bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Pancreatitis Activity Scoring System Predicts Clinical Outcomes in Patients With Infected Pancreatic Necrosis
Authors: Thiruvengadam Nikhil R. , Miranda Janille , Kim Christopher , Behr Spencer , Arain Mustafa A. 
Published: August 2021

Objectives
The Pancreatitis Activity Scoring System (PASS) is an objective tool validated in acute pancreatitis but not in infected pancreatic necrosis (IPN). Our aim was to evaluate the role of PASS in IPN.

Methods
We performed a retrospective cohort study of IPN patients admitted to the University of California, San Francisco from January 2011 to March 2019. Daily PASS scores were calculated for each patient. Receiver operator characteristic analysis was used to define the optimal cutoff PASS score to predict outcomes. The primary and secondary outcomes were 72 hours postintervention multiorgan failure (MOF) and early readmission (within 30 days), respectively.

Results
One hundred and four patients underwent intervention (median age, 55 years). Thirty-five patients (33.6%) developed MOF postintervention. A 72-hour postintervention PASS greater than 250 was strongly associated with postintervention MOF (area under curve, 0.87; adjusted odds ratio, 26.83; 95% confidence interval, 6.37–112.86; P < 0.001). Discharge PASS greater than 150 was associated with 30-day readmission (area under curve, 0.82; adjusted odds ratio, 26.44; 95% confidence interval, 8.48–82.43; P < 0.001).

Conclusions
The PASS score was associated with postintervention clinical outcomes and early readmission, suggesting it is a valid measure of disease activity in patients with IPN. Further prospective validation of PASS in IPN is needed.
Immunoglobulin G4-Related Disease Responder Index Correlates With the Risk of 1-Year Relapse in Type 1 Autoimmune Pancreatitis
Authors: Rogger Teresa Marzia , De Marchi Giulia , Brozzi Lorenzo , Amodio Antonio , Orsolini Giovanni , de Pretis Nicolò , Conti Bellocchi Maria Cristina , Crinò Stefano Francesco , Gabbrielli Armando , Ciccocioppo Rachele , Frulloni Luca 
Published: August 2021

Objectives
Type 1 autoimmune pancreatitis (AIP) is a manifestation of immunoglobulin G4–related diseases (IgG4-RD). To evaluate the activity of the disease, the IgG4-RD responder index (RI) has been created. This study evaluated the IgG4-RD RI as prognostic factor of 1-year disease relapse.

Methods
Patients diagnosed with type 1 AIP between January 2012 and December 2016, with available magnetic resonance imaging and IgG4 dosage, were enrolled. Immunoglobulin G4-RD RI was calculated at baseline (time 0), and at 3 to 6 and 12 to 18 months after the end of steroid therapy (time 1 and time 2, respectively).

Results
Thirty-three patients were included in the study. Immunoglobulin G4-RD RI was 8.9 (standard deviation [SD], 3.8) at time 0, 2.4 (SD, 3.1) at time 1 (P < 0.0001 vs time 0), and 4.2 (SD, 3.9) at time 2 (P = 0.02 vs time 1). Fourteen patients who relapsed within 1 year showed a higher mean value of IgG4-RD RI at time 0 (10.9; SD, 4.3) versus 19 who did not (7.4; SD, 2.6; P = 0.012). This difference was observed also at time 2 (6.8 vs 2.1; P = 0.002).

Conclusions
Immunoglobulin G4-RD RI correlates with type 1 AIP disease activity, and it predicts disease relapse within 1 year.
Gemcitabine Plus Nab-Paclitaxel Versus FOLFIRINOX in Locally Advanced, Unresectable Pancreatic Cancer
Authors: Arima Shiho , Kawahira Machiko , Shimokawa Mototsugu , Ido Akio , Koga Futa , Ueda Yujiro , Nakazawa Junichi , Komori Azusa , Otsu Satoshi , Fukahori Masaru , Makiyama Akitaka , Taguchi Hiroki , Honda Takuya , Shibuki Taro , Mitsugi Kenji , Nio Kenta , Ide Yasushi , Ureshino Norio , Mizuta Toshihiko , Shirakawa Tsuyoshi , Otsuka Taiga 
Published: August 2021

Objectives
FOLFIRINOX (FFX, a combination of oxaliplatin, irinotecan, fluorouracil, and leucovorin) and gemcitabine plus nab-paclitaxel (GnP) have been used as standard, first-line treatments for advanced pancreatic cancer. However, no study has compared the efficacy of the 2 regimens. This study retrospectively compared the efficacy and safety of the 2 regimens in patients with locally advanced pancreatic cancer.

