bluuebunny/crossref_metadata_2025_split huggingface dataset:
Taxonomic resolution of the ribosomal RNA operon in bacteria: implications for its use with long-read sequencing
Authors: de Oliveira Martins Leonardo , Page Andrew J , Mather Alison E , Charles Ian G 
Published: November 2019

AbstractDNA barcoding through the use of amplified regions of the ribosomal operon, such as the 16S gene, is a routine method to gain an overview of the microbial taxonomic diversity within a sample without the need to isolate and culture the microbes present. However, bacterial cells usually have multiple copies of this ribosomal operon, and choosing the ‘wrong’ copy could provide a misleading species classification. While this presents less of a problem for well-characterized organisms with large sequence databases to interrogate, it is a significant challenge for lesser known organisms with unknown copy number and diversity. Using the entire length of the ribosomal operon, which encompasses the 16S, 23S, 5S and internal transcribed spacer regions, should provide greater taxonomic resolution but has not been well explored. Here, we use publicly available reference genomes and explore the theoretical boundaries when using concatenated genes and the full-length ribosomal operons, which has been made possible by the development and uptake of long-read sequencing technologies. We quantify the issues of both copy choice and operon length in a phylogenetic context to demonstrate that longer regions improve the phylogenetic signal while maintaining taxonomic accuracy.
Nutraceutical approach to enhance lutein bioavailability via nanodelivery systems
Authors: Bhat Ishani , Yathisha Undiganalu Gangadharappa , Karunasagar Iddya , Mamatha Bangera Sheshappa 
Published: November 2019

Abstract
Lutein, a potent dietary carotenoid, has considerable biological activity and confers protection against age-related macular degeneration. Its bioavailability following consumption, however, depends on its rate of degradation. Nanodelivery systems with improved efficacy and stability are currently being developed to increase the bioavailability of lutein. This review examines nutraceutical approaches used in the development of such nanodelivery systems. It describes the methods of lutein preparation, the characteristics of various delivery systems, and the lutein delivery profile. In order to enhance lutein loading, provide electrostatic stabilization, and achieve the controlled release of lutein, adjuvants such as dextran moieties, whey proteins, medium-chain triglycerides, and chitosan polymers can be used to effectively reduce the particle size (&lt; 70 nm) and improve encapsulation efficiency (to 99.5%). The improved bioavailability of lutein via nanocrystals incorporated into rapidly dissolving films for oral consumption is a new area of exploratory research. This review aims to provide clarity about current research aimed at enhancing the bioavailability of lutein through the development of nanodelivery systems.
Young Drivers, Deterrence Theory, and Punishment Avoidance: A Qualitative Exploration
Authors: Bates Lyndel , Anderson Levi 
Published: November 2019

Abstract
Punishment avoidance occurs when a person commits an offence but is not punished for it. The aim of this article was to explore how young drivers experience punishment avoidance. New drivers aged between 17 and 25 years participated in 11 focus groups held in both metropolitan and regional areas in two Australian states: Queensland and Victoria. Thematic analysis identified that young drivers experience punishment avoidance in one of three ways. First, they can attempt to actively avoid punishment by engaging in deliberate actions to circumvent policing activities. Secondly, they can experience either direct or vicarious punishment avoidance of police enforcement. An example of this would be ‘talking their way out of a ticket’ after they had been caught by a police officer. Finally, their parents may help them avoid punishment by, for instance, paying the traffic fine on their child’s behalf. This article increases our understanding of how punishment avoidance occurs in practice.
Alcohol consumption and self-rated health among older people: population-based study in Sweden
Authors: Lindström Jim , Hellström Charlotta , Simonsson Bo , Molarius Anu 
Published: November 2019

Abstract

Objective
To analyse alcohol consumption and its association with self-rated health among a representative sample of older people in mid-Sweden.

Background
Over the past decades, alcohol consumption has increased in the older population in Sweden, but few studies have investigated the association between alcohol consumption and self-rated health in this group. The aim was therefore to investigate alcohol consumption and self-rated health among older Swedes.

Methods
The study is based on a cross-sectional study of 11,716 men and women, 65 years and over, answering a survey questionnaire sent to a random population sample in mid-Sweden in 2012. We assessed alcohol consumption with AUDIT-C and its association with self-rated health using logistic regression analysis, adjusting for age, economic situation, educational level, BMI, physical activity, social support and medication use.

Results
Men (83%) were more prone to drink alcohol compared to women (71%). The prevalence of risk drinking was about 2% for both genders. Alcohol consumption declined with age. Moderate consumption of alcohol was associated with lower probability of poor self-rated health compared to non-drinking with an adjusted odds ratio 0.64 (95% confidence interval: 0.54-0.76) for men and 0.68 (0.59-0.79) for women.

