bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes mellitus and endometrial carcinoma: Risk factors and etiological links
Authors: Wang Ya , Zeng Xinling , Tan Jie , Xu Yi , Yi Cunjian
Published: August 2022

The presence of diabetes mellitus (DM) has a critical influence on the occurrence and development of endometrial cancer (EC) and is associated with a poor prognosis. Patients with DM are twice as likely to progress to EC, probably because a high-glucose environment contributes to the growth and invasiveness of EC cells. In this review, we focus on the etiological links between DM and EC and provide an overview of potential biological mechanisms that may account for this relationship, including hyperglycemia, insulin resistance, hyperinsulinemia, glycolysis, chronic inflammation, obesity, and activation of signaling pathways involved in EC. Furthermore, we discuss the pharmacological management of EC associated with DM. Early treatment with metformin is expected to be an effective adjuvant alternative for EC in the future. This knowledge is important for further opening up preventive and therapeutic strategies for EC by targeting glucose metabolism.
Lip cyanosis as the first symptom of Leigh syndrome associated with mitochondrial complex I deficiency due to a compound heterozygous NDUFS1 mutation: A case report
Authors: Men Lina , Feng Jinxing , Huang Weimin , Xu Mingguo , Zhao Xiaoli , Sun Ruixin , Xu Jianfang , Cao Liming
Published: August 2022

Background:

Leigh syndrome (LS) is a rare, progressive, and fatal neurodegenerative disease that occurs mainly in infants and children. Neonatal LS has not yet been fully described.

Methods:

The study design was approved by the ethics review board of Shenzhen Children’s Hospital.

Results:

A 24-day-old full-term male infant presented with a 2-day history of lip cyanosis when crying in September 2021. He was born to nonconsanguineous Asian parents. After birth, the patient was fed poorly. A recurrent decrease in peripheral oxygen saturation and difficulty in weaning from mechanical ventilation during hospitalization were observed. There were no abnormalities on brain magnetic resonance imaging (MRI) or blood and urine organic acid analyses on admission. His lactic acid level increased markedly, and repeat MRI showed symmetrical abnormal signal areas in the bilateral basal ganglia and brainstem with disease progression. Trio whole-exome sequencing revealed 2 heterozygous mutations (c.64C > T [p.R22X] and c.584T > C [p.L195S]) in NDUFS1. Based on these findings, mitochondrial respiratory chain complex I deficiency-related LS was diagnosed. The patient underwent tracheal intubation and mechanical ventilation for respiratory failure. His oxygen saturation levels were maintained at normal levels with partially assisted ventilation. He was administered broad-spectrum antibiotics, oral coenzyme Q10, multivitamins, and idebenone. During hospitalization, the patient developed progressive consciousness impairment and respiratory and circulatory failure. He died on day 30.

Conclusion:

Lip cyanosis is an important initial symptom in LS. Mild upper respiratory tract infections can induce LS and aggravate the disease. No abnormal changes in the brain MRI were observed in the early LS stages in this patient. Multiple MRIs and blood lactic acid tests during disease progression and genetic testing are important for prompt and accurate diagnosis of LS.
Integrative medicine in patients with degenerative arthritis of the knee: A pilot randomized control study
Authors: Kwak Sang Gyu , Jung Hyun Jung , Choi Won-Kee
Published: August 2022

Background:

We aimed to comparatively analyze the effect of integrative medicine treatments (lifestyle change education, use of anti-inflammatory drugs, acupuncture, manual therapy-type massage) and conventional medical treatments (lifestyle change education and use of anti-inflammatory drugs) on pain control, knee function improvement, and quality of life improvement in patients with degenerative knee arthritis.

Methods:

In this study, 30 patients were randomly divided into the control group (n = 15) and the experimental group (n = 15). Both groups were prescribed anti-inflammatory drugs and lifestyle change education for 12 weeks. The experimental group underwent acupuncture including electroacupuncture, moxibustion, and manual therapy-type massage 12 times during the first 6 weeks. Evaluations were performed at 3 visits: visit 1 (before treatment), visit 2 (6 weeks after initial treatment), and visit 3 (12 weeks after initial treatment). The effect of each treatment was measured using Visual Analog Scale (VAS, 0–10), Western Ontario and McMaster Universities index (WOMAC), and SF-36.

Results:

From visit 1 to visit 2, the mean value of VAS decreased by 0.72 and 3.17 in the control and experimental groups, respectively. From visit 2 to visit 3, the mean VAS value decreased by 0.25 in the control group but increased by 0.87 in the experimental group. Among the sub-area of SF-36, the physical role restriction area and mental health area showed significant differences between the 2 groups over time (P = .024, P = .006).

