bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication Use and Health Care Utilization After a Cost-sharing Increase in Schizophrenia
Authors: Hamina Aleksi , Tanskanen Antti , Tiihonen Jari , Taipale Heidi 
Published: July 2020

Background:
Increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization.

Objective:
The objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases and on rates of hospitalizations and primary care contacts among persons with schizophrenia in Finland.

Research Design:
Interrupted time series analysis.

Subjects:
All persons with schizophrenia in Finland who were alive at the beginning of 2015 (N=41,017).

Measures:
We measured the rates of antipsychotic, other psychotropic and cardiometabolic drug purchasers, hospitalizations, and primary care contacts during 2015 and 2016 with data collected from several nationwide health care registers.

Results:
During 2016, the proportion of antipsychotic purchasers decreased by −0.26 percentage points per month [95% confidence interval (CI): −0.47 to −0.05] compared with 2015. The trend of other psychotropic purchasers decreased to −0.13 percentage points per month in 2016 (95% CI: −0.22 to −0.04) compared with 2015 and cardiometabolic drug purchases to −0.17 percentage points per month (95% CI: −0.29 to −0.05) compared with 2015. The decreasing trend of psychiatric hospitalizations in 2015 halted in 2016. There were no other significant differences in health care utilization.

Conclusions:
In our nationwide time-series analysis, we observed decreases in the slopes of antipsychotic and other drug purchases of persons with schizophrenia after prescription drug cost-sharing increase implementation on January 1, 2016. Policymakers need to be aware of the unintended consequences of increasing cost-sharing among people with severe mental disorders.
Functional lung volume mapping with perfusion Single-Photon Emission Computed Tomography scan for radiotherapy planning in patients with locally advanced nonsmall cell lung cancer
Authors: Follacchio Giulia Anna , D’Urso Pasqualina , Cassese Raffaele , Ferrara Carla , Bulzonetti Nadia , Monteleone Francesco , Musio Daniela , Liberatore Mauro , Tombolini Vincenzo 
Published: July 2020

Objectives
Radical chemotherapy-radiotherapy represents the standard treatment for locally-advanced nonsmall cell lung cancer (NSCLC). Conventional radiotherapy achieves limited local tumor control, but dose escalation to the primary tumor is prevented by radiotherapy-induced toxicity. The aim of this study was to evaluate feasibility of tailored intensity-modulated radiotherapy (IMRT) planning based on lung single-photon emission computed tomography (SPECT) perfusion data and to compare functional and conventional dose-volume parameters.

Methods
A total of 21 patients were prospectively enrolled. Patients underwent IMRT treatment with 2 Gy/fraction (median total dose of 60 Gy). Lung perfusion SPECT images were acquired before radiotherapy and 3 and 6 months after radiotherapy completion. SPECT and planning computed tomography images were co-registered using MIM-MAESTRO software with 3D-PET Edge algorithm. Lung volumes were defined anatomically as total lung and functionally as total not functional lung and total functional lung. Dose-volume histograms were calculated using QUANTEC constraints [mean lung dose (MLD)<20 Gy, V20<20%]. For each patient, conventional and functional radiotherapy plans were generated and compared.

Results
A total of 19 of 21 patients with NSCLC were included (mean age 66 years, 11 stage IIIA, 8 stage IIIB), 12/19 patients completed the 6-months follow-up. A significant reduction of mean V20 was observed in functional radiotherapy planning compared to conventional plan (405.9 cc, P < 0.001). Mean MLD was also lower in the SPECT-based plans, but the difference was not statistically relevant (0.8 Gy, P = 0.299). G2 radiation pneumonitis was observed in two patients.

Conclusions
Functional radiotherapy planning allowed to decrease functional lung irradiation compared to conventional planning. The possibility to limit radiotherapy-induced toxicity could allow us to perform an effective dose-escalation to target volume.
Sudden Death Due to Neck Paraganglioma
Authors: Abderrahim Sarra Ben , Meddeb Mohamed Ali , Marrakchi Jihene , Besbes Ghazi , Rammah-Rommani Soumaya , Hamdoun Moncef , Khelil Mehdi Ben 
Published: July 2020

