bluuebunny/crossref_metadata_2025_split huggingface dataset:
On the relations between focus, experience, and hospital performance
Authors: Zepeda E. David , Nyaga Gilbert N. , Young Gary J. 
Published: May 2020

Background
In the United States, a long-standing debate has existed over advantages/disadvantages of general versus specialty hospitals. A recent stream of research has investigated whether general hospitals accrue performance benefits from a focus strategy; a strategy of specializing in certain clinical conditions while remaining a multiproduct firm. In contrast, a substantial and long-standing body of research on hospitals has been concerned with the absolute volume of cases in a service area as an indication of experience based largely on the idea that absolute volume confers learning opportunities.

Purpose
We investigated whether hospital focus and experience in a service area have complementary effects or are largely substitutive for hospital performance.

Methodology/Approach
Key data sources were patient discharge records and hospital discharge profiles from California’s Office of Statewide Health Policy and Development for years 2010–2014. We specified hospital focus as the proportion of total cardiology-related discharges and hospital experience as the cumulative volume of cardiology-related discharges for each hospital. Performance was specified using quality (inpatient mortality and 30-day readmission) and efficiency (length of stay and cost) patient-level performance metrics. We analyzed the data using logistic and log-linear ordinary least squares regression models.

Results
Study results generally supported our hypotheses that focus and experience are related to better quality and efficiency performance and that the effects are largely substitutive for hospitals.

Conclusion
Our study extends the literature by finding that hospitals exhibit distinct and stable patterns regarding their positioning on focus and experience and that these patterns have important implications for hospitals’ performance in terms of quality and efficiency.

Practice Implications
Many general hospitals in the United States may be stretched too thin across service areas for which they lack necessary patient volumes for clinical proficiency. A viable alternative is to select a limited set of service areas on which to focus.
Impact of COVID‐19 on Pediatric Gastroenterology Fellow Training in North America
Authors: Mallon Daniel , Pohl John F. , Phatak Uma P. , Fernandes Melissa , Rosen John M. , Lusman Sarah S. , Nylund Cade M. , Jump Candi S. , Solomon Aliza B. , Srinath Arvind , Singer Andrew , Harb Rula , Rodriguez‐Baez Norberto , Whitfield Van Buren Kristin L. , Koyfman Shifra , Bhatt Riha , Soler‐Rodriguez Dellys M. , Sivagnanam Mamata , Lee Christine K. ,   NASPGHAN Training Committee COVID‐19 Survey Working Group
Published: May 2020

ABSTRACTBackground:The COVID‐19 pandemic has drastically changed healthcare systems and training around the world. The Training Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition sought to understand how COVID‐19 has affected pediatric gastroenterology fellowship training.Methods:A 21 question survey was distributed to all 77 pediatric gastroenterology fellowship program directors (PDs) in the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition program director database via email on April 7. Responses collected through April 19, 2020 were analyzed using descriptive statistics.Results:Fifty‐one of 77 (66%) PDs from the United States, Canada, and Mexico responded to the survey. Forty‐six of 51 (90%) PDs reported that they were under a “stay‐at‐home” order for a median of 4 weeks at the time of the survey. Two of the 51 (4%) programs had fellows participating in outpatient telehealth before COVID‐19 and 39 of 51 (76%) at the time of the survey. Fellows stopped participating in outpatient clinics in 22 of 51 (43%) programs and endoscopy in 26 of 51 (52%) programs. Changes to inpatient care included reduced fellow staffing, limiting who entered patient rooms, and rounding remotely. Fellows in 3 New York programs were deployed to adult medicine units. Didactics were moved to virtual conferences in 47 of 51 (94%) programs, and fellows used various online resources. Clinical research and, disproportionately, bench research were restricted.Conclusions:This report provides early information of the impact of COVID‐19 on pediatric fellowship training. Rapid adoption of telehealth and reduced clinical and research experiences were important changes. Survey information may spur communication and innovation to help educators adapt.
Sexual Arousal in Obsessive-Compulsive Disorder With and Without Contamination/Washing Symptoms
Authors: Pozza Andrea , Marazziti Donatella , Mucci Federico , Grassi Giacomo , Prestia Davide , Dèttore Davide 
Published: May 2020

