bluuebunny/crossref_metadata_2025_split huggingface dataset:
A simple index predicting mortality in acutely hospitalized patients
Authors: Froom P , Shimoni Z , Benbassat J , Silke B 
Published: October 2020

Summary

Background
Mortality rates used to evaluate and improve the quality of hospital care are adjusted for comorbidity and disease severity. Comorbidity, measured by International Classification of Diseases codes, do not reflect the severity of the medical condition, that requires clinical assessments not available in electronic databases, and/or laboratory data with clinically relevant ranges to permit extrapolation from one setting to the next.

Aim
To propose a simple index predicting mortality in acutely hospitalized patients.

Design
Retrospective cohort study with internal and external validation.

Methods
The study populations were all acutely admitted patients in 2015–16, and in January 2019–November 2019 to internal medicine, cardiology and intensive care departments at the Laniado Hospital in Israel, and in 2002–19, at St. James Hospital, Ireland. Predictor variables were age and admission laboratory tests. The outcome variable was in-hospital mortality. Using logistic regression of the data in the 2015–16 Israeli cohort, we derived an index that included age groups and significant laboratory data.

Results
In the Israeli 2015–16 cohort, the index predicted mortality rates from 0.2% to 32.0% with a c-statistic (area under the receiver operator characteristic curve) of 0.86. In the Israeli 2019 validation cohort, the index predicted mortality rates from 0.3% to 38.9% with a c-statistic of 0.87. An abbreviated index performed similarly in the Irish 2002–19 cohort.

Conclusions
Hospital mortality can be predicted by age and selected admission laboratory data without acquiring information from the patient’s medical records. This permits an inexpensive comparison of performance of hospital departments.
Signalling to Experts
Authors: Kurlat Pablo , Scheuer Florian 
Published: October 2020

Abstract
We study competitive equilibria in a signalling economy with heterogeneously informed buyers. In terms of the classic Spence (1973, The Quarterly Journal of Economics, 87, 355—374) model of job market signalling, firms have access to direct but imperfect information about worker types, in addition to observing their education. Firms can be ranked according to the quality of their information, i.e., their expertise. In equilibrium, some high-type workers forgo signalling and are hired by better informed firms, which make positive profits. Workers’ education decisions and firms’ use of their expertise are strategic complements, allowing for multiple equilibria that can be Pareto ranked. We characterize wage dispersion and the extent of signalling as a function of the distribution of expertise among firms. Our model can also be applied to a variety of other signalling problems, including securitization, corporate financial structure, insurance markets, or dividend policy.
Shedding Light on Drug-Induced Liver Injury: Activation of T Cells From Drug Naive Human Donors With Tolvaptan and a Hydroxybutyric Acid Metabolite
Authors: Hammond Sean , Gibson Andrew , Jaruthamsophon Kanoot , Roth Sharin , Mosedale Merrie , Naisbitt Dean J 
Published: October 2020

AbstractExposure to tolvaptan is associated with a significant risk of liver injury in a small fraction of patients with autosomal dominant polycystic kidney disease. The observed delayed onset of liver injury of between 3 and 18 months after commencing tolvaptan treatment, along with rapid recurrence of symptoms following re-challenge is indicative of an adaptive immune attack. This study set out to assess the intrinsic immunogenicity of tolvaptan and pathways of drug-specific T-cell activation using in vitro cell culture platforms. Tolvaptan (n = 7), as well as oxybutyric (DM-4103, n = 1) and hydroxybutyric acid (DM-4107, n = 18) metabolite-specific T-cell clones were generated from tolvaptan naive healthy donor peripheral blood mononuclear cells. Tolvaptan and DM-4103 T-cell clones could also be activated with DM-4107, whereas T-cell clones originally primed with DM-4107 were highly specific to this compound. A signature cytokine profile (IFN-γ, IL-13, granzyme B, and perforin) for almost all T-cell clones was identified. Mechanistically, compound-specific T-cell clone activation was dependent on the presence of soluble drug and could occur within 4 h of drug exposure, ruling out a classical hapten mechanism. However, antigen processing dependence drug presentation was indicated in many T-cell clones. Collectively these data show that tolvaptan-associated liver injury may be attributable to an adaptive immune attack upon the liver, with tolvaptan- and metabolite-specific T cells identified as candidate effector cells in such etiology.
Nulla Per Os (NPO) guidelines: time to revisit?
Authors: Friedrich Sabine , Meybohm Patrick , Kranke Peter 
Published: October 2020

Purpose of review
Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed.

