bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality and Safety in Healthcare, Part LXXXV
Authors: Harolds Jay A. 
Published: February 2021

Abstract
A high-reliability organization must have high-performing teams. Core teams in healthcare should include the patient and, where possible, the patient’s family. Everyone on the team should understand what is expected of them in terms of expertise, leadership, communication, mutual support, and awareness of the situation. One test of the excellence of a clinical team is having high-quality handoffs of patients.
Simultaneous Reconstruction of Mandibular and Maxillary Defects Using the Single Free Fibular Osseocutaneous Flap
Authors: Lin Chih-Hung , Kudva Adarsh 
Published: February 2021

Background
The facial profile requires adequate maxillary and mandibular projection. Although oral cancer tumor ablation might create ipsilateral maxillary and mandibular defect, fibular flap is popular in mandibular defect reconstruction. However, the maxillary defect results in sunken cheek or oral contracture. A single fibular flap can provide several struts to rebuild 2 jaws with adequate 3-dimensional spatial placement.

Materials and Methods
In total, 7 cases of secondary oral contracture and 2 cases of primary oncologic tumor ablation underwent single fibular flap for 2 jaws. Using multiple osteotomies, the distal fibular struts were used for the upper jaw, the second struts were discarded (3–4 cm), and proximal struts were used for mandible defect reconstruction. There were 5 accompanying free flaps for facial lining (2) and contralateral oral contracture release (3).

Results
All flaps survived without distal strut avascular necrosis, but 2 patients died from tumor metastasis. These patients presented adequate middle and lower facial profile. One patient underwent mandibular fibula strut distraction osteogenesis followed by integrated teeth on both jaws.

Conclusions
Single fibular transfer can accomplish 2 jaw bony defects and facial profile reconstruction. It can release oral contracture functionally and correct sunken cheek aesthetically. The reconstructed fibula can allow secondary teeth implantation rehabilitation.
Broad-Spectrum Antibiotics for Breast Expander/Implant Infection
Authors: Ozturk Cemile Nurdan , Ozturk Can , Sigurdson S. Lynn , Magner William J. , Sheedy Brenda , Lohman Robert , Moon Wong 
Published: February 2021

Background
Despite best practices, infection remains the most common complication after breast reconstruction with expanders and implants, ranging from 2% to 29%. Empiric broad-spectrum antibiotics are frequently used in nonsurgical treatment of implant-associated infections in an effort to salvage the reconstruction. Pitfalls of antibiotherapy include adverse events, vascular access site complications, and drug resistance. Our goals were to describe management of implant infections with broad-spectrum antibiotics, review treatment related adverse events, and report on outcomes of therapy.

Patients and Methods
A retrospective review was carried out to identify patients who were treated with intravenous (IV) antibiotics for periprosthetic infection. Patient characteristics, surgical details, and antibiotic therapy–related adverse events were collected. Eventual outcome related to expander/implant salvage was noted.

Results
A total of 101 patients (111 treatment episodes) were identified. Mean duration of antibiotic treatment was 18 days (range, 1–40 days). The most commonly used parenteral treatment was a combination of daptomycin with piperacillin-tazobactam (65%) or an alternative agent (16%). Fifty-nine percent of treatment episodes resulted in salvage of the expander or implant. Thirty-five percent treatment episodes were associated with 1 or more adverse events: diarrhea (12.6%), rash (10%), vaginal candidiasis (3.6%), agranulocytosis/neutropenic fever (3.6%), nausea (3.6%), urinary complaint (0.9%), myositis (0.9%), headache (0.9%), vascular line occlusion (1.8%), deep vein thrombosis (1.8%), and finger numbness (0.9%). No patients developed Clostridium difficile colitis. Five episodes (4%) needed discontinuation of antibiotics because of severe adverse events. The prosthesis was explanted in 3 of the cases of discontinued treatment.

