany , Heller Nick , McSweeney Sean , Rickman Jack , Blake Paul , Vasdev Ranveer , Edgerton Zach , Tejpaul Resha , Peterson Matt , Kalapara Arveen , Regmi Subodh , Papanikolopoulos Nikolaos , Weight Christopher 
Published: December 2019

ObjectiveTo understand better the public perception and comprehension with medical technology such as artificial intelligence and robotic surgery. Additionally, to identify sensitivity to, and comfort with, the use of AI and robotics in medicine a in order to ensure acceptability and quality of counseling and to guide future development.Subjects and MethodsA survey was conducted on a convenience sample of visitors to the Minnesota State Fair (n = 264). The survey investigated participant beliefs on the capabilities of AI and robotics in medicine and their comfort with such technology. Participants were randomized to receive one of two similar surveys. In the first a diagnosis was made by a physician and in the second by an AI application in order to compare confidence in human and computer-based diagnosis.ResultsThe median age of participants was 45 (IQR 28-59), 58% were female (n=154) vs. 42% male (n=110), 69% had completed at least a bachelor’s degree, 88% were Caucasian (n=233) vs. 12% ethnic minorities (n=31) and were from 12 states in the US with most from the Upper Midwest. Participants had nearly equal trust in AI vs. physician diagnoses, however, they were significantly more likely to trust an AI diagnosis of cancer over a doctor’s diagnosis when responding to the version of the survey that suggested an AI could make medical diagnosis (p = 9.32e-06). Though 55% of respondents (n=145) reported they were uncomfortable with automated robotic surgery the majority of the individuals surveyed (88%) mistakenly believed that partially autonomous surgery was already being performed. Almost all (94%) stated they would be willing to pay for an AI to review their medical imaging, if available.ConclusionMost participants express confidence in AI providing medical diagnoses, sometimes even over human physicians. Participants generally expressed concern with surgical AI, but mistakenly believe it is already happening. As AI applications make their way into medical practice, health care providers should be cognizant of patient misconceptions and the sensitivity that patients have to how such technology is represented.
Mutation of a PER2 phosphodegron perturbs the circadian phosphoswitch
Authors: Masuda Shusaku , Narasimamurthy Rajesh , Yoshitane Hikari , Kim Jae Kyoung , Fukada Yoshitaka , Virshup David M. 
Published: December 2019

AbstractCasein kinase 1 (CK1) plays a central role in regulating the period of the circadian clock. In mammals, PER2 protein abundance is regulated by CK1-mediated phosphorylation and proteasomal degradation. On the other hand, recent studies have questioned whether the degradation of the core circadian machinery is a critical step in clock regulation. Prior cell-based studies found that CK1 phosphorylation of PER2 at Ser478 recruits the ubiquitin E3 ligase β-TrCP, leading to PER2 degradation. Creation of this phosphodegron is regulated by a phosphoswitch that is also implicated in temperature compensation. However,in vivoevidence that this phosphodegron influences circadian period is lacking. Here, we generated and analyzed PER2-Ser478Ala knock-in mice. The mice showed longer circadian period in behavioral analysis. Molecularly, mutant PER2 protein accumulated in both the nucleus and cytoplasm of the mouse liver, whilePer2mRNA levels were minimally affected. Nuclear PER1, CRY1 and CRY2 proteins also increased, probably due to stabilization of PER2-containing complexes. In mouse embryonic fibroblasts derived from PER2-Ser478Ala::LUC mice, three-phase decay and temperature compensation of the circadian period was perturbed. These data provide directin vivoevidence for the importance of phosphorylation-regulated PER2 stability in the circadian clock and validate the phosphoswitch in a mouse model.
Rule adherence warps decision-making
Authors: Ebitz R. Becket , Tu Jiaxin Cindy , Hayden Benjamin Y. 
Published: December 2019

ABSTRACTWe have the capacity to follow arbitrary stimulus-response rules, meaning policies that determine how we will behave across circumstances. Yet, it is not clear how rules guide sensorimotor decision-making in the brain. Here, we recorded from neurons in three regions linked to decision-making, the orbitofrontal cortex, ventral striatum, and dorsal striatum, while macaques performed a rule-based decision-making task. We found that different rules warped the neural representations of chosen options by expanding rule-relevant coding dimensions relative to rule-irrelevant ones. Some cognitive theories suggest that warping could increase processing efficiency by facilitating rule-relevant computations at the expense of irrelevant ones. To test this idea, we modeled rules as the latent causes of decisions and identified a set of “rule-free” choices that could not be explained by simple rules. Contrasting these with rule-based choices revealed that following rules decreased the energetic cost of decision-making while warping the representational geometry of choice.SIGNIFICANCE STATEMENTOne important part of our ability to adapt flexibly to the world around us is our ability to implement arbitrary stimulus-response mappings, known as “rules”. Many studies have shown that when we follow a rule, its identity is encoded in neuronal firing rates. However, it remains unclear how rules regulate behavior. Here, we report that rules warp the way that sensorimotor information is represented in decision-making circuits: enhancing information that is relevant to the current rule at the expense of information that is irrelevant. These results imply that rules are implemented as a kind of attentional gate on what information is available for decision-making.
Dynamic representation of taste-related decisions in the gustatory insular cortex of mice
Authors: Vincis Roberto , Chen Ke , Czarnecki Lindsey , Chen John , Fontanini Alfredo 
Published: December 2019