Abstract
Different findings would indicate that obsessive-compulsive disorder (OCD), a common psychiatric condition, might significantly impair intimate relationships and sexual well-being. The aim of the present study was to ascertain whether OCD outpatients with contamination/washing symptoms experience a lower sexual arousal than those experiencing other symptoms. In addition, we explored whether a higher disgust propensity/sensitivity might moderate the relation between contamination/washing symptoms and impaired sexual arousal. A total of 72 outpatients (27 with contamination/washing symptoms and 45 with other obsessive-compulsive symptoms) were selected for this study and assessed by a battery of specific rating scales. The results highlighted how OCD patients with contamination/washing symptoms and higher disgust sensitivity showed an increased propensity to inhibition due to threat of sexual performance failure and consequences. It may be speculated that the disgust sensitivity may be a mechanism involved in the impairment of this well-being domain. In conclusion, these findings suggest that the sexual wellbeing should be evaluated during routine clinical evaluation of OCD patients.
225Ac-PSMA-617 Radioligand Posttherapy Imaging in Metastatic Castrate-Resistant Prostate Cancer Patient Using 3 Photopeaks
Authors: Vatsa Rakhee , Sood Ashwani , Vadi Shelvin Kumar , Das Chandan Krushna , Kaur Komalpreet , Parmar Madan , Mittal Bhagwant Rai 
Published: May 2020

Abstract
PSMA-based radioligand therapies have shown the beneficial effect in metastatic castrate-resistant prostate cancer (mCRPC) patients when they become refectory to the established treatments with associated potential toxicities and high mortality rate. 225Ac-PSMA therapy is known to be remarkably effective in substantially pretreated mCRPC patients. However, posttherapy imaging is usually not performed as alpha emitters are really difficult to image. We presents a patient of mCRPC treated with 225Ac-PSMA-617, and his posttherapy whole-body scans acquired by using 3 different photopeaks (78, 218, and 440 keV) fairly demonstrated the tracer's distribution and the efficacy of targeted alpha therapy.
Culprit Tumor as an Unexpected Extraosseous MDP Activity on Bone Scintigraphy in a Patient With Tumor-Induced Osteomalacia
Authors: Xia Xiaotian , Shao Fuqiang , Hu Fan , Gai Yongkang , Lan Xiaoli 
Published: May 2020

Abstract
A 39-year-old man with bone pain underwent 99mTc-MDP bone scan to assess skeletal lesions, which demonstrated multiple fractures and a focus of subtle extraosseous activity in the left thigh. A 99mTc-hynic-octreotide imaging was performed due to the suspected diagnosis of tumor-induced osteomalacia, which revealed a hypermetabolic subcutaneous nodule in the left thigh, which exactly corresponded to the same site of MDP activity. Biopsy confirmed the subcutaneous nodule as the culprit tumor of tumor-induced osteomalacia. Bone scan, as a conventional imaging, provided useful information for detecting culprit tumor as shown in our case.
FDG Hepatic Superscan Due to Metastatic Infiltration of Prostate Cancer
Authors: Yildirim Nilufer , Dede Didem Sener , Gumuskaya Berrak 
Published: May 2020

Abstract
A 69-year-old man with prostate cancer presented to the hospital with 2 weeks’ history of fever, abdominal distension, and fatigue. Laboratory findings showed signs of acute liver failure, and marked elevation of lactate dehydrogenase and tumor marker levels. Abdominal CT showed hepatomegaly with multiple hypodense lesions in both lobes, suggesting metastases. FDG PET/CT scan shows hypermetabolism unusually in the liver with significantly suppressed heart and brain activity, reminiscent of an FDG hepatic superscan. The hypermetabolic lesions confirmed with Tru-Cut needle biopsy of the liver as metastasis of prostate cancer.
Central-positive complexes in ECT-induced seizures: Evidence for thalamocortical mechanisms
Authors: Huels Emma R. , Hickman L. Brian , Ching ShiNung , Lenze Eric J. , Farber Nuri B. , Avidan Michael S. , Hogan R. Edward , Palanca Ben Julian A. 
Published: May 2020

