bluuebunny/crossref_metadata_2025_split huggingface dataset:
Independent freestanding emergency departments and implications for the rural emergency physician workforce in Texas
Authors: Luo Qian , Chong Nicholas , Chen Candice 
Published: December 2020

AbstractObjectiveIndependent freestanding emergency departments (IFEDs) have proliferated over the last decade, largely in Texas. We examined the IFED physician workforce composition and changes in emergency physician workforce supply across states and in rural Texas over the period of IFED proliferation following a 2009 legislation allowing the licensing of these sites.Data SourcesIFED websites, Texas Medical Board lookup tool, National Plan & Provider Enumeration System (NPPES), Provider Enrollment and Chain/Ownership System (PECOS), Medicare Physician Shared Patient Patterns, CareSet DocGraph Hop Teaming, Healthcare Provider Database.Study DesignDescriptive analysis of the IFED physician workforce; quasi‐experimental difference‐in‐difference analysis of Texas emergency physician movement into and out of the state; and difference‐in‐difference‐in‐difference analysis of the change in emergency physician supply between rural and urban areas in Texas compared with other states.Data Extraction MethodsUsing the NPIs obtained through Texas IFED websites and Texas Medical Board data, we examined NPPES/PECOS files, Medicare Physician Shared Patient Patterns, and CareSet DocGraph Hop Teaming for IFED physician practice locations from 2009 to 2017. We extracted all active emergency physicians from a Healthcare Provider Database, derived from a 5% Medicare claims (1999‐2017).Principal FindingsIn 2019, 545 physicians practiced in Texas IFEDs, of which 515 (94.5%) were emergency physicians. We located 533 in previous practice, of whom 522 (97.9%) previously practiced in Disproportionate Share Hospitals and 100 (18.8%) in rural areas. Following legislation to begin licensing IFEDs in 2009, there were on average 42.1 (P < .01) moving into Texas and 17.0 (P < .01) fewer moving out compared with all other states. Our results also indicated that the difference in emergency physician supply between rural and urban Texas was 1,002 (P < .01) fewer than for other states.ConclusionsNew models of health care organizations such as IFEDs have workforce implications that may further exacerbate rural and underserved workforce and access challenges.
Pretreatment CT and 18F‐FDG PET‐based radiomic model predicting pathological complete response and loco‐regional control following neoadjuvant chemoradiation in oesophageal cancer
Authors: Rishi Anupam , Zhang Geoffrey G , Yuan Zhigang , Sim Austin J , Song Ethan Y , Moros Eduardo G , Tomaszewski Michal R , Latifi Kujtim , Pimiento Jose M , Fontaine Jacques‐Pierre , Mehta Rutika , Harrison Louis B , Hoffe Sarah E , Frakes Jessica M 
Published: December 2020

AbstractIntroductionTo develop a radiomic‐based model to predict pathological complete response (pCR) and outcome following neoadjuvant chemoradiotherapy (NACRT) in oesophageal cancer.MethodsWe analysed 68 patients with oesophageal cancer treated with NACRT followed by esophagectomy, who had staging 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography (PET) and computed tomography (CT) scans performed at our institution. An in‐house data‐characterization algorithm was used to extract 3D‐radiomic features from the segmented primary disease. Prediction models were constructed and internally validated. Composite feature, Fc = α * FPET + (1 − α) * FCT, 0 ≤ α ≤ 1, was constructed for each corresponding CT and PET feature. Loco‐regional control (LRC), recurrence‐free survival (RFS), metastasis‐free survival (MFS) and overall survival (OS) were estimated by Kaplan–Meier analysis, and compared using log‐rank test.ResultsMedian follow‐up was 59 months. pCR was achieved in 34 (50%) patients. Five‐year RFS, LRC, MFS and OS were 67.1%, 88.5%, 75.6% and 57.6%, respectively. Tumour Regression Grade (TRG) 0–1 indicative of complete response or minimal residual disease was significantly associated with improved 5‐year LRC [93.7% vs 71.8%; P = 0.020; HR 0.19, 95% CI 0.04–0.85]. Four separate pCR predictive models were built for CT alone, PET alone, CT+PET and composite. CT, PET and CT+PET models had AUC 0.73 ± 0.08, 0.66 ± 0.08 and 0.77 ± 0.07, respectively. The composite model resulted in an improvement of pCR predicting power with AUC 0.87 ± 0.06. Stratifying patients with a low versus high radiomic score showed clinically relevant improvement in 5‐year LRC favouring low‐score group (91.1% vs. 80%, 95% CI 0.09–1.77, P = 0.2).ConclusionThe composite CT/PET radiomics model was highly predictive of pCR following NACRT. Validation in larger data sets is warranted to determine whether the model can predict clinical outcomes.
Mechanical stability and technical outcomes of monolithic CAD/CAM fabricated abutment‐crowns supported by titanium bases: An in vitro study
Authors: Pitta João , Hjerppe Jenni , Burkhardt Felix , Fehmer Vincent , Mojon Philippe , Sailer Irena 
Published: December 2020