SUMMARYResearch over the past decade has established the gustatory insular cortex (GC) as a model for studying how primary sensory cortices integrate multiple sensory, affective and cognitive signals. This integration occurs through time varying patterns of neural activity. Selective silencing of GC activity during specific temporal windows provided evidence for GC’s role in mediating taste palatability and expectation. Recent results also suggest that this area may play a role in decision making. However, existing data are limited to GC involvement in controlling the timing of stereotyped, orofacial reactions to aversive tastants during consumption. Here we present electrophysiological, chemogenetic and optogenetic results demonstrating the key role of GC in the execution of a taste-guided, reward-directed decision making task. Mice were trained in a taste-based, two-alternative choice task, in which they had to associate tastants sampled from a central spout with different actions (i.e., licking either a left or a right spout). Stimulus sampling and action were separated by a delay period. Electrophysiological recordings of single units revealed chemosensory processing during the sampling period and the emergence of task-related, cognitive signals during the delay period. Chemogenetic silencing of GC impaired task performance. Optogenetic silencing of GC allowed us to tease apart the contribution of activity during the sampling and the delay periods. While silencing during the sampling period had no effect, silencing during the delay period significantly impacted behavioral performance, demonstrating the importance of the cognitive signals processed by GC during this temporal window in driving decision making.Altogether, our data highlight a novel role of GC in controlling taste-guided, reward-directed choices and actions.
Cortical thickness and formal thought disorder in schizophrenia: An ultra high-field network-based morphometry study
Authors: Palaniyappan Lena , Al-Radaideh Ali , Gowland Penny A. , Liddle Peter F. 
Published: December 2019

AbstractBackgroundPersistent formal thought disorder (FTD) is a core feature of schizophrenia. Recent cognitive and neuroimaging studies indicate a distinct mechanistic pathway underlying the persistent positive FTD (pFTD or disorganized thinking), though its structural determinants are still elusive. Using network-based cortical thickness estimates from ultra-high field 7-Tesla Magnetic Resonance Imaging (7T MRI), we investigated the structural correlates of pFTD.MethodsWe obtained speech samples and 7T MRI anatomical scans from medicated clinically stable patients with schizophrenia (n=19) and healthy controls (n=20). Network-based morphometry was used to estimate the mean cortical thickness of 17 functional networks covering the entire cortical surface from each subject. We also quantified the vertexwise variability of thickness within each network to quantify the spatial coherence of the 17 networks, estimated patients vs. controls differences, and related the thickness of the affected networks to the severity of pFTD.ResultsPatients had reduced thickness of the frontoparietal and default mode networks, and reduced spatial coherence affecting the salience and the frontoparietal control network. A higher burden of positive FTD related to reduced frontoparietal thickness and reduced spatial coherence of the salience network. The presence of positive FTD, but not its severity, related to the reduced thickness of the language network comprising of the superior temporal cortex.ConclusionsThese results suggest that cortical thickness of both cognitive control and language networks underlie the positive FTD in schizophrenia. The structural integrity of cognitive control networks is a critical determinant of the expressed severity of persistent FTD in schizophrenia.
A multi-structural finite element model to simulate atomic force microscopy nanoindentation of single cells
Authors: Marcotti Stefania , Reilly Gwendolen C , Lacroix Damien 
Published: December 2019

AbstractSingle cell mechanical properties represent an increasingly studied descriptor for health and disease. Atomic force microscopy (AFM) has been widely used to measure single cell stiffness, despite its experimental limitations. The development of a computational framework to simulate AFM nanoindentation experiments could be a valuable tool to complement experimental findings. A single cell multi-structural finite element model was designed to this aim by using confocal images of bone cells, comprised of the cell nucleus, cytoplasm and actin cytoskeleton. The computational cell stiffness values were in the range of experimental values acquired on the same cells for nanoindentation of the cell nucleus and periphery, despite showing higher stiffness for the nucleus than for the periphery, oppositely to the average experimental findings. These results suggest it would be of interest to model different single cells with known experimental effective moduli to evaluate the ability of the computational models to replicate experimental results.