bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potential hypotensive effects of Umezu polyphenols: a 14-week community-based, double-masked and placebo-controlled trial
Authors: Takemura Shigeki , Yoshimasu Kouichi , Tsuno Kanami , Kuroda Mototsugu , Kishida Kunihiro , Mitani Takahiko , Miyashita Kazuhisa 
Published: September 2020

Objective
To evaluate blood pressure (BP)-lowering effects of Umezu polyphenols, polyphenols contained in Japanese plums, in a community-based sample by double-masked and placebo-controlled design.

Methods
Seventy-two Japanese community-dwellers who were interested in prevention or control of their BP (preferably high-normal BP or grade I hypertension) but without antihypertensive medication were randomized into Umezu polyphenols or placebo groups. Each subject took 800 mg/day of Umezu polyphenols or placebo for 12 weeks, followed by a 2-week washout period. Their home and office BP were monitored for 14 weeks in a double-masked manner. We analyzed 56 subjects who met the inclusion criteria.

Results
Home BP increased gradually in both the groups during the intervention period, while diastolic office BP insignificantly decreased in the intervention group. During the washout period, home systolic BP in the morning elevated only in the intervention group.

Conclusions
The study failed to collect consistent evidence of a clear persistent hypotensive effect of Umezu polyphenols.
The Effects of Market Competition on Cardiologists’ Adoption of Transcatheter Aortic Valve Replacement
Authors: Groeneveld Peter W. , Yang Lin , Segal Andrea G. , Karaca-Mandic Pinar , Kanter Genevieve P. 
Published: September 2020

Background:
For decades, the prevailing assumption regarding the diffusion of high-cost medical technologies has been that competitive markets favor more aggressive adoption of new treatments by health care providers (ie, the “Medical Arms Race”). However, novel regulations governing the adoption of transcatheter aortic valve replacement (TAVR) may have disrupted this paradigm when TAVR was introduced.

Objective:
The objective of this study was to assess the relationship between the market concentration of physician group practices and the adoption of TAVR in its first years of use.

Research Design:
This was a retrospective cohort study.

Subjects:
Physician group practices (n=5116) providing interventional cardiology services in the United States from May 1, 2012, to December 31, 2014.

Measures:
The first use of TAVR as indicated by a fee-for-service Medicare claim. Covariates including characteristics of the physician groups (ie, case volume, hospital affiliation, mean patient risk) as well as county-level and market-level characteristics.

Results:
By the close of 2014, 9.3% of practices had adopted TAVR. Cox proportional hazards models revealed a hazard ratio of 1.26 (95% confidence interval: 1.16–1.37, P<0.001) per 1000 point increase in the physician group practice Herfindahl-Hirschman Index, indicating each 1000 point increase in group practice Herfindahl-Hirschman Index was associated with a 26% relative increase in the rate of TAVR adoption.

Conclusions:
Adoption of TAVR by physician groups in concentrated markets was potentially a consequence of the unique regulations governing TAVR reimbursement, which favored the adoption of TAVR by physician groups with greater market power. These findings have important implications for how future regulations may shape patterns of technology adoption.
The Effects of a Stress Management Group Education Program on Symptoms of Depression, Anxiety, and Stress in People With Comorbid Diabetes and Chronic and/or Recurrent Foot and Ankle Complications
Authors: Lu Annie D. , Bonder-Smith Sheila , Li Xiaochun 
Published: September 2020

BACKGROUND:
Individuals with diabetic foot and ankle complications are at heightened risk for depression, anxiety, and stress.

PURPOSE:
This study evaluated the effect of a stress management group education (SMGE) program in this population.

METHODS:
The 21-question Depression Anxiety Stress Scales and the Problem Areas in Diabetes scale were administered prior to, upon completion of, and at approximately 6 weeks after the program.

RESULTS:
Twenty-five patients from an urban diabetic foot and ankle center completed the study.

