bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing trauma readiness costs in level III and level IV trauma centers
Authors: Atkins Elizabeth V. , Vaughn Kelli A. , Medeiros Regina S. , Patterson Gregory K. , Register Alicia R. , Ashley Dennis W. 
Published: November 2022

BACKGROUND
Readiness costs are expenses incurred by trauma centers to maintain essential infrastructure. Although the components for readiness are described in the American College of Surgeons' Resources for Optimal Care of the Injured Patient, the cost associated with each component is not well defined. Previous studies describe readiness costs for levels I and II trauma centers based on these criteria. The purpose of this study was to quantify the cost of levels III and IV trauma center readiness.

METHODS
The state trauma commission, along with trauma medical directors, program managers, and trauma center financial staff, standardized definitions for each component of trauma center readiness costs and developed a survey tool for reporting. Readiness costs were grouped into four categories: Administrative/Program Support Staff, Clinical Medical Staff, and Education/Outreach. A financial auditor analyzed all data to verify consistent cost reporting. Trauma center outliers were evaluated to validate variances. All levels III and IV trauma centers (n = 14) completed the survey on 2019 data.

RESULTS
Average annual readiness cost is $1,715,025 for a level III trauma center and $81,620 for level IV centers. Among the costliest components were clinical medical staff for level IIIs and administrative costs for level IVs, representing 54% and 97% of costs, respectively. Although education/outreach is mandated, levels III and IV trauma centers only spend approximately $8,000 annually on this category (0.8–3%).

CONCLUSION
This study defines the cost associated with each readiness component outlined in the Resources for Optimal Care of the Injured Patient manual. The average readiness cost for a level III trauma center is $1,715,025 and $81,620 for a level IV, underscoring the need for additional trauma center funding to meet the requirements set forth by the American College of Surgeons.

LEVEL OF EVIDENCE
Economic and Value-Based Evaluations; Level III.
Predictors of Length of Stay and Mortality During Simultaneous Liver-Kidney Transplant Index Admission: Results From the US-Multicenter SLKT Consortium
Authors: Barman Pranab M. , Patel Yuval A. , Xie Jiaheng , Zhang Min , Jo Jennifer , Sinha Jasmine , Answine Adeline , Schluger Aaron , Walter Kara , Biggins Scott W. , Cullaro Giuseppe , Wong Randi , Lai Jennifer C. , VanWagner Lisa B. , Magee John , Verna Elizabeth C. , Sharma Pratima 
Published: November 2022

Background.
Length of stay (LOS) during index solid organ transplant impacts morbidity and healthcare costs. To date, there are no studies evaluating characteristics and outcomes of simultaneous liver-kidney transplant (SLKT) index hospitalization. We examined factors associated with LOS and mortality during index SLKT admission.

Methods.
Adult SLKT recipients between 2002 and 2017 at 6 transplant centers across 6 UNOS regions were retrospectively enrolled in the US-Multicenter SLKT Consortium. Multivariable regression analyses assessed predictors of SLKT LOS and death during index admission.

Results.
Median age of cohort (N = 570) was 58 y (interquartile range: 51–64); 63% male, 75% White, 32.3% hepatitis C, 23.3% alcohol-related, 20.1% nonalcoholic steatohepatitis with median MELD-Na at SLKT 28 (23–34). Seventy-one percent were hospitalized at the time of SLKT with median LOS pretransplant of 10 d. Majority of patients were discharged alive (N = 549; 96%)‚ and 36% were discharged to subacute rehab facility. LOS for index SLKT was 19 d (Q1: 10, Q3: 34 d). Female sex (P = 0.003), Black race (P = 0.02), advanced age (P = 0.007), ICU admission at time of SLKT (P = 0.03), high MELD-Na (P = 0.003), on cyclosporine during index hospitalization (P = 0.03), pre-SLKT dialysis (P < 0.001), and kidney delayed graft function (P < 0.001) were the recipient factors associated with prolonged LOS during index SLKT hospitalization. Prolonged LOS also contributed to overall mortality (HR = 1.007; P = 0.03).

