bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initiating advance care planning at admission: a brief intervention to increase goals of care discussions in geriatric trauma patients in an urban level I trauma center
Authors: Hwang Franchesca , Son Joohee , Ensor Kelsey , Goulet Nicole , Brown Allison , Victory Jesse , Tyrie Leslie 
Published: November 2023

ObjectivesThe burden of geriatric trauma continues to rise. Older trauma patients experience higher morbidity and mortality and thus benefit from early goals of care (GOC) discussions and advance care planning (ACP). The American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) recommends holding a family meeting within 72 hours of admission when treating geriatric trauma patients. At our level I trauma center, we sought to increase early GOC discussions by implementing a new history and physical (H&P) note template for geriatric trauma patients.MethodsPatients (aged >65 years) admitted to the trauma surgery service (≥24 hours) were included in the study. The intervention was a change in the H&P note template to include confirmation of code status or previous ACP and identification of a healthcare proxy. Primary outcomes were the rates of recognizing a pre-existing Do-Not-Resuscitate (DNR) status/advanced directives at admission and of documentation of a GOC discussion within 72 hours. Outcomes from a 3-month period (March–May) during the pre-intervention (2021) and post-intervention (2022) periods were compared.ResultsThe pre-intervention and post-intervention groups had 107 and 150 patients, respectively. We observed an increase in recognition of pre-existing DNR code status at time of admission from 50% to 95% (p=0.003) and documentation of a GOC discussion within 72 hours from 17% to 83% (p<0.0001). We also observed a trend showing that new DNR orders were placed more frequently in the post-intervention period (9% vs 17%, p=0.098). The in-hospital mortality was not significantly different.ConclusionsThe importance of GOC discussions and ACP documentation for geriatric trauma patients is evident, but its completion can be challenging. Our intervention of a new H&P note template increased GOC discussions, and this implementation may be feasible in other trauma centers to comply with the ACS-TQIP Geriatric Trauma Management Guidelines.Level of evidenceLevel III.
Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients
Authors: Goswami Julie , Baxter Jacob , Schiltz Brenda M , Elsbernd Terri A , Arteaga Grace M , Klinkner Denise B 
Published: November 2023

ObjectivesThe American College of Surgeons Trauma Quality Improvement Program (TQIP) and Committee on Trauma released a best practice guideline for palliative care in trauma patients in 2017. Utilization of pediatric palliative care services for pediatric trauma patients has not been studied. We sought to identify patients who received the consultation and develop criteria for patients who would benefit from these resources at our institution.MethodsThe institutional pediatric trauma registry was queried to identify all admissions age 0–17 years old to the pediatric intensive care unit (PICU) or trauma ICU (TICU) from 2014 to 2021. Demographic and clinical features were obtained from the registry. Electronic medical records were reviewed to identify and review consultations to the ComPASS team. A clinical practice guideline (CPG) for palliative care consultations was developed based on the TQIP guideline and applied retrospectively to patients admitted 2014–2021. The CPG was then prospectively applied to patients admitted from March through November 2022.ResultsA total of 399 patients were admitted to the PICU/TICU. There were 30 (7.5%) deaths, 20 (66.7%) within 24 hours of admission. Palliative care consultations were obtained in 21 (5.3%). Of these, 10 (47.6%) patients were infants/toddlers <age 2 years, all had traumatic brain injury, 3 (14.3%) were for suspected child abuse, and many were for “goals of care” or family meetings. When the CPG was applied retrospectively, 109 (27.3%) patients met criteria for consultation. After 8 months of prospective implementation of this CPG, palliative care consultation was obtained in 25% (7 of 28) of pediatric trauma patients admitted to the ICU.ConclusionOur results demonstrate underused potential of the palliative care team to impact the hospital course of critically ill pediatric trauma patients. Ongoing studies will analyze the utility of CPG implementation for early involvement of palliative services in critically ill pediatric trauma patients.Level of EvidenceLevel III (retrospective cohort)
Achieving balanced transfusion early in critically bleeding trauma patients: an observational study exploring the effect of attending trauma surgical presence during resuscitation
Authors: Gaski Iver Anders , Naess Paal Aksel , Baksaas-Aasen Kjersti , Skaga Nils Oddvar , Gaarder Christine 
Published: November 2023

