bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using clinical analysis to classify 30-day trauma readmissions
Authors: West Sarah K. , O'Mara Michael “Shay” , Spalding M. Chance 
Published: May 2018

BACKGROUND
Unplanned hospital readmissions are common across specialties. Descriptive readmission studies commonly query large administrative databases, which some speculate lack clinical granularity. This article provides the framework for a process improvement initiative aimed at identifying clinically meaningful reasons for trauma readmission. Our study hypothesizes an expected difference between the clinically abstracted reasons for readmission and those documented by the data processing staff in the trauma registry and that those differences will be the starting point to target performance improvement.

METHODS
This is a retrospective, cohort study from 2014 to 2016 involving 18,998 trauma evaluations at a Level I trauma center. The systematic categorization of trauma readmissions was completed via clinical chart review. Readmissions were categorized following an organizational flowchart. The chart reviews ultimately resulted in two readmission categories: primary and secondary reasons for 30-day trauma readmission.

RESULTS
There were 413 readmissions, an overall readmission rate of 2.7%. The highest rate of readmission, by mechanism of injury, was gunshot wounds (11%). Secondary reasons for readmission predominated (76.1%). Complications led (41%), followed by observation (8.8%) and pain (8.6%). Following readmission chart review and categorization, the trauma registry data were queried and categorized via the same method. When the two methods of data collection were compared, there was a significant difference (p < 0.0001).

CONCLUSIONS
The granular dissection of readmission charts proved to assist in isolating clinically significant readmission variables, providing clarity into the reasons behind trauma readmission. If determined solely by the trauma registry data, our performance and quality improvement initiatives would be misguided. We recommend clinical oversight of databases, with clinical review of key areas in order to guide performance improvement.
The effect of verified pediatric trauma centers, state laws, and crash characteristics on time trends in adolescent motor vehicle fatalities, 1999-2015
Authors: Notrica David M. , Sayrs Lois W. , Krishna Nidhi 
Published: May 2018

BACKGROUNDMotor vehicle crashes are a leading cause of adolescent death from trauma. A recent study found American College of Surgeons–verified pediatric trauma centers (vPTC) were inversely correlated with pediatric mortality, but the analysis was limited to a single year. This study assesses the contribution of vPTCs, crash characteristics, and state driver laws on 15- to 17-year-old motor vehicle crash mortality for all 50 states from 1999 to 2015.METHODSProspective data on motor vehicle fatalities, crash characteristics, state driving laws, and American College of Surgeons–verified trauma centers were collected from publicly available sources for 50 US states from 1999 to 2015. A mixed fixed/random effects multivariate regression model was fitted to assess the relative contribution of crash characteristics, state laws, and vPTCs while controlling for state variation and time trends.RESULTSThe final regression model included driver and crash characteristics, verified trauma centers, and state laws. Camera laws ([B= −0.57 [p< 0.001]) were associated with a 57% decrease in the rate of change in adolescent crude fatalities. The lagged Level 1 vPTC crude rate (B= −0.12 [p< .001]) was protective and contributed independently to a 12% decline in the rate of change in teen fatalities over the time period. Seat belt laws (B= −0.15 [p< 0.001]), graduated driver’s license passenger restrictions (B= −0.07[p< 0.001]), graduated driver’s license learner permit period (B= −0.04 [p< 0.002]), nondeployed airbag (B= −0.003 [p< 0.001]), and Hispanic heritage (B= −0.003 [p< 0.05]) were protective. Increased risk of fatality was associated with minivan (B= 0.01 [p< 0.001]), speed > 90 mph (B= 0.004 [p< 0.001]), rural roads (B= 0.002 [p< 0.002], unknown seat belt compliance (B= 0.004 [p< 0.001]), and dry road surface (B= 0.005 [p< 0.001]).CONCLUSIONSState camera laws during the study time frame are associated with a 57% decrease in the rate of change in adolescent crude fatalities; vPTCs during the study time period reduced overall rate of change in the crude fatality rate by 12%. State laws, restrictions on teenage passengers and longer learner’s permit periods, and seat belt laws are associated with significant decreases in the crude teen mortality rate.LEVEL OF EVIDENCEProspective study and prevention, level III.
Selective nonoperative management of pharyngoesophageal injuries secondary to penetrating neck trauma: A single-center review of 86 cases
Authors: Madsen Andre S. , Oosthuizen George V. , Bruce John L. , Bekker Wanda , Laing Grant L. , Clarke Damian L. 
Published: May 2018

BACKGROUND
This article describes our experience with penetrating pharyngoesophageal injuries (PEI) in the light of a selective conservative approach, and has the objective to define criteria for nonoperative management (NOM).

