bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment Guideline Nonadherence Pretransport Associated With Need for Higher Level of Care in Children Transferred to a Pediatric Tertiary Care Center for Status Epilepticus
Authors: Philpott Natalia Garza , Dante Siddhartha A. , Philpott David , Perin Jamie , Bhatia Pooja , Henderson Eric , Costabile Philomena , Stratton Maera , Dabrowski Ania , Kossoff Eric H. , Klein Bruce L. , Noje Corina 
Published: May 2023

Objectives
We sought to investigate the association between adherence to the American Epilepsy Society (AES) 2016 guidelines for management of convulsive status epilepticus (SE) and clinical outcomes among children requiring interhospital transport for SE. We hypothesized that pretransport guideline nonadherence would be associated with needing higher level of care posttransfer.

Methods
This was a retrospective cohort study of children aged 30 days to 18 years transferred to our pediatric tertiary center from 2017 to 2019 for management of SE. Their care episodes were classified as 2016 American Epilepsy Society guideline adherent or nonadherent. There were 40 referring hospitals represented in this cohort.

Results
Of 260 care episodes, 55 (21%) were guideline adherent, 184 (71%) were guideline nonadherent, and 21 (8%) had insufficient data to determine guideline adherence. Compared with the adherent group, patients in the nonadherent care group had longer hospitalizations (32 hours [17–68] vs 21 hours [7–48], P = 0.006), were more likely to require intensive care unit admission (47% vs 31%), and less likely to be discharged home from the emergency department (16% vs 35%; χ2 test, P = 0.01). Intubation rates did not differ significantly between groups (25% vs 18%, P = 0.37). When we fit a multivariable model to adjust for confounding variables, guideline nonadherence was associated with need for higher level of care (odds ratio, 2.04; 95% confidence interval, 1.04–3.99). Treatment guideline adherence did not improve over the 3-year study period (2017: 22%, 2018: 19%, 2019: 29% [χ2 test for differences between any 2 years, P = 0.295]).

Conclusions
Guideline nonadherence pretransport was associated with longer hospitalizations and need for higher level of care among children transferred for SE at our institution. These findings suggest a need to improve SE guideline adherence through multifaceted quality improvement efforts targeting both the prehospital and community hospital settings.
The Impact of a Multifaceted Simulation Education and Feedback Program for Community Emergency Departments on Pediatric Diabetic Ketoacidosis Management
Authors: Waddell Kristen , Gaither Stacy L. , Rockwell Nicholas , Tofil Nancy M. , Rutledge Chrystal 
Published: May 2023

Objectives
We sought to determine if general emergency departments (GEDs) were managing pediatric diabetic ketoacidosis (DKA) correctly and if management could be improved using a multilayered educational initiative. We hypothesized that a multifaceted program of in situ simulation education and formal feedback on actual patient management would improve community GED management of pediatric DKA.

Methods
This study combined a prospective simulation-based performance evaluation and a retrospective chart review. A community outreach simulation education initiative was developed followed by a formal patient feedback process.

Results
Fifteen hospitals participated in simulation sessions and the feedback process. All hospitals were scored for readiness to provide care for critically ill pediatric patients using the Emergency Medical Services for Children (EMSC) Pediatric Readiness Assessment. Six of the 15 have had a second hospital visit that included a DKA scenario with an average performance score of 60.3%. A total of 158 pediatric patients with DKA were included in the chart review. The GEDs with higher patient volumes provided best practice DKA management more often (63%) than those with lower patient volumes (40%). Participating in a DKA simulated scenario showed a trend toward improved care, with 47.2% before participation and 68.2% after participation (P = 0.091). Participating in the formal feedback process improved best practice management provided to 68.6%. Best practice management was further improved to 70.3% if the GED participated in both a DKA simulation and the feedback process (P = 0.04).

Conclusions
A multifaceted program of in situ simulation education and formal feedback on patient management can improve community GED management of pediatric patients with DKA.
“To Ablate or Not to Ablate: The Question if Umbilectomy Decreases Donor Site Complications in DIEP Flap Breast Reconstruction?”
Authors: Kevin Perez , Teotia Sumeet S. , Haddock Nicholas T. 
Published: May 2023

Objectives:
There have been several considerations made in improving outcomes for DIEP flap breast reconstruction. The aim of this study is to evaluate the impact of umbilectomy in abdominally based breast reconstruction.