AbstractObjectivesTo evaluate mechanical stability (survival and complication rates) and bending moments of different all‐ceramic monolithic restorations bonded to titanium bases (hybrid abutment‐crowns) or to customized titanium abutments compared to porcelain‐fused‐to‐metal crowns (PFM) after thermo‐mechanical aging.Material and MethodsSixty conical connection implants (4.3 mm‐diameter) were divided in five groups (n = 12): PFM using gold abutment (GAbut‐PFM), lithium disilicate crown bonded to customized titanium abutment (TAbut+LDS), lithium disilicate abutment‐crown bonded to titanium base (TiBase+LDS), zirconia abutment‐crown bonded to titanium base (TiBase+ZR), polymer‐infiltrated ceramic‐network (PICN) abutment‐crown bonded to titanium base (TiBase+PICN). Simultaneous thermocycling (5°–55°C) and chewing simulation (1,200,000‐cycles, 49 N, 1.67 Hz) were applied. Catastrophic and non‐catastrophic events were evaluated under light microscope, and survival and complication rates were calculated. Specimens that survived aging were loaded until failure and bending moments were calculated.ResultsSurvival rates after aging were 100% (TAbut+LDS, TiBase+LDS), 91.7% (GA‐PFM), 66.7% (TiBase+ZR) and 58.3% (TiBase+PICN) and differed among the groups (p = .006). Non‐catastrophic events as screw loosening (GA‐PFM) and loss of retention or micro‐/macro‐movement (TiBase groups) were observed. Complication rates varied among the groups (p < .001). TiBase+PICN had lower bending moment than all the other groups (p < .001).ConclusionsHybrid abutment‐crowns made of lithium disilicate can be an alternative to PFM‐based restorations, although concerns regarding the bonded interface between the titanium base and abutment‐crown can be raised. PICN and zirconia may not be recommended due to its inferior mechanical and bonding outcomes, respectively. Titanium customized abutment with bonded lithium disilicate crown appears to be the most stable combination.
Inconsistencies in the association of clinical factors with the choice of early steroid withdrawal across kidney transplant centers: A national registry study
Authors: Bae Sunjae , Garonzik‐Wang Jacqueline M. , Massie Allan B. , McAdams‐DeMarco Mara A. , Coresh Josef , Segev Dorry L. 
Published: December 2020

AbstractBackgroundApproximately 30% of kidney transplant recipients undergo early steroid withdrawal (ESW) for maintenance immunosuppression. However, there is no consensus on which patients are suitable for ESW, and transplant centers may disagree on how various clinical factors characterize individual recipients' suitability for ESW.MethodsTo examine center‐level variation in the association of clinical factors with the choice of ESW, we studied 206 544 kidney transplant recipients from 278 centers in 2002‐2017 using SRTR data. We conducted multi‐level logistic regressions to characterize the association of clinical factors with the choice of ESW at each transplant center.ResultsThe association of clinical factors with the choice of ESW varied substantially across centers. We found particularly greater inconsistency in recipient age, PRA, re‐transplantation, living/deceased donor, post‐transplant length of stay, and delayed graft function. For example, across the entire population, re‐transplantation was associated with lower odds of ESW (population odds ratio = 0.350.400.46). When estimated at each center, this odds ratio was significantly lower than the population odds ratio at 48 (17.3%) centers and significantly higher at 28 (10.1%) centers.ConclusionsWe have observed apparent inconsistencies across transplant centers in the practice of tailoring ESW to the recipient's risk profile. Standardized guidelines for ESW tailoring are needed.
Cascading extinctions as a hidden driver of insect decline
Authors: Kehoe Rachel , Frago Enric , Sanders Dirk 
Published: December 2020