Abstract
Neck paragangliomas are relatively rare neuroendocrine nonsecretory tumors. They are mainly observed among adults and are often asymptomatic, causing a frequent delay in diagnosis. In pediatric cases, neck paragangliomas can be associated with adrenergic symptoms that may lead to complications.
A report of a sudden death due to a carotid paraganglioma in a young girl is reported. Autopsy revealed a thoracic arotic dissection and a 4-cm jugulocarotidian mass in the absence of traumatic injuries. Histology showed no evidence of underlying aortic disease, including signs of Marfan syndrome, and a paraganglioma. Postmortem biochemistry analysis showed blood metanephrines levels 100 times higher than normal range. The cause of death was an aortic dissection complicating a neck paraganglioma. The manner of death was concluded as natural.
Our case highlighted the importance for forensic pathologist to consider the diagnosis of paraganglioma in case of sudden hypertensive complications, especially among young people.
A Blueprint for Pediatric Emergency Resource Reallocation During the COVID-19 Pandemic
Authors: Fraymovich Susan , Levine Deborah A. , Platt Shari L. 
Published: July 2020

Objective
We present a blueprint for the reallocation of pediatric emergency resources in response to the COVID-19 pandemic.

Methods
New York-Presbyterian Hospital – Weill Cornell Medical Center is an urban, quaternary, academic medical center, a level 1 trauma center, and a regional burn center located in New York City. The novel coronavirus (COVID-19) pandemic created a unique challenge for pediatric emergency medicine. As the crisis heightened for adult patients, pediatric emergency services experienced a significant decline in volume and acuity.

Results
We offer guidelines to modify physical space, clinical services, staffing models, and the importance of steady leadership. Pediatric emergency space was converted to adult COVID-19 beds, necessitating the repurposing of nonclinical areas for pediatric patients. Efficient clinical pathways were created in collaboration with medical and surgical subspecialists for expedited emergency care of children. We transitioned staffing models to meet the changing clinical demands of the emergency department by both reallocation of pediatric emergency medicine providers to telemedicine and by expanding their clinical care to adult patients. Concentrated communication and receptiveness by hospital and department leadership were fundamental to address the dynamic state of the pandemic and ensure provider wellness.

Conclusions
Modification of physical space, clinical services, staffing models, and the importance of steady leadership enabled us to maintain outstanding clinical care for pediatric patients while maximizing capacity and service for adult COVID-19 patients in the emergency department.
Validation of the D:A:D Chronic Kidney Disease Risk Score Model Among People Living With HIV in the Asia-Pacific
Authors: Han Win Min , Bijker Rimke , Chandrasekaran Ezhilarasi , Pujari Sanjay , Ng Oon Tek , Ly Penh Sun , Lee Man-Po , Van Nguyen Kinh , Chan Yu-Jiun , Do Cuong Duy , Choi Jun Yong , Chaiwarith Romanee , Merati Tuti Parwati , Kiertiburanakul Sasisopin , Azwa Iskandar , Khusuwan Suwimon , Zhang Fujie , Gani Yasmin Mohamed , Tanuma Junko , Sangle Shashikala , Ditangco Rossana , Yunihastuti Evy , Ross Jeremy , Avihingsanon Anchalee ,   on behalf of IeDEA Asia-Pacific
Published: July 2020

Background:
We validated the Data collection on Adverse events of anti-HIV Drugs (D:A:D) full-risk and short-risk score models for chronic kidney disease (CKD) in the Asian HIV cohorts.

Settings:
A validation study among people living with HIV (PLHIV) aged ≥18 years among the cohorts in the Asia-Pacific region.

Methods:
PLHIV with a baseline estimated glomerular filtration rate > 60 mL/min/1.73 m2 were included for validation of the D:A:D CKD full version and short version without cardiovascular risk factors. Those with <3 estimated glomerular filtration rate measurements from baseline or previous exposure to potentially nephrotoxic antiretrovirals were excluded. Kaplan–Meier methods were used to estimate the probability of CKD development. The area under the receiver operating characteristics was also used to validate the risk score.

Results:
We included 5701 participants in full model {median 8.1 [interquartile range (IQR) 4.8–10.9] years follow-up} and 9791 in short model validation [median 4.9 (IQR 2.5–7.3) years follow-up]. The crude incidence rate of CKD was 8.1 [95% confidence interval (CI): 7.3 to 8.9] per 1000 person-years in the full model cohort and 10.5 (95% CI: 9.6 to 11.4) per 1000 person-years in the short model cohort. The progression rates for CKD at 10 years in the full model cohort were 2.7%, 8.9%, and 26.1% for low-risk, medium-risk, and high-risk groups, and 3.5%, 11.7%, and 32.4% in the short model cohort. The area under the receiver operating characteristics for the full-risk and short-risk score was 0.81 (95% CI: 0.79 to 0.83) and 0.83 (95% CI: 0.81 to 0.85), respectively.