Recent findings
Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperative delirium, patient discomfort, and extended hospital length of stay. Liberal approaches allowing clear fluids up to 1 h prior to anesthesia or until premedication/call to the operating room have shown no increase in adverse events among children. Various anesthesia societies now encourage clear fluid intake up to 1 h prior to pediatric elective anesthesia. Similar reports in the adult cohort are scarce.

Summary
Allowing sips of water until call to the operating room may help reducing prolonged preoperative fasting and improving patient comfort while keeping a flexibility in operating room schedule. The feasibility and safety of a liberal clear fluid fasting regimen among adults undergoing elective anesthesia needs to be evaluated in future studies.
Suture Stabilization of Open Physeal Fractures of the Great Toe Distal Phalanx (Seymour Fracture)
Authors: Reid Daniel B.C. , Deckey David G. , Procaccini Michaela , Eberson Craig P. 
Published: October 2020

Background:
Open physeal fractures of the distal phalanx of the hallux are analogous to Seymour fractures of the hand. When missed, these injuries can result in long-term sequelae including infection, pain, nail deformity, and physeal arrest. Nevertheless, there is a paucity in the literature regarding optimal surgical treatment for these challenging injuries. We present a novel technique and case series for suture-only stabilization of Seymour fractures of the great toe.

Methods:
Billing records were used to identify all children aged 18 years or younger who underwent operative treatment open distal phalanx fracture of the hallux with an associated nail bed injury. Electronic medical records and plain imaging were reviewed to identify mechanism of injury, surgical technique, results, complications, and follow-up.

Results:
Five boys with a mean age of 10.3 years (range, 5 to 13 y) met inclusion criteria. Forty percent (2/5) of injuries were missed by the initial treating providers. Only 2 patients presented to our institution primarily; 60% (3/5) patients were transferred from other facilities. The mechanism of injury was variable but generally involved “stubbing” the toe. The mean time from injury to surgical treatment was 2.6 days (range, 0 to 6 d). Median follow-up was 2 months (range, 1 to 96 mo). No patient complications (including infection) or reoperations were reported. On follow-up imaging, no physeal bars were evident on patients treated with suture-only technique.

Conclusions:
Seymour fracture of the hallux are uncommon, and there is frequently a delay in both presentation and diagnosis. Providers should have increased suspicion for these injuries when a physeal fracture of the great toe is associated with bleeding or nail bed injury. Currently, no consensus exists for treatment of these injuries. Suture-only stabilization represents a simple, reliable alternative to pin fixation.

Level of Evidence:
Level IV—retrospective case series.
Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome: Possible Late Indication for Coronavirus Disease 2019?
Authors: Soumagne Thibaud , Grillet Franck , Piton Gaël , Winiszewski Hadrien , Capellier Gilles 
Published: October 2020

Background:
There is now substantial evidence to support venovenous extracorporeal membrane oxygenation efficacy and safety for patients with severe acute respiratory distress syndrome. However, recent guidelines recommend against the initiation of extracorporeal membrane oxygenation in patients with mechanical ventilation for coronavirus disease 2019 severe acute respiratory distress syndrome for greater than 7–10 days.

Case Summary:
We report the case of a patient with coronavirus disease 2019 severe acute respiratory distress syndrome with successful late venovenous extracorporeal membrane oxygenation initiation after 20 days of mechanical ventilation. Respiratory compliance, arterial blood gases, and radiological lesions improved progressively under venovenous extracorporeal membrane oxygenation and ultraprotective ventilation. The patient was discharged from ICU.

