bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facility Variation in Troponin Ordering Within the Veterans Health Administration
Authors: Chui Philip W. , Esserman Denise , Bastian Lori A. , Curtis Jeptha P. , Gandhi Parul U. , Rosman Lindsey , Desai Nihar , Hauser Ronald G. 
Published: October 2020

Background:
Current United States guidelines recommend troponin as the preferred biomarker in assessing for acute coronary syndrome, but recommendations are limited about which patients to test. Variations in troponin ordering may influence downstream health care utilization.

Methods:
We performed a cross-sectional analysis of 3,308,131 emergency department (ED) visits in all 121 acute care facilities within the Veterans Health Administration from 2015 to 2017. We quantified the degree to which case mix and facility characteristics accounted for variations in facility rates in troponin ordering. We then assessed the association between facility quartiles of risk-adjusted troponin ordering and downstream resource utilization [inpatient admissions, noninvasive testing (stress tests, echocardiograms), and invasive procedures (coronary angiograms, percutaneous coronary interventions, and coronary artery bypass grafting surgeries)].

Results:
The proportion of ED visits with troponin orders ranged from 2.2% to 64.5%, with a median of 37.1%. Case mix accounted for 9.5% of the variation in troponin orders; case mix and differences in facility characteristics accounted for 34.6%. Facilities in the highest quartile of troponin ordering, as compared with those in the lowest quartile, had significantly higher rates of inpatient admissions, stress tests, echocardiograms, coronary angiograms, and percutaneous coronary intervention.

Conclusions:
Significant variation in troponin utilization exists across Veterans Health Administration facilities and that variation is not well explained by case mix alone. Facilities with higher rates of troponin ordering were associated with more downstream resource utilization.
Pediatric Feeding Disorder in Children With Short Bowel Syndrome
Authors: Christian Vikram J. , Van Hoorn Megan , Walia Cassandra L.S. , Silverman Alan , Goday Praveen S. 
Published: October 2020

ABSTRACTObjective:We aimed to characterize the prevalence of pediatric feeding disorder (PFD) in short bowel syndrome (SBS) and study factors contributing to the persistence of PFD.Methods:Single‐center retrospective study of patients diagnosed with SBS at age 6 months or younger. Data were collected in 3‐month intervals through age 2 years, and every 6 months through age 4 years. Demographic information, anthropometric data, and details regarding nutrition support were recorded and analyzed.Results:We reviewed 28 patients. Of the 21 patients who were weaned off parenteral nutrition, 57.1%, 81.0%, 90.5%, and 100.0% achieved this by 12, 24, 36, and 48 months of age, respectively. Of the 13 patients who were weaned off enteral nutrition, 30.8%, 69.2%, 76.9%, and 100.0% achieved this by 12, 24, 36, and 48 months, respectively.Discussion:The prevalence of PFD was 100.0%, 76.5%, 68.8%, and 70.0% at 1, 2, 3, and 4 years of age, respectively. All patients who exhibited resolution of PFD had an underlying etiology of necrotizing enterocolitis. Median small bowel percentage remaining was greater in patients who exhibited resolution of PFD compared to those who did not. Except for the group of patients seen at 4 years of age, a larger percentage of patients with vomiting/history of requirement of postpyloric feeds were seen among patients with PFD compared to those without PFD.Conclusion:PFD is prevalent in children with SBS. Although prevalence decreases over time, children with PFD will continue to require more medical attention than children that do not.
Genomic Study of Chinese Quadruple-negative GISTs Using Next-generation Sequencing Technology
Authors: Wang Si , Sun Rui-Ze , Han Qiang , Wang Si-Yao , Wang En-Hua , Liu Yang 
Published: October 2020

Purpose:
Approximately 10% of gastrointestinal stromal tumors (GISTs) are devoid of KIT, PDGFRA (platelet-derived growth factor-alpha), BRAF, and SDH alterations. The aim of this study was to characterize molecular drivers in Chinese patients with quadruple-negative GISTs.

Patients and Methods:
In 1022 Chinese patients with GIST, mutations of KIT and PDGFRA were analyzed by direct sequencing. Of these mutations, 142 KIT/PDGFRA wild-type (WT) GISTs were detected, and succinate dehydrogenase (SDH) deficiency was determined using immunohistochemistry analysis of succinate dehydrogenase B. In 78 KIT
WT/PDGFRA
WT/SDH
WT cases, we performed targeted 425 cancer-related gene analysis using next-generation sequencing. The correlation between molecular findings and clinicopathologic features was also analyzed.

Results:
We defined 72 quadruple-negative GISTs from enrollments. They featured nongastric localization with histologic characteristics of spindle cells and male predilection. An overall 27.78% (20/72) of quadruple-negative tumors carried TP53, and 25.00% (18/72) carried RB1 mutations, which were frequently associated with high mitotic index and large size. TP53 analyses demonstrated coexistence with mutational activation of other oncogenes in 12 of 20 cases. A total of 18 RB1-mutated cases were independent of TP53. Further, no tumors carried NF1 and BRAF mutations.

