Miracle-dz/UniFAR-FTUs huggingface dataset:
Measuring State Medicaid Home Care Participation and Intensity Using Latent Variables

Population aging and policies to redirect long-term care toward home- and community-based services have led to increases in Medicaid home care spending in most states. Changes in state Medicaid home care policy generosity may result from changes in the number of persons served (i.e., Participation) and/or changes in quantities of services covered (i.e., Intensity). This study measures state Medicaid home care Participation and Intensity comprehensively using latent variables, and uses those latent variables to describe changes in Medicaid home care policy generosity over time and across states. Yearly state-level data from the Medicaid Statistical Information System (1999-2012) are analyzed using exploratory and confirmatory factor analyses. Between 1999 and 2012, 29 states expanded both Participation and Intensity, whereas six states reduced both. In the remaining states, a trade-off occurred. Distinguishing between Medicaid home care Participation and Intensity deserves attention, as expansions along these two dimensions represent potentially different implications for beneficiaries.
Using Situation Awareness and Workload to Predict Performance in Submarine Track Management: A Multilevel Approach

Objective: Examine the extent to which subjective workload and situation awareness (SA) can predict variance in performance at the between- and within-person levels of analysis in a simulated submarine track management task. Background: SA and workload are crucial constructs in human factors that are conceptualized as states that change within individuals over time. Thus, a change in an individual’s subjective workload or SA over the course of performing a task should be predictive of their subsequent performance (within-person effects). However, there is little empirical evidence for this. Method: Participants monitored displays to track the behaviors of contacts in relationship to their own ship (Ownship) and landmarks. The Situational Awareness Global Assessment Technique measured SA, and the Air Traffic Workload Input Technique measured subjective workload. Results: When a participant’s subjective workload rating increased, their subsequent performance decreased, but there was no evidence for within-person effects of SA on performance. We replicated prior between-person level effects of SA; participants with higher SA performed better than those with lower SA. Conclusion: Change in an individual’s subjective workload rating (but not SA) was predictive of their subsequent performance. Because an increase in SA should increase the extent to which operators hold the knowledge required to perform subsequent tasks, further research is required to examine SA effects on performance at the within-person level. Application: Adapting automation is more likely to produce optimal outcomes if based on measurement of operator states that predict future task performance, such as workload.
Fetal weight estimation by ultrasound: development of Indian population-based models

Purpose Existing ultrasound-based fetal weight estimation models have been shown to have high errors when used in the Indian population. Therefore, the primary objective of this study was to develop Indian population-based models for fetal weight estimation, and the secondary objective was to compare their performance against established models. Methods Retrospectively collected data from 173 cases were used in this study. The inclusion criteria were a live singleton pregnancy and an interval from the ultrasound scan to delivery of ≤7 days. Multiple stepwise regression (MSR) and lasso regression methods were used to derive fetal weight estimation models using a randomly selected training group (n=137) with cross-products of abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC), and femur length (FL) as independent variables. In the validation group (n=36), the bootstrap method was used to compare the performance of the new models against 12 existing models. Results The equations for the best-fit models obtained using the MSR and lasso methods were as follows: log10(EFW)=2.7843700+0.0004197(HC×AC)+0.0008545(AC×FL) and log10(EFW)=2.38 70211110+0.0074323216(HC)+0.0186555940(AC)+0.0013463735(BPD×FL)+0.0004519715 (HC×FL), respectively. In the training group, both models had very low systematic errors of 0.01% (±7.74%) and -0.03% (±7.70%), respectively. In the validation group, the performance of these models was found to be significantly better than that of the existing models. Conclusion The models presented in this study were found to be superior to existing models of ultrasound-based fetal weight estimation in the Indian population. We recommend a thorough evaluation of these models in independent studies.
Levels of polybrominated diphenyl ethers in the Korean metropolitan population are declining: A trend from 2001 to 2013

Polybrominated diphenyl ethers (PBDEs) have been banned or voluntarily withdrawn from commerce worldwide. Declining levels of PBDEs in humans have been reported elsewhere, but not in Korea. We monitored 7 individual PBDE congeners (BDE‐28, BDE‐47, BDE‐99, BDE‐100, BDE‐153, BDE‐154, and BDE‐183) in 103 human serum samples collected in 2006. The arithmetic mean and median values for the sum of the 7 PBDEs (∑PBDEs) were 7.13 and 6.70 ng/g lipid, respectively. In addition, 6 pooled human serum samples collected in 2006, 2007, 2009, 2011, 2012, and 2013 were analyzed. A decrease in PBDE levels was observed, as reflected by the median value of ∑PBDEs from 5.98 in 2006 to 2.98 ng/g lipid in 2013 as well as in the pooled samples. The levels of individual congeners also decreased but at different declining rates. Based on these results and previously reported data, a definite decline in PBDE levels in the Korean metropolitan population could be observed from 2001 to 2013, providing the first evidence in Korea of the same decline observed elsewhere in the world. Environ Toxicol Chem 2018;37:2323–2330. © 2018 SETAC
Sildenafil and calcitonin gene-related peptide dilate intradural arteries: A 3T MR angiography study in healthy volunteers

