bluuebunny/crossref_metadata_2025_split huggingface dataset:
The hidden burden of unplanned readmission after emergency general surgery
Authors: Urrechaga Eva M. , Cioci Alessia C. , Parreco Joshua P. , Gilna Gareth P. , Saberi Rebecca A. , Yeh D. Dante , Zakrison Tanya L. , Namias Nicholas , Rattan Rishi 
Published: July 2021

BACKGROUND
There are no national studies of nonelective readmissions after emergency general surgery (EGS) diagnoses that track nonindex hospital readmission. We sought to determine the rate of overall and nonindex hospital readmissions at 30 and 90 days after discharge for EGS diagnoses, hypothesizing a significant portion would be to nonindex hospitals.

METHODS
The 2013 to 2014 Nationwide Readmissions Database was queried for all patients 16 years or older admitted with an EGS primary diagnosis and survived index hospitalization. Multivariable logistic regression identified risk factors for nonelective 30- and 90-day readmission to index and nonindex hospitals.

RESULTS
Of 4,171,983 patients, 13% experienced unplanned readmission at 30 days. Of these, 21% were admitted to a nonindex hospital. By 90 days, 22% experienced an unplanned readmission, of which 23% were to a nonindex hospital. The most common reason for readmission was infection. Publicly insured or uninsured patients accounted for 67% of admissions and 77% of readmissions. Readmission predictors at 30 days included leaving against medical advice (odds ratio [OR], 2.51 [2.47–2.56]), increased length of stay (4–7 days: OR, 1.42 [1.41–1.43]; >7 days: OR, 2.04 [2.02–2.06]), Charlson Comorbidity Index ≥2 (OR, 1.72 [1.71–1.73]), public insurance (Medicare: OR, 1.45 [1.44–1.46]; Medicaid: OR, 1.38 [1.37–1.40]), EGS patients who fell into the “Other” surgical category (OR, 1.42 [1.38–1.48]), and nonroutine discharge. Risk factors for readmission remained consistent at 90 days.

CONCLUSION
Given that nonindex hospital EGS readmission accounts for nearly a quarter of readmissions and often related to important benchmarks such as infection, current EGS quality metrics are inaccurate. This has implications for policy, benchmarking, and readmission reduction programs.

LEVEL OF EVIDENCE
Epidemiological study, level III.
Extracellular vesicle–associated procoagulant activity is highest the first 3 hours after trauma and thereafter declines substantially: A prospective observational pilot study
Authors: Rognes Ingrid Nygren , Hellum Marit , Ottestad William , Bache Kristi Grønvold , Eken Torsten , Henriksson Carola Elisabeth 
Published: July 2021

BACKGROUND
Trauma patients have high concentrations of circulating extracellular vesicles (EVs) following injury, but the functional role of EVs in this setting is only partly deciphered. We aimed to describe in detail EV-associated procoagulant activity in individual trauma patients during the first 12 hours after injury to explore their putative function and relate findings to relevant trauma characteristics and outcome.

METHODS
In a prospective observational study of 33 convenience recruited trauma patients, citrated plasma samples were obtained at trauma center admission and 2, 4, 6, and 8 hours thereafter. We measured thrombin generation from isolated EVs and the procoagulant activity of phosphatidylserine (PS)-exposing EVs. Correlation and multivariable linear regression analyses were used to explore associations between EV-associated procoagulant activity and trauma characteristics as well as outcome measures.

RESULTS
EV–associated procoagulant activity was highest in the first 3 hours after injury. EV–associated thrombin generation normalized within 7 to 12 hours of injury, whereas the procoagulant activity of PS-exposing EVs declined to a level right above that of healthy volunteers. Increased EV-associated procoagulant activity at admission was associated with higher New Injury Severity Score, lower admission base excess, higher admission international normalized ratio, prolonged admission activated partial thromboplastin time, higher Sequential Organ Failure Assessment score at day 0, and fewer ventilator-free days.

CONCLUSION
Our data suggest that EVs have a transient hypercoagulable function and may play a role in the early phase of hemostasis after injury. The role of EVs in trauma-induced coagulopathy and posttraumatic thrombosis should be studied bearing in mind this novel temporal pattern.

LEVEL OF EVIDENCE
Prognostic/epidemiologic, level V.
A pilot study of stored low titer group O whole blood + component therapy versus component therapy only for civilian trauma patients
Authors: Siletz Anaar E. , Blair Kevin J. , Cooper Richelle J. , Nguyen N. Charity , Lewis Scott J. , Fang Amy , Ward Dawn C. , Jackson Nicholas J. , Rodriguez Tyler , Grotts Jonathan , Hwang Jonathan , Ziman Alyssa , Cryer Henry Magill 
Published: July 2021

BACKGROUND
This pilot assessed transfusion requirements during resuscitation with whole blood followed by standard component therapy (CT) versus CT alone, during a change in practice at a large urban Level I trauma center.