Methods
We reviewed the records of patients with locally advanced pancreatic cancer who started FFX or GnP as first-line chemotherapy as part of a multicenter retrospective study in patients with unresectable pancreatic cancer treated with FFX or GnP (NAPOLEON study).

Results
Sixteen of the 63 patients were treated with FFX, and the other 47 patients were treated with GnP between December 2013 and March 2017. There were no significant differences in median overall survival rate between the GnP (15.5 months) and FFX (14.3 months, P = 0.60) groups or median progression-free survival rate between the GnP (8.8 months) and FFX (8.1 months, P = 0.51) groups. Both treatments were generally well tolerated, although anorexia was more severe in the FFX group than in the GnP group.

Conclusions
The effects of FFX and GnP were similar but resulted in different toxicities, which could guide agent choice.
Mucous Fistula Refeeding Promotes Earlier Enteral Autonomy in Infants With Small Bowel Resection
Authors: Woods Sean D. , McElhanon Barbara O. , Durham Megan M. , Figueroa Janet , Piazza Anthony J. 
Published: August 2021

ABSTRACTObjective:Infants requiring intestinal resection because of necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may benefit from mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. Previous series demonstrated improved outcomes with MFR but did not account for varied patient characteristics as potential sources of bias. We performed a cohort analysis using multivariable adjusted models to compare outcomes of patients with and without MFR.Methods:Retrospective chart review was performed for patients with NEC or SBA and small bowel resection with enterostomy and MF. Demographic and outcome data was compared between MFR and non‐MFR groups using adjusted multivariable analysis for potential confounding variables.Results:MFR was performed in 65 of 101 patients (64%), including 45 of 75 patients with NEC and 20 of 26 patients with SBA. Reasons for not receiving MFR included bowel stricture, technical limitation, or not otherwise specified. NEC patients receiving MFR had 14 fewer days to achieve full enteral feeds after intestinal reconnection, 22 fewer days of parenteral nutrition, lower peak direct bilirubin by 2.4 mg/dL, and 77% less odds of ursodiol use (all P < 0.01). SBA patients had similar trends not reaching statistical significance. Growth parameters were improved in MFR groups. There were no complications or increased infections from MFR.Conclusions:This study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, related to decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy.
Barriers to Universal Suicide Risk Screening for Youth in the Emergency Department
Authors: Seag Dana E. M. , Cervantes Paige E. , Baroni Argelinda , Gerson Ruth , Knapp Katrina , Tay Ee Tein , Wiener Ethan , Horwitz Sarah McCue 
Published: August 2021

Objective
Given the increasing rates of youth suicide, it is important to understand the barriers to suicide screening in emergency departments. This review describes the current literature, identifies gaps in existing research, and suggests recommendations for future research.

Methods
A search of PubMed, MEDLINE, CINAHL, PsycInfo, and Web of Science was conducted. Data extraction included study/sample characteristics and barrier information categorized based on the Exploration, Preparation, Implementation, Sustainment model.

Results
All studies focused on inner context barriers of implementation and usually examined individuals' attitudes toward screening. No study looked at administrative, policy, or financing issues.

Conclusions
The lack of prospective, systematic studies on barriers and the focus on individual adopter attitudes reveal a significant gap in understanding the challenges to implementation of universal youth suicide risk screening in emergency departments.
Resource Utilization During Low-Acuity Pediatric Emergency Department Visits
Authors: Li Joyce , Ramgopal Sriram , Marin Jennifer R. 
Published: August 2021

