bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fast-track versus conventional surgery in relation to time of hospital discharge following total hip arthroplasty: a single-center prospective study
Authors: de Carvalho Almeida Raul Frankllim , Serra Humberto Oliveira , de Oliveira Liszt Palmeira 
Published: August 2021

AbstractBackgroundTotal hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints.MethodsNinety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS, and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Studentttest, and Poisson regression approach.ResultsThe FTS and control groups were similar in age and sex distribution (p> 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p< 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001).ConclusionUse of FTS was associated with decreased LOS, compared with conventional THA.Trial registrationhttps://www.researchsquare.com/article/rs-369025/v1.
Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting – the PRIUS-study
Authors: Ivic Robert , Nurmi Jouni , Kurland Lisa , Vicente Veronica , Lindström Veronica , Djärv Therese , Kaartinen Johanna , Castrén Maaret , Bohm Katarina 
Published: August 2021

Abstract
Background
Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group.

Method
A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used.

Results
A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive.

Conclusion
Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment.

Trial registration
NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359.
Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis
Authors: Poon Wynne Hsing , Ramanathan Kollengode , Ling Ryan Ruiyang , Yang Isabelle Xiaorui , Tan Chuen Seng , Schmidt Matthieu , Shekar Kiran 
Published: August 2021

Abstract
Background
Prone positioning (PP) improves oxygenation and respiratory mechanics and is associated with lower mortality in patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite this, some patients develop refractory hypoxemia and hypercapnia requiring venovenous extracorporeal membrane oxygenation (VV ECMO) support and are usually cared for in supine position. The physiologic and outcome benefits of routine PP of patients during VV ECMO remains unclear. Hence, we conducted the systematic review and meta-analysis to evaluate the outcome benefits of PP for patients with ARDS being treated with VV ECMO.

Methods
After registration with PROSPERO (CRD42020199723), MEDLINE, EMBASE, Scopus and Cochrane databases were searched for relevant studies that reported PP in more than 10 adult patients supported with VV ECMO from origin to 1 March 2021. Studies were reviewed for quality using appropriate Joanna Briggs Institute (JBI) checklists, and certainty of evidence was assessed using the GRADE approach. The random-effects model (DerSimonian and Laird) was used. The primary outcome of interest was cumulative survival. Secondary outcomes were intensive care unit length of stay (ICU LOS) and ECMO duration. Changes in arterial blood gas (ABG) values, ventilator mechanics and complication rates were also studied.

Results
Of 812 potentially relevant publications, 12 studies (640 patients) met our inclusion criteria. Due to overlapping study populations, 11 studies were included in the final meta-analysis. Cumulative survival in patients that underwent PP was 57% (95% CI 41.9–71.4, high certainty). Patients that underwent PP had longer ICU LOS (+ 14.5 days, 95% CI 3.4–25.7, p = 0.01) and ECMO duration (+ 9.6 days, 95% CI 5.5–13.7, p < 0.0001). After PP, patients had significantly higher PaO2/FiO2 ratio, lower PaCO2 and reduced ventilator driving pressure, and no major complications were reported.

Conclusions
PP during VV ECMO appears safe with a cumulative survival of 57% and may result in longer ECMO runs and ICU LOS. However, evidence from appropriately designed randomized trials is needed prior to widespread adoption of PP on VV ECMO.
Transition from static culture to stirred tank bioreactor for the allogeneic production of therapeutic discogenic cell spheres
Authors: Rodriguez-Granrose Daniel , Zurawski Jeff , Heaton Will , Tandeski Terry , Dulatov Galina , Highsmith Angelica Adrian , Conen Mason , Clark Garrett , Jones Amanda , Loftus Hannah , LeBaron Cameron , Scull Erin , Farhang Niloo , Erickson Isaac , Bingham Justin , Decaria Paula , Jones Nephi , Foley Kevin T. , Silverman Lara 
Published: August 2021

AbstractBackgroundCulturing cells as cell spheres results in a tissue-like environment that drives unique cell phenotypes, making it useful for generating cell populations intended for therapeutic use. Unfortunately, common methods that utilize static suspension culture have limited scalability, making commercialization of such cell therapies challenging. Our team is developing an allogeneic cell therapy for the treatment of lumbar disc degeneration comprised of discogenic cells, which are progenitor cells expanded from human nucleus pulposus cells that are grown in a sphere configuration.MethodsWe evaluate sphere production in Erlenmeyer, horizontal axis wheel, stirred tank bioreactor, and rocking bag format. We then explore the use of ramped agitation profiles and computational fluid dynamics to overcome obstacles related to cell settling and the undesired impact of mechanical forces on cell characteristics. Finally, we grow discogenic cells in stirred tank reactors (STRs) and test outcomes in vitro (potency via aggrecan production and identity) and in vivo (rabbit model of disc degeneration).ResultsComputation fluid dynamics were used to model hydrodynamic conditions in STR systems and develop statistically significant correlations to cell attributes including potency (measured by aggrecan production), cell doublings, cell settling, and sphere size. Subsequent model-based optimization and testing resulted in growth of cells with comparable attributes to the original static process, as measured using both in vitro and in vivo models. Maximum shear rate (1/s) was maintained between scales to demonstrate feasibility in a 50 L STR (200-fold scale-up).ConclusionsTransition of discogenic cell production from static culture to a stirred-tank bioreactor enables cell sphere production in a scalable format. This work shows significant progress towards establishing a large-scale bioprocess methodology for this novel cell therapy that can be used for other, similar cell therapies.
Practical validation framework for competence measurement in VET: a validation study of an instrument for measuring basic commercial knowledge and skills in Switzerland
Authors: Rohr-Mentele Silja , Forster-Heinzer Sarah 
Published: August 2021

