bluuebunny/crossref_metadata_2025_split huggingface dataset:
Boston Febrile Infant Algorithm 2.0: Improving Care of the Febrile Infant 1–2 Months of Age
Authors: Dorney Kate , Neuman Mark I. , Harper Marvin B. , Bachur Richard G. 
Published: February 2023

Introduction:
Significant variation exists in the management of febrile infants, particularly those between 1 and 2 months of age. An established algorithm for well-appearing febrile infants 1–2 months of age guided clinical care for three decades in our emergency department. With mounting evidence for procalcitonin (PCT) to detect invasive bacterial infection (IBI), we revised our algorithm intending to decrease lumbar punctures (LPs) and antibiotic administration without increasing hospitalizations, revisits, or missed IBI.

Methods:
The algorithm’s risk stratification was revised based on the expert review of evidence regarding test performance of PCT for IBI in febrile infants. With the revision, routine LP and empiric antibiotics were not recommended for low-risk infants. We used quality improvement strategies to disseminate the revised algorithm and reinforce uptake. The primary outcomes were the proportion of infants undergoing lumbar punctures or receiving antibiotics. Admission rates, 72-hour revisits requiring admission, and missed IBI were monitored as balancing measures.

Results:
We studied 616 infants including 326 (52.9%), after the implementation of the revised algorithm. LP was performed in 66.2% prerevision and 31.9% postrevision (34.3% absolute reduction, P < 0.001). Antibiotic administration decreased by 26.2% (pre 62.4% to post 36.2%, P < 0.001) and hospitalization rates decreased by 8.1% (P = 0.03). There have been no missed IBIs. Adherence to the pathway led to a sustained reduction in LPs and antibiotic administration for 24 months.

Conclusion:
A revised pathway with the addition of PCT resulted in a safe, sustained reduction in LPs and reduced antibiotic administration in febrile infants 1–2 months of age.
Implementation of a Standardized Premedication Bundle to Improve Procedure Success for Nonemergent Neonatal Intubations
Authors: Diego Ellen K. , Malloy Katherine , Cox Toby , Broomall Allison , Orr Laura , Baxter Christina , Meany Sarah , Baker Nicole , Fraser Jennifer , Corbin Kelly Sanders , Gregoski Mathew J. , Wagner Carol L. , Ross Julie R. 
Published: February 2023

Introduction:
The American Academy of Pediatrics recommends premedication for all nonemergent neonatal intubations, yet there remains significant variation in this practice nationally. We aimed to standardize our unit’s premedication practices for improved intubation success and reduced adverse events.

Methods:
The study workgroup developed educational material and protocol content. Process measures included premedication use, education, and audit form completion. Primary (success on first intubation attempt and adverse event rates) and secondary (trainee success) study outcomes are displayed using statistical process control charts and pre-post cohort comparisons.

Results:
Forty-seven percent (97/206) of nurses completed educational intervention before protocol release, with an additional 20% (42/206) following a staff reminder. Two hundred sixteen (216) patients were intubated per protocol with 81% (174/216) audit completion. Compared with baseline (n = 158), intubation attempts decreased from 2 (IQR, 1–2) to 1 (IQR, 1–2) (P = 0.03), and success on the first attempt increased from 40% (63/158) to 57% (124/216) (P < 0.01), with a notable improvement in trainee success from less than 1% (1/40) to 43% (31/72) (P < 0.01). The rate of severe and rare adverse events remained stable; however, there was a rise in nonsevere events from 30% (48/158) to 45% (98/216). The tachycardia rate increased with atropine use. There was no change in chest wall rigidity, number of infants unable to extubate following surfactant, or decompensation awaiting medications.

