bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting Patients at Risk for Prolonged Hospital Stays
Authors: Doctoroff Lauren , Herzig Shoshana J. 
Published: August 2020

Background:
Patients with prolonged hospitalizations account for 14% of all hospital days in US hospitals. Predicting which medical patients are at risk for prolonged hospitalizations would allow early proactive management to reduce their length of stay.

Methods:
Using the National Inpatient Sample, we examined risk factors for prolonged hospitalizations among adults hospitalized on the medicine service in 2014. We defined prolonged hospitalizations as those lasting 21 days or longer. We divided the sample into derivation and validation sets, and used logistic regression to identify significant risk factors in the derivation set, which were validated in the validation set. We used the estimates from the model to derive a risk score for prolonged hospitalizations.

Results:
Our sample included 2,997,249 hospitalizations (median age of 66 y, 53.5% female). 1.2% of hospitalizations were 21 days or longer. Patients with prolonged hospitalizations were younger, and had a greater number of chronic diseases. A prolonged hospitalization risk score, derived from the many significant predictors in our model, performed well in discriminating between prolonged and nonprolonged hospitalizations, with c-statistics of 0.80 in both the derivation and validation sets.

Conclusions:
Our predictive model using readily available administrative data was able to discriminate between prolonged and nonprolonged hospitalizations in a national sample of medical patients, and performed well on internal validation. If prospectively validated, such a tool could be of use to hospitals and researchers interested in targeting development, testing, and/or deployment of programs to reduce length of stay.
Cost-effectiveness of Yoga for Chronic Low Back Pain in Veterans
Authors: Groessl Erik J. , Liu Lin , Richard Erin L. , Tally Steven R. 
Published: August 2020

Background:
Yoga interventions can improve function and reduce pain in persons with chronic low back pain (cLBP).

Objective:
Using data from a recent trial of yoga for military veterans with cLBP, we analyzed the incremental cost-effectiveness of yoga compared with usual care.

Methods:
Participants (n=150) were randomized to either 2× weekly, 60-minute yoga sessions for 12 weeks, or to delayed treatment (DT). Outcomes were measured at 12 weeks, and 6 months. Quality-adjusted life years (QALYs) were measured using the EQ-5D scale. A 30% improvement on the Roland-Morris Disability Questionnaire (primary outcome) served as an additional effectiveness measure. Intervention costs including personnel, materials, and transportation were tracked during the study. Health care costs were obtained from patient medical records. Health care organization and societal perspectives were examined with a 12-month horizon.

Results:
Incremental QALYs gained by the yoga group over 12 months were 0.043. Intervention costs to deliver yoga were $307/participant. Negligible differences in health care costs were found between groups. From the health care organization perspective, the incremental cost-effectiveness ratio to provide yoga was $4488/QALY. From the societal perspective, yoga was “dominant” providing both health benefit and cost savings. Probabilistic sensitivity analysis indicates an 89% chance of yoga being cost-effective at a willingness-to-pay of $50,000. A scenario comparing the costs of yoga and physical therapy suggest that yoga may produce similar results at a much lower cost.

Discussion/Conclusions:
Yoga is a cost-effective treatment for reducing pain and disability among military veterans with cLBP.
Tailored to Fit
Authors: Purcell Natalie , Becker William C. , Zamora Kara A. , McGrath Sarah L. , Hagedorn Hildi J. , Fabian Eva R. , McCamish Nicole , Seal Karen H. 
Published: August 2020

Background:
Veterans Affairs (VA) has rolled out a holistic, multicomponent Whole Health care model nationwide, yet no pragmatic trials have been conducted in real-world clinical settings to compare its effectiveness against other evidence-based approaches for chronic pain management in veterans.

Objectives:
We describe the adaptation of the first large pragmatic randomized controlled trial of the Whole Health model for chronic pain care for diverse VA clinical settings.