METHODS
This was a single-center prospective cohort pilot study. Male trauma patients received up to 4 units of cold-stored low anti-A, anti-B group O whole blood (LTOWB) as initial resuscitation followed by CT as needed (LTOWB + CT). A control group consisting of women and men who presented when LTOWB was unavailable, received CT only (CT group). Exclusion criteria included antiplatelet or anticoagulant medication and death within 24 hours. The primary outcome was total transfusion volume at 24 hours. Secondary outcomes were mortality, morbidity, and intensive care unit- and hospital-free days.

RESULTS
Thirty-eight patients received LTOWB, with a median of 2.0 (interquartile range [IQR] 1.0-3.0) units of LTOWB transfused. Thirty-two patients received CT only. At 24 hours after presentation, the LTOWB +CT group had received a median of 2,138 mL (IQR, 1,275–3,325 mL) of all blood products. The median for the CT group was 4,225 mL (IQR, 1,900–5,425 mL; p = 0.06) in unadjusted analysis. When adjusted for Injury Severity Score, sex, and positive Focused Assessment with Sonography for Trauma, LTOWB +CT group patients received 3307 mL of blood products, and CT group patients received 3,260 mL in the first 24 hours (p = 0.95). The adjusted median ratio of plasma to red cells transfused was higher in the LTOWB + CT group (0.85 vs. 0.63 at 24 hours after admission; p = 0.043. Adjusted mortality was 4.4% in the LTOWB + CT group, and 11.7% in the CT group (p = 0.19), with similar complications, intensive care unit-, and hospital-free days in both groups.

CONCLUSION
Beginning resuscitation with LTOWB results in equivalent outcomes compared with resuscitation with CT only.

LEVEL OF EVIDENCE
Therapeutic (Prospective study with 1 negative criterion, limited control of confounding factors), level III.
Reliable and valid assessment of procedural skills in resuscitative endovascular balloon occlusion of the aorta
Authors: Engberg Morten , Lönn Lars , Konge Lars , Mikkelsen Søren , Hörer Tal , Lindgren Hans , Søvik Edmund , Svendsen Morten Bo , Frendø Martin , Taudorf Mikkel , Russell Lene 
Published: July 2021

BACKGROUND
Valid and reliable assessment of skills is essential for improved and evidence-based training concepts. In a recent study, we presented a novel tool to assess procedural skills in resuscitative endovascular balloon occlusion of the aorta (REBOA), REBOA-RATE, based on international expert consensus. Although expert consensus is a strong foundation, the performance of REBOA-RATE has not been explored. The study aimed to examine the reliability and validity of REBOA-RATE.

METHODS
This was an experimental simulation-based study. We enrolled doctors with three levels of expertise to perform two REBOA procedures in a simulated scenario of out-of-hospital cardiac arrest. Procedures were video-recorded, and videos were blinded and randomized. Three clinical experts independently rated all procedures using REBOA-RATE. Data were analyzed using Messick’s framework for validity evidence, including generalizability analysis of reliability and determination of a pass/fail standard.

RESULTS
Forty-two doctors were enrolled: 16 novices, 13 anesthesiologists, and 13 endovascular experts. They all performed two procedures, yielding 84 procedures and 252 ratings. The REBOA-RATE assessment tool showed high internal consistency (Cronbach’s α = 0.95) and excellent interrater reliability (intraclass correlation coefficient, 0.97). Assessment using one rater and three procedures could ensure overall reliability suitable for high-stakes testing (G-coefficient >0.80). Mean scores (SD) for the three groups in the second procedure were as follows: novices, 32% (24%); anesthesiologists, 55% (29%); endovascular experts, 93% (4%) (p < 0.001). The pass/fail standard was set at 81%, which all experts but no novices passed.

CONCLUSION
Data strongly support the reliability and validity of REBOA-RATE, which successfully discriminated between all experience levels. The REBOA-RATE assessment tool requires minimal instruction, and one rater is sufficient for reliable assessment. Together, these are strong arguments for the use of REBOA-RATE to assess REBOA skills, allowing for competency-based training and certification concepts.