Conclusions.
Despite excellent survival, index SLKT admission was associated with high-resource utilization with more than half the patients with LOS >2 wk and affected overall patient survival. Further investigation is needed to optimize healthcare resources for these patients in a financially strained healthcare landscape.
Temporal Trends in Portopulmonary Hypertension Model for End-stage Liver Disease Exceptions and Outcomes
Authors: del Valle Kathryn T. , Krowka Michael J. , Heimbach Julie K. , Taner Timucin , DuBrock Hilary M. 
Published: November 2022

Background.
Model for end-stage liver disease (MELD) exception criteria for portopulmonary hypertension (POPH) were created to prioritize patients for liver transplant before POPH progression. Little is known about trends in POPH exception frequency, disease severity, pulmonary hypertension treatment patterns, or outcomes since the POPH MELD exception began.

Methods.
Using data from the Organ Procurement and Transplantation Network database, we describe the frequency of POPH MELD exceptions between 2006 and 2019, compare baseline patient characteristics, and characterize trends in liver disease and POPH severity‚ as well as POPH treatment and outcomes‚ over time. To facilitate comparison, we divided this 14-y period into 3 “eras” (2006–2010, 2011–2015, and 2016–2019).

Results.
Between 2006 and 2019, 504 unique POPH MELD exceptions were granted. Both liver disease severity and patient age have increased over time (P = 0.04 and P = 0.006, respectively). Posttreatment hemodynamic values (mean pulmonary arterial pressure and pulmonary vascular resistance) have significantly improved (P < 0.001 and P = 0.008, respectively). Treatment with endothelin receptor antagonists has become more prevalent, whereas use of parenteral therapy and monotherapy regimens has decreased (P < 0.001). Neither waitlist nor liver transplant mortality outcomes have significantly changed over the eras analyzed.

Conclusions.
In conclusion, 504 patients have received POPH MELD exceptions between 2006 and 2019. Since 2010, nearly all patients granted POPH MELD exceptions have met hemodynamic criteria for POPH. Over time, there has been a trend toward older age and higher MELD scores with significant changes in pulmonary arterial hypertension treatment patterns and an improvement in posttreatment hemodynamics without major change in outcomes.
Pressure injury prevention in adult critically ill patients: best practice implementation project
Authors: Ramalho Aline de Oliveira , Santiago Leidiane Moreira , Meira Luciana , Marin Alessandra , de Oliveira Larissa Bertacchini , Püschel Vilanice Alves de Araújo 
Published: November 2022

ABSTRACT

Objective:
This study assessed compliance with the best practices for pressure injury prevention among ICU patients at a tertiary hospital in São Paulo, Brazil.

Introduction:
Intensive care patients are at high risk of developing a pressure injury; preventing this requires a best practice protocol.

Method:
This best practice implementation project was conducted in a Brazilian tertiary hospital in three phases following the JBI Model of Evidence-based Healthcare. Ten criteria derived from the best available evidence were audited and monitored before and after best practice implementation.

Results:
The baseline and follow-up audits evaluated 28 patients at each step. A total of 448 h of care were analyzed using a monitoring camera and medical records. Compliance with all 10 audited criteria increased, with a 50% reduction in the prevalence of pressure injuries in intensive care. Of the 223 employees, 71% claimed to have some knowledge of pressure injury prevention, and 66% reported adequate adherence to prevention protocols.

Conclusion:
The audit and feedback strategy improved compliance with the criteria. Future audits are needed to promote the sustainability of evidence-based practice.
Fifteen essential science advances needed for effective restoration of the world's forest landscapes
Authors: Marshall Andrew R. , Waite Catherine E. , Pfeifer Marion , Banin Lindsay F. , Rakotonarivo Sarobidy , Chomba Susan , Herbohn John , Gilmour Donald A. , Brown Mark , Chazdon Robin L. 
Published: November 2022

