bluuebunny/crossref_metadata_2025_split huggingface dataset:
Localizing merging black holes with sub-arcsecond precision using gravitational-wave lensing
Authors: Hannuksela Otto A , Collett Thomas E , Çalışkan Mesut , Li Tjonnie G F 
Published: August 2020

ABSTRACT
The current gravitational-wave (GW) localization methods rely mainly on sources with electromagnetic counterparts. Unfortunately, a binary black hole does not emit light. Due to this, it is generally not possible to localize these objects precisely. However, strongly lensed gravitational waves, which are forecasted in this decade, could allow us to localize the binary by locating its lensed host galaxy. Identifying the correct host galaxy is challenging because there are hundreds to thousands of other lensed galaxies within the sky area spanned by the GW observation. However, we can constrain the lensing galaxy’s physical properties through both GW and electromagnetic observations. We show that these simultaneous constraints allow one to localize quadruply lensed waves to one or at most a few galaxies with the LIGO/Virgo/Kagra network in typical scenarios. Once we identify the host, we can localize the binary to two sub-arcsec regions within the host galaxy. Moreover, we demonstrate how to use the system to measure the Hubble constant as a proof-of-principle application.
Redefining the H-NS protein family: a diversity of specialized core and accessory forms exhibit hierarchical transcriptional network integration
Authors: Fitzgerald Stephen , Kary Stefani C , Alshabib Ebtihal Y , MacKenzie Keith D , Stoebel Daniel M , Chao Tzu-Chiao , Cameron Andrew D S 
Published: August 2020

Abstract
H-NS is a nucleoid structuring protein and global repressor of virulence and horizontally-acquired genes in bacteria. H-NS can interact with itself or with homologous proteins, but protein family diversity and regulatory network overlap remain poorly defined. Here, we present a comprehensive phylogenetic analysis that revealed deep-branching clades, dispelling the presumption that H-NS is the progenitor of varied molecular backups. Each clade is composed exclusively of either chromosome-encoded or plasmid-encoded proteins. On chromosomes, stpA and newly discovered hlpP are core genes in specific genera, whereas hfp and newly discovered hlpC are sporadically distributed. Six clades of H-NS plasmid proteins (Hpp) exhibit ancient and dedicated associations with plasmids, including three clades with fidelity for plasmid incompatibility groups H, F or X. A proliferation of H-NS homologs in Erwiniaceae includes the first observation of potentially co-dependent H-NS forms. Conversely, the observed diversification of oligomerization domains may facilitate stable co-existence of divergent homologs in a genome. Transcriptomic and proteomic analysis in Salmonella revealed regulatory crosstalk and hierarchical control of H-NS homologs. We also discovered that H-NS is both a repressor and activator of Salmonella Pathogenicity Island 1 gene expression, and both regulatory modes are restored by Sfh (HppH) in the absence of H-NS.
Real-world Time to Positivity of 2 Widely Used Commercial Blood Culture Systems in Patients With Severe Manifestations of Sepsis: An Analysis of the FABLED Study
Authors: Butler-Laporte Guillaume , Yansouni Cedric P , Paquette Katryn , Lawandi Alexander , Stabler Sarah N , Akhter Murtaza , Davidson Adam C , Gavric Marko , Jinah Rehman , Saeed Zahid , Demir Koray , Sangsari Sassan , Huang Kelly , Mahpour Amirali , Shamatutu Chris , Caya Chelsea , Troquet Jean-Marc , Clark Greg , Wong Titus , Lee Todd C , Stenstrom Robert , Sweet David , Cheng Matthew P 
Published: August 2020

Abstract

Background
Of all microbiological tests performed, blood cultures have the most impact on patient care. Timely results are essential, especially in the management of sepsis. While there are multiple available blood culture systems on the market, they have never been compared in a prospective study in a critically ill population.

Methods
We performed an analysis of the FABLED study cohort to compare culture results and time to positivity (TTP) of 2 widely used blood culture systems: BacT/Alert and BACTEC. In this multisite prospective study, patients with severe manifestations of sepsis had cultures drawn before antibiotics using systematic enrollment criteria and blood drawing methodology allowing for minimization of pre-analytical biases.

