bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Pilot Study Using Machine-learning Algorithms and Wearable Technology for the Early Detection of Postoperative Complications After Cardiothoracic Surgery
Authors: Beqari Jorind , Powell Joseph R. , Hurd Jacob , Potter Alexandra L. , McCarthy Meghan L. , Srinivasan Deepti , Wang Danny , Cranor James , Zhang Lizi , Webster Kyle , Kim Joshua , Rosenstein Allison , Zheng Zeyuan , Lin Tung Ho , Fang Zhengyu , Zhang Yuhang , Anderson Alex , Madsen James , Anderson Jacob , Clark Anne , Yang Margaret E. , Nurko Andrea , Li Jing , El-Jawahri Areej R. , Sundt Thoralf M. , Melnitchouk Serguei , Jassar Arminder S. , D’Alessandro David , Panda Nikhil , Schumacher Lana Y. , Wright Cameron D. , Auchincloss Hugh G. , Sachdeva Uma M. , Lanuti Michael , Colson Yolonda L. , Langer Nathaniel B. , Osho Asishana , Yang Chi-Fu Jeffrey , Li Xiao 
Published: March 2024

Objective:
To evaluate whether a machine-learning algorithm (ie, the “NightSignal” algorithm) can be used for the detection of postoperative complications before symptom onset after cardiothoracic surgery.

Background:
Methods that enable the early detection of postoperative complications after cardiothoracic surgery are needed.

Methods:
This was a prospective observational cohort study conducted from July 2021 to February 2023 at a single academic tertiary care hospital. Patients aged 18 years or older scheduled to undergo cardiothoracic surgery were recruited. Study participants wore a Fitbit watch continuously for at least 1 week preoperatively and up to 90 days postoperatively. The ability of the NightSignal algorithm—which was previously developed for the early detection of Covid-19—to detect postoperative complications was evaluated. The primary outcomes were algorithm sensitivity and specificity for postoperative event detection.

Results:
A total of 56 patients undergoing cardiothoracic surgery met the inclusion criteria, of which 24 (42.9%) underwent thoracic operations and 32 (57.1%) underwent cardiac operations. The median age was 62 (Interquartile range: 51–68) years and 30 (53.6%) patients were female. The NightSignal algorithm detected 17 of the 21 postoperative events at a median of 2 (Interquartile range: 1–3) days before symptom onset, representing a sensitivity of 81%. The specificity, negative predictive value, and positive predictive value of the algorithm for the detection of postoperative events were 75%, 97%, and 28%, respectively.

Conclusions:
Machine-learning analysis of biometric data collected from wearable devices has the potential to detect postoperative complications—before symptom onset—after cardiothoracic surgery.
A Randomized Clinical Trial: Patient Satisfaction of Paper Versus Electronic Provider Feedback
Authors: Margulies Samantha Lee , Bernard Adele , Leone Anna M. , Geller Elizabeth J. 
Published: March 2024

Importance
Minimal data compare patient satisfaction with completing paper versus electronic evaluations.

Objectives
This study aimed to compare patient satisfaction with completing paper versus electronic evaluations. Secondary objectives were assessing age, education, and socioeconomic status with comfort with technology; preference for evaluation type; and timeliness of completing evaluations.

Study Design
This was a single-center randomized trial comparing paper versus electronic patient evaluations of health care providers. Study participation occurred at the end of clinic visits.

Results
Among 145 participants, 73 (50.3%) were analyzed as paper versus 72 (49.7%) as electronic. Groups were similar in age, race, education level, income, insurance type, technology comfort, and technology use. Groups were similar in finding ease (P = 0.99) and satisfaction (P = 0.76) with their randomized method. For participants randomized to paper, 34% preferred paper, 25% preferred electronic, and 41% had no preference. Electronic feedback took longer to complete (4.5 minutes vs 3.4 minutes, P < 0.001). Older participants took longer to complete the evaluation (4.5 minutes vs 3.2 minutes, P < 0.001), had less internet use (P = 0.01), and were less likely to own a computer (P = 0.03) than younger participants. There were differences by education level for comfort with technology (P = 0.007) and internet use (P = 0.016). There were no differences in ease of feedback completion or satisfaction when comparing age, education status, or income status.

