bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Upper-Limb Loss and Prosthesis Use Affect Lower-Limb Gait Dynamics?
Authors: Armstrong Kiley , Brinkmann John T. , Stine Rebecca , Gard Steven A. , Major Matthew J. 
Published: July 2020

ABSTRACT

Introduction
Intentional interruption of upper-limb and lower-limb coordination of able-bodied subjects alters their gait biomechanics. However, the effect of upper-limb loss (ULL) on lower-limb gait biomechanics is not fully understood. The aim of this secondary study was to perform a follow-up analysis of a previous dataset to characterize the spatiotemporal parameters and lower-limb kinematics and kinetics of gait for persons with ULL when wearing and not wearing an upper-limb prosthesis (ULP). We were particularly interested in quantifying the effects of matching the mass and inertia of the prosthetic limb to the sound limb.

Materials and Methods
Ten persons with unilateral ULL walked at a self-selected speed under three randomly presented conditions: 1) not wearing a prosthesis; 2) wearing their customary prosthesis; and 3) wearing a mock prosthesis that can be adjusted to match the length, mass, and inertial properties of each subject's sound limb. Walkway-embedded force plates and a 12-camera digital motion capture system recorded ground reaction forces (GRFs) and retroreflective marker position data, respectively. Average spatiotemporal (walking speed, cadence, stance time, swing time, step length, double support time), lower-limb kinematic (joint angles), and lower-limb kinetic (ground forces, joint moments and powers) data were processed, and their statistical significance values were analyzed.

Result
Walking speed for each condition was nearly equivalent (1.20 ± 0.01 m/s), and differences between condition were nonsignificant (P = 0.769). The interaction effect (side × prosthesis) was significant for peak hip extension (P = 0.01) and second peak (propulsive) vertical GRF (P = 0.028), but separate follow-up analyses of both main effects were not significant (P ≥ 0.099). All other main effect comparisons were not significant (P ≥ 0.102).

Conclusions
Although the sample cohort was small and heterogeneous, the results of this study suggest that persons with unilateral ULL did not display significant limb side asymmetry in lower-limb gait spatiotemporal, kinetic, and kinematic parameters, regardless of ULP use.
Impact of the Affordable Care Act Medicaid Expansion on Utilization of Mental Health Care
Authors: Breslau Joshua , Han Bing , Lai Julie , Yu Hao 
Published: July 2020

Background:
The Affordable Care Act’s Medicaid expansions (ME) increased insurance coverage for low-income Americans, among whom unmet need for mental health care is high. Empirical evidence regarding the impact of expanding insurance coverage on use of mental health services among low income and minority populations is lacking.

Methods:
Data on mental health service use collected between 2007 and 2015 by the Medical Expenditures Panel Survey from nationally representative cross-sectional samples of low income (income<138% of the federal poverty line) adults were analyzed. Use trends among people in states that expanded Medicaid (ME states; n=29,827) were compared with concurrent trends among people in states that did not (non-ME states; n=22,873), with statistical adjustment for demographic characteristics and psychological distress.

Results:
Annual outpatient visits for mental health conditions increased by 0.513 (0.053–0.974) visits per person, from a baseline rate in ME states of 0.894 visits per person. However, no significant changes were observed in number of mental health related hospital stays, emergency department visits or prescription fills. The increase outpatient visits was limited to Hispanics and non-Hispanic Whites, with no increase in service use observed among non-Hispanic Blacks. There was no apparent increase in the number of users of outpatient mental health care (AOR=0.992, P=0.942) and a marginally significant (P=0.096) increase of 3.144 visits per user.

Discussion:
ME had a limited but positive impact on use of mental health services by low income Americans, although it may also have increased racial/ethnic disparities.
National Evaluation of Patient Preferences in Selecting Hospitals and Health Care Providers
Authors: Ellis Ryan J. , Yuce Tarik K. , Hewitt Daniel B. , Merkow Ryan P. , Kinnier Christine V. , Johnson Julie K. , Bilimoria Karl Y. 
Published: July 2020

Background:
Patient utilization of public reporting has been suboptimal despite attempts to encourage use. Lack of utilization may be due to discordance between reported metrics and what patients want to know when making health care choices.

Objective:
The objective of this study was to identify measures of quality that individuals want to be presented in public reporting and explore factors associated with researching health care.