METHODS
This retrospective single-center review of patients with penetrating neck injury treated for confirmed PEI over a 6-year period aimed to test our proposed hypothesis that NOM is safe for hemodynamically stable patients with PEI, who have no competing indications for exploration, have no established sepsis, and who have a water-soluble contrast swallow either showing no- or a contained extravasation.

RESULTS
Eighty-six (9%) patients with PEI (oropharynx, 17; hypopharynx, 40; esophagus, 29) of 948 patients with penetrating neck injury were included. Of the cohort 38 (44%) underwent NOM (oropharynx, 15 [88%]; hypopharynx, 18 [45%]; esophagus, 5 [17%]), and 48 (56%) were managed operatively. The median length of stay was 12 days (interquartile range, 19–8). Fifteen (17%) had a persistent leak and six (7%) mediastinitis. Five (6%) patients died but only one (1%) had isolated PEI. Retrospectively, 27 patients fulfilled our proposed criteria for NOM of which 23 had been treated actively by NOM (oropharynx, 8; hypopharynx, 12; esophagus, 3). For these patients, the length of stay was 10.0 days (interquartile range, 13–6), and none developed deep wound sepsis, mediastinitis, persistent leaks, or died. Of the remaining patients treated by NOM without fulfilling the proposed criteria, two were palliated (esophagus) and 13 were managed actively (oropharynx, 7; hypopharynx, 6). Only four of these patients (oropharynx, 1; hypopharynx, 3) were assessed with water-soluble contrast swallow, which showed noncontained extravasation, and three complicated with persistent leaks.

CONCLUSION
Nonoperative management of PEI is safe for a carefully selected subgroup of patients. However, most injuries to the caudal part of the cervical digestive tract mandate urgent exploration.

LEVEL OF EVIDENCE
Clinical Management Study, Level V evidence.
Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder?
Authors: Manser Stacey Stevens , Houck Katherine , Kramer Mark D. , Tabas Irene A. , Brown Carlos V.R. , Coopwood Ben 
Published: May 2018

BACKGROUND
Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD.

METHODS
The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers.

RESULTS
The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (β = 0.43, p < 0.001) and 90 days (β = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence.

CONCLUSION
The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients.

LEVEL OF EVIDENCE
Prospective randomized controlled trial, level II.
A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients
Authors: Manzano-Nunez Ramiro , Orlas Claudia P. , Herrera-Escobar Juan P. , Galvagno Samuel , DuBose Joseph , Melendez Juan J. , Serna Jose J. , Salcedo Alexander , Peña Camilo A. , Angamarca Edison , Horer Tal , Salazar Camilo J. , Lopez-Castilla Valeria , Ruiz-Yucuma Juan , Rodriguez Fernando , Parra Michael W. , Ordoñez Carlos A. 
Published: May 2018

BACKGROUND
Serious complications related to groin access have been reported with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA). We performed a systematic review and meta-analysis to estimate the incidence of complications related to groin access from the use of REBOA in adult trauma patients.

METHODS
We identified articles in MEDLINE and EMBASE. We reviewed all studies that involved adult trauma patients who underwent the placement of a REBOA and included only those that reported the incidence of complications related to groin access. A meta-analysis of proportions was performed.

RESULTS
We identified 13 studies with a total of 424 patients. REBOA was inserted most commonly by trauma surgeons or emergency room physicians. Information regarding puncture technique was reported in 12 studies and was available for a total of 414 patients. Percutaneous access and surgical cutdown were performed in 304 (73.4%) and 110 (26.5%) patients, respectively. Overall, complications related to groin access occurred in 5.6% of patients (n = 24/424). Lower limb amputation was required in 2.1% of patients (9/424), of which three cases (3/424 [0.7%]) were directly related to the vascular puncture from the REBOA insertion. A meta-analysis that used the logit transformation showed a 5% (95% CI 3%–9%) incidence of complications without significant heterogeneity (LR test: χ
2 = 0.73, p = 0.2, Tau-square = 0.2). In a second meta-analysis, we used the Freeman–Tukey double arcsine transformation and found an incidence of complications of 4% (95% CI 2%–7%) with low heterogeneity (I
2 = 16.3%).

CONCLUSION
We found that the incidence of complications related to groin access was of 4–5% based on a meta-analysis of 13 studies published worldwide. Currently, there are no benchmarks or quality measures as a reference to compare, and thus, further work is required to identify these benchmarks and improve the practice of REBOA in trauma surgery.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III.
An AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?
Authors: Byrge Nickolas , Heilbrun Marta , Winkler Nicole , Sommers Daniel , Evans Heather , Cattin Lindsay M. , Scalea Tom , Stein Deborah M. , Neideen Todd , Walsh Pamela , Sims Carrie A. , Brahmbhatt Tejal S. , Galante Joseph M. , Phan Ho H. , Malhotra Ajai , Stovall Robert T. , Jurkovich Gregory J. , Coimbra Raul , Berndtson Allison E. , O’Callaghan Thomas A. , Gaspard Scott F. , Schreiber Martin A. , Cook Mackenzie R. , Demetriades Demetrios , Rivera Omar , Velmahos George C. , Zhao Ting , Park Pauline K. , Machado-Aranda David , Ahmad Salman , Lewis Julie , Hoff William S. , Suleiman Ghada , Sperry Jason , Zolin Samuel , Carrick Matthew M. , Mallory Gina R. , Nunez Jade , Colonna Alexander , Enniss Toby , Nirula Ram 
Published: May 2018

INTRODUCTION
Pancreatic trauma results in high morbidity and mortality, in part caused by the delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies.

