bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recognition of Critically Ill Patients by Acute Healthcare Providers: A Multicenter Observational Study*
Authors: Kuit Merijn , Veldhuis Lars Ingmar , Hollmann Markus , Nanayakkara Prabath , Ridderikhof Milan 
Published: March 2023

OBJECTIVES:
Although the Modified Early Warning Score (MEWS) is increasingly being used in the acute care chain to recognize disease severity, its superiority compared with clinical gestalt remains unproven. Therefore, the aim of this study was to compare the accuracy of medical caregivers and MEWS in predicting the development of critical illness.

DESIGN:
This was a multicenter observational prospective study.

SETTING:
It was performed in a level-1 trauma center with two different sites and emergency departments (EDs) with a combined capacity of about 50.000 patients annually.

PATIENTS:
It included all adult patients presented to the ED by Emergency Medical Services (EMS).

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
For all patients, the acute caregivers were asked several standardized questions regarding clinical predicted outcome (clinical gestalt), and the MEWS was calculated. The primary outcome was the occurrence of critical illness, defined as ICU admission, serious adverse events, and mortality within 72 hours. The sensitivity, specificity, and discriminative power of both clinical gestalt and MEWS for the occurrence of critical illness were calculated as the area under the receiver operating characteristic curve (AUROC). Among the total of 800 included patients, 113 patients (14.1%) suffered from critical illness. The specificity for predicting three-day critical illness for all caregivers (for EMS nurses, ED nurses, and physicians) was 93.2%; 97.3%, and 96.8%, respectively, and was significantly (p < 0.01) better than an MEWS score of 3 or higher (70.4%). The sensitivity was significantly lower for EMS and ED nurses, but not significantly different for physicians compared with MEWS. The AUROCs for prediction of 3-day critical illness by both the ED nurses (AUROC = 0.809) and the physicians (AUROC = 0.848) were significantly higher (p = 0.032 and p = 0.010, respectively) compared with MEWS (AUROC = 0.731).

CONCLUSIONS:
For patients admitted to the ED by EMS, medical professionals can predict the development of critical illness within 3 days significantly better than the MEWS. Although MEWS is able to correctly predict those patients that become critically ill, its use leads to overestimation due to a substantial number of false positives.
Lymphomatoid Papulosis “Type E” Affecting the Palate: A Detailed Case Report and Review of Literature
Authors: Silveira Heitor Albergoni , Ragusa Silva Paula Verona , Pimentel Bruna Gonçalves , Nogueira Gustavo Milhomens , Chahud Fernando , Brunaldi Mariângela Ottoboni , León Jorge Esquiche 
Published: March 2023

Abstract:
Lymphomatoid papulosis (LyP) belongs to the spectrum of primary cutaneous CD30+ lymphoproliferative disorders, characterized by chronic, recurrent, self-healing papules, small nodules, or ulcers. The clinicopathological features of LyP can mimic overt lymphomas. To date, about 27 intraoral LyP cases have been reported. Of them, only 2 cases were diagnosed as angioinvasive LyP (type E). Herein, we report a 24-year-old Brazilian man who presented a large ulcerated lesion on the hard palate with rapid evolution. Remarkably, there was no involvement of the skin or other mucous membranes. Microscopy revealed a lymphoid infiltrate constituted by medium-sized to large atypical cells, with angiocentric and angiodestructive features. The atypical cells showed immunopositivity for CD3, CD8, CD30, CD56, granzyme B, perforin, and focally for MUM1/IRF4. Ki-67 highlighted almost all atypical lymphoid cells, whereas EBER1/2 was negative. After 2 months of follow-up, the lesion healed completely. Although rare, LyP type E should be included in the differential diagnosis of oral ulcers.
Agminated Halo Nevus: A Novel Presentation
Authors: Hassab-El-Naby Hussein M. M. , Rageh Mahmoud A. 
Published: March 2023