Research Design:
Patient interviews and focus groups were conducted to develop a survey exploring the relative importance of various health care measures.

Subjects:
Interviews and focus groups conducted at local outpatient clinics. A survey administered nationally on an anonymous digital platform.

Measures:
Likert scale responses were compared using tests of central tendency. Rank-order responses were compared using analysis of variance testing. Associations with binary outcomes were analyzed using multivariable logistic regression.

Results:
Overall, 4672 responses were received (42.0% response rate). Census balancing yielded 2004 surveys for analysis. Measures identified as most important were hospital reputation (considered important by 61.9%), physician experience (51.5%), and primary care recommendations (43.2%). Unimportant factors included guideline adherence (17.6%) and hospital academic affiliation (13.3%, P<0.001 for all compared with most important factors). Morbidity and mortality outcome measures were not among the most important factors. Patients were unlikely to rank outcome measures as the most important factors in choosing health care providers, irrespective of age, sex, educational status, or income.

Conclusions:
Patients valued hospital reputation, physician experience, and primary care recommendations while publicly reported metrics like patient outcomes were less important. Public quality reports contain information that patients perceive to be of relatively low value, which may contribute to low utilization.
Ga-68 DOTATATE PET/CT and F-18 FDG PET/CT in the evaluation of low and intermediate versus high-grade neuroendocrine tumors
Authors: You Helena , Kandathil Asha , Beg Muhammad , De Blanche Lorraine , Kazmi Syed , Subramaniam Rathan M. 
Published: July 2020

Objective
We investigated the role of Ga-68 DOTATATE PET/CT in comparison to F-18 FDG PET/CT in patients with low and intermediate versus high-grade neuroendocrine tumors (NETs).

Methods
We identified 81 patients who underwent Ga-68 DOTATATE PET/CT at our institution between May 2017 and December 2018 and met inclusion criteria of biopsy-proven NET with known Ki-67 index, histologic grade, or differentiation. Patients were divided into two groups. Control group included Ki-67 ≤20%, grade 1 or 2, or well-differentiated tumors. Experimental group included Ki-67 >20%, grade 3, or poorly-differentiated tumors.

Results
Mean age was 57 years, with 36 males and 45 females. Most common primary sites were small bowel, pancreas, and lung. Most common distant metastatic sites were liver and bone. In the control group (n = 67), median Ki-67 was 4% (range 1–30%). 55/67 (82.1%) DOTATATE and 6/11 (54.5%) FDG scans were positive (P = 0.04). Positive scans showed >10 lesions in 25/55 (45.5%) DOTATATE and 1/6 (16.7%) FDG scans (P = 0.18). 40/55 (72.7%) positive DOTATATE and 3/6 (50%) FDG scans showed distant disease (P = 0.25). In the experimental group (n = 14), median Ki-67 was 68% (range 25–95%). All 14 DOTATATE and all nine FDG scans were positive. Positive scans showed >10 lesions in 4/14 (28.6%) DOTATATE and 5/9 (55.6%) FDG scans (P = 0.20). 10/14 (71.4%) positive DOTATATE and 7/9 (77.8%) FDG scans showed distant disease (P = 0.74).

Conclusion
All patients with high grade, poorly-differentiated NETs had positive DOTATATE PET/CTs. In these patients, DOTATATE PET/CT did not significantly differ from FDG PET/CT in identifying >10 lesions or distant disease.
Role of 18F-FDG PET-derived parameters for predicting complete response to chemoradiotherapy in squamous cell anal carcinoma
Authors: Filippi Luca , Fontana Antonella , Spinelli Gian Paolo , Rossi Lugi , Bagni Oreste 
Published: July 2020

Purpose
We aimed to evaluate the accuracy of metabolic parameters, calculated on pretreatment positron emission computed tomography (PET/CT) with 18fluorodeoxyglucose (18F-FDG), for predicting complete response to chemoradiotherapy (CRT) of patients affected by squamous cell anal carcinoma (SCAC).

Patients and methods
Clinical records of 20 patients affected by SCAC and treated with CRT were retrospectively evaluated. 18F-FDG PET/CT was performed at time 0 (baseline) and time 1 (12 weeks after CRT). The following parameters were extracted from PET at time 0: standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Response was assessed according to PET response criteria in solid tumors and classified as complete metabolic response (CMR), partial metabolic response (PMR) and progressive metabolic disease (PMD). Receiver operating characteristic analysis was performed to analyze the predictive value of each PET-derived parameter on CMR.