BackgroundAfter 15 years of damage control resuscitation (DCR), studies still report high mortality rates for critically bleeding trauma patients. Adherence to massive hemorrhage protocols (MHPs) based on a 1:1:1 ratio of plasma, platelets, and red blood cells (RBCs) as part of DCR has been shown to improve outcomes. We wanted to assess MHP use in the early (6 hours from admission), critical phase of DCR and its impact on mortality. We hypothesized that the presence of an attending trauma surgeon during all MHP activations from 2013 would contribute to improving institutional resuscitation strategies and patient outcomes.MethodsWe conducted a retrospective analysis of all trauma patients receiving ≥10 RBCs within 6 hours of admission and included in the institutional trauma registry between 2009 and 2019. The cohort was divided in period 1 (P1): January 2009–August 2013, and period 2 (P2): September 2013–December 2019 for comparison of outcomes.ResultsA total of 141 patients were included, 81 in P1 and 60 in P2. Baseline characteristics were similar between the groups for Injury Severity Score, lactate, Glasgow Coma Scale, and base deficit. Patients in P2 received more plasma (16 units vs. 12 units; p<0.01), resulting in a more balanced plasma:RBC ratio (1.00 vs. 0.74; p<0.01), and platelets:RBC ratio (1.11 vs. 0.92; p<0.01). All-cause mortality rates decreased from P1 to P2, at 6 hours (22% to 8%; p=0.03), at 24 hours (36% vs 13%; p<0.01), and at 30 days (48% vs 30%, p=0.03), respectively. A stepwise logistic regression model predicted an OR of 0.27 (95% CI 0.08 to 0.93) for dying when admitted in P2.ConclusionsAchieving balanced transfusion rates at 6 hours, facilitated by the presence of an attending trauma surgeon at all MHP activations, coincided with a reduction in all-cause mortality and hemorrhage-related deaths in massively transfused trauma patients at 6 hours, 24 hours, and 30 days.Level of evidenceIV.
Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study
Authors: Cai Bin Bin , Wang Dong Pi 
Published: November 2023

ObjectivePostoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery.MethodsIn this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children’s hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs.ResultsTotally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery.ConclusionIdentifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.
A Metabolic Axis of Immune Intractability
Authors: Hinshaw Dominique C. , Patel Meet , Shevde Lalita A. 
Published: November 2023

Abstract
Immune cells in the tumor niche robustly influence disease progression. Remarkably, in cancer, developmental pathways are reenacted. Many parallels between immune regulation of embryonic development and immune regulation of tumor progression can be drawn, with evidence clearly supporting an immune-suppressive microenvironment in both situations. In these ecosystems, metabolic and bioenergetic circuits guide and regulate immune cell differentiation, plasticity, and functional properties of suppressive and inflammatory immune subsets. As such, there is an emerging pattern of intersection across the dynamic process of ontogeny and the ever-evolving tumor neighborhood. In this article, we focus on the convergence of immune programming during ontogeny and in the tumor microenvironment. Exemplifying dysregulation of Hedgehog (Hh) activity, a key player during ontogeny, we highlight a critical convergence of these fields and the metabolic axis of the nutrient sensing hexosamine biosynthetic pathway (HBP) that integrates glucose, glutamine, amino acids, acetyl CoA, and uridine-5′-triphosphate (UTP), culminating in the synthesis of UDP-GlcNAc, a metabolite that functions as a metabolic and bioenergetic sensor. We discuss an emerging pattern of immune regulation, orchestrated by O-GlcNAcylation of key transcriptional regulators, spurring suppressive activity of dysfunctional immune cells in the tumor microenvironment.
Cracking the Neural Code of How the Brain Represents Time May Make the Dualistic Stance Obsolete
Authors: van Wassenhove Virginie 
Published: November 2023

Abstract
This is an invited commentary on the position paper of Gruber, Block and Montemayor (2022). First, I oppose the premise in Gruber et al.’s proposal according to which there exists a ‘real’ and an ‘illusory’ time. Second, our knowledge about the universe is hypothesized, tested, and verified by the most complex physical systems known to date (brains) hence postulating the coexistence of an ‘absolute’ and a ‘real’, or an ‘illusory’ and a ‘nonillusory’ time might be unnecessary. Instead, and parsimoniously, (organic or atomic) measuring devices for duration, simultaneity, order, and so forth, have variable precision. The most exquisite clock is atomic, a good enough one for survival on Earth is at the scale of neural networks. A difference between measuring devices and brains is that the latter compute on stored temporal information. Last, I suggest additional gadgets for the Information Gathering and Utilizing Systems (IGUs) proposal. In sum, I oppose some of the theoretical premises while lending support to the idea that representing temporal statistics is a useful heuristics for some aspects of temporal cognition. From the cognitive neuroscience standpoint, IGUs are compatible with information-theoretic approaches, and with current Bayesian and predictive models implemented in neural systems, in which brains code information and compute on symbolic representations.
Assessing RRFS versus HRRR in Predicting Widespread Convective Systems over the Eastern CONUS
Authors: Grim Joseph A. , Pinto James O. , Dowell David C. 
Published: November 2023

