Miracle-dz/UniFAR-FTUs huggingface dataset:
Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study

Background Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status. Objective This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population. Methods We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs. Results Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ≥65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income <US $40,000. Increases in telehealth visits during the pandemic varied across subgroups, while decreases in outpatient visits were similar, except by age. Among age groups, the ≥65 years population had the least increase in telehealth visits (236.6%, 95% CI 228.8%-244.5%), with 4.9 per one person-year during the early pandemic period versus 1.5 per one person-year during the prepandemic period. During the same periods, across racial/ethnic groups, Hispanic individuals had the largest increase in telehealth visits (295.5%, 95% CI 275.5%-316.5%). Across income levels, telehealth visits in the low-income group increased the most (313.5%, 95% CI 294.8%-333.1%). The rate of combined outpatient and telehealth visits in the Hispanic, non-Hispanic Black, and low-income groups returned to prepandemic levels by October 2020. Conclusions The Hispanic group and low-income group had the largest percentage increase in telehealth utilization in response to the COVID-19 pandemic. The use of virtual care potentially mitigated the impact of the pandemic on health care utilization in these vulnerable populations.
Measurable Levels of Short‐Chain Chlorinated Paraffins in Western Hudson Bay Fishes but Limited Biomagnification from Fish to Ringed Seals

We investigated short‐chain (C10–13) chlorinated paraffins (SCCP) in an Arctic marine food web. In zooplankton, fishes, and ringed seals from western Hudson Bay, Canada, SCCP concentrations ranged from 38.3 to 687 ng g–1 lipid weight. Monte Carlo–simulated trophic‐adjusted biomagnification factors of individual SCCP congeners ranged from 0.07 to 0.55 for small pelagic fishes to seals. Despite relatively high concentrations in fishes, biomagnification of SCCPs within this food web appears limited. Environ Toxicol Chem 2021;40:2990–2999. © 2021 SETAC
Optic disc edema and chorioretinal folds develop during strict 6° head‐down tilt bed rest with or without artificial gravity

Spaceflight associated neuro‐ocular syndrome (SANS) is hypothesized to develop as a consequence of the chronic headward fluid shift that occurs in sustained weightlessness. We exposed healthy subjects (n = 24) to strict 6° head‐down tilt bed rest (HDTBR), an analog of weightlessness that generates a sustained headward fluid shift, and we monitored for ocular changes similar to findings that develop in SANS. Two‐thirds of the subjects received a daily 30‐min exposure to artificial gravity (AG, 1 g at center of mass, ~0.3 g at eye level) during HDTBR by either continuous (cAG, n = 8) or intermittent (iAG, n = 8) short‐arm centrifugation to investigate whether this intervention would attenuate headward fluid shift‐induced ocular changes. Optical coherence tomography images were acquired to quantify changes in peripapillary total retinal thickness (TRT), retinal nerve fiber layer thickness, and choroidal thickness, and to detect chorioretinal folds. Intraocular pressure (IOP), optical biometry, and standard automated perimetry data were collected. TRT increased by 35.9 µm (95% CI, 19.9–51.9 µm, p < 0.0001), 36.5 µm (95% CI, 4.7–68.2 µm, p = 0.01), and 27.6 µm (95% CI, 8.8–46.3 µm, p = 0.0005) at HDTBR day 58 in the control, cAG, and iAG groups, respectively. Chorioretinal folds developed in six subjects across the groups, despite small increases in IOP. Visual function outcomes did not change. These findings validate strict HDTBR without elevated ambient CO2 as a model for investigating SANS and suggest that a fluid shift reversal of longer duration and/or greater magnitude at the eye may be required to prevent or mitigate SANS.
Long-term outcome of rotational atherectomy according to burr-to-artery ratio and changes in coronary artery blood flow: Observational analysis