Results
Sixteen patients were finally enrolled. All presented increased 18F-FDG uptake in the primary tumor and 11 (68.7%) also showed metastatic lymph nodes. At PET/CT performed at time 1, 11 subjects (68.7%) presented CMR, three (18.7%) had PMR and the remaining two (12.5%) showed PMD (i.e. hepatic metastases). Among baseline PET-derived parameters, both MTV and TLG efficiently predicted response to CRT with an area under the curve of 0.9 (cutoff 62.3 cm3, sensitivity 80%, specificity 100%, P = <0.0001) and 0.87 (cutoff 654.1 g, sensitivity 80%, specificity 100%, P = 0.004), respectively.

Conclusion
Among PET-derived parameters, both MTV and TLG presented a high predictive value on subjects’ outcome after CRT.
Hemorrhagic Pseudocyst
Authors: Hu Mindy Bizhe , Kesha Kilak , Glenn Charley , Stables Simon , Tse Rexson 
Published: July 2020

Abstract
Mass lesions in the brain encompass a wide range neoplastic and nonneoplastic entities. These can present as a diagnostic pitfall, with nonspecific, overlapping symptoms and similar appearances on radiology. They may cause death through varied mechanisms, either specific to the underlying pathophysiology or due to the space-occupying effect of the lesion. We report a case of fatal hemorrhagic cerebral pseudocyst, a rare mass lesion, associated with a cerebral varix, causing death in a morbidly obese individual. To the best of our knowledge, there is no previous documentation in the postmortem literature of this entity as a cause of death. This case aims to document this rare entity in the differential diagnosis of a tumor-like lesion in the brain, highlight the clinical difficulty in its assessment, and demonstrate an uncommon mechanism of death, of a mass lesion acting as a focus causing seizures, with resulting hypoxia due to effects of morbid obesity and heart failure.
Utility of Body Habitus Parameters to Determine and Improve the Accuracy of the Broselow Tape
Authors: Saeed Wajeeha , Talathi Saurabh , Suneja Upma , Gupta Neha , Mandadi Akhila Reddy , Xu Hongyan , Leber Mark , Waseem Muhammad 
Published: July 2020

Objectives
The aims of this study were to determine and improve accuracy of the Broselow Tape (BT) in estimating children's weight by adding body habitus parameters.

Methods
This cross-sectional study was conducted in an urban hospital pediatric clinic. Children up to 8 years old coming in for well-child visit were included. Children with acute illness or presence of any chronic condition potentially resulting in growth disturbance and out of BT height range were excluded. The following body habitus parameters were measured using the Centers for Disease Control and Prevention guidelines: actual weight, predicted weight using BT (BTW), mid-thigh circumference (MTC), body mass index, mid-arm circumference, and waist-to-hip ratio.

Results
A total of 301 children were enrolled. Of these, 151 were male (50%). Hispanics constituted 160 (53.2%). There was a positive linear association between BTW and actual weight in the overall cohort (adjusted R
2 = 0.9164, P < 0.001). However, there was a difference in this association among children younger than 2 years and children older than 2 years (adjusted R
2 = 0.89 vs 0.4841). Incorporating MTC and/or waist circumference along with BTW in the model increased the accuracy, providing a better estimate of actual weight (adjusted R
2 = 0.94, P < 0.001).

Conclusions
We conclude that there might be inaccuracies in the weight predicted by BT in our patient population, especially those weighing more than 15 kg and older than 2 years. Our study also demonstrates that MTC correlates closely with the actual weight and could be used in addition to BT for more accurate weight estimation.
The Utility of Donor-specific Antibody Monitoring and the Role of Kidney Biopsy in Simultaneous Liver and Kidney Recipients With De Novo Donor-specific Antibodies
Authors: Parajuli Sandesh , Aziz Fahad , Blazel Justin , Muth Brenda L. , Garg Neetika , Mohamed Maha , Rice John , Mezrich Joshua D. , Hidalgo Luis G. , Mandelbrot Didier 
Published: July 2020

Background.
There is limited information about the utility of donor-specific antibody (DSA) against HLA monitoring and the role of protocol kidney biopsy for de novo DSA (dnDSA) in simultaneous liver and kidney (SLK) transplant recipients.