Conclusions:
Standardizing procedural care delivery reduced intubation attempts and increased the attempt success rate. However, this was accompanied by an increase in the rate of nonsevere adverse events.
In Vivo Performance of a Machine Learning Model Predicting Pediatric Sepsis at Triage
Authors: Piroutek Mary Jane , Heyming Theodore W. , Knudsen-Robbins Chloe , Feaster William , Lee Kent , Ehwerhemuepha Louis 
Published: February 2023

Introduction:
Sepsis is a leading cause of pediatric mortality across the globe. Early recognition reduces mortality; and improve outcomes however, rapid detection remains difficult. Although physiologic mechanisms contribute to the complexity the epidemiology of pediatric Emergency Department (ED) visits also contributes. A variety of sepsis screening methods have been designed, from alerts based on triage temperature and heart rate to more complex algorithms. Evaluation of such tools has suggested improved identification, yet there is a lack of definitive data.

Objective:
The objective of this study was to evaluate the implementation and performance of the S2T2 (Sepsis Screening Triage Tool) in a pediatric ED.

Methods:
The S2T2 is a multiclass stochastic gradient boosting machine learning model recently developed at the study institution. It uses ED triage data and historical data mined from electronic health record to predict sepsis potential at triage. S2T2 was operationalized on 2/1/21; performance data for this study were collected over the first 7 months of implementation (to 8/31/21). Sensitivity and specificity were assessed by comparison with final International Classification of Disease-10 diagnoses codes. The pediatric ED at which this model was developed is a level-2 pediatric trauma center with an annual census of approximately 96,000.

Results:
In total, 43,337 patients were included, 41 with severe sepsis and 121 with sepsis. S2T2 demonstrated a sensitivity of 41.5% and specificity of 99.2% for severe sepsis, and a sensitivity of 25.6% and specificity of 99.2% for sepsis.

Conclusion:
S2T2 may aide in the identification of pediatric patients at risk for sepsis, potentially allowing for accelerated diagnosis, intervention, improved care, and better outcomes.
MMP9 as a Potential Biomarker in 631 Human Implant-Induced Fibrotic Capsules A Systematic Analysis and Biomarker Study
Authors: Kuehlmann Britta , Bonham Clark Andrew , Gurtner Geoffrey C. , Prantl Lukas 
Published: February 2023

Background:
Capsular fibrosis (CF) often occurs around biomedical devices following implantation causing pain, discomfort, and device failure. Breast implantation remains among the most common medical procedures worldwide. Revealing specific genes that drive fibrotic deposition will help us to garner a better understanding of the pathophysiology of this disease and develop different strategies to combat it.

Methods:
Here, we collected 631 capsules around breast implants and were able to connect clinical baseline characteristics with histopathological findings. Additionally, we were able to conduct the first large systematic analysis to identify differentially-expressed genes in fibrotic human tissue samples, comparing the lowest form of fibrosis with the most aggravated one.

Results:
We identified 2,559 differentially-expressed genes upon which we performed a knowledge-based network generation and pathway association study to identify putative novel biomarkers for capsular fibrosis. We were able to show changes of cellular influx during progression of CF and distinguish several genes as potential clinical biomarkers and drug targets. Among these, MMP9 was one of the most upregulated (p-value: 0.006) and is attractive due to its wide detectability.

Conclusions:
MMP9 seems to be a potential biomarker to detect capsular fibrosis. It is a measurable indicator that can easily be detected in blood, sputum, and urine. For the diagnosis of fibrosis this biomarker might be exceedingly beneficial to developing novel screening methods and prophylaxes.

Clinical Relevance Statement:
Discovering biomarkers at the earliest and mildest stages for the diagnosis of fibrosis is clinically important. Our results bring new hope for biomarker-based diagnosis for CF.
Modified Surgical Model for Genito-Urinary Vascularized Composite Allotransplantations: An Anatomical Study
Authors: Ruiz François , Cetrulo Curtis L. , Timsit Marc-Olivier , Lantieri Laurent , Lellouch Alexandre G. 
Published: February 2023

