bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bicycle lanes: Are we running in circles or cycling in the right direction?
Authors: Smith Alison , Zucker Shana , Lladó-Farrulla Mónica , Friedman Jessica , Guidry Chrissy , McGrew Patrick , Schroll Rebecca , McGinness Clifton , Duchesne Juan 
Published: April 2019

BACKGROUND
The number of urban bicyclists has grown exponentially across the United States. Bike lanes were created to promote a safe environment for both motorist and cyclists, but few studies have specifically addressed the outcomes of these interventions. The aim of this study was to analyze the effect of bike lanes on bicycle usage and safety in a major urban city.

METHODS
A retrospective chart review of consecutive adult trauma patients presenting at an urban Level I trauma center due to motor vehicle versus bicycle collisions from January 1, 2007, to January 28, 2017, was performed. Cohorts were stratified into prebicycle and postbicycle lane implementation for analysis.

RESULTS
Bicycle use during the study period increased almost three fold (1,672 vs. 6,060, p < 0.0001). There was also a spike in the percent of yearly bicyclists as trauma patients during the 10-year period (0.7% vs. 1.5%, p < 0.05). A total of 184 patients brought to the trauma center were identified. Significant differences between the prebike lane and postbike lane groups were identified for average Injury Severity Score (12.7 ± 1.7 vs. 8.0 ± 0.6 p = 0.0134), Glasgow Coma Scale score on arrival (12.6 ± 0.7 vs. 13.9 ± 0.2, p = 0.0171), proportion of head and face injuries (59.4% to 38.8%, p = 0.047), and patients requiring surgical intervention (100% to 55.9%, p < 0.0001).

CONCLUSION
As bicycle lanes become increasing popular in US cities, it is important to review the success of this intervention on improving safety. Preliminary results from this study suggest that the implementation of urban bike lanes improved bicyclist safety. Further studies should focus on specific injury prevention programs, which could help to target areas such as helmet use and riding a bicycle while impaired to help improve overall safety.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level IV.
Lower education and income predict worse long-term outcomes after injury
Authors: Herrera-Escobar Juan P. , Seshadri Anupamaa J. , Rivero Rachel , Toppo Alexander , Al Rafai Syeda S. , Scott John W. , Havens Joaquim M. , Velmahos George , Kasotakis George , Salim Ali , Haider Adil H. , Nehra Deepika 
Published: April 2019

BACKGROUND
Lower socioeconomic status (SES) is known to be associated with higher morbidity and mortality following injury. However, the impact of individual SES on long-term outcomes after trauma is unknown. The objective of this study was to determine the impact of educational level and income on long-term outcomes after injury.

METHODS
Trauma patients with moderate to severe injuries admitted to three Level-I trauma centers were contacted 6 months to 12 months after injury to evaluate functional status, return to work/school, chronic pain, and posttraumatic stress disorder (PTSD). Lower SES status was determined by educational level and income. Adjusted logistic regression models were built to determine the association between educational level and income (lowest vs. highest quartile determined by census-tract area) on each of the long-term outcomes. A sensitivity analysis was performed using the national median household income ($57,617) as threshold for defining low versus high income.

RESULTS
A total of 1,516 patients were followed during a 36-month period. Forty-nine percent had a low educational level, and 26% were categorized in the low-income group. Mean (SD) age and injury severity score were 60 (21.5) and 14.3 (7.3), respectively, with most patients (94%) having blunt injuries. After adjusting for confounders, low educational level was associated with poor long-term outcomes: functional limitation [odds ratio (OR), 1.78 (95% confidence interval (CI), 1.41–2.26)], has not yet returned to work/school [OR, 2.48 (95% CI, 1.70–3.62)], chronic pain [OR, 1.63 (95% CI, 1.27–2.10)], and PTSD [OR, 2.23 (95% CI, 1.60–3.11)]. Similarly, low-income level was associated with not yet return to work/school [OR, 1.97 (95% CI, 1.09–3.56)], chronic pain [OR,1.70 (95% CI, 1.14–2.53)], and PTSD [OR, 2.20 (95% CI, 1.21–3.98)]. In sensitivity analyses, there were no significant differences in long-term outcomes between income levels.