Research Design:
Informed by the Promoting Action on Research Implementation in Health Systems implementation framework, we conducted qualitative semistructured interviews to obtain feedback on trial design from VA leadership, frontline clinicians, and veterans with chronic pain at 5 VA enrollment sites. Next, we convened in-person evidence-based quality improvement (EBQI) meetings with study stakeholders (including frontline clinicians and administrators) at each site to discuss study design; review interview themes; and identify site-specific barriers, facilitators, and approaches to implementation. Ethnographic observations from EBQI meetings provided additional insight into implementation strategies.

Subjects:
Seventy-four veteran and VA staff stakeholders were interviewed; 71 stakeholders participated in EBQI meetings.

Results:
At each site, unique clinical contexts and varying resources for Whole Health and pain care delivery affected plans for trial implementation. We present examples of local adaptations that emerged through the formative evaluation process to facilitate implementation and yield a more pragmatic trial design.

Conclusions:
A systematic formative evaluation can facilitate engagement and buy-in of study stakeholders. Locally tailored pragmatic implementation strategies may improve the likelihood of successful trial execution as well as future implementation of evidence-based pain care approaches in real-world clinical settings.
Relation of the Networks Formed by Diabetic Patients Sharing Physicians With Emergency Department Visits and Hospitalizations
Authors: Davis James , Lim Eunjung , Taira Deborah A. , Chen John 
Published: August 2020

Objective:
The objective of this study was to evaluate if the networks of diabetic patients sharing physicians are associated with emergency department (ED) visits and hospitalizations.

Study Design:
This is a retrospective cohort study.

Methods:
We used administrative data from a large insurer in Hawaii in 2010. Three types of networks were defined based on patient visits: (1) the total number of links from one patient to other patients sharing a physician; (2) the number of other patients connected by sharing the physician seen the most often; and (3) the number of other patients connected by seeing all the same physicians during the year. The networks were characterized into thirds based on their complexity and analyzed using zero-inflated negative binomial regression models on ED visits and hospitalizations.

Results:
The study included 38,767 diabetes patients with a mean age of 64 years. Patients sharing the most physicians had double the risks of ED visits and hospitalizations. Patients linked by belonging to the largest primary care practices had a 28% reduced odds of ED visits. Patients linked by seeing all of the same physicians during the year had the fewest primary care providers and specialists visits and 25%–50% reductions in ED visits and hospitalizations.

Conclusions:
Networks of diabetic patients sharing all the same physicians were associated with decreased ED visits and hospitalizations. Encouraging diabetic patients to find a provider they like and trust and to stay in the provider’s care may help reduce the risks of adverse events. Physicians building loyalty among their patients may reduce their patients’ risks.
The Utility of 18FDG PET/CT Versus Bone Scan for Identification of Bone Metastases in a Pediatric Sarcoma Population and a Review of the Literature
Authors: Tal Adit L. , Doshi Hiten , Parkar Fauziya , Abraham Tony , Love Charito , Ye Kenny , Yang Rui , Hoang Bang , Loeb David , Chou Alexander , Geller David , Moadel Renee 
Published: August 2020

Background:
Outcome of patients with osteosarcoma (OS) and Ewing sarcoma (EWS) is dependent on presence of metastases. Imaging guidelines for OS and EWS include radiographs, computed tomography (CT), and magnetic resonance imaging for primary tumor evaluation and CT chest and bone scintigraphy (BS) for metastatic detection. 18Fluorodeoxyglucose (18FDG) positron emission tomography (PET)/CT has become more common for disease evaluation, yet there is no consensus for its use in this population.

Objective:
We aimed to compare identification of osseous metastases using BS versus 18FDG PET/CT in our patient population. We hypothesized that 18FDG PET/CT is more likely to detect osseous metastases both at diagnosis and relapse.

Materials and Methods:
We performed retrospective chart reviews of pediatric sarcoma patients treated at our institution from 2008 to 2019. Paired BS and 18FDG PET/CT scans were reviewed. Review of the literature was also performed.

Results:
Thirty-three patients had paired BS and 18FDG PET/CT during diagnosis or treatment. Fifteen patients had distant osseous metastases. In the OS cohort, 8/16 patients had osseous metastases; 100% of these patients were detected on 18FDG PET/CT and 75% on BS. Thirty-one bony lesions were seen on imaging in OS patients; 100% of these were identified on 18FDG PET/CT but only 29% on BS. In the EWS cohort, 6/15 patients had osseous metastases; 100% of these patients were detected on 18FDG PET/CT and 50% on BS. Eighteen bony lesions were seen on imaging in EWS patients; 94% of these were identified on 18FDG PET/CT, but only 28% on BS.

