bluuebunny/crossref_metadata_2025_split huggingface dataset:
Debility Risk Model as a Predictor for Postsurgical Outcomes
Authors: Hanna Yousif , Nandra Kulvir , Kustera Christopher , Smith Jessica , Metzinger Matthew , Patel Kamini , Cowan Scott 
Published: December 2020

Background Decreased patient functional status is associated with higher rates of postoperative morbidity and mortality. The Vizient program recently implemented a debility risk model to identify patients with impaired functional status. We examined the relationship between this novel model and inpatient postsurgical outcomes in a large urban tertiary care center. Methods The Vizient database was accessed to compare surgical outcomes between patients coded with debility and patients without debility between January 2017 and December 2018. Data for each surgical specialty were obtained, and a chi-squared analysis was used to detect differences in readmission rates, mortality, and postoperative complications (defined by Vizient). These complications include pneumonia, postoperative infection, anesthesia complications, and shock. Results We found patients with debility have a higher mortality rate (3%) than patients without debility (2%) across all surgical specialties ( P = .0103). Patients with debility have a higher 30-day readmission rate (16%) than those without debility (8%) across all specialties ( P < .0001). Patients with debility had a higher rate of inpatient complications for neurosurgery (12.11% vs. 8%, P = .008), trauma surgery (11.9% vs. 6%, P =.025), general surgery (17.67% vs. 7%, P = .013), and cardiac surgery (47.06% vs. 18%, P =.0025). Conclusions Our study supports the use of the Vizient debility code to predict postsurgical outcomes and risk stratify patients. By extension, functional status assessments in preoperative evaluation of patients remain important. Further, studies can build upon this data to measure the impact of preoperative, outpatient debility assessments in surgical patients.
Tracheostomy in Patients on Venovenous Extracorporeal Membrane Oxygenation: Is It Safe?
Authors: Kelley Katherine M. , Galvagno Samuel M. , Wallis Marianne , Mazzeffi Michael A. , Deatrick Kristopher , Betzold Richard , Scalea Thomas , Menaker Jay 
Published: December 2020

Background The anticoagulation and coagulopathy associated with venovenous extracorporeal membrane oxygenation (VV-ECMO) lead to concern for increased risks of tracheostomy. The purpose of this study is to evaluate the safety of tracheostomy in patients on VV-ECMO. Methods Patients admitted between November 2015 and January 2019 to a dedicated intensive care unit for VV-ECMO were reviewed retrospectively. Results 96 patients underwent tracheostomy. Tracheostomy was performed percutaneously in 51 patients, open in 24, and hybrid in 21. 28 patients had postprocedure bleeding which was from the tracheostomy site in 13, the airway in 13, and both in 2. 6 patients had major tracheostomy site bleeding and 3 patients had major airway bleeding. 7 patients had minor tracheostomy site bleeding, 10 patients had minor airway bleeding, and 2 patients had minor bleeding at both. Bleeding complications were more common following percutaneous tracheostomy. Being on anticoagulation prior to tracheostomy was protective. Discussion Bleeding following tracheostomy in VV-ECMO is common with higher bleeding rates observed for those done percutaneously. Most complications were minor. Tracheostomy in patients on VV-ECMO appears safe
Protocol of a Multi-centric Randomized Controlled Trial to Evaluate Efficacy of Telephone-Based Psychosocial Interventions on Future Suicide Risk in Suicide Attempters
Authors: Beniwal Ram Pratap , Sreedaran Priya , Chari Uttara , Ashok MV  , Bhatia Triptish 
Published: December 2020