Summary:
Total penile reconstruction represents a surgical challenge. Autologous reconstructions offer limited aesthetic results as well as variable urinary function recovery. To date, five Genito-Urinary Vascularized Composite Allotransplantations (GUVCA) have been performed worldwide. However, in all cases, vascular complications have been reported. The objective of this study is to develop a modified surgical model for penile allotransplantation to limit the number of microsurgical anastomoses while ensuring vascular reliability. We studied penile allotransplantation by performing dissections on 12 subjects. The study was carried out to ensure the vascularization of the entire penis shaft while limiting the number of anastomoses.
The penis vasculature includes numerous angiosomes between its different subunits. The penile skin envelope is supplied by both external and internal pudendal vessels. The cavernous and spongy bodies are supplied by terminal branches of the internal pudendal vessels. The anterior pubic osteotomy approach allows access to the root of the cavernous bodies and to the Alcock ducts. This modified surgical model for penile allotransplantation could help future teams involved in GUVCA to improve urinary and sexual function.
TQIP mortality reporting system case reports: Unanticipated mortality due to failures in clinical performance
Authors: Williams Regan F. , Davis Kimberly A. ,   the ACS TQIP Mortality Reporting System Writing Group
Published: February 2023

ABSTRACT
The Trauma Quality Improvement Program Mortality Reporting System is an online anonymous case reporting system designed to share experiences from rare events that may have contributed to unanticipated mortality at contributing trauma centers. The Trauma Quality Improvement Program Mortality Reporting System Working group monitors submitted cases and organizes them into emblematic themes. This report summarizes unanticipated mortality from two cases of failure of clinical performance and presents strategies to mitigate these events locally with the hope of decreasing unanticipated mortality nationwide.
Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion
Authors: Abraham Nader , Ludwig Elsa K. , Schaaf Cecilia R. , Veerasammy Brittany , Stewart Amy S. , McKinney Caroline , Freund John , Brassil John , Samy Kannan P. , Gao Qimeng , Kahan Riley , Niedzwiecki Donna , Cardona Diana M. , Garman Katherine S. , Barbas Andrew S. , Sudan Debra L. , Gonzalez Liara M. 
Published: February 2023

Background.
Successful intestinal transplantation is currently hindered by graft injury that occurs during procurement and storage, which contributes to postoperative sepsis and allograft rejection. Improved graft preservation may expand transplantable graft numbers and enhance posttransplant outcomes. Superior transplant outcomes have recently been demonstrated in clinical trials using machine perfusion to preserve the liver. We hypothesized that machine perfusion preservation of intestinal allografts could be achieved and allow for transplantation in a porcine model.

Methods.
Using a translational porcine model, we developed a device for intestinal perfusion. Intestinal samples were collected at the time of organ procurement, and after 6 h of machine perfusion for gross and histologic evaluation, hourly chemistry panels were performed on the perfusate and were used for protocol optimization. Following transplantation, porcine recipient physical activity, systemic blood parameters, and vital signs were monitored for 2 d before sacrifice.

Results.
In initial protocol development (generation 1, n = 8 grafts), multiple metabolic, electrolyte, and acid-base derangements were measured. These factors coincided with graft and mesenteric edema and luminal hemorrhage and were addressed with the addition of dialysis. In the subsequent protocol (generation 2, n = 9 grafts), differential jejunum and ileum perfusion were observed resulting in gross evidence of ileal ischemia. Modifications in vasodilating medications enhanced ileal perfusion (generation 3, n = 4 grafts). We report successful transplantation of 2 porcine intestinal allografts after machine perfusion with postoperative clinical and gross evidence of normal gut function.

Conclusions.
This study reports development and optimization of machine perfusion preservation of small intestine and successful transplantation of intestinal allografts in a porcine model.
Pilot Study of the Effects of Paced Breathing on Measures of Convergent and Divergent Thinking
Authors: Wallace McKenzie B. , Costa Amy N. , Ferguson Bradley J. , Carey Megan A. , Rzeppa Chloe , Kille Briana M. , Drysdale David R. , Sutton Briann E. , Shuler Brianne H. , Johnson Ryan P. , Kwenda Elizabeth P. , Hadley Jamie , Snyders Whitney , Beversdorf David Q. 
Published: February 2023

Background:
The ability of the autonomic nervous system’s stress response to impair aspects of cognitive flexibility is known. However, the ability to modulate the sympathetic response and improve these cognitive impairments via nonpharmacological intervention, such as paced breathing (PB), requires further investigation.