Conclusions
Patients were satisfied with paper and electronic health care provider evaluations, regardless of age or other demographics. Evaluations were completed quickly during visits. Requesting feedback from patients via multiple modalities is feasible in a varied patient population.
Understanding the Pursuit of Third-Line Therapies for Overactive Bladder: A Mixed Methods Study
Authors: Gonzalez Javier D. , Martin Leigh , Osmundsen Blake , Garg Bharti , Gregory W. Thomas , Cichowski Sara 
Published: March 2024

Importance
Overactive bladder (OAB) affects millions of women in the United States, with negative effects in multiple domains that have an impact on quality of life. Third-line therapies for OAB are as effective or superior to lifestyle/behavior modification and medical management, yet few women access these treatments and often spend more than 36 months to reach these treatments after starting medication. Factors associated with time to reach third-line therapy are not well studied, and little is known about how patients progress through care pathways for OAB.

Objectives
The aim of the study was to determine factors associated with the time spent between second- and third-line therapy for OAB at an academic urogynecology and reconstructive pelvic surgery practice. We sought to identify demographic, treatment, clinical factors, and themes in barriers to receiving treatment for OAB.

Study Design
This was a mixed methods study consisting of a retrospective cohort study followed by qualitative key informant interviews.

Results
Eighty-five total participants were included in the analysis, and 42 (49.5%) spent more than 36 months between initiation of medical management and initial third-line therapy for OAB. No significant (P > 0.05) demographic, clinical, or treatment differences were found between groups. Facilitators and obstacles to receiving third-line therapy were identified among key informants, and a treatment decision framework was developed.

Conclusions
Women often spend more than 36 months to pursue third-line therapy for OAB. Existing objective variables are poor predictors of pursuit of third-line treatment, and leveraging known facilitators and obstacles can be used to develop improved care pathways for OAB.
Dual Incontinence and Risk of Fall: A Retrospective Cohort Study
Authors: Kravitz Elizabeth , Thompson Jacqueline J. , Christiansen Theresa , Arya Lily , Andy Uduak , Kim Edward K. 
Published: March 2024

Importance
Although there is a known association between urinary incontinence (UI) and fall risk, it is unclear if having both UI and fecal incontinence, or dual incontinence (DI), increases this risk.

Objective
The objective of our study was to elucidate a relationship between DI and falls.

Study Design
This was a retrospective cohort study at a tertiary academic health system of female patients 65 years and older presenting for a new patient visit to a urogynecology health care professional for UI from 2019 to 2021. Demographic data and responses to intake questionnaires on fall and markers of frailty were extracted. Multivariable logistic regression was performed to identify factors associated with fall adjusting for covariates identified upon univariate comparison.

Results
A total of 2,814 women were included in the analysis; 2,661 patients reported UI alone, and 153 reported DI. A greater proportion of women with DI reported a fall in the past year compared with those with UI alone (22.9% vs 12.2%, P < 0.001). Univariable comparison showed that these 2 groups differed regarding age, body mass index, and estimated median household income. On multivariable logistic regression, DI was significantly associated with falls (adjusted odds ratio 2.56; 95% confidence interval, 1.02–5.46). Other factors independently associated with falls in older women with UI include (adjusted odds ratio, 95% confidence interval): lower income groups (2.35, 1.50–3.67 for $20,000–$40,000, compared with $100,000 and higher-income group), difficulty with activities of daily living (1.60, 1.25–2.13), and unintentional weight loss (1.68, 1.05–2.68).

Conclusion
Patients with DI have a 2-fold higher risk of fall compared with patients with UI alone.
Urinary Sphingosine-1-Phosphate as a Biomarker for Bladder Pain Syndrome
Authors: Eggers Erica , Crouss Tess , Lipetskaia Lioudmila , DiSanto Michael 
Published: March 2024

Importance
Sphingosine-1-phosphate (S1P) is a signaling molecule involved in inflammation and bladder contraction.

Objectives
The aims of this case-control pilot study were to compare urinary S1P concentrations in bladder pain syndrome (BPS) participants to controls and determine whether these concentrations correlate with disease severity and duration.

Study Design
Adult females with BPS and controls were enrolled. Bladder pain syndrome participants completed an O’Leary-Sant questionnaire. Information on duration of symptoms and treatment history was obtained. Urinary S1P and creatinine concentrations were determined. Mann-Whitney U tests were used to compare groups, and Spearman correlation was used to test for associations between concentrations and duration and severity of symptoms.

