bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach
Authors: Brown Elizabeth A. , White Brandi M. , Jones Walter J. , Gebregziabher Mulugeta , Simpson Kit N. 
Published: May 2021

Abstract
Background
The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

Methods
We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to 2015. Segmented regression analysis was utilized to determine the impact of policy reform on PH rates.

Results
The Affordable Care Act’s Medicaid expansion led to decreased rates of PH (improved access to care); however, the finding was not significant (coefficient estimate: −0.0059, CI −0.0225, 0.0107, p = 0.4856). Healthcare system characteristics, such as Medicaid spending per enrollee and Medicaid income eligibility, were associated with a significant decrease in rates of PH (improved access to care). However, the Medicaid-to-Medicare fee index (physician reimbursement) and states with a Democratic state legislature had a significant increase in rates of PH (poor access to care).

Conclusion
Health policy reform and healthcare delivery characteristics impact access to care. Researchers should continue evaluating such policy changes across more states over longer periods of time. Researchers should translate these findings into cost analysis for state policy-makers to make better-informed decisions for their constituents.

Contribution to knowledge
Ambulatory care-sensitive conditions are a feasible method for evaluating policy and measuring access to primary care. Policy alone cannot improve access to care. Other factors (trust, communication, policy-makers’ motivations and objectives, etc.) must be addressed to improve access.
Serial Tap Test of patients with idiopathic normal pressure hydrocephalus: impact on cognitive function and its meaning
Authors: da Rocha Samanta Fabrício Blattes , Kowacs Pedro André , de Souza Ricardo Krause Martinez , Pedro Matheus Kahakura Franco , Ramina Ricardo , Teive Hélio A. Ghizoni 
Published: May 2021

Abstract
Background
Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, urinary incontinence and cognitive decline. Symptoms are potentially reversible and treatment is based on cerebrospinal fluid shunting. The tap test (TT) is used to identify patients that will benefit from surgery. This procedure consists of the withdrawal of 20 to 50 mL of cerebrospinal fluid (CSF) through a lumbar puncture (LP) after which the symptoms of the triad are tested. Improvement in the quality and speed of gait are already recognized but cognitive improvement depends on several factors such as tests used, the time elapsed after LP for re-testing, and the number of punctures. Serial punctures may trigger similar conditions as external lumbar drainage (ELD) to the organism.

Objective
This study aimed to identify how serial punctures affect cognition to increase the sensitivity of the test and consequently the accuracy of surgical indication.

Methods
Sixty-one patients with INPH underwent baseline memory and executive tests repeatedly following the 2-Step Tap Test protocol (2-STT – two procedures of 30 mL lumbar CSF drainage separated by a 24-h interval). The baseline scores of INPH patients were compared with those of 55 healthy controls, and with intragroup post-puncture scores of the 2-STT.

Results
The group with INPH had lower performance than the control group in all cognitive tests (RAVLT, Stroop, CFT, FAR-COWA, FAB, MMSE, orientation, mental control), except for the forward digit span test (p = 0.707). After conducting LP procedures, the Stroop test (words, colors and errors), RAVLT (stage A1, A6 and B1), and CFT (immediate and delayed R) scores were equal to those of the control group (p > 0.05). The INPH group presented significant improvement after the first puncture in MMSE (p = 0.031) and in the Stroop Test (points) (p < 0.001). After the second puncture, subjects improved in orientation, MMSE, RAVLT (B1), Stroop (points, words, errors) and CFT (IR).

Conclusion
Progressive cognitive improvement occurred over the 2-STT and changes were more significant after the second LP in all cognitive domains except for RAVLT (A7). Encephalic alert system ‘arousal’ seems to participate in early improvements observed during 2-STT. The second LP increased the sensitivity of the drainage test to detect changes in cognitive variables, and consequently improved the quality of the method.
Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study
Authors: Moges Solomon , Belete Tilahun , Mekonen Tesfa , Menberu Melak 
Published: May 2021

Abstract
Background
Relapse in psychiatric disorders is highly distressing that posed a huge burden to the patients, family, and society. It interrupts the process of recovery and may increase the risk of resistance to treatment. Relapse detection and taking preventive measures against its possible factors are crucial for a better prognosis.

Objective
To assess lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow-up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia.

