bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fragmented Care of Hospital Super-utilizers: A Cross-sectional Study
Authors: Kaltenborn Zachary , Paul Koushik , Kirsch Jonathan , Aylward Michael , Rogers Elizabeth , Rhodes Michael , Usher Michael 
Published: December 2020

Abstract
Background: Super-utilizers with 4 or more admissions per year frequently receive low-quality care and disproportionately contribute to healthcare costs. Inpatient care fragmentation (admission to multiple different hospitals) in this population has not been well described.Objective: To determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes.Research Design: We analyzed inpatient data from the Health Care Utilization Project’s State Inpatient and Emergency Department database from 6 states from 2013. After identifying hospital super-utilizers, we stratified by the number of different hospitals visited in a 1-year period. We determined how patient demographics, costs, and outcomes varied by degree of fragmentation. We then examined how fragmentation would influence a hospital’s ability to identify super-utilizers. Subjects: Adult patients with 4 or more inpatient stays in 1 year. Measures: Patient demographics, cost, 1-year hospital reported mortality, and probability that a single hospital could correctly identify a patient as a super-utilizer. Results: Of the 167,515 hospital super-utilizers, 97,404 (58.1%) visited more than 1 hospital in a 1-year period. Fragmentation was more likely among younger, non-white, low-income, under-insured patients, in population-dense areas. Patients with fragmentation were more likely to be admitted for chronic disease management, psychiatric illness, and substance abuse. Inpatient fragmentation was associated with higher yearly costs and lower likelihood of being identified as a super-utilizer. Conclusions: Inpatient care fragmentation is common among super-utilizers, disproportionately affects vulnerable populations. It is associated with high yearly costs and a decreased probability of correctly identifying super-utilizers.
Association of Lipoprotein and Thyroid Hormones With Cognitive Dysfunction in Patients With Systemic Lupus Erythematosus
Authors: Lu Li , Kong Wei , Zhou Kangxing , Chen Jinglei , Hou Yayi , Dou Huan , Liang Jun 
Published: December 2020

Abstract
Background: Neuropsychiatric systemic lupus erythematosus (NPSLE) occurs up to 75% of adult SLE patients, and is one of the major causes of death in SLE patients. Cognitive dysfunction is a typical clinical feature of NPSLE, which seriously affects the quality of life of patients. Dyslipidemia and thyroid disease, which were prevalent in SLE patients, both related to the neuropsychiatric disturbances, including significant psychiatric and cognitive disturbance. This study aimed to investigate whether cognitive dysfunction in patients with systemic lupus erythematosus (SLE) was related to the expression of serum thyroid hormone and lipoproteins.Methods: A total of 121 patients with SLE and 65 healthy controls (HCs) at Nanjing Drum Tower Hospital completed a cognitive function test, then 81 SLE patients were divided into high cognition (n=33) group and low cognition group (n=48). The differences in clinical and laboratory tests and the correlations between IgG, IgM, albumin, T3, and T4 levels and cognitive function were analyzed. The enzyme-linked immunosorbent assay was used to determine the serum levels of 4 lipoproteins (APOE, APOA1, IGF-1, and IGFBP7) in 81 patients.Results: Patients with SLE were less educated with abnormal cognitive function compared with HCs. The levels of albumin, T3 (P < 0.05), and T4 decreased in low-cognition patients, while D-dimer, anti-dsDNA antibody, and IgM levels increased. The serum IgG and IgM levels showed a significant negative correlation with partial cognitive function. The serum T3 and T4 levels positively correlated with cognition. The expression of APOE, APOA1, IGF-1, and IGFBP7 showed no difference between the high- and low-cognition groups. However, the serum APOE level negatively correlated with Line Orientation, APOA1 positively correlated with Coding, and IGFBP7 negatively correlated with Graphic copy (P < 0.05), and IGF-1 had no correlation with any cognitive functions.Conclusions: Thyroid hormones (T3 and T4) and lipoproteins (APOE, APOA1, and IGFBP7) were associated with cognitive dysfunction in SLE. Whether T3 and T4 can be used in clinical practice as the biomarkers of cognitive dysfunction in SLE needs further exploration.
Evaluation of Measles Surveillance Systems in Ginnir District, Bale Zone, Southeast Ethiopia: A Concurrent Embedded Mixed Quantitative/Qualitative Study&nbsp;
Authors: Sani Falaho , Hasen Mohammed , Seid Mohammed , Umer Nuriya 
Published: December 2020