CONCLUSION:
The SMGE program demonstrated decreased levels of anxiety, depression, and diabetes problem areas for our study population.
Emotions of Orthopaedic Arthroplasty Patients
Authors: Zabalegui Adelaida , Cabrera Esther , Cano Sara , Copanitsanou Panagiota , Fatkulina Natalja , Katajisto Jouko , Papastavrou Evridiki , Sigurdardottir Arun K. , Valkeapää Kirsi , Leino-Kilpi Helena 
Published: September 2020

METHODS:
This was a pre/post-observational study examining patients' emotions before and during elective knee or hip replacement surgery for osteoarthritis in seven European Union countries to identify factors related to better emotional status at discharge.

INSTRUMENTS:
In addition to demographic data, information was collected on quality of life (EuroQoL five-dimension questionnaire), hospital expectations (Knowledge Expectations of Hospital Patients Scale), symptoms, and experienced emotions.

ANALYSIS:
Total negative emotions scores at baseline and discharge were transformed into median values. Multivariate analysis identified the baseline factors related to better emotional status at discharge.

RESULTS:
Patients (n = 1,590), mean age 66.7 years (SD = 10.6), had a significant reduction in the frequency of total negative emotions at discharge as compared with baseline. The multivariate model showed better health status (odds ratio [OR] = 1.012; p = .004), better emotional status at baseline (≥24 points), and shorter duration of hospital stay (OR = 0.960; p = .011) as independent factors associated with better emotional status at discharge (OR = 4.297; p = .001).

CONCLUSIONS:
Patients undergoing elective knee or hip replacement surgery for osteoarthritis improve their emotional status during hospitalization, with fewer negative emotions at discharge. Good emotional status, feeling of higher health status at baseline, and shorter hospitalization were independently associated with better emotional status at discharge.
A Comparison Study—Oral Patient-Controlled Analgesia Versus Traditional Delivery of Pain Medication Following Orthopaedic Procedures
Authors: Collins Laurie , Cata Denise M. , Conley N. Sharon 
Published: September 2020

BACKGROUND:
Orthopedic surgical patients have reported significantly lower numeric pain scores using a Wi-Fi oral patient-controlled analgesia (PCA) device compared to patients receiving oral as-needed (PRN) medication by manual administration. More than 90% of nurses using the oral PCA device have agreed that the device saved them time. The manual administration of PRN pain medication is frequently delayed and consumes a significant amount of nursing time. Delays in PRN pain medication delivery have been classed as missed nursing care, called an error of omission.

PURPOSE:
The purpose of this timing study was to examine if the use of the oral PCA device would reduce the nursing time to accomplish the delivery of PRN oral pain medication compared to the manual administration by nursing staff.

METHODS:
Each total task for the manual and device administration of a single PRN delivery of an oral pain medication was divided into subtasks. Personal data assistant (PDA) devices were programmed to enable the collection of timing data for each subtask for both methods.

RESULTS:
The manual administration time was 12.7 minutes per single dose beginning with the patient medication request and ending with pain reassessment. The oral PCA device steps to program the device, deliver one of eight doses of medication, and discharge the patient from the device required 2.06 minutes of nursing time. Reloading an additional eight-dose tray required 40 seconds of nursing time per dose of medication administered.

CONCLUSION:
The oral PCA saved 84% of the nursing time to administer each dose of PRN medication manually. These data provide evidence that the oral PCA device would reduce the nursing time to deliver a single dose of PRN oral pain medication.
Association of Socioeconomic Characteristics With Where Children Receive Emergency Care
Authors: Chang Lawrence , Rees Chris A. , Michelson Kenneth A. 
Published: September 2020

Objective
Outcomes of emergency care delivered to children vary by patient-level socioeconomic factors and by emergency department (ED) characteristics, including pediatric volume. How these factors intersect in emergency care-seeking patterns among children is not well understood. The objective of this study was to characterize national associations of neighborhood income and insurance type of children with the characteristics of the EDs from which they receive care.

Methods
We conducted a cross-sectional study of ED visits by children from 2014 to 2017 using the Nationwide Emergency Department Sample. We determined the associations of neighborhood income and patient insurance type with the proportions of visits to EDs by pediatric volume category, both unadjusted and adjusted for patient-level factors including urban-rural status of residence.