Abstract:
Halo nevus is a benign type of melanocytic nevi commonly found in children and manifests as a central pigmented part surrounded by a well-defined hypopigmented area. Halo nevi are commonly located on the trunk. The central nevus may show partial or complete regression, whereas the associated halo may persist or enlarge. The term ‘agminated nevus’ refers to a cluster of melanocytic nevi restricted to an area of the body and commonly reported with acquired melanocytic nevi, blue nevi, and Spitz nevi. To the best of our knowledge, agminated halo nevus has not been previously described. We hereby report 2 cases with clinical and histopathologic findings consistent with the diagnosis of agminated halo nevus.
Effect of paediatric caudal injection volume on optic nerve sheath diameter and regional cerebral oximetry
Authors: Gönen Aybike Onur , Kaya Güner , Tütüncü Ayşe Çiğdem , Özcan Rahşan , Emre Şenol , Kendigelen Pinar 
Published: March 2023

BACKGROUND
Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO2) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure.

OBJECTIVES
Comparing how caudal injection volumes of 0.8 and 1.25 ml kg−1 influence ONSD and CrSO2 within the first 30 min after injection.

DESIGN
Prospective, randomised and parallel group trial.

SETTING
Operating room.

PATIENTS
Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single-shot caudal anaesthesia.

INTERVENTION
Single-shot caudal anaesthesia with 0.8 ml kg−1 (group L, n = 29) and 1.25 ml kg−1 (group H, n = 29) of 2 mg kg−1 bupivacaine solution.

MAIN OUTCOME MEASURES
Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near-infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block.

RESULTS
Mean ONSD values increased from a baseline of 4.4 ± 0.2 mm to a maximum of 4.5 ± 0.2 mm 20 min after injection in group L and from a baseline of 4.5 ± 0.3 mm to a maximum of 4.8 ± 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO2.

CONCLUSION
Caudal injection with 1.25 ml kg−1 increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg−1 and neither volume caused a clinically important reduction in CrSO2.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04491032
RECURRENT FLOATERS AFTER LIMITED VITRECTOMY FOR VISION DEGRADING MYODESOPSIA
Authors: Boneva Stefaniya K. , Nguyen Justin H. , Gui Wei , Hoerig Cameron , Mamou Jonathan , Ketterling Jeffrey A. , Chong Lawrence P. , Sebag J. 
Published: March 2023

Purpose:
Limited vitrectomy improves vision degrading myodesopsia, but the incidence of recurrent floaters postoperatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters.

Methods:
A total of 286 eyes (203 patients, 60.6 ± 12.9 years) undergoing limited vitrectomy for vision degrading myodesopsia were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical posterior vitreous detachment (PVD) induction. CS (Freiburg Acuity Contrast test: Weber index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively.

Results:
No eyes (0/179) with preoperative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 eyes (14.1%) without complete preoperative PVD (mean follow-up = 39 months vs. 31 months in 85 eyes without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (younger than 52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) men (92.9%) predominated. Reoperation was elected by 11 patients, who had partial PVD preoperatively in 5/11 (45.5%). At study entry, CS was degraded (3.55 ± 1.79 %W) but improved postoperatively by 45.6% (1.93 ± 0.86 %W, P = 0.033), while vitreous echodensity reduced by 86.6% (P = 0.016). New-onset PVD postoperatively degraded CS anew, by 49.4% (3.28 ± 0.96 %W; P = 0.009) in patients electing reoperation. Repeat vitrectomy normalized CS to 2.00 ± 0.74%W (P = 0.018).

Conclusion:
Recurrent floaters after limited vitrectomy for vision degrading myodesopsia are caused by new-onset PVD, with younger age, male sex, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.
Association of clear vs blue-light filtering intraocular lenses with mental and behavioral disorders and diseases of the nervous system among patients receiving bilateral cataract surgery
Authors: Karesvuo Minna , Kanclerz Piotr , Hecht Idan , Achiron Asaf , Tuuminen Raimo 
Published: March 2023

Purpose:
To analyze new-onset mental and behavioral disorders and nervous system diseases in patients with cataract implanted with either non–blue-light filtering (BLF) or BLF intraocular lenses (IOLs) in both eyes.