LEVEL OF EVIDENCE
Diagnostic test, no or poor gold standard, level V.
KRP-203 Is a Desirable Immunomodulator for Islet Allotransplantation
Authors: Fathi Ibrahim , Nishimura Ryuichi , Imura Takehiro , Inagaki Akiko , Kanai Norifumi , Ushiyama Akira , Kikuchi Masafumi , Maekawa Masamitsu , Yamaguchi Hiroaki , Goto Masafumi 
Published: July 2021

Background.
The current standard immunosuppressive regimens, calcineurin inhibitors, have diabetogenic and anti-vascularization effects on islet grafts. KRP-203, a sphingosine-1-phosphate functional antagonist, exerts its immunomodulatory function through lymphocyte sequestration. However, the effect of this antagonist on islets is unclear. We examined the effect of KRP-203 on the islet function and vascularization and sought a calcineurin-free regimen for islet allotransplantation.

Methods.
KRP-203 was administered for 14 d to mice, then diabetogenic effect was evaluated by blood glucose levels and a glucose tolerance test. Static glucose stimulation, the breathing index, and insulin/DNA were examined using isolated islets. Islet neovascularization was evaluated using a multiphoton laser scanning microscope. After islet allotransplantation with either KRP-203 alone, sirolimus alone, or both in combination, the graft survival was evaluated by blood glucose levels and immunohistochemical analyses. A mixed lymphocyte reaction was also performed to investigate the immunologic characteristics of KRP-203 and sirolimus.

Results.
No significant differences in the blood glucose levels or glucose tolerance were observed between the control and KRP-203 groups. Functional assays after islet isolation were also comparable. The multiphoton laser scanning microscope showed no inhibitory effect of KRP-203 on islet neovascularization. Although allogeneic rejection was effectively inhibited by KRP-203 monotherapy (44%), combination therapy prevented rejection in most transplanted mice (83%).

Conclusions.
KRP-203 is a desirable immunomodulator for islet transplantation because of the preservation of the endocrine function and lack of interference with islet neovascularization. The combination of KRP-203 with low-dose sirolimus may be promising as a calcineurin-free regimen for islet allotransplantation.
Synergistic multi-spectral CT reconstruction with directional total variation
Authors: Cueva Evelyn , Meaney Alexander , Siltanen Samuli , Ehrhardt Matthias J. 
Published: July 2021

This work considers synergistic multi-spectral CT reconstruction where information from all available energy channels is combined to improve the reconstruction of each individual channel. We propose to fuse these available data (represented by a single sinogram) to obtain a polyenergetic image which keeps structural information shared by the energy channels with increased signal-to-noise ratio. This new image is used as prior information during a channel-by-channel minimization process through the directional total variation. We analyse the use of directional total variation within variational regularization and iterative regularization. Our numerical results on simulated and experimental data show improvements in terms of image quality and in computational speed.
This article is part of the theme issue ‘Synergistic tomographic image reconstruction: part 2’.
Aureimonas mangrovi sp. nov., a marine alphaproteobacterium isolated from mangrove sediment in Thailand
Authors: Huang Hao , Punnarak Porntep , Zhang Qinghua , Piumsomboon Ajcharaporn , Wang Lei , Li Weiwen , Chen Shunyang , Chen Guangcheng , Ou Danyun 
Published: July 2021

Two bacterial strains, designated as 1-4-3T and 1-4-4, were isolated from a mangrove sediment cultured with coastal seawater. The cells were Gram-stain-negative, motile, short, rod-shaped bacteria with flagella. Growth occurred at 4–37 °C, pH 7.0–9.0, and 0–7% NaCl. The predominant fatty acids of the novel strains were C18 : 1
ω7c, C19 : 0 cyclo ω8c, C18 : 0, and C16 : 0. A phylogenetic analysis based on 16S rRNA gene sequences and whole genome phylogeny analysis based on distance matrix revealed an affiliation between the two strains and the genus

Aureimonas

, with closest sequence similarity to

A. populi

4M3-2T (96.41 and 96.64% similarity, respectively) and

A. glaciistagni

(96.01 and 96.23% similarity, respectively). The DNA G+C content of strain 1-4-3T was 66.80 mol%. Strain 1-4-3T displayed low DNA–DNA relatedness to

A. populi

4M3-2T, with an average nucleotide identity value of 77.47 % and digital DNA–DNA hybridization value of 22.83 %. Genotypic, chemotaxonomic, and phenotypic data indicate that strains 1-4-3T and 1-4-4 represent a novel species of the genus

