Development and Evaluation of a Machine Learning Model for the Early Identification of Patients at Risk for Sepsis.

Study Objective: The Third International Consensus Definitions (Sepsis-3) Task Force recommended the use of the quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score to screen patients for sepsis outside of the ICU. However, subsequent studies raise concerns about the sensitivity of qSOFA as a screening tool. We aim to use machine learning to develop a new sepsis screening tool, the Risk of Sepsis (RoS) score, and compare it with a slate of benchmark sepsis-screening tools, including the Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment (SOFA), qSOFA, Modified Early Warning Score, and National Early Warning Score.

The voice conveys emotion in ten globalized cultures and one remote village in Bhutan.

With data from 10 different globalized cultures and 1 remote, isolated village in Bhutan, we examined universals and cultural variations in the recognition of 16 nonverbal emotional vocalizations. College students in 10 nations (Study 1) and villagers in remote Bhutan (Study 2) were asked to match emotional vocalizations to 1-sentence stories of the same valence. Guided by previous conceptualizations of recognition accuracy, across both studies, 7 of the 16 vocal burst stimuli were found to have strong or very strong recognition in all 11 cultures, 6 vocal bursts were found to have moderate recognition, and 4 were not universally recognized.

Ethical considerations in embedding a surgeon in a military or civilian tactical team.

Tactical emergency medical services (TEMS) bring immediate medical support to the inner perimeter of special weapons and tactics team activations. While initially envisioned as a role for an individual dually trained as a police officer and paramedic, TEMS is increasingly undertaken by physicians and paramedics who are not police officers. This report explores the ethical underpinnings of embedding a surgeon within a military or civilian tactical team with regard to identity, ethically acceptable actions, triage, responsibility set, training, certification, and potential future refinements of the role of the tactical police surgeon.

Massive transfusion of blood in the surgical patient.

Hemorrhage remains a leading cause of morbidity and death in both civilian and military trauma. Restoration of effective end-organ perfusion by stopping hemorrhage and restoring intravascular volume in such a way as to minimize acidosis, hypothermia, and coagulopathy, almost always requires the use of blood and/or blood-component therapy. The best method to manage life-threatening hemorrhage is to avoid the circumstance that prompted it or to mitigate blood loss early in the injury cycle; otherwise, blood replacement must suffice.

The evaluation of morbidity and mortality in abdominal aortic aneurysm repair patients as related to body mass index.

Background: This study evaluates the relationship between body mass index (BMI) and other comorbidities on the overall morbidity and mortality of abdominal aortic aneurysm (AAA) repair.

Methods: A database of all nonemergent open and endovascular AAA repairs performed at our center from 2004 to 2008 was created. The outcomes at the predefined time intervals were then evaluated for each group of patients.

A single center experience in the use of polyurethaneurea arteriovenous grafts.

Background: Polytetrafluoroethylene (PTFE) grafts often require temporary catheters, which increase costs as well as risk of infection, bleeding, and poor blood flow. Polyurethaneurea (PUU) grafts can be cannulated within 24 hours of placement, avoiding the need for temporary catheters.

Methods: Hemodialysis patients who were not candidates for arteriovenous fistula (AVF) were eligible for the study.