bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes in adhesive small bowel obstruction from a large statewide database: What to expect after nonoperative management
Authors: Wessels Lyndsey E. , Calvo Richard Y. , Dunne Casey E. , Bowie Jason M. , Butler William J. , Bansal Vishal , Beth Sise C. , Sise Michael J. 
Published: January 2019

BACKGROUND
Although adhesive small-bowel obstruction (ASBO) is frequently managed nonoperatively, little is known regarding outcomes on readmission following this approach. Using a large population-based dataset, we evaluated risk factors for operative intervention and mortality at readmission in patients with ASBO who were initially managed nonoperatively.

METHODS
The ASBO patients were identified in the California Office of Statewide Health Planning and Development 2007 to 2014 patient discharge database. Patients who were managed operatively at index admission or had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for nonadhesive obstructive small bowel disease were excluded. Associations between risk factors and both operative intervention and death following readmission were evaluated using survival analysis.

RESULTS
Among 15,963 ASBO patients, 3,103 (19.4%) had at least one readmission. The 1,069 (34.5%) who received an operation during their first readmission presented sooner (175 days vs. 316 days, p < 0.001) and were more likely to die during that readmission (5.2% vs. 0.7%, p < 0.001). Operative management at first readmission was associated with younger age, fewer comorbidities, and shorter times to readmission. Patients operatively managed at first readmission had longer times to second readmission compared with nonoperative patients. Stratified analyses using nonoperative patients as the reference over the study period revealed that patients who underwent lysis of adhesions and bowel resection were 5.04 times (95% confidence interval [CI], 2.82–9.00) as likely to die while those who underwent lysis only were 2.09 times (95% CI, 1.14–3.85) as likely to die. Patients with bowel resection only were at an increased risk for subsequent interventions beyond the first readmission (hazard ratio, 1.79; 95% CI, 1.11–2.87).

CONCLUSION
In a large cohort readmitted for ASBO and initially managed nonoperatively, subsequent operative intervention conferred a greater risk of death and a longer time to readmission among survivors. Prospective research is needed to further delineate outcomes associated with initial nonoperative management of ASBO.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
A review of early warning systems for prompt detection of patients at risk for clinical decline
Authors: Kramer Andrew A. , Sebat Frank , Lissauer Matthew 
Published: January 2019

ABSTRACT
Early Warning Scores (EWS) are a composite evaluation of a patient's basic physiology, changes of which are the first indicators of clinical decline and are used to prompt further patient assessment and when indicated intervention. These are sometimes referred to as “track and triggers systems” with tracking meant to denote periodic observation of physiology and trigger being a predetermined response criteria. This review article examines the most widely used EWS, with special attention paid to those used in military and trauma populations.
The earliest EWS is the Modified Early Earning Score (MEWS). In MEWS, points are allocated to vital signs based on their degree of abnormality, and summed to yield an aggregate score. A score above a threshold would elicit a clinical response such as a rapid response team. Modified Early Earning Score was subsequently followed up with the United Kingdom's National Early Warning Score, the electronic cardiac arrest triage score, and the 10 Signs of Vitality score, among others.
Severity of illness indicators have been in military and civilian trauma populations, such as the Revised Trauma Score, Injury Severity Score, and Trauma and Injury Severity. The sequential organ failure assessment score and its attenuated version quick sequential organ failure assessment were developed to aggressively identify patients near septic shock.
Effective EWS have certain characteristics. First, they should accurately capture vital signs information. Second, almost all data should be derived electronically rather than manually. Third, the measurements should take into consideration multiple organ systems. Finally, information that goes into an EWS must be captured in a timely manner. Future trends include the use of machine learning to detect subtle changes in physiology and the inclusion of data from biomarkers. As EWS improve, they will be more broadly used in both military and civilian environments.