Setting:
Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.

Design:
A retrospective registry-based cohort study of patients operated between September 2007 and December 2018 who were followed until December 2021. We included 4986 patients who underwent bilateral cataract surgery.

Methods:
Patients were implanted with either non-BLF IOLs (N = 2609) or BLF IOLs (N = 2377) in both eyes. Follow-up before the first-eye surgery and between the first-eye and the second-eye surgery was performed to acknowledge the preexisting disorders and diseases. After the second-eye surgery, the groups were analyzed for the new-onset mental and behavioral disorders and diseases of the nervous system subcategorized by the International Classification of Diseases codes.

Results:
1707 male and 3279 female patients, aged 73.2 ± 8.6 years at the first-eye surgery and 74.3 ± 8.8 years at the second-eye surgery, were identified. In univariate log-rank tests, the use of BLF IOLs showed no association in overall new-onset disorders or diseases over non-BLF IOLs, in any subtype diagnosis codes except for sleep disorders, which favored BLF IOLs (P = .003). A multivariate analysis adjusted for age and sex identified no associations in any new-onset disorders or diseases. Multivariate analysis of sleep disorders showed a nonsignificant advantage for BLF-IOLs (hazard ratio 0.756, 95% CI 0.534-1.070, P = .114).

Conclusions:
BLF IOLs were not associated with mental and behavioral disorders or diseases of the nervous system.
Converting patients from warfarin to non-vitamin K antagonist oral anticoagulants
Authors: Romanelli Sarah , Rivera Veronica 
Published: March 2023

ABSTRACT

Background:
Non-vitamin K antagonist oral anticoagulants (NOACs) are favorable in stroke prevention for geriatric patients with nonvalvular atrial fibrillation versus warfarin. These anticoagulants do not require international normalized ratio (INR) monitoring and have lower food/drug interactions. In addition, NOACs have risk reduction in bleeding and all-cause mortality compared with warfarin.

Local problem:
At a geriatric primary care practice, two registered nurses manage 88 patients on warfarin for INR monitoring. Nurse practitioners (NPs) provide oversight for warfarin titration after abnormal results. The goal of this quality-improvement project was to decrease the time spent monitoring patients on warfarin.

Methods:
Primary care providers and cardiologists of patients on warfarin were contacted to gain approval of transition to a NOAC. The NP reviewed patients' renal function and the indication for anticoagulation and then created a list of eligible patients for transition.

Interventions:
Patients eligible for transition to NOACs were contacted for their consent. The transition process included stopping warfarin, ordering apixaban, ordering INR level, educating about starting apixaban, and coordinating appropriate follow-up.

Results:
Of 88 patients on warfarin, 21 were eligible for conversion from warfarin to apixaban. Of these 21 patients, 66% (n = 14) consented to the conversion. Of those who were not converted to apixaban, five declined due to cost and two were lost to follow-up.

Conclusion:
There was a reduction in nurses' monthly monitoring of patients on warfarin by 22%. Transition to NOAC was not only beneficial for patient safety and efficacy but also reduced nursing clinical time for anticoagulation encounters.
Unilateral alveolar cleft size on prenatal 2-D ultrasonography predicts cleft of the secondary palate in fetal unilateral cleft lip: A Pilot Study.
Authors: Rubio Eva , Mantilla-Rivas Esperanza , Manrique Monica , Fan Kenneth L , Blask Anna , Rada Erin M. , Bulas Dorothy , White Marney A. , Rogers Gary F. , Oh Albert K. 
Published: March 2023

BACKGROUND:
Prenatal diagnosis of cleft palate (CP) is challenging. The current study’s objective was to investigate if prenatal alveolar cleft width is associated with the likelihood of a cleft of the secondary palate in unilateral cleft lip (CL).