Results
We enrolled 315 patients; 144 had blood cultures (47 positive) with BacT/Alert and 171 with BACTEC (53 positive). Patients whose blood cultures were processed using the BacT/Alert system were younger (median, 64 vs 70 years; P = .003), had a higher proportion of HIV (9.03% vs 1.75%; P = .008) and a lower qSOFA (P = .003). There were no statistically significant differences in the most commonly identified bacterial species. TTP was shorter for BACTEC (median [interquartile range {IQR}], 12.5 [10–14] hours) compared with BacT/Alert (median [IQR], 17 [14–21] hours; P &lt; .0001).

Conclusions
In this large prospective multi-centre study comparing the two blood culture systems among patients with severe manifestations of sepsis, and using a rigorous pre-analytical methodology, the BACTEC system yielded positive culture results 4.5 hours earlier than BacT/Alert. These results apply to commonly isolated bacteria. However, our study design did not allow direct comparison of TTP for unusual pathogens nor of clinical sensitivity between systems. More research is needed to determine the clinical implications of this finding.
Improving Intranasal Naloxone Prescribing Through EMR Modification and Automation
Authors: Crusco Salvatore , Smith Earl , Rajupet Sritha 
Published: August 2020

Background:
In 2017, approximately 11.4 million Americans used opioids inappropriately. Nearly 47,600 deaths in 2017 were attributable to overdose on opioids. Intranasal naloxone was approved by the Food and Drug Administration in 2015 as a rescue medication for opioid overdose. New York State launched a prescription drug monitoring program in 2012, the Internet System for Tracking Over-Prescribing (I-STOP), that required completion before dispensing any controlled substance. Currently, prescribing naloxone at our institution requires 10 clicks and 2 free text boxes. The goal of this project was to increase the prescribing of intranasal naloxone by utilizing EMR automation and visualization tools.

Methods:
Our intervention embedded a section within the required I-STOP note, displaying the last date naloxone was prescribed and an option to “prescribe intranasal naloxone.” If checked, a prepopulated order dialog box was generated.

Results:
Intranasal naloxone orders for the institution totaled 65 for 2 months before the intervention and 203 for 2 months after the intervention, with 112 (55%) coming directly from the I-STOP note modification. Ease of prescribing improved as total clicks were reduced from 10 to 2, and free text boxes from 2 to 0.

Conclusions:
Our findings suggest that a clinical decision support system can be an effective way to increase hospital-wide naloxone prescribing rates. We were able to increase prescribing rates by more than three-fold, significantly increasing the availability of a rescue medication to individuals at high-risk for overdose. Intranasal naloxone prescribing increased with the implementation of a visual reminder and a more intuitive ordering experience while preserving provider autonomy.
Topical Vancomycin Powder Decreases the Proportion of Staphylococcus aureus Found in Culture of Surgical Site Infections in Operatively Treated Fractures
Authors: Qadir Rabah , Costales Timothy , Coale Max , Zerhusen Timothy , Joshi Manjari , O'Toole Robert V. 
Published: August 2020

Objectives:
To determine whether patients with operatively treated fractures and surgical site infection after use of topical vancomycin powder have a lower proportion of Staphylococcus aureus infections than patients who did not receive topical vancomycin powder.

Design:
Retrospective cohort study.

Setting:
Level I trauma center.

Patients:
Treatment group: 10 of 133 patients (145 fractures) with surgical site infections who received intrawound vancomycin powder at the time of wound closure for fracture fixation. Control group: 175 patients who sustained deep surgical site infections during the same period but did not receive vancomycin powder.

Intervention:
Vancomycin powder or no vancomycin powder.

Main Outcome Measurement:
Proportion of patients' cultures positive for S. aureus.

Results:
The proportion of cultures positive for S. aureus was significantly lower in patients with surgical site infection who received vancomycin powder than in those who did not receive vancomycin powder (10% [1 of 10 patients in the treatment group] vs. 50% [87 of 175 patients in the control group]; P = 0.02). A trend was observed for a lower proportion of methicillin-resistant S. aureus (0% vs. 23%; P = 0.12).