LEVEL OF EVIDENCE
Review article, level I.
Minimally invasive preperitoneal balloon tamponade and abdominal aortic junctional tourniquet versus open packing for pelvic fracture-associated hemorrhage: Not all extrinsic compression is equal
Authors: Do Woo S. , Forte Dominic M. , Sheldon Rowan R. , Weiss Jessica B. , Barron Morgan R. , Sokol Kyle K. , Black George E. , Hegge Sara R. , Eckert Matthew J. , Martin Matthew J. 
Published: January 2019

BACKGROUND
Minimally invasive preperitoneal balloon tamponade (PPB) and abdominal aortic junctional tourniquets (AAJT) have been proposed as alternatives to open preperitoneal packing (OP) for the management of pelvic fracture-associated hemorrhage. We hypothesized that the PPB (SpaceMaker Pro) and AAJT would result in similar rates of survival and blood loss versus OP.

METHODS
Thirty-two swine underwent creation of a combined open-book pelvic fracture and major iliac vascular injuries. Animals were randomized to no intervention (n = 7), OP (n = 10), PPB (n = 9), or AAJT (n = 6) at a mean arterial pressure <40 mm Hg following initiation of uncontrolled hemorrhage. Survival (up to 60 minutes + 10 minutes after intervention reversal), hemodynamics, extraperitoneal pressures, blood loss, and associated complications were compared between groups.

RESULTS
Prior to injury, no difference was measured between groups for weight, hemodynamics, lactate, and hematocrit (all p > 0.05). The injury was uniformly lethal without intervention, with survival time (mean) of 5 minutes, peak preperitoneal pressure (PP) of 14 mm Hg, blood loss of 960 g, and peak lactate of 2.6 mmol/L. Survival time was 44 minutes with OP versus 60 minutes with PPB and AAJT (p < 0.01). Peak PP (mm Hg) was 19 with OP, 23 with PPB, and 23 with AAJT (p > 0.05). Blood loss (g) was 850 with OP, 930 with PPB, and 600 with AAJT (p > 0.05). Peak lactate (mmol/L) was 3.3 with OP, 4.3 with PPB, and 6.3 with AAJT (p < 0.01). Only 33% of AAJT animals survived intervention reversal versus 60% for OP and 67% for PPB (p < 0.01). Necropsy revealed bowel/bladder injury in 50% of AAJT subjects versus 0% in all other arms (p < 0.01).

CONCLUSION
Preperitoneal balloon tamponade is a safe and potentially effective alternative to OP for the management of lethal pelvic fracture-associated hemorrhage. Abdominal aortic junctional tourniquet offers a similar survival benefit to PPB but has concerning rates of ischemia-reperfusion and compressive abdominal organ injury.
Thromboelastography and rotational thromboelastometry for the surgical intensivist: A narrative review
Authors: Drumheller Byron C. , Stein Deborah M. , Moore Laura J. , Rizoli Sandro B. , Cohen Mitchell J. 
Published: January 2019

BACKGROUNDViscoelastic tests (VETs), specifically thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are gaining popularity in the management of critically ill surgical patients with hemorrhage or thrombosis due to their comprehensive characterization of the coagulation process and point-of-care availability in comparison to conventional coagulation tests (CCTs). We review current evidence for VET use in patients in the surgical intensive care unit (SICU).METHODSWe searched PUBMED, EMBASE and the Cochrane Library through May 30, 2018 for articles that evaluated the use of VETs in patient populations and clinical scenarios germane to the surgical intensivist. Individual articles were critically evaluated for relevance and appropriate methodology using a structured technique. Information on patient characteristics, timing and methods of CCTs/VETs, and outcomes was collected and summarized in narrative form.RESULTSOf 2,589 identified articles, 36 were included. Five (14%) were interventional studies and 31 (86%) were observational. Twenty-five (69%) evaluated TEG, 11 (31%) ROTEM and 18 (50%) CCTs. Investigated outcomes included quantitative blood loss (13 (36%)), blood product transfusion (9 (25%)), thromboembolic events (9 (25%)) and mortality (6 (17%)). We identified 12 clinical scenarios with sufficient available evidence, much of which was of limited quantity and poor methodological quality. Nonetheless, research supports the use of VETs for guiding early blood product administration in severe traumatic hemorrhage and for the prediction of abstract excess bleeding following routine cardiac surgery. In contrast, evidence suggests VET-based heparin dosing strategies for venous thromboembolism prophylaxis are not superior to standard dosing in SICU patients.CONCLUSIONWhile VETs have the potential to impact the care of critically ill surgical patients in many ways, current evidence for their use is limited, mainly because of poor methodological quality of most available studies. Further high-quality research, including several ongoing randomized controlled trials, is needed to elucidate the role of TEG/ROTEM in the SICU population.LEVEL OF EVIDENCESystematic review, level IV
Non-electroencephalography-based seizure detection
Authors: Beniczky Sándor , Jeppesen Jesper 
Published: January 2019