Conclusion:

Integrative medicine treatment has superior effects in pain control over conventional medical treatment. In integrative medicine treatment, pain control tends to decrease with time, but still superior over conventional medical treatment up to 6 weeks after treatment (12 weeks after initial treatment).
Quality of Care for US Adults With Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared With Other Primary Care Settings
Authors: Knitter Alexandra C. , Murugesan Manoradhan , Saulsberry Loren , Wan Wen , Nocon Robert S. , Huang Elbert S. , Bolton Joshua , Chin Marshall H. , Laiteerapong Neda
Published: August 2022

Objective:

The objective of this study was to evaluate indicators of diabetes quality of care for US nonelderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHCs) versus non-FQHCs.

Research Design and Methods:

We analyzed diabetes process measures and acute health services utilization with 2012 US fee-for-service and managed care Medicaid claims in all 50 states and DC. We compared FQHC (N=121,977) to non-FQHC patients (N=700,401) using propensity scores to balance covariates and generalized estimating equation models.

Results:

Overall, laboratory-based process measures occurred more frequently (range, 65.7%–76.6%) than measures requiring specialty referrals (retinal examinations, 33.3%; diabetes education, 3.4%). Compared with non-FQHC patients, FQHC patients had about 3 percentage point lower rates of each process measure, except for higher rates of diabetes education [relative risk=1.09, 95% confidence interval (CI): 1.03–1.16]. FQHC patients had fewer overall [incident rate ratio (IRR)=0.87, 95% CI: 0.86–0.88] and diabetes-related hospitalizations (IRR=0.79, 95% CI: 0.77–0.81), but more overall (IRR=1.06, 95% CI: 1.05–1.07) and diabetes-related emergency department visits (IRR=1.10, 95% CI: 1.08–1.13).

Conclusions:

This national analysis identified opportunities to improve diabetes management among Medicaid enrollees with type 2 diabetes, especially for retinal examinations or diabetes education. Overall, we found slightly lower rates of most diabetes care process measures for FQHC patients versus non-FQHC patients. Despite having higher rates of emergency department visits, FQHC patients were significantly less likely to be hospitalized than non-FQHC patients. These findings emphasize the need to identify innovative, effective approaches to improve diabetes care for Medicaid enrollees, especially in FQHC settings.
Racial/Ethnic Disparities in Substance Use Treatment in Medicaid Managed Care in New York City
Authors: Alegría Margarita , Falgas-Bague Irene , Fukuda Marie , Zhen-Duan Jenny , Weaver Cole , O’Malley Isabel , Layton Timothy , Wallace Jacob , Zhang Lulu , Markle Sheri , Lincourt Pat , Hussain Shazia , Lewis-Fernández Roberto , John Dolly A. , McGuire Thomas
Published: August 2022

Objective:

The aim was to assess the magnitude of health care disparities in treatment for substance use disorder (SUD) and the role of health plan membership and place of residence in observed disparities in Medicaid Managed Care (MMC) plans in New York City (NYC).

Data Source:

Medicaid claims and managed care plan enrollment files for 2015–2017 in NYC.

Research Design:

We studied Medicaid enrollees with a SUD diagnosis during their first 6 months of enrollment in a managed care plan in 2015–2017. A series of linear regression models quantified service disparities across race/ethnicity for 5 outcome indicators: treatment engagement, receipt of psychosocial treatment, follow-up after withdrawal, rapid readmission, and treatment continuation. We assessed the degree to which plan membership and place of residence contributed to observed disparities.

Results:

We found disparities in access to treatment but the magnitude of the disparities in most cases was small. Plan membership and geography of residence explained little of the observed disparities. One exception is geography of residence among Asian Americans, which appears to mediate disparities for 2 of our 5 outcome measures.

Conclusions:

Reallocating enrollees among MMC plans in NYC or evolving trends in group place of residence are unlikely to reduce disparities in treatment for SUD. System-wide reforms are needed to mitigate disparities.
Measuring Equity in the Hospital Setting
Authors: Beckett Megan K. , Hambarsoomian Katrin , Martino Steven C. , Agniel Denis , Hudson Scholle Sarah , Maksut Jessica L. , Mathews Megan , Orr Nate , Elliott Marc N.
Published: August 2022

Background:

Health care quality varies by patient factors, including race-and-ethnicity and preferred language. Addressing inequities requires identifying them and incentivizing equity.

Objectives:

We apply an approach first implemented in the Medicare Advantage setting to measure equity in patient experiences by race-and-ethnicity [Asian American and Native Hawaiian or Pacific Islander (AA and NHPI), Black, Hispanic, vs. White] and language preference (English-preferring vs. another-language-preferring). We identify characteristics of hospitals providing high-quality equitable care.

Research Design:

We estimated, standardized, and combined performance measures into a Health Equity Summary Score (HESS) using 2016–2019 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data. The HCAHPS HESS considered current cross-sectional performance, within-hospital improvement, and overall improvement by race-and-ethnicity and language preference.

Subjects:

A total of 3333 US hospitals with 2019 HCAHPS Star Ratings.