Method
An institution-based cross-sectional study was conducted from July 13-August 13, at Comprehensive Specialized Hospitals in Amhara region, Ethiopia, 2020. Data were collected from 415 randomly selected participants using an interviewer administered questionnaire. Relapse was determined using participants’ medical records and a semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 25. Logistic regression analysis was done to identify the explanatory variables of relapse. Variables with P-value < 0.05 were considered significantly associated with relapse.

Result
The magnitude of lifetime relapse was 57.4% (95% CI = 53–62%). Relapse was significantly associated with comorbidity of another mental illness (AOR = 1.84, 95% CI = 1.06, 3.18), non-adherence to medication (AOR = 2.23, 95% CI = 1.22, 4.07), shorter duration on treatment (AOR = 1.71, 95% CI = 1.05, 2.81), and experiencing stressful life events (AOR = 2.42, CI = 1.2, 4.66).

Conclusion
In the current study, more than half of the participants had lifetime relapses. Comorbid mental illnesses, non-adherence, duration of treatment ≤ 5 years, and experiencing stressful life events were factors associated with relapse. This requires each stakeholder to give concern and work collaboratively on the respective factors that lead to relapse.
Determination of complete chromosomal haplotypes by bulk DNA sequencing
Authors: Tourdot Richard W. , Brunette Gregory J. , Pinto Ricardo A. , Zhang Cheng-Zhong 
Published: May 2021

AbstractHaplotype phase represents the collective genetic variation between homologous chromosomes and is an essential feature of non-haploid genomes. Here we describe a computational strategy to reliably determine complete whole-chromosome haplotypes using a combination of bulk long-range sequencing and Hi-C sequencing. We demonstrate that this strategy can resolve the haplotypes of parental chromosomes in diploid human genomes with high precision (>99%) and completeness (>98%) and assemble the syntenic structure of rearranged chromosomes in aneuploid cancer genomes at base pair level resolution. Our work enables direct interrogation of chromosome-specific alterations and chromatin reorganization using bulk DNA sequencing.
Limited haplotype diversity underlies polygenic trait architecture across 70 years of wheat breeding
Authors: Scott Michael F. , Fradgley Nick , Bentley Alison R. , Brabbs Thomas , Corke Fiona , Gardner Keith A. , Horsnell Richard , Howell Phil , Ladejobi Olufunmilayo , Mackay Ian J. , Mott Richard , Cockram James 
Published: May 2021

Abstract
Background
Selection has dramatically shaped genetic and phenotypic variation in bread wheat. We can assess the genomic basis of historical phenotypic changes, and the potential for future improvement, using experimental populations that attempt to undo selection through the randomizing effects of recombination.

Results
We bred the NIAB Diverse MAGIC multi-parent population comprising over 500 recombinant inbred lines, descended from sixteen historical UK bread wheat varieties released between 1935 and 2004. We sequence the founders’ genes and promoters by capture, and the MAGIC population by low-coverage whole-genome sequencing. We impute 1.1 M high-quality SNPs that are over 99% concordant with array genotypes. Imputation accuracy only marginally improves when including the founders’ genomes as a haplotype reference panel. Despite capturing 73% of global wheat genetic polymorphism, 83% of genes cluster into no more than three haplotypes. We phenotype 47 agronomic traits over 2 years and map 136 genome-wide significant associations, concentrated at 42 genetic loci with large and often pleiotropic effects. Around half of these overlap known quantitative trait loci. Most traits exhibit extensive polygenicity, as revealed by multi-locus shrinkage modelling.

Conclusions
Our results are consistent with a gene pool of low haplotypic diversity, containing few novel loci of large effect. Most past, and projected future, phenotypic changes arising from existing variation involve fine-scale shuffling of a few haplotypes to recombine dozens of polygenic alleles of small effect. Moreover, extensive pleiotropy means selection on one trait will have unintended consequences, exemplified by the negative trade-off between yield and protein content, unless selection and recombination can break unfavorable trait-trait associations.
Tejaas: reverse regression increases power for detecting trans-eQTLs
Authors: Banerjee Saikat , Simonetti Franco L. , Detrois Kira E. , Kaphle Anubhav , Mitra Raktim , Nagial Rahul , Söding Johannes 
Published: May 2021