Conclusions:
As coronavirus disease 2019 is a new and incompletely understood entity, we believe that late extracorporeal membrane oxygenation may be considered in selected patients as a bridge to recovery. Further prospective studies are, however, needed.
In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs
Authors: Maratta Christina , Hutchison Kristen , Moore Gregory P. , Bagshaw Sean M. , Granton John , Kirpalani Haresh , Stelfox Henry Thomas , Ferguson Niall , Cook Deborah , Parshuram Christopher S. 
Published: October 2020

Objectives:
Overnight physician staffing in the ICU has been recommended by the Society of Critical Care Medicine and the Leapfrog Consortium. We conducted a survey to review practice in the current era and to compare this with results from a 2006 survey.

Design:
Cross-sectional survey.

Setting:
Canadian adult ICUs.

Participants:
ICU directors.

Interventions:
None.

Measurement and Main Results:
A 29-question survey was sent to ICU directors describing overnight staffing by residents, fellows, nurse practitioners, and staff physicians, as well as duty duration, clinical responsibilities, and unit characteristics. We established contact with 122 ICU directors, of whom 107 (88%) responded. Of the 107 units, 60 (56%) had overnight in-house physicians. Compared with ICUs without overnight in-house physician coverage, ICUs with in-house physicians were in larger hospitals (p < 0.0001), had more beds (p < 0.0001), had more ventilated patients (p < 0.0001), and had more admissions (p < 0.0001). Overnight in-house physicians were first year residents (R1) in 20 of 60 (33%), second to fifth year residents (R2–R5) in 46 of 60 (77%), and Critical Care Medicine trainees in 19 of 60 (32%). Advanced practice nurses provided overnight coverage in four of 107 ICUs (4%). The most senior in-house physician was a staff physician in 12 of 60 ICUs (20%), a Critical Care Medicine trainee in 14 of 60 (23%), and a resident (R2–R5) in 20 of 60 (33%). The duration of overnight duty was on average 20–24 hours in 22 of 46 units (48%) with R2–R5 residents and 14 of 19 units (74%) covered by Critical Care Medicine trainees.

Conclusions:
Variability of in-house overnight physician presence in Canadian adult ICUs is linked to therapeutic complexity and unit characteristics and has not changed significantly over the decade since our 2006 survey. Additional evidence about patient and resident outcomes would better inform decisions to revise physician scheduling in Canadian ICUs.
Key Role of Respiratory Quotient to Reduce the Occurrence of Hypoxemia During Extracorporeal Gas Exchange: A Theoretical Analysis*
Authors: Cipriani Elisa , Langer Thomas , Bottino Nicola , Brusatori Serena , Carlesso Eleonora , Colombo Sebastiano Maria , Zanella Alberto , Pesenti Antonio , Grasselli Giacomo 
Published: October 2020

Objectives:
Extracorporeal respiratory support, including low blood flow systems providing mainly extracorporeal CO2 removal, are increasingly applied in clinical practice. Gas exchange physiology during extracorporeal respiratory support is complex and differs between full extracorporeal membrane oxygenation and extracorporeal CO2 removal. Aim of the present article is to review pathophysiological aspects which are relevant for the understanding of hypoxemia development during extracorporeal CO2 removal. We will describe the mathematical and physiologic background underlying changes in respiratory quotient and alveolar oxygen tension during venovenous extracorporeal gas exchange and highlight the clinical implications.

Design:
Theoretical analysis of venovenous extracorporeal gas exchange.

Setting:
Italian university research hospital.

Patients:
None.

Interventions:
None.

Measurements and Main Results:
While the effect of extracorporeal CO2 removal on the respiratory quotient of the native lung has long been known, the role of extracorporeal oxygenation in dictating changes in the respiratory quotient has been less addressed. Indeed, both extracorporeal CO2 removal and extracorporeal oxygen delivery affect the respiratory quotient of the native lung and thus influence the alveolar Po
2. Indeed, for the same amount of extracorporeal CO2 extraction, it is possible to reduce the Fio
2, reduce the risk of absorption atelectasis, and maintain the same alveolar Po
2, by increasing the extracorporeal oxygen delivery.