There has never been a more pressing and opportune time for science and practice to collaborate towards restoration of the world's forests. Multiple uncertainties remain for achieving successful, long-term forest landscape restoration (FLR). In this article, we use expert knowledge and literature review to identify knowledge gaps that need closing to advance restoration practice, as an introduction to a landmark theme issue on FLR and the UN Decade on Ecosystem Restoration. Aligned with an Adaptive Management Cycle for FLR, we identify 15 essential science advances required to facilitate FLR success for nature and people. They highlight that the greatest science challenges lie in the conceptualization, planning and assessment stages of restoration, which require an evidence base for why, where and how to restore, at realistic scales. FLR and underlying sciences are complex, requiring spatially explicit approaches across disciplines and sectors, considering multiple objectives, drivers and trade-offs critical for decision-making and financing. The developing tropics are a priority region, where scientists must work with stakeholders across the Adaptive Management Cycle. Clearly communicated scientific evidence for action at the outset of restoration planning will enable donors, decision makers and implementers to develop informed objectives, realistic targets and processes for accountability. This article paves the way for 19 further articles in this theme issue, with author contributions from across the world.This article is part of the theme issue ‘Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration’.
Identifying hotspots for ecosystem restoration across heterogeneous tropical savannah-dominated regions
Authors: Lewis Kennedy , Barros Fernanda de V. , Moonlight Peter W. , Hill Timothy C. , Oliveira Rafael S. , Schmidt Isabel B. , Sampaio Alexandre B. , Pennington R. Toby , Rowland Lucy 
Published: November 2022

There is high potential for ecosystem restoration across tropical savannah-dominated regions, but the benefits that could be gained from this restoration are rarely assessed. This study focuses on the Brazilian Cerrado, a highly species-rich savannah-dominated region, as an exemplar to review potential restoration benefits using three metrics: net biomass gains, plant species richness and ability to connect restored and native vegetation. Localized estimates of the most appropriate restoration vegetation type (grassland, savannah, woodland/forest) for pasturelands are produced. Carbon sequestration potential is significant for savannah and woodland/forest restoration in the seasonally dry tropics (net biomass gains of 58.2 ± 37.7 and 130.0 ± 69.4 Mg ha−1). Modelled restoration species richness gains were highest in the central and south-east of the Cerrado for savannahs and grasslands, and in the west and north-west for woodlands/forests. The potential to initiate restoration projects across the whole of the Cerrado is high and four hotspot areas are identified. We demonstrate that landscape restoration across all vegetation types within heterogeneous tropical savannah-dominated regions can maximize biodiversity and carbon gains. However, conservation of existing vegetation is essential to minimizing the cost and improving the chances of restoration success.This article is part of the theme issue ‘Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration’.
Forest restoration in a time of fire: perspectives from tall, wet eucalypt forests subject to stand-replacing wildfires
Authors: Lindenmayer David B. , Bowd Elle J. , Gibbons Philip 
Published: November 2022

Wildfires have the potential to add considerably to the already significant challenge of achieving effective forest restoration in the UN Decade on Ecosystem Restoration. While fire can sometimes promote forest restoration (e.g. by creating otherwise rare, early successional habitats), it can thwart it in others (e.g. by depleting key patch types and stand structures). Here we outline key considerations in facilitating restoration of some tall wet temperate forest ecosystems and some boreal forest ecosystems where the typical fire regime is rare high-severity stand-replacing fire. Some of these ecosystems are experiencing altered fire regimes such as increased fire extent, severity and/or frequency. Achieving good restoration outcomes in such ecosystems demands understanding fire regimes and their impacts on vegetation and other elements of biodiversity and then selecting ecosystem-appropriate management interventions. Potential actions range from doing nothing (as the ecosystem already maintains full post-fire regenerative capacity) to interventions prior to a conflagration like prescribed burning to limit the risks of high-severity fire, excluding activities that impair post-fire recovery (e.g. post-fire logging), and artificial seeding where natural regeneration fails. The most ecologically effective actions will be ecosystem-specific and context-specific and informed by knowledge of the ecosystem in question (such as plant life-history attributes) and inter-relationships with attributes like vegetation condition at the time it is burnt (e.g. young versus old forest).This article is part of the theme issue ‘Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration’.
The phenotypic spectrum of terminal and subterminal 6p deletions based on a social media-derived cohort and literature review
Authors: Rraku Eleana , Kerstjens-Frederikse Wilhelmina S. , Swertz Morris A. , Dijkhuizen Trijnie , van Ravenswaaij-Arts Conny M. A. , Engwerda Aafke 
Published: November 2022