AbstractTrans-acting expression quantitative trait loci (trans-eQTLs) account for ≥70% expression heritability and could therefore facilitate uncovering mechanisms underlying the origination of complex diseases. Identifying trans-eQTLs is challenging because of small effect sizes, tissue specificity, and a severe multiple-testing burden. Tejaas predicts trans-eQTLs by performing L2-regularized “reverse” multiple regression of each SNP on all genes, aggregating evidence from many small trans-effects while being unaffected by the strong expression correlations. Combined with a novel unsupervised k-nearest neighbor method to remove confounders, Tejaas predicts 18851 unique trans-eQTLs across 49 tissues from GTEx. They are enriched in open chromatin, enhancers, and other regulatory regions. Many overlap with disease-associated SNPs, pointing to tissue-specific transcriptional regulation mechanisms.
Vector role and human biting activity of Anophelinae mosquitoes in different landscapes in the Brazilian Amazon
Authors: Oliveira Tatiane M. P. , Laporta Gabriel Z. , Bergo Eduardo S. , Chaves Leonardo Suveges Moreira , Antunes José Leopoldo F. , Bickersmith Sara A. , Conn Jan E. , Massad Eduardo , Sallum Maria Anice Mureb 
Published: May 2021

Abstract
Background
Environmental disturbance, deforestation and socioeconomic factors all affect malaria incidence in tropical and subtropical endemic areas. Deforestation is the major driver of habitat loss and fragmentation, which frequently leads to shifts in the composition, abundance and spatial distribution of vector species. The goals of the present study were to: (i) identify anophelines found naturally infected with Plasmodium; (ii) measure the effects of landscape on the number of Nyssorhynchus darlingi, presence of Plasmodium-infected Anophelinae, human biting rate (HBR) and malaria cases; and (iii) determine the frequency and peak biting time of Plasmodium-infected mosquitoes and Ny. darlingi.

Methods
Anopheline mosquitoes were collected in peridomestic and forest edge habitats in seven municipalities in four Amazon Brazilian states. Females were identified to species and tested for Plasmodium by real-time PCR. Negative binomial regression was used to measure any association between deforestation and number of Ny. darlingi, number of Plasmodium-infected Anophelinae, HBR and malaria. Peak biting time of Ny. darlingi and Plasmodium-infected Anophelinae were determined in the 12-h collections. Binomial logistic regression measured the association between presence of Plasmodium-infected Anophelinae and landscape metrics and malaria cases.

Results
Ninety-one females of Ny. darlingi, Ny. rangeli, Ny. benarrochi B and Ny. konderi B were found to be infected with Plasmodium. Analysis showed that the number of malaria cases and the number of Plasmodium-infected Anophelinae were more prevalent in sites with higher edge density and intermediate forest cover (30–70%). The distance of the drainage network to a dwelling was inversely correlated to malaria risk. The peak biting time of Plasmodium-infected Anophelinae was 00:00–03:00 h. The presence of Plasmodium-infected mosquitoes was higher in landscapes with > 13 malaria cases.

Conclusions
Nyssorhynchus darlingi, Ny. rangeli, Ny. benarrochi B and Ny. konderi B can be involved in malaria transmission in rural settlements. The highest fraction of Plasmodium-infected Anophelinae was caught from midnight to 03:00 h. In some Amazonian localities, the highest exposure to infectious bites occurs when residents are sleeping, but transmission can occur throughout the night. Forest fragmentation favors increases in both malaria and the occurrence of Plasmodium-infected mosquitoes in peridomestic habitat. The use of insecticide-impregnated mosquito nets can decrease human exposure to infectious Anophelinae and malaria transmission.

Graphical Abstract
Short-chain fatty acids can improve lipid and glucose metabolism independently of the pig gut microbiota
Authors: Zhou Hua , Yu Bing , Sun Jing , Liu Zuohua , Chen Hong , Ge Liangpeng , Chen Daiwen 
Published: May 2021

Abstract
Background
Previous studies have shown that exogenous short-chain fatty acids (SCFAs) introduction attenuated the body fat deposition in conventional mice and pigs. However, limited studies have evaluated the effects of exogenously introduced SCFAs on the lipid and glucose metabolism independently of the gut microbiota. This study was to investigate the effects of exogenous introduction of SCFAs on the lipid and glucose metabolism in a germ-free (GF) pig model.

