bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Type 2 Diabetes Mellitus and Smoking on Changes in Corneal Endothelial Morphology and Cell Density
Authors: Antičić-Eichwalder Marija , Lex Susanne , Sarny Stephanie , Schweighofer Jakob , Marić Ivana , El-Shabrawi Yosuf 
Published: November 2021

Purpose:The purpose of this study was to compare the corneal endothelial morphology and cell density of diabetic smokers and nonsmokers with 50 to 70 age-matched healthy subjects and to determine whether smoking increases the effects of type 2 diabetes mellitus (DM) on these corneal parameters.Methods:This prospective cohort study included 200 patients who were assigned to 4 groups, including smokers with type 2 DM (group 1), nonsmokers with type 2 DM (group 2), healthy smokers (group 3), and healthy nonsmokers (control group, group 4). Noncontact specular microscopy was used to measure central endothelial cell density (ECD), coefficient of variation of cell area, percentage of hexagonal cells, and central corneal pachymetry (CCT).Results:According to the ECD and CCT values (P< 0.001 andP= 0.013, respectively), a significant difference was observed between the groups. The mean ECD was lowest in diabetic smokers (1917 ± 399 cells/mm2). Healthy smokers and diabetic smokers had significantly lower ECD compared with the control group (P= 0.03 andP< 0.001, respectively). Healthy smokers and diabetic smokers had significantly lower ECD compared with diabetic nonsmokers (P= 0.012 andP< 0.001, respectively). The cornea was significantly thicker in the diabetic smokers than in the control group (P= 0.013).Conclusions:The coexistence of DM and smoking causes a significant decrease in ECD and an increase in CCT. Cigarette smoking is more harmful to corneal endothelial cells than DM alone.
Combining sinus plain film and sinus ultrasound as a screening tool for maxillary fungal sinusitis
Authors: Ho Nien-Hsuan , Hung Li-Ting , Kuan Edward C. , Ho Ching-Yin , Hsu Cheng-Chieh , Lan Ming-Ying 
Published: November 2021

Background:
Early identification of fungal sinusitis remains a challenge. Previously, we observed a high false negative rate of using A-mode ultrasound to diagnose maxillary fungal sinusitis. This study aims to assess the accuracy of the diagnosis of fungal maxillary sinusitis using sinus plain film and ultrasound.

Methods:
The screening criteria is defined as the combination of a positive sinus plain film and a false negative sinus ultrasound. We retrospectively reviewed preoperative imaging of patients with fungal sinusitis and unilateral bacterial sinusitis of the maxillary sinus undergoing functional endoscopic sinus surgery from May 2013 to December 2019 in our hospital and evaluated the diagnostic performance of this screening method.

Results:
Forty-eight patients were included. Twenty-two and 26 patients were diagnosed with fungal sinusitis and bacterial sinusitis, respectively. Sixteen patients (72.7%) with fungal sinusitis presented with a false negative sinus ultrasound and met our screening criteria for fungal sinusitis. The screening criteria reached significance in the receiver operating characteristic curve analysis (p < 0.001). The area under the curve was 0.829. The sensitivity, specificity, and accuracy are 72.7%, 93.2%, and 88.4%, respectively.

Conclusion:
A high false negative rate of sinus ultrasound in patients with fungal sinusitis was found. A positive sinus plain film combined with a false negative sinus ultrasound can potentially become an easy and cost-effective screening tool for diagnosing fungal maxillary sinusitis before consideration of computed tomography scanning.
Protective ventilation in patients with acute respiratory distress syndrome related to COVID-19: always, sometimes or never?
Authors: Mega Chiara , Cavalli Irene , Ranieri Vito Marco , Tonetti Tommaso 
Published: November 2021

Purpose of review
To review current evidence on the pathophysiology of COVID-19-related acute respiratory distress syndrome (ARDS) and on the implementation of lung protective ventilation.