Abstract
Background: Public health surveillance systems should be evaluated periodically to ensure that the problems of public health importance are being monitored efficiently and effectively. Despite the widespread measles outbreak in Ginnir district of Bale zone in 2019, evaluation of measles surveillance system has not been conducted. Therefore, we evaluated the performance of measles surveillance system and its key attributes in Ginnir district, Southeast Ethiopia.Methods: We conducted a concurrent embedded mixed quantitative/qualitative study in August 2019 among 15 health facilities/study units in Ginnir district. Health facilities are selected using lottery method. The qualitative study involved purposively selected 15 key informants. Data were collected using semi-structured questionnaire adapted from Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems through face-to-face interview and record review. The quantitative findings were analyzed using Microsoft Excel 2016 and summarized by frequency and proportion. The qualitative findings were narrated and summarized based on thematic areas to supplement the quantitative findings.Results: The structure of surveillance data flow was from the community to the respective upper level. Emergency preparedness and response plan was available only at the district level. Completeness of weekly report was 95%, while timeliness was 87%. No regular analysis and interpretations of surveillance data, and the supportive supervision and feedback system was weak. The participation and willingness of surveillance stakeholders in implementation of the system was good. The surveillance system was found to be useful, easy to implement, representative and can accommodate and adapt to changing conditions. Report documentation and quality of data was poor at lower level health facilities. Stability of the system has been challenged by shortage of budget and logistics, staff turnover and lack of update trainings.Conclusions: The surveillance system was acceptable, useful, simple, flexible and representative. Data quality, timeliness and stability of the system were attributes that require improvement. The overall performance of measles surveillance system in the district was poor. Hence, regular analysis of data, preparation and dissemination of epidemiological bulletin, capacity building and regular supervision and feedback are recommended to enhance performance of the system.
Pre-Diabetes is a Predictor of Short-Term Poor Outcomes After Acute Ischemic Stroke Using iv Thrombolysis.: Pre-Diabetes Might Be an Alienated Area From Medical Attention Before Stroke Onset
Authors: Kim Byoung-Gwon , Kim Ga-Yeon , Cha Jae-Kwan 
Published: December 2020

Abstract
Backgrounds: Pre-diabetes is an intermediate state between normal glucose metabolism and diabetes. Recent studies suggest that the presence of pre-diabetes is associated with poor outcomes after AIS. However, the results have been controversial. This study examines whether pre-diabetes influences the patients' short and long-term outcomes for AIS using IV thrombolysis. Methods: We enrolled 661 AIS patients with IV thrombolysis. Based on the 2010 ADA guidelines, patients were classified as pre-diabetes, with HbA1c levels of 5.7%–6.4%; diabetes, HbA1c levels more than 6.5%; and NGM (normal glucose metabolism), with HbA1c levels less than 5.7%. We investigated short-term outcomes, including early neurologic deterioration (END), in-hospital death, and poor functional outcomes (mRS>2) at 90days. As for long-term outcomes, poor functional outcomes were measured at 1 year. Results: Of the 661 AIS patients treated with IV thrombolysis, 197 patients (29.8%) were diagnosed with pre-diabetes, and 210 (31.8%) were diagnosed with diabetes. In a multivariate analysis, pre-diabetes was an independent predictor for END (OR=2.02; 95% CI 1.12-3.62; p=0.02) and in-hospital death (OR=3.12; 95% CI 1.06-9.09; p=0.04). In contrast, diabetes was a significant independent factor for poor long-term outcomes (OR=1.75; 95% CI 1.09-2.78; p=0.02) after correcting confounding factors. Conclusion: Unlike diabetes, pre-diabetes can be an important predictor of short-term outcomes after AIS. However, more detailed research is needed to specify the precise mechanisms by which pre-diabetes affects the prognosis of acute ischemic stroke.
Comparative Genetic Analysis of Invasive Fall Armyworm Populations Provides Evidence for Population Expansion in India
Authors: Nayyar Nishtha , Ramasamy Gracy , Thotambyl Ashika , Govindasamy Mohan , Muthugounder Mohan , Chaudhary Malvika , Day Roger , N Bakthavatsalam , Thiruvengadam Venkatesan 
Published: December 2020