Results:

The HCAHPS HESS was calculable for 44% of hospitals. High-scoring (4–5 diamonds on a 1-diamond to 5-diamond scale) hospitals tended to be smaller than intermediate-scoring [3 diamonds (14% of high-scoring hospitals had <100 beds vs. 7% of intermediate-scoring hospitals, P<0.001) and were less often for-profit (20% vs. 31%, P<0.001)]. While a significant percentage (29%) of patients served by high-scoring hospitals were AA and NHPI, Black, or Hispanic, and 9% were another-language-preferring, there were smaller proportions of Black and Hispanic patients in high-scoring versus other hospitals. HESS performance was negatively associated with the percentage of patients preferring another language to English. HESS scores were moderately correlated with overall Star Ratings (r=0.70).

Conclusions:

The HCAHPS HESS and practices of high-scoring hospitals could promote more equitable patient experiences.
Louisiana Medicaid Expansion and Pent-Up Demand
Authors: Walker Brigham , Zhou Danju , Callison Kevin
Published: August 2022

Background:

Nearly half a million newly eligible people enrolled in Louisiana Medicaid following its expansion.

Objectives:

To evaluate postexpansion utilization trends in Louisiana Medicaid.

Research Design:

We plotted utilization trends for expansion and traditional Medicaid beneficiaries and conducted regression analyses to evaluate differences in monthly trends for over 2 years following expansion.

Subjects:

We restricted our sample to a balanced panel of beneficiaries aged 18–64. The expansion population included beneficiaries who enrolled in the first month of eligibility. The nonexpansion group enrolled at least a year pre-expansion.

Measures:

Monthly office visits, emergency department visits, and inpatient stays per 1000 enrollees, drawn from the Louisiana Medicaid Data Warehouse claims database.

Results:

Compared with trends among traditional Medicaid beneficiaries, expansion beneficiaries utilized 4.59 [P=0.08] more monthly office visits per 1000 enrollees in their first year, increasing to 6.33 [P<0.01] more per month thereafter. Monthly emergency department visit trends were not statistically significantly different in the first year but were 0.71 [P<0.01] monthly visits lower for expansion beneficiaries thereafter. Trends in monthly inpatient stays were 0.23 [P=0.02] stays per 1000 enrollees higher in the first year for expansion beneficiaries but were not statistically significantly different thereafter.

Conclusions:

Louisiana Medicaid expansion beneficiaries experienced lower initial rates of office visits compared with traditional Medicaid beneficiaries, but these rates consistently increased over the first 2 years after expansion. The expansion population had uniformly higher levels of emergency department and inpatient visits throughout the study period. After the first postexpansion year, emergency department visits among expansion beneficiaries fell relative to traditional beneficiaries while inpatient utilization trends leveled off after an initial increase.
Effect of the 2012 US Preventive Services Task Force Recommendations on Prostate-Specific Antigen Screening in a Medicare Advantage Population
Authors: Zhu Yingying , Koethe Benjamin , Ollendorf Daniel A. , Wong John B. , Neumann Peter J. , Kim David D.
Published: August 2022

Background:

In 2012, the US Preventive Service Task Force revised its recommendations for prostate-specific antigen (PSA) screening from “insufficient evidence” to “do not recommend” for men aged 70–74 while maintaining “do not recommend” for men aged 75+.

Methods:

Using the difference-in-difference approach, we evaluated whether the rate of change in the use of low-value PSA screening differed between the control group (men aged 75+, N=7,856,204 person–years) and the intervention group (men aged 70–74, N=5,329,192 person–years) enrolling in the Medicare Advantage plan without a history of prostate cancer within the OptumLabs Data Warehouse claims data (2009–2019). A generalized estimating equation logistic model was specified with independent variables: an intervention group indicator, a pre- and post-period (after 2012 Q2) indicator, index time, and interaction terms. We assumed a 12-month dissemination period.

Results:

Before the revised recommendation in 2012, the trends did not significantly differ between the 2 age groups with the odds of receiving PSA screening decreasing by 1.2% (95% confidence interval [1.0, 1.4%]) per quarter. However, the odds of receiving PSA screening increased by 3.0% [2.8, 3.2%] per quarter across both groups since the revision. There was no significant additional change in the trend for those aged 70–74 (0.1% [−0.2, 0.5%]).

Conclusions:

Although the 2012 US Preventive Service Task Force’s recommendations were expected to only change behaviors among men aged 70–74, our analysis found that men aged 70–74 and aged 75+ exhibited similar trends from 2009 to 2019, including the increased use of low-value PSA screening since 2016. Multifaceted efforts to discourage low-value PSA screening would be important for a sustained impact.
Ovarian Signet-ring Stromal Tumor
Authors: Tchrakian Nairi , Oliva Esther , Chong Anne-Sophie , Rivera-Polo Barbara , Bennett Jennifer A. , Nucci Marisa R. , Sah Shatrughan , Schoolmeester J. Kenneth , van der Griend Rachael A. , Foulkes William D. , Clarke Blaise A. , Young Robert H. , McCluggage W. Glenn
Published: August 2022