Results
Twenty-five participants were in each group. Median S1P concentration was 1,225 ng/dL in the BPS group and 2,183 ng/dL in the control group, which was significantly different (P < 0.0001). This difference did not persist when normalized to urinary creatinine (P = 0.58). No differences were noted in urinary S1P concentrations between treated and untreated participants (P = 0.53) or with symptom scores of 13 or greater and less than 13 (P = 0.69). Sphingosine-1-phosphate levels did not correlate with O’Leary-Sant scores (P = 0.08) or duration of symptoms (P = 0.67). Results did not change when using S1P concentrations normalized to creatinine.

Conclusions
This study demonstrated successful quantification of human urinary S1P concentrations. A difference in urinary S1P was found between BPS participants and controls but not when normalized to creatinine. While this is the first study to investigate urinary S1P as a biomarker for BPS, results suggest that it may have a potential role as a biomarker requiring further research.
Pain Related to Intradetrusor BotulinumtoxinA: A Randomized Clinical Trial
Authors: Miceli Lia M. , Antosh Danielle D. , Nisar Tariq , Stewart Julie , Rutledge Emily C. , Khavari Rose 
Published: March 2024

Importance
OnabotulinumtoxinA (BTX-A) is an effective treatment for overactive bladder (OAB), but few studies have been done to evaluate injection techniques.

Objective
The primary objective was to evaluate procedural discomfort between 2 commonly used injection techniques for BTX-A.

Study Design
This was a single-blinded, randomized clinical trial of women undergoing injection of 100 U BTX-A for idiopathic OAB. Patients were randomized to 5 mL/5 injection or 10 mL/10 injection groups. Bladder pain was assessed by a validated Numeric Pain Rating Scale. Overactive bladder symptoms were assessed with a standardized questionnaire (Overactive Bladder Questionnaire Short Form). Patient satisfaction, treatment efficacy, and adverse events were assessed at 30 days after procedure.

Results
One hundred eight patients were randomized to 52 in the 5 mL/5 injection arm and 56 in the 10 mL/10 injection arm. Mean procedural pain scores were 3.2 (±2.3) in the 5 mL/5 injection group versus 3.6 (±2.1) in the 10 mL/10 injection group (P = 0.21). No difference was found when categorizing pain scores into ordinal outcomes of low (P = 0.55), medium (P = 0.70), and high (P = 1.0) or a binary outcome of low (P = 0.55) versus medium + high (P = 0.55). Multivariate analyses did not effect statistical significance between the 2 groups for the ordinal outcome (odds ratio = 1.86; 95% confidence interval = 0.77 = 4.52; P = 0.17) or the binary outcome (odds ratio = 1.81; 95% confidence interval = 0.68–4.77; P = 0.28). No difference was observed between overall patient satisfaction, global impression of improvement, Overactive Bladder Questionnaire Short Form scores, or adverse outcomes.

Conclusions
Procedural discomfort related to BTX-A injection for idiopathic OAB was not different between 2 injection protocols. Overall satisfaction was high for both groups, and there was no difference in symptom scores or adverse events.
Impact of resuscitation adjuncts on postintubation hypotension in patients with isolated traumatic brain injury
Authors: Anand Tanya , Hejazi Omar , Conant Madolyn , Joule Dylan , Lundy Megan , Colosimo Christina , Spencer Audrey , Nelson Adam , Magnotti Lou , Joseph Bellal 
Published: March 2024

INTRODUCTION
Postintubation hypotension (PIH) is a risk factor of endotracheal intubation (ETI) after injury. For those with traumatic brain injury (TBI), one episode of hypotension can potentiate that injury. This study aimed to identify the resuscitation adjuncts that may decrease the incidence of PIH in this patient population.

METHODS
This is a 4-year (2019–2022) prospective observational study at a level I trauma center. Adult (18 years or older) patients with isolated TBI requiring ETI in the trauma bay were included. Blood pressures were measured 15 minutes preintubation and postintubation. Primary outcome was PIH, defined as a decrease in systolic blood pressure of ≥20% from baseline or to ≤80 mm Hg, or any decrease in mean arterial pressure to ≤60 mm Hg. Multivariable logistic regression was performed to identify the associations of preintubation vasopressor, hypertonic saline (HTS), packed red blood cell, and crystalloids on PIH incidence.

