bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcutaneous Laryngeal Ultrasonography for Assessing Vocal Cord Twitch Response in Thyroid Operation during Predissection Vagus Nerve Stimulation
Authors: Kuo Ting-Chun , Chen Kuen-Yuan , Lai Chieh-Wen , Wang Yi-Chia , Lin Ming-Tsan , Chang Chin-Hao , Wu Ming-Hsun 
Published: April 2022

BACKGROUND
In this study, we aimed to report our experience with the use of intraoperative transcutaneous laryngeal ultrasonography (TLUSG) to evaluate the vocal cord twitch response during predissection vagus nerve stimulation in thyroid surgeries and examine the reliability of this technique when compared with that of laryngeal twitch palpation (LTP).

STUDY DESIGN
The prospective data collection of consecutive patients who underwent open thyroidectomy with intraoperative neuromonitoring (IONM) was reviewed retrospectively. We recorded the electromyographic activity and assessed the vocal cord twitch response on LTP, TLUSG. We compared the accessibility, sensitivity, and specificity of the techniques.

RESULTS
A total of 110 patients (38 men and 72 women) with 134 nerves at risk were enrolled. The vocal cord was assessable by TLUSG in 103 (93.6%) patients and by LTP in 64 (59.1%) patients. Two patients showed negative predissection IONM signal but positive on TLUSG and the presence of laryngeal twitch response confirmed by laryngoscopy. Fourteen patients showed positive IONM signals and presence of the vocal cord twitch response on TLUSG but not on LTP. The sensitivity and specificity were 70.21% and 100%, respectively, for LTP, and those both were 100% for TLUSG. For patients who could be assessed using both techniques, TLUSG had better accuracy than LTP (100% vs 80.33%, p = 0.0005).

CONCLUSIONS
The innovative intraoperative application of TLUSG is better for evaluating the laryngeal twitch response than LTP. This technique provides practical troubleshooting guidance for patients with no IONM signals during predissection vagus nerve stimulation.
Multi-Institutional Quality Improvement Project to Minimize Opioid Prescribing in Children after Appendectomy Using NSQIP-Pediatric
Authors: Kelley-Quon Lorraine I , Ourshalimian Shadassa , Lee Justin , Russell Katie W , Kling Karen , Shew Stephen B , Mueller Claudia , Jensen Aaron R , Vu Lan , Padilla Benjamin , Ostlie Daniel , Smith Caitlin , Inge Thomas , Roach Jonathan , Ignacio Romeo , Lofberg Katrine , Radu Stephanie , Rohan Autumn , Wang Kasper S 
Published: April 2022

BACKGROUND
There is wide variation in opioid prescribing after appendectomy in children and adolescents, with recent increases noted in opioid-related pediatric deaths from prescription and illicit opioids. The goal of this project was to minimize opioid prescribing at the time of discharge for children undergoing appendectomy by using Quality Improvement (QI) methodology.

STUDY DESIGN
Children (18 years of age or less) who underwent appendectomy were evaluated from January to December 2019 using NSQIP-Pediatric at 10 children’s hospitals within the Western Pediatric Surgery Research Consortium. Before project initiation, 5 hospitals did not routinely prescribe opioids after appendectomy (protocol). At the remaining 5 hospitals, prescribing was not standardized and varied by surgeon (no-protocol). A prospective multi-institutional QI project was used to minimize outpatient opioid prescriptions for children after appendectomy. The proportion of children at each hospital receiving an opioid prescription at discharge was compared for 6 months before and after the intervention using chi-square analysis.

RESULTS
Overall, 1,524 children who underwent appendectomy were evaluated from January to December 2019. After the QI intervention, overall opioid prescribing decreased from 18.2% to 4.0% (p < 0.001), with significant decreases in protocol hospitals (2.7% vs 0.8%, p = 0.038) and no-protocol hospitals (37.9% vs 8.8%, p < 0.001). The proportion of 30-day emergency room visits did not change after the QI intervention (8.9% vs 9.9%, p = 0.54) and mean postintervention pain management satisfaction scores were high.