Background: Persons with previous history of a suicide attempt are at increased future risk of death by suicide. These vulnerable individuals, however, do not seek receive or seek help from mental health services. Telephone-based psychosocial interventions are potential strategies in augmenting mental health care in such persons. Methods: We aim to compare the efficacy of telephone-based psychosocial interventions (TBPI) with routine telephone reminders in persons with recent suicide attempts using a multi-site, parallel group, rater-blind, two-arm randomized controlled trial design in 362 participants. In the first group, participants will receive three sessions of TBPI comprising of brief supportive interventions, problem-solving strategies, and reminders for adherence to prescribed mental health treatment at weekly intervals. In the second group, participants will receive three telephone reminders for adherence to prescribed mental health treatment at weekly intervals. We will follow up participants for 6 months. Primary outcomes are suicidal ideation scores on Beck’s Scale for Suicide Ideation and number of repeat suicide attempts. Secondary outcomes are scores on Beck’s Hopelessness Scale, Beck’s Depression Inventory, Connor–Davidson Resilience Scale and Visual Analogue Rating Scales for acceptability of interventions. Outcomes will be assessed at 1, 3, and 6 months after receiving telephone interventions or reminders. Results: The trial is currently underway after prospective registration under Clinical Trials Registry of India and has recruited 260 participants till August 15, 2020. Conclusion: This study has potential to generate evidence on additional strategies for use along with standard mental health treatments in management of high-risk suicide behaviors.
Challenges of Building, Deploying, and Using AI-Enabled Telepsychiatry Platforms for Clinical Practice Among Urban Indians: A Qualitative Study
Authors: Thenral M  , Annamalai Arunkumar 
Published: December 2020

Background: Published literature shows the overall challenges associated with artificial intelligence (AI)-enabled medicine and telepsychiatry more from the western perspective, with no specific mention from the perspective of individual stakeholders or Indians. This study was conceptualized to understand the perceived challenges of building, deploying, and using AI-enabled telepsychiatry for clinical practice from the perspectives of psychiatrist, patients, and the technology experts (who build such services) in urban India. Methods: Between February 2020 and April 2020, a semistructured topic guide was drafted for qualitative exploratory study among psychiatrists ( n = 14), their patients ( n = 14), technology experts ( n = 13), and Chief Executive Officers (CEOs) ( n = 5) of health technology incubation centers. Interviews were conducted over the phone, recorded, and analyzed using the grounded theory approach. Results: Almost all respondents cited ethical, legal, accountability, and regulatory implications as challenges. The major issues stated by patients were privacy/confidentiality, ethical violations, security/ hacking, and data ownership. Psychiatrists cited lack of clinical validation, lack of established studies or trials, iatrogenic risk, and healthcare infrastructure issues as the main challenges. Technology experts stated data-related issues as the major challenge. The CEOs quoted the lack of interdisciplinary experts as one of the main challenges in building deployable AI-enabled telepsychiatry in India. Conclusions: There are challenges to deploy an AI-enabled telepsychiatry platform in India. There is a need to constitute an interdisciplinary team to systematically address these challenges. Deployment of AI-enabled telepsychiatry is not possible without clinical validation and addressing current challenges.
Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review
Authors: Broese Johanna MC , de Heij Albert H , Janssen Daisy JA , Skora Julia A , Kerstjens Huib AM , Chavannes Niels H , Engels Yvonne , van der Kleij Rianne MJJ 
Published: December 2020

Background: Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically. Aim: To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes. Design: Systematic review and narrative synthesis (PROSPERO CRD42017079962). Data sources: Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively. Results: Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients). Conclusion: Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.
Transient visual blurring during a sexual intercourse in a young woman with surgically corrected myopia and unrecognized pigmentary glaucoma: A rare case report
Authors: Cozzupoli G. M. , Salgarello T. , Giudiceandrea A. , Rizzo S. 
Published: December 2020

Purpose: To present a rare case of unilateral visual loss episodes occurred during sexual intercourse in a young patient affected by unrecognized pigmentary glaucoma and previously undergone myopic refractive surgery. Case description: The patient presented surgically flattened corneas and markedly asymmetric pigmentary glaucoma. Conclusions: Previous refractive surgery, sexual intercourse, and athletic lifestyle might be risk factors for acute pigment dispersion and chronic progression of pigmentary glaucoma in young myopic patients. During their ophthalmic examination prior to refractive surgery, greater attention should be paid to detect early signs of pigmentary dispersion, and awareness of these dangerous situations should be raised in affected patients.
Intraocular lens power calculation formula accuracy: Comparison of 12 formulas for a trifocal hydrophilic intraocular lens
Authors: Rocha-de-Lossada Carlos , Colmenero-Reina Elvira , Flikier David , Castro-Alonso Francisco-Javier , Rodriguez-Raton Alvaro , García-Madrona Jose-Luis , Peraza-Nieves Jorge , Sánchez-González José-María 
Published: December 2020