Objective:
To better elucidate the effects of PB on cognition.

Method:
We employed a PB protocol in a total of 52 healthy men and women and measured performance on convergent and divergent cognitive tasks, perceived stress, and physiological measures (eg, blood pressure, heart rate). Participants attended two experimental sessions consisting of either PB or normal breathing followed by cognitive assessments including convergent (compound remote associate, anagram) and divergent (alternate use, fluency) tasks. Experiment 2 consisted of more difficult versions of cognitive tasks compared with Experiment 1.

Results:
In Experiment 1, PB significantly reduced the female participants’ systolic and diastolic blood pressure immediately after the breathing protocol without affecting their cognition. In Experiment 2, PB significantly reduced perceived stress immediately after the breathing protocol, regardless of sex. There was no effect on cognition in Experiment 2, but a correlation was observed between perceived stress change and anagram number solved change.

Conclusion:
While PB modulates sympathetic activity in females, there was a lack of improvement in cognitive flexibility performance. At least for a single trial of PB, cognitive flexibility did not improve.
Learning Curve for Transanal Total Mesorectal Excision for Low Rectal Malignancy
Authors: Matsuda Takeru , Ryuichiro Sawada , Hasegawa Hiroshi , Yamashita Kimihiro , Harada Hitoshi , Urakawa Naoki , Goto Hironobu , Kanaji Shingo , Oshikiri Taro , Kakeji Yoshihiro 
Published: February 2023

Background:
Although transanal total mesorectal excision (TaTME) is a promising treatment for low rectal cancers; it is considered technically demanding, and the number of cases required to become proficient in TaTME remains unknown. The purpose of this study was to assess the TaTME learning curve based on the TME completion time.

Study Design:
This retrospective analysis comprised of 128 individuals who received TaTME between September 2016 and December 2021. The cumulative sum method was used to generate the learning curve. The duration of the procedure from the beginning to the end of the circumferential rendezvous was used to define the TME completion time.

Results:
The learning curve consists of three phases: phase I (learning phase: cases 1–38), phase II (consolidation phase: cases 39–70), and phase III (maturing phase: cases 71–128). As the phases varied, both the overall operative time and TME completion time considerably decreased. Through the three phases of TaTME, intraoperative adverse events decreased, and in phase III, none occurred. Only one instance of local recurrence occurred during phase III, while none occurred during phase I or II.

Conclusion:
After 70 operations, the surgeon could join the mastery phase of TaTME based on the TME completion time. After the mastering phase began, there were no intraoperative negative occurrences. From the beginning, the oncological safety could be guaranteed.
Does CPT Modifier 22 Appropriately Reflect a Difficult Pancreaticoduodenectomy? Retrospective Analysis of Operative Outcomes and Cost
Authors: Mustansir Fatima , Jajja Mohammad Raheel , Lovasik Brendan P , Sharma Jyotirmay , Lin Edward , Sweeney John F , Sarmiento Juan M 
Published: February 2023

