bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less
Authors: Zosa Brenda M. , Elliott Charles W. , Kurlander David E. , Johnson Freedom , Ho Vanessa Phillis , Claridge Jeffrey A. 
Published: July 2018

BACKGROUNDTo evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours).METHODSAdults admitted (2010–2015) to a Level I trauma center intensive care unit with at least one facial bone fracture and major injuries isolated to the head and neck were included. Our primary analysis compared infectious complications of the head or neck (H/N infection) between patients given short or extended courses of antibiotic prophylaxis. Multivariate logistic regression and analysis of propensity score matched pairs were performed.RESULTSA total of 403 patients were included, 85.6% had blunt injuries and 72.7% had their facial fracture managed nonoperatively. The H/N infection rate was 11.2%. Two hundred eighty patients received a short course of antibiotics and 123 patients received an extended course. Median Injury Severity Score was 14 in both groups (p= 0.78). Patients receiving an extended course of antibiotics had higher rates of H/N infection (20.3% vs. 7.1%,p< 0.001). Factors associated with development of H/N infection included younger age, penetrating injury, open fracture, upper face or mandible fracture, fractures in multiple facial thirds, vascular injury, hypertension, and extended antibiotic course. Multivariate logistic regression identified younger age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–1.00;p= 0.02), multiple facial third fractures (OR, 4.9; 95% CI, 2.4–10.2;p< 0.001), and penetrating mechanism (OR, 3.1; 95% CI, 1.5–6.4;p= 0.003) as independent predictors of H/N infection, but not antibiotic duration. Propensity score-matched analysis found no differences in H/N infection between short and extended antibiotic courses (11.4% vs. 12.5%;p= 1.0). Subgroup analyses demonstrated no differences in H/N infection between short or extended antibiotic courses by injury pattern, mechanism, or treatment (operative or nonoperative).CONCLUSIONThese results lead us to believe that we should limit antibiotics to 24 hours or less upon admission for facial fractures.LEVEL OF EVIDENCETherapeutic/care management, level IV.
Abdominal Aortic and Junctional Tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class II hemorrhage
Authors: Brännström Andreas , Rocksén David , Hartman Johan , Nyman Niklas , Gustavsson Jenny , Arborelius Ulf P. , Günther Mattias 
Published: July 2018

BACKGROUND
Uncontrolled hemorrhage is a leading cause of tactical trauma-related deaths. Hemorrhage from the pelvis and junctional regions are particularly difficult to control due to the inability of focal compression. The Abdominal Aortic and Junctional Tourniquet (AAJT) occludes aortic blood flow by compression of the abdomen. The survivability of tourniquet release beyond 120 minutes is unknown and fluid requirements to maintain sufficient blood pressure during prolonged application are undetermined. We therefore compared 60-minute and 240-minute applications and release of the AAJT for 30 minutes, with crystalloid fluid therapy, after a Class II hemorrhage.

METHODS
Sixty-kilogram anesthetized pigs were subjected to 900-mL hemorrhage and AAJT application for 60 minutes (n = 5), 240 minutes (n = 5), and fluid therapy only for 240 minutes (n = 5) and reperfusion for 30 minutes.

RESULTS
The AAJT application was hemodynamically and respiratory tolerable for 60 minutes and 240 minutes. Cumulative fluid requirements decreased by 64%, comparable to 3000 mL of crystalloids. Mechanical ventilation was impaired. AAJT increased the core temperature by 0.9°C compared with fluid therapy. Reperfusion consequences were reversible after 60 minutes but not after 240 minutes. A 240-minute application resulted in small intestine and liver ischemia, persisting hyperkalemia, metabolic acidosis, and myoglobinemia, suggesting rhabdomyolysis.

CONCLUSION
The AAJT application for 240 minutes with reperfusion was survivable in an intensive care setting and associated with abdominal organ damage. Long time consequences and spinal cord effects was not assessed. We propose an application time limit within 60 minutes to 240 minutes, though further studies are needed to increase the temporal resolution. The AAJT application may be considered as a rescue option to maintain central blood pressure and core temperature in cases of hemorrhagic shock from extremity bleedings, if fluid therapy is unavailable or if the supply is limited.