Purpose of review
There is need for automated seizure detection using mobile or wearable devices, for objective seizure documentation and decreasing morbidity and mortality associated with seizures. Due to technological development, a high number of articles have addressed non-electroencephalography (EEG)-based seizure detection. However, the quality of study-design and reporting is extremely heterogeneous. We aimed at giving the reader a clear picture on the current state of seizure detection, describing the level of evidence behind the various devices.

Recent findings
Fifteen studies of phase-2 or above, demonstrated that non-EEG-based devices detected generalized tonic–clonic seizures (GTCS) with high sensitivity (≥90%) and low false alarm rate (FAR) (down to 0.2/day). We found limited evidence for detection of motor seizures other than GTCS, mostly from subgroups in larger studies, targeting GTCS. There is little evidence for non-EEG-based detection of nonmotor seizures: sensitivity is low (19–74%) with extremely high FAR (50–216/day).

Summary
Detection of GTCS is reliable and there are several, validated devices on the market. However, detection of other seizure types needs further research.
Transcranial Direct Current Stimulation on Opium Craving, Depression, and Anxiety
Authors: Taremian Farhad , Nazari Samira , Moradveisi Latif , Moloodi Reza 
Published: January 2019

Objectives
Transcranial direct current stimulation can be effective in reducing the craving for food, alcohol, and methamphetamine. Because its effects have not been tested on patients with opium use disorder, we investigated its efficacy when it is combined with a standard methadone maintenance therapy protocol.

Methods
We carried out a pretest-posttest control group method to evaluate the effect of transcranial direct current stimulation at the dorsolateral prefrontal cortex (right anodal/left cathodal) on opium craving, depression, and anxiety symptoms. We considered opium craving as a primary outcome as well as depression and anxiety symptoms as secondary outcomes. Sixty participants with opium use disorder were randomly assigned into 3 groups (n = 20 for each group): (1) an active transcranial direct current stimulation with methadone maintenance treatment (active tDCS group), (2) sham transcranial direct current stimulation with methadone maintenance treatment (sham tDCS group), and (3) only methadone maintenance treatment (methadone maintenance treatment group). All participants completed the Desire for Drug Questionnaire, Obsessive-Compulsive Drug Use Scale, Beck Depression Inventory II, and Beck Anxiety Inventory a week before and a week after the treatment. The outcomes were assessed by independent assessors who were blind to the treatment conditions.

Results
The active tDCS group had a significant reduction in opium craving, depression, and anxiety symptoms compared with the other 2 groups.

Conclusions
Our results provide a preliminary support for using the transcranial direct current stimulation along with methadone maintenance therapy in the treatment of patients with opium use disorder.
Reproductive success in the barn owl is linked to partner compatibility in glucocorticoid levels
Authors: Béziers Paul , Jenni Lukas , Roulin Alexandre , Almasi Bettina 
Published: January 2019