CONCLUSION
Low educational level is strongly associated with worse long-term outcomes after injury. However, although household income is associated with long-term outcomes, it matters where the threshold is. The impact of different socioeconomic measures on long-term outcomes after trauma cannot be assumed to be interchangeable.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
Shock index and pulse pressure as triggers for massive transfusion
Authors: Zhu Caroline S. , Cobb Danielle , Jonas Rachelle B. , Pokorny Douglas , Rani Meenakshi , Cotner-Pouncy Tracy , Oliver Jenny , Cap Andrew , Cestero Ramon , Nicholson Susannah E. , Eastridge Brian J. , Jenkins Donald H. 
Published: April 2019

BACKGROUND
Hemorrhage is the most common cause of preventable death in trauma patients. These mortalities might be prevented with prehospital transfusion. We sought to characterize injured patients requiring massive transfusion to determine the potential impact of a prehospital whole blood transfusion program. The primary goal of this analysis was to determine a method to identify patients at risk of massive transfusion in the prehospital environment. Many of the existing predictive models require laboratory values and/or sonographic evaluation of the patient after arrival at the hospital. Development of an algorithm to predict massive transfusion protocol (MTP) activation could lead to an easy-to-use tool for prehospital personnel to determine when a patient needs blood transfusion.

METHODS
Using our Level I trauma center's registry, we retrospectively identified all adult trauma patients from January 2015 to August 2017 requiring activation of the MTP. Patients who were younger than 18 years, older than 89 years, prisoners, pregnant women, and/or with nontraumatic hemorrhage were excluded from the study. We retrospectively collected data including demographics, blood utilization, variable outcome data (survival, length of stay, intensive care unit days, ventilator days), prehospital vital signs, prehospital transport times, and Injury Severity Score. The independent-samples t test and χ2 test were used to compare the group who died to the group who survived. p < 0.05 was considered significant. Based on age and mechanism of injury, relative risk of death was calculated. Graphs were generated using Microsoft Excel software to plot patient variables.

RESULTS
Our study population of 102 MTP patients had an average age of 42 years and average Injury Severity Score of 29, consisted of 80% males (82/102), and was 66% blunt trauma (67/102). The all-cause mortality was 67% (68/102). The positive predictive value of death for patients with pulse pressure of less than 45 and shock index of greater than 1 was 0.78 for all patients, but was 0.79 and 0.92 for blunt injury and elderly patients, respectively.

CONCLUSIONS
Our data demonstrate a high mortality rate in trauma patients who require MTP despite short transport times, indicating the need for early intervention in the prehospital environment. Given our understanding that the most severely injured patients in hemorrhagic shock require blood resuscitation, this study demonstrates that this subset of trauma patients requiring massive transfusion can be identified in the prehospital setting. We recommend using Emergency Medical Services pulse pressure in combination with shock index to serve as a trigger for initiation of prehospital whole blood transfusion.

LEVEL OF EVIDENCE
Therapeutic/care management, level V.
Google Street View assessment of environmental safety features at the scene of pedestrian automobile injury
Authors: Isola Patrick D. , Bogert James N. , Chapple Kristina M. , Israr Sharjeel , Gillespie Thomas L. , Weinberg Jordan A. 
Published: April 2019

BACKGROUND
Pedestrians struck by automobiles are at significant risk for mortality. Multiple environmental features have been developed to promote separation of pedestrians from motor vehicles. However, data on the effectiveness of these pedestrian traffic safety features are lacking. The purpose of this study was to use Google Street View to assess the locations of pedestrian-automobile injury and evaluate the relationship of environmental pedestrian safety features to pedestrian involved crashes.

METHODS
Our trauma registry was queried for pedestrians injured by automobile collision. Google Street View was used to identify safety features present at each injury location. A composite safety score was created by summing the number of safety features at each crash location. A logistic regression model was performed to evaluate the impact of safety features on mortality.

RESULTS
Our sample consisted of 631 patients (69.3% male) with an average age of 40.4 ± 17.0 years and median Injury Severity Score of 10 (5–22). A multivariate logistic regression revealed safety score (range, 0–6) significantly predicted mortality with each one-unit increment associated with a 27.8% decrease in risk of mortality.

CONCLUSION
Increasing number of safety features as represented in a composite score may decrease risk of pedestrian mortality. Google Street View appears to be a viable tool to study the presence and effectiveness of these pedestrian safety features.

