Corrigendum: Probing auditory scene analysis.

[This corrects the article on p. 293 in vol. 8, PMID: 25309314.]

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

The effect of stimulus context on the buildup to stream segregation

Stream segregation is the process by which the auditory system disentangles the mixture of sound inputs into discrete sources that cohere across time. The length of time required for this to occur is termed the “buildup” period. In the current study, we used the buildup period as an index of how quickly sounds are segregated into constituent parts. Specifically, we tested the hypothesis that stimulus context impacts the timing of the buildup and, therefore, affects when stream segregation is detected. To measure the timing of the buildup we recorded the Mismatch Negativity component (MMN) of event-related brain potentials (ERPs), during passive listening, to determine when the streams were neurophysiologically segregated. In each condition, a pattern of repeating low (L) and high (H) tones (L-L-H) was presented in trains of stimuli separated by silence, with the H tones forming a simple intensity oddball paradigm and the L tones serving as distractors. To determine the timing of the buildup, probe tones occurred in two positions of the trains, early (within the buildup period) and late (past the buildup period). The context was manipulated by presenting roving vs. non-roving frequencies across trains in two conditions. MMNs were elicited by intensity probe tones in the Non-Roving condition (early and late positions) and the Roving condition (late position only) indicating that neurophysiologic segregation occurred faster in the Non-Roving condition. This suggests a shorter buildup period when frequency was repeated from train to train. Overall, our results demonstrate that the dynamics of the environment influence the way in which the auditory system extracts regularities from the input. The results support the hypothesis that the buildup to segregation is highly dependent upon stimulus context and that the auditory system works to maintain a consistent representation of the environment when no new information suggests that reanalyzing the scene is necessary