RESULTS
Of the 490 enrolled patients, 16% had mild (head AIS, ≤2), 35% had moderate (head AIS, 3–4), and 49% had severe TBI (head AIS, ≥5). The mean ± SD age was 42 ± 22 years, and 71% were male. The median ISS, head AIS, and Glasgow Coma Scale were 26 (19–38), 4 (3–5), and 6 (3–11), respectively. The mean ± SD systolic blood pressure 15 minutes preintubation and postintubation were 118 ± 46 and 106 ± 45, respectively. Before intubation, 31% received HTS; 10%, vasopressors; 20%, crystalloids; and 14%, at least 1 U of packed red blood cell (median, 2 [1–2] U). Overall, 304 patients (62%) developed PIH. On multivariable regression analysis, preintubation use of vasopressors and HTS was associated with significantly decreased odds of PIH independent of TBI severity, 0.310 (0.102–0.944, p = 0.039) and 0.393 (0.219–0.70, p = 0.002), respectively.

CONCLUSION
Nearly two thirds of isolated TBI patients developed PIH. Preintubation vasopressors and HTS are associated with a decreased incidence of PIH. Such adjuncts should be considered prior to ETI in patients with suspected TBI.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Locally Advanced Adenocarcinoma of the Esophagus: Is Esophagectomy Associated with Improved Overall Survival?
Authors: Kramer Sarah P , Swanson James , Fernando Mitchel , Park Simon , Verm Raymond , Abdelsattar Zaid , Cohn Tyler , Luchette Fred A , Baker Marshall S 
Published: March 2024

BACKGROUND:
Esophagectomy in locally advanced esophageal adenocarcinoma is challenging and carries risk. The value of esophagectomy in locally advanced esophageal adenocarcinoma is not well-defined.

STUDY DESIGN:
The National Cancer Database was used to identify patients with cT4 esophageal adenocarcinoma from 2004 to 2020. Multivariable regression was used to identify factors associated with use of esophagectomy. Cox modeling was used to identify factors associated with all-cause mortality. Patients undergoing esophagectomy were 1:1 propensity score–matched to patients treated nonsurgically. Kaplan–Meier analysis was used to compare 5-year overall survival (OS).

RESULTS:
A total of 3,703 patients met inclusion criteria. Of those, 541 (15%) underwent esophagectomy, and 3,162 (85%) did not. Age 65 years or less (adjusted odds ratio [aOR] 1.69, 95% CI 1.33 to 2.14), White race (aOR 2.98, 95% CI 2.24 to 3.96), treatment in academic centers (aOR 1.64, 95% CI 1.33 to 2.02), private insurance (aOR 1.88, 95% CI 1.50 to 2.36), and tumors less than 6 cm (aOR 1.86, 95% CI 1.44 to 2.40) were associated with use of esophagectomy. Government of lack of insurance (hazard ratio [HR] 1.23, 95% CI 1.12 to 1.35), income <$46,000 (HR 1.11, 95% CI 1.03 to 1.20), treatment in nonacademic centers (HR 1.16, 95% CI 1.07 to 1.25), Charlson-Deyo Comorbidity Index 1 or more (HR 1.22, 95% CI 1.12 to 1.32), and tumors 6 cm or more (HR 1.20, 95% CI 1.09 to 1.32) were associated with risk of all-cause mortality. Esophagectomy (HR 0.50, 95% CI 0.44 to 0.56) and systemic therapy (HR 0.40, 95% CI 0.37 to 0.43) were associated with decreased risk of all-cause mortality. Patients undergoing esophagectomy had higher rates of 5-year OS (27.4% vs 13.2%, p < 0.0001) and longer median OS (24.71 vs 10.09 months, p < 0.0001). Among cT4b patients, those who underwent esophagectomy had higher rates of 5-year OS (24.5% vs 12.3%, p < 0.0001) and longer median OS (25.53 vs 11.01 months, p < 0.0001).

CONCLUSIONS:
In cT4 esophageal adenocarcinoma, esophagectomy is associated with improved rates of 5-year OS compared with nonsurgical treatment.
Deep continual multitask out-of-hospital incident severity assessment from changing clinical features
Authors: Ferri Pablo , Sáez Carlos , Félix-De Castro Antonio , Sánchez-Cuesta Purificación , García-Gómez Juan M 
Published: March 2024