LEVEL OF EVIDENCE
Therapeutic study, level II.
A comparison of resuscitation intensity and critical administration threshold in predicting early mortality among bleeding patients: A multicenter validation in 680 major transfusion patients
Authors: Meyer David E. , Cotton Bryan A. , Fox Erin E. , Stein Deborah , Holcomb John B. , Cohen Mitchell , Inaba Kenji , Rahbar Elaheh 
Published: July 2018

BACKGROUND
To address deficiencies associated with the classic definition of massive transfusion (MT), critical administration threshold (CAT) and resuscitation intensity (RI) were developed to better quantify the overall severity of illness and predict the need for transfusions and early mortality. We sought to evaluate these as more appropriate replacements for MT in defining mortality risk in patients undergoing major transfusions.

METHODS
Patients predicted to receive MT at 12 Level I trauma centers were randomized in the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial. MT of 10 U or greater red blood cell (RBC) in 24 hours; CAT+, 3 U or greater RBC in the first hour; and RI, total products in the first 30 minutes (1 U RBC, 1 U plasma, 1000 mL crystalloid, 500 mL colloid each valued at 1 U). Resuscitation intensity was evaluated as a continuous variable and dichotomized as RI4+, where RI is 4 U or greater. Each metric was evaluated for its ability to predict mortality at 3 hours, 6 hours, and 24 hours, and at 30 days.

RESULTS
Of the 680 patients, 301 patients met MT definition, 521 were CAT+, and 445 were RI4+. Of those that died, 23% never reached MT threshold, but all were captured by CAT+ and RI4+. The 3-hour (9% vs. 9%), 6-hour (14% vs. 14%), 24-hour (17% vs. 18%), and 30-day mortality rates (28% vs. 29%) were similar between CAT+ and RI4+ patients. When RI was evaluated as a continuous variable, each unit increase was associated with a 20% increase in hemorrhage-related mortality (odds ratio, 1.20; 95% confidence interval, 1.15–1.29; p < 0.05).

CONCLUSION
Both RI and CAT are valid surrogates for early mortality in patients undergoing major transfusion, capturing patients omitted by the MT definition. The CAT+ showed the best sensitivity; RI4+ demonstrated better specificity and good positive predictive values and negative predictive values. While CAT+ may be suited for patients receiving an RBC-dominant resuscitation, RI4+ is more comprehensive. RI can also be used as a continuous variable to provide quantitative as well as qualitative risk of death.

LEVEL OF EVIDENCE
Prognostic, level III.
Severely injured trauma patients with admission hyperfibrinolysis: Is there a role of tranexamic acid? Findings from the PROPPR trial
Authors: Khan Muhammad , Jehan Faisal , Bulger Eileen M. , O'Keeffe Terence , Holcomb John B. , Wade Charles E. , Schreiber Martin A. , Joseph Bellal 
Published: July 2018

INTRODUCTION
Administration of tranexamic acid (TXA) in coagulopathy of trauma gained popularity after the CRASH-2 trial. The aim of our analysis was to analyze the role of TXA in severely injured trauma patients with admission hyperfibrinolysis.

METHODS
We reviewed the prospectively collected Pragmatic, Randomized Optimal Platelet and Plasma Ratios database. We included patients with admission hyperfibrinolysis (Ly30 >3%) on thromboelastography. Patients were stratified into two groups (TXA and No-TXA) and were matched in 1:2 ratio using propensity score matching for demographics, admission vitals, and injury severity. Primary outcome measures were 6-, 12-, and 24-hour and 30-day mortality; 24-hour transfusion requirements; time to achieve hemostasis; and rebleeding after hemostasis requiring intervention. Secondary outcome measures were thrombotic complications.