Aureimonas

, for which we propose the name Aureimonas mangrovi sp. nov. The type strain is 1-4-3T (=LMG 31693T=CGMCC 1.18507T).
Reduced COVID-19 Hospitalizations among New York City Residents Following Age-Based SARS-CoV-2 Vaccine Eligibility: Evidence from a Regression Discontinuity Design
Authors: Greene Sharon K. , Levin-Rector Alison , McGibbon Emily , Baumgartner Jennifer , Devinney Katelynn , Ternier Alexandra , Sell Jessica , Kahn Rebecca , Kishore Nishant 
Published: July 2021

AbstractBackgroundIn clinical trials, several SARS-CoV-2 vaccines were shown to reduce risk of severe COVID-19 illness. Local, population-level, real-world evidence of vaccine effectiveness is accumulating. We assessed vaccine effectiveness for community-dwelling New York City (NYC) residents using a quasi-experimental, regression discontinuity design, leveraging a period (January 12–March 9, 2021) when ≥65-year-olds were vaccine-eligible but younger persons, excluding essential workers, were not.MethodsWe constructed segmented, negative binomial regression models of age-specific COVID-19 hospitalization rates among 45–84-year-old NYC residents during a post-vaccination program implementation period (February 21–April 17, 2021), with a discontinuity at age 65 years. The relationship between age and hospitalization rates in an unvaccinated population was incorporated using a pre-implementation period (December 20, 2020–February 13, 2021). We calculated the rate ratio (RR) and 95% confidence interval (CI) for the interaction between implementation period (pre or post) and age-based eligibility (45–64 or 65–84 years). Analyses were stratified by race/ethnicity and borough of residence. Similar analyses were conducted for COVID-19 deaths.ResultsHospitalization rates among 65–84-year-olds decreased from pre- to post-implementation periods (RR 0.85, 95% CI: 0.74–0.97), controlling for trends among 45–64-year-olds. Accordingly, an estimated 721 (95% CI: 126–1,241) hospitalizations were averted. Residents just above the eligibility threshold (65–66-year-olds) had lower hospitalization rates than those below (63–64-year-olds). Racial/ethnic groups and boroughs with higher vaccine coverage generally experienced greater reductions in RR point estimates. Uncertainty was greater for the decrease in COVID-19 death rates (RR 0.85, 95% CI: 0.66–1.10).ConclusionThe vaccination program in NYC reduced COVID-19 hospitalizations among the initially age-eligible ≥65-year-old population by approximately 15%. The real-world evidence of vaccine effectiveness makes it more imperative to improve vaccine access and uptake to reduce inequities in COVID-19 outcomes.
Dynamic, stage-course protein interaction network using high power CpG sites in Head and Neck Squamous Cell Carcinoma
Authors: Riaz Arsalan , Shah Maryam , Zaheer Saad , Salam Abdus , Khan Faisal F 
Published: July 2021

SummaryHead and neck cancer is the sixth leading cause of cancer across the globe and is significantly more prevalent in South Asian countries, including Pakistan. Prediction of pathological stages of cancer can play a pivotal role in early diagnosis and personalized medicine. This project ventures into the prediction of different stages of head and neck squamous cell carcinoma (HNSCC) using prioritized DNA methylation patterns. DNA methylation profiles for each HNSCC stage (stage-I-IV) were used to extensively analyze 485,577 methylation CpG sites and prioritize them on the basis of the highest predictive power using a wrapper-based feature selection method, along with different classification models. We identified 68 high-power methylation sites which predicted the pathological stage of HNSCC samples with 90.62 % accuracy using a Random Forest classifier. We set out to construct a protein-protein interaction network for the proteins encoded by the 67 genes associated with these sites to study its network topology and also undertook enrichment analysis of nodes in their immediate neighborhood for GO and KEGG Pathway annotations which revealed their role in cancer-related pathways, cell differentiation, signal transduction, metabolic and biosynthetic processes. With information on the predictive power of each of the 67 genes in each HNSCC stage, we unveil a dynamic stage-course network for HNSCC. We also intend to further study these genes in light of functional datasets from CRISPR, RNAi, drug screens for their putative role in HNSCC initiation and progression.
Considerations for using multiple imputation in propensity score-weighted analysis
Authors: Eiset Andreas Halgreen , Frydenberg Morten 
Published: July 2021