Methods:
This is a retrospective study that evaluated post-operative outcomes of patients who underwent DIEP autologous flap breast reconstruction at an academic center between January 2015 – December 2021 performed by one of two reconstructive surgeons. Primary outcome variables included abdominal donor site complications. Secondary outcome variables included treatment outcomes for complications. Covariates included demographic information, comorbidities, cancer treatment, and smoking.

Results:
Four hundred eight patients underwent DIEP flap breast reconstruction with one hundred ninety-four (47.5%) undergoing umbilectomy. Umbilectomy resulted in decreased number of total wounds per patient (0.35 ± 0.795) compared to umbilical preservation (0.75 ± 1.322, p < 0.001) as well as decreased associated risk of any reported wounds (OR = 0.530, p = 0.009). Associations that trended towards significance occurred between umbilectomy and minor wound separation, and partial necrosis; both showing decreased risks. Significant association was noted between umbilectomy and donor site seroma (χ2(1) = 6.348, p = 0.016) showing an increased risk (OR = 5.761).

Conclusion:
The topic of umbilectomy should be discussed with patients and considered as a part of DIEP flap breast reconstruction given the reduction in the risk of abdominal donor site wounds. Though umbilectomy decreases the rate of wounds it can increase risk of seroma, thus other interventions such as progressive tension sutures may be explored to aid in reducing seroma and improving wound healing.
Comparison of trans-alar suture technique and external wedge resection for alar base narrowing
Authors: Kaboodkhani Reza , Kazemi Tayebeh , Naderi Noushin , Rabiei Nikta , Babaei Amirhossein 
Published: May 2023

Background:
Alar narrowing is indicated in some rhinoplasty surgeries. This study compared trans-alar sutures and external wedge resection for alar narrowing in the patients undergoing rhinoplasty.

Methods:
This study was a single-blind randomized controlled trial with a parallel design. Participants were randomly allocated to trans-alar suturing technique or external wedge resection groups (1:1 allocation ratio). Primary outcomes were scar formation and satisfaction score (Rhinoplasty Outcome Evaluation [ROE] questionnaire and patient component of Patient Scar Assessment Questionnaire [PSAQ]) after 12 months. Secondary outcomes were the duration of procedure, amount of bleeding, and need for bleeding control.

Results:
In total, 44 and 46 patients completed the study in the trans-alar suture and external wedge resection groups, respectively. The post-operative assessment showed a significantly lower scar formation rate in the trans-alar suture group (75.0% vs. 37.0%; p<0.001). ROE questionnaire revealed no statistically significant difference in patient satisfaction between two groups. The PSAQ results showed that patients who received trans-alar sutures had a lower overall score (1 (1 to 1)) compared with the external wedge resection group (2 to 1 to 4.50) (p-value<0.001). The duration of the procedure (p<0.001), amount of bleeding (p<0.001), and need for bleeding control (p-value=0.009) were significantly lower in the trans-alar suture group than in the external wedge resection group.

Conclusion:
Trans-alar sutures result in high post-operative patient satisfaction. This approach has a decreased incidence of scarring, operation time, bleeding, and the necessity for bleeding control.
Impact of CXCR4-Directed PET/CT on Staging and Proposed Oncologic Management in Patients With Digestive System Tumors
Authors: Weich Alexander , Serfling Sebastian E. , Schlötelburg Wiebke , Higuchi Takahiro , Hartrampf Philipp E. , Schirbel Andreas , Heinrich Marieke , Buck Andreas K. , Rowe Steven P. , Kosmala Aleksander , Werner Rudolf A. 
Published: May 2023

Purpose
To elucidate the influence of CXC motif chemokine receptor 4 (CXCR4)–directed imaging on staging and proposed oncologic management in patients with digestive system tumors compared with guideline-appropriate imaging (GAI).