AbstractElectroconvulsive therapy (ECT) relies on the electrical induction of generalized seizures to treat major depressive disorder and other psychiatric illnesses. These planned procedures provide a clinically relevant model system for studying neurophysiologic characteristics of generalized seizures. We recently described novel central-positive complexes (CPCs), which were observed during ECT-induced seizures as generalized, high-amplitude waveforms with maximum positive voltage over the vertex. Here, we performed a systematic characterization of 6,928 CPC ictal waveforms recorded in 11 patients undergoing right unilateral (RUL) ECT. Analyses of high-density 65-electrode EEG recordings during these 50 seizures allowed evaluation of these CPCs across temporal, spatial, and spectral domains. Peak-amplitude CPC scalp topology was consistent across seizures, showing maximal positive polarity over the midline fronto-central region and maximal negative polarity over the suborbital regions. Total duration of CPCs positively correlated with the time required for return of responsiveness after ECT treatment (r = 0.39, p = 0.005). The rate of CPCs showed a frequency decline consistent with an exponential decay (median 0.032 (IQR 0.053) complexes/second). Gamma band (30-80 Hz) oscillations correlated with the peak amplitude of CPCs, which was also reproducible across seizures, with band power declining over time (r = −0.32, p < 10−7). The sources of these peak potentials were localized to the bilateral medial thalamus and cingulate cortical regions. Our findings demonstrated CPC characteristics that were invariant to participant, stimulus charge, time, and agent used to induce general anesthesia during the procedure. Consistent with ictal waveforms of other generalized epilepsy syndromes, CPCs showed topographic distribution over the fronto-central regions, predictable intra-seizure frequency decline, and correlation with gamma-range frequencies. Furthermore, source localization to the medial thalamus was consistent with underlying thalamocortical pathophysiology, as established in generalized epilepsy syndromes. The consistency and reproducibility of CPCs offers a new avenue for studying the dynamics of seizure activity and thalamocortical networks.
A simulation-based procedure to estimate base rates from Covid-19 antibody test results I: Deterministic test reliabilities
Authors: Joosten Reinoud , Abhishta Abhishta 
Published: May 2020

AbstractWe design a procedure (the complete Python code may be obtained athttps://github.com/abhishta91/antibody_montecarlo) using Monte Carlo (MC) simulation to establish the point estimators described below and confidence intervals for the base rate of occurence of an attribute (e.g., antibodies against Covid-19) in an aggregate population (e.g., medical care workers) based on a test. The requirements for the procedure are the test’s sample size (N) and total number of positives (X), and the data on test’s reliability.Themodusis the prior which generates the largest frequency of observations in the MC simulation with precisely the number of test positives (maximum-likelihood estimator). Themedianis the upper bound of the set of priors accounting for half of the total relevant observations in the MC simulation with numbers of positives identical to the test’s number of positives.Our rather preliminary findings areThe median and the confidence intervals suffice universally.The estimatormay be outside of the two-sided 95% confidence interval.Conditions such that the modus, the median and another promising estimator which takes the reliability of the test into account, are quite close.Conditions such that the modus and the latter estimator must be regarded as logically inconsistent.Conditions inducing rankings among various estimators relevant for issues concerning over-or underestimation.JEL-codes:C11, C13, C63
Analysis of hospitalized COVID-19 patients in the Mount Sinai Health System using electronic medical records (EMR) reveals important prognostic factors for improved clinical outcomes
Authors: Wang Zichen , Zheutlin Amanda B. , Kao Yu-Han , Ayers Kristin L. , Gross Susan J. , Kovatch Patricia , Nirenberg Sharon , Charney Alexander W. , Nadkarni Girish N. , O’Reilly Paul F. , Just Allan C. , Horowitz Carol R. , Martin Glenn , Branch Andrea D. , Glicksberg Benjamin S. , Charney Dennis S. , Reich David L. , Oh William K. , Schadt Eric E. , Chen Rong , Li Li 
Published: May 2020