Methods.
We analyzed SLK transplant recipients transplanted between January 2005 and December 2017, who had DSA checked posttransplant. Patients were divided into 2 groups based on whether they developed dnDSA posttransplant (dnDSA+) or not (dnDSA−). Kidney graft rejection ±45 d of dnDSA and a kidney death–censored graft survival were the primary endpoints.

Results.
A total of 83 SLK transplant recipients fulfilled our selection criteria. Of those, 23 were dnDSA+ and 60 were dnDSA−. Twenty-two of 23 dnDSA+ patients had DSA against class II HLA, predominantly against DQ. Fifteen recipients underwent kidney biopsy ±45 d of dnDSA. Six of these were clinically indicated due to kidney graft dysfunction. The other 9 had a protocol kidney biopsy only due to dnDSA, and 6 of these 9 had a rejection. Also, 3 recipients had sequential biopsies of both the kidney and liver grafts. Among those with sequential biopsies of both grafts, there was a difference between the organs in the rate and types of rejections. At last follow up, dnDSA was not associated with graft failure of either the kidney or liver.

Conclusions.
Although our study was limited by a small sample size, it suggests the potential utility of DSA monitoring and protocol kidney biopsy for dnDSA.
Contact tracing during Phase I of the COVID-19 pandemic in the Province of Trento, Italy: key findings and recommendations
Authors: Fateh-Moghadam Pirous , Battisti Laura , Molinaro Silvia , Fontanari Steno , Dallago Gabriele , Binkin Nancy , Zuccali Mariagrazia 
Published: July 2020

ABSTRACTIntroductionContact tracing is a key pillar of COVID-19 control. In response to the COVID-19 epidemic in the Autonomous Province of Trento (Italy) a software was developed to standardize data collection and facilitate surveillance of contacts and outbreaks and map the links between bases and contacts. In this paper, we present the results of contact tracing efforts during Phase I of the epidemic (March-April, 2020, mostly under lockdown), including sociodemographic characteristics of contacts who became cases and of the cases who infected one or more contact.MethodsA contact tracing website was developed that included components for geolocation and linking of cases and contacts using open source software. Information on community-based confirmed and probable cases and their contacts was centralized on the website. Information on cases came directly from the central case database, information on contacts was collected by telephone interviews following a standard questionnaire. Contacts were followed via telephone, emails, or an app.ResultsThe 2,812 laboratory-diagnosed community cases of COVID-19 had 6,690 community contacts, of whom 890 (13.3%) developed symptoms. Risk of developing symptomatic disease increased with age and was higher in workplace contacts than cohabitants or non-cohabiting family or friends. The greatest risk of transmission to contacts was found for the 14 cases <15 years of age (22.4%); 8 of the 14, who ranged in age from <1 to 11 years) infected 11 of 49 contacts. Overall, 606 outbreaks were identified, 74% of which consisted of only two cases.DiscussionThe open-source software program permitted the centralized tracking of contacts and rapid identification of links between cases. Workplace contacts were at higher risk of developing symptoms. Although childhood contacts were less likely to become cases, children were more likely to infect household members, perhaps because of the difficulty of successfully isolating children in household settings.
SARS-CoV-2 Infection and Stroke: Coincident or Causal?
Authors: Walker Melanie , Young Christopher C. , Sharma Malveeka , Levitt Michael R. , Tirschwell David L. ,   the WWAMI Stroke Investigators
Published: July 2020

AbstractNeurological manifestations of SARS-CoV-2 infection described in isolated case reports and single institutions do not accurately reflect the clinical spectrum of disease across all geographies in a global pandemic. Data collected during peak of the Covid-19 pandemic from stroke centers in five states reveal few similarities to what has recently been published. Given the diversity in phenotype, we caution policymakers and health care providers when considering cerebrovascular complications from SARS-CoV-2 infection.
Blood Pressure and Risk of Atrial Fibrillation: A Mendelian Randomization Study
Authors: Hyman Matthew C. , Levin Michael G. , Gill Dipender , Walker Venexia M. , Georgakis Marios K. , Davies Neil , Marchlinski Francis E. , Damrauer Scott M. 
Published: July 2020