Purpose: To evaluate the accuracy of 12 intraocular lens (IOL) power formulas; Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hill-Radial Basis Function (RBF), Hoffer Q, Holladay I, Kane, Ladas Super Formula, Olsen Lenstar, Panacea, Pearl-DGS, Sanders-Retzlaff-Kraff/theoretical (SRK/T). In addition, an analysis of the efficacy as a function of the axial length was performed. Methods: About 171 from 93 patients: 68 male eyes and 103 female eyes. Twelve IOL power formula calculations were studied with one IOL platform (trifocal hydrophilic IOL, FineVision Micro F), one biometer (Lenstar LS 900), one topographer (CSO Sirius Topographer), one surgeon, and one optometrist. Optimization were determined to be zeroed mean refractive prediction error. Mean error (ME), mean absolute error (MAE), median absolute error (MedAE) and refractive accuracy within ±1.00 D was calculated. Axial length was split in short and medium eyes. Results: One hundred and seventy eyes were included. Formulas were ranked by percentage within ±0.50 diopters and MAE (D). Among all eyes, Olsen 86.55% (0.273 D) and Barrett Universal II 86.55% (0.285D). For short eyes (<22.5 mm), Olsen 90.70% (0.273 D) and Kane 90.70% (0.225 D). For medium eyes, Barrett 89.34% (0.237 D) and Pearl 86.89% (0.263 D). Conclusion: Olsen and Barrett formula obtained excellent accuracy for overall eyes. Kane and Olsen formula obtained the best results in short eyes. For medium axial length Barrett formula achieved the best accuracy results.
Biomagnification of ionizable organic compounds in rainbow trout Oncorhynchus mykiss
Authors: Mueller Carolin , Trapp Stefan , Polesel Fabio , Kuehr Sebastian , Schlechtriem Christian 
Published: December 2020

Abstract
Background
The assessment of persistence, bioaccumulation and toxicity (PBT) is part of the regulation process of ionic organic compounds (IOCs) and a major challenge, as a commonly acknowledged approach for the estimation of the bioaccumulation potential of IOCs is still missing. The goal of the present study was, therefore, to experimentally determine the bioaccumulation of fully ionized compounds and to identify screening parameters that can indicate high bioaccumulation potential of IOCs. Three feeding studies with rainbow trout (Oncorhynchus mykiss) were carried out according to OECD TG 305. Separation of liver, gastrointestinal tract (GIT) and carcass allowed to further elucidate the tissue distribution of the individual test substances. The chemicals chosen had characteristics that made them suspect for high bioaccumulation, and included two cations (tetrabutylphosphonium bromide (TBP), trimethyloctadecyl ammonium chloride (TMOA)) and four anions (benzotriazole, tecloftalam, pentachlorophenol (PCP), MEE-phosphonate). Data on the dietary biomagnification of IOCs (strong acids) were also collected from published literature.

Results
The highest distribution factors were found for the GIT, followed by liver. However, none of the tested IOCs showed a distinct biomagnification potential, as kinetic biomagnification factors (BMFk) ranged between 0.001 and 0.05 g/g (median 0.009 g/g). Cations showed lower assimilation efficiency (α) than anions, except for tecloftalam. In contrast, anions showed a considerably faster depuration rate (half-life less than 0.5 days) compared to cations (half-life of around 5 days). Sixteen potential screening parameters for BMF were calculated with a chemical property estimation tool (ACD/i-Lab) and correlated with the BMF data from this study and from literature. The number of hydrogen bond donors (nHBD) showed the highest correlation to measured BMF, but the prediction is only based on two values (one or two nHBD), while the other descriptors were insignificantly correlated.