LEVEL OF EVIDENCE
Epidemiological, level III
Comparison of Functional Outcomes Between Elderly and Young Patients With Traumatic Brain Injury in a Subacute Rehabilitation Unit
Authors: Kim Doo Young , Kim Min-Hyun , Pyun Sung-Bom 
Published: April 2019

Objectives:
To compare the clinical characteristics and outcomes between elderly and young patients with traumatic brain injury (TBI) in a subacute rehabilitation unit.

Subjects and Methods:
Ninety-two TBI patients who had been admitted to a rehabilitation unit from January 2010 to July 2017 were included for analysis and categorized into elderly and young TBI patient groups. A retrospective analysis was performed to compare the clinical characteristics and functional outcomes of the 2 groups at admission and discharge. The main measures included the Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Glasgow Outcome Scale (GOS).

Results:
The most common cause of injury was fall, and subdural hematoma was more common in the elderly group. Although initial GCS scores were similar between both groups, BBS and MBI scores at admission were significantly lower in elderly patients. At discharge, the MMSE, BBS, and MBI scores were significantly better in the young TBI group. However, the amount of functional improvement (Δ) in MMSE, BBS, and MBI scores during admission and the home discharge rate were similar in both groups (P > .05).

Conclusion:
Although the initial injury severity was similar in both groups, the functional outcome of cognition, balance, and activities of daily living at discharge was better in the young TBI group. However, the amount of functional improvement was similar after rehabilitation, regardless of age.
Effects of Aerobic Exercise on Electrophysiological Features of Diabetic Peripheral Neuropathy
Authors: Azizi Sirous , Najafi Sharif , Rezasoltani Zahra , Sanati Ehsan , Zamani Nahid , Dadarkhah Afsaneh 
Published: April 2019

Objective:
To investigate electrophysiological effects of exercise on peripheral neuropathy in patients with type 2 diabetes mellitus.

Methods:
Thirty-five patients (21 women) with diabetic peripheral neuropathy were included with mean (SD) age of 56.9 (6.2) years. We performed electrophysiological studies, and after 8 weeks of exercise, reevaluated the participants.

Results:
Sural sensory nerve (P < .001) and tibial compound muscle (P = .001) action potential increased, while F-wave (P = .024) and nerve conduction velocity (P = .001) decreased significantly. Conduction velocity for deep peroneal nerve showed a significant increase (P = .001).

Conclusion:
Aerobic exercise improves electrophysiological features and should be considered in the therapy of diabetic peripheral neuropathy.
Pretransplant Donor-specific IFNγ ELISPOT as a Predictor of Graft Rejection: A Diagnostic Test Accuracy Meta-analysis
Authors: Montero Nuria , Farouk Samira , Gandolfini Ilaria , Crespo Elena , Jarque Marta , Meneghini Maria , Torija Alba , Maggiore Umberto , Cravedi Paolo , Bestard Oriol 
Published: April 2019

Background.
Pretransplant interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT) has been proposed as a tool to quantify alloreactive memory T cells and estimate the risk of acute rejection (AR) after kidney transplantation, but studies have been inconclusive so far. We performed a meta-analysis to evaluate the association between pretransplant IFN-γ ELISPOT and AR and assess its predictive accuracy at the individual level.

Methods.
We estimated the pooled summary of odds ratio for AR and the joined sensitivity and specificity for predicting AR using random-effects and hierarchical summary receiver-operating characteristic models. We used meta-regression models with the Monte Carlo permutation method to adjust for multiple tests to explain sensitivity and specificity heterogeneity across studies. The meta-analytic estimates of sensitivity and specificity were used to calculate positive and negative predictive values across studies.

Results.
The analysis included 12 studies and 1181 patients. IFN-γ ELISPOT was significantly associated with increased AR risk (odds ratio: 3.29; 95% confidence interval (CI), 2.34-4.60); hierarchical summary receiver operating characteristic jointly estimated sensitivity and specificity values were 64.9% (95% CI, 53.7%-74.6%) and 65.8% (95% CI, 57.4%-73.5%), respectively, with moderate heterogeneity across studies. After adjusting for multiple testing, meta-regression models showed that thymoglobulin induction, recipient black ethnicity, living versus deceased donors, and geographical location did not affect sensitivity or specificity. Because of the varying AR incidence of the studies, positive and negative predictive values ranged between 16%–60% and 70%–95%, respectively.