Conclusions
Our findings show favorable outcomes and well-tolerated adverse effects with broad-spectrum parenteral antibiotherapy for periprosthetic infection. However, every effort should be made to deescalate therapy by narrowing the spectrum or limiting the duration, to minimize adverse events and development of bacterial resistance. Treating surgeons need to carefully weigh benefits of therapy and be aware of potential complications that might necessitate discontinuation of treatment.
Intracranial Volume Measured and Correlated to Cephalic Index in Syndromic and Nonsyndromic Anterior Brachycephaly
Authors: Kronig Otto D.M. , Kronig Sophia A.J. , Van Adrichem Léon N.A. 
Published: February 2021

Background
Premature fusion of both coronal sutures (anterior brachycephaly) alters skull shape and potentially affects intracranial volume (ICV). Currently little is known about preoperative ICV in anterior brachycephaly. Aim is to measure preoperative ICV and compare this with normative data. Additionally, ICV will be correlated to most used clinical method of quantification: cephalic index (CI).

Methods
Preoperative patients with anterior brachycephaly (age, ≤12 months) were included and categorized by syndrome (when present). Computed tomography scans were used for ICV measurement by manual segmentation (OsiriX (Fondation OsiriX, Geneva, Switzerland)). Intracranial volume of each subgroup was compared with Lichtenberg normative cranial volume growth curves for controls. Cephalic index was calculated and correlated to ICV using Pearson correlation coefficient.

Results
Thirty-four patients with both syndromic and nonsyndromic anterior brachycephaly were included: 17 with Apert syndrome, 6 with Muenke syndrome, 5 with Saethre Chotzen syndrome, 3 with Crouzon, 1 with craniofrontonasal dysplasia, and 2 nonsyndromal. Mean age at preoperative computed tomography scan was 4 months (1–10 months). Mean ICV was 847.31 cm3 (473.91–1459.22 cm3). Nineteen of 34 patients had skull volumes between ±2 SD curves of Lichtenberg, none of the patients had an ICV smaller than −2 SD and 15 of 34 had an ICV larger than +2 SD. Mean ICV in Apert syndrome was 829.85 cm3 (473.91–1061.53 cm3), in Muenke syndrome 942.06 cm3 (768.02–1136.75 cm3), in Saethre Chotzen syndrome 779.72 cm3 (609.21–1002.95 cm3), in Crouzon syndrome 700.57 cm3 (652.31–784.32 cm3), in craniofrontonasal dysplasia 738.97 cm3, and in the nonsyndromal group 1154.64 cm3 (850.07–1459.22 cm3). Apert had a mean greater than +2SD above the mean, the other subgroups had a mean within normal ranges (±2 SD). Correlation between severity of brachycephaly and overall ICV was low (r = 0.42).

Conclusions
Mean preoperative ICV in both syndromic and nonsyndromic anterior brachycephaly was 847.31 cm3. Intracranial volume in anterior brachycephaly is in 55.9% between normal ranges (±2 SD). In 44.1% ICV was greater than +2 SD, especially in Apert syndrome (11/16 Apert patients). None of the included patients had a deviant small ICV of less than −2 SD. Additionally, low correlation between ICV and CI (r = 0.42) was found and therefore CI is not suitable for estimating ICV in anterior brachycephaly.
Globalization of The Journal of Craniofacial Surgery Over The Last Decade: A Continent, Country, and State Level Analysis
Authors: Liechty Andrew E. , O’Rorke Erin V. , French Mackenzie M. , Vu Giap H. , Robinson Emily M. , Cho Daniel Y. , Friedrich Jeffrey B. , Susarla Srinvas M. 
Published: February 2021

Abstract
Craniofacial surgery continues to be a rapidly evolving field, due in part to interdisciplinary collaboration that has allowed for sharing of knowledge and methodologies, which has expanded greatly due to online journals and publications. The Journal of Craniofacial Surgery (JCS) is a highly regarded journal that has attracted attention for its mission to increase diversity and global representation in manuscript submissions and research publications. The purpose of this study is to provide an objective measurement of global participation in craniofacial research specifically as it pertains to the JCS. Through a bibliometric analysis, the country of origin of all articles published in the JCS from 2010 to 2019 was analyzed. In line with its mission, the JCS increased its overall production 1.9 times during the past decade and increased its global representation 1.6 times, as represented by the number of countries contributing (78). The journal produced 8147 articles with Turkey (1424), USA (1397), China (1178), South Korea (1023), and Italy (644) being the top producers. The highest represented states were Florida (156), New York (130), California (117), Massachusetts (112), and Pennsylvania (106). The Journal of Craniofacial Surgery has the greatest diversity of country representation of the major plastic and reconstructive journals compared. Overall the JCS has stayed true to its mission to foster craniofacial research and is a valuable resource for craniofacial surgeons across the world. This study provides an analysis of trends in global contributions to craniofacial research and highlights areas for further increasing global contributors to the field of craniofacial surgery.
Neurodevelopmental, Cognitive, and Psychosocial Outcomes for Individuals With Pathogenic Variants in the TCF12 Gene and Associated Craniosynostosis
Authors: Kennedy-Williams Patrick , Care Helen , Dalton Louise , Horton Jo , Kearney Anna , Rooney Natasha , Hotton Matthew , Pinckston Molly , Huggons Esme , Culshaw Laura , Kilcoyne Sarah , Johnson David , Wilkie Andrew O.M. , Wall Steven 
Published: February 2021