Conclusions:
We report the genomic analysis of Chinese quadruple-negative patients. These databases may help advance our understanding of quadruple-negative GISTs’ progression. Next-generation sequencing from GISTs is feasible to provide relevant data for guiding individualized therapy.
Burnout and Resiliency Trends in Pediatric Emergency Medicine Fellows
Authors: Zargham Shiva , Rominger Annie 
Published: October 2020

Objective
Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing.

Methods
A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed.

Results
There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score.

Conclusions
This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.
Rehabilitation of a Post–Intensive Care Unit Patient After Severe COVID-19 Pneumonia
Authors: Ramalingam Mothi Babu , Huang Youyi , Lim Peter A. C. 
Published: October 2020

Abstract
The recent novel severe acute respiratory syndrome coronavirus 2 infection resulted in a coronavirus disease 2019 pandemic that significantly strained healthcare systems globally. The early wave of patients in Singapore with severe pneumonia requiring intensive care units are gradually being referred for post–critical illness management with our inpatient medical rehabilitation unit. There is growing information regarding the actual rehabilitation process for patients severely affected by coronavirus disease 2019. This case report shares experiences and challenges faced during rehabilitation of severe coronavirus disease 2019 pneumonia and post–intensive care syndrome. It also describes the post–discharge rehabilitation program in a setting of strict nationwide safe distancing and stay-home policies.
Unilateral Hypoglossal Nerve Palsy as a COVID-19 Sequel
Authors: Costa Martins Daniela , Branco Ribeiro Sofia , Jesus Pereira Isabel , Mestre Susana , Rios Jonathan 
Published: October 2020

Abstract
Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2 is spreading around the world, and the outbreak continues to escalate. Recently, it has been noticed that besides the typical respiratory complications, some severely affected coronavirus disease 2019 patients also experience neurological manifestations. Here, we describe the case of a newly diagnosed unilateral hypoglossal nerve palsy in a severe coronavirus disease 2019 patient. The intubation procedure was uneventful, and magnetic resonance imaging excluded the most reported causes of isolated hypoglossal nerve injury. This case reports a rare condition. Although a reasonable doubt remains, it cannot be excluded that it may be a neurological manifestation of severe acute respiratory syndrome coronavirus 2, the authors believe it to be the cause of the palsy. The main importance of this article is to alert clinicians for neurological sequels that may require a targeted rehabilitation program.
A Critical Examination of Length of Stay in Autologous Breast Reconstruction: A National Surgical Quality Improvement Program Analysis
Authors: Kotha Vikas S. , Abadeer Andrew I. , Amdur Richard L. , Song David H. , Fan Kenneth L. 
Published: October 2020

Background:
This study aims to use the National Surgical Quality Improvement Program database to identify factors associated with extended postoperative length of stay after breast reconstruction with free tissue transfer.

Methods:
Consecutive cases of breast reconstruction with free tissue transfer were retrieved from the National Surgical Quality Improvement Program (2005 to 2017) database using CPT code 19364. Extended length of stay (dependent variable) was defined as greater than 5 days.

Results:
Nine thousand six hundred eighty-six cases were analyzed; extended length of stay was noted in 34 percent. On regression, patient factors independently associated with extended length of stay were body mass index (OR, 1.5; 95 percent CI, 1.2 to 1.9; p < 0.001), diabetes (OR, 1.3; 95 percent CI, 1.1 to 1.6; p = 0.003), and malignancy history (OR, 1.9; 95 percent CI, 1.22 to 3.02; p = 0.005). Operation time greater than 500 minutes (OR, 3; 95 percent CI, 2.73 to 3.28; p < 0.001) and immediate postmastectomy reconstruction (OR, 1.7; 95 percent CI, 1.16 to 2.48; p < 0.001) conferred risk for extended length of stay. Bilateral free tissue transfer was not significant. Operations performed in 2017 were at lower risk (OR, 0.2; 95 percent CI, 0.06 to 0.81; p = 0.02) for extended length of stay. Reoperation is more likely following operative transfusion and bilateral free tissue transfers, but less likely following concurrent alloplasty. Given a known operation time (minutes), postoperative length of stay (days) can be calculated using the following equation: length of stay = 2.559 + 0.003 × operation time.

Conclusions:
This study characterizes the risks for extended length of stay after free tissue transfer breast reconstruction using a prospective multicenter national database. The result of this study can be used to risk-stratify patients during surgical planning to optimize perioperative decision-making.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Associations Between Financial Strain and Emotional Well-Being With Physiological Responses to Acute Mental Stress
Authors: Steptoe Andrew , Emch Sadie , Hamer Mark 
Published: October 2020

ABSTRACT

Objective
This study aimed to investigate associations between financial strain and emotional well-being, health, and physiological responses to acute mental stress.