Conclusions.
Pretransplant IFN-γ ELISPOT is significantly associated with increased risk of AR but provides suboptimal predictive ability at an individual level. Prospective randomized clinical trials are warranted.
Impact of Cold Ischemia Time on Outcomes of Deceased Donor Kidney Transplantation: An Analysis of a National Registry
Authors: Peters-Sengers Hessel , Houtzager Julia H.E. , Idu Mirza M. , Heemskerk Martin B.A. , van Heurn Ernst L.W. , Homan van der Heide Jaap J. , Kers Jesper , Berger Stefan P. , van Gulik Thomas M. , Bemelman Frederike J. 
Published: April 2019

Background.Cold ischemia time (CIT) is known to impact kidney graft survival rates. We compare the impact of CIT on graft failure and mortality in circulatory death versus brain death donor kidneys and how it relates to donor age.Methods.We used the prospective Dutch Organ Transplantation Registry to include 2153 adult recipients of brain death (n = 1266) and circulatory death (n = 887) donor kidneys after static cold storage from transplants performed between 2005 and 2012. CIT was modeled nonlinearly with splines. Associations and interactions between CIT, donor type, donor age, 5-year (death-censored) graft survival, and mortality were evaluated.Results.The median CIT was 16.2 hours (interquartile range 12.8–20), ranging from 3.4 to 44.7 hours for brain death and 4.7 to 46.6 hours for circulatory death donor kidneys. At >12 hours of CIT, we observed an increased risk of graft failure in kidneys donated after circulatory death versus after brain death. This risk rose significantly at >22 hours of CIT (hazard ratio 1.45; 95% confidence interval, 1.01-2.49;P= 0.043). Kidneys that came from 60-year-old circulatory death donors demonstrated elevated hazard risk at 19 hours of CIT, a shorter timeline than that for kidneys that came from brain death donors of the same age (hazard ratio 1.33; 95% confidence interval, 1.00-1.78;P= 0.045). The additional harmful effects of increased CIT in kidneys from circulatory-death donors were also found for death-censored graft failure but did not affect mortality rates in any significant way.Conclusions.The findings support the hypothesis that prolonged cold ischemia is more harmful for circulatory death donor kidneys that have already been subjected to a permissible period of warm ischemia. Efforts should be made to reduce CIT, especially for older circulatory death donor kidneys.
Selective Recruitment of Large Lower Lobe Atelectasis on Donor Back Table in Rejected Donor Lungs
Authors: Okamoto Toshihiro , Niikawa Hiromichi , Wheeler David , Ayyat Kamal S. , Basem Soliman , Itoda Yoshifumi , Sunagawa Gengo , Farver Carol F. , McCurry Kenneth R. 
Published: April 2019

Background.
Large atelectatic areas in donor lungs are frequently resistant to standard recruitment maneuvers, producing a tenaciously low PO2/FiO2 ratio. The aim of this study is to investigate the optimal protocol for the recruitment of large atelectatic areas in the context of ex vivo lung perfusion (EVLP).

Methods.
Seventeen rejected lungs with large lower lobe atelectasis (≥40%) were divided into 2 groups: manual resuscitation (n = 5) and selective recruitment (n = 12). Transplant suitability was then evaluated in cellular EVLP. In the manual resuscitation group, following bronchoscopy, if the conventional recruitment maneuver was not successful, a bagging technique was utilized to resolve atelectasis in EVLP. In the selective recruitment group, a pediatric endotracheal tube was introduced to the lower lobe bronchus on the back table of the donor hospital. Selective recruitment of the lower lobe was accomplished while keeping peak inspiratory pressure <30 cm H2O for 30 seconds.

Results.
The average atelectasis size and lung weight in 17 donor lungs was 75.4 ± 20.6% and 960 ± 221 g, respectively. There were no significant differences between the 2 groups in all donor variables, except cold ischemic time (P = 0.001, 5.2 ± 0.5 versus 6.4 ± 0.7 hours). The selective recruitment group was associated with better transplant suitability (P = 0.035, 75% versus 20%), better PO2/FiO2 ratio (P = 0.186, 324 ± 89 versus 258 ± 87 mm Hg), lower lung weight (P = 0.057, 997.9 ± 229.2 versus 1377.2 ± 452.9 g), and better pathological score (P < 0.05, 1.0 ± 1.3 versus 2.8 ± 0.8) than the manual resuscitation group.