Methods
From our PET/CT database, we retrospectively identified 37 patients with advanced digestive system tumors, which had been scheduled for CXCR4-targeted [68Ga]Ga-pentixafor PET/CT for potential theranostic considerations. In all subjects, concurrent GAI was also available. Patients were afflicted with gastroenteropancreatic neuroendocrine neoplasms (21/37 [56.8%]), pancreatic duct adenocarcinoma (6/37 [16.2%]), cholangiocarcinoma (5/37 [13.5%]), hepatocellular carcinoma (4/37 [10.8%]), and colorectal carcinoma (1/37 [2.7%]). Staging results and impact on proposed oncologic management by a board-certified gastroenterologist were compared between GAI and [68Ga]Ga-pentixafor PET/CT.

Results
Relative to GAI, CXCR4-directed PET/CT resulted in staging changes in 14 of 37 patients (37.8%). Upstaging was seen in 1 of 14 patients (7.1%), whereas downstaging was recorded in the remaining 13 of 14 patients (92.9%). Among those, staging changes would not have triggered any changes in oncological management in 4 of 14 (28.6%). For the remaining 10 of 14 patients (71.4%), however, findings on [68Ga]Ga-pentixafor PET/CT would have impacted subsequent clinical algorithm, including the necessity for further diagnostic steps or failure to initiate antitumor therapy.

Conclusion
[68Ga]Ga-pentixafor PET/CT missed tumor lesions in 13 patients with digestive system tumors, which would have led to inappropriate downstaging and clinical treatment of 10 patients. As such, our results do not support a more widespread use of [68Ga]Ga-pentixafor PET/CT for clinical staging in those tumor entities.
Artificial intelligence evaluation of focused assessment with sonography in trauma
Authors: Levy Brittany E. , Castle Jennifer T. , Virodov Alexandr , Wilt Wesley S. , Bumgardner Cody , Brim Thomas , McAtee Erin , Schellenberg Morgan , Inaba Kenji , Warriner Zachary D. 
Published: May 2023

BACKGROUND
The focused assessment with sonography in trauma (FAST) is a widely used imaging modality to identify the location of life-threatening hemorrhage in a hemodynamically unstable trauma patient. This study evaluates the role of artificial intelligence in interpretation of the FAST examination abdominal views, as it pertains to adequacy of the view and accuracy of fluid survey positivity.

METHODS
Focused assessment with sonography for trauma examination images from 2015 to 2022, from trauma activations, were acquired from a quaternary care level 1 trauma center with more than 3,500 adult trauma evaluations, annually. Images pertaining to the right upper quadrant and left upper quadrant views were obtained and read by a surgeon or radiologist. Positivity was defined as fluid present in the hepatorenal or splenorenal fossa, while adequacy was defined by the presence of both the liver and kidney or the spleen and kidney for the right upper quadrant or left upper quadrant views, respectively. Four convolutional neural network architecture models (DenseNet121, InceptionV3, ResNet50, Vgg11bn) were evaluated.

RESULTS
A total of 6,608 images, representing 109 cases were included for analysis within the “adequate” and “positive” data sets. The models relayed 88.7% accuracy, 83.3% sensitivity, and 93.6% specificity for the adequate test cohort, while the positive cohort conferred 98.0% accuracy, 89.6% sensitivity, and 100.0% specificity against similar models. Augmentation improved the accuracy and sensitivity of the positive models to 95.1% accurate and 94.0% sensitive. DenseNet121 demonstrated the best accuracy across tasks.

CONCLUSION
Artificial intelligence can detect positivity and adequacy of FAST examinations with 94% and 97% accuracy, aiding in the standardization of care delivery with minimal expert clinician input. Artificial intelligence is a feasible modality to improve patient care imaging interpretation accuracy and should be pursued as a point-of-care clinical decision-making tool.

LEVEL OF EVIDENCE
Diagnostic Test/Criteria; Level III.
Alpha-methyltyrosine reduces the acute cardiovascular and behavioral sequelae in a murine model of traumatic brain injury
Authors: Woodman Ryan , Miller Coleman , Student Jeffrey , Freeman Kalev , Perl Daniel , Lockette Warren 
Published: May 2023

BACKGROUND
Increased catecholamines contribute to heightened cardiovascular reactivity and behavioral deficits after traumatic brain injury (TBI); adrenergic receptor blockade has limited success in reducing adverse sequelae of TBI. Injury-induced increases in the synthesis of catecholamines could contribute to adverse outcomes in TBI. Inhibition of catecholamine synthesis with alpha-methyltyrosine (αMT) could offer a benefit after TBI.