AbstractImportanceObservational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces overall arrhythmia burden, but it remains unclear whether hypertension is causative for AF.ObjectiveThe primary objective of this study was to investigate the relationship between blood pressure and risk of AF using genetic proxies for blood pressure within a Mendelian randomization (MR) framework. We secondarily explored the relationship between genetically proxied use of anti-hypertensive drugs and risk of AF.DesignTwo-sample MR was performed using an inverse-variance weighted meta-analysis with weighted median MR and Egger intercept tests performed as sensitivity analyses. Genetic proxies for the anti-hypertensive drug classes were used to investigate the impact of these therapies on the risk of AF.SettingInternational Consortium of Blood Pressure, UK Biobank and Atrial Fibrillation Genetics Consortium.ParticipantsSummary statistics for systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were obtained from the International Consortium of Blood Pressure and the UK Biobank discovery analysis (>750,000 individuals of European ancestry).Summary statistics for AF were obtained from the 2018 Atrial Fibrillation Genetics Consortium multi-ethnic GWAS (>65,000 AF cases and >522,000 referents).ExposureGenetically predicted SBP, DBP and PP as quantified by risk scores.Main OutcomeOdds ratio for AF per 10 mmHg increase in genetically proxied blood pressure.ResultsTen mmHg increases in genetically proxied SBP, DBP or PP were associated with increased odds of AF (SBP: OR 1.17, 95% CI 1.11-1.22, p=1⨯ 10−11; DBP: OR 1.25, 95% CI 1.16-1.35, p=3⨯ 10−8; PP: OR 1.1, 95% CI 1.0-1.2, p=0.05). Ten mmHg decreases in SBP estimated by genetic proxies of anti-hypertensive medications showed calcium channel blockers (OR 0.66, 95% CI 0.57-0.76, p=8⨯ 10−9) and beta-blockers (OR 0.61, 95% CI 0.46-0.81, p=6⨯ 10−4) decreased the risk of AF.Conclusions and RelevanceBlood pressure-increasing genetic variants were associated with increased risk of AF, consistent with a causal relationship between blood pressure and AF. These data support the concept that blood pressure reduction through pharmacologic intervention, and specifically calcium channel blockade or beta blockade could reduce the risk of AF.
A HYBRID KNOWLEDGE-BASED AND MODIFIED REGRESSION ANALYSIS APPROACH FOR COVID-19 TRACKING IN USA
Authors: Hussein Rafaat 
Published: July 2020

AbstractSince its appearance in 2019, the covid-19 virus deluged the world with unprecedented data in short time. Despite the countless worldwide pertinent studies and advanced technologies, the spread is neither contained nor defeated. In fact, there is a record surge in the number of confirmed new cases since July 2020. This article presents a new predictive Knowledge-based (KB) toolkit named CORVITT (Corona Virus Tracking Toolkit) and modified linear regression model. This hybrid approach uses the confirmed new cases and demographic data, implemented. CORVITT is not an epidemiological model, in the sense that it does not model disease transmission, nor does it use underlying epidemiological parameters like the reproductive rate. It forecasts the spread in order to assist the official to make proactive intervention.
Impact of the COVID-19 Pandemic on the Short-term Course of Obsessive-Compulsive Disorder
Authors: Sharma Lavanya P , Balachander Srinivas , Thamby Abel , Bhattacharya Mahashweta , Kishore Chethana , Shanbhag Vandita , Jaisoorya TS , Narayanaswamy Janardhanan C , Arumugham Shyam Sundar , Reddy YC Janardhan 
Published: July 2020

AbstractBackgroundThere is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there is little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. We also assessed for predictors of relapse and emergence of COVID–19–themed obsessive–compulsive symptoms.MethodsA cohort of patients with a primary diagnosis of OCD (n=240) who were on regular follow-up at a tertiary care specialty OCD Clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic (‘pandemic’ cohort). Data from the medical records of an independent set of patients with OCD (n=207) who were followed–up during the same period, one year prior, was used for comparison (historical controls).ResultsThe ‘pandemic’ group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores (Chi-square for likelihood-ratio test of the Group × Time interaction = 2.73, p= 0.255) and relapse rate [21% vs 20%, adjusted odds ratio = 0.81 (95% CI 0.41 -1.59, p=0.535]. Pre-existing contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms.LimitationsFollow-up 2 months after pandemic declaration may be too early understand the true impact.ConclusionsThe COVID-19 pandemic, at least in the short-run, did not influence the course of illness in those who were on medications. It would be pertinent to evaluate the long-term impact of the pandemic on the course of OCD.Highlights