1. The decline in insect abundance and diversity observed in many ecosystems is of major concern because of the long‐term consequences for ecosystem function and stability.2. Species in ecological communities are connected through interactions forming complex networks. Therefore, initial extinctions can cause further species losses through co‐extinctions and extinction cascades, where single extinctions can lead to waves of secondary extinctions. Such knock‐on effects can multiply the initial impact of disturbances, thereby largely adding to the erosion of biodiversity. However, our knowledge of their importance for the current insect decline is hampered because secondary extinctions are challenging to both detect and predict.3. In this review, we bring together theory and knowledge about secondary extinctions in the light of the main drivers of insect decline. We evaluate potential and evidence for cascading extinction for the different drivers and identify major pathways. By providing selected examples we discuss how habitat loss, pollution, species invasions, climate change and overexploitation can cause cascading extinctions. We argue that habitat loss and pollution in particular have the largest potential for such extinctions by changing community structure, the physical environment, and community robustness.4. Overall, cascading extinction are part of an ecosystems' response to anthropogenic drivers but are so far not explicitly measured in their contribution when evaluating biodiversity loss. This knowledge is necessary to predict biodiversity loss and find strategies to buffer against the devastating long‐term impact of habitat loss, pollution, species invasions, and climate change.
Economic burden of epilepsy in children: A population‐based matched cohort study in Canada
Authors: Widjaja Elysa , Guttmann Astrid , Tomlinson George , Snead O. Carter , Sander Beate 
Published: December 2020

AbstractObjectiveThe economic burden of childhood epilepsy to the health care system remains poorly understood. This study aimed to determine phase‐specific and cumulative long‐term health care costs in children with epilepsy (CWE) from the health care payer perspective.MethodsThis cohort study utilized linked health administrative databases in Ontario, Canada. Incident childhood epilepsy cases were identified from January 1, 2003 to June 30, 2017. CWE were matched to children without epilepsy (CWOE) on age, sex, rurality, socioeconomic status, and comorbidities, and assigned prediagnosis, initial, ongoing, and final care phase based on clinical trajectory. Phase‐specific, 1‐year and 5‐year cumulative health care costs, attributable costs of epilepsy, and distribution of costs across different ages were evaluated.ResultsA total of 24 411 CWE were matched to CWOE. The costs were higher for prediagnosis and initial care than ongoing care in CWE. Hospitalization was the main cost component. The costs of prediagnosis, initial, and ongoing care were higher in CWE than CWOE, with the attributable costs at $490 (95% confidence interval [CI] = $352‐$616), $1322 (95% CI = $1247‐$1402), and $305 (95% CI = $276‐$333) per 30 patient‐days, respectively. Final care costs were lower in CWE than CWOE, with attributable costs at −$2515 (95% CI = −$6288 to $961) per 30 patient‐days. One‐year and 5‐year cumulative costs were higher in CWE ($14 776 [95% CI = $13 994‐$15 546] and $39 261 [95% CI = $37 132‐$41 293], respectively) than CWOE ($6152 [95% CI = $5587‐$6768] and $15 598 [95% CI = $14 291‐$17 006], respectively). The total health care costs were highest in the first year of life in CWE for prediagnosis, initial, and ongoing care.SignificanceHealth care costs varied along the continuum of epilepsy care, and were mainly driven by hospitalization costs. The findings identified avenues for remediation, such as enhancing care around the time of epilepsy diagnosis and better care coordination for epilepsy and comorbidities, to reduce hospitalization costs and the economic burden of epilepsy care.
Effect of rolling process on fatigue performance of stir zone of AA6061‐T6 doube‐side friction stir welding joint
Authors: Du Chengchao , Pan Qiuhong , Chen Shujin , Tian Shuang 
Published: December 2020

AbstractStir zone (SZ) of AA6061‐T6 double‐side friction stir welding (DS‐FSW) joint with a thickness of 6 mm had a poor fatigue performance compared with that of base metal (BM). The rolling process was employed to improve the fatigue performance of SZ. The results showed that rolling process increased the dislocation density in SZ and remarkably enhanced its fatigue performance. The crack initiation played a key role in the fatigue performance of SZ. It relied on the debonding of lamellar structure in SZ. The debonding of lamellar structure depended on the cracking of fine grain layer in lamellar structure.
INTO THE UNKNOWN: CLUES, HINTS, AND PROJECTS IN THE HISTORY OF KNOWLEDGE
Authors: KELLER VERA 
Published: December 2020

