Adapting Language Models for Non-Parallel Author-Stylized Rewriting

Given the recent progress in language modeling using Transformer-based neural models and an active interest in generating stylized text, we present an approach to leverage the generalization capabilities of a language model to rewrite an input text in a target author's style. Our proposed approach adapts a pre-trained language model to generate author-stylized text by fine-tuning on the author-specific corpus using a denoising autoencoder (DAE) loss in a cascaded encoder-decoder framework. Optimizing over DAE loss allows our model to learn the nuances of an author's style without relying on parallel data, which has been a severe limitation of the previous related works in this space. To evaluate the efficacy of our approach, we propose a linguistically-motivated framework to quantify stylistic alignment of the generated text to the target author at lexical, syntactic and surface levels. The evaluation framework is both interpretable as it leads to several insights about the model, and self-contained as it does not rely on external classifiers, e.g. sentiment or formality classifiers. Qualitative and quantitative assessment indicates that the proposed approach rewrites the input text with better alignment to the target style while preserving the original content better than state-of-the-art baselines.Comment: Accepted for publication in Main Technical Track at AAAI 2

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States.

BackgroundWhile safety-net hospitals (SNH) play a critical role in the care of underserved communities, they have been associated with inferior postoperative outcomes. This study evaluated the association of hospital safety-net status with clinical and financial outcomes following esophagectomy.MethodsAll adults (≥18 years) undergoing elective esophagectomy for benign and malignant gastroesophageal disease were identified in the 2010-2019 Nationwide Readmissions Database. Centers in the highest quartile for the proportion of uninsured/Medicaid patients were classified as SNH (others: non-SNH). Regression models were developed to evaluate adjusted associations between SNH status and outcomes, including in-hospital mortality, perioperative complications, and resource use. Royston-Parmar flexible parametric models were used to assess time-varying hazard of non-elective readmission over 90 days.ResultsOf an estimated 51,649 esophagectomy hospitalizations, 9,024 (17.4%) were performed at SNH. While SNH patients less frequently suffered from gastroesophageal malignancies (73.2 vs 79.6%, pConclusionsCare at safety-net hospitals was associated with higher odds of in-hospital mortality, perioperative complications, and non-elective rehospitalization following elective esophagectomy. Efforts to provide sufficient resources at SNH may serve to reduce complications and overall costs for this procedure

Clinical and financial outcomes of transplant recipients following emergency general surgery operations

Introduction: Due to immunosuppression and underlying comorbidities, transplant recipients represent a vulnerable population following emergency general surgery (EGS) operations. The present study sought to evaluate clinical and financial outcomes of transplant patients undergoing EGS. Methods: The 2010–2020 Nationwide Readmissions Database was queried for adults (≥18 years) with non-elective EGS. Operations included bowel resection, perforated ulcer repair, cholecystectomy, appendectomy and lysis of adhesions. Patients were classified by transplant history (Non-transplant, Kidney/Pancreas, Liver, Heart/Lung). The primary outcome was in-hospital mortality while perioperative complications, resource utilization and readmissions were secondarily considered. Multivariable regression models evaluated the association of transplant status on outcomes. Entropy balancing was employed to obtain a weighted comparison to adjust for intergroup differences. Results: Of 7,914,815 patients undergoing EGS, 25,278 (0.32 %) had prior transplantation. The incidence of transplant patients increased temporally (2010: 0.23 %, 2020: 0.36 %, p < 0.001) with Kidney/Pancreas comprising the largest proportion (63.5 %). Non-transplant more frequently underwent appendectomy and cholecystectomy while transplant patients more commonly received bowel resections. Following entropy balancing, Liver was associated with decreased odds of mortality (AOR: 0.67, 95 % CI: 0.54–0.83, Reference: Non-transplant). Incremental hospitalization duration was longer in Liver and Heart/Lung compared to Non-transplant. Odds of acute kidney injury, readmissions and costs were higher in all transplant types. Conclusion: The incidence of transplant recipients undergoing EGS operations has increased. Liver was observed to have lower mortality compared to Non-transplant. Transplant recipient status, regardless of organ, was associated with greater resource utilization and non-elective readmissions. Multidisciplinary care coordination is warranted to mitigate outcomes in this high-risk population

Risk and factors associated with venous thromboembolism following abdominal transplantation