Conclusion:
The D:A:D CKD full-risk and short-risk score performed well in predicting CKD events among Asian PLHIV. These risk prediction models may be useful to assist clinicians in identifying individuals at high risk of developing CKD.
Minimum energy bounds on longitudinal elastic constants of transversely isotropic unidirectional composites
Authors: pham Duc-Chinh 
Published: July 2020

We consider the
n
-component transversely isotropic unidirectional elastic composites, the longitudinal axis of which is parallel to those of the transversely isotropic components as well as the generators of the cylindrical phase boundaries between them. From the minimum energy and complementary energy principles, with appropriate constant strain and piece-wise constant stress trial fields, optimization and iteration techniques, a set of bounds for the macroscopic (effective) longitudinal elastic constants of the composites (including the simple lower arithmetic average estimate for longitudinal Young modulus
E
eff
≥
E

V

) are constructed. Numerical examples are provided to illustrate the obtained results.
Resveratrol and Copper for treatment of severe COVID-19: an observational study (RESCU 002)
Authors: Mittra Indraneel , de Souza Rosemarie , Bhadade Rakesh , Madke Tushar , Shankpal P.D. , Joshi Mohan , Qayyumi Burhanuddin , Bhattacharjee Atanu , Gota Vikram , Gupta Sudeep , Chaturvedi Pankaj , Badwe Rajendra 
Published: July 2020

AbstractBackgroundTo be universally applicable in treatment of severe COVID-19, novel therapies, especially those with little toxicity and low cost, are urgently needed. We report here the use of one such therapeutic combination involving two commonly used nutraceuticals, namely resveratrol and copper in patients with this disease. This study was prompted by pre-clinical reports that sepsis-related cytokine storm and fatality in mice can be prevented by oral administration of small quantities of resveratrol and copper. Since cytokine storm and sepsis are major causes of death in severe COVID-19, we retrospectively analyzed outcomes of patients with this condition who had received resveratrol and copper.Methods & FindingsOur analysis comprised of 230 patients with severe COVID-19 requiring inhaled oxygen who were admitted in a single tertiary care hospital in Mumbai between April 1 and May 13 2020. Thirty of these patients received, in addition to standard care, resveratrol and copper at doses of 5.6 mg and 560 ng, respectively, orally, once every 6 hours, until discharge or death. These doses were based on our pre-clinical studies, and were nearly 50 times and 2000 times less, respectively, than those recommended as health supplements. A multivariable-adjusted analysis was used to model the outcome of death in these patients and evaluate factors associated with this event. A binary logistic regression analysis was used, with age, sex, presence of comorbidities and receipt of resveratrol-copper as covariates. Data were updated as of May 30 2020. The number of deaths in resveratrol-copper and standard care only groups were 7/30 (23.3%, 95% CI 8.1%-38.4%) and 89/200 (44.5%, 95% CI 37.6%-51.3%), respectively. In multivariable analysis, age >50 years [odds ratio (OR) 2.558, 95% CI 1.454-4.302, P=0.0011] and female sex (OR 1.939, 95% CI 1.079-3.482, P=0.0267) were significantly associated, while presence of co-morbidities was not significantly associated (OR 0.713, 95% CI 0.405-1.256, P=0.2421) with death. There was a trend towards reduction in death in patients receiving resveratrol-copper (OR 0.413, 95% CI 0.164-1.039, P= 0.0604).ConclusionsWe provide preliminary results of a novel approach to the treatment of severe COVID-19 using a combination of small amounts of commonly used nutraceuticals, which is non-toxic and inexpensive, and therefore could be widely accessible globally. The nearly two-fold reduction in mortality with resveratrol-copper observed in our study needs to be confirmed in a randomized controlled trial.
Divide in Vaccine Belief in COVID-19 Conversations: Implications for Immunization Plans
Authors: Tyagi Aman , Carley Kathleen M. 
Published: July 2020

