bluuebunny/crossref_metadata_2025_split huggingface dataset:
The importance of understanding and measuring health system structural, functional, and clinical integration
Authors: Ridgely M. Susan , Buttorff Christine , Wolf Laura J. , Duffy Erin Lindsey , Tom Ashlyn K. , Damberg Cheryl L. , Scanlon Dennis P. , Vaiana Mary E. 
Published: December 2020

AbstractObjectiveWe explore if there are ways to characterize health systems—not already revealed by secondary data—that could provide new insights into differences in health system performance. We sought to collect rich qualitative data to reveal whether and to what extent health systems vary in important ways across dimensions of structural, functional, and clinical integration.Data SourcesInterviews with 162 c‐suite executives of 24 health systems in four states conducted through “virtual” site visits between 2017 and 2019.Study DesignExploratory study using thematic comparative analysis to describe factors that may lead to high performance.Data CollectionWe used maximum variation sampling to achieve diversity in size and performance. We conducted, transcribed, coded, and analyzed in‐depth, semi‐structured interviews with system executives, covering such topics as market context, health system origin, organizational structure, governance features, and relationship of health system to affiliated hospitals and POs.Principal FindingsHealth systems vary widely in size and ownership type, complexity of organization and governance arrangements, and ability to take on risk. Structural, functional, and clinical integration vary across systems, with considerable activity around centralizing business functions, aligning financial incentives with physicians, establishing enterprise‐wide EHR, and moving toward single signatory contracting. Executives describe clinical integration as more difficult to achieve, but essential. Studies that treat “health system” as a binary variable may be inappropriately aggregating for analysis health systems of very different types, at different degrees of maturity, and at different stages of structural, functional, and clinical integration. As a result, a “signal” indicating performance may be distorted by the “noise.”ConclusionsDeveloping ways to account for the complex structures of today's health systems can enhance future efforts to study systems as complex organizations, to assess their performance, and to better understand the effects of payment innovation, care redesign, and other reforms.
Evolution of the home health care market: The expansion and quality performance of multi‐agency chains
Authors: Geng Fangli , Mansouri Sarah , Stevenson David G. , Grabowski David C. 
Published: December 2020

AbstractObjectiveTo examine the growth and evolution of the home health agency (HHA) market and to compare quality performance across HHA ownership categories.Data SourceAgency characteristics were extracted from Medicare cost reports and Provider of Services file. Quality of care and patient characteristics were extracted from Quality of Patient Care Star Ratings and HHA Public Use File.Study DesignAgency‐ and state‐level analyses were conducted to describe HHA market trends. Patient characteristics and quality measures were compared across ownership categories of interest.Data Collection/Extraction MethodsAll Medicare‐certified HHAs in operation, 2005‐2018.Principal FindingsOver the study period, the HHA sector grew substantially, increasing from 7899 to 10 818 agencies, and chain‐owned HHAs doubled in number from 903 (11.4% of all agencies) to 1841 (17.0%). In 2018, across agency types, for‐profit nonchain agencies were the largest category both in the number of agencies (67.8%) and the number of Medicare enrollees served (40.7%). Additionally, for‐profit nonchain agencies grew most in total number, from 4293 (54.3%) to 7337 (67.8%), while for‐profit chain agencies grew most in the number of Medicare enrollees served, from 439 998 (12.9%) to 1 082 385 (28.3%). Regarding patient composition, for‐profit nonchain agencies served the highest proportion of dual eligible beneficiaries (42.2%) and African‐Americans (27.9%) among all agency types. Regarding quality performance, a higher star rating is significantly (P < .01) associated with chain agency status. Moreover, chain HHAs performed better on self‐reported process measures, and risk‐adjusted self‐reported outcome measures; however, they performed worse on risk‐adjusted claims‐based outcome measures. These results were similar across for‐profit and nonprofit chain agencies.ConclusionChains play a growing role in the home health sector. Substantial differences in geographic distribution, patient composition, and quality performance were observed between chain‐ and nonchain HHAs. Examining the growth and performance of multi‐agency chains can help inform quality reporting and monitoring, assess payment adequacy, and facilitate greater transparency and accountability within the HHA marketplace.
Technological Change in Dairy Farming with Increased Price Volatility
Authors: Frick Fabian , Sauer Johannes 
Published: December 2020