Background Sildenafil and calcitonin gene-related peptide are vasoactive substances that induce migraine attacks in patients. The intradural arteries are thought to be involved, but these have never been examined in vivo. Sildenafil is the only migraine-inducing compound for which cephalic, extracranial artery dilation is not reported. Here, we investigate the effects of sildenafil and calcitonin gene-related peptide on the extracranial and intradural parts of the middle meningeal artery. Methods In a double-blind, randomized, three-way crossover, placebo-controlled head-to-head comparison study, MR-angiography was recorded in healthy volunteers at baseline and twice after study drug (sildenafil/ calcitonin gene-related peptide/saline) administration. Circumferences of extracranial and intradural middle meningeal artery segments were measured using semi-automated analysis software. The area under the curve for circumference change was compared using paired t-tests between study days. Results Twelve healthy volunteers completed the study. The area under the curveBaseline-120min was significantly larger on both the sildenafil and the calcitonin gene-related peptide day in the intradural middle meningeal artery (calcitonin gene-related peptide, p = 0.013; sildenafil, p = 0.027) and the extracranial middle meningeal artery (calcitonin gene-related peptide, p = 0.0003; sildenafil, p = 0.021), compared to placebo. Peak intradural middle meningeal artery dilation was 9.9% (95% CI [2.9–16.9]) after sildenafil (T30min) and 12.5% (95% CI [8.1–16.8]) after calcitonin gene-related peptide (T30min). Peak dilation of the extracranial middle meningeal artery after calcitonin gene-related peptide (T30min) was 15.7% (95% CI [11.2–20.1]) and 18.9% (95% CI [12.8–24.9]) after sildenafil (T120min). Conclusion An important novel finding is that both sildenafil and calcitonin gene-related peptide dilate intradural arteries, supporting the notion that all known pharmacological migraine triggers dilate cephalic vessels. We suggest that intradural artery dilation is associated with headache induced by calcitonin gene-related peptide and sildenafil.
Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience.

OBJECTIVE In this paper the authors review their 16-year single-institution consecutive patient experience in the endoscopic treatment of nonsyndromic craniosynostosis with an emphasis on careful review of any associated treatment-related complications and methods of complication avoidance, including preoperative planning, intraoperative management, and postoperative care and follow-up. METHODS A retrospective chart review was conducted on all patients undergoing endoscopic, minimally invasive surgery for nonsyndromic craniosynostosis at Rady Children's Hospital from 2000 to 2015. All patients were operated on by a single neurosurgeon in collaboration with two plastic and reconstructive surgeons as part of the institution's craniofacial team. RESULTS Two hundred thirty-five patients underwent minimally invasive endoscopic surgery for nonsyndromic craniosynostosis from 2000 to 2015. The median age at surgery was 3.8 months. The median operative and anesthesia times were 55 and 105 minutes, respectively. The median estimated blood loss (EBL) was 25 ml (median percentage EBL 4.2%). There were no identified episodes of air embolism or operative deaths. One patient suffered an intraoperative sagittal sinus injury, 2 patients underwent intraoperative conversion of planned endoscopic to open procedures, 1 patient experienced a dural tear, and 1 patient had an immediate reexploration for a developing subgaleal hematoma. Two hundred twenty-five patients (96%) were admitted directly to the standard surgical ward where the median length of stay was 1 day. Eight patients were admitted to the intensive care unit (ICU) postoperatively, 7 of whom had preexisting medical conditions that the team had identified preoperatively as necessitating a planned ICU admission. The 30-day readmission rate was 1.7% (4 patients), only 1 of whom had a diagnosis (surgical site infection) related to their initial admission. Average length of follow-up was 2.8 years (range < 1 year to 13.4 years). Six children (< 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (> 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension. CONCLUSIONS In this large single-center consecutive patient series in the endoscopic treatment of nonsyndromic craniosynostosis, significant complications were avoided, allowing for postoperative care for the vast majority of infants on a standard surgical ward. No deaths, catastrophic postoperative morbidity, or evidence of the development of symptomatic intracranial hypertension was observed.
Thalidomide in Combination with Chemotherapy in Treating Elderly Patients with Acute Myeloid Leukemia