Signet-ring stromal tumor (SRST) is a rare ovarian stromal neoplasm characterized by a population of bland signet-ring cells, devoid of mucin or lipid, in a generally cellular fibromatous stroma. Previous reports have described heterogenous immunohistochemical and molecular genetic findings, including occasional nuclear β-catenin expression and/or CTNNB1 mutations. We report 10 ovarian stromal neoplasms originally diagnosed as SRST. All but 1 tumor underwent detailed immunohistochemical analysis (including β-catenin) and 5 of 10 had CTNNB1 mutation analysis performed. All tumors contained a population of morphologically bland signet-ring cells that ranged from 15% to 95% of the neoplasm, characterized by a single large empty intracytoplasmic vacuole, mostly with nuclear indentation. Six of the 10 tumors contained cellular fibroma-like areas, comprising from 10% to 85% of the neoplasm. Three of the 10 tumors were reclassified as microcystic stromal tumor with signet-ring cells on the basis of the microcyst formation and hyalinized stroma, beta-catenin and cyclin D1 nuclear expression and/or CTNNB1 mutation, CD10 staining and largely absent expression of inhibin and calretinin. In the remaining 7 tumors, the diagnosis of SRST remained, constituting the largest series of SRST reported in the literature to date. The results of our study suggest that a subset of tumors diagnosed as ovarian SRST, especially those which show β-catenin nuclear positivity and/or CTNNB1 mutation, likely represent microcystic stromal tumor with variant morphology. We also suggest that at least a subset of SRSTs without evidence of Wnt/β-catenin pathway abnormalities may be related to ovarian fibromas. We discuss the differential diagnosis of ovarian neoplasms containing signet-ring cells.
A Core Outcome Measurement Set for Pediatric Critical Care*
Authors: Pinto Neethi P. , Maddux Aline B. , Dervan Leslie A. , Woodruff Alan G. , Jarvis Jessica M. , Nett Sholeen , Killien Elizabeth Y. , Graham Robert J. , Choong Karen , Luckett Peter M. , Heneghan Julia A. , Biagas Katherine , Carlton Erin F. , Hartman Mary E. , Yagiela Lauren , Michelson Kelly N. , Manning Joseph C. , Long Debbie A. , Lee Jan Hau , Slomine Beth S. , Beers Sue R. , Hall Trevor , Morrow Brenda M. , Meert Kathleen , Arias Lopez Maria del Pilar , Knoester Hennie , Houtrow Amy , Olson Lenora , Steele Lisa , Schlapbach Luregn J. , Burd Randall S. , Grosskreuz Ruth , Butt Warwick , Fink Ericka L. , Watson R. Scott ,   for the POST-PICU Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)
Published: August 2022

Objectives:

To identify a PICU Core Outcome Measurement Set (PICU COMS), a set of measures that can be used to evaluate the PICU Core Outcome Set (PICU COS) domains in PICU patients and their families.

Design:

A modified Delphi consensus process.

Setting:

Four webinars attended by PICU physicians and nurses, pediatric surgeons, rehabilitation physicians, and scientists with expertise in PICU clinical care or research (n = 35). Attendees were from eight countries and convened from the Pediatric Acute Lung Injury and Sepsis Investigators Pediatric Outcomes STudies after PICU Investigators and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network PICU COS Investigators.

Subjects:

Measures to assess outcome domains of the PICU COS are as follows: cognitive, emotional, overall (including health-related quality of life), physical, and family health. Measures evaluating social health were also considered.

Interventions:

None.

Measurements and Main Results:

Measures were classified as general or additional based on generalizability across PICU populations, feasibility, and relevance to specific COS domains. Measures with high consensus, defined as 80% agreement for inclusion, were selected for the PICU COMS. Among 140 candidate measures, 24 were delineated as general (broadly applicable) and, of these, 10 achieved consensus for inclusion in the COMS (7 patient-oriented and 3 family-oriented). Six of the seven patient measures were applicable to the broadest range of patients, diagnoses, and developmental abilities. All were validated in pediatric populations and have normative pediatric data. Twenty additional measures focusing on specific populations or in-depth evaluation of a COS subdomain also met consensus for inclusion as COMS additional measures.

Conclusions:

The PICU COMS delineates measures to evaluate domains in the PICU COS and facilitates comparability across future research studies to characterize PICU survivorship and enable interventional studies to target long-term outcomes after critical illness.
Association Between Centralization and Outcome for Children Admitted to Intensive Care in Australia and New Zealand: A Population-Based Cohort Study*
Authors: Slater Anthony , Beca John , Croston Elizabeth , McEniery Julie , Millar Johnny , Norton Lynda , Numa Andrew , Schell David , Secombe Paul , Straney Lahn , Young Paul , Yung Michael , Gabbe Belinda , Shann Frank ,   for the Australian and New Zealand Intensive Care Society Pediatric Study Group and Centre for Outcomes and Resource Evaluation
Published: August 2022

Objectives:

To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs).

Design:

A retrospective cohort study using registry data for two epochs of ICU admissions, 2003–2005 and 2016–2018.

Setting:

Population-based study in ANZ.

Patients:

A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded.

Interventions:

None.