METHODS
We created a multicenter, pancreatic trauma registry from 18 Level 1 and 2 trauma centers. Adult, blunt or penetrating injured patients from 2005 to 2012 were analyzed. Sensitivity and specificity of CT scan identification of main pancreatic duct injury was calculated against operative findings. Independent predictors for mortality, adult respiratory distress syndrome (ARDS), and pancreatic fistula and/or pseudocyst were identified through multivariate regression analysis. The association between outcomes and operative management was measured.

RESULTS
We identified 704 pancreatic injury patients of whom 584 (83%) underwent a pancreas-related procedure. CT grade modestly correlated with OR grade (r2 0.39) missing 10 ductal injuries (9 grade III, 1 grade IV) providing 78.7% sensitivity and 61.6% specificity. Independent predictors of mortality were age, Injury Severity Score (ISS), lactate, and number of packed red blood cells transfused. Independent predictors of ARDS were ISS, Glasgow Coma Scale score, and pancreatic fistula (OR 5.2, 2.6–10.1). Among grade III injuries (n = 158, 22.4%), the risk of pancreatic fistula/pseudocyst was reduced when the end of the pancreas was stapled (OR 0.21, 95% CI 0.05–0.9) compared with sewn and was not affected by duct stitch placement. Drainage alone in grades IV (n = 25) and V (n = 24) injuries carried increased risk of pancreatic fistula/pseudocyst (OR 8.3, 95% CI 2.2–32.9).

CONCLUSION
CT is insufficiently sensitive to reliably identify pancreatic duct injury. Patients with grade III injuries should have their resection site stapled instead of sewn and a duct stitch is unnecessary. Further study is needed to determine if drainage alone should be employed in grades IV and V injuries.

LEVEL OF EVIDENCE
Epidemiologic/Diagnostic study, level III.
Population Health, Ethnicity, and Rate of Living Donor Kidney Transplantation
Authors: Reed Rhiannon D. , Sawinski Deirdre , Shelton Brittany A. , MacLennan Paul A. , Hanaway Michael , Kumar Vineeta , Long Dustin , Gaston Robert S. , Kilgore Meredith L. , Julian Bruce A. , Lewis Cora E. , Locke Jayme E. 
Published: May 2018

Background
Living donor kidney transplantation has declined in the United States since 2004, but the relationship between population characteristics and rate of living donation is unknown. The goal of our study was to use data on general population health and socioeconomic status to investigate the association with living donation.

Methods
This cross-sectional, ecological study used population health and socioeconomic status data from the CDC Behavioral Risk Factor Surveillance System to investigate the association with living donation. Transplant centers performing 10 or greater kidney transplants reported to the Scientific Registry of Transplant Recipients in 2015 were included. Center rate of living donation was defined as the proportion of all kidney transplants performed at a center that were from living donors.

Results
In a linear mixed-effects model, a composite index of health and socioeconomic status factors was negatively associated with living donation, with a rate of living donation that was on average 7.3 percentage points lower among centers in areas with more comorbid disease and poorer socioeconomic status (95% confidence interval, −12.2 to −2.3, P = 0.004). Transplant centers in areas with higher prevalence of minorities had a rate of living donation that was 7.1 percentage points lower than centers with fewer minorities (95% confidence interval, −11.8 to −2.3, P = 0.004).

Conclusions
Center-level variation in living donation was associated with population characteristics and minority prevalence. Further examination of these factors in the context of patient and center-level barriers to living donation is warranted.
Hyperactive Rac1 drives MAPK-independent proliferation in melanoma by assembly of a mechanosensitive dendritic actin network
Authors: Mohan Ashwathi S. , Dean Kevin M. , Kasitinon Stacy Y. , Isogai Tadamoto , Siruvallur Murali Vasanth , Han Sangyoon J. , Roudot Philippe , Groisman Alex , Welf Erik , Danuser Gaudenz 
Published: May 2018