ABSTRACTThis essay argues for integrating the history of ignorance into the history of knowledge. Through a case study of the (failed) project of colonial Virginian sericulture in the seventeenth and eighteenth centuries, it explores the entanglement of various forms of knowledge and ignorance. These comprise forms of knowledge that have been presented as certain, such as clues and rules, and empirical, such as observations and questionnaires. They also include forms highlighting probabilism and risk‐benefit analyses, such as projects, and forms that made a virtue of uncertainty, such as hints. By exploring the cultural meanings and social functions of these forms of knowledge, this essay illustrates their coproduction with sociopolitical ideals, norms, and biases. The history of unspecified ignorance—including knowledge suppressed due to racism, misogyny, and other social biases—intersects with the history of these agnotological and epistemological tools. Such intersections collectively make up the history of knowledge.
Surgery cancellation: A scoping review of patients' experiences
Authors: Viftrup Anette , Dreyer Pia , Nikolajsen Lone , Holm Anna 
Published: December 2020

ABSTRACTAims and objectivesTo review the literature on patients’ experiences of surgery cancellation to gain knowledge of nursing care needs and identify gaps in evidence.BackgroundSurgery cancellations are an ongoing challenge in healthcare systems with negative impacts on healthcare costs, hospital staff and patients. Most research addresses the reasons for cancellation and implementation of preventive interventions, but limited knowledge exists about patients’ experiences of cancellation.DesignThe scoping review was undertaken using the methodology recommended by the Joanna Briggs Institute for Scoping Reviews and the Reporting Cheklist for Scoping Reviews (PRISMA‐ScR).MethodsA systematic search was conducted by two independent researchers in Cochrane Library, CINAHL, PubMed and PsycINFO. A forward and backward citation search was performed in Scopus, and references in relevant studies were explored. The tool Covidence was applied to select, compare and discuss relevant articles. The Mixed Methods Appraisal Tool was used for critical appraisal.ResultsSurgery cancellation is emotionally harmful with negative effects on patients. Four themes were identified: ‘Initial reactions to cancellation’, ‘Reactions during a new waiting period at home and during readmission to hospital’, ‘Information about cancellation’ and ‘The experience of new practical arrangements’. Patients whose surgery was cancelled experienced initial feelings such as anger, rejection and anxiety and physical/psychosomatic symptoms in the extended waiting period. Patients prefered early sufficient information about cancellation from the surgeon. The practical arrangements were stressfull for the patients.ConclusionNursing care and identification of vulnerable patients are essential to prevent negative effects in the extended waiting period. Provision of timely, sufficient and professional information about cancellation from the surgeon is important. Further research assessing consequences of cancellation is needed.Relevance to clinical practicePatients would benefit if hospitals find systems to minimise cancellation, and healthcare professionals could systematically develop professional supportive interventions tailored to patients’ individual needs.
Dental service utilization and immigrant family structure
Authors: Okunseri Christopher E. , Rota Klea , Okunseri Elaye , Patel Kadam , Garcia Raul I. , Zheng Cheng , Szabo Aniko 
Published: December 2020

AbstractObjectivesTo determine the patterns and time trends of dental services received and access to dental care among immigrant and US‐born children living in the United States.MethodsWe analyzed the nationally representative Medical Expenditure Survey data for 2007–2015. Survey weighted mean and frequency were calculated for all the years and for each year for the complete cohort and for the four subgroups of children categorized based on the child's and parents' birthplace (United States or Foreign). These groups were compared to detect differences in dental service received.ResultsOverall 34,482 children aged <18 years were included in the analysis representing the weighted sample size of 564,255,643. Utilization of preventive dental services increased from 37.2 percent in 2007 to 44.4 percent in 2015 overall (P < 0.0001), with similar trend seen within all subgroups. Immigrant children compared to US‐born children had higher numbers of surgical and restorative procedures (17 versus 16 per 100‐person years, P = 0.03), fewer had at least one preventive dental visit in a year (32.8 percent versus 43.0 percent, P < 0.0001) and were less likely be unable to access dental care (3.0 percent versus 1.7 percent, P = 0.005). Fewer children had delayed access to dental care in recent years (2.0 percent in 2007 to 1.5 percent in 2015) and the decline was consistent in all the subgroups.ConclusionStratification into the different subgroups allowed for improved understanding of dental procedure utilization and dental services utilization in all subgroups increased over time. Immigrant children had lower utilization of preventive procedures and higher utilization of surgical and restorative procedures.
The mechanisms of skeletal muscle atrophy in response to transient knockdown of the vitamin D receptor in vivo
Authors: Bass Joseph J. , Kazi Abid A. , Deane Colleen S. , Nakhuda Asif , Ashcroft Stephen P. , Brook Matthew S. , Wilkinson Daniel J. , Phillips Bethan E. , Philp Andrew , Tarum Janelle , Kadi Fawzi , Andersen Ditte , Garcia Amadeo Muñoz , Smith Ken , Gallagher Iain J. , Szewczyk Nathaniel J. , Cleasby Mark E. , Atherton Philip J 
Published: December 2020