ObjectivesThe aims of the study were to estimate testing and treatment rates among pediatric low-acuity emergency department (ED) visits and to compare testing and treatment patterns at general and pediatric-specific EDs.MethodsWe performed a cross-sectional study of triage level 4 or 5 pediatric visits from a complex survey of nonfederal US EDs from 2008 to 2017. We analyzed demographics, vital signs, disposition, testing, and treatment. We calculated proportions for each data element and used χ2tests to determine differences between general and pediatric EDs.ResultsThere were an estimated 306.2 million pediatric visits with 129.1 million acuity level 4 or 5 visits (57.2%; 95% confidence interval, 55.4%–58.9%), with diagnostic testing performed in 47.1% and medications administered in 69.6% of the visits. Most low-acuity visits (82.0%) were to general EDs. Tests performed more frequently in general EDs compared with pediatric EDs included radiographs (25.8% vs 15.7%,P< 0.01), complete blood count (6.4% vs 3.9%,P< 0.01), electrolytes (11.6% vs 3.7%,P< 0.01), and glucose (2.0% vs 0.9%,P< 0.01). Ultrasound was used less frequently in general EDs (0.5 vs 0.7,P< 0.01). There were similar rates of intravenous fluid and overall medication administration and a higher proportion of patients receiving antibiotics in general EDs (28.7% vs 23.8%,P< 0.01).ConclusionsMore than half of pediatric visits to the ED are low acuity. Although general EDs relied on more imaging, blood testing and antibiotics, and pediatric EDs on ultrasound, overall resource utilization was high in this population across both ED types and can likely be reduced.
Training Experiences of Emergency Department Providers in the Recognition of Child Trafficking
Authors: Bechtel Kirsten , Passmore Sarah , Kondis Jamie , Walker Descartes Ingrid , Adewusi Adebimpe , Greenbaum Virginia 
Published: August 2021

Objective
Trafficked children face challenges to obtaining appropriate health care that may be addressed by clinician training. We evaluated emergency department (ED) staff's training experiences regarding child trafficking and attitudes toward educational efforts to provide informed recommendations for improvement in the recognition and evaluation of trafficked children in the ED setting.

Methods
In this cross-sectional study of general and pediatric ED staff across 6 cities in the United States, participants completed a 25-question, online anonymous survey. Differences in proportions between categorical data were examined using χ2/Fisher exact tests. Differences in means were evaluated using Student t test and 1-way analysis of variance.

Results
The 484 participants included physicians (33.0%), nurses (27.4%), resident physicians (12.2%), and social workers (10.1%). Only 12.4% reported being very confident in recognizing child trafficking. Barriers to recognition included lack of awareness and training on child sex trafficking (37.4%, 58.3%) and labor trafficking (38.4%, 50.6%), sensitivity of the topic (44.4%), lack of institutional guidelines (29.8%) and social work coverage (26.0%), and the assumption that children will not disclose victimization (16.5%). Although 62.2% of the respondents had prior training in child sex trafficking, only 13.3% reported that it was adequate. Barriers to training included lack of easy access (82.5%), belief that prior training was adequate (13.3%), poor-quality curricula (5.1%), and low priority of topic (4.1%). Recommendations for training included a 1-hour module/webinar/lecture (43.1%), rounds (40.5%), written guidelines (9.8%), and individualized, case-based learning (6.6%).

Conclusions
We found that although most ED providers stated that they had prior training in the recognition of child trafficking, few expressed confidence in their ability to recognize and evaluate trafficked children. Barriers to education included a lack of awareness of and access to available curricula. Providers supported a variety of formats for further education. Strategies for improving educational access are discussed.
Psychometric Properties of the Safety Climate Survey in Austrian Acute Care: Factor Structure, Reliability, and Usability
Authors: Glarcher Manela , Kaiser Karin , Nestler Nadja , Kutschar Patrick 
Published: August 2021

Background
Hospitals are complex organizations with a potential for medical errors that can be influenced by safety culture. Safety climate, as measurable element of safety culture, illustrates the perception of safety-relevant aspects of health care staff at a certain time. The Safety Climate Survey is applied internationally to measure safety climate. However, psychometrics for the German version of the survey have yet not been evaluated. The aim of this study is to explore the factor structure, reliability, and potential usefulness of the Safety Climate Survey in Austrian acute care.

Methods
Cross-sectional surveys of physicians, therapists, and nurses/midwives were implemented. An exploratory factor analysis was carried out, both in total sample and split by 2 selected professions. After deriving a factor structure for both professions, internal consistency and scale means were calculated for the subscales. Finally, mean subscale differences between physicians and nurses/midwives were tested.