Background Rotational atherectomy (RA) has been proven to be efficient for the treatment of calcified and diffuse coronary artery lesions. However, the optimal burr-to-artery ratio (BtAR) remains unidentified as well as an influence of change in blood flow on long-term outcome. Aim of our study was to examine the association between long-term outcome, and both BtAR and change in coronary flow during RA. Methods We conducted a retrospective study including patients who underwent RA. Two independent observers calculated BtAR, pre- and postprocedural corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC) for artery treated with RA. The long-term outcome was defined as all-cause mortality. Results Receiver operating characteristic curve analysis of BtAR determined threshold of 0.6106 for all-cause mortality detection with sensitivity 50.0%, specificity 90.8%, and area under the curve 0.730 (p < 0.001). Kaplan-Meier survival analysis showed that the all-cause mortality rate in the group with the BtAR > 0.6106 is significantly higher compared to the patients with lower BtAR (hazard ratio [HR] 3.76, 95% confidence interval [CI] 1.51–9.32; p < 0.001). Kaplan-Meier survival analysis revealed that the all-cause mortality rate in the group with impairment in coronary flow was significantly higher compared to group with cTFC difference ≤ 0 after RA (HR 3.28, 95% CI 1.56–9.31; p = 0.02). Conclusions Burr-to-artery ratio > 0.6106 is associated with worse prognosis of patients treated with RA. Patients showing post-RA impairment in blood flow in the target artery have worse prognosis.
Serum 25-hydroxy vitamin D level is associated with cognitive impairment in people aged 65 years and older.

BACKGROUND Vitamin D deficiency is prevalent in the population, especially in older people. In recent years, studies have revealed an association between a low vitamin D level and cognitive decline. The present research aimed to investigate the relationship of serum 25-hydroxyvitamin D (25-OH-D) level with cognitive function in senior patients. METHODS We recruited 299 patients aged 65 years and older. The patients were grouped based on their serum 25-OH-D levels into group A (<10.0 ng/mL), B (10.0-19.9 ng/mL), and C (≥20.0 ng/mL). Cognitive function was assessed with the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR) scale, and Activities of Daily Living (ADL) scale. RESULTS MMSE and MoCA scores were significantly lower in group A (26.02±3.99 and 21.56±5.59, respectively) than in group B (27.34±2.79 and 23.94±4.74, respectively) and group C (27.65±2.54 and 24.95±4.45, respectively). The proportion of patients with cognitive impairment was increased in group A (71.1%) compared to group B (55.3%) and group C (43.9%), and the difference was statistically significant (both P<0.01). Spearman's correlation analysis showed that MMSE and MoCA had a positive relationship with serum 25-OH-D level (β=0.173 and 0.243, both P<0.01) with adjustments for factors as age, sex, and education level. Stepwise regression analysis indicated that MMSE and MoCA scores were correlated with serum 25-OH-D level, age, and education level. CONCLUSIONS A lower level of 25-OH-D is common in senior patients and is associated with cognitive impairment. Patients with severe deficiency of vitamin D (serum 25-OH-D level <10 ng/mL) have lower MMSE and MoCA scores and a higher risk of cognitive dysfunction.
Morpho‐functional variation and response pattern of microglia through rodent ontogeny showing infant microglia as stable and adaptive than matured

Microglia, myelo‐monocytic lineage cells, that enter in the developing brain at early embryonic stages and integrate in CNS, are involved in almost all neuroinflammatory conditions. We studied how microglia change their responses through the development and maturation of brain in normal physiological conditions using an ex situ model to delineate their age‐specific morpho‐functional responsiveness. Rapidly isolated microglia from different age‐matched rats were characterized with Iba1+/CD11b/c+/MHCclassII+, cultured, studied for cell‐cycle/proliferative potency, ROS generation and phagocytosis, viability and morphological analysis induced with GMCSF, MCSF, IL‐4, IL‐6, IL‐10, and IFN‐γ. The study showed marked differences in cellular properties, stability, and viability of microglia through ontogeny with specific patterns in their studied functions which were coherent with their in situ morpho‐functional attributes. Phagocytic behavior showed a notable shift from ROS independence to dependence toward maturation. Perinatal microglia were found persistent in ex situ environment and neonatal microglia qualified as the most potent and versatile responders for morpho‐functional variations under cytokine induced conditions. The study identified that microglia from infants were the most stable, adaptive, and better responders, which can perform as an ex situ model system to study microglial biology.
Reactions to Participating in Sexual and Dating Violence Research Among Native American Youth