Results
Of 107.6 million ED visits by children nationally from 2014 to 2017, children outside of the wealthiest neighborhood income quartile had lower proportions of visits to high-volume pediatric EDs (57.1% poorest quartile, 51.5% second, 56.6% third, 63.5% wealthiest) and greater proportions of visits to low-volume pediatric EDs (4.4% poorest, 6.4% second, 4.6% third, 2.3% wealthiest) than children in the wealthiest quartile. Adjustment for patient-level factors, particularly urban-rural status, inverted this association, revealing that lower neighborhood income was independently associated with visiting higher-volume pediatric EDs. Publicly insured children were modestly more likely to visit higher-volume pediatric EDs than privately insured and uninsured children in both unadjusted and adjusted analyses.

Conclusions
Nationally, children in lower-income neighborhoods tended to receive care in pediatric EDs with lower volume, an association that appears principally driven by urban-rural differences in access to emergency care.
Patterns of PrEP Retention Among HIV Pre-exposure Prophylaxis Users in Baltimore City, Maryland
Authors: Wu Linxuan , Schumacher Christina , Chandran Aruna , Fields Errol , Price Ashley , Greenbaum Adena , Jennings Jacky M. ,   the IMPACT Partner Collaborative
Published: September 2020

Background:
HIV pre-exposure prophylaxis (PrEP) retention, defined as quarterly clinical evaluation, is critical to reducing HIV incidence. Our objectives were to determine: (1) visit- and individual-level PrEP retention patterns; (2) and individual-level characteristics associated with low-level PrEP retention 12 months after initiation among PrEP users in Baltimore City, Maryland.

Methods:
Information was abstracted from medical records among individuals initiating PrEP between October 1, 2015 and February 28, 2018. Visit-level PrEP retention was defined as evidence of PrEP use, documented PrEP prescription, or current PrEP use at each quarterly follow-up visit. Low-level PrEP retention was defined as <3/4 quarters with documented PrEP use. Multilevel mixed effects Poisson regression was used to determine characteristics associated with low-level PrEP retention.

Results:
Among 412 individuals initiating PrEP and followed for 12 months, the majority was: cis-gender male (83.7%, n = 345), non-Hispanic Black (56.3%, n = 232) and gay, bisexual, or other man who has sex with men (74.0%, n = 305). By quarterly visits, PrEP retention was: 3-month: 69.4% (n = 286); 6-month: 51.9% (n = 214); 9-month: 44.5% (n = 183); and 12-month: 41.1% (n = 169). Three-fifths (58.5%, n = 241) had low-level PrEP retention. Cis-gender females (vs. cis-gender males) (adjusted relative risk: 1.36, 95% confidence interval: 1.04 to 1.77) were more likely to have low-level PrEP retention.

Conclusions:
Our observed PrEP retention rates are lower than what may be needed to reduce HIV incidence. Future research should examine individual- and clinic-level barriers and facilitators to PrEP retention programs by key population to inform interventions for PrEP retention.
Epidemiological Analysis and the Nomogram for Possible Risk Factors for Severe Microtia
Authors: Guo Rui , Wang Bingqing , Wang Yue , Zhang Yongbiao , Liu Tun , Zhang Qingguo 
Published: September 2020

Background:
Microtia is a severe congenital malformation of the external ear. This study aimed to explore the epidemiologic characteristics and the possible risk factors in patients with severe microtia in China, and integrate significant variables into a predictive nomogram.

Methods:
A total of 965 patients with microtia were included. This retrospective case study was conducted from July 2014 to July 2019 at Plastic Surgery Hospital in China. The detailed questionnaires concerning potential risk factors were completed and data were gathered. Chi-Square and Fisher tests were used to analyze the variables, and a multivariate logistic regression model was used to select variables related to severe microtia, and then construct a nomogram. The nomogram model was evaluated by the concordance index (C-index), calibration plot, and receiver operating characteristics (ROCs) curve. Bootstraps with 1000 resamples were applied to these analyses.