METHODS
Original research trial in mice randomized to αMT (50 mg·kg−1·d−1) or vehicle for 1 week after TBI induced by controlled cortical impact. Primary outcomes of cardiovascular reactivity and behavioral deficits were assessed after 1 week. Secondary outcomes included blood brain barrier permeability and quantification of gene transcription whose products determine intraneuronal chloride concentrations, the release of catecholamines, and activation of the sympathetic nervous system. These genes were the alpha-2 adrenergic receptor (“Adra2c”), the sodium-potassium-chloride cotransporter (“Nkcc1”), and the potassium chloride cotransporter (“Kcc2”). We also assessed the effect of TBI and αMT on the neuronal chloride/bicarbonate exchanger (“Ae3”).

RESULTS
Traumatic brain injury–induced increases in blood pressure and cardiac reactivity were blocked by αMT. Inhibition of catecholamine synthesis decreased blood brain barrier leakage and improved behavioral outcomes after TBI. Traumatic brain injury diminished the transcription of Adra2c and enhanced expression of Nkcc1 while reducing Kcc2 transcription; αMT prevented the induction of the Nkcc1 by TBI without reversing the effects of TBI on Kcc2 expression; αMT also diminished Ae3 transcription.

CONCLUSION
Traumatic brain injury acutely increases cardiovascular reactivity and induces behavioral deficits in an αMT-sensitive manner, most likely by inducing Nkcc1 gene transcription. Alpha-methyltyrosine may prove salutary in the treatment of TBI by attenuating the enhanced expression of Nkcc1, minimizing blood brain barrier leakage, and diminishing central catecholamine and sympathetic output. We also found an unreported relationship between Kcc2 and the chloride/bicarbonate exchanger, which should be considered in the design of trials planned to manipulate central intraneuronal chloride concentrations following acute brain injury.
Structural and Functional Changes of Brain in Children With Intermittent Exotropia: A Study Combining Multiple MRI Modalities
Authors: Zhu Hui , Guo Wei , Wu Qian , Hu Hao , Xu Xiaoquan , Wu Feiyun , Du Jiangbo , Liu Hu , Hu Zhibin 
Published: May 2023

Background:
To investigate structural and functional changes of brain in children with intermittent exotropia (IXT) and their relationship with clinical features.

Methods:
Twenty-one IXT patients (mean age 9.38 ± 2.62 years) and 21 age-, gender-, education-, and handedness-matched healthy controls (HCs, mean age 9.52 ± 3.28 years) underwent high-resolution T1 imaging, diffusion tensor imaging (DTI), and resting-state functional MRI (rs-fMRI). The gray and white matter volume analyzed by voxel-based morphometry (VBM) based on T1 imaging, the fractional anisotropy (FA) and mean diffusivity (MD) indices based on DTI, and the amplitude of low frequency fluctuation (ALFF) value based on rs-fMRI were compared between these 2 groups. The correlations between MRI-derived parameters in significant brain regions and various clinical characteristics of IXT were analyzed.

Results:
Compared with HCs, IXT children showed significantly decreased FA in right precentral gyrus (PRG) and right postcentral gyrus (POG), and significantly decreased ALFF in bilateral calcarine sulcus, bilateral cuneus, left lingual gyrus, and left superior occipital gyrus. The FA value in right PRG and right POG was negatively correlated with disease duration (r = −0.520, P = 0.016), angle of exodeviation at near (r = −0.549, P = 0.010), and angle of exodeviation at distance (r = −0.547, P = 0.010).