Measurements and Main Results:

The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42–0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05–2.53 for all admissions; 1.73, CI, 1.002–3.00 for high-risk admissions).

Conclusions:

Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.
Factors Associated With Mechanical Ventilation Duration in Pediatric Burn Patients in a Regional Burn Center in the United States*
Authors: Garren Benjamin N. , Akhondi-Asl Alireza , DePamphilis Matthew A. , Burns Jeffrey P. , Sheridan Robert L.
Published: August 2022

Objectives:

Among burned children who arrive at a burn center and require invasive mechanical ventilation (IMV), some may have prolonged IMV needs. This has implications for patient-centered outcomes as well as triage and resource allocation decisions. Our objective was to identify factors associated with the duration of mechanical ventilation in pediatric patients with acute burn injury in this setting.

Design:

Single-center, retrospective cohort study.

Setting:

Registry data from a regional, pediatric burn center in the United States.

Patients:

Children less than or equal to 18 years old admitted with acute burn injury who received IMV between January 2005 and December 2020.

Interventions:

None.

Measurements and Main Results:

Ventilator days were defined as any full or partial day having received IMV via an endotracheal tube or tracheostomy, not inclusive of time spent ventilated for procedures. Of 5,766 admissions for acute burn care, 4.3% (n = 249) required IMV with a median duration of 10 days. A multivariable model for freedom from mechanical ventilation showed that the presence of inhalational injury (subhazard ratio [sHR], 0.62; 95% CI, 0.46–0.85) and burns to the head and neck region (sHR, 0.94; 95% CI, 0.90–0.98) were associated with increased risk of remaining mechanically ventilated at any time point. Older (sHR, 1.03; 95% CI, 1.01–1.04) and male children (sHR, 1.39; 95% CI, 1.05–1.84) were more likely to discontinue mechanical ventilation. A majority of children (94.8%) survived to hospital discharge.

Conclusions:

The presence of inhalational injury and burns to the head and neck region were associated with a longer duration of mechanical ventilation. Older age and male gender were associated with a shorter duration of mechanical ventilation. These factors should help clinicians better estimate a burned child’s expected trajectory and resource-intensive needs upon arrival to a burn center.
The Effect of Center Esophagectomy Volume on Outcomes in Clinical Stage I to III Esophageal Cancer
Authors: Rhodin Kristen E. , Raman Vignesh , Jensen Christopher W. , Kang Lillian , Harpole David H. , D’Amico Thomas A. , Tong Betty C.
Published: August 2022

Objective:

To determine the threshold annualized esophagectomy volume that is associated with improved survival, oncologic resection, and postoperative outcomes.

Background:

Esophagectomy at high-volume centers is associated with improved outcomes; however, the definition of high-volume remains debated.

Methods:

The 2004 to 2016 National Cancer Database was queried for patients with clinical stage I to III esophageal cancer undergoing esophagectomy. Center esophagectomy volume was modeled as a continuous variable using restricted cubic splines. Maximally selected ranks were used to identify an inflection point of center volume and survival. Survival was compared using multivariable Cox proportional hazards methods. Multivariable logistic regression was used to examine secondary outcomes.

Results:

Overall, 13,493 patients met study criteria. Median center esophagectomy volume was 8.2 (interquartile range: 3.2–17.2) cases per year. On restricted cubic splines, inflection points were identified at 9 and 30 cases per year. A multivariable Cox model was constructed modeling annualized center surgical volume as a continuous variable using 3 linear splines and inflection points at 9 and 30 cases per year. On multivariable analysis, increasing center volume up to 9 cases per year was associated with a substantial survival benefit (hazard ratio: 0.97, 95% confidence interval, 0.95–0.98, P≤0.001). On multivariable logistic regression, factors associated with undergoing surgery at a high-volume center (>9 cases per year) included private insurance, care at an academic center, completion of high school education, and greater travel distance.

Conclusions:

This National Cancer Database study utilizing multivariable analysis and restricted cubic splines suggests the threshold definition of a high-volume esophagectomy center as one that performs at least 10 operations a year.
Perioperative management of pressure injury: a best practice implementation project
Authors: Menšíková Andrea , Klugarová Jitka , Klugar Miloslav , Menšík Ivo , Soukopová Žaneta , Pokorná Andrea
Published: August 2022

Objectives:

This project aimed to set up a control mechanism for the prevention of pressure injuries during surgery.

Introduction:

Structured and comprehensive risk assessment is effective in identifying individuals at risk for pressure injuries. The subsequent use of proper positioning aids (modern gel-filled positioning aids used to position the head and limbs: floating limb concept) reduces the incidence of surgery-related pressure injuries.

Methods:

The best practice implementation project used the JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in local healthcare practice. The study was carried out from January 2020 to February 2021 at the private clinic of aesthetic surgery (Brno, Czech Republic). A baseline audit involving 27 patients was undertaken and measured against six best practice recommendations. This step was followed by the implementation of targeted strategies and finally, a postimplementation follow-up audit was conducted.