AbstractIn biparental species, reproductive success depends not only on the quality of the parents, the care they each provide and many environmental factors such as territory quality and food availability, but also on the ability of the parents to collaborate and divide reproductive tasks. Because hormones, such as corticosterone (CORT), modulate physiological and behavioural functions that are associated to reproductive success, hormonal compatibility between pair members is likely to have consequences on reproductive success. Here, we investigated in the barn owl (Tyto alba) whether baseline and stress-induced CORT levels are correlated between breeding partners and whether this correlation is associated to fitness parameters (i.e., clutch size, offspring number and body mass). We found that the combination of CORT levels in the two partners predicts reproductive parameters. Pairs with similar baseline CORT levels during incubation produced more fledglings than pairs with dissimilar baseline CORT levels. On the other hand, pairs showing dissimilar stress-induced CORT responses during the period of offspring rearing produced more fledglings than pairs with similar stress-induced responses. Offspring body mass was associated only with maternal (baseline and stress-induced) CORT levels and depended on the context with baseline CORT being potentially adjusted to environmental conditions but also to the energetic demand of reproduction. Hence, to produce large broods good quality mothers might increase their baseline CORT to meet the energetic demand of the brood, while mothers in unfavourable habitats may have smaller broods but still need to increase baseline CORT to cope with the environmental challenges. Taken together, the results show that the association between parental CORT levels and reproductive success are context-dependent and rely on the combination of parental CORT levels. Assuming that CORT levels reflect investment in parental care, our study suggests that parents coordinate their reproductive activities in a complex way to ensure a high reproductive success.
Accounting for imperfect detection in species with sessile life cycle stages: a case study of bumble bee colonies
Authors: Iles David T. , Pugesek Genevieve , Kerr Natalie Z. , Dorian Nicholas N. , Crone Elizabeth E. 
Published: January 2019

AbstractFor bumble bees, colonies (not individual workers) are the functional unit of the population. Estimates of colony density are thus critical for understanding population distribution and trends of this important pollinator group. Yet, surveys of bumble bee colonies and other taxa with sessile life cycle states rarely account for imperfect detection.Here we demonstrate the use of mark-recapture methods to estimate the density of bumble bee colonies across the landscape using standardized survey protocols.We found that the probability of detecting colonies in standardized surveys varied considerably across space, through time, and among colonies.Using simulations, we also show that imperfect detection can obscure true variation in density among plots, or generate spurious variation in counts even when all plots have the same density. In both cases, we show that mark-recapture can be used to generate unbiased estimates of density, with relatively low search effort compared to conventional survey methods for bumble bee colonies.Our study illustrates the advantages of mark-recapture for optimizing survey protocols for species with cryptic and sessile life cycle stages, which will be a valuable tool in ongoing studies of pollinator nesting ecology.
Use of a pandemic H1N1 strain with updated haemagglutinin and neuraminidase results in increased nasopharyngeal shedding and improved immunogenicity to Russian-backbone live attenuated influenza vaccine among children aged 2 – 4 years old: an open-label, prospective, observational, phase 4 study in The Gambia
Authors: Lindsey Benjamin B. , Jagne Ya Jankey , Armitage Edwin P. , Singanayagam Anika , Sallah Hadijatou J. , Drammeh Sainabou , Senghore Elina , Mohammed Nuredin I. , Jeffries David , Höschler Katja , Tregoning John S. , Meijer Adam , Clarke Ed , Dong Tao , Barclay Wendy , Kampmann Beate , de Silva Thushan I. 
Published: January 2019

AbstractBackgroundPoor efficacy and effectiveness of the pandemic H1N1 (pH1N1) component in intranasal live attenuated influenza vaccine (LAIV) has been demonstrated in several studies. The reasons for this are unclear, but may be due to impaired replicative fitness of pH1N1 A/California/07/2009-like (Cal09) LAIV strains.MethodsIn an open-label, prospective, observational, phase 4 study, we evaluated the impact of updating the pH1N1 component in the Russian-backbone trivalent LAIV from Cal09 in 2016-17 (n=118) to an A/Michigan/45/2015-like strain (A/17/New York/15/5364, NY15) in 2017-18 (n=126), on shedding and immunogenicity in Gambian children aged 2-4 years old. The study was nested within a larger randomised controlled trial investigating LAIV-microbiome interactions (ClinicalTrials.govNCT02972957).FindingsCal09 showed impaired nasopharyngeal shedding compared to H3N2 and influenza B, along with sub-optimal serum antibody and T-cell responses. Following the switch to NY15, a significant increase in pH1N1 shedding was seen, along with improvements in seroconversion and influenza-specific CD4+ T-cell responses. Viral kineticsin vitromirrored these findings, with NY15 showing greater replicative ability than Cal09 in human nasal epithelial cells. Persistent shedding to day 7 was independently associated with both seroconversion and CD4+ T cell response in multivariable logistic regression.InterpretationOur results suggest that the pH1N1 component switch in LAIV may have overcome problems in prior formulations. LAIV effectiveness against pH1N1 should therefore improve in upcoming influenza seasons. Our data also highlight the importance of evaluating replicative fitness, in addition to antigenicity, when selecting annual LAIV components and design of potentially more effective vaccines.FundingThe Wellcome Trust.
Sequence based mapping identifiesAWNS1, a candidate transcription repressor underlying awn suppression at theB1locus in wheat
Authors: DeWitt Noah , Guedira Mohammed , Lauer Edwin , Sarinelli Martin , Tyagi Priyanka , Fu Daolin , Hao QunQun , Murphy J. Paul , Marshall David , Akhunova Alina , Jordan Katie , Akhunov Eduard , Brown-Guedira Gina 
Published: January 2019