The purpose of the current study was to explore the reactions of Native American adolescents to participating in survey research on sexual and dating violence. Participants were 149 Native American adolescents who completed a survey in school. Survey items included sexual assault, dating violence, sexual harassment, and demographic questions. At the end of the survey, participants were asked if they were upset by the survey. Results showed that almost a quarter of youth were upset by the survey (24.2%), victims were more likely than non-victims to be upset by the survey, perpetrators were more likely than non-perpetrators to be upset by the survey, and sexual minorities were more likely than non-sexual minorities to be upset by the survey. Sex and age did not emerge as significantly associated with being upset. Participants were asked to describe why they were upset, and a content analysis revealed four categories of responses (i.e., feeling awkward or weird, topic of the survey, reminders, and “other”). Overall, although the research was well tolerated by most of the participants, researchers should consider adding information about what might increase feelings of upset in parental consent and youth assent forms, such as being reminded of a past upsetting experience and/or feeling awkward or weird because of some of the questions.
A Medication Adherence Promotion System to Reduce Late Kidney Allograft Rejection: A Quality Improvement Study.

RATIONALE AND OBJECTIVE Adolescent and young adult kidney transplant recipients have high risk of rejection related to suboptimal adherence. Multi-component interventions improve adherence in controlled trials, but clinical implementation is lacking. We describe an initiative to reduce allograft rejection using evidence-based adherence promotion clinical strategies. STUDY DESIGN Interrupted time series. SETTING AND PARTICIPANTS Kidney transplant recipients cared for at Cincinnati Children's Hospital ≥1 year post-transplant and taking ≥1 immunosuppressive medication from 2014 through 2017. QUALITY IMPROVEMENT ACTIVITIES The following interventions were implemented over 14 months: 1) adherence promotion training for clinical staff, 2) EHR-supported adherence risk screening, 3) systematic assessment of medication adherence barriers, 4) designation of specific staff to address adherence barriers, 5) shared decision-making with the patients to overcome adherence barriers, 6) follow-up to assess progress, 7) optional electronic medication monitoring. OUTCOMES Primary Outcome: Late acute rejection. Process measures: barriers assessments performed, barriers identified, number of interventions performed. Secondary outcomes/balancing measures: de novo DSA, biopsy rate, rejections per biopsy. ANALYTICAL APPROACH Time series analysis using statistical process control, evaluated patient-days between acute rejections as well as monthly rejections per 100 patient-months before and after implementation. To control for known rejection risk factors including changes in treatment and case mix, multivariable analyses were performed. RESULTS The monthly rejection rate fell from 1.61 rejections/100 patient-months in the 26-months pre-implementation to 0.88 rejections/100 patient-months in the 22-months post-implementation. In multivariable analysis, MAPS was associated with a 50% reduction in rejection incidence (IRR 0.50, 95% CI: 0.27-0.91, p=0.02). DSA and time since transplant were also associated with rejection incidence (IRR 2.27, p=0.02 and IRR 0.87, p=0.02, respectively) LIMITATIONS: A single center study. Potential confounding by unmeasured variables. CONCLUSIONS Clinical implementation of evidence-based adherence-promotion strategies was associated with a 50% reduction in acute rejection incidence over two years.
Lung ultrasound correlates with radiographic severity and pattern in COVID-19 pneumonia: a preliminary study.