Methods
Participants were 542 healthy men and women aged 53 to 76 years from the Whitehall II study divided into those who reported no (n = 316), some (n = 135), or moderate/severe (n = 91) financial strain. Emotional well-being and self-reported health were assessed at baseline and 3 years later. Laboratory mental stress testing involved assessment of blood pressure (BP), heart rate, and lipid reactivity and recovery, and plasma interleukin 6 responses to challenging behavioral tasks. Analyses adjusted for objective financial status, age, sex, socioeconomic status (SES), and marital status.

Results
Financial strain was positively associated with more depressive symptoms; lower positive affect; greater loneliness; lower optimism, self-esteem, and sense of control; and poorer self-reported physical health, mental health, and sleep (all, p < .001). Longitudinally, financial strain predicted poorer outcomes 3 years later, but associations were attenuated after baseline levels were taken into account. Financial strain was associated with reduced systolic and diastolic BP reactivity to acute stress (mean systolic BP increase = 32.34 [15.2], 28.95 [13.1], and 27.26 [15.2] mm Hg in the none, some, and moderate/severe financial strain groups), but not with heart rate, interleukin 6, or lipid responses.

Conclusions
Financial strain was correlated with a range of emotional and health-related outcomes independently of objective financial status. The diminished BP reactions to acute mental stress suggest that financial strain may contribute to dynamic chronic allostatic load.
At the Heart of Neurological Dimensionality: Cross-Nosological and Multimodal Cardiac Interoceptive Deficits
Authors: Abrevaya Sofía , Fittipaldi Sol , García Adolfo M. , Dottori Martin , Santamaria-Garcia Hernando , Birba Agustina , Yoris Adrián , Hildebrandt Malin Katharina , Salamone Paula , De la Fuente Alethia , Alarco-Martí Sofía , García-Cordero Indira , Matorrel-Caro Miguel , Pautassi Ricardo Marcos , Serrano Cecilia , Sedeño Lucas , Ibáñez Agustín 
Published: October 2020

ABSTRACT

Objective
Neurological nosology, based on categorical systems, has largely ignored dimensional aspects of neurocognitive impairments. Transdiagnostic dimensional approaches of interoception (the sensing of visceral signals) may improve the descriptions of cross-pathological symptoms at behavioral, electrophysiological, and anatomical levels. Alterations of cardiac interoception (encompassing multidimensional variables such as accuracy, learning, sensibility, and awareness) and its neural correlates (electrophysiological markers, imaging-based anatomical and functional connectivity) have been proposed as critical across disparate neurological disorders. However, no study has examined the specific impact of neural (relative to autonomic) disturbances of cardiac interoception or their differential manifestations across neurological conditions.

Methods
Here, we used a computational approach to classify and evaluate which markers of cardiac interoception (behavioral, metacognitive, electrophysiological, volumetric, or functional) offer the best discrimination between neurological conditions and cardiac (hypertensive) disease (model 1), and among neurological conditions (Alzheimer’s disease, frontotemporal dementia, multiple sclerosis, and brain stroke; model 2). In total, the study comprised 52 neurological patients (mean [standard deviation] age = 55.1 [17.3] years; 37 women), 25 cardiac patients (age = 66.2 [9.1] years; 13 women), and 72 healthy controls (age = 52.65 [17.1] years; 50 women).

Results
Cardiac interoceptive outcomes successfully classified between neurological and cardiac conditions (model 1: >80% accuracy) but not among neurological conditions (model 2: 53% accuracy). Behavioral cardiac interoceptive alterations, although present in all conditions, were powerful in differentiating between neurological and cardiac diseases. However, among neurological conditions, cardiac interoceptive deficits presented more undifferentiated and unspecific disturbances across dimensions.

Conclusions
Our result suggests a diffuse pattern of interoceptive alterations across neurological conditions, highlighting their potential role as dimensional, transdiagnostic markers.
Recent release from prison — A novel risk factor for intimate partner homicide
Authors: Cirone Justin , Keskey Robert , Hampton David , Slidell Mark , Crandall Marie , Rattan Rishi , Velopulos Catherine G. , Allen Debra , Williams Brian H. , Wilson Kenneth , Zakrison Tanya L. 
Published: October 2020

BACKGROUND
The United States has the highest per-capita incarceration rate and the largest prison population in the world. More than two thirds of recently incarcerated individuals will be arrested again within 3 years of release and may commit crimes as serious as homicide soon after discharge. The pattern of homicidal violence currently remains unknown for recently incarcerated homicide suspects (RIHS) and their victims.