AbstractWe present our considerations for using multiple imputation to account for missing data in propensity score-weighted analysis with bootstrap percentile confidence interval. We outline the assumptions underlying each of the methods and discuss the methodological and practical implications of our choices and briefly point to alternatives. We made a number of choicesa priorifor example to use logistic regression-based propensity scores to produce “standardized mortality ratio”-weights and Substantive Model Compatible-Full Conditional Specification to multiply impute missing data (given no violation of underlying assumptions). We present a methodology to combine these methods by choosing the propensity score model based on covariate balance, using this model as the substantive model in the multiple imputation, producing and averaging the point estimates from each multiple imputed data set to give the estimate of association and computing the percentile confidence interval by bootstrapping. The described methodology is demanding in both work-load and in computational time, however, we do not consider the prior a draw-back: it makes some of the underlying assumptions explicit and the latter may be a nuisance that will diminish with faster computers and better implementations.
Crowd Annotations Can Approximate Clinical Autism Impressions from Short Home Videos with Privacy Protections
Authors: Washington Peter , Leblanc Emilie , Dunlap Kaitlyn , Kline Aaron , Mutlu Cezmi , Chrisman Brianna , Stockham Nate , Paskov Kelley , Wall Dennis P. 
Published: July 2021

AbstractArtificial Intelligence (A.I.) solutions are increasingly considered for telemedicine. For these methods to adapt to the field of behavioral pediatrics, serving children and their families in home settings, it will be crucial to ensure the privacy of the child and parent subjects in the videos. To address this challenge in A.I. for healthcare, we explore the potential for global image transformations to provide privacy while preserving behavioral annotation quality. Crowd workers have previously been shown to reliably annotate behavioral features in unstructured home videos, allowing machine learning classifiers to detect autism using the annotations as input. We evaluate this method with videos altered via pixelation, dense optical flow, and Gaussian blurring. On a balanced test set of 30 videos of children with autism and 30 neurotypical controls, we find that the visual privacy alterations do not drastically alter any individual behavioral annotation at the item level. The AUROC on the evaluation set was 90.0% +/- 7.5% for the unaltered condition, 85.0% +/- 9.0% for pixelation, 85.0% +/- 9.0% for optical flow, and 83.3% +/- 9.3% for blurring, demonstrating that an aggregation of small changes across multiple behavioral questions can collectively result in increased misdiagnosis rates. We also compare crowd answers against clinicians who provided the same annotations on the same videos and find that clinicians are more sensitive to autism-related symptoms. We also find that there is a linear correlation (r=0.75, p<0.0001) between the mean Clinical Global Impression (CGI) score provided by professional clinicians and the corresponding classifier score emitted by the logistic regression classifier with crowd inputs, indicating that the classifier’s output probability is a reliable estimate of clinical impression of autism from home videos. A significant correlation is maintained with privacy alterations, indicating that crowd annotations can approximate clinician-provided autism impression from home videos in a privacy-preserved manner.
Fragmented QRS is independently predictive of long-term adverse clinical outcomes in Asian patients hospitalized for heart failure: a retrospective cohort study
Authors: Kai Chan Jeffrey Shi , Zhou Jiandong , Lee Sharen , Li Andrew , Tan Martin , Leung Keith S K , Jeevaratnam Kamalan , Liu Tong , Roever Leonardo , Liu Ying , Tse Gary , Zhang Qingpeng 
Published: July 2021

AbstractBackgroundFragmented QRS (fQRS) results from myocardial scarring and predicts cardiovascular mortality and ventricular arrhythmia (VA). We evaluated the prevalence and prognostic value of fQRS in Asian patients hospitalized for heart failure.Methods and resultsThis was a retrospective cohort study of adult patients hospitalized for heart failure between 1st January 2010 and 31st December 2016 at a tertiary center in Hong Kong. The baseline ECG was analysed. QRS complexes (<120 ms) with fragmented morphology in ≥2 contiguous leads were defined as fQRS. The primary outcome was a composite of cardiovascular mortality, VA, and sudden cardiac death (SCD). The secondary outcomes were the components of the primary outcome, myocardial infarction, and new-onset atrial fibrillation. In total, 2192 patients were included, of whom 179 (8.20%) exhibited fQRS. The follow-up duration was 5.63±4.09 years. fQRS in any leads was associated with a higher risk of the primary outcome (adjusted hazard ratio (HR) 1.541 [1.185, 2.004], p=0.001), but not myocardial infarction or new-onset atrial fibrillation. fQRS in >2 contiguous leads was an independent predictor of SCD (HR 2.679 [1.252, 5.729], p=0.011). In patients without ischaemic heart disease (N=1396), fQRS in any leads remained predictive of VA and SCD (adjusted HR 3.336 [1.343, 8.282], p=0.009, and 1.928 [1.135, 3.278], p=0.015, respectively), but not cardiovascular mortality (adjusted HR 1.049 [0.662, 1.662], p=0.839).ConclusionfQRS is an independent predictor of cardiovascular mortality, VA, and SCD. Higher fQRS burden increased SCD risk. The implications of fQRS in heart failure patients without ischaemic heart disease require further studies.