AbstractImportanceThere is an urgent need to understand patient characteristics of having COVID-19 disease and evaluate markers of critical illness and mortality.ObjectiveTo assess association of clinical features on patient outcomes.Design, Setting, and ParticipantsIn this observational case series, patient-level data were extracted from electronic medical records for 28,336 patients tested for SARS-CoV-2 at the Mount Sinai Health System from 2/24/ to 4/15/2020, including 6,158 laboratory-confirmed cases.ExposuresConfirmed COVID-19 diagnosis by RT-PCR assay from nasal swabs.Main Outcomes and MeasuresEffects of race on positive test rates and mortality were assessed. Among positive cases admitted to the hospital (N = 3,273), effects of patient demographics, hospital site and unit, social behavior, vital signs, lab results, and disease comorbidities on discharge and death were estimated.ResultsHispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to population base rates (p<2e-16); however, no differences in mortality rates were observed in the hospital. Outcome differed significantly between hospitals (Gray’s T=248.9;p<2e-16), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR=1.05 [95% CI, 1.04-1.06]; p=1.15e-32), oxygen saturation (HR=0.985 [95% CI, 0.982-0.988]; p=1.57e-17), care in ICU areas (HR=1.58 [95% CI, 1.29-1.92]; p=7.81e-6), and elevated creatinine (HR=1.75 [95% CI, 1.47-2.10]; p=7.48e-10), alanine aminotransferase (ALT) (HR=1.002, [95% CI 1.001-1.003]; p=8.86e-5) white blood cell (WBC) (HR=1.02, [95% CI 1.01-1.04]; p=8.4e-3) and body-mass index (BMI) (HR=1.02, [95% CI 1.00-1.03]; p=1.09e-2). Asthma (HR=0.78 [95% CI, 0.62-0.98]; p=0.031) was significantly associated with increased length of hospital stay, but not mortality. Deceased patients were more likely to have elevated markers of inflammation. Baseline age, BMI, oxygen saturation, respiratory rate, WBC count, creatinine, and ALT were significant prognostic indicators of mortality.Conclusions and RelevanceWhile race was associated with higher risk of infection, we did not find a racial disparity in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. We identified clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk and evaluate the impact on survival.
Predicted impact of the COVID-19 pandemic on global tuberculosis deaths in 2020
Authors: Glaziou Philippe 
Published: May 2020

AbstractPolicies widely adopted in response to the ongoing pandemic of Covid-19, particularly lockdowns and reassignments of health personnel and equipment, are impacting the performance of TB prevention and care programmes. Estimates of the impact of reductions in the performance of global TB detection and care on TB mortality over 2020 are presented. A global TB case detection decrease by an average 25% over a period of 3 months (as compared to the level of detection before the pandemic), will lead to a predicted additional 190 000 (56 000 – 406 000) TB deaths.
Silent cold-sensing neurons drive cold allodynia in neuropathic pain states
Authors: MacDonald Donald Iain , Luiz Ana P. , Millet Queensta , Emery Edward C. , Wood John N. 
Published: May 2020

SummaryNeuropathic pain patients often experience innocuous cooling as excruciating pain. The cell and molecular basis of this cold allodynia is little understood. We usedin vivocalcium imaging of sensory ganglia to investigate the activity of peripheral cold-sensing neurons in three mouse models of neuropathic pain: oxaliplatin-induced neuropathy, partial sciatic nerve ligation and ciguatera poisoning. In control mice, cold-sensing neurons were few in number and small in size. In neuropathic animals with cold allodynia, a set of normally silent large-diameter neurons became sensitive to cooling. Many silent cold-sensing neurons expressed the nociceptor markers NaV1.8 and CGRPα. Ablating these neurons diminished cold allodynia. Blocking KV1 voltage-gated potassium channels was sufficient to triggerde novocold sensitivity in silent cold-sensing neurons. Thus silent cold-sensing neurons are unmasked in diverse neuropathic pain states and cold allodynia results from peripheral sensitization caused by altered nociceptor excitability.Graphical Abstract
Elevated plasma cortisol associated with larger ventricles and smaller hippocampal volumes – a study in 2 independent elderly cohorts
Authors: Rajagopalan Priya , Nho Kwangsik , Risacher Shannon L. , Jahanshad Neda , Boyle Christina P. , Saykin Andrew J. , Thompson Paul M. 
Published: May 2020

AbstractCortisol is considered the most fundamental stress hormone and is elevated in stress and multiple neuropsychiatric conditions. Prior studies have shown associations of plasma cortisol levels with total cerebral and hippocampal volumes and less consistently with the amygdala. Here, we extend our hypothesis to test associations of plasma cortisol with 1) ventricular 2) hippocampal and 3) amygdalar volumes, in two independent elderly cohorts across a broad cognitive spectrum ranging from normal cognition to Alzheimer’s disease.We demonstrate elevated cortisol to be associated with larger lateral ventricular volumes and smaller hippocampal volumes, predominantly in the right cerebral hemisphere, regardless of age, sex or cognitive status. We noted a non-significant trend of smaller amygdalar volumes with elevated cortisol.Our findings support smaller brain parenchyma volumes seen with elevated cortisol and may encourage effective strategies reducing cortisol and stress. They may also serve as imaging biomarkers for assessing therapeutic benefits of stress and cortisol lowering interventions aiming to halt or reverse the brain volume alterations and theoretically improve cognition and quality of life.HighlightsElevated cortisol associated with larger ventricular volumes and smaller hippocampal volumesAssociations are predominantly noted in the right cerebral hemisphere.Similar non-significant trends noted in amygdalar volumesCortisol and stress reducing strategies may halt brain changes and improve quality of lifeImaging biomarkers may help assess efficacy of cortisol-lowering therapeutic interventions
Design of an Epitope-Based Peptide Vaccine against the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): A Vaccine-informatics Approach
Authors: Alam Aftab , Khan Arbaaz , Imam Nikhat , Siddiqui Mohd Faizan , Waseem Mohd , Malik Md. Zubbair , Ishrat Romana 
Published: May 2020