Conclusion
The suspected dietary bioaccumulation potential of the six IOCs could not be confirmed in the feeding studies with rainbow trout. The more than twenty screening parameters showed no particularly high correlation neither with the test results nor with the BMF values collected from literature. The results corroborate earlier findings that ionization lowers the tendency of a chemical for dietary bioaccumulation, compared to non-ionized chemicals. In addition to the lipophobicity of ionic molecule moieties, fast depuration seems to be a major reason for the observed low dietary bioaccumulation of ionic compounds, in particular anions. Fast depuration may happen due to rapid metabolism of charged compounds, and future studies should test this hypothesis.
Heterologous expression of the atypical tetracycline chelocardin reveals the full set of genes required for its biosynthesis
Authors: Lukežič Tadeja , Pikl Špela , Zaburannyi Nestor , Remškar Maja , Petković Hrvoje , Müller Rolf 
Published: December 2020

Abstract
Background
Chelocardin (CHD) exhibits a broad-spectrum antibiotic activity and showed promising results in a small phase II clinical study conducted on patients with urinary tract infections. Importantly, CHD was shown to be active also against tetracycline-resistant Gram-negative pathogens, which is gaining even more importance in today’s antibiotic crisis. We have demonstrated that modifications of CHD through genetic engineering of its producer, the actinomycete Amycolatopsis sulphurea, are not only possible but yielded even more potent antibiotics than CHD itself, like 2-carboxamido-2-deacetyl-chelocardin (CD-CHD), which is currently in preclinical evaluation. A. sulphurea is difficult to genetically manipulate and therefore manipulation of the chd biosynthetic gene cluster in a genetically amenable heterologous host would be of high importance for further drug-discovery efforts.

Results
We report heterologous expression of the CHD biosynthetic gene cluster in the model organism Streptomyces albus del14 strain. Unexpectedly, we found that the originally defined CHD gene cluster fails to provide all genes required for CHD formation, including an additional cyclase and two regulatory genes. Overexpression of the putative pathway-specific streptomyces antibiotic regulatory protein chdB in A. sulphurea resulted in an increase of both, CHD and CD-CHD production. Applying a metabolic-engineering approach, it was also possible to generate the potent CHD analogue, CD-CHD in S. albus. Finally, an additional yield increase was achieved in S. albus del14 by in-trans overexpression of the chdR exporter gene, which provides resistance to CHD and CDCHD.

Conclusions
We identified previously unknown genes in the CHD cluster, which were shown to be essential for chelocardin biosynthesis by expression of the full biosynthetic gene cluster in S. albus as heterologous host. When comparing to oxytetracycline biosynthesis, we observed that the CHD gene cluster contains additional enzymes not found in gene clusters encoding the biosynthesis of typical tetracyclines (such as oxytetracycline). This finding probably explains the different chemistries and modes of action, which make CHD/CD-CHD valuable lead structures for clinical candidates. Even though the CHD genes are derived from a rare actinomycete A. sulphurea, the yield of CHD in the heterologous host was very good. The corrected nucleotide sequence of the CHD gene cluster now contains all gene products required for the production of CHD in a genetically amenable heterologous host, thus opening new possibilities towards production of novel and potent tetracycline analogues with a new mode of action.
The reversal of human phylogeny: Homo left Africa as erectus, came back as sapiens sapiens
Authors: Árnason Úlfur , Hallström Björn 
Published: December 2020