BACKGROUND Coronavirus Disease 2019 (COVID-19) was outbreaking in late 2019 and a proportion of patients developed to pneumonia. Although chest CT is a pivotal diagnostic tool for COVID-19 pneumonia, CT is expensive and also radiological burden for patients. There is urgent to investigate the role of lung ultrasound (LUS) in diagnosing and monitoring COVID-19 pneumonia. METHODS A total of 8 patients with confirmed cases of COVID-19 pneumonia in Shantou Central Hospital from January 2020 to February 2020 were retrospectively studied. All participants underwent chest HRCT and LUS examination; both were independently performed within 1 day of the other. The radiological patterns were reviewed by 2 radiologists who were blind to the clinical information. A senior ultrasound physician, blind to HRCT results and clinical data, performed bedside LUS in the isolation ward. The CT score was used (a semi-quantitative scoring system) to assess radiographic severity and extent. A B-lines score denoting the extent and severity of sonographic lesion was calculated by summing the number of B-lines on 18 scanning sites. RESULTS B-lines (100%), pleural irregularities (25%), consolidation (25%), and pleural effusion (25%) were the main findings of LUS examination. Interstitial abnormalities, ground-glass opacities (GGO), consolidations and local or bilateral patchy shadowing were the main findings of HRCT examination. The findings of LUS and HRCT were compared point to point and high consistency was found between the 2 measurements. A significant correlation was also found between the B-lines score and CT score [r=0.96, 95% confidence interval (CI): 0.81 to 0.99, P=0.0001]. CONCLUSIONS Both LUS patterns and B-lines score are significantly correlated with HRCT findings and score, respectively, supporting its role in assessing COVID-19 pneumonia severity, screening, and following up dynamic changes of pneumonia.
Prevalence of Untreated HIV and Associated Risk Behaviors Among the Sexual Partners of Recent Migrants and Long-term Residents in Rakai, Uganda

Supplemental Digital Content is Available in the Text. Background: Migrants in sub-Saharan Africa are at increased risk of HIV acquisition after migration, but little is known about their sexual partners at place of destination. Setting: Rakai Community Cohort Study (RCCS) in Uganda. Methods: From 1999 to 2016, persons aged 15–49 years were surveyed in the RCCS and reported on their 4 most recent sexual partners in the last year. We compared the characteristics of sexual partners reported by migrants moving into RCCS communities in the last 2 years (ie, in-migrants) with those of long-term residents with no recent migration history. Among a subset of participants in cohabitating epidemiologically linked couples of known HIV serostatus, we also assessed prevalence of having ≥1 untreated HIV-positive partner among in-migrants and long-term residents. Results: One hundred sixteen thousand seven hundred forty-four sexual partners were reported by 29,423 participants. The sexual partnerships of in-migrants were significantly less likely to be marital, more likely to span community boundaries, and shorter in duration than those of long-term residents. In-migrants also reported more sexual partners and were less likely to know their partner's HIV status or to have told their partner their HIV status. Among 7558 epidemiologically linked couples, HIV-negative in-migrants were more likely to partner with untreated HIV-positive persons compared with HIV-negative long-term residents (women: 6.3% vs. 4.1%; prevalence risk ratio = 1.77, 95% confidence interval: 1.49 to 2.11; men: 6.9% vs. 3.9%; prevalence risk ratio = 1.72, 95% confidence interval: 1.38–2.14). Conclusion: There is a higher frequency of risky sexual behaviors among the partnerships of in-migrants compared with those of long-term residents. Among cohabitating couples, in-migrants are more likely to partner with untreated HIV-positive individuals.
“Maternal diabetes mellitus and its impact on the risk of delivering a child with congenital heart disease: a systematic review and meta-analysis”