Conclusions:
Worsening of hypoxemia is frequent during low-flow extracorporeal CO2 removal combined with ultraprotective mechanical ventilation. In this context, increasing extracorporeal oxygen delivery, increases the respiratory quotient of the native lung and could reduce both the occurrence of alveolar hypoxia and absorption atelectasis, thus optimizing the residual lung function.
Association Between Pediatric Delirium and Quality of Life After Discharge*
Authors: Silver Gabrielle , Doyle Hannah , Hegel Emily , Kaur Savneet , Mauer Elizabeth A. , Gerber Linda M. , Traube Chani 
Published: October 2020

Objective:
Delirium occurs frequently in critically ill children, with highest rates reported in children under 5 years old. The objective of this study was to measure the residual effect of delirium on quality of life at 1 and 3 months after hospital discharge.

Design:
Prospective observational cohort study.

Setting:
Urban academic PICU.

Patients:
Children younger than five years of age at time of admission to the PICU.

Interventions:
All children were screened for delirium (using the Cornell Assessment for Pediatric Delirium) throughout their stay in the PICU. Quality of life was measured using the Infant-Toddler Quality of Life questionnaire at three time points: baseline, 1 month, and 3 months after hospital discharge. Infant-Toddler Quality of Life scores were compared between children who did and did not develop delirium.

Measurements and Main Results:
Two hundred seven children were enrolled. One hundred twenty-two completed the 1-month follow-up, and 117 completed the 3-month follow-up. Fifty-six children (27%) developed delirium during their PICU stay. At follow-up, Infant-Toddler Quality of Life scores for the PICU cohort overall were consistently lower than age-related norms. When analyzed by delirium status, children who had experienced delirium scored lower in every quality of life domain when compared with children who did not experience delirium. Even after controlling for severity of illness, delirious patients demonstrated an average 11-point lower general health score than nondelirious patients (p = 0.029).

Conclusion:
This pilot study shows an independent association between delirium and decreased quality of life after hospital discharge in young children.
Variations in Criteria for Eligibility Determination for Early Intervention Services with a Focus on Eligibility for Children with Neonatal Complications
Authors: Dempsey Allison G. , Goode Rachel H. , Colon Marcos T. , Holubeck Phil , Nsier Hisham , Zopatti Katherine , Needelman Howard 
Published: October 2020

ABSTRACT:

Objective:
The purpose of this policy review is to describe data on eligibility determination practices for early intervention (EI) services across the United States as they particularly relate to eligibility determination for children seen in neonatal follow-up clinics.

Method:
Policy information was gathered from posted information on state EI websites and confirmed through follow-up phone calls. Information collected included definition of delay, approved measures for developmental assessment, and inclusion criteria for medically at-risk status based on birth weight, prematurity, and/or neonatal abstinence syndrome/prenatal exposure.

Results:
States varied widely across enrollment practices and policies. Forty percent of states defined eligibility based on percent delay (vs SD). Thirty-five states had criteria for enrollment based on birth weight and/or prematurity, and 19 states specifically allowed enrollment for an infant with neonatal abstinence syndrome.

Conclusion:
Providers working in neonatal follow-up clinics should be carefully educated about the eligibility criteria and approved tests for assessing development in the states in which they practice, recognizing that there is obvious and significant variability across states.
Factors Associated with Resilience in Families of Children with Autism Spectrum Disorder
Authors: Al-Jadiri Aseel , Tybor David J. , Mulé Christina , Sakai Christina 
Published: October 2020

ABSTRACT:

Objectives:
Families of children with autism spectrum disorder (ASD) report high levels of stress and poor psychological functioning. Resilience serves to buffer these challenges. Little is known about the factors associated with resilience in these families.