Conclusion:
For patients in our institution with OS or EWS, osseous metastases were more likely detected using 18FDG PET/CT.
Temperament and Character Profiles of Ankylosing Spondylitis Patients Compared With Major Depression Patients and Healthy Controls
Authors: Tönük Şükrü Burak , Arısoy Özden , Öztürk Erhan Arif , Boztaş Mehmet Hamid , Çifci Kaygusuz Çiğdem , Erdem Sultanoğlu Tuba 
Published: August 2020

Background/Objective
Depressive disorder is common in patients with ankylosing spondylitis (AS), who exhibit specific brain imaging abnormalities resembling those in major depression (MD). We compared temperament and character profiles between patients with AS and MD.

Methods
The study involved 36 patients with AS, 40 with MD, and 36 healthy controls (HCs). The participants were age-, sex-, and education-matched. Depression, anxiety, temperament, and character were evaluated using the Temperament and Character Inventory and physician-rated Hamilton Depression and Anxiety Scales. Disease severity was assessed using the Bath Ankylosing Spondylitis Disease Activity, Radiology, Metrology, and Functionality Indexes; erythrocyte sedimentation rate; and C-reactive protein.

Results
Depression and anxiety scores were highest in MD, lowest in HCs, and intermediate in AS (p < 0.001). Harm avoidance was significantly higher in MD and AS than HCs (p = 0.01). Reward dependency was lower (p = 0.011) and self-transcendence higher in AS only (p = 0.034). Bath Ankylosing Spondylitis Radiology Index was negatively correlated with depression (p = 0.020). Bath Ankylosing Spondylitis Radiology Index and Bath Ankylosing Spondylitis Metrology Index were negatively correlated with harm avoidance (p < 0.05). Disease duration was negatively correlated with self-transcendence (p = 0.027). Harm avoidance was correlated with depression score (p = 0.029). Patients under tumor necrosis factor α inhibitor treatment had lower cooperativeness score (p = 0.022).

Conclusions
Patients with AS had a specific Temperament and Character Inventory pattern. Harm avoidance was common in both AS and MD. In AS, harm avoidance and depression decreased in patients with progression, probably because progressive fusion of the spinal segments causes decrease in pain. Harm avoidance (fear of pain) seemed to be an acting factor for occurrence of depressive symptoms in AS.
Impaired Cardiac Autonomic Control in Women With Fibromyalgia Is Independent of Their Physical Fitness
Authors: Schamne Julio Cezar , Ressetti Juliana Campos , Lima-Silva Adriano Eduardo , Okuno Nilo Massaru 
Published: August 2020

Background/Objective
Evidence has suggested abnormal cardiac autonomic responses to exercise in patients with fibromyalgia (FM). However, it is not clear whether the dysautonomia represents a reduced physical fitness rather directly related to FM pathogenesis. Thus, we aimed to verify the cardiac autonomic responses before, during, and after a maximal incremental exercise in women with FM and whether these hypothesized alterations would be dependent with their physical fitness.

Methods
This is a cross-sectional study with 23 FM women and 17 healthy women. The participants performed a maximal incremental cycling test to determine their maximal workload (W
max) and were further matched by their W
max (14 FM patients, W
max: 128.6 ± 16.2 W; and 14 healthy women, W
max: 131.9 ± 15.9 W). Beat-to-beat heart rate (HR) was continuously monitored to calculate HR variability indexes at rest, chronotropic reserve during exercise, and HR recovery.

Results
Heart rate variability indexes related to vagal modulation were significantly lower in FM patients than in healthy women (p < 0.05). The chronotropic reserve and the HR recovery at 30, 120, 180, 300, and 600 seconds after exercise were all lower in FM patients compared with those of healthy women (p < 0.05). Similar findings were found when analysis was performed using the matched physical fitness subgroup.