AbstractCompetence development and measurement are of great interest to vocational education and training (VET). Although there are many instruments available for measuring competence in diverse settings, in many cases, the completed steps of validation are neither documented nor made transparent in a comprehensible manner. Understanding what an instrument actually measures is extremely important, inter alia, for evaluating test results, for conducting replication studies and for enforcing adaptation intentions. Therefore, more thorough and qualitative validation studies are required. This paper presents an approach to facilitate validation studies using the example of thesimuLINCAtest. The approach to validation applied in this study was developed in the field of medicine; nevertheless, it provides a promising means of assessing the validity of (computer-based) instruments in VET. We present the approach in detail along a newly developed computer-based simulation (simuLINCA) that measures basic commercial knowledge and skills of apprentices in Switzerland. The strength of the presented approach is that it provides practical guidelines that help perform the measurement process and support an increase in transparency. Still, it is flexible enough to allow different concepts to test development and validity. The approach applied proved to be practicable for VET and the measurement of occupational competence. After extending and slightly modifying the approach, a practical validation framework, including the description of each step and questions to support the application of it, is available for the VET context. The computer-based test instrument,simuLINCA, provides insights into how a computer-based test for measuring competence in various occupational fields can be developed and validated.SimuLINCAshowed satisfying evidence for a valid measurement instrument. It could, however, be further developed, revised and extended.
Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: A retrospective study
Authors: Wang Peng-peng , Tang Li-xing , Zhang Jie , Yang Xiao-jian , Zhang Wei , Han Yang , Xiao Xiao , Ni Xin , Ge Wen-tong 
Published: August 2021

Background Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants. Methods Clinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra-low-dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years. Results The septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.00), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases. Conclusions The endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.
A novel method of reversed migration capillary electrophoresis for determination of linear alkylbenzene sulfonates
Authors: Huang Zhuo , Wang Weike , Xie Lingxian , Lin Li 
Published: August 2021

AbstractA reversed migration capillary electrophoresis (RMCE) has been developed to determine linear alkylbenzene sulfonates (LAS). The sample stacking and separation conditions have been systematically investigated and optimized under reversed separation voltage at a low pH value. The separation effect of LAS homologs has been greatly improved based on the relative motion of electrophoresis and electroosmotic flow. RMCE demonstrates a good linear range of 0.1 mg/l to 10.0 mg/l, and the detection limit of LAS homologs reaches 0.001–0.004 mg/l. The relative standard deviations (n=6) of peak area and migration time were 2.25–4.40% and 0.67–0.75%, respectively. RMCE has also been applied for LAS detection in practical wastewater. The results show RMCE exhibits easy pretreatment, fast detection, high sensitivity, good peak shapes and resolution, and less solvent consumption, compared with the established high-performance liquid chromatography method.
Physiological and transcriptome analysis elucidates the metabolic mechanism of versatile Porphyridium purpureum under nitrogen deprivation for exopolysaccharides accumulation
Authors: Ji Liang , Li Shaohua , Chen Cheng , Jin Haojie , Wu Haizhen , Fan Jianhua 
Published: August 2021

AbstractPorphyridium purpureumis a mesophilic, unicellular red alga rich in phycoerythrin, sulfate polysaccharides, and polyunsaturated fatty acids. Nitrogen deficiency inhibited the growth ofP. purpureumand resulted in yellowing of the cells and thickening of the extracellular viscousness sheath. Under nitrogen stress, the contents of total lipids and exopolysaccharides inP. purpureumwere increased by 65.2% and 188.0%, respectively. We demonstrate that the immediate response ofP. purpureumto nitrogen deficiency is mediated by carbon flow to polysaccharide synthesis, while the synthesis of lipids is enhanced as a permanent energy storage substance at the later stage. Based on transcriptome annotation information, we elucidate the synthesis pathway of polysaccharides fromP. purpureumfrom the perspective of glycosyl-donor interconversion, and demonstrate that the n-6 pathway is the main synthesis pathway of polyunsaturated fatty acids. This study not only provides a production strategy for polysaccharides and fatty acids by single-celled marine red algaeP. purpureum, but also provides targets for further genetic modification.
How child mental health training is conceptualized in four low- and middle-income countries
Authors: Vostanis Panos , Eruyar Seyda , Haffejee Sadiyya , O’Reilly Michelle 
Published: August 2021