Abstract Aim Maternal pregestational diabetes mellitus (PGDM), type 1 or type 2, has been established as a potential risk factor for congenital heart disease (CHD). At the same time, the correlation between gestational diabetes mellitus (GDM) and increased risk of CHD has not been yet fully elucidated. The objective of this systematic review and meta-analysis (PROSPERO number: CRD42020182390) was to analyze the existing evidence on PGDM and to attempt to fill, to the best of our ability, the remaining knowledge gap in the association of GDM with CHD. Materials and methods Two authors have independently searched the Pubmed/Medline, Scopus, Cochrane, Web of Science, and Theses Global databases with keywords and Boolean operators. The search yielded 9333 relevant articles, which were later screened for eligibility. Original peer-reviewed (case-control or cohort) studies were included if they were published in English between 1997 and 2020. Thirteen studies on mothers with PGDM and seven studies on mothers with GDM were finally included in our meta-analysis to investigate the association of maternal diabetes with the risk of delivering a child with CHD. The selected studies were all assessed for their methodological quality using the Newcastle–Ottawa scale. Associations with p < . 05 were considered statistically significant. Results Our meta-analysis (I 2 > 75%, total population: n = 12,461,586) of 79,476 women with PGDM and 160,893 with GDM produced an odds ratio of 3.48 (2.36–4.61) and 1.55 (1.48–1.61), respectively. Additionally, we did not find any noticeable difference in the risk for CHD among diabetic women living in the USA and Europe. Nevertheless, it still needs to be clarified, whether or not the gestational diabetic population includes undiagnosed women with preexisting diabetes, which might account for the increased risk of delivering a child with CHD in women classified as suffering from GDM. Conclusion While both GDM and PGDM seem to significantly increase the risk of CHD in comparison with the general population, PDGM appears to have a greater association with CHD, being correlated with a 3.5-fold increase in the risk of malformation. Preconceptional and gestational diabetes care are, therefore, essential to mitigate the adverse effect of hyperglycemia on fetal heart formation during pregnancy.
A Mixture Response Time Process Model for Aberrant Behaviors and Item Nonresponses

Abstract In high-stakes, large-scale, standardized tests with certain time limits, examinees are likely to engage in either one of the three types of behavior (e.g., van der Linden & Guo, 2008; Wang & Xu, 2015): solution behavior, rapid guessing behavior, and cheating behavior. Oftentimes examinees do not always solve all items due to various reasons such as time limit or test-taking strategy. Item nonresponses may happen due to intentionally omitting some items (omitted responses) or due to lack of time (not-reached responses). Both types are related to latent abilities and hence the missingness is nonignorable. In this article, we proposed an innovative mixture response time process model (1) to detect two most common aberrant behaviors: rapid guessing behavior and cheating behavior, and (2) to account for two types of item nonresponses: not-reached items and omitted items. The new model combines the two-stage approach of Wang et al. (2018) with Lu and Wang (2020) model. It also contains two steps: (1) a mixture response time process model is first fitted to the responses and response times data to distinguish normal and aberrant behaviors and to account for the missing data mechanism; and (2) a Bayesian residual index is used to further distinguish rapid guessing and cheating behaviors. Simulation results show that the two-stage method yields accurate item and person parameter estimates, as well as high detection of aberrant behaviors. A real data analysis was conducted to illustrate the potential application of the proposed method.
Parietal alpha tACS shows inconsistent effects on visuospatial attention

Transcranial alternating current stimulation (tACS) is a popular technique that has been used for manipulating brain oscillations and inferring causality regarding the brain-behaviour relationship. Although it is a promising tool, the variability of tACS results has raised questions regarding the robustness and reproducibility of its effects. Building on recent research using tACS to modulate visuospatial attention, we here attempted to replicate findings of lateralized parietal tACS at alpha frequency to induce a change in attention bias away from the contra- towards the ipsilateral visual hemifield. 40 healthy participants underwent tACS in two separate sessions where either 10 Hz tACS or sham was applied via a high-density montage over the left parietal cortex at 1.5 mA for 20 min, while performance was assessed in an endogenous attention task. Task and tACS parameters were chosen to match those of previous studies reporting positive effects. Unlike these studies, we did not observe lateralized parietal alpha tACS to affect attention deployment or visual processing across the hemifields as compared to sham. Likewise, additional resting electroencephalography immediately offline to tACS did not reveal any notable effects on individual alpha power or frequency. Our study emphasizes the need for more replication studies and systematic investigations of the factors that drive tACS effects.