bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome Reporting Patterns in Total Hip Arthroplasty
Authors: Vajapey Sravya P. , Morris Jesse , Li Dan , Greco Nicholas G. , Li Mengnai , Spitzer Andrew I. 
Published: April 2020

Background:There has been a shift toward using patient-reported outcome measures (PROMs) to capture functional improvement and patient satisfaction after total hip arthroplasty (THA). Because there is no standard measure or set of measures, variability in reporting patterns makes comparison across studies difficult.Methods:We performed a review of the literature using the keywords “total hip arthroplasty” and “total hip replacement” to electronically search PubMed, using the date range August 1, 2014, to August 1, 2019. Randomized clinical trials (RCTs) that were published in 12 high-impact journals were analyzed.Results:One hundred and fifty-nine RCTs were included. The most common topic of investigation was hip implant design and materials, followed by the effect of different hip approaches on patient outcomes. The follow-up period was classified as short-term (<2 years), mid-term (2 to 10 years), or long-term (>10 years). Only 6% of the RCTs reported long-term outcomes. The comprehensiveness of studies was determined on the basis of how many of the 7 following outcome domains were assessed: subjective hip function (PROMs), objective outcome measures (examination findings, laboratory values, etc.), imaging analysis, survivorship, patient satisfaction, pain assessment, and postoperative complications. Subjective hip function and imaging findings were the most commonly reported outcome domains, while implant survivorship and patient satisfaction were the least frequently reported. There was substantial variation in outcome reporting, with 35 unique PROMs utilized to assess subjective hip function. Although the Harris hip score was the most commonly used joint-specific PROM, it was only reported in 42% of the studies. None of the RCTs reported results in all 7 outcome domains, and 13.8% of studies reported results in only 1 outcome domain.Conclusions:There is substantial variability and a lack of comprehensiveness in outcome measures used to report results in THA clinical trials, making it nearly impossible to perform cross-study comparisons.Clinical Relevance:There is an immediate need for the establishment of a standardized set of measures to allow comparison of outcomes across studies.
Lacustrine cyclicity in the early Eocene Green River Formation, Uinta Basin, Utah: Evidence from X-ray fluorescence core scanning
Authors: Walters Andrew P. , Meyers Stephen R. , Carroll Alan R. , Hill Tina R. , Vanden Berg Michael D. 
Published: April 2020

ABSTRACTThe Green River Formation preserves an extraordinary archive of terrestrial paleoclimate during the Early Eocene Climatic Optimum (EECO; ∼ 53–50 Ma), expressing multiple scales of sedimentary cyclicity previously interpreted to reflect annual to Milankovitch-scale forcing. Here we utilize X-ray fluorescence (XRF) core scanning and micro X-ray fluorescence (micro-XRF) scanning in combination with radioisotopic age data to evaluate a rock core record of laminated oil shale and carbonate mudstone from Utah's Uinta Basin, with the parallel objectives of elucidating the paleo-environmental significance of the sedimentary rhythms, testing a range of forcing hypotheses, and evaluating potential linkages between high- and low-frequency forcing. This new assessment reveals that the ∼ 100-μm-scale laminae—the most fundamental rhythm of the Green River Formation—are most strongly expressed by variations in abundance of iron and sulfur. We propose that these variations reflect changes in redox state, consistent with annual stratification of the lake. In contrast to previous studies, no support was found for ENSO or sunspot cycles. However, millimeter- to centimeter-scale rhythms—temporally constrained to the decadal to centennial scale—are strongly expressed as alternations in the abundance of silicate- versus carbonate-associated elements (e.g., Al and Si vs. Ca), suggesting changes in precipitation and sediment delivery to the paleo-lake. Variations also occur at the meter scale, defining an approximate 4 m cycle interpreted to reflect precession. We also identify punctuated intervals, associated principally with one phase of the proposed precession cycle, where Si disconnects from the silicate input. We propose an alternative authigenic or biogenic Si source for these intervals, which reflects periods of enhanced productivity. This result reveals how long-term astronomical forcings can influence short-term processes, yielding insight into decadal- to millennial-scale terrestrial climate change in the Eocene greenhouse earth.
OPEC+ Moves To End Price War With 9.7 Million B/D Cut
Authors: Jacobs Trent 
Published: April 2020