Results:
Of the 965 microtia patients, 629 (65.2%) were male and 867 (89.8%) were sporadic. The cases were observed more commonly in unilateral (83.1%) and right-sided (52.0%). And multiple malformations were observed in 392 (40.6%) cases. Multivariate logistic regression analysis showed that maternal age, miscarriage frequency, virus infection, anemia, using progesterone, paternal alcohol intake, and topography of living areas were associated with a higher risk of severe microtia. All the significant variables were combined into a predictive nomogram (C-index = 0.755,95% CI = 0.703–0.807). Higher prediction accuracy (adjusted C-index = 0.749) was further verified via bootstrap validation. The calibration plot showed good performance, and the ROCs curve analysis demonstrated high sensitivity and specificity.

Conclusions:
Most microtia patients are male, sporadic, and accompanied by other malformations, which are similar to the phenotypic analysis results of other studies. A nomogram predicting severe microtia was constructed to provide scientific guidance for individualized prevention in clinical practice.
Should We Be Utilizing More Liver Grafts From Pediatric Donation After Circulatory Death Donors? A National Analysis of the SRTR from 2002 to 2017
Authors: Sasaki Kazunari , Nair Amit , Firl Daniel J. , McVey John C. , El-Gazzaz Galal , Diago Uso Teresa , Fujiki Masato , Aucejo Federico N. , Quintini Cristiano , Kwon Choon-Hyuck D. , Hashimoto Koji , Miller Charles M. , Eghtesad Bijan 
Published: September 2020

Background.
Rates of withdrawal of life-sustaining treatment are higher among critically ill pediatric patients compared to adults. Therefore, livers from pediatric donation after circulatory death (pDCD) could improve graft organ shortage and waiting time for listed patients. As knowledge on the utilization of pDCD is limited, this study used US national registry data (2002–2017) to estimate the prognostic impact of pDCD in both adult and pediatric liver transplant (LT).

Methods.
In adult LT, the short-term (1-year) and long-term (overall) graft survival (GS) between pDCD and adult donation after circulatory death (aDCD) grafts was compared. In pediatric LT, the short- and long-term prognostic outcomes of pDCD were compared with other type of grafts (brain dead, split, and living donor).

Results.
Of 80 843 LTs in the study, 8967 (11.1%) were from pediatric donors. Among these, only 443 were pDCD, which were utilized mainly in adult recipients (91.9%). In adult recipients, short- and long-term GS did not differ significantly between pDCD and aDCD grafts (hazard ratio = 0.82 in short term and 0.73 in long term, both P > 0.05, respectively). Even “very young” (≤12 y) pDCD grafts had similar GS to aDCD grafts, although the rate of graft loss from vascular complications was higher in the former (14.0% versus 3.6%, P < 0.01). In pediatric recipients, pDCD grafts showed similar GS with other graft types whereas waiting time for DCD livers was significantly shorter (36.5 d versus 53.0 d, P < 0.01).

Conclusions.
Given the comparable survival seen to aDCDs, this data show that there is still much scope to improve the utilization of pDCD liver grafts.
A short report: Acute, non-COVID related medical admissions during the first wave of COVID-19: A retrospective comparison of changing patterns of disease
Authors: Riley B , Packer M , Gallier S , Sapey E , Atkin C 
Published: September 2020