Abstract
Fall Armyworm (FAW), Spodoptera frugiperda, is a polyphagous pest capable of feeding over 80 plant species and was indigenous to Western Hemisphere until recently. Within a span of four years, FAW has established itself throughout most of the regions in Africa and Asia incurring significant losses in maize production. Owing to its revamped distribution range, it would be prudent to analyse the ensuing genetic changes and study the emerging phylogeographic patterns across the world. In this regard, we would like to provide a current snapshot of genetic diversity of FAW in India after two years of the initial introduction and compare it with the worldwide diversity in order to trace the origins and evolutionary trajectories of FAW in India.We have investigated around 145 FAW samples from different regions in India for strain identity and polymorphism analysis on the basis of partial mitochondrial cytochrome oxidase I (COI) gene sequences. Apart from the ancestral rice and corn strain haplotype, our study demonstrates the presence of 19 more haplotypes unique to India at a haplotype diversity of 0.498. We were also able to record the occurrence of inter-strain hybrid haplotypes of rice and corn strain in India. Regional heterogeneity within Indian populations seems to be quite low representative of extensive migration of FAW within India. Distribution analysis of pairwise differences and rejection of neutrality tests suggest that the FAW population in India is undergoing expansion. However, the scenario is much different for rest of the invaded regions like Africa and other Asian countries where FAW still appear to evolve neutrally. Our data is consistent with the findings suggesting a recent and common origin for invasive FAW populations in Asia and Africa, with significant population structure observed in Indian populations.This study reports the highest genetic diversity for Indian FAW populations till date and identifies India as the emerging hotspot for expansion of COIA rice haplotypes across the world. The findings will be useful to track the subsequent evolution of FAW and would have important ramifications for FAW behaviour and composition throughout the world.
Ascorbic Acid Modulation by ABI4 Transcriptional Repression of VTC2 in The Salt Tolerance of Arabidopsis
Authors: Kakan Xiamusiya , Yu Yanwen , Li Shenghui , Li Xiaoying , Huang Rongfeng , Wang Juan 
Published: December 2020

Abstract
Background:Abscisic acid (ABA) plays an important role in plant abiotic stress responses, and ABA INSENSITIVE 4 (ABI4) is a pivotal transcription factor in the ABA signaling pathway. In Arabidopsis, ABI4 negatively regulates salt tolerance; however, the mechanism through which ABI4 regulates plant salt tolerance is poorly understood. Our previous study showed that ABI4 directly binds to the promoter of the VITAMIN C DEFECTIVE 2 (VTC2) gene, inhibiting the transcription of VTC2 and ascorbic acid (AsA) biosynthesis.Results: In the present study, we found that treatment with exogenous AsA could alleviate salt stress sensitivity of ABI4-overexpressing transgenic plants. The decreased AsA content and increased reactive oxygen species (ROS) levels in ABI4-overexpressing seedlings under salt treatment indicated that AsA-promoted ROS scavenging was related to ABI4-mediated salt tolerance. Gene expression analysis showed that ABI4 was induced at the early stage of salt stress, giving rise to reduced VTC2 expression. Accordingly, the abundance of the VTC2 protein decreased under the same salt stress conditions, and was absent in the ABI4 loss-of-function mutants, suggesting that the transcriptional inhibition of ABI4 on VTC2 resulted in the attenuation of VTC2 function. In addition, other encoding genes in the AsA biosynthesis and recycling pathways showed different responses to salt stress, demonstrating that AsA homeostasis is complicated under salinity stress. Conclusions: This study elucidates the negative modulation of ABI4 in salt stress tolerance through the regulation of AsA biosynthesis and ROS accumulation in plants.
Novel Myostatin-Specific Antibody Enhances Muscle Strength in Muscle Disease Models
Authors: Muramatsu Hiroyasu , Kuramochi Taichi , Katada Hitoshi , Ueyama Atsunori , Ruike Yoshinao , Ohmine Ken , Shida-Kawazoe Meiri , Miyano-Nishizawa Rie , Shimizu Yuichiro , Okuda Momoko , Hori Yuji , Hayashi Madoka , Haraya Kenta , Ban Nobuhiro , Nonaka Tatsuya , Honda Masaki , Kitamura Hidetomo , Hattori Kunihiro , Kitazawa Takehisa , Igawa Tomoyuki , Kawabe Yoshiki , Nezu Junichi 
Published: December 2020