Background: Venous thromboembolism (VTE) remains under-studied among patients undergoing kidney, liver and pancreas (abdominal) transplantation. We characterized the risk and predictors of VTE using a nationally-representative cohort. Methods: The 2014–2019 Nationwide Readmissions Database was queried to identify all adults undergoing abdominal transplantation. Patients who developed pulmonary embolism or deep venous thrombosis were considered the VTE cohort (others: nonVTE). Multivariable models were developed to identify factors linked with VTE and assess the independent associations between VTE and key outcomes. Results: Of ~141,977 transplant recipients, 1.9 % (2722) developed VTE. The VTE cohort was similarly female (39.2 vs 38.0, p = 0.51), but more often demonstrated a higher Elixhauser comorbidity index (4.19 ± 1.40 vs 3.93 ± 1.39, p < 0.001).After adjustment, congestive heart failure (AOR 1.54, 95%CI 1.25–1.91), cardiac arrhythmias (AOR 1.54, 95%CI 1.34–1.78), peripheral vascular disease (AOR 1.29, 95%CI 1.02–1.63), coagulopathies (AOR 1.63, 95%CI 1.38–1.92), previous history of VTE (AOR 1.14, 95%CI 1.06–1.22), and heparin-induced thrombocytopenia (AOR 2.61, 95%CI 2.07–3.28) were associated with VTE. The development of VTE was linked with significantly greater in-hospital mortality (AOR 4.56, 95%CI 2.07–10.10), as well as infectious (AOR 2.59, 95%CI 1.55–4.21), cardiac (AOR 2.59, 95%CI 1.39–4.82), and respiratory (AOR 1.78, 95%CI 1.21–2.63) complications. VTE was further associated with increased length of stay (+8.18 days, 95%CI +1.32–15.41), expenditures (+$42,000, 95$24,800-59,210), and odds of VTE upon readmission (AOR 4.51, 95%CI 1.32–15.41). Conclusions: VTE after abdominal transplantation is linked with significantly greater in-hospital mortality, complications, resource utilization, and risk of VTE at readmission. Novel risk assessments and prophylaxis protocols are needed to reduce VTE incidence and sequelae

Unadjusted outcomes after admission for cardiac device infection; (+) COVID-19, infected with COVID-19 virus; (-) COVID-19, non-infected with COVID-19 virus.

Unadjusted outcomes after admission for cardiac device infection; (+) COVID-19, infected with COVID-19 virus; (-) COVID-19, non-infected with COVID-19 virus.</p

Baseline patient, clinical, and hospital factors after admission for cardiac device infection during and prior to the COVID-19 pandemic.

Baseline patient, clinical, and hospital factors after admission for cardiac device infection during and prior to the COVID-19 pandemic.</p

Impact of delayed intervention following admission for small bowel obstruction: A contemporary analysis

Background: The optimal timing of surgical intervention for small bowel obstruction (SBO) remains debated. Methods: All adults admitted for SBO were identified in the 2018–2019 National Inpatient Sample. Patients undergoing small bowel resection or lysis of adhesion after three days were considered part of the Delayed cohort. All others were classified as Early. Multivariable regressions were used to assess independent predictors of delayed surgical intervention as well as associations between delayed management and in-hospital mortality, major adverse events (MAE), perioperative complications, postoperative length of stay (LOS), hospitalization costs and non-home discharge. Results: Among 28,440 patients who met study criteria, 52.0 % underwent delayed intervention. Black race (AOR 1.19, 95 % CI 1.03–1.36, ref.: White) and Medicare coverage (AOR 1.16, 95 % CI 1.01–1.33, ref.: private payer) were associated with increased odds of delayed surgical management. While delayed intervention was not significantly associated with death (AOR 1.27, 95 % CI 0.97–1.68), it was linked to greater odds of MAE (AOR 1.30, 95 % CI 1.16–1.45) and several perioperative complications. The Delayed cohort also faced an incremental increase in postoperative LOS (+1.29 days, 95 % CI 0.89–1.70) and hospitalization costs (+$11,000, 95 % CI 10,000-12,000). Moreover, delayed intervention was linked to increased odds of non-home discharge (AOR 1.64, 95 % CI 1.47–1.84). Conclusions: Delay in surgical management following SBO is linked to inferior clinical outcomes and increased resource use. Our findings highlight the need to ensure proper timing of surgery for SBO as well as efforts to standardize these practices across all demographics of patients

STROBE statement—Checklist of items that should be included in reports of observational studies.

STROBE statement—Checklist of items that should be included in reports of observational studies.</p