Results
Of 5160 eligible staff, 933 respondents participated. A 6-factor solution explaining 59.1% of total variance was identified. Comparison by profession illustrated that the factor structures and item loading patterns differ between physicians and nurses/midwives. To achieve an overarching solution, 5 items were excluded from consecutive subscale measures because of cross-loadings and contradictory factor loadings. Subscales demonstrated good to low internal consistency (α = 0.794–0.535). Significant mean differences between subscales of professions were found relating to 3 factors.

Conclusions
The German Safety Climate Survey measures safety climate multidimensionally rather than unidimensionally and demonstrated some limitations in factor structures and item loadings but overall had satisfactory reliability of the 6 subscales.
The Arcuate Eminence and Superior Semicircular Canal: Magnetic Resonance Imaging Study
Authors: Tsutsumi Satoshi , Ono Hideo , Ishii Hisato 
Published: August 2021

Objective
The present study aimed to explore the relationship between the arcuate eminence (AE) and superior semicircular canal (SSC) using the constructive interference steady-state (CISS) sequence.

Patients and Methods
After conventional magnetic resonance imaging, a total of 71 patients underwent the CISS sequence in thin-sliced coronal sections.

Results
In all patients, the SSC was delineated on both sides. In contrast, the AE was identified only in 29 of 71 patients (40.8%) on both sides, varying in shape and relative location to the SSC in the mediolateral dimension. The shortest distance between the highest point of the SSC and middle fossa floor was 1.3 ± 1.1 mm on the right side and 1.3 ± 0.9 mm on the left with considerable variability. A dehiscent SSC with a distance less than 0.2 mm was found in 11.3% of 142 sides. On 22 sides (15.5%), the site on the middle fossa floor, reaching the SSC with the shortest distance (reference point) corresponded to the apex of the AE, equally on the right and left. On 36 sides (25.4%), the distance between the reference point and the apex of the AE was measured as 3.0 ± 1.1 mm on the 18 right sides and 3.7 ± 1.6 mm on the 18 left sides.

Conclusions
The relationship between AE and SSC is highly variable. Arcuate eminence was not a reliable landmark of the SSC. High-resolution CISS sequence is useful for exploring these structures.
The Past, Present, and Future (Liquid Biopsy) of Serum Tumor Markers in Lung Cancer: A Primer for the Radiologist
Authors: Vos Derek , Rao Sanjay , Pierce Jonathan D. , Smith Daniel A. , Tirumani Sree Harsha , Yoest Jennifer M. , Ramaiya Nikhil H. 
Published: August 2021

Abstract
Lung cancer continues to be a major cause of death throughout the world. The ability to both accurately diagnose lung cancer in its early stages and monitor response to treatment is essential to reducing the morbidity and mortality associated with the disease. Serum tumor markers have been identified as potential biomarkers that may aid in lung cancer diagnosis and surveillance. These markers, when combined with cross-sectional imaging, may result in more robust screening and surveillance protocols. The future role of serum tumor markers in lung cancer includes the advancement of “liquid biopsies,” in which peripheral blood samples are analyzed for tumor components without the need for a tissue biopsy.
Risk Stratification of Ductal Carcinoma In Situ and Texture Analysis of Contrast-Enhanced Breast Magnetic Resonance Imaging
Authors: Lee Eun Byul , Kim Sung Hun , Park Ga Eun , Lee Jeongmin , Kang Bong Joo 
Published: August 2021

Objective
The aim of this study was to investigate whether texture analysis of contrast-enhanced T1 weighted images could predict risk of ductal carcinoma in situ (DCIS).

Methods
The study included 185 DCIS lesions that were classified as either low risk or non–low risk using surgical pathology records. All magnetic resonance imaging texture analyses were performed using postprocessing software, and texture-derived parameters were extracted.

Results
The sphericity, compactness, and spherical disproportion were significantly different in the low-risk and non–low risk groups using the Van Nuys Prognostic Index (mean ± SD, 0.479 ± 0.189 vs 0.414 ± 0.176, 0.161 ± 0.159 vs 0.112 ± 0.134, and 2.569 ± 1.434 vs 2.934 ± 1.374, respectively; P < 0.05). In the univariate analyses, sphericity (odds ratio, 7.091; 95% confidence interval, 1.236–40.666; P = 0.028) and compactness (odds ratio, 9.267; 95% confidence interval, 1.125–76.360; P = 0.039) were significantly associated with a high probability of being low risk according to the Van Nuys Prognostic Index.