Abstract
Heterozygous mutations in the TCF12 gene were discovered in 2013 as a cause of craniosynostosis (CS). However, limited information regarding the behavioral phenotypic profile is available. Here the authors provide the first detailed study of the neurodevelopmental, cognitive, and psychosocial outcomes for patients with a pathogenic TCF12 variant and associated CS.
A clinical casenote audit was conducted at the 4 UK highly specialized craniofacial centers. A total of 35 patients aged 18 months to 10 years with an identified TCF12 pathogenic variant and CS (bicoronal CS = 45.7%, unicoronal CS = 40.0%, multisuture = 14.3%) were included. Standardized screening and/or assessment of full-scale intelligence quotient, social communication, development, behavior, and self-concept were conducted.
In the majority of cases, outcomes were consistent with age-related expectations. About 75% of patients demonstrated no delay across any early developmental domain, while 84.6% demonstrated full-scale intelligence quotient scores within 1 standard deviation of the population mean. Significant behavioral difficulties were demonstrated by parent reporters in 26.3% to 42.1% of cases (dependent upon domain). Clinically elevated social communication profiles were present in (41.7%) of parent-reported cases. Levels of self-concept (at age 10) were consistent with age-related normative data.
Most patients with a TCF12 pathogenic variant had a mild behavioral and cognitive phenotype, although they may be at a slightly increased risk of social communication difficulties and psychosocial issues. Although not measured statistically, there were no clear associations between surgical history and cognitive, behavioral, or psychosocial outcomes. This paper highlights the need for robust integrated developmental assessment of all CS patients, particularly those with an identified syndrome.
Prognostic Accuracy of VqSOFA for Predicting 28-day Mortality in Patients with Suspected Sepsis in the Emergency Department
Authors: Suttapanit Karn , Wisan Munlika , Sanguanwit Pitsucha , Prachanukool Thidathit 
Published: February 2021

ABSTRACT

Background:
Sepsis screening in the emergency department (ED) is challenging. The quick Sequential Organ Failure Assessment (qSOFA) score had poor accuracy for predicting mortality in both the intensive care unit and ED. High lactate levels were associated with an increased mortality. However, a previous study using lactate levels in combination with the qSOFA score did not observe a meaningful improvement in predictive accuracy. This study assessed the prognostic accuracy of venous lactate levels plus the qSOFA (VqSOFA) score for predicting 28-day mortality.

Methods:
Patients who visited the Ramathibodi ED with suspected sepsis were enrolled. The VqSOFA, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores were calculated using the initial vital signs and laboratory values. Prognostic accuracy was measured using the area under the receiver operating characteristic (AUROC) curve of the VqSOFA score and Sepsis-3 criteria for predicting 28-day mortality.

Results:
In total, 1,139 patients were enrolled, 118 of whom died within 28 days of admission. The AUROCs of the VqSOFA, qSOFA, and SOFA scores were 0.851 (95% CI 0.813–0.889), 0.813 (95% CI 0.772–0.854), and 0.728 (95% CI 0.671–0.784), respectively. Using VqSOFA score ≥ 3 as the cutoff, the sensitivity, specificity, and positive likelihood ratio were 74.6%, 82.5%, and 4.25%, respectively. VqSOFA ≥ 3 was linked to a low probability of 28-day survival and higher odds of vasopressor and ventilator use within 24 h.