METHODS:
The authors reviewed 2D US images in fetuses with unilateral CL from 1/2012-2/2016. Images of the fetal face were obtained with a linear and/or curved probe in the axial and coronal planes. Measurements of the alveolar ridge gap were taken by the senior radiologist. Post-natal phenotype findings were compared with prenatal findings.

RESULTS:
Thirty patients with unilateral CL met inclusion criteria; average gestational age was 26.67 ± 5.11 weeks (range 20.71, 36.57 weeks). Ten fetuses were found to have an intact alveolar ridge by prenatal US; postnatal exam confirmed intact secondary palate in all. Small alveolar defects <4 mm were noted in 3 fetuses; postnatal examination documented CP in a single patient. CP was confirmed in 15 of the remaining 17 fetuses who had alveolar cleft width >4 mm. An alveolar defect ≥ 4 mm on prenatal US was associated with greater likelihood of a cleft of the secondary palate (c 2 (2, n=30) = 20.23, p<.001).

CONCLUSION:
In the setting of unilateral CL, prenatal US documentation of alveolar defects ≥4 mm are highly predictive of the presence of a cleft of the secondary palate. Conversely, an intact alveolar ridge is associated with an intact secondary palate.
An Optimizing Surgical Procedures for Correcting Severe Constricted Ears: Helix Costal Cartilage Scaffold Combined With V-Y Advanced Flap
Authors: Wu Huanhuan , Dong Guoxuan , Liu Tun , Qian Jin , Wang Bingqing , Wang Yue 
Published: March 2023

Purpose:
A constricted ear is a deformity that is distinguished by curling of the upper portion of the ear, which includes the helix, scapha, and antihelix. The treatment for severely constricted ears seems to be quite invasive. To reduce invasiveness and fully utilize the folded cartilage, the authors used a helix costal cartilage scaffold combined with a single V-Y advanced flap in the correction of Tanzer type IIB constricted ear deformity to investigate the clinical effect.

Materials and Methods:
From 2020 to 2021, autologous costal cartilage helix stent combined with local V-Y advanced flap was applied to correct the constricted ear malformation in 18 patients admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences.

Results:
All patients were followed for a duration of 6 to 12 months (average 7 months). Reconstructed auricles were cosmetically satisfying, with a natural-looking helix and enlarged cavum conchae cavity, as well as auricle sizes that were close to normal and near symmetry between both ears.

Conclusions:
With satisfactory clinical results, our technique can be used to repair types IIB cup ear deformities. It has a broad range of practical applications.
Coronavirus Disease 2019 and the Yale Response: A Semistructured Interview Study on Plastic Surgery Resident Education and Departmental Adaptation to the Lockdown
Authors: Sasson Daniel C. , Hsia Henry C. 
Published: March 2023

Background:
Sooner-than-expected progression to statewide lockdown at the height of the coronavirus disease 2019 pandemic left minimal time for medical specialty boards, including The American Board of Plastic Surgery, to issue guidance for their respective programs. As a result, programs were tasked with developing creative alternatives to their standard resident curricula and department schedules.

Objective:
To capture attending and resident experience of the coronavirus disease 2019 lockdown in narrative form and to understand what specific changes enacted to maintain adequate education should be considered for continuation after the pandemic’s conclusion.

Methods:
Qualitative, semistructured interviews of residents, fellows, and faculty of the Section of Plastic and Reconstructive Surgery during 2019 to 2020 academic year were conducted on the following topics: (1) general reflection on lockdown, (2) resident maintenance of daily logs, (3) multi-institutional collaborative lectures, (4) modified didactic curriculum, (5) virtual 3-dimensional craniofacial planning sessions, (6) maintenance of department camaraderie, and (7) effect on preparation to become a surgeon.

Results:
Twenty interviews (response rate 77%) were conducted between October 2020 and February 2021. Of residents, 100% felt observing the craniofacial planning sessions was beneficial, with many explicitly noting it provided a unique perspective into the surgeon’s thought process behind planned manipulations, to which they usually are not privy. Of residents, 100% felt confident at the time of the interview that the lockdown would have no lasting effects on their preparation to become a surgeon.