AbstractThe recurrent and recent global outbreak of SARS-CoV-2 has turned into a global concern which has infected more than 19-million people all over the globe, and this number is increasing in hours. Unfortunate no vaccine or specific treatment is available, which make it more deadly. A vaccine-informatics approach has shown significant breakthrough in peptide-based epitope mapping and opens the new horizon in vaccine development. In this study, we have identified a total of 15 antigenic peptides (including T and B cells) in the surface glycoprotein of SARS-CoV-2 which showed non-toxic nature, non-allergenic, highly antigenic and non-mutated in other SARS-CoV-2 virus strains. The population coverage analysis has found that CD4+T-cell peptides showed higher cumulative population coverage over to CD8+peptides in the 16 different geographical regions of the world. We identified twelve peptides(LTDEMIAQY, WTAGAAAYY, WMESEFRVY, IRASANLAA, FGAISSVLN, VKQLSSNFG, FAMQMAYRF, FGAGAALQI, YGFQPTNGVGYQ, LPDPSKPSKR, QTQTNSPRRARS and VITPGTNTSN) that are 80% - 90% identical with experimentally determined epitopes of SARS-CoV, and this will likely be beneficial for a quick progression of the vaccine design. Moreover, docking analysis suggested that identified peptides are tightly bound in the groove of HLA molecules which can induce the T-cell response. Overall this study allows us to determine potent peptide antigen targets in surface glycoprotein on intuitive grounds which open up a new horizon in COVID-19 research. However, this study needs experimental validation by in vitro and in vivo.
Gold Nanoparticles interacting with Synthetic Lipid Rafts: an AFM investigation
Authors: Ridolfi Andrea , Caselli Lucrezia , Montis Costanza , Mangiapia Gaetano , Berti Debora , Brucale Marco , Valle Francesco 
Published: May 2020

AbstractInorganic nanoparticles (NPs) represent promising examples of engineered nanomaterials, providing interesting biomedical solutions in several fields, like therapeutics and diagnostics. Despite the extensive number of investigations motivated by their remarkable potential for nanomedicinal applications, the interactions of NPs with biological interfaces are still poorly understood. The effect of NPs on living organisms is mediated by biological barriers, such as the cell plasma membrane, whose lateral heterogeneity is thought to play a prominent role in NPs adsorption and uptake pathways. In particular, biological membranes feature the presence of rafts, i.e. segregated lipid micro and/or nano-domains in the so-called liquid ordered phase (Lo), immiscible with the surrounding liquid disordered phase (Ld). Rafts are involved in various biological functions and act as sites for the selective adsorption of materials on the membrane. Indeed, the thickness mismatch present along their boundaries generates energetically favorable conditions for the adsorption of NPs. Despite its clear implications in NPs internalization processes and cytotoxicity, a direct proof of the selective adsorption of NPs along the rafts’ boundaries is still missing to date. Here we use multicomponent Supported Lipid Bilayers (SLBs) as reliable synthetic models, reproducing the nanometric lateral heterogeneity of cell membranes. After being characterized by Atomic Force Microscopy (AFM) and Neutron Reflectivity (NR), multi-domain SLBs are challenged by prototypical inorganic nanoparticles, i.e. citrated gold nanoparticles (AuNPs), under simplified and highly controlled conditions. By exploiting AFM, we demonstrate that AuNPs preferentially target lipid phase boundaries as adsorption sites. The herein reported study consolidates and extends the fundamental knowledge on NPs-membrane interactions, which constitute a key aspect to consider when designing NPs-related biomedical applications.