AbstractAccompanied by steps towards market liberalisation, dairy farmers in the European Union have been confronted with increased price risk in recent years, which might affect their innovation behaviour. We examine technological change and technical efficiency of specialised dairy farms in West Germany before and during a phase of volatile milk prices. Additionally, we compare the results with mixed dairy farms, which might have an advantage by diffusing price risk through diversification. Our results indicate a slowdown in technological change in specialised as well as in mixed dairy farming coinciding with the start of a volatile market phase.
The effects of dithiothreitol (DTT) on fluorescent qPCR dyes
Authors: Hudson Brittany C. , Cox Jordan O. , Seashols‐Williams Sarah J. , Dawson Cruz Tracey 
Published: December 2020

AbstractDNA extractions of semen samples commonly utilize dithiothreitol (DTT) to reduce and disrupt disulfide bonds. Although traditional extraction techniques remove DTT before downstream analyses, the forensic DNA community has recently explored Y‐screening, direct amplification, and direct cell lysis assays that omit purification but employ reducing agents to lyse spermatozoa. This study examined the impact of residual DTT on downstream processes involving fluorescent dyes. Quantification using Investigator® Quantiplex HYres revealed a significant increase in the male DNA yield (p = 0.00056) and a >150,000,000‐fold increase in the male:human DNA ratio when DTT remained in extracts versus when it was filtered out using a traditional purification method. When DTT was present with Quantifiler™ Trio, the true mean DNA yield for the large autosomal target significantly increased (p = 0.038) and the average reported DNA yields increased 1.1‐fold, >9.5‐fold, and 1.3‐fold for the small autosomal, large autosomal, and male targets, respectively. DTT‐spiked DNA standards from both kits were impacted similarly to samples with residual DTT, demonstrating that observed effects were related to DTT and not the extraction method. This study corroborates other reports that DTT adversely affects multiple dyes (e.g., Cy5, Quasar 670, SYBR Green I, TMR, and Mustang Purple®). Overall, DTT causes inaccurate quantities and, consequently, inaccurate calculated male:female ratios when used in conjunction with these kits. Thus, implementation of newer direct‐to‐PCR assays incorporating DTT should either be avoided or used only with carefully evaluated, compatible dyes.
Degrees of contrast: Detection of latent bloodstains on fabric using an alternate light source (ALS) and the effects of washing
Authors: James Matthew E. 
Published: December 2020

AbstractBlood is often a piece of evidence of violent crimes and will often be on the perpetrator's clothing. If the perpetrator is wearing dark clothing, it can be easily identified by chemical means such as Bluestar®, but this can destroy the pattern, which may be evidentiary itself. This study explores the use of alternate light source (ALS) to photograph bloodstains on dark and/or patterned fabrics to provide an alternate, noninvasive tool before the use of chemical detection techniques. Sixty‐nine (69) unwashed fabrics, of various dark colored and dark patterns, were photographed in monochrome under ambient light and subsequently with and without a filter under ultraviolet (UV), violet, blue, green, and infrared light. This study used ImageJ to measure the contrast between the bloodstain and the fabric and thus the effectiveness of each wavelength. Each fabric was washed, photographed, and analyzed five times or until the bloodstain was no longer visible under ALS. Results indicated photography with ALS was a viable method for blood detection on fabrics and should be used prior to chemical means. Further, infrared, followed by violet light with no filter, was the most effective light source for viewing bloodstains on dark fabrics without the use of chemicals. However, these wavelengths were not effective on military uniforms. This study also described one effect fabric manufacturer chemical treatments have on bloodstains and the effect of washing fabrics with bloodstains.
Exploring the highs and lows of very low carbohydrate high fat diets on weight loss and diabetes‐ and cardiovascular disease‐related risk markers: A systematic review
Authors: Ross Lynda J. , Byrnes Angela , Hay Robin L. , Cawte Andrea , Musial Jane E. 
Published: December 2020

