bluuebunny/crossref_metadata_2025_split huggingface dataset:
Generosity of state insurance mandates and growth in the workforce for autism spectrum disorder
Authors: McBain Ryan K , Cantor Jonathan H , Kofner Aaron , Callaghan Timothy , Stein Bradley D , Yu Hao 
Published: December 2020

All 50 US states have enacted mandates requiring insurers to cover autism-related services. We assessed whether and to what extent variation in generosity of state insurance mandates has been associated with rate of growth in the health workforce for children with autism spectrum disorder: including board-certified behavioral analysts, child psychiatrists, and pediatricians. Drawing data from the National Conference of State Legislatures and Area Health Resource Files, we evaluated eight mandate policy features, utilizing a fixed-effect longitudinal regression framework to examine their relationships with workforce growth during a 15-year period (2003–2017) over which 44 states enacted a mandate. Aspects of mandate generosity included ages covered, spending caps, and types of services covered. We found that mandate generosity was closely associated with the magnitude of increase in supply of board-certified behavioral analysts and—to a lesser extent—child psychiatrists. States with the most generous mandates would be expected to have 39% more board-certified behavioral analysts and 17% more child psychiatrists in 2017, compared to states with least generous mandates. We found no association between mandate generosity and supply of pediatricians. Collectively, our results suggest that the degree of generosity afforded by mandates may be as important as the passage of mandate legislation itself for encouraging workforce growth. Lay abstract To improve access to health services for children with autism spectrum disorder, US states have passed laws requiring health insurers to cover autism-related care, commonly known as state insurance mandates. However, the features of mandates differ across states, with some state laws containing very generous provisions and others containing very restrictive provisions such as whether the mandates include children aged above 12 years, whether there is a limit on spending, and whether there are restrictions on the types of services covered. This study examined the relationship between generosity of mandates and growth in the health workforce between 2003 and 2017, a period during which 44 states passed mandates. We found that states that enacted more generous mandates experienced significantly more growth in board-certified behavioral analysts who provide behavioral therapy as well as more growth in child psychiatrists. We did not find differences in the growth of pediatricians, which is a less specialized segment of the workforce. Our findings were consistent across eight different mandate features and suggest that the content of legislation may be as important as whether or not legislation has been passed in terms of encouraging growth in the supply of services for children with autism spectrum disorder.
Surgeon Applications of Patient Preferences in Treatment Decision Making for First-Time Anterior Shoulder Dislocation
Authors: Lau Brian C. , Hutyra Carolyn A. , Streufert Benjamin , Reed Shelby D. , Orlando Lori A. , Huber Joel C. , Taylor Dean C. , Mather Richard C. 
Published: December 2020

Background: Treatment of a first-time anterior shoulder dislocation (FTASD) is sensitive to patient preferences. The operative or nonoperative management debate provides an excellent opportunity to learn how surgeons apply patient preferences in treatment decisions. Purpose: To determine how patient preferences (repeat dislocation risk, recovery difficulties, fear of surgery, treatment costs) and surgeon factors influence a surgeon’s treatment plan for FTASD. Study Design: Cross-sectional study. Methods: Eight clinical vignettes of hypothetical patients with FTASD (including age, sex, and activity level) were presented to members of the Magellan Society. A second set of matched vignettes with patient preferences and clinical variables were also presented. The vignettes represented scenarios in which evidence does not favor one treatment over another. Respondents were asked how they would manage each hypothetical case. Respondents also estimated the risk of redislocation for the nonoperative cases for comparison with the published rates. Finally, respondents completed a Likert-scale questionnaire to determine their perceptions on factors influencing their decisions. Results: A total of 103 orthopaedic surgeons completed the survey; 48% practiced in an academic hospital; 79% were in practice for 10 years or longer; and 75% had completed a sports medicine fellowship. Patient preferences were the single most important factor influencing treatment recommendation, with activity type and age also important. Just 62% of the surgeon estimates of the risk of redislocation were consistent with the published rates. The inclusion of patient preferences to clinical variables changed treatment recommendations in 62.5% of our hypothetical cases. Respondents rated patient treatment preference as the leading factor in their treatment decision making. Conclusion: Patient preferences were important when deciding the appropriate treatment for FTASD. Respondents were inconsistent when applying evidence in their decision making and estimates of recurrent instability. Decision support tools that deliver patient preferences and personalized evidence-based outcome estimates improve the quality of decision making at the point of care.
Patient preferences for systemic sclerosis treatment: A descriptive study within an Italian cohort
Authors: El Aoufy Khadija , Bruni Cosimo , Rasero Laura , Matucci Cerinic Marco , Furst Daniel Eric 
Published: December 2020