CONCLUSION
Opioid prescribing can be minimized in children after appendectomy without increasing emergency room visits or decreasing patient satisfaction. Furthermore, NSQIP-Pediatric can be used as a platform for multi-institutional collaboration for successful implementation of QI projects.
Index Admission Cholecystectomy and Recurrence of Pediatric Gallstone Pancreatitis: Multicenter Cohort Analysis
Authors: Muñoz Abraham Armando S , Osei Hector , Bajinting Adam , Cowles Robert A , Greenspon Jose , Hosfield Brain D , Keller Martin S , Landman Matthew P , Owens Hawkins , Shaughnessy Matthew P , St. Peter Shawn D , Sujka Joseph , Vogel Adam M , Villalona Gustavo A 
Published: April 2022

BACKGROUND
We aim to evaluate recurrence rates of gallstone pancreatitis in children undergoing early vs interval cholecystectomy.

STUDY DESIGN
A multicenter, retrospective review of pediatric patients admitted with gallstone pancreatitis from 2010 through 2017 was performed. Children were evaluated based on timing of cholecystectomy. Early cholecystectomy was defined as surgery during the index admission, whereas the delayed group was defined as no surgery or surgery after discharge. Outcomes, recurrence rates, and complications were evaluated.

RESULTS
Of 246 patients from 6 centers with gallstone pancreatitis, 178 (72%) were female, with mean age 13.5 ± 3.2 years and a mean body mass index of 28.9 ± 15.2. Most (90%) patients were admitted with mild pancreatitis (Atlanta Classification). Early cholecystectomy was performed in 167 (68%) patients with no difference in early cholecystectomy rates across institutions. Delayed group patients weighed less (61 kg vs. 72 kg, p = 0.003) and were younger (12 vs. 14 years, p = 0.001) than those who underwent early cholecystectomy. However, there were no differences in clinical, radiological, or laboratory characteristics between groups. There were 4 (2%) episodes of postoperative recurrent pancreatitis in the early group compared with 22% in the delayed group. More importantly, when cholecystectomy was delayed more than 6 weeks from index discharge, recurrence approached 60%. There were no biliary complications in any group.

CONCLUSIONS
Cholecystectomy during the index admission for children with gallstone pancreatitis reduces recurrent pancreatitis. Recurrence proportionally increases with time when patients are treated with a delayed approach.
Surgical Outcomes Improvement and Health Inequity in a Regional Quality Collaborative
Authors: Curran Thomas , Zhang Jingwen , Gebregziabher Mulugeta , Taber David J , Marsden Justin E , Booth Alexander , Magwood Gayenell S , Mauldin Patrick D , Baliga Prabhakar K , Lockett Mark A 
Published: April 2022

BACKGROUND:
Surgical quality improvement initiatives may impact sociodemographic groups differentially. The objective of this analysis was to assess the trajectory of surgical morbidity by race and age over time within a Regional Collaborative Quality Initiative.

STUDY DESIGN:
Adults undergoing eligible general surgery procedures in South Carolina Surgical Quality Collaborative hospitals were analyzed for the presence of at least 1 of 22 morbidities between August 2015 and February 2020. Surgery-level multivariable logistic regression assessed the racial differences in morbidity over time, stratified by age group (18 to 64 years, 65 years and older), and adjusting for potential patient- and surgical-level confounders.

RESULTS:
A total of 30,761 general surgery cases were analyzed, of which 28.4% were performed in Black patients. Mean morbidity rates were higher for Black patients than non-Black patients (8.5% vs 6.0%, p < 0.0001). After controlling for race and other confounders, a significant decrease in monthly mean morbidity through time was observed in each age group (odds ratio [95% CI]: age 18 to 64 years, 0.986 [0.981 to 0.990]; age 65 years and older, 0.991 [0.986 to 0.995]). Comparing morbidity rates from the first 4 months of the collaborative to the last 4 months reveals older Black patients had an absolute decrease in morbidity of 6.2% compared with 3.6% for older non-Black patients. Younger Black patients had an absolute decrease in morbidity of 4.7% compared with a 3.0% decrease for younger non-Black patients.

CONCLUSIONS:
Black patients had higher morbidity rates than non-Black patients even when controlling for confounders. The reasons for these disparities are not apparent. Morbidity improved over time in all patients with older Black patients seeing a larger absolute decrease in morbidity.
Public Humiliation in the Surgical Clerkship: Qualitative Analysis of Responses to the Association of American Medical Colleges Graduation Questionnaire
Authors: Mullins Clarence , Callahan Edward , Hageman Heather , Chen Herbert , Lindeman Brenessa 
Published: April 2022

BACKGROUND:
Nearly 1 in 5 medical students reports at least 1 incident of mistreatment, with many occurring in the perioperative environment. We aimed to further define the types of mistreatment occurring perioperatively in a national data set by using a mixed-methods approach.