Results:

The baseline audit results showed significant deficits between current practice and best practice in all but two criteria. Barriers to implementation of nursing clinical handover best practice criteria were identified by the project team and an education strategy was implemented, documentation for recording possible risks of pressure injuries was created, and new positioning aids were purchased and introduced into clinical practice. There were significantly improved outcomes across all best practice criteria in the follow-up audit.

Conclusion:

Clinical audits were proved to promote best practice in healthcare. Focused education, provision, and use of relevant tools and aids can have an immediate and positive impact on clinical practice. Future audits are planned to ensure the sustainability of practice changes.
Administration of chemotherapy in patients admitted to a haematology service: a best practice implementation project
Authors: Coutinho Verónica Rita Dias , Santos Cristina Maria de Oliveira , Rodrigues Catarina Isabel , Santos Catarina Isabel Geraldes , Apóstolo João Luis Alves , Cardoso Daniela Filipa Baptista , Klugarova Jitka , Klugar Miloslav
Published: August 2022

Objectives:

To promote evidence-based practices related to the prevention of adverse events associated with medication administration (only chemotherapy) in a hospital service.

Introduction:

The medication management process in a hospital setting is highly complex, going through multiple stages from drug selection, procurement and storage, to prescription, validation, dispensing, preparation, administration and monitoring.

Methods:

An evidence implementation project based on an audit and feedback approach was conducted from December 2019 to April 2021 using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice.

Results:

The results of the baseline audit showed that the 10 audit criteria were mostly met; however, two of the criteria (criterion 6: the expiry date of medication is checked before use and criterion 7: the nurse who prepares the medication administers the medication to the patient) had low compliance (respectively, 0 and 67.9%). After identifying the barriers and implementing strategies to deal with the identified barriers, we verified a significant improvement in compliance with best practices (criterion 6 improved to 64.3% and criterion 7 to 78.6%).

Conclusion:

This implementation project was a success, achieving a great improvement of the implementation of evidence-based guidelines concerning the prevention of adverse events associated with medication administration in a hospital in central Portugal. More such projects should be planned to sustain the implementation of evidence-based methods to improve health outcomes, patient safety, costs and health systems.
A systematic review of clinical health conditions predicted by machine learning diagnostic and prognostic models trained or validated using real-world primary health care data
Authors: Abdulazeem Hebatullah , Whitelaw Sera , Schauberger Gunther , Klug Stefanie J.
Published: August 2022

Aim

With the rapid advances in technology and data science, machine learning (ML) is being adopted by the health care sector; but there is a lack of literature addressing the health conditions targeted by the ML prediction models within primary health care (PHC). To fill this gap in knowledge, we conducted a systematic review following the PRISMA guidelines to identify the health conditions targeted by ML in PHC.

Methods

We searched the Cochrane Library, Web of Science, PubMed, Elsevier, BioRxiv, Association of Computing Machinery (ACM), and IEEE Xplore databases for studies published from January 1990 to January 2022. We included any primary study addressing ML diagnostic or prognostic predictive models that were supplied completely or partially by real-world PHC data. We performed literature screening, data extraction, and risk of bias assessment. Health conditions were categorized according to international classification of diseases. Extracted date were analyzed quantitatively and qualitatively.

Results

We identified 109 studies investigating 42 health conditions. These studies included 273 ML prediction models supplied by the PHC data of 24.2 million participants from 19 countries. We found that 82% of the studies were retrospective. 76.6% of the studies reported diagnostic predictive ML models. 77% of all reported models aimed for models’ development without external validation. Risk of bias assessment revealed that 90.8% of the studies were of high or unclear risk of bias. The most frequently reported health conditions were Alzheimer’s disease and diabetes mellitus.

Conclusions

To the best of our knowledge, this is the first review to investigate the extent of the health conditions targeted by the ML prediction models within PHC settings. Our study provides an important summary on the presently available ML models in PHC, which can be used in further research and implementation efforts.
How Important Are Study Designs? A Simulation Assessment of Vaccine Effectiveness Estimation Bias with Time-Varying Vaccine Coverage, and Heterogeneous Testing and Baseline Attack Rates
Authors: Suah Jing Lian , Bar-Zeev Naor , Knoll Maria Deloria
Published: August 2022

Objective

We studied how commonly used vaccine effectiveness (VE) study designs (variations of cohorts, and test-negative designs) perform under epidemiological nuances more prominent in the COVID-19 era, specifically time-varying vaccine coverage, and heterogeneous testing behaviour and baseline attack rates with selection on willingness to vaccinate.

Methodology

We simulated data from a multi-parameter conceptual model of the epidemiological environment using 888125 parameter sets. Four configurations of cohorts, and two test-negative designs, were conducted on the simulated data, from which estimation bias is computed. Finally, stratified and fixed effects linear regressions were estimated to quantify the sensitivity of estimation bias to model parameters.

Findings

Irrespective of study designs, dynamic vaccine coverage, and heterogeneous testing behaviour and baseline attack rates are important determinants of bias. Study design choices have non-trivial effects on VE estimation bias even if these factors are absent. The importance of these sources of bias differ across study designs.