Objectives: The aim of this study is to ascertain systemic sclerosis patients’ preferences regarding the formulations of the medications they use. Methods: We undertook questionnaires and interviews aimed at understanding systemic sclerosis patients’ preferences with respect to the medications they used. Results: Among 160 systemic sclerosis patients, we found that the majority does not have difficulty taking their medication. However, preferences were identified (81.25% – 65/80 – preferred oral meds and 47.50% – 38/80 – disliked rectal/vaginal meds), as well as some systemic sclerosis patients have significant difficulties using their medications. In fact, factors such as swallowing and fine finger motion difficulties were frequent, while intravenous/intramuscular/subcutaneous medicines were usually not preferred because they are felt as inconvenient (intravenous = 33.4% and subcutaneous/intramuscular = 10%) or painful (intravenous = 37.50% and subcutaneous/intramuscular = 10%) Conclusion: Most systemic sclerosis patients are able to take their medication despite having some difficulties. However, as there were clear preferences, we could improve patients’ adherence to drug therapy if taking these preferences into account.
Triple-Helix Structured Model Based on Problem-Knowledge-Solution Co-evolution for Innovative Product Design Process
Authors: Hui Qian , Li Yan , Tao Ye , Liu Hongwei 
Published: December 2020

AbstractA design problem with deficient information is generally described as wicked or ill-defined. The information insufficiency leaves designers with loose settings, free environments, and a lack of strict boundaries, which provides them with more opportunities to facilitate innovation. Therefore, to capture the opportunity behind the uncertainty of a design problem, this study models an innovative design as a composite solving process, where the problem is clarified and resolved from fuzziness to satisfying solutions by interplay among design problems, knowledge, and solutions. Additionally, a triple-helix structured model for the innovative product design process is proposed based on the co-evolution of the problem, solution, and knowledge spaces, to provide designers with a distinct design strategy and method for innovative design. The three spaces interact and co-evolve through iterative mappings, including problem structuring, knowledge expansion, and solution generation. The mappings carry the information processing and decision-making activities of the design, and create the path to satisfying solutions. Finally, a case study of a reactor coolant flow distribution device is presented to demonstrate the practicability of this model and the method for innovative product design.
First reported case of penile prosthesis infection from brucellosis: case report
Authors: Moohialdin Nabil N. , Shamsodini Ahmad , Wilson Steven K. , Abdeljaleel Osama , Alnadhari Ibrahim , Abdulmuhsin Ausama Saadi 
Published: December 2020

AbstractBackgroundInfection after the penile prosthesis can be devastating to both the patient and surgeon with various complications and consequences. After introduction of antibiotic-coated implants, the rate of infection has dramatically decreased, but still we see uncommon organisms causing infection. We present a first case report of penile prosthesis infection by brucellosis due to raw milk ingestion. To our knowledge, this is the first reported case of brucellosis penile prosthesis infection.Case presentationWe present a first case report of penile prosthesis infection by brucellosis due to raw milk ingestion. A 75-year-old, diabetic male patient presented with penile prosthesis infection 5 months post-penile exchange surgery due to mechanical malfunctioning of 2-piece penile prosthesis which was inserted 11 years ago. The initial treatment with broad spectrum antibiotics did not subside the infection. After diagnosis of brucellosis, the antibiotic was changed to anti-brucellosis (Rifampicin + Tetracycline). The patient improved dramatically and was discharged home with smooth follow-up course.ConclusionBrucellosis can cause infection of penile prosthesis and can be treated with anti-brucellosis antibiotics without necessitating surgical intervention and removal of prosthesis.
Genome-wide identification, phylogenetic and expression pattern analysis of GATA family genes in Brassica napus
Authors: Zhu Weizhuo , Guo Yiyi , Chen Yeke , Wu Dezhi , Jiang Lixi 
Published: December 2020

Abstract
Background
Transcription factors GATAs are involved in plant developmental processes and respond to environmental stresses through binding DNA regulatory regions to regulate their downstream genes. However, little information on the GATA genes in Brassica napus is available. The release of the reference genome of B. napus provides a good opportunity to perform a genome-wide characterization of GATA family genes in rapeseed.