Recent findings
Although multiple observations and physiological studies seem to show a different pathophysiological behaviour in COVID-19-ARDS compared with ‘classical’ ARDS, numerous studies on thousands of patients do not confirm these findings and COVID-19-ARDS indeed shares similar characteristics and interindividual heterogeneity with ARDS from other causes. Although still scarce, present evidence on the application of lung protective ventilation in COVID-19-ARDS shows that it is indeed consistently applied in ICUs worldwide with a possible signal towards better survival at least in one study. The levels of positive end-expiratory pressure (PEEP) usually applied in these patients are higher than in ‘classical’ ARDS, proposing once again the issue of PEEP personalization in hypoxemic patients. In the absence of robust evidence, careful evaluation of the patient is needed, and empiric settings should be oriented towards lower levels of PEEP.

Summary
According to the present evidence, a lung protective strategy based on low tidal volume and plateau pressures is indicated in COVID-19-ARDS as in ARDS from other causes; however, there are still uncertainties on the appropriate levels of PEEP.
Skilled Nursing Facility Participation in a Voluntary Medicare Bundled Payment Program
Authors: Ying Meiling , Temkin-Greener Helena , Thirukumaran Caroline P. , Joynt Maddox Karen E. , Holloway Robert G. , Li Yue 
Published: November 2021

Importance:
Model 3 of the Bundled Payments for Care Improvement (BPCI) is an alternative payment model in which an entity takes accountability for the episode costs. It is unclear how BPCI affected the overall skilled nursing facility (SNF) financial performance and the differences between facilities with differing racial/ethnic and socioeconomic status (SES) composition of the residents.

Objective:
The objective of this study was to determine associations between BPCI participation and SNF finances and across-facility differences in SNF financial performance.

Design, Setting, and Participants:
A longitudinal study spanning 2010–2017, based on difference-in-differences analyses for 575 persistent-participation SNFs, 496 dropout SNFs, and 13,630 eligible nonparticipating SNFs.

Main Outcome Measures:
Inflation-adjusted operating expenses, revenues, profit, and profit margin.

Results:
BPCI was associated with reductions of $0.63 million in operating expenses and $0.57 million in operating revenues for the persistent-participation group but had no impact on the dropout group compared with nonparticipating SNFs. Among persistent-participation SNFs, the BPCI-related declines were $0.74 million in operating expenses and $0.52 million in operating revenues for majority-serving SNFs; and $1.33 and $0.82 million in operating expenses and revenues, respectively, for non–Medicaid-dependent SNFs. The between-facility SES gaps in operating expenses were reduced (differential difference-in-differences estimate=$1.09 million). Among dropout SNFs, BPCI showed mixed effects on across-facility SES and racial/ethnic differences in operating expenses and revenues. The BPCI program showed no effect on operating profit measures.

Conclusions:
BPCI led to reduced operating expenses and revenues for SNFs that participated and remained in the program but had no effect on operating profit indicators and mixed effects on SES and racial/ethnic differences across SNFs.
Impacts of Initial Prescription Length and Prescribing Limits on Risk of Prolonged Postsurgical Opioid Use
Authors: Young Jessica C. , Dasgupta Nabarun , Chidgey Brooke A. , Stürmer Til , Pate Virginia , Hudgens Michael , Jonsson Funk Michele 
Published: November 2021

Background:
In response to concerns about opioid addiction following surgery, many states have implemented laws capping the days supplied for initial postoperative prescriptions. However, few studies have examined changes in the risk of prolonged opioid use associated with the initial amount prescribed.

Objective:
The objective of this study was to estimate the risk of prolonged opioid use associated with the length of initial opioid prescribed and the potential impact of prescribing limits.

Research Design:
Using Medicare insurance claims (2007–2017), we identified opioid-naive adults undergoing surgery. Using G-computation methods with logistic regression models, we estimated the risk of prolonged opioid use (≥1 opioid prescription dispensed in 3 consecutive 30-d windows following surgery) associated with the varying initial number of days supplied. We then estimate the potential reduction in cases of prolonged opioid use associated with varying prescribing limits.