Conclusions:
VqSOFA was more predictive of 28-day mortality and vasopressor and mechanical ventilator use than the qSOFA and SOFA scores.
An Intention-to-treat View of Lung Transplantation for Interstitial Lung Disease: Successful Strategies to Minimize Waiting List and Posttransplant Mortality
Authors: Zhu Michael Z.L. , Levvey Bronwyn J. , McGiffin David C. , Snell Gregory I. 
Published: February 2021

Background.
Access to lung transplantation (LTx) and rates of waiting list and posttransplant mortality for patients with interstitial lung disease (ILD) remain problematic. We evaluated the outcomes of ILD patients listed for LTx at our institution.

Methods.
Between 2012 and 2018, adult patients with ILD were listed and transplanted from a donor-pool that included extended criteria and donation after circulatory-determined death donors. Patients were categorized as experiencing 1 of 4 competing events: transplant, waitlist death, delisting, or alive on waitlist. Multivariable competing risk regression analysis was performed to determine predictors of waitlist death/delisting. Posttransplant survival was analyzed using Kaplan-Meier methods.

Results.
Among 187 patients listed, 82% (153 of 187) underwent LTx (median time-to-transplant, 2.0 mo), whereas 16% (30 of 187) died or were delisted (median time-to-event, 1.6 mo). At 90 d, 6 mo, and 12 mo after listing, 51%, 63%, and 78% of patients had been transplanted, whereas 10%, 14%, and 16% had died or were delisted. Multivariable predictors of waitlist death/delisting were: blood group O compared to A (subdistribution hazard ratio [SHR]: 6.43, P < 0.001), shorter height (per 1 cm, SHR: 1.11, P < 0.001), hospitalization at listing (SHR: 3.98, P = 0.002), and reduced 6-min-walk test distance (per 50 m, SHR: 1.28, P = 0.001). Among LTx recipients, 24% (36 of 153) underwent single LTx. Donor lungs were 58% (88 of 153) extended-criteria, inclusive of 24% (37 of 153) circulatory-determined death. Ninety-day and 1-, 3-, and 5-y retransplant free survival were 97% ± 1%, 92% ± 2%, 81% ± 4%, and 69% ± 6%.

Conclusions.
Patients with ILD require a rapid transit to LTx after listing. Despite this, the vast majority of ILD patients in this study reached LTx with excellent early and midterm outcomes.
Cost Structures of US Organ Procurement Organizations
Authors: Held Philip J. , Bragg-Gresham Jennifer L. , Peters Thomas G. , McCormick Frank , Chertow Glenn , Vaughan William P. , Roberts John P. 
Published: February 2021

Background.
The goal is to provide a national analysis of organ procurement organization (OPO) costs.

Methods.
Five years of data, for 51 of the 58 OPOs (2013–2017, a near census) were obtained under a FOIA. OPOs are not-for-profit federal contractors with a geographic monopoly. A generalized 15-factor cost regression model was estimated with adjustments to precision of estimates (P) for repeated observations. Selected measures were validated by comparison to IRS forms.

Results.
Decease donor organ procurement is a $1B/y operation with over 26 000 transplants/y. Over 60% of the cost of an organ is overhead. Profits are $2.3M/OPO/y. Total assets are $45M/OPO and growing at 9%/y. “Tissue” (skin, bones) generates $2–3M profit/OPO/y. A comparison of the highest with the lower costing OPOs showed our model explained 75% of the cost difference. Comparing costs across OPOs showed that highest-cost OPOs are smaller, import 44% more kidneys, face 6% higher labor costs, report 98% higher compensation for support personnel, spend 46% more on professional education, have 44% fewer assets, compensate their Executive Director 36% less, and have a lower procurement performance (SDRR) score.

Conclusions.
Profits and assets suggest that OPOs are fiscally secure and OPO finances are not a source of the organ shortage. Asset accumulation ($45M/OPO) of incumbents suggests establishing a competitive market with new entrants is unlikely. Kidney-cost allocations support tissue procurements. Professional education spending does not reduce procurement costs. OPO importing of organs from other OPOs is a complex issue possibly increasing cost ($6K/kidney).
Comparison of the clinical characteristics and mortality in ARDS due to COVID-19 versus ARDS due to Influenza A-H1N1pdm09
Authors: Hernández Cárdenas Carmen , Lugo Gustavo , Hernández García Diana , Pérez-Padilla Rogelio 
Published: February 2021