Methods
Twelve hysterectomy-derived newborn pigs were reared in six sterile isolators. All pigs were hand-fed with sterile milk powder for 21 d, then the sterile feed was introduced to pigs for another 21 d. In the second 21-d period, six pigs were orally administrated with 25 mL/kg sterile saline per day and considered as the GF group, while the other six pigs were orally administrated with 25 mL/kg SCFAs mixture (acetic, propionic, and butyric acids, 45, 15, and 11 mmol/L, respectively) per day and regarded as FA group.

Results
Orally administrated with SCFAs tended to increase the adiponectin concentration in serum, enhance the CPT-1 activity in longissimus dorsi, and upregulate the ANGPTL4 mRNA expression level in colon (P < 0.10). Meanwhile, the mRNA abundances of ACC, FAS, and SREBP-1C in liver and CD36 in longissimus dorsi of the FA group were decreased (P < 0.05) compared with those in the GF group. Besides, the mRNA expression of PGC-1α in liver and LPL in longissimus dorsi tended to (P < 0.10) upregulate and downregulate respectively in the FA group. Moreover, oral administration of SCFAs tended to increase the protein level of GPR43 (P < 0.10) and decrease the protein level of ACC (P < 0.10) in liver. Also, oral administration of SCFAs upregulated the p-AMPK/AMPK ratio and the mRNA expressions of GLUT-2 and GYS2 in liver (P < 0.05). In addition, the metabolic pathway associated with the biosynthesis of unsaturated fatty acids was most significantly promoted (P < 0.05) by oral administration of SCFAs.

Conclusions
Exogenous introduction of SCFAs might attenuate the fat deposition and to some extent improve the glucose control in the pig model, which occurred independently of the gut microbiota.
Long-term survival without recurrence after surgery for gastric yolk sac tumor-like carcinoma: a case report
Authors: Umeda Hibiki , Kikuchi Satoru , Kuroda Shinji , Yano Shuya , Tanaka Takehiro , Noma Kazuhiro , Nishizaki Masahiko , Kagawa Shunsuke , Umeda Yuzo , Fujiwara Toshiyoshi 
Published: May 2021

Abstract
Background
Gastric yolk sac tumor (YST)-like carcinoma is extremely rare, and its prognosis is poor, because most patients have widespread metastases at the time of diagnosis. We report a case of gastric YST-like carcinoma with an adenocarcinoma component without metastases in which curative resection was performed.

Case presentation
A 77-year-old man complaining of melena and dizziness due to anemia was diagnosed with poorly differentiated adenocarcinoma in the gastric cardia, with a benign ulcer in the gastric body. He underwent total gastrectomy with D2 lymph node dissection for the tumor. Histological examination of the resected specimens revealed a mixture of reticular and glandular neoplastic components morphologically. In the reticular area, an endodermal sinus pattern and some Schiller–Duval bodies were confirmed. Gastric YST-like carcinoma with adenocarcinoma components, T2N0M0 Stage IB, was diagnosed. Immunohistochemical analysis showed that the YST was positive for carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and p53. In contrast, the adenocarcinoma was positive for p53 and negative for CEA and AFP. The patient remained healthy as of 7 years postoperatively, with no recurrence.

Conclusions
Routine medical examinations or endoscopic examinations for accidental symptom may be helpful for early diagnosis and good prognosis for gastric YST-like carcinoma, although the prognosis is generally poor.
Relative preference and demographic parameters of Encarsia formosa Gahan against Trialeurodes vaporariorum (Westwood)
Authors: Walia Anamika , Verma S. C. , Sharma P. L. , Sharma Nidhi , Palial Shivani 
Published: May 2021