RESULTS
We analyzed 680 patients. Of those, 118 had admission hyperfibrinolysis, and 93 patients (TXA: 31 patients; No-TXA: 62 patients) were matched. Matched groups were similar in age (p = 0.33), gender (p = 0.84), race (p = 0.81), emergency department (ED) Glasgow Coma Scale (p = 0.34), ED systolic blood pressure (p = 0.28), ED heart rate (p = 0.43), mechanism of injury (p = 0.45), head Abbreviated Injury Scale score (p = 0.68), injury severity score (p = 0.56), and blood products ratio (p = 0.44). Patients who received TXA had a lower 6-hour mortality rate (34% vs. 13%, p = 0.04) and higher 24-hour transfusion of plasma (15 vs. 10 units, p = 0.03) compared with the No-TXA group. However, there was no difference in 12-hour (p = 0.24), 24-hour (p = 0.25), and 30-day mortality (p = 0.82). Similarly, there was no difference in 24-hour transfusion of RBC (p = 0.11) or platelets (p = 0.13), time to achieve hemostasis (p = 0.65), rebleeding requiring intervention (p = 0.13), and thrombotic complications (p = 0.98).

CONCLUSION
Tranexamic acid was associated with increased 6-hour survival but does not improve long-term outcomes in severely injured trauma patients with hemorrhage who develop hyperfibrinolysis. Moreover, TXA administration was not associated with thrombotic complications. Further randomized clinical trials will identify the subset of trauma patients who may benefit from TXA.

LEVEL OF EVIDENCE
Therapeutic study, level III.
Waiting List Mortality and Transplant Rates for NASH Cirrhosis When Compared With Cryptogenic, Alcoholic, or AIH Cirrhosis
Authors: Thuluvath Paul J. , Hanish Steven , Savva Yulia 
Published: July 2018

Background
Patients with nonalcoholic steatohepatitis (NASH) cirrhosis have excellent postliver transplant survival despite having many comorbidities. We hypothesized that this could be due to a selection bias.

Methods
We analyzed the United Network for Organ Sharing data from 2002 to 2016 and compared postliver transplant survival of NASH (n = 7935) patients with cryptogenic cirrhosis (CC) (n = 6087), alcoholic cirrhosis (AC) (n = 16 810), and autoimmune hepatitis cirrhosis (AIH) (n = 2734).

Results
By 3 years of listing, the cumulative incidence (CI) of death or deterioration was 29% for NASH, 28% for CC and AC, and 24% for AIH, but when adjusted for risk factors, the CI was similar for NASH and AIH. The factors that increased the risk of waiting list removal due to death/deterioration were poor performance status, encephalopathy, diabetes, high Model for End-stage Liver Disease, Hispanic race, older age and a low serum albumin. Most patients were transplanted within the first year (median, 2 months; interquartile range, 1-7 months) of listing and by 5 years, the unadjusted CI of transplantation was 54% for NASH, 52% for CC, 51% for AIH, and 48% for AC. The adjusted CI of transplantation within 2 months of listing was higher for AC (subhazard ratio [SHR], 1.17), AIH (SHR, 1.17), and CC (SHR, 1.13) when compared with NASH, but after 2 months, adjusted transplantation rates decreased in AC (SHR, 0.6), AIH (SHR, 0.78), and CC (SHR, 0.95). The negative predictors of receiving a transplant were dialysis, female sex, nonwhite race, high albumin, and creatinine.

Conclusions
Patients with NASH cirrhosis are not disadvantaged by higher waitlist removal or lower transplantation rates.
The Spectral Footprints of Periodic and Rhythmic Patterns
Authors: Johnson Emily L. , Kaplan Peter W. , Ritzl Eva K. 
Published: July 2018

Summary:
Visual displays of quantitative EEG, consisting of mathematical processing of EEG signals for graphical display, are powerful tools to enhance review of raw EEG. Quantitative EEG is widely used for seizure detection and for delayed cerebral ischemia detection, and it improves efficiency of long-term monitoring review. Here, we review the signature “footprints” of periodic and rhythmic patterns on quantitative EEG. While changes in the frequency and rhythmicity shown on quantitative EEG can highlight these patterns, review of raw EEG to evaluate and confirm the pattern is vital.
Ictal–Interictal Continuum
Authors: Kalamangalam Giridhar P. , Pohlmann-Eden Bernhard 
Published: July 2018