AbstractImportanceInfection with the SARS-Cov-2 and Influenza A-H1N1 viruses is responsible for the first pandemics of the 21st century. Both of these viruses can cause severe pneumonia and acute respiratory distress syndrome (ARDS). The clinical differences and mortality associated with these two pandemic pneumonias in patients with ARDS are not well establishedObjectiveTo compare case-fatality between ARDS-Covid-19 and ARDS-Influenza A (H1N1), adjusting for known prognostic risk factors.Design, Setting and ParticipantsOne hundred forty-seven patients with COVID-19 were compared with 94 with Influenza A-H1N1, all of these were admitted to the intensive care unit of the Referral Center for Respiratory Diseases and COVID-19 in Mexico City and fulfilled the criteria of ARDS.ResultsPatients arrived at the hospital after 9 days of symptoms. Influenza patients had more obesity, more use of Norepinephrine, and higher levels of lactic dehydrogenase and glucose, and fewer platelets and lower PaO2/FIO2. Crude mortality was higher in COVID than in influenza (39% vs. 22%; p = 0.005). In a Cox proportional hazard model, patients with a diagnosis of COVID-19 had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score, ventilatory ratio, and prone ventilation. In the fully adjusted model, the ventilatory ratio and the absence of prone-position ventilation were also predictors of mortality.CONCLUSIONCOVID-19 patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death than similar patients with Influenza A-H1N1, after adjusting for SOFA score and other relevant risk factors for mortality.QuestionIs the mortality of ARDS associated with Covid-19 greater than that of ARDS associated to influenza H1N1?FindingsIn a Cox proportional hazard model, patients with a diagnosis of COVID-19 had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score.MeaningCOVID-19 patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death than similar patients with Influenza A-H1N1
Ultrafast Simulation of Large-Scale Neocortical Microcircuitry with Biophysically Realistic Neurons
Authors: Oláh Viktor János , Pedersen Nigel P , Rowan Matthew JM 
Published: February 2021

AbstractUnderstanding the activity of the mammalian brain requires an integrative knowledge of circuits at distinct scales, ranging from ion channel gating to circuit connectomics. To understand how multiple parameters contribute synergistically to circuit behavior, neuronal computational models are regularly employed. However, traditional models containing anatomically and biophysically realistic neurons are computationally demanding even when scaled to model local circuits. To overcome this limitation, we trained several artificial neural net (ANN) architectures to model the activity of realistic, multicompartmental neurons. We identified a single ANN that accurately predicted both subthreshold and action potential firing and correctly generalized its responses to previously unobserved synaptic input. When scaled, processing times were orders of magnitude faster compared with traditional approaches, allowing for rapid parameter-space mapping in a circuit model of Rett syndrome. Thus, we present a novel ANN approach that allows for rapid, detailed network experiments using inexpensive, readily available computational resources.
Sense of absence: Spatial perception through active sensing by insect antennal mechanosensory system
Authors: Ifere Nwuneke Okereke , Shidara Hisashi , Sato Nodoka , Ogawa Hiroto 
Published: February 2021

ABSTRACTAnimals perceive their surroundings by using various modalities of sensory inputs to navigate their locomotion. Nocturnal insects such as crickets use mechanosensory inputs mediated by their antennae to navigate under dark conditions. Active sensing with voluntary antennal movements improves spatial information, but it remains unclear how accurately the insects can perceive the surrounding space by using their antennal system. Crickets exhibit escape behavior in response to a short air-puff, which is detected by the abdominal mechanosensory organ called cerci and is perceived as a “predator approach” signal. We placed objects of different shapes at different locations with which the cricket actively made contact using its antenna. We then examined the effects on wind-elicited escape. The crickets changed their movement trajectory depending on the shape and location of the objects so that they could avoid collision with these obstacles even when the escape behavior was triggered by another modality of stimulus. For instance, when a wall was placed in front of the crickets so that it was detected by one side of their antenna, the escape trajectory in response to a stimulus from behind was significantly biased toward the side opposite the wall. However, if the antenna on the free side without the wall was ablated, this modulation to avoid collision diminished, suggesting that the antenna on the free side provided information of “absence” of obstacles. This study demonstrated that crickets were able to perceive spatial information, including the presence or absence of objects by active sensing with their antennal system.Summary StatementCrickets can acquire spatial information such as shape, location and orientation of objects through active sensing by antennal mechanosensory system, which also provides information about the absence of objects.