Conclusions:
Vancomycin powder might alter the bacteriology of surgical site infections and decrease the proportion in culture of the most common organism typically present after fracture surgery infection. These findings suggest that the application of vancomycin powder might change the bacteriology of surgical site infections when they occur, regardless of the effect on overall infection rates. Although our bacteriology results are clinically and statistically significant, these findings must be confirmed in larger randomized controlled trials.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Do Fully Threaded Transiliac–Transsacral Screws Improve Mechanical Stability of Vertically Unstable Pelvic Fractures? A Cadaveric Biomechanical Analysis
Authors: Shannon Steven F. , Oppizzi Giovanni , Schloss Michael G. , Atchison Jared , Nascone Jason , Sciadini Marcus , Zhang Li-Qun , O'Toole Robert V. , Jaeblon Todd 
Published: August 2020

Objective:
To determine whether fully threaded transiliac–transsacral (TI-TS) fixation is biomechanically superior to partially threaded TI-TS fixation of vertically unstable transforaminal sacral fractures.

Methods:
Vertically unstable zone 2 sacral fractures were created in 20 human cadaveric pelves with a unilateral osteotomy and resection of 1 cm of bone through the foramen of the sacrum to represent comminution. Ten specimens received either 2 7.3-mm fully threaded or 2 7.3-mm partially threaded TI-TS screw fixation at the S1 and S2 body, and every specimen received standard 3.5-mm 8-hole parasymphyseal plating anteriorly. Each pelvis was loaded to 250 N at 3 Hz for 100,000 cycles and then loaded to failure. The primary outcome was fracture displacement at the S1 foramen, which was measured at 25,000, 50,000, 75,000, and 100,000 cycles. Secondary outcomes were simulated clinical failure of ≥1 cm displacement at the S1 foramen to determine occurrence probability of failure, and load at failure was defined as 2.5 cm of the linear loading system displacement. Specimens in the fully threaded and partially threaded cohorts were otherwise respectively comparable in regards to age, gender, and bone density.

Results:
Five of the 10 TI-TS partially threaded specimens experienced simulated clinical failure with >1 cm displacement at the S1 foramen compared with 0 of the 10 TI-TS fully threaded cohort (50% vs. 0%, P = 0.03). The mean maximal displacement at the S1 foramen was greater in the partially threaded cohort (9.3 mm) compared with the fully threaded cohort (3.6 mm; P = 0.004). Fully threaded specimens also demonstrated greater mean force to failure than the partially threaded specimens (461 N vs. 288 N; P = 0.0001).

Conclusions:
Fully threaded TI-TS screw fixation seems to be mechanically superior to partially threaded fixation in a cadaveric vertically unstable transforaminal sacral fracture model with significantly less displacement of the posterior pelvic ring and greater load to failure.
Dural Leak: Is It Deterrent to Outcomes in Spine Surgery?
Authors: Patel Jwalant , Kundnani Vishal , Kuriya Suraj 
Published: August 2020

Study Design.
Retrospective case-control study.

Objectives.
To review the incidence of dural leaks, evaluate the efficacy of primary closure of durotomy and to study its effect on clinical outcome. The secondary aim is to classify the dural leaks and proposing a treatment algorithm for dural leaks.

Summary of Background Data.
Dural leaks are described as one of the fearful complications in spine surgery. Literature evaluating the actual incidence, ideal treatment protocol, efficacy of primary repair techniques and its effects on long-term surgical outcomes are scanty.

Methods.
It was a retrospective analysis of 5390 consecutively operated spine cases over a period of 10 years. All cases were divided into two groups—study group (with dural leak-255) and control group (without dural leak-5135). Dural leaks were managed with the proposed treatment algorithm. Blood loss, surgical time, hospital stay, time for return to mobilization, pain free status, and clinical outcome score (ODI, VAS, NDI, and Wang criteria) were assessed in both groups at regular intervals. The statistical comparison between two groups was established with chi-square and t-tests.

Results.
The overall incidence of dural leaks was 4.73% with highest incidence in revision cases (27.61%). There was significant difference noted in mean surgical blood loss (P 0.001), mean hospital stay (P 0.001), time to achieve pain-free status after surgery, and return to mobilization between two groups. However, no significant difference was noted in operative time (P 0.372) and clinical outcome scores at final follow-up between the two groups.