Summary:
The term “ictal–interictal” continuum has seen wide adoption in the critical care EEG domain, referring to the presence of abnormal periodic activity on the scalp EEG variably associated with seizures. The historical origin of the ictal–interictal continuum concept is discussed with a review of known and surmised physiological mechanisms for their origin and relationship to seizures. Therapeutic approaches to patients exhibiting ictal–interictal continuum EEG patterns are reviewed, and some open scientific questions highlighted. Further understanding of the ictal–interictal continuum is likely to significantly improve the care of the critically ill neurological patient.
Approach to Managing Periodic Discharges
Authors: Bauerschmidt Andrew , Rubinos Clio , Claassen Jan 
Published: July 2018

Summary:
Use of continuous EEG monitoring in the intensive care unit setting has increased detection of not only subclinical seizures, but also patterns of discharges that have epileptiform features and periodicity yet do not meet the criteria for seizures. These periodic discharges present a clinical challenge: some patterns may reflect brain injury that has already occurred, although there is evidence that some periodic discharges represent an ongoing process causing additional brain injury and necessitate treatment. Herein, we review the available data regarding the clinical significance of different categories of periodic discharges, specifically those that have features physiologically similar to seizures. We propose a stepwise approach to assessment and management of periodic discharges and lay out the general paradigm of (1) clinical assessment including benzodiazepine trial, (2) EEG assessment, with a focus on discharge frequency, and (3) integration of adjunctive data such as neuroimaging and metabolic data when available. A flowchart is provided to simplify and summarize this approach. The goal of this approach is to treat patterns associated with increased risk of seizures and/or additional brain injury, while avoiding unnecessary interventions.
Neuroimaging Correlates of Periodic Discharges
Authors: Herlopian Aline , Struck Aaron F. , Rosenthal Eric , Westover Brandon M. 
Published: July 2018

Summary:
Despite being first described over 50 years ago, periodic discharges continue to generate controversy as to whether they are always, sometimes, or never “ictal.” Investigators and clinicians have proposed adjunctive markers to help clarify this distinction—in particular measures of perfusion and metabolism. Here, we review the growing number of neuroimaging studies using Fluorodeoxyglucose-PET, MRI diffusion, Magnetic resonance perfusion, Single Photon Emission Computed Tomography, and Magnetoencepgalography to gain further insight into the physiology and clinical significance of periodic discharges. To date, however, no definitive consensus exists regarding the features of periodic discharges that warrant treatment intensification. However, an emerging consilience among neuroimaging modalities suggests that periodic discharges can induce a hyperexcitatory state with associated hypermetabolism and hyperperfusion, which may result in local metabolic failure.
Functional exploration of natural networks and ecological communities
Authors: Ankenbrand Markus J. , Hohlfeld Sonja C. Y. , Weber Lorenz , Förster Frank , Keller Alexander 
Published: July 2018

Abstract

Species composition assessment of ecological communities and networks is an important aspect of biodiversity research. Yet often ecological traits of organisms in a community are more informative than scientific names only. Furthermore, other properties like threat status, invasiveness, or human usage are relevant to many studies, but cannot be evaluated from taxonomy alone. Despite public databases collecting such information, it is still a tedious manual task to enrich community analyses with such, especially for large‐scaled data.

Thus we aimed to develop a public and free tool that eases bulk trait mapping of community data in a web browser, implemented with current standard web and database technologies.

Here, we present the Fennec (Functional Exploration of Natural Networks and Ecological Communities), a workbench that eases the process of mapping publicly available trait data to the user's communities in an automated process. Usage is either by a local self‐hosted or a public instance (https://fennec.molecular.eco) covering exemplary traits. Alongside the software, we also provide usage and hosting documentation as well as online tutorials.

The Fennec aims to motivate public trait data submission and its reuse in meta‐analyses. Further, it is an open‐source development project with the code freely available to use and open for community contributions (https://github.com/molbiodiv/fennec).
Egg masses of some stream‐dwelling caddisflies (Trichoptera: Hydrobiosidae) from Victoria, Australia
Authors: Lancaster Jill , Glaister Alena 
Published: July 2018