Conclusions
The documented cardiac autonomic abnormalities at rest, during, and after exercise in FM patients persist even when physical fitness status is taken in account. Thus, strategies to attenuate the dysautonomia in FM patients must be considered.
The Species Awareness Index (SAI): a Wikipedia-derived conservation culturomics metric for public biodiversity awareness
Authors: Millard Joseph W , Gregory Richard D , Jones Kate , Freeman Robin 
Published: August 2020

AbstractThreats to global biodiversity are well-known, but slowing currents rates of biodiversity loss remains an ongoing challenge. The Aichi Targets set out 20 goals on which the international community should act to alleviate biodiversity decline, one of which (Target 1) aimed to raise public awareness of the importance of biodiversity. Whilst conventional indicators for Target 1 are of low spatial and temporal coverage, conservation culturomics has demonstrated how biodiversity awareness can be quantified at the global scale. Following the Living Planet Index methodology, here we introduced the Species Awareness Index (SAI), an index of changing species awareness on Wikipedia. We calculated this index at the page level for 41,197 IUCN species across 10 Wikipedia languages, incorporating over 2 billion views. Bootstrapped indices for the page level SAI show that overall awareness of biodiversity is marginally increasing, although there are differences among taxonomic classes and languages. Among taxonomic classes, overall awareness of reptiles is increasing fastest, and amphibians slowest. Among languages, overall species awareness for the Japanese Wikipedias is increasing fastest, and the Chinese and German Wikipedias slowest. Although awareness of species on Wikipedia as a whole is increasing, and is significantly higher in traded species, over the period 2016-2020 change in interest appears not to be strongly related to the trade of species or animal pollinators. As a data source for public biodiversity awareness Wikipedia could be integrated into the Biodiversity Engagement Indicator, thereby incorporating a more direct link to biodiversity itself.
Coherent Optical Scattering and Interferometry (COSI) for label-free multiparameter quantitative imaging of intra-thrombus stabilityin vitro
Authors: Zheng Y. , Montague S. J. , Lim Y. J. , Xu T. , Xu T. , Gardiner E. E. , Lee W. M. 
Published: August 2020

ABSTRACTAlthough existing microfluidicsin vitroassays recapitulate blood vessel microenvironment using surface-immobilized agonists under biofluidic flows, these assays do not quantify intra-thrombus mass and activities of adhesive platelets at agonist margin and uses fluorescence labeling, therefore limiting clinical translation potential. Here, we describe a real time label-freein vitroquantitative imaging flow assay calledCoherentOpticalScattering and phaseInterferometry (COSI) that evaluates both intra-thrombus and adhesive-only platelet dynamics using only changes in refractive index. By combining coherent optical scattering and optical interferometry, we evaluated and quantified both intra-thrombus mass with picogram accuracy and adhesive platelet-only events/dynamics with high spatial-temporal resolution (400 nm/s) under fluid shear stress using only changes in refractive index. Using oblique illumination, COSI provide a ∼ 4 µm thin axial slice that quantifies the magnitude of physical of surface adhesive platelets (spreading, adhesion and consolidation) in a developing thrombus without labelling under fluid shear stress. We achieve real time visualization of recruitment of single platelet into thrombus and further correlate it to the developing mass of a thrombus. The adhesive platelet activity exhibit stabilized surface activity of around 2 µm/s and intra-thrombus mass exchange were balanced at around 1 picogram after treatment of a broad range metalloproteinase inhibitor (250 µM GM6001).SignificanceThe combination of phase imaging with transmitted light and backscattering imaging via oblique illumination in COSI unpicked intra-thrombus mass and adhesive platelet-only activity events at picogram and sub-micrometer precision with millisecond time resolution under fluid shear stress. COSI maps the longitudinal time dynamics of adhesive platelets along changing thrombus mass under metalloproteinase inhibition, and demonstrates potential for real-time correlative microfluidic label-free imaging for flow-dependent biological adhesive events.
NVX-CoV2373 vaccine protects cynomolgus macaque upper and lower airways against SARS-CoV-2 challenge
Authors: Guebre-Xabier Mimi , Patel Nita , Tian Jing-Hui , Zhou Bin , Maciejewski Sonia , Lam Kristal , Portnoff Alyse D. , Massare Michael J. , Frieman Matthew B. , Piedra Pedro A. , Ellingsworth Larry , Glenn Gregory , Smith Gale 
Published: August 2020