AbstractBackgroundThe greenhouse whitefly,Trialeurodes vaporariorum(Westwood) (Hemiptera: Aleyrodidae), is a cosmopolitan, polyphagous and a serious pest of vegetables and ornamentals in greenhouse.Encarsia formosaGahan (Hymenoptera: Aphelinidae) is an important primary endoparasitoid species of the greenhouse whitefly.ResultsIn the present study, per cent parasitisation attained 50% on the 4th instar and 46% on the third 3rd instar ofT. vaporariorumbyE.formosa.The mean duration period of the parasitoid from egg to host mummification, mummification to adult emergence (pupal period) was 11 and 7.8 days on 3rd instar and 8.5 and 7.6 days on 4th instar, respectively. The total time period from egg to adult emergence reached 18.8 days on 3rd instar and 16.2 days on 4th instar. Longevity of the female parasitoids was 8.3 and 8.8 days on 3rd and 4th instars, respectively. The pre-ovipositional, ovipositional and post-ovipositional periods of the parasitoid were 1.2, 6.4 and 1.0 days on 3rd instar and 1.2, 6.7 and 1.0 days on 4th instar, respectively. The finite rate of natural increase (λ), doubling time and weekly multiplication rate of the 3rd instar was 1.16±0.002 times per day, 4.71±0.04 days and 2.80±0.03 folds, respectively and 1.17±0.002 times per day, 4.34±0.04 days and 3.06±0.03 folds for the 4th instar.ConclusionsStudies indicated that the 4th nymphal instar of the host was more suitable for parasitisation withE. formosa.The parasitoid species could be mass multiplied and utilised as a component of integrated pest management programme ofT. vaporariorumafter evaluation under field conditions.
Undescribed GJB2 c.35dupG homozygous prelingual distinguished from c.35delG homozygous/compound heterozygous deafs, dwelling a German ancestry Venezuelan isolate
Authors: Arias Sergio , Paradisi Irene , Hernández Alba , Kanzler Daniela 
Published: May 2021

Abstract
Background
Among ten hearing-impaired (HI) families mostly of German descent dwelling the Venezuelan isolate Colonia Tovar, which were initially studied several decades ago to assess the etiology of their profound/prelingual nonsyndromic deafness phenotype, an undescribed genotype/phenotype was found. Forty-eight subjects, including 8 of the still living 143 originally searched with audiograms 4 decades ago, were retested and their DNA collected. A genomic search of 27 loci involved in HI was performed on a randomly chosen prelingual deaf patient. Subsequently, GJB2 sequencing was performed in all subjects from each pedigree. Haplotypes were constructed with five intragenic GJB2 SNPs (rs117685390, rs7994748, rs2274084, rs2274083, and rs3751385). Audiograms performed along 5 decades were compared to evaluate age-related hearing loss in the different genotypes found in the population.

Results
Three prelingual deaf siblings, having the highest recorded symmetrical hearing loss of all the known affected in the isolate, carried the very rare mutation c.35dupG (p.V13Cfs*35) at GJB2 in a homozygous condition. Two additional GJB2 mutations were identified (p.W77R and c.35delG) in the isolate. Allelic disequilibrium in both c.35dupG and p.W77R carriers (with in-phase haplotype T;T;G;A;C) were found, although not so in the 2 other found c.35delG independent haplotypes. A compound heterozygote in trans (c.35delG/c.35dupG) was audiometrically distinguishable from both the c.35dupG and c.35delG homozygotes.

Conclusions
A relatively higher frequency of mutation of c.35dupG found than elsewhere was retrospectively inferred for the ancient population of the Kaiserstuhl region in Germany, having an opposite epidemiological situation to the one found with the contiguous and very frequent c.35delG. Haplotype analysis suggests founder phenomena and independent occurrence, hundreds of generations back in Caucasoid populations for both mutations.
Utilizing blast furnace ferronickel slag as paste replacement to reduce white Portland cement content and improve performance of mortar
Authors: Guan Qingfeng , Xia Jingliang , Leng Faguang , Zhou Yongxiang 
Published: May 2021

AbstractAs a special type of cement that can provide construction with aesthetics, white Portland cement (WPC) is restricted by the high cost of its production. To reduce the consumption of WPC and carbon dioxide emissions without degrading the properties of mortar, this work produced various mortar mixes by replacing an equal volume of the paste (the total volume of WPC and water) with blast furnace ferronickel slag (FNS), the by-product of ferronickel smelting. The workability, 28-day compressive strength, carbonation depth, water permeability, and drying shrinkage test were conducted, and mercury intrusion porosimetry (MIP) test was used to characterize the pore structure. The results show that the paste replacement method is eco-friendlier and more effective than the traditional cement replacement technology in utilizing FNS to reduce WPC consumption, which may promote the development of white concrete construction.