Abstract
This study provides a comparison of the operational HRRR version 4 and its eventual successor, the experimental Rapid Refresh Forecast System (RRFS) model (summer 2022 version), at predicting the evolution of convective storm characteristics during widespread convective events that occurred primarily over the eastern United States during summer 2022. In total 32 widespread convective events were selected using observations from the MRMS composite reflectivity, which includes an equal number of MCSs, quasi-linear convective systems (QLCSs), clusters, and cellular convection. Each storm system was assessed on four primary characteristics: total storm area, total storm count, storm area ratio (an indicator of mean storm size), and storm size distributions. It was found that the HRRR predictions of total storm area were comparable to MRMS, while the RRFS overpredicted total storm area by 40%–60% depending on forecast lead time. Both models tended to underpredict storm counts particularly during the storm initiation and growth period. This bias in storm counts originates early in the model runs (forecast hour 1) and propagates through the simulation in both models indicating that both miss storm initiation events and/or merge individual storm objects too quickly. Thus, both models end up with mean storm sizes that are much larger than observed (RRFS more so than HRRR). Additional analyses revealed that the storm area and individual storm biases were largest for the clusters and cellular convective modes. These results can serve as a benchmark for assessing future versions of RRFS and will aid model users in interpreting forecast guidance.
An Experimental Investigation of Hazard Statement Compliance in Procedures Using Eye Tracking Technology: Should Task be Included in the C-HIP Model?
Authors: Hendricks Joseph W. , Peres S. Camille 
Published: November 2023

Objective Using eye tracking technology, this study sought to determine if differences in hazard statement (HS) compliance based on design elements are attributable to attention maintenance (AM). Background Recent empirical work has demonstrated counter-intuitive findings for HS designs embedded in procedures. Specifically, prevalent HS designs in procedures were associated with lower compliance. Method The current study utilized eye tracking technology to determine whether participants are attending to HSs differently based on the inclusion or absence of visually distinct HS design elements typically used for consumer products. We used two different designs that previously yielded the largest gap in HS compliance. In a fully-crossed design, 33 participants completed four rounds of tasks using four procedures with embedded HSs. To assess AM, eye tracking was used to measure gaze and fixation duration. Results The results indicated there are differences in AM between the two designs. The HSs that included elements traditionally considered effective in the consumer products literature elicited lower fixation duration times, and were associated with lower compliance. However, AM did not mediate the design effect on compliance. Conclusions The study results suggest the design of HSs are impacting individuals as early as the AM stage of the C-HIP model. The absence of HS design-AM-compliance mediation suggests other C-HIP elements more directly explain the HS design-compliance effects. Application These results provide more evidence that the communication of Health, Environment, and Safety information in procedures may need to be different from those on consumer products, suggesting design efficacy may be task dependent.
Manufacturing woven carbon fabrics with electrode function via high-pressure spray of active lithium-ion particles
Authors: Han Zhibin , Feng Yuncong , Zhang Wanrui , Xiong Yifeng , Zhang Weizhao 
Published: November 2023

In this paper, an innovative approach was presented to manufacture woven carbon fabric cathodes via high-pressure spray to coat LiFePO4 (LFP), acetylene black (AB) and polyvinylidene fluoride (PVDF) onto carbon fibers. The fabrics were desized to improve conductivity prior to coating. Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) were adopted to ensure that the selected process parameters could achieve complete removal of the polymer sizing and dispersion of the LFP particles on both the spray surface and inner architecture of the fabrics. The subsequent electrochemical characterization showed that the fabric cathodes could, on average, produce excellent specific capacities of over 110 mAh/g and areal capacities of over 3.0 mAh/cm2 with good rate performance. With 98% efficiency and 0.97 retention after 100 cycles, the cathodes also depicted superb long-cycle performance, meaning that the coating with electrochemical activity could adhere firmly to the fiber surface.
Localised intravascular coagulation complicating venous malformations: Clinical characterisation
Authors: Blaise Sophie , Soya Esaie , Nou Monira , Malloizel-Delaunay Julie , Thiel Hélène , Bisdorff-Bresson Annouk , Seinturier Christophe 
Published: November 2023