AbstractThe objective was to establish how stakeholders in low- and middle-income countries (LMIC) conceptualize child mental health impact. Semi-structured interviews were conducted with 18 stakeholders from disadvantaged urban communities in Kenya, South Africa, Turkey and Brazil. Participants represented education, welfare and health care agencies; as well as community and religious groups. Data were analysed through a thematic approach and three related themes were identified. Impact was defined as a process of change, with child-centred outcomes and measures that were broader than mental health symptoms improvement. Beneficiaries were identified at child, family, community and service level. Participants wished to see strategies that ensured sustainability of impact, namely child mental health policy, stakeholder engagement, interdisciplinary working, and capacity-building for all stakeholder groups. Child mental health service transformation in LMIC, especially in areas of deprivation, needs to build on existing resources and strengths by co-producing psychosocial outcomes with a range of professional and community stakeholders. Impact on children’s mental wellbeing can be achieved through a co-ordinated strategy that involves designated policy, capacity-building, and interdisciplinary networks with meaningful community involvement.
Impact of a Dedicated Cancer Urgent Care Center on Acute Care Utilization
Authors: Gould Rothberg Bonnie E. , Canavan Maureen E. , Mun Sophia , Sedghi Tannaz , Carafeno Tracy , Raucci Maureen , Dest Vanna , Sinanis Naralys , Gross Cary P. , Adelson Kerin B. 
Published: August 2021

PURPOSE: Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS: We conducted a quasi-experimental study anchored around the Oncology Extended Care Clinic (OECC) opening date. We evaluated two parallel 4-month periods: a post-OECC period that followed a 5-month run-in phase, and the identical calendar period 1 year earlier. Our primary outcomes included all emergency department (ED) presentations and hospital admissions during the 3-month window following the index provider visit. We used Poisson models to calculate absolute pre-OECC v post-OECC rate differences. RESULTS: Our cohort included 2,095 patients in the pre-OECC period and 2,188 in the post-OECC period. We identified 32.6 ED visits/100 patients and 41.2 hospitalizations/100 patients in the pre-OECC period, versus 28.2 ED visits/100 patients and 26.1 hospitalizations/100 patients post-OECC. After adjusting for age, sex, race and ethnicity, and practice location, we observed a significant decrease of 4.6 ED visits/100 patients during the post-OECC period (95% CI, –8.92/100 to –0.28/100; P = .04) compared with the pre-OECC period. There was no significant association between the OECC opening and hospitalization rate (rate difference: –3.29 admissions/100 patients; 95% CI, –8.24/100 to 1.67/100; P = .19). CONCLUSION: Establishing a cancer-specific urgent care center was significantly associated with a modest decrease in emergency room utilization but not with hospitalization rate. Barriers included clinic capacity, patient awareness, and physician comfort with advanced practice provider autonomy. Optimizing workflow and standardizing clinical pathways can create benchmarks useful for value-based payments.
Reformulation of PULSAR for Analysis of Pulsatile LH Secretion and a Revised Model of Estrogen-Negative Feedback in Mice
Authors: Porteous Robert , Haden Patricia , Hackwell Eleni C R , Singline Aaron , Herde Michel K , Desai Reena , Handelsman David J , Grattan David R , Herbison Allan E 
Published: August 2021

Abstract
The recent use of the tail-tip bleeding approach in mice has enabled researchers to generate detailed pulse and surge profiles of luteinizing hormone (LH) secretion in mice. However, the analysis of pulsatile LH secretion is piecemeal across the field with each laboratory using their own methodology. We have reformulated the once-popular PULSAR algorithm of Merriam and Wachter to operate on contemporary computer systems and provide downloadable and online pulse analysis platforms. As it is now possible to record the activity of the gonadotropin-releasing hormone pulse generator in freely behaving mice, we have been able to unambiguously define LH pulses in intact and gonadectomized male and female mice. These data sets were used to determine the appropriate PULSAR parameter sets for analyzing pulsatile LH secretion in the mouse. This was then used to establish an accurate model of estrogen negative feedback in the mouse. Intact and ovariectomized mice given Silastic capsules containing 1, 2, and 4 μg 17-β-estradiol/20 g body weight were tail-tip bled at 6-min intervals, and the resultant LH profiles were analyzed with PULSAR. Only the 4 μg 17-β-estradiol capsule treatment was found to return LH pulse amplitude and frequency to that of intact diestrous mice. Ultrasensitive mass spectrometry analysis showed that the 4 μg 17-β-estradiol capsule generated circulating estradiol levels equivalent to that of diestrous mice. It is hoped that the reformulation of PULSAR and generation of a realistic model of estrogen-negative feedback will provide a platform for the more uniform assessment of pulsatile hormone secretion in mice.