Abstract
Myostatin, a member of the transforming growth factor-b superfamily, is an attractive target for muscle disease therapy because of its role as a negative regulator of muscle growth and strength. Here, we describe a novel antibody therapeutic approach that maximizes the potential of myostatin-targeted therapy. We generated an antibody, GYM329, that specifically binds the latent form of myostatin and inhibits its activation. Additionally, via “sweeping antibody technology”, GYM329 reduces or “sweeps” myostatin in the muscle and plasma. Compared with conventional anti-myostatin agents, GYM329 and its surrogate antibody exhibit superior muscle strength-improvement effects in three different mouse disease models. We also demonstrate that the superior efficacy of GYM329 is due to its myostatin specificity and sweeping capability. Furthermore, we show that a GYM329 surrogate increases muscle mass in normal cynomolgus monkeys without any obvious toxicity. Our findings indicate the potential of GYM329 to improve muscle strength in patients with muscular disorders.
Population Genetic Analysis of Pinus Koraiensis in China Inferred Using EST-SSR&nbsp;Markers
Authors: Li Xiang , Zhao Minghui , Xu Yujin , Li Yan , Tigabu Mulualem , Zhao Xiyang 
Published: December 2020

Abstract
Background Pinus koraiensis (commonly known as Korean pine), is a well-known conifer species in China with high economic, ornamental and ecological values. More than 50% of the P. koraiensis forests in the world are distributed in Northeast China, a region with abundant germplasm resources. However, these natural P. koraiensis populations are in danger of genetic erosion caused by continuous climate changes and frequent human activity. Little work has been conducted on the population genetic structure and genetic differentiation of P. koraiensis in China. Here, representative individuals from 16 natural P. koraiensis populations were sampled and genotyped, and polymorphic expressed sequence tag-simple sequence repeat (EST-SSR) markers were used to comprehensively evaluate genetic diversity, population structure and differentiation of P. koraiensis populations in China.ResultsA total of 480 samples from 16 populations were collected in the natural distribution area of P. koraiensis. Analysis of molecular variance (AMOVA) of the EST-SSR marker data showed that 33% of the total genetic variation was among populations and 67% was within populations. A high level of genetic diversity was found across P. koraiensis populations (average Na=10.33, Ne=2.514, He=0.521), and the highest levels of genetic diversity were found in Heihe (He=0.449), Zhanhe (He=0.413), Liangshui (He=0.370) and Tieli (He=0.414) populations. Moreover, pairwise Fst values reveled significant genetic differentiation among populations (mean Fst=0.177). Structure and Neighbor-joining (NJ) tree analyses and principal component analysis (PCA) revealed two genetic clusters: cluster 1 from Xiaoxinganling Mountains and cluster 2 from Changbaishan Mountains, which were consistent with the geographical distributions of the natural populations. ConclusionsThe findings provide new genetic information for future genome-wide association studies (GWAS), marker-assisted selection (MAS) and genomic selection (GS) in natural P. koraiensis breeding programs and can aid the development of conservation strategies for this valuable conifer species.
Analysis of axial Length of Marfan Syndrome with Bilateral Ectopia Lentis by Z-scores for Chinese Patients under 20 years Old
Authors: Chen Zexu , Chen Jiahui , Zhang Min , Zheng Jialei , Deng Michael , Chen Tianhui , Ji Yinghong , Jiang Yongxiang 
Published: December 2020

Abstract
Purpose: To analyze the axial length (AL) in young patients with Marfan syndrome (MFS) and bilateral ectopia lentis (EL) before the lens surgery. Methods: This study reviewed MFS patients under 20 with bilateral EL from January 2015 to October 2020. The Z-scores were introduced in terms of the number of standard deviations (SD) from the mean of age-matched normative data. Using Z-scores, the distribution of AL and influence factors were evaluated. The correlations between AL and other biometrics were analyzed. Results: We reviewed 183 patients, and enrolled both eyes. The mean age was 8.44 ± 4.69 years old. The mean AL increased from 23.41 ± 1.73 mm under 5 years old to 26.40 ± 2.28 mm in the 16-20 age group, and when plotted, the trend presented a logarithmic curvature. The mean Z-AL score was 1.74 ± 2.68. One-third of eyes had Z-score < 0. The right eye and the eye complicated with megalocornea had larger Z-AL scores. A positive correlation was found between Z-AL and Z-Corneal Curvature Radius (r = 0.265, P < 0.001).Conclusion: Young patents with bilateral EL but small AL should not be excluded from MFS without systematic examination. The age-adjusted Z-score will facilitate further study of the individual variations in AL across different ages.
Self-clocking fast and variation tolerant true random number generator based on a stochastic mott memristor
Authors: Kim Gwangmin , In Jae Hyun , Rhee Hakseung , Park Woojoon , Song Hanchan , Kim Kyung Min 
Published: December 2020