AbstractAwns are stiff, hair-like structures that grow from the spikelets of wheat (Triticum aestivumL.) and other grasses. In wild wheat relatives, awns play a role in seed dispersal. Awn suppression in domesticated wheat, where awns are shortened or even eliminated entirely, is variably adaptive with both awned and awnless types under widespread cultivation. Although theB1locus on the long arm of chromosome 5A is a major determinant of awn suppression, no underlying gene or mechanism of action has been identified. Using association mapping, we identified a SNP marker located on the distal end of 5AL (5A28417) predictive of awn status in a panel of 640 U.S. winter wheat breeding lines, indicating thatB1was the determinant of awn suppression in this germplasm. Analysis of historical data available for the panel determined5A28417was also significantly associated with grain test weight. Evaluation of spike morphology and kernel traits was undertaken in a 341 RIL population developed from a cross between awned soft winter wheat cultivar LA95135 and awnless cultivar SS-MPV57. Awn suppression in the population co-segregated with 5A28417 and was co-located with QTL for number of spikelets per spike, kernel weight and kernel length. Fine-mapping locatedB1to a region containing only two predicted genes, including a C2H2 zinc finger transcription factor 219 bp from 5A28417 that we namedAWNS-A1. Deletions encompassing both genes were present in awned mutants of the awnless cultivar Brundage. Polymorphisms in theAWNS-A1coding region were not observed in diverse wheat germplasm. However, sequencing of wheat lines representing different marker haplotypes in the surrounding region identified a deletion 3 kb downstream ofAWNS-A1.A marker for this deletion was highly predictive of awn suppression in a collection of diverse wheat accessions, and indicates thatAWNS-A1is likely the major determinant of awn suppression in global wheat germplasm.AWNS-A1is more highly expressed in developing spikes of awnless individuals, suggesting a mechanism for awn suppression.
Development of a Prediction Model for Incident Atrial Fibrillation using Machine Learning Applied to Harmonized Electronic Health Record Data
Authors: Tiwari Premanand , Colborn Katie , Smith Derek E. , Xing Fuyong , Ghosh Debashis , Rosenberg Michael A. 
Published: January 2019

AbstractAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia, whose early detection could lead to significant improvements in outcomes through appropriate prescription of anticoagulation. Although a variety of methods exist for screening for AF, there is general agreement that a targeted approach would be preferred. Implicit within this approach is the need for an efficient method for identification of patients at risk. In this investigation, we examined the strengths and weaknesses of an approach based on application of machine-learning algorithms to electronic health record (EHR) data that has been harmonized to the Observational Medical Outcomes Partnership (OMOP) common data model. We examined data from a total of 2.3M individuals, of whom 1.16% developed incident AF over designated 6-month time intervals. We examined and compared several approaches for data reduction, sample balancing (re-sampling) and predictive modeling using cross-validation for hyperparameter selection, and out-of-sample testing for validation. Although no approach provided outstanding classification accuracy, we found that the optimal approach for prediction of 6-month incident AF used a random forest classifier, raw features (no data reduction), and synthetic minority oversampling technique (SMOTE) resampling (F1 statistic 0.12, AUC 0.65). This model performed better than a predictive model based only on known AF risk factors, and highlighted the importance of using resampling methods to optimize ML approaches to imbalanced data as exists in EHRs. Further studies using EHR data in other medical systems are needed to validate the clinical applicability of these findings.