Conclusion.
Primary closure should be undertaken in all amenable major dural leak cases. Dural leaks managed as proposed by the author's treatment algorithm have shown a comparable clinical outcome as in patients without dural leaks. Dural leak is a friendly adverse event that does not prove a deterrent to long-term clinical outcome in spine surgeries.

Level of Evidence: 4
Opioid Use in Adults With Low Back or Lower Extremity Pain Who Undergo Spine Surgical Treatment Within 1 Year of Diagnosis
Authors: Fatemi Parastou , Zhang Yi , Ho Allen , Lama Roberto , Jin Michael , Veeravagu Anand , Desai Atman , Ratliff John K. 
Published: August 2020

Study Design.
Retrospective longitudinal cohort.

Objective.
We investigated opioid prescribing patterns amongst adults in the United States diagnosed with low back or lower extremity pain (LBP/LEP) who underwent spine surgery.

Summary of Background Data.
Opioid-based treatment of LBP/LEP and postsurgical pain has separately been associated with chronic opioid use, but a combined and large-scale cohort study is missing.

Methods.
This study utilizes commercial inpatient, outpatient, and pharmaceutical insurance claims. Between 2008 and 2015, patients without previous prescription opioids with a new diagnosis of LBP/LEP who underwent surgery within 1 year after diagnosis were enrolled. Opioid prescribing patterns after LBP/LEP diagnosis and after surgery were evaluated. All patients had 1-year postoperative follow-up. Low and high frequency (6 or more refills in 12 months) opioid prescription groups were identified.

Results.
A total of 25,506 patients without previous prescription opioids were diagnosed with LBP/LEP and underwent surgery within 1 year of diagnosis. After LBP/LEP diagnosis, 18,219 (71.4%) were prescribed opioids, whereas 7287 (28.6%) were not. After surgery, 2952 (11.6%) were prescribed opioids with high frequency and 22,554 (88.4%) with low frequency. Among patients prescribed opioids before surgery, those with high-frequency prescriptions were more likely to continue this pattern postoperatively than those with low frequency prescriptions preoperatively (OR 2.15, 95% CI 1.97–2.34). For those prescribed opioids preoperatively, average daily morphine milligram equivalent (MME) decreased after surgery (by 2.62 in decompression alone cohort and 0.25 in arthrodesis cohort, P < 0.001). Postoperative low-frequency patients were more likely than high-frequency patients to discontinue opioids one-year after surgery (OR 3.78, 95% CI 3.59–3.99). Postoperative high-frequency patients incurred higher cost than low-frequency patients. Postoperative high-frequency prescribing varied widely across states (4.3%–20%).

Conclusion.
A stepwise association exists between opioid use after LEP or LBP diagnosis and frequency and duration of opioid prescriptions after surgery. Simultaneously, the strength of prescriptions as measured by MME decreased following surgery.

Level of Evidence: 3
Neurological Disturbance of the Upper Extremities After Cervical Laminoplasty
Authors: Yoshioka Nao , Takayama Motohiro , Kobayashi Tamaki , Murai Nozomu , Ioroi Yoshihiko 
Published: August 2020

Study Design.
A retrospective study.

Objective.
The aim of this study was to explore the relationship between postoperative neurological disturbance of the upper extremities (NDUE) after cervical laminoplasty and intervertebral foraminal stenosis.

Summary of Background Data.
The relationship between foraminal stenosis and neurological disturbance in the C5 segment (C5 palsy) has been reported, but the relationship at other levels has not been examined before. We evaluated foraminal stenosis morphologically using three-dimensional computed tomography (3D-CT), alongside other risk factors for NDUE.

Methods.
We retrospectively reviewed patients treated by open-door laminoplasty at the authors’ institution between January and June 2016. NDUE was defined as postoperative motor deterioration and/or newly emerged sensory disturbance within 2 weeks of surgery. Radiological measurements were performed in bilateral intervertebral foramina from C5 to C8, using 3D-CT. Investigation using magnetic resonance imaging (MRI) was also performed.