STUDY DESIGN:
A sample of 2,224 responses to the general public humiliation free-text question on the 2015 Association of American Medical College’s Graduation Questionnaire were analyzed. Using grounded theory methodology, 4 raters independently created and refined the coding schema. Final coding was determined by majority rating. Descriptive statistics, interrater reliability, and chi-square analysis were performed where appropriate.

RESULTS:
Among responses, 2,411 events were identified. Interrater reliability was moderate (>0.41) on 94% of variables. Events occurring in a specific setting implicated the surgery clerkship and the operating room 53.2% and 21.8% of the time, respectively. Perioperative events accounted for nearly one-third of verbal abuse reports (30.5%, 324/1059), and almost half of events described yelling (47.0%, 178/379). Mistreatment involving physical contact was significantly more likely to occur in the operating room (59% vs 41%, p < 0.001). Events coded as possibly routine education (n = 379) were significantly less common perioperatively than nonsurgical settings (20.5% vs 79.4%, p = 0.007).

CONCLUSIONS:
A significant proportion of medical student mistreatment events occur in the context of surgery. Surgeons and trainees must play active roles in leading and instituting needed changes to improve the learning environment to support medical students and recruit a sufficient future surgical workforce.
Quality of Life Associated with Open vs Minimally Invasive Pancreaticoduodenectomy: A Prospective Pilot Study
Authors: Moris Dimitrios , Rushing Christel , McCracken Emily , Shah Kevin N , Zani Sabino , Perez Alexander , Allen Peter J , Niedzwiecki Donna , Fish Laura J , Blazer Dan G 
Published: April 2022

BACKGROUND:
This prospective study was designed to compare quality of life (QoL) among patients who underwent open (O-PD) vs minimally invasive pancreaticoduodenectomy (MI-PD), using a combination of validated qualitative and quantitative methodologies.

STUDY DESIGN:
From 2017 to 2019, patients scheduled for pancreaticoduodenectomy (PD) were enrolled and presented with Functional Assessment of Cancer Therapy-Hepatobiliary surveys preoperatively, before discharge, at first postoperative visit and approximately 3 to 4 months after operation (“3 months”). Longitudinal plots of median QoL scores were used to illustrate change in each score over time. In a subset of patients, content analysis of semistructured interviews at postoperative time points (1.5 to 6 months after operation) was conducted.

RESULTS:
Among 56 patients who underwent PD, 33 had an O-PD (58.9%). Physical and functional scores decreased in the postoperative period but returned to baseline by 3 months. No significant differences were found in any domains of QoL at baseline and in the postoperative period between patients who underwent O-PD and MI-PD. Qualitative findings were concordant with quantitative data (n = 14). Patients with O-PD and MI-PD reported similar experiences with complications, pain, and wound healing in the postoperative period. Approximately half the patients in both groups reported “returning to normal” in the 6-month postoperative period. A total of 4 patients reported significant long-term issues with physical and functional well-being.

CONCLUSIONS:
Using a novel combination of qualitative and quantitative analyses in patients undergoing PD, we found no association between operative approach and QoL in patients who underwent O-PD vs MI-PD. Given the increasing use of minimally invasive techniques for PD and the steep learning curve associated with these techniques, continued assessment of patient benefit is critical.
Nuclear Factor Erythroid 2–Related Factor 2 Activation and Burn-Induced Cardiac Dysfunction
Authors: Wen Jake J , Mobli Keyan , Rontoyanni Victoria G , Cummins Claire B , Radhakrishnan Geetha L , Murton Andrew , Radhakrishnan Ravi S 
Published: April 2022

BACKGROUND:
Our previous studies have found that burn injury induces cardiac dysfunction through interruption of the antioxidant-response element (ARE) pathway in cardiac mitochondria. Nuclear factor erythroid 2–related factor 2 (Nrf2) is a key regulator that activates many antioxidant enzymes. Oltipraz (Olti) is a Nrf2 activator and a well-known inducer of NQO1 along with other enzymes that comprise the Nrf2-associated antioxidants. We propose that Nrf2 activation will induce the ARE pathway, leading to abrogation of burn-induced cardiac dysfunction.