AbstractWhen developing Machine Learning models to support emergency medical triage, it is important to consider how changes over time in the data can negatively affect the models’ performance. The objective of this study was to assess the effectiveness of novel Deep Continual Learning pipelines in maximizing model performance when input features are subject to change over time, including the emergence of new features and the disappearance of existing ones. The model is designed to identify life-threatening situations, predict its admissible response delay, and determine its institutional jurisdiction. We analyzed a total of 1 414 575 events spanning from 2009 to 2019. Our findings demonstrate important performance improvements, up to 4.9% in life-threatening, 18.5% in response delay and 1.7% in jurisdiction, in absolute F1-score, compared to the current triage protocol, and improvements up to 4.4% in life-threatening and 11% in response delay, in absolute F1-score, respect to non-continual approaches.
A novel scale for assessing caregiving competence in family caregivers of persons with dementia
Authors: Suganuma Ippei , Ogawa Noriyuki , Kamijou Kenji , Nakanishi Aki , Kawasaki Ippei , Itotani Keisuke , Okada Shinichi 
Published: March 2024

AbstractThe aging of family caregivers and the challenges of long-distance caregiving attributed to the increase in the number of elderly individuals living alone have raised concerns about dementia caregiving in Japan. Additionally, with the shifts in family dynamics due to declining birth rates and an extended average lifespan, adapting support strategies for family caregivers is necessary. Thus, it is necessary to measure the caregiving competence of family caregivers early and effectively. However, a comprehensive caregiving competence scale tailored to dementia, including aspects such as caregiving burden, affirmation, and coping, is lacking. Therefore, this study aimed to develop a Caregiving Competence Scale for Dementia (CCSD) for primary family caregivers caring for individuals with dementia. This study focused on primary family caregivers caring for individuals with cognitive impairment and various degrees of dementia. The initial version of the CCSD was developed, and a questionnaire survey was conducted to validate its structural validity and reliability. A total of 150 participants were included in the analysis. The exploratory factor analysis identified five factors with 27 items: Factor 1: “Positive Emotions and Awareness,” Factor 2: “Presence or Absence of Consultation Partners and Family Support,” Factor 3: “Caregiving Burden and Coping Skills,” Factor 4: “Dementia Literacy,” and Factor 5: “Engagement and Emotional Control.” The confirmatory factor analysis revealed a good model fit (comparative fit index = 0.905 and root mean square error of approximation = 0.072). The overall Cronbach’s alpha coefficient for the scale was 0.892. The CCSD, comprising 27 items covering five factors, has been successfully developed as a measurement scale. Measuring caregiving competence contributes to developing targeted support strategies for primary family caregivers and facilitating appropriate interventions.
Objective turning measures improve diagnostic accuracy and relate to real-world mobility/combat readiness in chronic mild traumatic brain injury
Authors: Fino Peter C. , Antonellis Prokopios , Parrington Lucy , Weightman Margaret M. , Dibble Leland E. , Lester Mark E. , Hoppes Carrie W. , King Laurie A. 
Published: March 2024

ABSTRACTIntroductionBalance and mobility problems are common consequences after mild traumatic brain injury (mTBI). However, turning and non-straight locomotion, which are required for daily living, are rarely assessed in clinical tests of function after mTBI. Therefore, the primary goals of this study were to assess 1) the added value of clinic-based turning task variables, obtained using wearable sensors, over standard general assessments of mobility, and 2) assess the associations between general assessments of mobility, objective variables from clinic-based turning tasks, and ecologically-relevant functional tasks.Materials and MethodsFifty-three individuals with mTBI and 57 healthy controls participated across three sites. Participants were tested in a single session that encompassed self-reported questionnaires including demographic information and balance and mobility testing including the use of wearable sensors. Lasso regression models and the area under the receiver-operator characteristic curve (AUC) assessed diagnostic accuracy. Partial correlation coefficients assessed the relationship between each variable with ecologically-relevant functional tasks.ResultsMultivariate models revealed high diagnostic accuracy, with an AUC of 0.92, using multiple clinic-based turning variables. The complex turning course (CTC) yielded the highest multivariate AUC (95% CI) of 0.90 (0.84, 0.95) for single task, and the average lap time from the CTC had the highest univariate AUC (95% CI) of 0.70 (0.58, 0.78). Turning variables provided added value, indicated by higher AUCs, over standard general assessments of mobility. Turning variables had strong associations with ecologically-relevant functional tasks and outperformed general assessments of mobility.DiscussionClinic-based turning tasks, especially the CTC, have high diagnostic accuracy, strong associations with ecologically-relevant functional tasks, and require relatively short time(s) to complete. Compared to general assessments of mobility, clinic-based turning tasks may be more ecologically-relevant to daily function. Future work should continue to examine the CTC alongside other promising tools for return-to-activity assessments.