Conclusion
Since the study was cross-sectional the direction of the association could not be determined, and the results should not be interpreted as an argument for promoting alcohol consumption among older people.
Procalcitonin and Neutrophil Lymphocyte Ratio After Spinal Instrumentation Surgery
Authors: Inose Hiroyuki , Kobayashi Yutaka , Yuasa Masato , Hirai Takashi , Yoshii Toshitaka , Okawa Atsushi 
Published: November 2019

Study Design.
This was a retrospective observational study.

Objective.
To assess the diagnostic value of procalcitonin (PCT) and neutrophil lymphocyte ratio (NLR) for predicting surgical site infection (SSI) in patients undergoing spinal instrumentation surgery, we analyzed a large consecutive cohort of patients who had undergone spinal instrumentation surgery.

Summary of Background Data.
Although PCT and NLR are commonly used as markers for bacterial infection, the diagnostic value of these factors for predicting SSI in the context of spinal instrumentation surgery has not been extensively investigated.

Methods.
We retrospectively investigated 242 patients who underwent spinal instrumentation surgery and evaluated the significance of various postoperative measures for predicting SSI, including PCT and NLR. We then determined the diagnostic cut-off values for these markers in the prediction of SSI using receiver operating characteristic curve analysis.

Results.
Among the 242 patients analyzed, 10 were diagnosed with infection. Even though univariate analysis showed that neutrophil percentage and NLR at 6 to 7 days postoperatively were significant predictors for SSI, PCT at 6 to 7 days postoperatively did not differ significantly between the SSI and non-SSI groups. The cut-off value used for neutrophil percentage at 6 to 7 days postoperatively was more than 69.0% [sensitivity, 80.0%; specificity, 70.0%; area under the curve, 0.737]. The cut-off value used for NLR at 6 to 7 days postoperatively was 3.87 (sensitivity, 70.0%; specificity, 73.2%; area under the curve, 0.688).

Conclusion.
Neutrophil percentage and NLR at 6 to 7 days postoperatively were more useful markers than PCT at 6 to 7 days postoperatively for early prediction of SSI in patients who had undergone spinal instrumentation surgery. Therefore, routine use of PCT as a predictor of postoperative infection is not supported by the results of this study.

Level of Evidence: 4
Complications with Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis in the Obese Population
Authors: Buyuk Abdul Fettah , Shafa Eiman , Dawson John M. , Schwender James D. 
Published: November 2019

Study Design.A level-3 retrospective cohort analysis.Objective.The aim of this study was to describe obesity's effect on complications and outcomes in degenerative spondylolisthesis patients treated by minimally invasive transforaminal lumbar interbody fusion (MI TLIF).Summary of Background Data.Obesity is associated with a greater complication rate among lumbar spine surgery patients. Poor clinical outcomes might likewise be supposed, but the association is not well established. Minimally invasive techniques have been developed to reduce complications and improve clinical outcomes in comparison to traditional open techniques.Methods.We reviewed 134 consecutive patients with degenerative spondylolisthesis undergoing MI TLIF. Subjects were grouped into nonobese (N = 65) and obese (N = 69) cohorts. The obese group was further subdivided by BMI. Patient demographics, perioperative complications, and outcome scores were collected over a minimum of 24 months. Four periods (intraoperative, postoperative hospitalization, 6-month, and 24-month postoperative) were assessed.Results.Cohort demographics were not significantly different, but it was noted that obese patients had more major comorbidities than nonobese patients. There was no difference in intraoperative complications between the two groups. The in-hospital complication rate was significantly greater in the obese group. The 6-month postoperative complication rate was not different between cohorts. Wound drainage was most common and noted only in the obese cohort. Complications at 24 months were not different but did trend toward significance in the obese for recurrence of symptoms and total complications. Functional outcome was better among nonobese subjects compared with obese subjects at every interval (significant at 6 and 12 months). Back pain scores were significantly better among nonobese subjects than obese subjects at 24 months, but Leg Pain scores were not different.Conclusions.MI TLIF can be safely performed in the obese population despite a higher in-hospital complication rate. Knowledge of common complications will help the treatment team appropriately manage obese patients with degenerative spondylolisthesis.Level of Evidence:3
Simulation-Based Team Leadership Training Improves Team Leadership During Actual Trauma Resuscitations: A Randomized Controlled Trial
Authors: Fernandez Rosemarie , Rosenman Elizabeth D. , Olenick Jeffrey , Misisco Anthony , Brolliar Sarah M. , Chipman Anne K. , Vrablik Marie C. , Kalynych Colleen , Arbabi Saman , Nichol Graham , Grand James , Kozlowski Steve W. J. , Chao Georgia T. 
Published: November 2019

Objectives:
Trauma resuscitations are complex critical care events that present patient safety-related risk. Simulation-based leadership training is thought to improve trauma care; however, there is no robust evidence supporting the impact of leadership training on clinical performance. The objective of this study was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during actual trauma resuscitations.