AbstractBackgroundThe COVID-19 pandemic was associated with social restrictions in the UK from 16th March 2020. It was unclear if the lockdown period was associated with differences in the case-mix of non-COVID acute medical admissions compared with the previous year.MethodsRetrospective data were collected for 1st-30th April 2019 and 1st–30th April 2020 from University Hospitals Birmingham NHS Foundation Trust, one of the largest hospitals in the UK with over 2 million patient contacts per year. The latter time period was chosen to coincide with the peak of COVID-19 cases in the West Midlands. All patients admitted under acute medicine during these time periods were included. COVID-19 was confirmed by SARS-Cov-2 swab or a probable case of COVID-19 based on World Health Organization diagnostic parameters. Non-COVID patients were those with a negative SARS-Cov-2 swab and no suspicion of COVID-19. Data was sourced from UHB’s in-house electronic health system (EHS).ResultsThe total number of acute medical admissions fell comparing April 2019 (n = 2409) to April 2020 (n = 1682). As a proportion of total admissions, those aged under 45 years decreased, while those aged 46 and over did not change.The number of admissions due to psychiatric conditions and overdoses was higher in April 2020 (p < 0.001). When viewed as a proportion of admissions, alcohol-related admissions (p = 0.004), psychiatric conditions and overdoses (p< 0.001) increased in April 2020 than in April 2019. The proportion of patients who were in hospital due to falls also increased in April 2020 (p< 0.001). In the same period, the absolute number and the proportion of admissions that were due to non-specific chest pain, to musculoskeletal complaints and patients who self-discharged prior to assessment decreased (p = 0.02, p = 0.01 and p = 0.002 respectively).There were no significant differences in non-COVID-related intensive care admissions or mortality between the same months in the two years.ConclusionIn this large, single-centre study, there was a change in hospitalised case-mix when comparing April 2019 with April 2020: an increase in conditions which potentially reflect social isolation (falls, drug and alcohol misuse and psychiatric illness) and a decrease in conditions which rarely require in-patient hospital treatment (musculoskeletal pain and non-cardiac chest pain) especially among younger adults. These results highlight two areas for further research; the impact of social isolation on health and whether younger adults could be offered alternative health services to avoid potentially unnecessary hospital assessment.
Implementation of the Maternal Early Warning Criteria during early postpartum. A prospective observational study
Authors: Ibáñez-Lorente Cristina , Casans-Francés Rubén , Bellas-Cotán Soledad , Muñoz-Alameda Luis E. 
Published: September 2020

AbstractObjectiveTo evaluate the implementation of an early warning system in obstetric patients (MEWC) during the first two hours after delivery in a tertiary-care hospital.MethodThe MEWC system implementation was carried out from 15th March to 15th September 2018, over 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, diuresis, uterine involution, and bleeding. A trigger was defined as any abnormal parameter that prompted the need for bedside examination by an obstetrician and an anesthesiologist. We carried out a sensitivity-specificity study of the trigger and multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission and stay.ResultsThe protocol was triggered in 75 patients (6.43%). The leading cause of alarm activation was altered systolic blood pressure (32 [42.7%] patients), followed by obstetric causes (24 [32%] patients). Of these patients, eleven developed PFD. Twenty-eight patients were false-negatives. Sensitivity and specificity of MEWC protocol were 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. Multivariate analysis showed a relationship between alarm activation and PFD.Conclusions:Our MEWC protocol presented low sensitivity and high specificity, having a significant number of false-negative patients.
Phylogenomic Assessment of the Role of Hybridization and Introgression in Trait Evolution
Authors: Wang Yaxuan , Cao Zhen , Ogilvie Huw A. , Nakhleh Luay 
Published: September 2020

AbstractTrait evolution among a set of species—a central theme in evolutionary biology—has long been understood and analyzed with respect to a species tree. However, the field of phylogenomics, which has been propelled by advances in sequencing technologies, has ushered in the era of species/gene tree incongruence and, consequently, a more nuanced understanding of trait evolution. For a trait whose states are incongruent with the branching patterns in the species tree, the same state could have arisen independently in different species (homoplasy) or followed the branching patterns of gene trees, incongruent with the species tree (hemiplasy). Another evolutionary process whose extent and significance are better revealed by phylogenomic studies is gene flow between different species. In this work, we present a phylogenomic method for assessing the role of hybridization and introgression in the evolution of polymorphic or monomorphic binary traits. We apply the method to simulated evolutionary scenarios to demonstrate the interplay between the parameters of the evolutionary history and the role of introgression in a binary trait’s evolution (which we callxenoplasy). Very importantly, we demonstrate, including on a biological data set, that inferring a species tree and using it for trait evolution analysis in the presence of gene flow could lead to misleading hypotheses about trait evolution.