AbstractBackgroundThe molecular out of Africa hypothesis, OOAH, has been considered as an established fact amid population geneticists for some 25–30 years despite the early concern with it among phylogeneticists with experience beyond that ofHomo. The palaeontological support for the hypothesis is also questionable, a circumstance that in the light of expanding Eurasian palaeontological knowledge has become accentuated through the last decades.ResultsThe direction of evolution in the phylogenetic tree of modern humans (Homo sapiens sapiens,Hss) was established inter alia by applying progressive phylogenetic analysis to an mtDNA sampling that included a Eurasian, Lund, and the African Mbuti, San and Yoruba. The examination identified the African populations as paraphyletic, thereby compromising the OOAH. The finding, which was consistent with the out of Eurasia hypothesis, OOEH, was corroborated by the mtDNA introgression fromHssintoHsnn(Neanderthals) that demonstrated the temporal and physical Eurasian coexistence of the two lineages. The results are consistent with the palaeontologically established presence ofH. erectusin Eurasia, a Eurasian divergence betweenH. sapiensandH. antecessor≈ 850,000 YBP, anHsdivergence betweenHssandHsn(Neanderthals + Denisovans) ≈ 800,000 YBP, an mtDNA introgression fromHssintoHsnn* ≈ 500,000 YBP and an Eurasian divergence among the ancestors of extantHss≈ 250,000 YBP at the exodus of Mbuti/San into Africa.ConclusionsThe present study showed that Eurasia was not the receiver but the donor inHssevolution. The findings thatHomoleft Africa aserectusand returned assapiens sapiensconstitute a change in the understanding ofHsevolution to one that conforms to the extensive Eurasian record ofHspalaeontology and archaeology.
Rapid Sequence Induction With a Standard Intubation Dose of Rocuronium After Magnesium Pretreatment Compared With Succinylcholine: A Randomized Clinical Trial
Authors: Czarnetzki Christoph , Albrecht Eric , Masouyé Philippe , Baeriswyl Moira , Poncet Antoine , Robin Matthias , Kern Christian , Tramèr Martin R. 
Published: December 2020

BACKGROUND:
Succinylcholine remains the muscle relaxant of choice for rapid sequence induction (RSI) but has many adverse effects. High-dose rocuronium bromide may be an alternative to succinylcholine for RSI but recovery times are nearly doubled compared with a standard intubating dose of rocuronium. Magnesium sulfate significantly shortens the onset time of a standard intubating dose of rocuronium. We set out to investigate whether intravenous (IV) pretreatment with MgSO4 followed by a standard intubating dose of rocuronium achieved superior intubation conditions compared with succinylcholine.

METHODS:
Adults were randomized to receive a 15-minute IV infusion of MgSO4 (60 mg·kg–1) immediately before RSI with propofol 2 mg·kg–1, sufentanil 0.2 μg·kg–
1 and rocuronium 0.6 mg·kg–1, or a matching 15-minute IV infusion of saline immediately before an identical RSI, but with succinylcholine 1 mg·kg–1. Primary end point was the rate of excellent intubating conditions 60 seconds after administration of the neuromuscular blocking agent and compared between groups using multivariable log-binomial regression model. Secondary end points were blood pressure and heart rate before induction, before and after intubation, and adverse events up to 24 hours postoperatively.

RESULTS:
Among 280 randomized patients, intubating conditions could be analyzed in 259 (133 MgSO4-rocuronium and 126 saline-succinylcholine). The rate of excellent intubating conditions was 46% with MgSO4-rocuronium and 45% with saline-succinylcholine. The analysis adjusted for gender and center showed no superiority of MgSO4-rocuronium compared with saline-succinylcholine (relative risk [RR] 1.06, 95% confidence interval [CI], 0.81-1.39, P = .659). The rate of excellent intubating conditions was higher in women (54% [70 of 130]) compared with men (37% [48 of 129]; adjusted RR 1.42, 95% CI, 1.07-1.91, P = .017). No significant difference between groups was observed for systolic and diastolic blood pressures. Mean heart rate was significantly higher in the MgSO4-rocuronium group. The percentage of patients with at least 1 adverse event was lower with MgSO4-rocuronium (11%) compared with saline-succinylcholine (28%) (RR 0.38, 95% CI, 0.22-0.66, P < .001). With saline-succinylcholine, adverse events consisted mainly of postoperative muscle pain (n = 26 [19%]) and signs of histamine release (n = 13 [9%]). With MgSO4-rocuronium, few patients had pain on injection, nausea and vomiting, or skin rash during the MgSO4-infusion (n = 5 [4%]).

CONCLUSIONS:
IV pretreatment with MgSO4 followed by a standard intubating dose of rocuronium did not provide superior intubation conditions to succinylcholine but had fewer adverse effects.