Results
In this study, 96 GATA genes randomly distributing on 19 chromosomes were identified in B. napus, which were classified into four subfamilies based on phylogenetic analysis and their domain structures. The amino acids of BnGATAs were obvious divergence among four subfamilies in terms of their GATA domains, structures and motif compositions. Gene duplication and synteny between the genomes of B. napus and A. thaliana were also analyzed to provide insights into evolutionary characteristics. Moreover, BnGATAs showed different expression patterns in various tissues and under diverse abiotic stresses. Single nucleotide polymorphisms (SNPs) distributions of BnGATAs in a core collection germplasm are probably associated with functional disparity under environmental stress condition in different genotypes of B. napus.

Conclusion
The present study was investigated genomic structures, evolution features, expression patterns and SNP distributions of 96 BnGATAs. The results enrich our understanding of the GATA genes in rapeseed.
Demethylation alters transcriptome profiling of buds and leaves in ‘Kyoho’ grape
Authors: Jia Haoran , Zhang Zibo , Sadeghnezhad Ehsan , Pang Qianqian , Li Shangyun , Pervaiz Tariq , Su Ziwen , Dong Tianyu , Fang Jinggui , Jia Haifeng 
Published: December 2020

Abstract
Background
Grape buds and leaves are directly associated with the physiology and metabolic activities of the plant, which is monitored by epigenetic modifications induced by environment and endogenous factors. Methylation is one of the epigenetic regulators that could be involved in DNA levels and affect gene expression in response to stimuli. Therefore, changes of gene expression profile in leaves and bud through inhibitors of DNA methylation provide a deep understanding of epigenetic effects in regulatory networks.

Results
In this study, we carried out a transcriptome analysis of ‘Kyoho’ buds and leaves under 5-azacytidine (5-azaC) exposure and screened a large number of differentially expressed genes (DEGs). GO and KEGG annotations showed that they are mainly involved in photosynthesis, flavonoid synthesis, glutathione metabolism, and other metabolic processes. Functional enrichment analysis also provided a holistic perspective on the transcriptome profile when 5-azaC bound to methyltransferase and induced demethylation. Enrichment analysis of transcription factors (TFs) also showed that the MYB, C2H2, and bHLH families are involved in the regulation of responsive genes under epigenetic changes. Furthermore, hormone-related genes have also undergone significant changes, especially gibberellin (GA) and abscisic acid (ABA)-related genes that responded to bud germination. We also used protein-protein interaction network to determine hub proteins in response to demethylation.

Conclusions
These findings provide new insights into the establishment of molecular regulatory networks according to how methylation as an epigenetic modification alters transcriptome patterns in bud and leaves of grape.
The effect of ALDH2 rs671 gene mutation on clustering of cardiovascular risk factors in a big data study of Chinese population: associations differ between the sexes
Authors: Wang Danchen , Zou Yutong , Yu Songlin , Lin Songbai , Li Honglei , Yin Yicong , Qiu Ling , Xu Tengda , Wu Jie 
Published: December 2020

Abstract
Background

The ALDH2 rs671 genetic polymorphism has been linked with cardiovascular diseases (CVDs), but comprehensive epidemiological studies are lacking. An observational, retrospective big data study was carried out to evaluate the associations between this polymorphism and clustering cardiovascular risk factors (CRFs) in a Chinese population.

Methods
A total of 13,101 individuals (8431 males and 4670 females) were enrolled. Genetic polymorphism was assessed using gene mutation detection kits, coupled with an automatic fluorescent analyzer. Other data were obtained from the records of the Department of Health Care at Peking Union Medical College Hospital.

Results
Comparing the concentrations of common biochemical analytes, including BMI, SBP, DBP, ALT, AST, γ-GT, TBil, Cr, Glu, TC, TG, and HDL-C among individuals with the GG, GA, and AA genotypes of ALDH2 rs671, we found significant differences in males (all p < 0.001), but not in females. For males, the frequencies of hypertension, diabetes, and obesity were significantly higher for GG than for GA or AA (all p < 0.05). However, there was no significant difference for dyslipidemia, and no significant associations were observed for all frequencies in females. The prevalence of individuals with 1–4 CRFs was significantly higher among GG males than those carrying GA or AA, and fewer GG males had non-CRFs (all p < 0.05).