BACKGROUND:CPT coding allows addition of a 2-digit modifier code to denote particularly difficult procedures necessitating additional reimbursement, called the modifier 22. The use of modifier 22 in relation to pancreatic surgery and outcomes, specifically pancreaticoduodenectomy (PD), has not been explored.STUDY DESIGN:All PDs performed from 2010 to 2019 at a quaternary healthcare system were analyzed for differences in preoperative characteristics, outcomes, and cost based on the use of modifier 22. Adjusted logistic regression analysis was used to identify factors predictive of modifier 22 use.RESULTS:A total of 1,284 patients underwent PD between 2010 and 2019; 1,173 with complete data were included, of which 320 (27.3%) were coded with modifier 22. Patients coded with modifier 22 demonstrated a significantly longer duration of surgery (365.9 ± 168.4 vs 227 ± 97.1; p < 0.001). They also incurred significantly higher cost of index admission ($37,446 ± 34,187 vs $28,279 ± 27,980; p = 0.002). An adjusted multivariable analysis (specifically adjusted for surgeon variation) revealed duration of surgery (p < 0.001), neoadjuvant chemotherapy (p = 0.039), class II obesity (p = 0.019), and chronic pancreatitis (p = 0.005) to be predictive of modifier 22 use.CONCLUSIONS:Despite the subjective nature of this CPT modifier, modifier 22 is an appropriate marker of intraoperative difficulty. Preoperative and intraoperative characteristics that lead to its addition may be used to further delineate difficult PDs.
Near infrared conjugated polymer nanoparticles (CPN™) for tracking cells using fluorescence and optoacoustic imaging
Authors: Muñiz-García Ana , Pichardo Alejandra Hernandez , Littlewood James , Sharkey Jack , Wilm Bettina , Peace Hannah , O’Callaghan Dermott , Green Mark , Taylor Arthur , Murray Patricia 
Published: February 2023

AbstractTracking the biodistribution of cell therapies is crucial for understanding their safety and efficacy. Optical imaging techniques are particularly useful for tracking cells due to their clinical translatability and potential for intra-operative use to validate cell delivery. However, there is a lack of appropriate optical probes for cell tracking. The only FDA-approved material for clinical use is indocyanine green (ICG). ICG can be used for both fluorescence and photoacoustic imaging, but is prone to photodegradation, and at higher concentrations, undergoes quenching and can adversely affect cell health. We have developed novel near-infrared imaging probes comprising conjugated polymer nanoparticles (CPNs™) that can be fine-tuned to absorb and emit light at specific wavelengths. To compare the performance of the CPNs™ with ICG forin vivocell tracking, labelled mesenchymal stromal cells (MSCs) were injected subcutaneously in mice and detected using fluorescence imaging (FI) and a form of photoacoustic imaging called multispectral optoacoustic tomography (MSOT). MSCs labelled with either ICG or CPN™ 770 could be detected with FI, but only CPN™ 770-labelled MSCs could be detected with MSOT. These results show that CPNs™ show great promise for tracking cellsin vivousing optical imaging techniques, and for some applications, out-perform ICG.
Food Insecurity amid COVID-19 Lockdowns: Assessing Sociodemographic Indicators of Vulnerability in Harar and Kersa, Ethiopia
Authors: Muir Jonathan A. , Dheresa Merga , Madewell Zachary J. , Getachew Tamirat , Mengesha Gezahegn , Whitney Cynthia G. , Assefa Nega , Cunningham Solveig A. 
Published: February 2023

ABSTRACTObjectiveThe COVID-19 pandemic was associated with widespread social disruptions, as governments implemented lockdowns to quell disease spread. To advance knowledge of consequences for households in lower-income countries, we examine food insecurity during the pandemic period.DesignCross-sectional study using logistic regression to examine factors associated with food insecurity. Data were collected between August and September of 2021 through a Health and Demographic Surveillance System (HDSS) using a survey instrument focused on knowledge regarding the spread of COVID-19; food availability; COVID-19 related shocks/coping; under-five child healthcare services; and healthcare services for pregnant women.SettingThe study is set in two communities in Eastern Ethiopia, one rural and one urban.ParticipantsA random sample of 880 households residing in Kersa and Harar.ResultsRoughly 16% of households reported not having enough food to eat during the pandemic, an increase of 6% since before the pandemic. After adjusting for other variables, households were more likely to report food insecurity if they were living in an urban area, were a larger household, had a family member lose employment, reported an increase in food prices, or were food insecure before the pandemic. Households were less likely to report food insecurity if they were wealthier or had higher household income.DiscussionAfter taking other characteristics into consideration, households in urban areas were at higher risk for food insecurity. These findings point to the need for expanding food assistance programs to more urban areas to help mitigate the impact of lockdowns on more vulnerable households.