Conclusion.
A selective recruitment procedure is a safe and effective method of eliminating large atelectasis before EVLP.
Risk of Corneal Graft Rejection After High-risk Keratoplasty Following Fine-needle Vessel Coagulation of Corneal Neovascularization Combined With Bevacizumab: A Pilot Study
Authors: Hos Deniz , Le Viet Nhat Hung , Hellmich Martin , Siebelmann Sebastian , Roters Sigrid , Bachmann Bjoern O. , Cursiefen Claus 
Published: April 2019

Background.
Corneal neovascularization is considered an important risk factor for allograft rejection after corneal transplantation (keratoplasty). Therefore, the aim of this study was to determine whether preoperative reduction of corneal neovascularization by fine-needle thermal cauterization combined with bevacizumab reduces the incidence of allograft rejection after subsequent high-risk keratoplasty.

Methods.
In this interventional uncontrolled clinical pilot study, 31 eyes of 31 patients with corneal neovascularization in at least one corneal quadrant were included. All eyes were treated by fine-needle thermal cauterization of corneal vessels and subconjunctival injection of bevacizumab. Both treatments were repeated in the cases of visible reperfusion of occluded vessels. Afterward, penetrating keratoplasty was performed. When corneal neovascularization was present on the day of keratoplasty, additional vessel cauterization and injection of bevacizumab was performed. Patients were then followed to determine the incidence of allograft rejection.

Results.
In 18 eyes, vessel cauterization with bevacizumab injection was performed once before keratoplasty, whereas 13 eyes required retreatment before keratoplasty. No complications were observed. In 23 eyes, corneal neovascularization was present on the day of keratoplasty due to reperfusion of previously occluded vessels and simultaneous vessel cauterization with bevacizumab injection was performed. During follow-up (mean: 560 days; range: 59–1095 days), 4 graft rejection episodes in 4 eyes were observed. Estimated probabilities of corneal graft survival were 92.9% after 1 year (number at risk: 23), 78.4% after 2 years (number at risk: 9), and 78.4% after 3 years (number at risk: 3).

Conclusions.
Our initial results indicate that angioregressive treatment of pathological corneal vessels by fine-needle thermal cauterization combined with subconjunctival injection of bevacizumab before high-risk keratoplasty seems to result in graft survival rates comparable to survival rates seen in normal-risk keratoplasty. The findings of our pilot study warrant further controlled clinical trials with longer follow-up in a larger patient cohort.
Psychiatric Symptoms in Patients With Dementia
Authors: Riedel Oliver , Klotsche Jens , Pisa Federica E. 
Published: April 2019

Purpose:
Neuropsychiatric symptoms (NPS) are common in Alzheimer Disease (AD). Treatment could be optimized by supplementing the clinician’s impression of a patient with information from the caregiver. Yet the agreement between caregivers and physicians on the presence of NPS in patients with AD is understudied.

Methods:
Data were obtained from a 2-staged survey in neurology outpatient offices. At stage 1, patients (n=403) were documented by their physicians, including an assessment on the presence of NPS. At stage 2, patients’ CGs (n=171) were asked about the presence of NPS in the patients, based on questions from the Neuropsychiatric Inventory. Caregivers were screened for depression with the Depression Screening Questionnaire.

Patients:
The study sample comprised patients with mild or moderate AD.

Results:
NPS frequency varied between 52.6% [95% confidence interval (CI), 44.9%-60.3%] and 67.2% (95% CI, 59.7%-74.2%, reported by CGs) and 34.2% (95% CI, 26.8%-42.1%) and 50.9% (95% CI, 42.9%-58.9%, reported by physicians). Apathy, depression, aggression, and irritability occurred most frequently according to both sources. κ values were lowest for euphoria (κ=0.03; 95% CI, −0.08 to 0.25), and highest for depression (κ=0.26; 95% CI, 0.11-0.43). CG depression was associated with an increased probability (odds ratio=2.9; 95% CI, 1.2-6.7) of disagreement between caregivers and physicians on the patient’s mental status.

Conclusion:
NPS, though very prevalent in dementia patients, are perceived differently by caregivers and physicians. This divergence increases depending on the psychological health of caregivers.