Background: Currently, the treatment decisions in elderly patients with acute myeloid leukemia (AML) are difficult and remain controversial. This study aims to evaluate the effect of thalidomide plus chemotherapy on elderly patients with AML. Methods: 70 elderly AML patients (median age 71 years) were enrolled into this prospective study and randomly assigned to either the control arm (PC, n = 35) or the investigational arm (TPC, n = 35). Patients in the PC arm received a non-intensive regimen composed of cytarabine, aclarubicin and G-CSF (CAG) chemotherapy for induction of remission, and patients in the TPC arm received in addition thalidomide at a maximum dose of 200 mg/day. Results: After 2 courses of induction therapy, complete response rate of TPC and PC arms was 54.3% and 57.1%, respectively (p = 0.810). At the last follow-up, the Kaplan-Meier estimate showed that the median overall survival (OS) and event-free survival (EFS) in patients in the PC arm was inferior to those of patients in the TPC arm. Using a stratified Cox model adjusted for randomized treatment, patients receiving thalidomide plus chemotherapy were shown to derive some survival benefit in both OS and EFS. Overall, the hematological and non-hematological toxicity were similar between the 2 treatment arms. Conclusions: Thalidomide in combination with chemotherapy is an alternative treatment option for elderly patients with AML.
Microbiological Parameters in the Primary Production of Berries: A Pilot Study

The primary production of fresh soft fruits was considered to be a suspected critical point for the contamination of frozen berries that were responsible for the large 2013–2014 Hepatitis A virus (HAV) outbreak in Europe. In this study, an Italian berries’ production area was studied for its agro-technical characteristics, and the fresh fruits were analyzed for the presence of enteric viruses (HAV and Norovirus (NoV) genogroup I and genogroup II (GGI and GGII)), the enumeration of hygienic quality parameters, and the prevalence of bacterial pathogens. A total of 50 producers were sampled, who specialized in the exclusive or shared cultivation of berries. Escherichia coli was detected in two blackberry samples, whereas HAV and Norovirus were not detected. The samples were negative for Salmonella spp. , Listeria monocytogenes, and Shiga toxin-producing Escherichia coli (STEC). The farms’ attributes were not associated with positive samples, apart from the presence of E. coli and the aerobic mesophilic bacteria for blackberry that were statistically correlated. In blueberries, the high aerobic mesophilic count could likely be associated with the resistance of the outer layer to handling. However, the two pathogens (Salmonella spp. and STEC) and the targeted viruses (HAV, NoV GGI and GGII) were not detected, highlighting the low risk of foodborne pathogens and viral contamination at the primary production stage of the berry food chain in the area considered in this pilot study.
Flavodiiron-Mediated O2 Photoreduction Links H2 Production with CO2 Fixation during the Anaerobic Induction of Photosynthesis1[OPEN]

Flavodiiron proteins recycle large amounts of O2 during the anaerobic induction of photosynthesis and act as a relay of hydrogenases in priming CO2 fixation in Chlamydomonas reinhardtii. Some microalgae, such as Chlamydomonas reinhardtii, harbor a highly flexible photosynthetic apparatus capable of using different electron acceptors, including carbon dioxide (CO2), protons, or oxygen (O2), allowing survival in diverse habitats. During anaerobic induction of photosynthesis, molecular O2 is produced at photosystem II, while at the photosystem I acceptor side, the reduction of protons into hydrogen (H2) by the plastidial [FeFe]-hydrogenases primes CO2 fixation. Although the interaction between H2 production and CO2 fixation has been studied extensively, their interplay with O2 produced by photosynthesis has not been considered. By simultaneously measuring gas exchange and chlorophyll fluorescence, we identified an O2 photoreduction mechanism that functions during anaerobic dark-to-light transitions and demonstrate that flavodiiron proteins (Flvs) are the major players involved in light-dependent O2 uptake. We further show that Flv-mediated O2 uptake is critical for the rapid induction of CO2 fixation but is not involved in the creation of the micro-oxic niches proposed previously to protect the [FeFe]-hydrogenase from O2. By studying a mutant lacking both hydrogenases (HYDA1 and HYDA2) and both Flvs (FLVA and FLVB), we show that the induction of photosynthesis is strongly delayed in the absence of both sets of proteins. Based on these data, we propose that Flvs are involved in an important intracellular O2 recycling process, which acts as a relay between H2 production and CO2 fixation.
Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults

Essentials Risk factors of bleeding in adult immune thrombocytopenia are not known. This multicenter study assessed risk factors of bleeding at immune thrombocytopenia onset. Platelet count thresholds associated with bleeding were < 20 × 109 L−1 and < 10 × 109 L−1. Exposure to anticoagulants was a major risk factor of severe bleeding.
Towards Consensus on Essential Components of Physical Examination in Primary Care-based Memory Clinics*

Background Primary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting. Methods We distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada. Results 90 surveys were completed for an overall response rate of 66.7%. Assessments of vital signs, gait, and for features of Parkinsonism were identified as essential by most respondents. There was little consensus on which clinician should be responsible for specific physical examination maneuvers. Conclusions While we identified specific physical examination maneuvers deemed by providers to be both necessary and feasible to perform in the context of primary care-based memory clinics, further research is needed to clarify interprofessional roles related to the examination.
Pressure injury prevention for paediatric cardiac surgical patients using a nurse-driven standardized clinical assessment and management plan

Abstract Background The description of pressure injury development is limited in children with CHD. Children who develop pressure injuries experience pain and suffering and are at risk for additional morbidity. Objectives The objective of this study was to develop a standardized clinical assessment and management plan to describe the development of pressure injury in paediatric cardiac surgical patients and evaluate prevention strategies. Methods Using a novel quality improvement initiative, postoperative paediatric cardiac surgical patients were started on a nurse-driven pressure injury prevention standardized clinical assessment and management plan on admission. Data were recorded relevant to nursing assessments and management based on pre-defined targeted data statements and algorithm. Nursing feedback regarding diversions was recorded and analysed. Results Data on 674 congenital paediatric cardiac surgical patients who met criteria were collected between May, 2011 and June, 2012. In 5918 patient days, a total of 4603 skin assessments were completed by nurses from the cardiac ICU and the cardiac inpatient unit, representing 77% of the expected assessments. The majority (70%, 21/30) of the 30 pressure injuries were medical-device-related and 30% (9/30) were immobility-related. The overall incidence of pressure injury was 4.4%: device-related was 3.1% and immobility-related was 1.3%. Most pressure injuries were Stage 1 (40%), followed by Stage 2 (26.7%), mucosal membrane injury (26.7%), and suspected deep tissue injuries (6.7%). Conclusion A nurse-driven pressure injury prevention standardized clinical assessment and management plan supported a programme-based evaluation of nursing practice and patient outcomes. Review of practices highlighted opportunities to standardise and focus prevention practices and ensure communication of patient vulnerabilities.
Positive Association between Preoperative Total Testosterone Levels and Risk of Positive Surgical Margins by Prostate Cancer: Results in 476 Consecutive Patients Treated Only by Radical Prostatectomy

Objective: To evaluate preoperative total testosterone (TT) as a predictor of positive surgical margins (PSM) in prostate cancer (PCA). Patients and methods: During the period from November 2014 to July 2017, preoperative TT was measured in 476 PCA patients undergoing only radical prostatectomy (RP) and including all risk classes. Surgical margins were stated negative, focal positive (single and less than 1 mL), and multifocal positive (more than 1). The risk of TT and clinical factors associated with the risk of PSM (focal or multifocal versus negative) was evaluated by the multinomial logistic regression model. Results: Overall, PSM were detected in 149 cases (31.3%), which included 99 patients with focal cancer invasion (20.8%) and 50 subjects with multifocal cancer invasion (10.5%). In univariate analysis, PSM associated with higher median levels of TT and prostate-specific antigen than controls. Multifocal PSM associated with higher rates of high-risk PCA (42%) than focal (22.2%) or control cases (18.3%). In multivariate analysis, TT was the only independent factor positively associated with the risk of focal PSM when compared to controls (OR 1.002; p = 0.035). TT (OR 1.003; p = 0.002) and high-risk PCA (OR 1.002; p = 0.047) were independent factors, which positively associated with the risk of multifocal PSM when compared to controls. Risk models were computed. Conclusions: In a large and contemporary cohort of patients elected to primary RP, TT was an independent positive factor associated with the risk of focal and multifocal PSM. TT associated with aggressive PCA biology.
High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

Introduction: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC). Patients and Methods: The study period was from January 2002 to December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death. Results: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8–23); 58.2% (CI 50.7–65); 73.7% (CI 66.3–79.7); and 84.5% (CI 77.8–89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8–40.6); 71.4% (CI 67.3–75.2); 89.8% (CI 86.6–92.3); and 95.7% (CI 93.4–97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses. Conclusions: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.