A month-long price war that began in March and caused global oil prices to crash at a record pace is winding down, thanks to an unusual and historic deal between the world’s major oil producers.
The big moment came after 4 days of negotiations in mid-April led by the Organization of Petroleum Exporting Countries (OPEC) and its chief outside partner Russia inked an agreement to cut crude output by 9.7 million B/D. The cuts are the biggest OPEC and its allies have ever made—and the first to involve the US.
The price cuts will take effect this month and extend through June. After June, output curtailments are to be gently rolled back to 7.8 million B/D starting in July and lasting to the end of 2020. The coalition of producing nations will then loosen the reductions to 5.8 million B/D from January 2021 to April 2022. This third phase will be subject to review next year.
Each country’s reduction will be determined from their October baselines—except for Russia and Saudi Arabia. The two largest producers in the agreement are each reducing output from a baseline of 11 million B/D to 8.5 million B/D.
In urging immediate action, OPEC Secretary General Mohammed Barkindo reminded oil and energy ministers from more than 20 nations that at current levels of production, the world’s crude storage capacity would be topped out by May. “There is a grizzly shadow hanging over all of us,” he said. “We do not want this shadow to envelope us. It will have a crushing and long-term impact on the entire industry.”
Considered an essential step toward stabilizing crude markets, the agreement did not come without some dramatics. Mexico, a key partner in the so-called OPEC+ group, refused to commit to its proposed cut of 400,000 B/D, instead saying it was working with the US to share a combined cut of 350,000 B/D. The US, meanwhile, had never previously participated in a coordinated cut led by OPEC.
US President Donald Trump said he agreed to “help Mexico along” by assuming the lion’s share of reductions requested by OPEC. The decision by the US to intervene came as a surprise to many observers. “I was going to pick up the slack, and they would make it up to us at a later date,” he added, indicating that Mexico could repay the favor in “a different form.”
In the end, the informal arrangement proved to be just what the coalition of producers needed to hear to grant Mexico its wish to cut back just 100,000 B/D. On 12 April, the deal was approved by OPEC+ which moved its official reduction target from 10 million B/D to 9.7 million B/D to reflect the arrangement.
“It would not have seemed in the cards three weeks ago that something like this could possibly happen,” Daniel Yergin, the vice chairman at IHS Markit, said. “Among other things, it reflected a pivot on the part of President Trump from focusing on low gasoline prices to focusing on the national security implications of devastating the US oil industry. Low gasoline prices are not a big thing at a time when most everybody is at home and can’t drive anyway.”
Feasibility and Evaluation of a Large-Scale External Validation Approach for Patient-Level Prediction in an International Data Network: Validation of models predicting stroke in female patients newly diagnosed with atrial fibrillation.
Authors: Reps Jenna Marie , Williams Ross D , You Seng Chan , Falconer Thomas , Minty Evan , Callahan Alison , Ryan Patrick B , Park Rae Woong , Lim Hong-Seok , Rijnbeek Peter 
Published: April 2020

Abstract
Background: To demonstrate how the Observational Healthcare Data Science and Informatics (OHDSI) collaborative network and standardization can be utilized to scale-up external validation of patient-level prediction models by enabling validation across a large number of heterogeneous observational healthcare datasets.Methods: Five previously published prognostic models (ATRIA, CHADS2, CHADS2VASC, Q-Stroke and Framingham) that predict future risk of stroke in patients with atrial fibrillation were replicated using the OHDSI frameworks. A network study was run that enabled the five models to be externally validated across nine observational healthcare datasets spanning three countries and five independent sites. Results: The five existing models were able to be integrated into the OHDSI framework for patient-level prediction and they obtained mean c-statistics ranging between 0.57-0.63 across the 6 databases with sufficient data to predict stroke within 1 year of initial atrial fibrillation diagnosis for females with atrial fibrillation. This was comparable with existing validation studies. The validation network study was run across nine datasets within 60 days once the models were replicated. An R package for the study was published at https://github.com/OHDSI/StudyProtocolSandbox/tree/master/ExistingStrokeRiskExternalValidation.Conclusion : This study demonstrates the ability to scale up external validation of patient-level prediction models using a collaboration of researchers and a data standardization that enable models to be readily shared across data sites. External validation is necessary to understand the transportability or reproducibility of a prediction model, but without collaborative approaches it can take three or more years for a model to be validated by one independent researcher. In this paper we show it is possible to both scale-up and speed-up external validation by showing how validation can be done across multiple databases in less than 2 months. We recommend that researchers developing new prediction models use the OHDSI network to externally validate their models.
Smoking is Associated with a Higher Risk of Unplanned Medical Visits among Adult Patients with Diabetes, using Retrospective Electronic Medical Record Data from 2014-2016
Authors: Selya Arielle , Johnson Eric L , Weber Tess L , Russo Jaymi , Stansbury Cheryl , Anshutz Drake , Griese Emily , Hsu Benson 
Published: April 2020