Conclusions
Whole-lesion texture analysis may be helpful in identifying patients classified as having low-risk DCIS before surgery.
Characteristic Features of Ear and Ear-Prints in Forensic Identification
Authors: Rani Deepika , Krishan Kewal , Sahani Ramesh , Shrestha Rijen , Kanchan Tanuj 
Published: August 2021

Introduction and Objectives:
The human external ear is a morphologically perplexing structure with wide variations in its features across individuals. Advances in forensic science have established the use of morphological features and prints of different parts of the human body in establishing the identity of an individual. The present study aims to establish such an identification process by examining the use of comparative analysis of ear prints and ear photographs.

Methodology:
The study examined the morphological features of ear prints of 140 participants (71 males and 69 females) ranging in age from 18 to 25 years (with a mean age of 20.22 ± 1.77 years), recruited from a North Indian population. Prints of both the ears were recorded, using the inking method. The morphological features of the ear prints were compared with the photographs of the ear for their uniqueness and individualization using likelihood ratios.

Results:
The degree ofantihelix curvature demonstrated the highest correlation (98.57%) between the morphological features visible on the ear and the expressions of these features in an ear print. The impression of earlobes, Darwin tubercle, crus of the helix, and shape of the external ear showed accuracy between 70% and 90%, whereas correlations below 70% accuracy were recorded for the other features. The likelihood ratios for 12 parameters were reported to be more than 10x, representing that the identification made using these parameters was > 10 times more likely to be true identification as compared to false positives. Moreover, 5 parameters were found to show high sensitivity, with values greater than 3 standard deviations (0.997), with an additional 9 parameters found to have good sensitivity at values greater than 2 standard deviations (<0.95). Similarly, 2 parameters were found to show high specificity, with values greater than 3 standard deviations (0.997), with an additional 18 parameters found to have good sensitivity at values greater than 2 standard deviations (<0.95).

Conclusions:
Elevated features of the ear, such as helix, antihelix, antitragus, tragus, and inter-tragic notch; particularly the degree of antihelix curvature, are more easily impressed and identifiable on an ear print. The results support that ear prints may provide important clues to assist in establishing the identity of an individual if several morphological features are evaluated concurrently.
Acute intensive care unit resuscitation of severely injured trauma patients: Do we need a new strategy?
Authors: Beni Catherine E. , Arbabi Saman , Robinson Bryce R.H. , O’Keefe Grant E. 
Published: August 2021

BACKGROUND
Unlike recent advances in blood product resuscitation, intravenous crystalloid (IVF) use after intensive care unit (ICU) admission in hemorrhagic shock has received less attention and current recommendations are based on limited evidence. To address this knowledge gap, we aimed to determine associations between IVF administration during acute ICU resuscitation and outcomes. We hypothesized that larger IVF volumes are associated with worse outcomes.

METHODS
We linked our trauma registry with electronic health record data (2012–2015) to identify adults with an initial lactate level of ≥4 mmol/L and documented lactate normalization (≤2 mmol/L), excluding those with isolated head Abbreviated Injury Scale score ≥3. We focused on the period from ICU admission to lactate normalization, analyzing duration, volume of IVF, and proportion of volume as 1-L boluses. We used linear regression to determine associations with ICU length of stay and duration of mechanical ventilation in survivors, and logistic regression to identify associations with acute kidney injury and home discharge while adjusting for important covariates.

RESULTS
We included 337 subjects. Median time to lactate normalization was 15 hours (interquartile range, 7–25 hours), and median IVF volume was 3.7 L (interquartile range, 1.5–6.4 L). The fourfold difference between the upper and lower quartiles of both duration and volume remained after stratifying by injury severity. Hourly volumes tapered over time but persistently aggregated at 0.5 and 1 L, with 167 subjects receiving at least one 0.5-L bolus for 6 hours after ICU admission. Administration of larger volumes was associated with longer ICU length of stay and duration of mechanical ventilation, as well as acute kidney injury.

CONCLUSION
There is substantial variation in volume administered during acute ICU resuscitation, both absolutely and temporally, despite accounting for injury severity. Administration of larger volumes during acute ICU resuscitation is associated with worse outcomes. There is an opportunity to improve outcomes by further investigating and standardizing this important phase of care.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.