Objective The International Union of Phlebology recommends measuring at least D-dimer and fibrinogen levels in the diagnosis of extensive extra-truncular venous malformations, with a surface area of 10 cm2 or those which are deep, as well as prior to any interventional procedure. The aim of the study was to characterise venous malformations associated with a possible vascular complication. Method This study was an observational and multicentre study. The objective was to explore the presence of a possible coagulation disorder among patients with venous malformation. The primary endpoint was to characterise venous malformations with increased D-dimer levels. Results The majority of the 72 venous malformations were located in the trunk region, mostly in intramuscular or subcutaneous locations. There were 72 venous malformations with increased D-dimer levels including 3 with biological disseminated intravascular coagulation (elevated D-dimer and fibrinogen <1 g/L). The anticoagulant treatments administered were very heterogeneous in class and dosage, and at the end of the treatment, 17 elevated D-dimers were persistent, 9 venous malformations remained painful and 27 showed thrombotic regression. Conclusion Venous vascular malformations are probably underestimated and should probably be explored more systematically in terms of coagulation disorder regardless of size or symptomatology. The therapeutic recommendations to treat localised intravascular coagulation with low-molecular weight are not widely applied. Studies are needed, in particular to assess the role of oral anticoagulants in the management of coagulation disorder among patients with venous malformation.
FKBP5 associated CD8 T cell infiltration is a novel prognostic biomarker in luminal B breast cancer
Authors: Tong Fei , Lu Genlin , Zang Jie , Hao Dingji , Xu Wangjue , Chen Jida , Ding Qiong , Xiong Hanchu 
Published: November 2023

Objective To investigate the relationship between FKBP prolyl isomerase 5 ( FKBP5) gene expression and CD8 T cells in tumour progression and immunology of the luminal B subtype of breast cancer (LBBC) using bioinformatics analyses. Methods The Gene Expression Profiling Interactive Analysis 2, Human Protein Atlas and breast cancer gene-expression miner v4.5 databases were used for data mining and analysing FKBP5, its co-expressed genes and CD8 T cell-related markers. The Tumor IMmune Estimation Resource 2.0 database was used for analysing the correlation and prognosis of FKBP5 and CD8 T cell infiltration level in LBBC. Results Upregulated FKBP5 expression was correlated with improved survival in LBBC. Upregulated FKBP5-related CD8 T cell markers were also demonstrated to be significantly correlated with better survival in LBBC and might play a role in the biological activity of FKBP5. Conclusion These findings suggest that FKBP5 and its associated CD8 T cell infiltration are potential benign prognostic indicators for LBBC.
Safety and efficacy of continuous intravenous labetalol for blood pressure control in neurosurgical patients
Authors: Noiphithak Raywat , Duangprasert Gahn , Sukhor Sasikan , Durongkaweroj Pichayaphong , Yindeedej Vich 
Published: November 2023

Objectives Current evidence supporting the use of continuous intravenous labetalol for blood pressure (BP) control in neurosurgical patients is limited. This study aims to assess the efficacy and safety of labetalol in neurosurgical patients and identify potential contributing factors to these outcomes. Methods We retrospectively reviewed the medical records of neurosurgical patients who received continuous labetalol infusion for BP control. Efficacy was assessed based on the time needed to achieve the target BP (systolic BP ≤ 140 mmHg or diastolic BP ≤ 90 mmHg). Safety was assessed according to adverse events that occurred during labetalol administration. Factors associated with efficacy and safety were analyzed using a logistic regression model. Results Among 79 patients enrolled in this study, 47 (59.49%) achieved the target BP within 1 hour (early response). No factors were significantly associated with an early response. Hypotension was observed in 11 patients (13.9%), and bradycardia was observed in 8 patients (10.1%). Hypotension was significantly associated with patient age and motor impairment, while bradycardia was significantly associated with diabetes mellitus. Conclusion The efficacy and safety profiles of labetalol infusion suggest this treatment as a promising option for BP control in neurosurgical patients.
Advance Care Planning: A Story of Trust Within the Family
Authors: Iunius Lory A. , Vilpert Sarah , Meier Clément , Jox Ralf J. , Borasio Gian Domenico , Maurer Jürgen 
Published: November 2023

As the family usually plays a central role at the end of life, the quality of family relationships may influence how individuals approach advance care planning (ACP). Our study investigates the associations of trust in relatives with regard to end-of-life (EOL) issues—used as a proxy measure of family relationship quality—with individuals’ engagement in EOL discussions, advance directive (AD) awareness, approval and completion, and designation of a healthcare proxy. Using nationally representative data of adults aged 55 years and over from wave 6 (2015) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland ( n = 1911), we show that complete trust in relatives is related to higher engagement in ACP. Subject to patient consent, the family should, therefore, be included in the ACP process, as such practice could enhance patient-centered EOL care and quality of life at the end of life.