Methods:
Data from the National Survey of Children's Health (NSCH) 2016 were used to investigate independent child, parent, and health care factors associated with resilience in families of children with ASD. We used the NSCH's family resilience composite derived from 4 survey questions focused on (1) communication, (2) working together to solve problems, (3) drawing on strengths, and (4) staying hopeful during difficult times. We defined family resilience as high or low based on the number of questions answered “all of the time” or “most of the time” versus “some of the time” or “none,” respectively. Using survey weights, univariate and multivariate logistic regression analyses identified associations of child, parent, and health care factors with low family resilience.

Results:
We analyzed data representing 1151 children with ASD. Low resilience was reported in 32% of families. Low family resilience was significantly associated with parent factors such as not having someone to turn to for support, cutting work hours, and feeling “child hard to care for”; child ASD-related factors such as moderate ASD severity; and health care factors such as lack of satisfaction in communications with providers.

Conclusion:
The findings highlight specific vulnerabilities in families of children with ASD that are associated with low family resilience. Intervention approaches that have the ability to improve overall family resilience should be carefully considered.
Healthy Vascular Aging Is Associated With Higher Cardiorespiratory Fitness
Authors: Fleenor Bradley S. , Carlini Nicholas A. , Kaminsky Leonard A. , Whaley Mitchell H. , Peterman James E. , Harber Matthew P. 
Published: October 2020

Background:
Healthy vascular aging (HVA) and cardiorespiratory fitness (CRF) are each independently associated with lower cardiovascular disease-related mortality. It is unknown, however, whether the CRF-related reductions in cardiovascular disease risk are related to HVA. We hypothesized that HVA would be associated with higher CRF in men and women from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST).

Methods:
Apparently healthy men and women ≥50 yr of age from the BALL ST cohort (n = 101) who underwent a maximal cardiopulmonary exercise test to assess CRF (V˙O
2peak) were included in the study. Participants were divided into either HVA, defined as brachial systolic blood pressure <140/90 mm Hg without taking medications and carotid-femoral pulse wave velocity <7.6 m/sec, or no HVA for subjects with SBP >140/90 mm Hg and/or PWV >7.6 m/sec.

Results:
Participants with HVA had a higher age- and sex-adjusted CRF percentile (62 ± 5 vs 47 ± 3, P < .05), with women having a greater prevalence of HVA than men (36% vs 15%, P < .05). Both carotid-femoral pulse wave velocity (r =−0.27, P < .05) and brachial systolic blood pressure (r =−0.23, P < .05) were independently and inversely associated with CRF for the entire cohort. Men and women with HVA were younger having a lower body fat percentage and higher low-density lipoprotein cholesterol (P < .05, all).

Conclusions:
These data demonstrate that HVA is associated with higher CRF, which may partially explain the preventative cardioprotective effects of CRF.
Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention
Authors: He Qing-Hua , Zheng Jing , Liu Jia-Li , Wang Jun , You Li-Ming 
Published: October 2020

Background
The theory of planned behavior (TPB), combined with social support, forms the extended TPB, which has shown to predict adherence to health-related behavior effectively, but few studies have applied it to explain medication adherence in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

Objectives
The aim of this study was to explore the factors associated with medication adherence and the underlying mechanisms based on the extended TPB among patients with CHD after PCI.

Methods
A cross-sectional descriptive study was conducted among patients with CHD after PCI in 2 major hospitals in Guangzhou, China. Medication adherence was measured with the Medication Adherence Report Scale. Constructs of the TPB contributing to medication adherence were assessed by the Theory of Planned Behavior Questionnaire for Medication Adherence. Social support was measured by the Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to examine the hypotheses based on the extended TPB.

Results
A total of 300 patients were surveyed and 26.0% of them were nonadherent. The structural equation modeling had good fit indices and estimated 62.6% of the variance in medication adherence. Regarding the relationships between the extended TPB constructs and medication adherence, “intention” was directly associated with medication adherence, and “perceived behavioral control” positively predicted medication adherence directly and indirectly. “Affective attitude” and “subjective norm” were indirectly associated with medication adherence through “intention.” Social support exerted an indirect effect on medication adherence through “subjective norm.”

Conclusions
The extended TPB is an appropriate model to predict medication adherence and provides an effective framework for adherence-enhancing interventions.