Key points
Reduced vitamin D receptor (VDR) expression prompts skeletal muscle atrophy.
Atrophy occurs through catabolic processes, namely the induction of autophagy, while anabolism remains unchanged.
In response to VDR‐knockdown mitochondrial function and related gene‐set expression is impaired.
In vitro VDR knockdown induces myogenic dysregulation occurring through impaired differentiation.
These results highlight the autonomous role the VDR has within skeletal muscle mass regulation.
AbstractVitamin D deficiency is estimated to affect ∼40% of the world's population and has been associated with impaired muscle maintenance. Vitamin D exerts its actions through the vitamin D receptor (VDR), the expression of which was recently confirmed in skeletal muscle, and its down‐regulation is linked to reduced muscle mass and functional decline. To identify potential mechanisms underlying muscle atrophy, we studied the impact of VDR knockdown (KD) on mature skeletal muscle in vivo, and myogenic regulation in vitro in C2C12 cells. Male Wistar rats underwent in vivo electrotransfer (IVE) to knock down the VDR in hind‐limb tibialis anterior (TA) muscle for 10 days. Comprehensive metabolic and physiological analysis was undertaken to define the influence loss of the VDR on muscle fibre composition, protein synthesis, anabolic and catabolic signalling, mitochondrial phenotype and gene expression. Finally, in vitro lentiviral transfection was used to induce sustained VDR‐KD in C2C12 cells to analyse myogenic regulation. Muscle VDR‐KD elicited atrophy through a reduction in total protein content, resulting in lower myofibre area. Activation of autophagic processes was observed, with no effect upon muscle protein synthesis or anabolic signalling. Furthermore, RNA‐sequencing analysis identified systematic down‐regulation of multiple mitochondrial respiration‐related protein and genesets. Finally, in vitro VDR‐knockdown impaired myogenesis (cell cycling, differentiation and myotube formation). Together, these data indicate a fundamental regulatory role of the VDR in the regulation of myogenesis and muscle mass, whereby it acts to maintain muscle mitochondrial function and limit autophagy.
Bleeding risk with rivaroxaban compared with vitamin K antagonists in patients aged 80 years or older with atrial fibrillation
Authors: Hanon Olivier , Vidal Jean-Sébastien , Pisica-Donose George , Orvoën Galdric , David Jean-Philippe , Chaussade Edouard , Caillard Laure , de Jong Laura W , Boulloche Nicolas , Vinsonneau Ulric , Bouée Stéphane , Krolak-Salmon Pierre , Fauchier Laurent , Jouanny Pierre , Sacco Guillaume , Bellarbre Fabienne , Belmin Joël , Puisieux François , Lilamand Matthieu , Paillaud Elena , Boureau Anne Sophie 
Published: December 2020

ObjectiveDirect oral anticoagulants have been evaluated in the general population, but proper evidence for their safe use in the geriatric population is still missing. We compared the bleeding risk of a direct oral anticoagulant (rivaroxaban) and vitamin K antagonists (VKAs) among French geriatric patients with non-valvular atrial fibrillation (AF) aged ≥80 years.MethodsWe performed a sequential observational prospective cohort study, using data from 33 geriatric centres. The sample comprised 908 patients newly initiated on VKAs between September 2011 and September 2014 and 995 patients newly initiated on rivaroxaban between September 2014 and September 2017. Patients were followed up for up to 12 months. One-year risks of major, intracerebral, gastrointestinal bleedings, ischaemic stroke and all-cause mortality were compared between rivaroxaban-treated and VKA-treated patients with propensity score matching and Cox models.ResultsMajor bleeding risk was significantly lower in rivaroxaban-treated patients (7.4/100 patient-years) compared with VKA-treated patients (14.6/100 patient-years) after multivariate adjustment (HR 0.66; 95% CI 0.43 to 0.99) and in the propensity score–matched sample (HR 0.53; 95% CI 0.33 to 0.85). Intracerebral bleeding occurred less frequently in rivaroxaban-treated patients (1.3/100 patient-years) than in VKA-treated patients (4.0/100 patient-years), adjusted HR 0.59 (95% CI 0.24 to 1.44) and in the propensity score–matched sample HR 0.26 (95% CI 0.09 to 0.80). Major lower bleeding risk was largely driven by lower risk of intracerebral bleeding.ConclusionsOur study findings indicate that bleeding risk, largely driven by lower risk of intracerebral bleeding, is lower with rivaroxaban than with VKA in stroke prevention in patients ≥80 years old with non-valvular AF.