Conclusion

A re-benchmarking of methodology, especially for studying COVID-19 VE, and implementation of vaccine-preventable disease surveillance systems that minimise these sources of bias, are warranted.

Highlights

This paper simulated a theoretical model with frictions in vaccination, testing, baseline disease risks, and heterogeneous vaccine effectiveness to evaluate estimation bias across four cohort and two test-negative designs.

In theory, bias depends on behavioural asymmetries (in testing, and baseline risk) between the vax-willing and vax-unwilling, and the speed of vaccination rollout.

There is intrinsic estimation bias across all study designs, with the direction and magnitude contingent on specific conditions.

In scenarios that may be reflective of past SARS-CoV-2 waves, the degree of bias can be substantial, attributable to variation in assumed testing and baseline risk frictions.

A regression-based decomposition indicates that study designs have visibly different primary sources of estimation bias, and degree of robustness in general.

This study warrants a re-benchmarking of methodology and reporting checklists for VE research, and informs the design of cost-effective surveillance by quantifying part of the bias-implementation cost trade-off.
Identifiability and inference of phylogenetic birth-death models
Authors: Legried Brandon , Terhorst Jonathan
Published: August 2022

Recent theoretical work on phylogenetic birth-death models offers differing viewpoints on whether they can be estimated using lineage-through-time data. Louca and Pennell (2020) showed that the class of models with continuously differentiable rate functions is nonidentifiable: any such model is consistent with an infinite collection of alternative models, which are statistically indistinguishable regardless of how much data are collected. Legried and Terhorst (2022a) qualified this grave result by showing that identifiability is restored if only piecewise constant rate functions are considered.

Here, we contribute new theoretical results to this discussion, in both the positive and negative directions. Our main result is to prove that models based on piecewise polynomial rate functions of any order and with any (finite) number of pieces are statistically identifiable. In particular, this implies that spline-based models with an arbitrary number of knots are identifiable. The proof is simple and self-contained, relying mainly on basic algebra. We complement this positive result with a negative one, which shows that even when identifiability holds, rate function estimation is still a difficult problem. To illustrate this, we prove some rates-of-convergence results for hypothesis testing using birth-death models. These results are information-theoretic lower bounds which apply to all potential estimators.
A Spatiotemporal History of Key San Francisco Estuary Pelagic Fish Species
Authors: Stompe Dylan K. , Moyle Peter B. , Oken Kiva L. , Hobbs James A. , Durand John R.
Published: August 2022

Estuaries across the globe have been subject to extensive abiotic and biotic changes and are often monitored to track trends in species abundance. The San Francisco Estuary is a novel ecosystem that has been deeply altered by anthropogenic factors, resulting in fish declines over the past 100 years. To track these species declines, a patchwork of monitoring programs has operated regular fish surveys dating back to the late 1950s. While most of these surveys are designed to track population-scale changes in fish abundance, they are methodologically distinct, with different target species, varying spatial coverage and sample frequency, and differing gear types. To remediate for individual survey limitations, we modeled pelagic fish distributions with integrated data from many sampling programs. We fit binomial generalized linear mixed models with spatial and spatiotemporal random effects to map annual trends in the distribution of detection probabilities of striped bass, Delta smelt, longfin smelt, threadfin shad, and American shad for the years 1980 to 2017. Detection probabilities decreased dramatically for these fishes in the Central and South Delta, especially after the year 2000. In contrast, Suisun Marsh, one of the largest tidal marshes on the west coast of the United States, acted as a refuge habitat with reduced levels of decline or even increased detection probabilities for some species. Our modeling approach demonstrates the power of utilizing disparate datasets to identify regional trends in the distribution of estuarine fishes.
The western redcedar genome reveals low genetic diversity in a self-compatible conifer
Authors: Shalev Tal J. , Gamal El-Dien Omnia , Yuen Macaire M.S. , Shengqiang Shu , Jackman Shaun D. , Warren René L. , Coombe Lauren , van der Merwe Lise , Stewart Ada , Boston Lori B. , Plott Christopher , Jenkins Jerry , He Guifen , Yan Juying , Yan Mi , Guo Jie , Breinholt Jesse W. , Neves Leandro G. , Grimwood Jane , Rieseberg Loren H. , Schmutz Jeremy , Birol Inanc , Kirst Matias , Yanchuk Alvin D. , Ritland Carol , Russell John H. , Bohlmann Joerg
Published: August 2022