AbstractBackgroundTerminal 6p deletions are rare, and information on their clinical consequences is scarce, which impedes optimal management and follow-up by clinicians. The parent-driven Chromosome 6 Project collaborates with families of affected children worldwide to better understand the clinical effects of chromosome 6 aberrations and to support clinical guidance. A microarray report is required for participation, and detailed phenotype information is collected directly from parents through a multilingual web-based questionnaire. Information collected from parents is then combined with case data from literature reports. Here, we present our findings on 13 newly identified patients and 46 literature cases with genotypically well-characterised terminal and subterminal 6p deletions. We provide phenotype descriptions for both the whole group and for subgroups based on deletion size.ResultsThe total group shared a common phenotype characterised by ocular anterior segment dysgenesis, vision problems, brain malformations, congenital defects of the cardiac septa and valves, mild to moderate hearing impairment, eye movement abnormalities, hypotonia, mild developmental delay and dysmorphic features. These characteristics were observed in all subgroups, confirming a dominant role forFOXC1, one of the most distally deleted genes. Additional characteristics were seen in individuals with terminal deletions exceeding 4.02 Mb, namely complex heart defects, corpus callosum abnormalities, kidney abnormalities and orofacial clefting. Some of these additional features may be related to the loss of other genes in the terminal 6p region, such asRREB1for the cardiac phenotypes andTUBB2AandTUBB2Bfor the cerebral phenotypes. In the newly identified patients, we observed previously unreported features including gastrointestinal problems, neurological abnormalities, balance problems and sleep disturbances.ConclusionsWe present an overview of the phenotypic characteristics observed in terminal and subterminal 6p deletions. This reveals a common phenotype that can be highly attributable to haploinsufficiency ofFOXC1, with a possible additional effect of other genes in the 6p25 region. We also delineate the developmental abilities of affected individuals and report on previously unrecognised features, showing the added benefit of collecting information directly from parents. Based on our overview, we provide recommendations for clinical surveillance to support clinicians, patients and families.
The phenotypic spectrum of terminal 6q deletions based on a large cohort derived from social media and literature: a prominent role forDLL1
Authors: Engwerda Aafke , Kerstjens-Frederikse Wilhelmina S. , Corsten-Janssen Nicole , Dijkhuizen Trijnie , van Ravenswaaij-Arts Conny M. A. 
Published: November 2022

AbstractBackgroundTerminal 6q deletions are rare, and the number of well-defined published cases is limited. Since parents of children with these aberrations often search the internet and unite via international social media platforms, these dedicated platforms may hold valuable knowledge about additional cases. The Chromosome 6 Project is a collaboration between researchers and clinicians at the University Medical Center Groningen and members of a Chromosome 6 support group on Facebook. The aim of the project is to improve the surveillance of patients with chromosome 6 aberrations and the support for their families by increasing the available information about these rare aberrations. This parent-driven research project makes use of information collected directly from parents via a multilingual online questionnaire. Here, we report our findings on 93 individuals with terminal 6q deletions and 11 individuals with interstitial 6q26q27 deletions, a cohort that includes 38 newly identified individuals.ResultsUsing this cohort, we can identify a common terminal 6q deletion phenotype that includes microcephaly, dysplastic outer ears, hypertelorism, vision problems, abnormal eye movements, dental abnormalities, feeding problems, recurrent infections, respiratory problems, spinal cord abnormalities, abnormal vertebrae, scoliosis, joint hypermobility, brain abnormalities (ventriculomegaly/hydrocephaly, corpus callosum abnormality and cortical dysplasia), seizures, hypotonia, ataxia, torticollis, balance problems, developmental delay, sleeping problems and hyperactivity. Other frequently reported clinical characteristics are congenital heart defects, kidney problems, abnormalities of the female genitalia, spina bifida, anal abnormalities, positional foot deformities, hypertonia and self-harming behaviour. The phenotypes were comparable up to a deletion size of 7.1 Mb, and most features could be attributed to the terminally located geneDLL1. Larger deletions that includeQKI(>7.1 Mb) lead to a more severe phenotype that includes additional clinical characteristics.ConclusionsTerminal 6q deletions cause a common but highly variable phenotype. Most clinical characteristics can be linked to the smallest terminal 6q deletions that include the geneDLL1(>500 kb). Based on our findings, we provide recommendations for clinical follow-up and surveillance of individuals with terminal 6q deletions.
Protection against infection with the Omicron BA.5 subvariant among people with previous SARS-CoV-2 infection - surveillance results from southern Sweden, June to August 2022
Authors: Kahn Fredrik , Bonander Carl , Moghaddassi Mahnaz , Bennet Louise , Malmqvist Ulf , Inghammar Malin , Björk Jonas 
Published: November 2022