AbstractAimVery low carbohydrate high fat diets (VLCHF) are increasingly popular for weight loss and diabetes management, but the risk implications of long‐term adherence to a high‐fat‐diet remain unclear, especially in high‐risk populations. This review aimed to examine adherence, weight loss, diabetes‐ and cardiovascular disease (CVD)‐related risk markers in adults consuming VLCHF diets.MethodsOnline databases were searched for randomised controlled trials ≥3 months duration that met a pre‐defined macronutrient prescription: VLCHF ≤25%E carbohydrate, >35%E fat; low fat (LF) ≥45%E carbohydrate, ≤30%E fat; and reported energy, saturated fat (SFA), weight, blood glucose, cholesterol and blood pressure (BP). Studies were excluded if the macronutrient prescription was not targeted (n = 32); not met (n = 17) or not reported (n = 13).ResultsEight studies included: 1217 commenced; 922 completed overweight and obese adults. Diets were isocaloric moderately energy‐restricted, closely monitored with ongoing support from dietitians, physicians, and/or nurses. Four studies reported non‐adherence beyond 3 months (n = 3) and 6 months (n = 1) despite interventions of 12, 15 and 24 months. VLCHF diets were high in fat and SFA (fat 49%‐56%E; SFA 11%‐21%E) compared to LF diets (fat 13%‐29%E; SFA 5%‐11%E). All groups achieved significant weight loss and improvements in BP and blood glucose. LDL‐C reduction favoured LF, P < .05; increased HDL‐C and reduced triglyceride levels favoured VLCHF, P < .05.ConclusionsVLCHF and LF diets with moderate energy restriction demonstrate similar weight loss and improvements to BP to 3 months. However, adherence is likely poor without intensive support from health professionals. Dietary SFA should be monitored to ensure recommended intakes, but longer‐term studies with high adherence are required to confirm the level of CVD‐risk and potential harms.
The Overseen and Unseen: Agribusiness Plantations, Indigenous Labor, and Land Struggle in Brazil
Authors: Sullivan LaShandra 
Published: December 2020

ABSTRACTThis article analyzes the land conflict between plantation owners and indigenous activists in Mato Grosso do Sul, Brazil, by ethnographically tracing the role of state‐issued identification and work documents in the subjugation of Indigenous laborers. Some state agencies contradictorily attempt to protect rural workers via the proliferation of such documents. In practice, this serves only to invisibly bind Indigenous workers to networks of local strongmen, who effectively operate as their overseers. As such, work documents facilitate new, but familiar, forms of exploitation of racialized labor. These circumstances are part of the impetus and logic of Indigenous land protesters’ “occupation” of agribusiness plantations. Activists seek to reclaim land as a counter to historical and ongoing conditions of displacement and coercion. [land conflict, labor, race, Indigeneity, Brazil]
A critical examination of the false hope harms argument
Authors: Bobier Christopher A. 
Published: December 2020

AbstractMarleen Eijkholt presents a new argument in healthcare ethics, the false hope harms (FHH) argument. In brief, false hope promotes a host of individual harms (e.g., financial, physical, and psychological harms) and system‐level harms (e.g., distrust of medical practitioners, increased complexity of care and the associated costs), all of which provide reason for healthcare providers to stop promoting false hope in medicine. The goal of this paper is to show that the FHH argument is unsuccessful.
Specialised endocytic proteins regulate diverse internalisation mechanisms and signalling outputs in physiology and cancer
Authors: Giangreco Giovanni , Malabarba Maria Grazia , Sigismund Sara 
Published: December 2020