Conclusions:
IXT children exhibited abnormalities of white matter microstructure and reduced spontaneous neural activities in brain regions involving in oculomotor performance and binocular fusion. Further studies are needed to determine whether these findings are related to the neuropathologic mechanism or downstream changes of IXT.
Southern ocean carbon and heat impact on climate
Authors:   The SO-CHIC consortium, Sallée J. B. , Abrahamsen E. P. , Allaigre C. , Auger M. , Ayres H. , Badhe R. , Boutin J. , Brearley J. A. , de Lavergne C. , ten Doeschate A. M. M. , Droste E. S. , du Plessis M. D. , Ferreira D. , Giddy I. S. , Gülk B. , Gruber N. , Hague M. , Hoppema M. , Josey S. A. , Kanzow T. , Kimmritz M. , Lindeman M. R. , Llanillo P. J. , Lucas N. S. , Madec G. , Marshall D. P. , Meijers A. J. S. , Meredith M. P. , Mohrmann M. , Monteiro P. M. S. , Mosneron Dupin C. , Naeck K. , Narayanan A. , Naveira Garabato A. C. , Nicholson S-A. , Novellino A. , Ödalen M. , Østerhus S. , Park W. , Patmore R. D. , Piedagnel E. , Roquet F. , Rosenthal H. S. , Roy T. , Saurabh R. , Silvy Y. , Spira T. , Steiger N. , Styles A. F. , Swart S. , Vogt L. , Ward B. , Zhou S. 
Published: May 2023

The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea–ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate.
This article is part of a discussion meeting issue ‘Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities’.
The Southern Ocean mixed layer and its boundary fluxes: fine-scale observational progress and future research priorities
Authors: Swart Sebastiaan , du Plessis Marcel D. , Nicholson Sarah-Anne , Monteiro Pedro M. S. , Dove Lilian A. , Thomalla Sandy , Thompson Andrew F. , Biddle Louise C. , Edholm Johan M. , Giddy Isabelle , Heywood Karen J. , Lee Craig , Mahadevan Amala , Shilling Geoff , de Souza Ronald Buss 
Published: May 2023

Interactions between the upper ocean and air-ice-ocean fluxes in the Southern Ocean play a critical role in global climate by impacting the overturning circulation and oceanic heat and carbon uptake. Remote and challenging conditions have led to sparse observational coverage, while ongoing field programmes often fail to collect sufficient information in the right place or at the time-space scales required to constrain the variability occurring in the coupled ocean-atmosphere system. Only within the last 10 years have we been able to directly observe and assess the role of the fine-scale ocean and rapidly evolving atmospheric marine boundary layer on the upper limb of the Southern Ocean's overturning circulation. This review summarizes advances in mechanistic understanding, arising in part from observational programmes using autonomous platforms, of the fine-scale processes (1–100 km, hours-seasons) influencing the Southern Ocean mixed layer and its variability. We also review progress in observing the ocean interior connections and the coupled interactions between the ocean, atmosphere and cryosphere that moderate air-sea fluxes of heat and carbon. Most examples provided are for the ice-free Southern Ocean, while major challenges remain for observing the ice-covered ocean. We attempt to elucidate contemporary research gaps and ongoing/future efforts needed to address them.This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.
Sparse observations induce large biases in estimates of the global ocean CO
2
sink: an ocean model subsampling experiment
Authors: Hauck Judith , Nissen Cara , Landschützer Peter , Rödenbeck Christian , Bushinsky Seth , Olsen Are 
Published: May 2023

Estimates of ocean

CO

2

uptake from global ocean biogeochemistry models and

p

CO

2

-based data products differ substantially, especially in high latitudes and in the trend of the

CO

2

uptake since 2000. Here, we assess the effect of data sparsity on two

p

CO

2

-based estimates by subsampling output from a global ocean biogeochemistry model. The estimates of the ocean

CO

2

uptake are improved from a sampling scheme that mimics present-day sampling to an ideal sampling scheme with 1000 evenly distributed sites. In particular, insufficient sampling has given rise to strong biases in the trend of the ocean carbon sink in the

p

CO

2

products. The overestimation of the

CO

2

flux trend by 20–35% globally and 50–130% in the Southern Ocean with the present-day sampling is reduced to less than

15
%

with the ideal sampling scheme. A substantial overestimation of the decadal variability of the Southern Ocean carbon sink occurs in one product and appears related to a skewed data distribution in

p

CO

2

space. With the ideal sampling, the bias in the mean

CO

2

flux is reduced from 9–12% to 2–9% globally and from 14–26% to 5–17% in the Southern Ocean. On top of that, discrepancies of about

0.4

PgC

yr

−
1

(15%) persist due to uncertainties in the gas-exchange calculation.

This article is part of a discussion meeting issue ‘Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities’.