Conclusion
Polymorphisms of ALDH2 rs671 are associated with clustering CRFs, especially hypertension and diabetes in males, but not in females. These associations are likely mediated by alcohol intake, which is also associated with this gene.
Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students
Authors: Bagacean Cristina , Cousin Ianis , Ubertini Anne-Helene , El Yacoubi El Idrissi Mohamed , Bordron Anne , Mercadie Lolita , Garcia Leonor Canales , Ianotto Jean-Christophe , De Vries Philine , Berthou Christian 
Published: December 2020

AbstractBackgroundVerbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients’ satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses.MethodsThree raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis.ResultsFrom the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task ‘Gathering information’ (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for ‘Exploration of the patients’ problems to discover the biomedical perspective’ (p = 0.007), ‘Exploration of the patients’ problems to discover background information and context’ (p = 0.0004) and for ‘Closing the session – Forward planning’ (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups.ConclusionsMedical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students’ awareness for this type of communication and increase doctor-patient interaction effectiveness.
The first familial NSD2 cases with a novel variant in a Chinese father and daughter with atypical WHS facial features and a 7.5-year follow-up of growth hormone therapy
Authors: Hu Xuyun , Wu Di , Li Yuchuan , Wei Liya , Li Xiaoqiao , Qin Miao , Li Hongdou , Li Mengting , Chen Shaoke , Gong Chunxiu , Shen Yiping 
Published: December 2020

Abstract
Background
Wolf-Hirschhorn syndrome is a well-characterized genomic disorder caused by 4p16.3 deletions. Wolf-Hirschhorn syndrome patients exhibit characteristic facial dysmorphism, growth retardation, developmental delay, intellectual disability and seizure disorders. Recently, NSD2 gene located within the 165 kb Wolf-Hirschhorn syndrome critical region was identified as the key causal gene responsible for most if not all phenotypes of Wolf-Hirschhorn syndrome. So far, eight NSD2 loss of function variants have been reported in patients from different parts of the world, all were de novo variants.

Methods
In our study, we performed whole exome sequencing for two patients from one family. We also reviewed more NSD2 mutation cases in pervious literature.

Results
A novel loss of function NSD2 variant, c.1577dupG (p.Asn527Lysfs*14), was identified in a Chinese family in the proband and her father both affected with intellectual disability. After reviewing more NSD2 mutation cases in pervious literature, we found none of them had facial features that can be recognized as Wolf-Hirschhorn syndrome. In addition, we have given our proband growth hormone and followed up with this family for 7.5 years.

Conclusions
Here we reported the first familial NSD2 variant and the long-term effect of growth hormone therapy for patients. Our results suggested NSD2 mutation might cause a distinct intellectual disability and short stature syndrome.
Beyond standardized mortality ratios; some uses of smoothed age-specific mortality rates on small areas studies
Authors: Perez-Panades Jordi , Botella-Rocamora Paloma , Martinez-Beneito Miguel Angel 
Published: December 2020

AbstractBackgroundMost epidemiological risk indicators strongly depend on the age composition of populations, which makes the direct comparison of raw (unstandardized) indicators misleading because of the different age structures of the spatial units of study. Age-standardized rates (ASR) are a common solution for overcoming this confusing effect. The main drawback of ASRs is that they depend on age-specific rates which, when working with small areas, are often based on very few, or no, observed cases for most age groups. A similar effect occurs with life expectancy at birth and many more epidemiological indicators, which makes standardized mortality ratios (SMR) the omnipresent risk indicator for small areas epidemiologic studies.MethodsTo deal with this issue, a multivariate smoothing model, theM-model, is proposed in order to fit the age-specific probabilities of death (PoDs) for each spatial unit, which assumes dependence between closer age groups and spatial units. This age–space dependence structure enables information to be transferred between neighboring consecutive age groups and neighboring areas, at the same time, providing more reliable age-specific PoDs estimates.ResultsThree case studies are presented to illustrate the wide range of applications that smoothed age specific PoDs have in practice . The first case study shows the application of the model to a geographical study of lung cancer mortality in women. This study illustrates the convenience of considering age–space interactions in geographical studies and to explore the different spatial risk patterns shown by the different age groups. Second, the model is also applied to the study of ischaemic heart disease mortality in women in two cities at the census tract level. Smoothed age-standardized rates are derived and compared for the census tracts of both cities, illustrating some advantages of this mortality indicator over traditional SMRs. In the latest case study, the model is applied to estimate smoothed life expectancy (LE), which is the most widely used synthetic indicator for characterizing overall mortality differences when (not so small) spatial units are considered.ConclusionOur age–space model is an appropriate and flexible proposal that provides more reliable estimates of the probabilities of death, which allow the calculation of enhanced epidemiological indicators (smoothed ASR, smoothed LE), thus providing alternatives to traditional SMR-based studies of small areas.