Abstract
The intrinsic stochasticity of the memristor can be used to generate true random numbers, essential for non-decryptable hardware-based security devices. Here we propose a novel and advanced method to generate true random numbers utilizing the stochastic oscillation behavior of a NbOx mott memristor, exhibiting self-clocking, fast and variation tolerant characteristics. The random number generation rate of the device can be at least 40 kbs-1, which is the fastest record compared with previous volatile memristor-based TRNG devices. Also, its dimensionless operating principle provides high tolerance against both ambient temperature variation and device-to-device variation, enabling robust security hardware applicable in harsh environments.
Quantified Assessment of Deep Brain Stimulation on Parkinson's Patients with Task fNIRS Measurements and Functional Connectivity Analysis: A Pilot Study
Authors: Yu Ningbo , Liang Siquan , Lu Jiewei , Shu Zhilin , Li Haitao , Yu Yang , Wu Jialing , Han Jianda 
Published: December 2020

Abstract
Background: Deep brain stimulation (DBS) has proved effective for Parkinsons disease (PD), but the identification of stimulation parameters relies on doctors’ subjective judgment on patient behavior.Methods: Five PD patients performed 10-meter walking tasks under different brain stimulation frequencies. During walking tests, a wearable functional near-infrared spectroscopy (fNIRS) system was used to measure the concentration change of oxygenated hemoglobin (ΔHbO2) in prefrontal cortex, parietal lobe and occipital lobe. Brain functional connectivity and global efficiency were calculated to quantify the brain activities.Results: We discovered that both the global and regional brain efficiency of all patients varied with stimulation parameters, and the DBS pattern enabling the highest brain efficiency was optimal for each patient, in accordance with the clinical assessments and DBS treatment decision made by the doctors.Conclusions: Task fNIRS assessments and brain functional connectivity analysis promise a quantified and objective solution for patient-specific optimization of DBS treatment.Trial registration: The study was approved by the Ethical Committee of Tianjin Huanhu Hospital (2019-35), and has been registered in Chinese Clinical Trial Registry (ChiCTR1900022715).
Implementation Research Training for Learners in Low- and Middle-income Countries: Evaluating Behavior Change After Participating in a Massive Online Open Course
Authors: Launois Pascal , Maher Dermot , Certain Edith , Ross Bella , Penkunas Michael J. 
Published: December 2020

Abstract
Background: Implementation research (IR) can play a critical role in the delivery of disease control interventions, particularly in low- and middle-income countries (LMICs). The growing demand for IR training has led to the development of a range of training programs and university courses, the majority of which can not be accessed by learners in LMICs. This article reports on the evaluation of a massive open online course (MOOC) developed by the Special Programme for Research and Training in Tropical Diseases hosted by the World Health Organization on the topic of IR with a focus on infectious diseases of poverty. This study followed Kirkpatrick’s Model to evaluate training programs with a specific focus on post-training changes in behavior.Methods: MOOC participants were invited to take part in an anonymous online survey examining their IR knowledge and how they applied it in their professional practice approximately 1-1.5 years after completing the MOOC. The survey contained 43 open-ended, multiple choice and Likert-type questions. Descriptive statistics were calculated for the quantitative data and responses to the open-ended questions were thematically coded.Results: A total of 748 MOOC participants responded to the survey. The demographic profile of the survey respondents aligned with that of the MOOC participants, with nearly 70% of respondents originating from Africa. Responses to the quantitative and open-ended survey questions revealed that respondents’ IR knowledge had improved to a large extent as a result of the MOOC, and that they used the knowledge and skills gained in their professional lives frequently. Respondents most often cited changes in their conceptual understanding of IR and understanding of the research process as substantial areas of change influenced by participating in the MOOC.Conclusions: These findings indicate that the MOOC was successful in targeting learners from LMICs, in strengthening their IR knowledge and in contributing to their ability to apply it in their professional practice. The utility of MOOCs for providing IR training to learners in LMICs, where implementation challenges are encountered often, makes this platform an ideal standalone learning tool or one that could be combined with other training formats.