Design:
Randomized controlled trial.

Setting:
Harborview Medical Center (level 1 trauma center).

Subjects:
Seventy-nine second- and third-year residents were randomized and 360 resuscitations were analyzed.

Interventions:
Subjects were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition.

Measurements and Main Results:
Participant-led actual trauma resuscitations were video recorded and coded for leadership behaviors and patient care. We used random coefficient modeling to account for the nesting effect of multiple observations within residents and to test for post-training group differences in leadership behaviors while controlling for pre-training behaviors, Injury Severity Score, postgraduate training year, and days since training occurred. Sixty participants completed the study. There was a significant difference in post-training leadership behaviors between the intervention and control conditions (b1 = 4.06, t (55) = 6.11, p < 0.001; intervention M = 11.29, se = 0.66, 95% CI, 9.99–12.59 vs control M = 7.23, se = 0.46, 95% CI, 6.33–8.13, d = 0.92). Although patient care was similar between conditions (b = 2.00, t (55) = 0.99, p = 0.325; predicted means intervention M = 62.38, se = 2.01, 95% CI, 58.43–66.33 vs control M = 60.38, se = 1.37, 95% CI, 57.69–63.07, d = 0.15), a test of the mediation effect between training and patient care suggests leadership behaviors mediate an effect of training on patient care with a significant indirect effect (b = 3.44, 95% CI, 1.43–5.80). Across all trauma resuscitations leadership was significantly related to patient care (b1 = 0.61, se = 0.15, t (273) = 3.64, p < 0.001).

Conclusions:
Leadership training resulted in the transfer of complex skills to the clinical environment and may have an indirect effect on patient care through better team leadership.
Conditional Survival With Increasing Duration of ICU Admission: An Observational Study of Three Intensive Care Databases
Authors: Marshall Dominic C. , Hatch Robert A. , Gerry Stephen , Young J. Duncan , Watkinson Peter 
Published: November 2019

Objectives:
Prolonged admissions to an ICU are associated with high resource utilization and personal cost to the patient. Previous reports suggest increasing length of stay may be associated with poor outcomes. Conditional survival represents the probability of future survival after a defined period of treatment on an ICU providing a description of how prognosis evolves over time. Our objective was to describe conditional survival as length of ICU stay increased.

Design:
Retrospective observational cohort study of three large intensive care databases.

Setting:
Three intensive care databases, two in the United States (Medical Information Mart for Intensive Care III and electronic ICU) and one in United Kingdom (Post Intensive Care Risk-Adjusted Alerting and Monitoring).

Patients:
Index admissions to intensive care for patients 18 years or older.

Interventions:
None.

Measurements and Main Results:
A total of 11,648, 38,532, and 165,125 index admissions were analyzed from Post Intensive Care Risk-Adjusted Alerting and Monitoring, Medical Information Mart for Intensive Care III and electronic ICU databases respectively. In all three cohorts, conditional survival declined over the first 5–10 days after ICU admission and changed little thereafter. In patients greater than or equal to 75 years old conditional survival continued to decline with increasing length of stay.

Conclusions:
After an initial period of 5–10 days, probability of future survival does not decrease with increasing length of stay in unselected patients admitted to ICUs. These findings were consistent between the three populations and suggest that a prolonged admission to an ICU is not a reason for a pessimism in younger patients but may indicate a poor prognosis in the older population.
A Novel Use of Prehospital Telemedicine to Decrease Door to Computed Tomography Results in Acute Strokes
Authors: Bilotta Mary , Sigal Adam P. , Shah Ankit , Martin Anthony , Schlappy David A. , Sorensen Greg , Barbera Charles 
Published: November 2019

ABSTRACT

Introduction:
Timely emergency department (ED) recognition of acute strokes reduces morbidity and mortality and improves outcomes. Prehospital telehealth evaluation rapidly assesses patients with stroke symptoms and mobilizes resources before ED arrival, decreasing ED arrival to computed tomography (CT) result times. Expediting CT results reduces the decision time to determining thrombolytic therapy eligibility.