ABSTRACTThere is an urgent need for a safe and protective vaccine to control the global spread of SARS-CoV-2 and prevent COVID-19. Here, we report the immunogenicity and protective efficacy of a SARS-CoV-2 subunit vaccine (NVX-CoV2373) produced from the full-length SARS-CoV-2 spike (S) glycoprotein stabilized in the prefusion conformation. Cynomolgus macaques (Macaca fascicularis) immunized with NVX-CoV2373 and the saponin-based Matrix-M adjuvant induced anti-S antibody that was neutralizing and blocked binding to the human angiotensin-converting enzyme 2 (hACE2) receptor. Following intranasal and intratracheal challenge with SARS-CoV-2, immunized macaques were protected against upper and lower infection and pulmonary disease. These results support ongoing phase 1/2 clinical studies of the safety and immunogenicity of NVX-CoV2327 vaccine (NCT04368988).HighlightsFull-length SARS-CoV-2 prefusion spike with Matrix-M1™ (NVX-CoV2373) vaccine.Induced hACE2 receptor blocking and neutralizing antibodies in macaques.Vaccine protected against SARS-CoV-2 replication in the nose and lungs.Absence of pulmonary pathology in NVX-CoV2373 vaccinated macaques.
Evaluation of Compatibility of 16S rRNA V3V4 and V4 Amplicon Libraries for Clinical Microbiome Profiling
Authors: Liu Po-Yu , Wu Wei-Kai , Chen Chieh-Chang , Panyod Suraphan , Sheen Lee-Yan , Wu Ming-Shiang 
Published: August 2020

ABSTRACTSequencing of the 16S rRNA gene by Illumina next-generation sequencing is broadly used in microbiome studies. Different hypervariable regions of the 16S rRNA gene, V3V4 (amplified with primers 341F–805R) or V4 (V4O; primers 515F–806R), are selected, depending on the targeted resolution. However, in population-based clinical studies, combining V3V4 and V4 data from different studies for a meta-analysis is challenging. Reads generated by short-read (150-bp) high-throughput sequencing platforms do not fully recover the V4 region read-length. Here, we evaluated the compatibility of 16S rRNA V3V4 and V4 amplicons for microbiome profiling. We compared taxonomic compositions obtained by the analysis of V3V4 and V4 amplicons, and V4 fragments trimmed from V3V4 amplicons. We also evaluated an alternative V4 region (V4N; primers 519F–798R) designed for efficient stitching with 150-bp paired-end sequencing. First, we simulated a global investigation of environmental prokaryotesin silico. This revealed that V4O primers recovered the highest proportion of fragments (81.7%) and most phyla, including archaea. Empirical sequencing of standard (mock) and human fecal samples revealed biased patterns of each primer that were similar to the ones determined byin silicosimulation. Further, for human fecal microbiome profiling, the between-sample variance was greater than the systematic bias of each primer. The use of trimmed V4 fragments and single-end amplicons resulted in the same systematic bias. In conclusion, paired-end V4O sequencing yielded the most accurate data for both, simulation and mock community sequencing; the V4O amplicons were compatible with trimmed V4 sequences for microbiome profiling.IMPORTANCENext-generation sequencing of the 16S rRNA gene is a commonly used approach for clinical microbiome studies. Different amplicons of the 16S rRNA hypervariable regions are used in different studies, which creates incompatible sequence features when comparing and integrating data among studies by using 16S denoising pipelines. Here we compared the type of data and coverage obtained when different 16S rRNA amplicons were analyzed.In silicoand empirical analyses of the human fecal microbiome revealed that the V3V4 amplicons are compatible with V4 amplicons after trimming up to the same region. These observations demonstrate that reconciling the compatibility of clinical microbiome data from different studies improve not only the sample size but also the confidence of the hypothesis tested.