STUDY DESIGN:
In this study, we investigated the effect of Nrf2-deficiency in mice on burn-induced cardiac dysfunction. Wild-type (WT) and Nrf2-deficient mice received 30% total body surface area burn injury and were treated with or without Olti and then harvested at 3 hours and 24 hours post burn (3 hpb and 24 hpb).

RESULTS:
As expected, Nrf2-deficient mice exhibited exacerbated cardiac dysfunction after burn injury, as measured by Vevo 2100 echocardiography. Electron microscopy showed that Nrf2 depletion worsened burn injury–induced cardiac mitochondrial damage. In addition, Nrf2 depletion increased cardiac mitochondrial dysfunction and myocardial fibrosis after burn injury. Treatment with Olti ameliorated the heart dysfunction in burned Nrf2−/+ mice, improved cardiac mitochondrial structure and oxidative phosphorylation, as well as decreased cardiac fibrosis. These results suggest that Nrf2 and its downstream targets modulate cardiac function after burn injury.

CONCLUSIONS:
In summary, Nrf2 depletion worsens cardiac dysfunction after burn injury. Nrf2 activation, with a drug such as Olti, offers a promising therapeutic strategy for abrogating burn-induced cardiac dysfunction.
Identification and Genomic Assessment of Daptomycin-, Linezolid-, Vancomycin-resistant Enterococcus faecium During Protracted Infection
Authors: Pincus Nathan B. , Joshi Tejas , Gatesy Samuel W.M. , Al-Heeti Omar , Moore W. Justin , Bachta Kelly E. R. 
Published: April 2022

ABSTRACTLinezolid and daptomycin resistance among Enterococccus faecium (Efm) isolates, while rare, is a major challenge for clinicians who are often limited to broad-spectrum or combination antibiotic therapies for management. Combination therapy with a beta-lactam has been reported, but limited clinical evidence exists to support its use. We describe the clinical management of a prolonged Efm intraabdominal (IA) infection and subsequent bacteremia, along with observed multidrug resistance development and use of serial whole genome sequencing to better understand resistance mechanisms. Combination antimicrobial therapy with daptomycin (DAP) and ceftaroline (CPT) was used to treat the patient’s catheter-associated daptomycin-, linezolid-, vancomycin-resistant Efm (DLVRE) bloodstream infection. In vitro antimicrobial testing of this DLVRE revealed only minor synergy between daptomycin and ceftaroline; However, the patient’s bacteremia cleared following initiation of combination therapy in conjunction with catheter removal. Sequencing of the patient’s DLVRE revealed multiple genomic mutations which explain both linezolid and daptomycin resistance and the presence of a plasmid containing known resistance determinants for vancomycin. Daptomycin resistance was attributed to the presence of chromosomal mutations in liaS (Thr120Ala), liaR (Trp73Cys), and cls (Asp13Ile), while linezolid resistance was attributed to the presence of the G2576T variant allele in some of 23S rRNA gene copies. Sequential whole genome sequencing of two additional bacterial isolates from the same patient revealed protracted colonization with a single DLVRE clone and suggested the development of bacterial subpopulations. Pairing clinical isolate susceptibilities with whole genome sequencing should be encouraged in clinical practice to better inform antimicrobial management in cases of multidrug resistance.
The new normal? Dynamics and scale of the SARS-CoV-2 variant Omicron epidemic in England
Authors: Eales Oliver , de Oliveira Martins Leonardo , Page Andrew J. , Wang Haowei , Bodinier Barbara , Tang David , Haw David , Jonnerby Jakob , Atchison Christina , Ashby Deborah , Barclay Wendy , Taylor Graham , Cooke Graham , Ward Helen , Darzi Ara , Riley Steven , Elliott Paul , Donnelly Christl A. , Chadeau-Hyam Marc 
Published: April 2022