AbstractEggs are a largely neglected life stage in most ecological studies of aquatic insects, despite the importance of oviposition behaviour and fecundity estimates for many research questions. Incorporating egg stages into ecological research requires that ecologists can identify and quantify eggs, but descriptions of eggs and egg masses are scarce for many groups and particularly for Australian taxa. This paper focusses on stream‐dwelling caddisflies in the family Hydrobiosidae and provides species‐level identifications, morphological descriptions and images of egg masses of some species that commonly occur in south‐eastern Australia. All the species we identified laid plaque‐shaped egg masses attached to the underside of river rocks that protrude above the water surface. These egg masses can be identified in the field with the naked eye or the aid of a low‐magnification hand lens. Interspecific variations in egg mass morphology were primarily thickness and firmness of the spumaline layer, egg mass size and arrangement of eggs within the mass. We also provide some ecological information on clutch sizes and the physical characteristics of oviposition sites, and we discuss various ways in which these taxa could be exploited as model systems for ecological research.
Neurodevelopmental subtypes of bipolar disorder are related to cortical folding patterns: An international multicenter study
Authors: Sarrazin Samuel , Cachia Arnaud , Hozer Franz , McDonald Colm , Emsell Louise , Cannon Dara M , Wessa Michele , Linke Julia , Versace Amelia , Hamdani Nora , D'Albis Marc‐Antoine , Delavest Marine , Phillips Mary L. , Brambilla Paolo , Bellani Marcella , Polosan Mircea , Favre Pauline , Leboyer Marion , Mangin Jean‐François , Houenou Josselin 
Published: July 2018

ObjectivesBrain sulcation is an indirect marker of neurodevelopmental processes. Studies of the cortical sulcation in bipolar disorder have yielded mixed results, probably due to high variability in clinical phenotype. We investigated whole‐brain cortical sulcation in a large sample of selected patients with high neurodevelopmental load.MethodsA total of 263 patients with bipolar disorder I and 320 controls were included in a multicentric magnetic resonance imaging (MRI) study. All subjects underwent high‐resolution T1‐weighted brain MRI. Images were processed with an automatized pipeline to extract the global sulcal index (g‐SI) and the local sulcal indices (l‐SIs) from 12 a priori determined brain regions covering the whole brain. We compared l‐SI and g‐SI between patients with and without early‐onset bipolar disorder and between patients with and without a positive history of psychosis, adjusting for age, gender and handedness.ResultsPatients with early‐onset bipolar disorder had a higher l‐SI in the right prefrontal dorsolateral region. Patients with psychotic bipolar disorder had a decreased l‐SI in the left superior parietal cortex. No group differences in g‐SI or l‐SI were found between healthy subjects and the whole patient cohort. We could replicate the early‐onset finding in an independent cohort.ConclusionsOur work suggests that bipolar disorder is not associated with generalized abnormalities of sulcation, but rather with localized changes of cortical folding restricted to patients with a heavy neurodevelopmental loading. These findings support the hypothesis that bipolar disorder is heterogeneous but may be disentangled using MRI, and suggest the need for investigations into neurodevelopmental deviations in the disorder.
How self‐generated labelling shapes transfer of learning during early childhood: The role of individual differences
Authors: Moser Alecia , Olsen Sarah , Rusnak Sylvia N. , Barr Rachel , Gerhardstein Peter 
Published: July 2018

Multiple factors influence imitation during toddlerhood, including task complexity, social contingency, and individual differences. We conducted a secondary data analysis of individual differences in self‐generated labelling using data collected from a complex puzzle imitation task with 355 2‐ to 3‐year‐olds. This analysis indicated that toddlers’ ability to label the completed puzzle (fish or boat) was associated with better imitation performance. Labelling occurs during social interactions; therefore, our second analysis tested how labelling differed as a function of the level of social scaffolding in each condition. This analysis revealed that self‐generated labelling was lower when the social demonstrator was removed and the task was presented on a touchscreen. This study is one of the first to examine self‐generated labelling during a complex imitation task in toddlers and increases our understanding of the complexity of memory processing needed for imitation learning.Statement of contributionWhat is already known on this subject?Toddlers exhibit a transfer of learning deficit from 2D media, including books, TV, and tablets.Self‐generated labelling enhances children's learning, through attentional and cognitive mechanisms.Children are sensitive to reduced social cues in screen media contributing to the transfer deficit.What does this study add?Self‐generated labelling is associated with better goal imitation performance.Self‐generated labelling occurs more frequently under social conditions.