METHODS
A retrospective analysis of the 36 states included in the 2003 to 2017 National Violent Death Reporting System was performed with a focus on RIHS and their victims. Pearson χ2 and Wilcoxon rank sum tests were used for comparison.

RESULTS
There were 249 RIHS in the database of the 14,561 homicides where suspect recent incarceration status was documented. Compared with not–recently incarcerated suspects, RIHS were more likely to be White (41% vs. 29%, p < 0.001) and male (97% vs. 91%, p < 0.001). Recently incarcerated homicide suspects more often had a known relationship with the victim (75% vs. 51%, p < 0.001), and these homicides more often occurred in the victim’s own home (43% vs. 34%, p = 0.006). Intimate partner violence was a factor in 31% of the RIHS cases (vs. 17%, p < 0.001). The homicide weapon was most likely to be a firearm (57.8%, p < 0.001). Only 6.4% of homicides were due to mental health illness. Gang violence, while more common in the RIHS group, was still only a precipitating factor in 12.0% of the homicides (vs. 7.4%, p = 0.006).

CONCLUSION
Recently incarcerated homicide suspects are more likely to kill a known person in their own home with a firearm, and these homicides are frequently categorized as intimate partner homicides. Gang violence and mental health are not frequent precipitating factors in these deaths. Additional future interventions are urgently needed to eliminate these preventable deaths by alerting previous or current intimate partners of those being discharged from the prison system.
A multicenter study on definitive surgery for isolated hip fracture within 24 hours
Authors: Ang Darwin , Anglen Jeffrey , Ziglar Michele , Armstrong John , Offner Patrick , McKenney Mark , Plurad David , Flaherty Stephen , Gonzalez Ernest , Liu Huazhi , Danish Mary , McCormack Gregory , Nash Julie , Nagy Roger , Carrick Matthew 
Published: October 2020

INTRODUCTION
Isolated hip fractures (IHFs) in the elderly are high-frequency, life-altering events. Definitive surgery ≤24 hours of admission is associated with improved outcomes. An IHF process management guideline (IHF-PMG) to expedite definitive surgery ≤24 hours was developed for a multihospital network. We report on its feasibility and subsequent patient outcomes.

METHODS
This is a prospective multicenter cohort study, involving 85 levels 1, 2, 3, and 4 trauma centers. Patients with an IHF between 65 and 100 years old were studied. Four cohorts were examined: (1) hospitals that did not implement any PMG, (2) hospitals that used their own PMG, (3) hospitals that partially used the network IHF-PMG, and (4) hospitals that used the network’s IHF-PMG. Multivariable logistic regression with reliability adjustment was used to calculate the expected value of observed to expected (O/E) mortality. Statistical significance was defined as p < 0.05.

RESULTS
Data on 24,457 IHF were prospectively collected. Following implementation of the IHF-PMG, overall IHF O/E mortality ratios decreased within the hospital network, from 1.13 in 2017 to 0.87 in 2018 and 0.86 in 2019. Hospitals that developed their own IHF-PMG or used the enterprise-wide IHF-PMG had the lowest inpatient O/E mortality at 0.59 and 0.65, respectively.

CONCLUSION
Goal-directed IHF-PMG for definitive surgery ≤24 hours was implemented across a large hospital network. The IHF-PMG was associated with lower inpatient mortality.

LEVEL OF EVIDENCE
Therapeutic/ Care management, Level III.
Diffraction-Limited Molecular Cluster Quantification with Bayesian Nonparametrics
Authors: Bryan J. Shepard , Sgouralis Ioannis , Pressé Steve 
Published: October 2020

AbstractLife’s fundamental processes involve multiple molecules operating in close proximity within cells. To probe the composition and kinetics of molecular clusters confined within small (diffraction-limited) regions, experiments often report on the total fluorescence intensity simultaneously emitted from labeled molecules confined to such regions. Methods exist to enumerate total fluorophore numbers (e.g., step counting by photobleaching). However, methods aimed at step counting by photobleaching cannot treat photophysical dynamics in counting nor learn their associated kinetic rates. Here we propose a method to simultaneously enumerate fluorophores and determine their individual photophysical state trajectories. As the number of active (fluorescent) molecules at any given time is unknown, we rely on Bayesian nonparametrics and use specialized Monte Carlo algorithms to derive our estimates. Our formulation is benchmarked on synthetic and real data sets. While our focus here is on photophysical dynamics (in which labels transition between active and inactive states), such dynamics can also serve as a proxy for other types of dynamics such as assembly and disassembly kinetics of clusters. Similarly, while we focus on the case where all labels are initially fluorescent, other regimes, more appropriate to photoactivated localization microscopy, where fluorophores are instantiated in a non-fluorescent state, fall within the scope of the framework. As such, we provide a complete and versatile framework for the interpretation of complex time traces arising from the simultaneous activity of up to 100 fluorophores.