AbstractAlthough endocytosis was first described as the process mediating macromolecule or nutrient uptake through the plasma membrane, it is now recognised as a critical component of the cellular infrastructure involved in numerous processes, ranging from receptor signalling, proliferation and migration to polarity and stem cell regulation. To realise these varying roles, endocytosis needs to be finely regulated. Accordingly, multiple endocytic mechanisms exist that require specialised molecular machineries and an array of endocytic adaptor proteins with cell‐specific functions. This review provides some examples of specialised functions of endocytic adaptors and other components of the endocytic machinery in different cell physiological processes, and how the alteration of these functions is linked to cancer. In particular, we focus on: (i) cargo selection and endocytic mechanisms linked to different adaptors; (ii) specialised functions in clathrin‐mediated versus non‐clathrin endocytosis; (iii) differential regulation of endocytic mechanisms by post‐translational modification of endocytic proteins; (iv) cell context‐dependent expression and function of endocytic proteins. As cases in point, we describe two endocytic protein families, dynamins and epsins. Finally, we discuss how dysregulation of the physiological role of these specialised endocytic proteins is exploited by cancer cells to increase cell proliferation, migration and invasion, leading to anti‐apoptotic or pro‐metastatic behaviours.
Concomitant overexpression of mir‐182‐5p and mir‐182‐3p raises the possibility of IL‐17–producing Treg formation in breast cancer by targeting CD3d, ITK, FOXO1, and NFATs: A meta‐analysis and experimental study
Authors: Soheilifar Mohammad Hasan , Vaseghi Hajar , Seif Farhad , Ariana Mehdi , Ghorbanifar Shima , Habibi Nazanin , Papari Barjasteh Fatemeh , Pornour Majid 
Published: December 2020

AbstractT cells are polarized toward regulatory T cells (Tregs) in tumor microenvironment by the shuttling of microRNAs that target T cell–activating signaling pathways. We evaluated the expression of the miR‐182 cluster (miR‐96, 182, and 183) in peripheral blood mononuclear cells (PBMCs) of patients with breast cancer (BC), and T cell polarization by the expression of FOXO1, NFATs, ITK, TCR/CD3 complex, and IL‐2/IL‐2RA. Twenty‐six microRNAs overexpressed in tumor tissues and sera of these patients were extracted by a meta‐analysis. Then, the expression of the miR‐182 cluster was investigated in PBMCs and sera of these patients and correlated with their targets in PBMCs. Finally, miR‐182 was cloned into Jurkat cells to evaluate its effects on T cell polarization. FOXO1, CD3d, ITK, NFATc3, NFATc4, and IL‐2RA were targeted by miR‐182, due to which their expression decreased in PBMCs of patients. Although IL‐6, IL‐17, and TGF‐β increased after miR‐182 transduction, IL‐2 dramatically decreased. We revealed CD4+FOXP3+ T cell differentiation in the miR‐182–transduced group. Although miR‐182 has inhibitory effects on T cells by the inhibition of FOXO1, TCR/CD3 complex, NFATs, and IL‐2/IL‐2RA signaling pathways, it increases FOXP3, TGF‐β, and IL‐17 expression to possibly drive T cell deviation toward the transitional state of IL‐17–producing Tregs and Treg formation in the end.
Comparison of long‐term antithyroid drugs versus radioactive iodine or surgery for Graves' disease: A review of the literature
Authors: El Kawkgi Omar M. , Ross Douglas S. , Stan Marius N. 
Published: December 2020

AbstractBackgroundThe management of Graves' disease (GD) in the US is shifting towards increased use of anti‐thyroid drugs (ATD). If patients fail to achieve remission after a standard course of therapy of 12–18 months, long‐term treatment with ATD (≥24 months) may be chosen over definitive therapy with radioiodine (RAI) or surgery. Clinicians will need to contrast this strategy to ablative therapies as they help patients in decision making.SummaryReview of the literature illustrates that long‐term ATD delivers euthyroidism with minimal complications, low financial cost and with an advantageous profile regarding quality of life (QoL) and other biological outcomes.ConclusionsLong‐term ATD is a viable alternative to ablative therapies in the management of GD offering advantages across multiple patient centred outcomes. Decision making must factor differences in this approach compared to ablative therapies and ultimately be tailored to individualized patient situations.
The ratio FEV1/FVC and its association to respiratory symptoms—A Swedish general population study
Authors: Torén Kjell , Schiöler Linus , Lindberg Anne , Andersson Anders , Behndig Annelie F. , Bergström Göran , Blomberg Anders , Caidahl Kenneth , Engvall Jan E. , Eriksson Maria J. , Hamrefors Viktor , Janson Christer , Kylhammar David , Lindberg Eva , Lindén Anders , Malinovschi Andrei , Lennart Persson Hans , Sandelin Martin , Eriksson Ström Jonas , Tanash Hanan , Vikgren Jenny , Johan Östgren Carl , Wollmer Per , Sköld C. Magnus 
Published: December 2020

AbstractChronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.70 after bronchodilation. It is unclear which is the most optimal ratio in relation to respiratory morbidity. The aim was to investigate to what extent different ratios of FEV1/FVC were associated with any respiratory symptom. In a cross‐sectional general population study, 15,128 adults (50–64 years of age), 7,120 never‐smokers and 8,008 ever‐smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41–0.56). Among never‐smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41–0.70). Among ever‐smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16–1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38–0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80–0.85, with similar results among never‐smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.
Effects of Imports and Exports on China's PM2.5 Pollution
Authors: Li Zhaohua , Fang Ziwei , Tang Zhuyu 
Published: December 2020

AbstractThis paper examines the effects of imports and exports on China's PM2.5 pollution using data from 31 provinces during the period 2001–2016. At the aggregate level, our analysis shows that exports have a pollution‐generating effect while imports have a pollution‐shifting effect on provincial PM2.5 pollution. Cross‐sectional analysis reveals that imports and exports exhibit opposite effects on manufacturing and high‐tech industries, but demonstrate the same pollution‐generating effect for the heavy industry sector. At the regional level, the effects are similar to those at the aggregate level. We also examine the impacts of other factors on PM2.5 pollution. Our empirical evidence shows that PM2.5 pollution is positively correlated with domestic sales, population density, economic growth, urbanization rate, and transportation, but negatively correlated with energy efficiency and industry structure. This paper suggests that reducing exports and increasing imports will help to reduce PM2.5 pollution.
Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial
Authors: Teoh Anthony Yuen Bun , Kongkam Pradermchai , Bapaye Amol , Ratanachu Thawee , Reknimitr Rungsun , Lakthakia Sundeep , Chan Shannon Melissa , Gadhikar Harshal P. , Korrapati Sravan Kumar , Lee Yun Nah , Medarapalem Jahangeer , Ridtitid Wiriyaporn , Moon Jong Ho 
Published: December 2020

BackgroundLong‐term placement of lumen apposing metal stents (LAMS) with high lumen apposing force may result in adverse events. The aim of the current study was to assess the long‐term efficacy and safety of a self‐approximating LAMS with lower lumen apposing force for endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) and ‐gallbladder drainage (EUS‐GBD).MethodsFive Asian institutions participated in this study. Consecutive patients suffering from obstructive jaundice with failed ERCP or acute cholecystitis that were at high risk for cholecystectomy were recruited. We evaluated the technical and clinical success rates, adverse events rates, types of interventions through the stent and the patency profile.ResultsFrom June 2017 to Oct 2018, a total of 53 patients received EUS‐CDS (26) and EUS‐GBD (27). The technical and clinical success rates were similar between the two groups (88.5% vs 88.9%, P = 1 and 88.5% vs 88.9%, P = 1 respectively). The differences in 30‐day mortality rates [2 (7.7%) vs 2 (7.7%), P = 1] and adverse events [3 (11.5%) vs 3 (11.5%), P = 1] did not reach significance. Regarding long‐term outcomes, two patients in each group suffered from adverse events (P = 1). One patient in the EUS‐GBD group who was on direct oral anticoagulant suffered from stent induced bleeding.ConclusionThe self‐approximating LAMS with lower lumen apposing force was effective and safe with a low risk of buried stent syndrome and bleeding in the longer term.The ClinicalTrials.gov Identifier was NCT03002051.