AbstractThe development of a viable COVID-19 vaccine is a work in progress, but the success of the immunization campaign will depend upon public acceptance. In this paper, we classify Twitter users in COVID-19 discussion into vaccine refusers (anti-vaxxers) and vaccine adherers (vaxxers) communities. We study the divide between anti-vaxxers and vaxxers in the context of whom they follow. More specifically, we look at followership of 1) the U.S. Congress members, 2) four major religions (Christianity, Hinduism, Judaism and Islam), 3) accounts related to the healthcare community, and 4) news media accounts. Our results indicate that there is a partisan divide between vaxxers and anti-vaxxers. We find a religious community with a higher than expected fraction of anti-vaxxers. Further, we find that the variance of vaccine belief within the news media accounts operated by Russian and Iranian governments is higher compared to news media accounts operated by other governments. Finally, we provide messaging and policy implications to inform the COVID-19 vaccine and future vaccination plans.
Baseline Cardiometabolic Profiles and SARS-CoV-2 Risk in the UK Biobank
Authors: Scalsky Ryan J. , Desai Karan , Chen Yi-Ju , O’Connell Jeffery R. , Perry James A. , Hong Charles C. 
Published: July 2020

AbstractBackgroundSARS-CoV-2 is a rapidly spreading coronavirus with a high incidence of severe upper respiratory infection that first presented in Wuhan, China in December 2019. Many factors have been identified as risk factors for SARS-CoV-2, with much attention being paid to body mass index (BMI), but little investigation has been done to investigate dysregulation of lipid profiles and diabetes, which are often comorbid in high BMI patients.ObjectiveThis study seeks to describe the impact of BMI, HDL, LDL, ApoA, ApoB, triglycerides, hemoglobin A1c (HbA1c), diabetes, alcohol and red wine intake on SARS-CoV-2 risk in UK Biobank (UKB) study participants.MethodsWe examined the effect of BMI, lipid profiles, diabetes and alcohol intake on the risk of testing positive for SARS-Cov-2 among 9,005 UKB participants tested for SARS-CoV-2 from March 16 through June 29, 2020. Logistic regression was performed on the target variables controlling for age, sex and ancestry.ResultsBMI, Type II diabetes and HbA1c were associated with increased SARS-CoV-2 risk (p < 0.05) while HDL and ApoA were associated with decreased risk (p < 0.001). Additionally, red wine intake was associated with reduced SARS-CoV-2 risk (p < 0.05). LDL, ApoB and triglyceride levels were not found to be significantly associated with increased risk.ConclusionElevated HDL and ApoA levels and alcohol intake, specifically red wine intake, were associated with reduced risk of testing positive for SARS-CoV-2, while type II diabetes and HbA1c were associated with increased risk. The effects of alcohol, type II diabetes and HbA1c levels may be indirect, mediated in part through regulation of HDL levels. In summary, our study corroborates the emerging picture that high HDL levels may confer protection against SARS-CoV-2.HighlightsIncreases in HDL is associated with reduced risk of testing positive for SARS-CoV-2.Type II diabetes and hemoglobin A1C levels were associated with elevated risk of testing positive for SARS-CoV-2, but this effect was abrogated when controlling for HDL.Alcohol intake, specifically red wine intake, is associated with reduced risk of testing positive for SARS-CoV-2, though this effect may in part be moderated by HDL.LDL and Triglycerides were not associated with increased risk of testing positive for SARS-CoV-2.
Utility and impact of inpatient pediatric physiologic monitoring
Authors: Gourishankar Anand , Evangelista Monaliza , Ellsworth Misti , Hsu Jean 
Published: July 2020

AbstractObjectiveTo study the practice and effect of monitoring pediatric patients on the hospital length of stay (LOS).MethodsWe conducted a cross-sectional observational study of pediatric patients in the general ward from October to December 2016. We recorded the use of cardiac, pulse-oximeter, or both, and physician order at the time of admission. We studied the proportions of monitoring on different patient groups. The median length of stay assessed for various modes of monitoring. We did regression analysis for the effect of cardiopulmonary monitoring, orders, and medical complexity on hospital length of stay.ResultsAmong 398 patients, patients with cardiac monitor and pulse oximeter with orders were 68 % and 82%, respectively. The pulmonary group of patients had more monitoring than the neurology group of patients. LOS was shorter in patients without monitors; the median difference for the cardiac monitor was 1 day, and pulse oximeter was 0.5 days. Cardiac monitor order increased LOS by 22% (95% CI, 0.5% to 48%) and complex past medical history increased it by 25% (95% CI, 4% to 51%).ConclusionOur study highlights the variable practice in using monitors, demanding a standardized approach. The judicious use of monitoring reduces prolonged hospital stay.
Comorbidities associated with regional variations in COVID-19 mortality revealed by population-level analysis
Authors: Yang Hongxing , Zhong Fei 
Published: July 2020

AbstractCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has developed into a global health crisis. Understanding the risk factors for poor outcomes of COVID-19 is thus important for successful management and control of the pandemic. However, the progress and severity of the epidemic across different regions show great differentiations. We hypothesized the origination of these differences are based on location-dependent variations in underlying population-wide health factors. Disease prevalence or incidence data of states and counties of the United States were collected for a group of chronic diseases, including hypertension, diabetes, obesity, stroke, coronary heart disease, heart failure, physical inactivation, and common cancers (e.g., lung, colorectal, stomach, kidney and renal). Correlation and regression analysis identified the prevalence of heart failure as a significant positive factor for region-level COVID-19 mortality. Similarly, the incidence of gastric cancer and thyroid cancer were also identified as significant factors contributing to regional variation in COVID-19 mortality. To explore the implications of these results, we re-analyzed the RNA-seq data for stomach adenocarcinoma (STAD) and colon carcinoma (COAD) from The Cancer Genome Atlas (TCGA) project. We found that expression of genes in the immune response pathways were more severely disturbed in STAD than in COAD, implicating higher probability for STAD patients or individuals with precancerous chronic stomach diseases to develop cytokine storm once infected with COVID-19. Taken together, we conclude that location variations in particular chronic diseases and cancers contribute significantly to the regional variations in COVID-19 mortality.
Exposure to a COVID-19 carrier: transmission trends in respiratory tract and estimation of infectious dose
Authors: Basu Saikat 
Published: July 2020

ABSTRACTHow human respiratory physiology and inhaled airflow therein proceed to impact transmission of SARS-CoV-2, leading to the initial infection, is an open question. An answer can help determine the susceptibility of an individual on exposure to a COVID-2019 carrier and can also quantify the still-unknowninfectious dosefor the disease. Combining computational fluid mechanics-based tracking of respiratory transport in anatomic domains with sputum assessment data from hospitalized COVID-19 patients and earlier measurements of ejecta size distribution during regular speech – this study shows that the regional deposition of virus-laden inhaled droplets at the initial nasopharyngeal infection sites, located in the upper airway, peaks over the droplet size range of 2.5 – 19µ; and reveals that the number of virions that can potentially establish the infection is, at most, of𝒪(102).
Pharmacological and Non-Pharmacological Interventions to Enhance Sleep in Mild Cognitive Impairment and Mild Alzheimer’s Disease: A Systematic Review
Authors: Blackman Jonathan , Swirski Marta , Clynes James , Harding Sam , Leng Yue , Coulthard Elizabeth 
Published: July 2020

ABSTRACTSuboptimal sleep causes cognitive decline and probably accelerates Alzheimer’s Disease (AD) progression. Several sleep interventions have been tested in established AD dementia cases. However early intervention is needed in the course of AD at Mild Cognitive Impairment (MCI) or mild dementia stages to help prevent decline and maintain good quality of life. This systematic review aims to summarize evidence on sleep interventions in MCI and mild AD dementia.Seven databases were systematically searched for interventional studies where ≥75% of participants met diagnostic criteria for MCI/mild AD dementia, with a control group and validated sleep outcome measures. Studies with a majority of participants diagnosed with Moderate to Severe AD were excluded.20164 references were returned after duplication removal. 284 full papers were reviewed with 12 retained. Included papers reported 11 separate studies, total sample (n=602), mean age 76.3 years. Nine interventions were represented: Cognitive Behavioural Therapy – Insomnia (CBT-I), A Multi-Component Group Based Therapy, Phase Locked Loop Acoustic Stimulation, Melatonin, Donepezil, Galantamine, Rivastigmine, Tetrahydroaminoacridine and Continuous Positive Airway Pressure (CPAP). Psychotherapeutic approaches utilising adapted CBT-I achieved statistically significant improvements in the Pittsburgh Sleep Quality Index with one study reporting co-existent improved actigraphy variables. Melatonin significantly reduced sleep latency and sleep to wakefulness transitions in a small sample. CPAP demonstrated efficacy in participants with Obstructive Sleep Apnoea. Evidence to support other interventions was limited.There is a paucity of evidence for sleep interventions in MCI and mild AD highlighting a pressing need for high quality experimental studies exploring alternative sleep interventions.