SummaryThe SARS-CoV-2 pandemic has been characterised by the regular emergence of genomic variants which have led to substantial changes in the epidemiology of the virus. With natural and vaccine-induced population immunity at high levels, evolutionary pressure favours variants better able to evade SARS-CoV-2 neutralising antibodies. The Omicron variant was first detected in late November 2021 and exhibited a high degree of immune evasion, leading to increased infection rates in many countries. However, estimates of the magnitude of the Omicron wave have relied mainly on routine testing data, which are prone to several biases. Here we infer the dynamics of the Omicron wave in England using PCR testing and genomic sequencing obtained by the REal-time Assessment of Community Transmission-1 (REACT-1) study, a series of cross-sectional surveys testing random samples of the population of England. We estimate an initial peak in national Omicron prevalence of 6.89% (5.34%, 10.61%) during January 2022, followed by a resurgence in SARS-CoV-2 infections in England during February-March 2022 as the more transmissible Omicron sub-lineage, BA.2 replaced BA.1 and BA.1.1. Assuming the emergence of further distinct genomic variants, intermittent epidemics of similar magnitude as the Omicron wave may become the ‘new normal’.
Comparing evolvability and pleiotropy across environments
Authors: Tarkington Jason , Zufall Rebecca 
Published: April 2022

AbstractThe environment can play an important role in determining evolutionary outcomes (Reboud and Bell 1997; Stanton et al. 2000; Gresham et al. 2008; Cooper and Lenski 2010; Becks and Agrawal 2012; Bailey et al. 2015). Populations may increase in fitness more after evolution in one environment than in another (Hegreness et al. 2008). This may be because the distance between the ancestral genotype and the top of the locally accessible fitness peak may be greater in one environment or the other. Additionally, the rate at which mutations occur and populations move up the peaks could differ. For this reason, comparing evolvability across environments presents an interesting problem. Here, we show an environment impacts evolvability in two ways, directly by impacting the rate of adaptative evolution, and indirectly by limiting the range of fitness outcomes that are possible. We show that correlated responses are often highly idiosyncratic, due to variation in the range of possible fitness outcomes in the environment and differences in pleiotropic effects across environments but can also be predicted from the ancestral growth rate regardless of the environment in which populations evolve. Interestingly, we also show a negative correlation between increase in an environment X following evolution in environment Y and the increase in environment Y following evolution in environment X. These results highlight the necessity to measure fitness in both environments when comparing the evolvability or repeatability of evolution across environments.
Decision heuristics in contexts exploiting intrinsic skill
Authors: Dundon Neil M. , Colas Jaron T. , Garrett Neil , Babenko Viktoriya , Rizor Elizabeth , Yang Dengxian , MacNamara Máirtín , Petzold Linda , Grafton Scott T. 
Published: April 2022

AbstractHeuristics can inform human decision making in complex environments through a reduction of computational requirements (accuracy-resource trade-off) and a robustness to overparameterisation (less-is-more). However, tasks capturing the efficiency of heuristics typically ignore action proficiency in determining rewards. The requisite movement parameterisation in sensorimotor control questions whether heuristics preserve efficiency when actions are nontrivial. We developed a novel action selection-execution task requiring joint optimisation of action selection and spatio-temporal skillful execution. Optimal choices could be determined by a simple spatial heuristic, or by more complex planning. Computational models of action selection parsimoniously distinguished human participants who adopted the heuristic from those using a more complex planning strategy. Broader comparative analyses then revealed that participants using the heuristic showed combined decisional (selection) and skill (execution) advantages, consistent with a less-is-more framework. In addition, the skill advantage of the heuristic group was predominantly in the core spatial features that also shaped their decision policy, evidence that the dimensions of information guiding action selection might be yoked to salient features in skill learning.Author SummaryWe often must choose between actions and then execute them, e.g., a tennis player chooses between a forehand and backhand and then skilfully executes the shot. To select actions, the player might plan their action with either shot, and select whichever simulated outcome is more advantageous. However, a more efficient approach might instead be to use a “heuristic”, i.e., a simpler rule, such as, forehand always on one side of the court, and backhand on the other. In this work, we look at whether styles of planning are related to physical skill performing actions, e.g., would a more skillful tennis player be more likely to use planning or a heuristic? We use a new task that requires people to choose and execute complex actions. Regarding choices, we use computational modeling to identify which people use some degree of planning, and which people use a simpler heuristic. Then, regarding action execution, we reveal that heuristic decision makers are in fact more skilled. However, they are not superiorly skilled in all aspects of performance, showing an advantage solely in the aspect of skill most closely linked to the information (spatial) they use for their heuristic. We therefore reveal the first ever evidence that a relation exists between the complexity of our action-related decisions and how broadly we learn associated motor behaviour.