Abstract
Background Smoking exacerbates the complications of diabetes, but little is known about whether patients with diabetes who smoke have more unplanned medical visits than those who do not smoke. This study examines the association between smoking status and unplanned medical visits among patients with diabetes. Methods Data were drawn from electronic medical records (EMR’s) from a large healthcare provider in the Northern Plains region of the US, from adult (≥18 years old) patients with type 1 or type 2 diabetes who received care at least once during 2014-16 (N=62,149). The association between smoking status (current, former, or never smoker) and having ≥1 unplanned visit (comprised of emergency department visits, hospitalizations, hospital observations, and urgent care) was examined after adjusting for age, race/ethnicity, and body mass index (BMI). The top ten most common diagnoses for unplanned visits were examined by smoking status. Results Both current and former smoking were associated with an approximately 1.2-fold increase in the odds of having at least one unplanned medical visit in the 3-year period (OR=1.22, 95% CI=1.16-129; OR=1.23, 95% CI=1.19-1.28, respectively), relative to never-smokers. Most common diagnoses for all patients were pain-related. However, diagnoses related to musculoskeletal system and connective tissue disorders were more common among smokers. Smoking is associated with a higher rate of unplanned medical visits among patients with diabetes in this regional healthcare system. Conclusions Results from this study reveal higher rates of unplanned visits among smokers and former smokers, as well as increased frequencies of unplanned medical visits among current smokers.
Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials
Authors: Zheng Xinxun , Tang Yuming , Gao Yuan , Liu Zhiheng 
Published: April 2020

Abstract
Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is associated with a reduced blood loss in patients undergoing hip fracture surgery compared to general anesthesia. However, this result was underpowered. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue
What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments
Authors: Kwesiga Brendan , Aliti Tom , Kakande Pamela Nabukhonzo , Byawaka Peter , Najjuko Susan , Hsu Justine , Ataguba John , Kabaniha Grace 
Published: April 2020

Abstract
Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, mandatory prepayment through health insurance will be needed to reduce the burden of OOP health spending further.
AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study
Authors: Zujalovic Benedikt , Mayer Benjamin , Hafner Sebastian , Balling Florian , Barth Eberhard 
Published: April 2020

Abstract
Background In consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuro-inflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if single-point measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients.Methods In this prospective, observational, single-center study, 175 patients, admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. Results There was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%.Conclusion The longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities.Trial registration Retrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020
Endothelial colony-forming cells reduced the lung injury induced by cardiopulmonary bypass in rats
Authors: Sun Haibin , Zhao Xiaoqing , Tai Qihang , Xu Guangxiao , Ju Yingnan , Gao Wei 
Published: April 2020

Abstract
Background: Cardiopulmonary bypass (CPB) results in severe lung injury via inflammation and endothelial injury. The aim of this study was to evaluate the effect of endothelial colony-forming cells (ECFCs) on lung injury in rats subjected to CPB. Methods: Thirty-two rats were randomized into the sham, CPB, CPB/ECFC and CPB/ECFC/L-NIO groups. The rats in the sham group received anaesthesia, and the rats in the other groups received CPB. The rats also received PBS, ECFCs and L-NIO-pretreated ECFCs. After 24 hours of CPB, pulmonary capillary permeability, including the PaO 2 /FiO 2 ratio, protein levels in bronchoalveolar lavage fluid (BALF) and lung tissue wet/dry weight, was evaluated. The cell numbers and cytokines in BALF and peripheral blood were tested. Endothelial injury, lung histological injury and apoptosis were assessed. The oxidative stress response and apoptosis-related proteins were analysed. Results: After CPB, all the data deteriorated compared with those obtained in the S group (sham vs CPB vs CPB/ECFC vs CPB/ECFC/L-NIO: histological score: 1.62±0.51 vs 5.37±0.91 vs 3.37±0.89 vs 4.37±0.74; PaO 2 /FiO 2 : 389±12 vs 233±36 vs 338±28 vs 287±30; wet/dry weight: 3.11±0.32 vs 6.71±0.73 vs 4.66±0.55 vs 5.52±0.57; protein levels: 134±22 vs 442±99 vs 225±41 vs 337±53, all P<0.05). Compared to the CPB treatment, ECFCs significantly improved pulmonary capillary permeability and PaO 2 /FiO 2 . Similarly, ECFCs also decreased the inflammatory cell number and pro-inflammatory factors in BALF and peripheral blood, as well as the oxidative stress response in the lung tissue. ECFCs reduced the lung histological injury score and apoptosis and regulated apoptosis-related proteins in the lung tissue. Compared with CPB/ECFC group, all the indicators were partly reversed by the L-NIO. Conclusions: ECFCs significantly reduced lung injury induced by inflammation after CPB.