AbstractWe evaluated the protection afforded by SARS-CoV-2 natural infection against reinfection among vaccinated during a calendar period from June to August 2022 when Omicron BA.5 was the dominating subvariant in Scania county, Sweden. We formed a study cohort (n = 71 592) mainly consisting of health care workers by restricting to people 18-64 years old who received their first vaccine dose relatively early (24 April 2021 or sooner). We used continuous density case-control 1:10 sampling matched for sex and age within the study cohort, and thereby obtained 1 114 cases during Omicron BA.5 dominance and 11 140 controls who were analysed with conditional logistic regression. Limited protection against reinfection was suggested from prior infection of virus variants before Omicron (11%, 95% confidence interval [CI] −10 to 28%]. By contrast, prior Omicron infection offered clear protection (65%, 95% CI 56-73%). For the Omicron BA.2 subvariant, stronger protection was suggested during early (85%, 95% CI 75-91%) than later BA.5 dominance (66%, 95% CI 48-78%). Lower protection was observed from the previous BA.1 subvariant (30%; 95% CI −4 to 53%). These findings suggest that natural infection from the Omicron subvariants contributes to short-term population protection against reinfection with the subvariant BA.5 among vaccinated, but wanes considerably 5-6 months after infection.
Successful Detection of Delta and Omicron Variants of SARS-CoV-2 by Veterinary Diagnostic Laboratory Participants in an Interlaboratory Comparison Exercise
Authors: Deng Kaiping , Nemser Sarah M. , Frost Kirstin , Goodman Laura B. , Ip Hon S. , Killian Mary Lea , Ulaszek Jodie , Kiener Shannon , Kmet Matthew , Uhlig Steffen , Hettwer Karina , Colson Bertrand , Nichani Kapil , Schlierf Anja , Tkachenko Andriy , Miller Megan R. , Reddy Ravinder , Tyson Gregory H. 
Published: November 2022

AbstractBackgroundSince the beginning of the COVID-19 pandemic veterinary diagnostic laboratories have tested diagnostic samples for SARS-CoV-2 not only in animals, but in over five million human samples. An evaluation of the performance of those laboratories is needed using blinded test samples to ensure that laboratories report reliable data to the public. This interlaboratory comparison exercise (ILC3) builds on two prior exercises to assess whether veterinary diagnostic laboratories can detect Delta and Omicron variants spiked in canine nasal matrix or viral transport medium.MethodsInactivated Delta variant at levels of 25 to 1,000 copies per 50 μL of nasal matrix were prepared for participants by the ILC organizer, an independent laboratory, for blinded analysis. Omicron variant at 1,000 copies per 50 μL of transport medium was also included. Feline infectious peritonitis virus (FIPV) RNA was used as a confounder for specificity assessment. A total of 14 test samples were prepared for each participant. Participants used their routine diagnostic procedures for RNA extraction and real-time RT-PCR. Results were analyzed according to International Organization for Standardization (ISO) 16140 - 2:2016.ResultsThe overall results showed 93% detection for Delta and 97% for Omicron at 1,000 copies per 50 μL (22-200 copies per reaction). The overall specificity was 97% for blank samples and 100% for blank samples with FIPV. No differences in Ct values were significant for samples with the same virus levels between N1 and N2 markers, nor between the two variants.ConclusionsThe results indicated that all ILC3 participants were able to detect both Delta and Omicron variants. The canine nasal matrix did not significantly affect SARS-CoV-2 detection.Impact StatementEnsuring accurate detection methods for SARS-CoV-2 is critical as veterinary diagnostic labs are testing both human and animal samples. This exercise used blinded test samples and provided high confidence in the sensitivity of methods in twenty-nine laboratories for detection of SARS-CoV-2 variants while addressing the impact of sample matrix. Importantly, the results indicated that variants and matrix do not impact detection results. Additionally, this article examined decision-making criteria for Ct cut-off values from different laboratories and encouraged them to review and potentially reassess their criteria to improve future performance. This knowledge will lead to higher confidence in laboratory detection of current and new SARS-CoV-2 variants and aid in establishing reasonable cut-off parameters for these diagnostics tests.