Results.
Thirty-one patients were reviewed, and 10 (32.3%) developed NDUE. Nineteen NDUE were observed: seven were in the C5 segment, five in the C6 segment, three in the C7 segment, and four in the C8 segment. Four patients (40%) had NDUE from multiple segments. The mean width of the foramen was 2.60 ± 1.26 mm and 3.66 ± 1.66 mm (P = 0.007), and cross-sectional area was 32.8 ± 10.8 mm2 and 41.6 ± 12.4 mm2 (P = 0.003), in symptomatic (n = 19) and nonsymptomatic (n = 187) foramina, respectively. The mean transverse diameter of bony spurs and the maximum shift of the spinal cord on MRI was significantly larger in the NDUE group. The odds ratio of having a foraminal cross-sectional area under 28.0 mm2 in combination with a maximum spinal shift over 3.10 mm was 14.6 (P < 0.001).

Conclusion.
Stenosis of the intervertebral foramen could be a risk factor for NDUE after cervical laminoplasty, and could be aggravated by excessive posterior spinal cord shift.

Level of Evidence: 3
Plasma Exchange: An Effective Rescue Therapy in Critically Ill Patients With Coronavirus Disease 2019 Infection
Authors: Fernandez Javier , Gratacos-Ginès Jordi , Olivas Pol , Costa Montserrat , Nieto Susana , Mateo Dolors , Sánchez María Belén , Aguilar Ferran , Bassegoda Octavi , Ruiz Pablo , Caballol Berta , Pocurull Anna , Llach Joan , Mustieles María Jesús , Cid Joan , Reverter Enric , Toapanta Nestor David , Hernández-Tejero María , Martínez José Antonio , Claria Joan , Fernández Carlos , Mensa José , Arroyo Vicente , Castro Pedro , Lozano Miquel ,   for the Covid Clinic Critical Care (CCCC) Group
Published: August 2020

Objectives:
Infection by severe acute respiratory syndrome coronavirus-2 can induce uncontrolled systemic inflammation and multiple organ failure. The aim of this study was to evaluate if plasma exchange, through the removal of circulating mediators, can be used as rescue therapy in these patients.

Design:
Single center case series.

Setting:
Local study.

Subjects:
Four critically ill adults with coronavirus disease 19 pneumonia that failed conventional interventions.

Interventions:
Plasma exchange. Two to six sessions (1.2 plasma volumes). Human albumin (5%) was used as the main replacement fluid. Fresh frozen plasma and immunoglobulins were administered after each session to avoid coagulopathy and hypogammaglobulinemia.

Measurements and Main Results:
Serum markers of inflammation and macrophage activation. All patients showed a dramatic reduction in inflammatory markers, including the main cytokines, and improved severity scores after plasma exchange. All survived to ICU admission.

Conclusions:
Plasma exchange mitigates cytokine storm, reverses organ failure, and could improve survival in critically ill patients with coronavirus disease 2019 infection.
Understanding Barriers to Access and Utilization of Developmental Disability Services Facilitating Transition
Authors: Bear Ami , Drew Christine , Zuckerman Katharine E. , Phelps Randall A. 
Published: August 2020

ABSTRACT:

Objective:
To explore the barriers faced by parents of individuals with intellectual and developmental disabilities when obtaining and using Developmental Disability Services (DDS) to support adolescent transition.

Methods:
The authors conducted a basic interpretive qualitative study using semistructured interviews. Interviews were manually coded by the team of university-based researchers using constant comparative analysis. The codes were grouped into themes. Thematic saturation occurred after 18 interviews with parents (n = 10) and service coordinators for DDS (n = 8).

Results:
Barriers to DDS enrollment included emotional and administrative burden, fear of invasion of privacy, lack of a qualifying diagnosis, difficulties in accessing information about services, and misinformation about services. Barriers to DDS use once enrolled were difficulty in finding/hiring direct support professionals, high turnover of direct support professionals, and lack of training and skill among direct support professionals. Participants also noted high turnover among service coordinators, further administrative burden from hiring direct support professionals, and required home visits by service coordinators as additional barriers to service use. Participants reported benefits of DDS including increased inclusion for clients in the community, the use of person-centered skill building, and access to respite care and system navigation support.

Conclusion:
Although all participants reported benefits of acquiring services, there are significant barriers to acquiring and maintaining these services. Recommendations based on these barriers are provided for DDS, federal policy makers, and local support professionals along with a toolkit of potential strategies to support families.