Methods:
Seventeen ambulances in our region were supplied with equipment to perform a nonrecordable video examination with an ED physician. Emergency Medical Service requested a physician video examination on patients with a positive prehospital Cincinnati Stroke Scale. The physician and paramedic conducted an NIH-8 scale, and, based on the assessment, the patients were placed directly on the CT scanner table.

Results:
Four time intervals that impact CT acquisition and thrombolytic decision-making were measured. There was improvement in all time intervals. Time from ED arrival to CT order decreased 1.7 minutes. Time from arrival to study start decreased 5.7 minutes. Time from CT order to result decreased 3.89 minutes and time from ED arrival to CT result decreased 5.6 minutes.

Discussion:
Prehospital telehealth consults with paramedics, and the receiving hospital for acute strokes significantly decreased times for all metrics studied including the time from ED arrival to CT result.
Effects of core stability exercise for patients with neck pain
Authors: He Yikang , Sun Wudong , Zhao Xianghu , Ma Ming , Zheng Zengbin , Xu Liang 
Published: November 2019

Abstract

Background:
Neck pain is an important cause of disability. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Exercise therapy appears to be effective at decreasing pain and improving function for patients with NP in practice guidelines. Core stability exercise is becoming increasingly popular for NP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with NP. The aim of this study is to explore the therapeutic effect of core stability exercise for neck pain.

Methods:
This review will only include randomized controlled trials (RCTs). Published articles from July 2009 to July 2019 will be identified using electronic searches. Search strategy will be performed in 3 English databases, 1 Chinese database, and the WHO International Clinical Trials Registry Platform. Two reviewers will screen, select studies, extract data, and assess quality independently. The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.

Results:
We will provide some more practical and targeted results investigating the effect of Core Stability Exercise (CSE) for Neck Pain (NP) in the current meta-analysis. Meanwhile, we will ascertain study progress of Core Stability Exercise for Neck Pain and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.

Conclusion:
The stronger evidence about Neck Pain's rehabilitative effect and safety will be provided for clinicians and policymakers.

Systematic review registration:
PROSPERO CRD42017055711.

Ethics and dissemination:
We do not apply for formal ethical approval from ethics committee because all of the study data in our review will be obtained in an anonymous way. Findings of this study are projected to be disseminated through peer-review publications.
Decompression with fusion is not in superiority to decompression alone in lumbar stenosis based on randomized controlled trials
Authors: Xu Shuai , Wang Jinyu , Liang Yan , Zhu Zhenqi , Wang Kaifeng , Qian Yalong , Liu Haiying 
Published: November 2019

Abstract

Background:
Although some studies had been published, it was more controversial on the superiority of decompression alone (D) and decompression with fusion (F) for the treatment of lumbar spinal stenosis (LSS) recently, especially newest articles with different opinions. A meta-analysis was performed to compare efficacy on D and F for LSS regardless of degenerative spondylolisthesis (DS) with randomized controlled trials (RCTs).

Methods:
The databases include PUBMED/MEDLINE, EMBASE, Cochrane Library, and Web of Science from January 1970 to December 2018. The information of screened studies included demographics, clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed. Subgroup analysis was stratified by DS and follow-up time (36 months). Continuous variables and dichotomous variables were respectively reported as weighted mean difference and odds ratios (ORs). The strength of evidence was evaluated by the grades of recommendation, assessment, development, and evaluation (GRADE) system.

Results:
Nine RCTs met inclusion criteria with a total of 857 patients (367 were in D group and 490 were in F group). There were no statistical difference in visual analog scale changes on back and leg pain between D and F group (mean difference [MD] = −0.03, 95% confidence interval [CI] [–0.38, 0.76], z = 0.08, P = .94; MD = 0.11, 95% CI [–1.08, 1.30], z = 0.18, P = .86, respectively); patients’ satisfaction was of no difference between the 2 groups, together with the change of the Oswestry disability index and European quality of life-5 dimensions (P > .05). There were no difference in the rate of complication (P = .50) and reoperation (P = .11) while a statistical significance of longer operation duration (P < .0001), more blood loss (P = .004) but amazing lower rate of adjacent segment degenerative/disease (ASD) (OR = 2.35, P = .02) in F group. The subgroup analysis on DS showed that basically all measures were in consistency with meta-analysis. There was a higher reoperation rate in middle-to-long term (>36 months) in D group and ASD was the most seasons of reoperation no matter the follow-up time. According to the GRADE system, the grade of this meta-analysis was of “High” quality.

Conclusion:
F group has no better clinical results than D alone in LSS, regardless of DS and follow-up. The conclusion is of “High” quality and the grade strength of recommendation was “Strong.”