We assembled the 9.8 Gbp genome of western redcedar (WRC, Thuja plicata), an ecologically and economically important conifer species of the Cupressaceae. The genome assembly, derived from a uniquely inbred tree produced through five generations of self-fertilization (selfing), was determined to be 86% complete by BUSCO analysis – one of the most complete genome assemblies for a conifer. Population genomic analysis revealed WRC to be one of the most genetically depauperate wild plant species, with an effective population size of approximately 300 and no significant genetic differentiation across its geographic range. Nucleotide diversity, π, is low for a continuous tree species, with many loci exhibiting zero diversity, and the ratio of π at zero-to four-fold degenerate sites is relatively high (∼ 0.33), suggestive of weak purifying selection. Using an array of genetic lines derived from up to five generations of selfing, we explored the relationship between genetic diversity and mating system. While overall heterozygosity was found to decline faster than expected during selfing, heterozygosity persisted at many loci, and nearly 100 loci were found to deviate from expectations of genetic drift, suggestive of associative overdominance. Non-reference alleles at such loci often harbor deleterious mutations and are rare in natural populations, implying that balanced polymorphisms are maintained by linkage to dominant beneficial alleles. This may account for how WRC remains responsive to natural and artificial selection, despite low genetic diversity.
Supramodal representation of the sense of body ownership in the human parieto-premotor and extrastriate cortices
Authors: Sonobe Yusuke , Yamagata Toyoki , Yang Huixiang , Haruki Yusuke , Ogawa Kenji
Published: August 2022

The sense of body ownership, defined as the sensation that one’s body belongs to oneself, is a fundamental component of bodily self-consciousness. Several studies have shown the importance of multisensory integration for the emergence of the sense of body ownership, together with the involvement of the parieto-premotor and extrastriate cortices in bodily awareness. However, whether the sense of body ownership elicited by different sources of signal, especially visuotactile and visuomotor inputs, is represented by common neural patterns remains to be elucidated. We used functional magnetic resonance imaging (fMRI) to investigate the existence of neural correlates of the sense of body ownership independent of the sensory modalities. Participants received tactile stimulation or executed finger movements while given synchronous and asynchronous visual feedback of their hand. We used multi-voxel patterns analysis (MVPA) to decode the synchronous and asynchronous conditions with cross-classification between two modalities: the classifier was first trained in the visuotactile sessions and then tested in the visuomotor sessions and vice versa. Regions of interest-based and searchlight analyses revealed significant above-chance cross-classification accuracies in the bilateral intraparietal sulcus (IPS), the bilateral ventral premotor cortex (PMv), and the left extrastriate body area (EBA). Moreover, we observed a significant positive correlation between the cross-classification accuracy in the left PMv and the difference in subjective ratings of the sense of body ownership between the synchronous and asynchronous conditions. Our findings revealed the neural representations of the sense of body ownership in the IPS, PMv, and EBA that is invariant to the sensory modalities.

Significance Statement

Previous studies have shown neural correlates of the sense of body ownership in parieto-premotor and extrastriate cortices. However, whether the sense of body ownership induced by different sensory inputs is represented in common neural patterns remains unelucidated. Using functional magnetic resonance imaging (fMRI) with multi-voxel pattern analysis (MVPA), we investigated neural representations of the sense of body ownership invariant to modalities. Decoding neural patterns for visuotactile and visuomotor modalities revealed successful cross-classification accuracies in intraparietal sulcus (IPS), ventral premotor cortex (PMv), and extrastriate body area (EBA). Furthermore, cross-classification accuracy in PMv was positively correlated with subjective ratings of the sense of body ownership. These findings demonstrate that supramodal representations in parieto-premotor and extrastriate cortices underlie the sense of body ownership.
Exceeding expectations: the genomic basis of nitrogen utilization efficiency and integrated trait plasticity as avenues to improve nutrient stress tolerance in cultivated sunflower (Helianthus annuusL.)
Authors: Temme Andries A. , Kerr Kelly L. , Nolting Kristen M. , Dittmar Emily L. , Masalia Rishi R. , Bucksch Alexander , Burke John M. , Donovan Lisa A.
Published: August 2022

Maintaining crop productivity is a challenge as population growth, climate change, and increasing fertilizer costs necessitate expanding crop production to poorer lands whilst reducing inputs. Enhancing crops’ nutrient use efficiency is thus an important goal, but requires a better understanding of related traits and their genetic basis.

We investigated variation in low nutrient stress tolerance in a diverse panel of cultivated sunflower genotypes grown under high and low nutrient conditions, assessing relative growth rate (RGR) as performance. We assessed variation in traits related to nitrogen utilization efficiency (NUtE), mass allocation, and leaf elemental content.

Across genotypes, nutrient limitation reduced RGR. Moreover, higher vigor (higher control RGR) was associated with a greater absolute decrease under stress. Given this trade-off, we focused on nutrient stress tolerance independent from vigor. This tolerance metric correlated with the change in NUtE, plasticity for a suite of morphological traits, and leaf element content. Genome-wide association analyses revealed regions associated with variation and plasticity in multiple traits, including two key regions with ostensibly additive effects on NUtE change.

Our results demonstrate potential avenues for improving sunflower nutrient stress tolerance independent from vigor and highlight specific traits and genomic regions that could play a role in enhancing tolerance.

Highlight

Genetic associations and trait correlations show that, in cultivated sunflower, selection for increased nitrogen utilization efficiency and plasticity in key traits is a promising avenue for increasing nutrient stress tolerance.