Conclusions:
Rapid changes enacted at Yale enabled resident training to advance, and documentation of the success of these changes can inform future curriculum design.
The early rise and spread of evolutionary game theory: perspectives based on recollections of early workers
Authors: Grodwohl Jean-Baptiste , Parker Geoff A. 
Published: March 2023

Though the first attempts to introduce game theory into evolutionary biology failed, new formalism by Maynard Smith and Price in 1973 had almost instant success. We use information supplied by early workers to analyse how and why evolutionary game theory (EGT) spread so rapidly in its earliest years. EGT was a major tool for the rapidly expanding discipline of behavioural ecology in the 1970s; each catalysed the other. The first models were applied to animal contests, and early workers sought to improve their biological reality to compare predictions with observations. Furthermore, it was quickly realized that EGT provided a general evolutionary modelling method; not only was it swiftly applied to diverse phenotypic adaptations in evolutionary biology, it also attracted researchers from other disciplines such as mathematics and economics, for which game theory was first devised. Lastly, we pay attention to exchanges with population geneticists, considering tensions between the two modelling methods, as well as efforts to bring them closer.
This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
The evolutionarily stable strategy, animal contests, parasitoids, pest control and sociality
Authors: Hardy Ian C. W. , Mesterton-Gibbons Mike 
Published: March 2023

The evolutionarily stable strategy, ESS, concept was first used in biology to understand sex ratio bias and, shortly afterwards, to explore the logic of contests over essential and indivisible resources. ESS models formed the basis of much subsequent research on animal behaviour and placed game-theoretic thinking firmly within the behavioural ecology approach. Among behavioural ecologists studying parasitoids, it was those asking questions about the evolution of sex ratios who first made extensive use of the game-theoretic approach. A later growth of interest in parasitoid host defence and fighting behaviour made use of these tractable study species to explore contests and their connections to further aspects of life-history evolution plus some pest control applications. Our aims are to (i) introduce the topic of contests, which are engaged in by a very wide array of animal taxa, and the importance, both historical and conceptual, of the game-theoretic approach to their study, and (ii) review recent studies of parasitoid contests, including those that have considered the context of social evolution and the performance of parasitoids as agents of biological control. We consider that game-theoretic models are eminently testable and applicable and will likely endure as valuable tools in studies of parasitoid biology.This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
The rarer-sex effect
Authors: Gardner Andy 
Published: March 2023

The study of sex allocation—that is, the investment of resources into male versus female reproductive effort—yields among the best quantitative evidence for Darwinian adaptation, and has long enjoyed a tight and productive interplay of theoretical and empirical research. The fitness consequences of an individual's sex allocation decisions depend crucially upon the sex allocation behaviour of others and, accordingly, sex allocation is readily conceptualized in terms of an evolutionary game. Here, I investigate the historical development of understanding of a fundamental driver of the evolution of sex allocation—the rarer-sex effect—from its inception in the writing of Charles Darwin in 1871 through to its explicit framing in terms of consanguinity and reproductive value by William D. Hamilton in 1972. I show that step-wise development of theory proceeded through refinements in the conceptualization of the strategy set, the payoff function and the unbeatable strategy.
This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
Evolutionarily stable preferences
Authors: Alger Ingela 
Published: March 2023

The 50-year old concept of an evolutionarily stable strategy provided a key tool for theorists to model ultimate drivers of behaviour in social interactions. For decades, economists ignored ultimate drivers and used models in which individuals choose strategies based on their preferences—a proximate mechanism for behaviour—and the distribution of preferences in the population was taken to be fixed and given. This article summarizes some key findings in the literature on evolutionarily stable preferences, which in the past three decades has proposed models that combine the two approaches: individuals inherit their preferences, the preferences determine their strategy choices, which in turn determine evolutionary success. One objective is to highlight complementarities and potential avenues for future collaboration between biologists and economists.
This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.