AbstractCancer cells use a variety of mechanisms to subvert growth regulation and overcome environmental challenges. Often, these same mechanisms enable cancer cells to also develop resistance to targeted therapies. Here, we describe how a hyperactivating mutation of the Rac1 GTPase (Rac1P29S) harnesses Rac1’s role as a regulator of actin polymer assembly to sustain cell cycle progression in growth limiting conditions. This proliferative advantage supports metastatic colonization of melanoma cells and confers insensitivity to inhibitors of the mitogen-activated protein kinase (MAPK) pathway, a frequent target for melanoma treatment. Rac1P29S bypasses the MAPK axis through a mechanism that necessitates cell-matrix attachment, however, does not depend on integrin-mediated focal adhesion assembly and focal adhesion kinase signaling. Even without involvement of canonical adhesion signaling, cells carrying the Rac1P29S mutation show elevated traction upon drug treatment and require mechanical resistance from their surrounding matrix to gain a proliferative advantage. We describe an alternative arm for cell mechanosensing, whereby actin polymerization against a matrix of minimal rigidity organizes biochemical cues to drive proliferative signals. Hyperactivation of Rac1 by the P29S mutation channels this pathway in melanoma through Arp 2/3-dependent formation of a constrained actin brush network that results in the inactivation of tumor suppressor NF2/Merlin. These data suggest an alternative mechanism for mechanosensitive growth regulation that can be hijacked by cancer cells to circumvent the adverse conditions of foreign microenvironments or drug treatment.
RCD1 Coordinates Chloroplastic and Mitochondrial Electron Transfer through Interaction with ANAC Transcription Factors in Arabidopsis
Authors: Shapiguzov Alexey , Vainonen Julia P. , Hunter Kerri , Tossavainen Helena , Tiwari Arjun , Järvi Sari , Hellman Maarit , Wybouw Brecht , Aarabi Fayezeh , Alseekh Saleh , Sipari Nina , Nikkanen Lauri , Der Kelen Katrien Van , Krasensky-Wrzaczek Julia , Salojärvi Jarkko , Brosché Mikael , Keinänen Markku , Tyystjärvi Esa , Rintamäki Eevi , De Rybel Bert , Fernie Alisdair R. , Breusegem Frank Van , Permi Perttu , Aro Eva-Mari , Wrzaczek Michael , Kangasjärvi Jaakko 
Published: May 2018

AbstractSignaling from chloroplasts and mitochondria, both dependent on reactive oxygen species (ROS), merge at the nuclear protein RADICAL-INDUCED CELL DEATH1 (RCD1). ROS produced in the chloroplasts affect the abundance, thiol redox state and oligomerization of RCD1. RCD1 directly interactsin vivowith ANAC013 and ANAC017 transcription factors, which are the mediators of the ROS-related mitochondrial complex III retrograde signa and suppresses activity of ANAC013 and ANAC017. Inactivation ofRCD1leads to increased expression of ANAC013 and ANAC017-regulated genes belonging to the mitochondrial dysfunction stimulon (MDS), including genes for mitochondrial alternative oxidases(AOXs).Accumulating AOXs and other MDS gene products alter electron transfer pathways in the chloroplasts, leading to diminished production of chloroplastic ROS and increased protection of photosynthetic apparatus from ROS damage. RCD1-dependent regulation affects chloroplastic and mitochondrial retrograde signaling including chloroplast signaling by 3’-phosphoadenosine 5’-phosphate (PAP). Sensitivity of RCD1 to organellar ROS provides feedback control of nuclear gene expression.
The Impact of Reward on Attention in Schizophrenia
Authors: Bansal Sonia , Robinson Benjamin M. , Geng Joy J. , Leonard Carly J. , Hahn Britta , Luck Steven J. , Gold James M. 
Published: May 2018

ABSTRACTTraditionally, attention was thought to be directed by either top-down goals or bottom-up salience. Recent studies have shown that the reward history of a stimulus feature also acts as a powerful attentional cue. This is particularly relevant in schizophrenia, which is characterized by motivational and attentional deficits. Here, we examine the impact of reward on selective attention.Forty-eight people with schizophrenia (PSZ) and 34 non-psychiatric control subject (NCS) discriminated the location of a target dot appearing inside a left circle or right circle. The circles were different colors, one of which was associated with reward via pre-training. In the first 2 blocks, targets were equally likely to appear in the left or right circle. In the last 4 blocks, the target was 75% likely on one side, thus allowing us to separately examine how attention was impacted by reward (color) and probability (location).PSZ had slower overall reaction times (RTs) than NCS. Both groups showed robust effects of spatial probability and reward history, with faster RTs for the rewarded color and for the more probable location. These effects were similar in PSZ and NCS. Negative symptom severity correlated with overall RT slowing, but there were no correlations between symptoms and reward-associated biasing of attention.PSZ demonstrated RT slowing but normal reward history and spatial probability-driven RT facilitation. These results are conceptually similar to prior findings showing intact implicit reward effects on response bias, and suggest that implicit processing of reward and probability is intact in PSZ.