Results:
We identified 1,060,596 opioid-naive surgical patients. Among the 70.0% who received an opioid for postoperative pain, 1.9% had prolonged opioid use. The risk of prolonged use increased from 0.7% (1 d supply) to 4.4% (15+ d). We estimated that a prescribing limit of 4 days would be associated with a risk reduction of 4.84 (3.59, 6.09)/1000 patients and would be associated with 2255 cases of prolonged use potentially avoided. The commonly used day supply limit of 7 would be associated with a smaller reduction in risk [absolute risk difference=2.04 (−0.17, 4.25)/1000].

Conclusions:
The risk of prolonged opioid use following surgery increased monotonically with increasing prescription duration. Common prescribing maximums based on days supplied may impact many patients but are associated with relatively low numbers of reduced cases of prolonged use. Any prescribing limits need to be weighed against the need for adequate pain management.
Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas
Authors: Martino Steven C. , Elliott Marc N. , Hambarsoomian Katrin , Weech-Maldonado Robert , Tamayo Loida , Gaillot Sarah , Haviland Amelia M. 
Published: November 2021

Background:
Hispanic older adults face substantial health disparities compared with non–Hispanic-White (hereafter “White”) older adults. To the extent that these disparities stem from cultural and language barriers faced by Hispanic people, they may be compounded by residence in rural areas.

Objective:
The objective of this study was to investigate possible interactions between Hispanic ethnicity and rural residence in predicting the health care experiences of older adults in the United States, and whether disparities in care for rural Hispanic older adults differ in Medicare Advantage versus Medicare Fee-for-Service.

Subjects:
Medicare beneficiaries age 65 years and older who responded to the 2017–2018 nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

Methods:
We fit a series of linear, case-mix–adjusted models predicting Medicare CAHPS measures of patient experience (rescaled to a 0–100 scale) from ethnicity, place of residence, and Medicare coverage type.

Results:
In all residential areas, Hispanic beneficiaries reported worse experiences with getting needed care (−3 points), getting care quickly (−4 points), and care coordination (−1 point) than White beneficiaries (all P’s<0.001). In rural areas only, Hispanic beneficiaries reported significantly worse experiences than White beneficiaries on doctor communication and customer services (−3 and −9 points, respectively, P<0.05). Tests of a 3-way interaction between ethnicity, rural residence, and coverage type were nonsignificant.

Conclusions:
There is a need to improve access to care and care coordination for Hispanic beneficiaries overall and doctor-patient communication and customer service for rural Hispanic beneficiaries. Strategies for addressing deficits faced by rural Hispanics may involve cultural competency training and provision of language-appropriate services for beneficiaries (perhaps as telehealth services).
Immediate comfort perception of 3D-printed foot orthoses in individuals with unilateral heel pain
Authors: Ho Malia , Nguyen Julie , Talbot Kerwin , Heales Luke , Kean Crystal , Kong Pui W. , Stanton Robert 
Published: November 2021

Background:
Custom-made foot orthoses (FOs) play an integral part in managing foot disorders. Traditional FO fabrication is time-consuming and labor intensive. Three-dimensional (3D) printed FOs save time and cost compared with the traditional manufacturing process. To date, the differences in dimensions and comfort perception of these orthoses have not been compared in a pathological population.

Objective:
Compare the dimensions between 3D-printed and traditionally made FOs and comfort perception between 3D-printed, traditionally made, and no FOs in individuals with flatfeet and unilateral heel pain.

Study design:
Within-subject single-blinded randomized crossover study design.

Methods:
Thirteen participants had custom-made FOs using 3D-printing and traditional processes. Orthotic lengths, widths, arch heights, and heel cup heights were compared. Participants performed walking trials under three conditions: (1) no orthoses, (2) 3D-printed orthoses, and (3) traditionally made orthoses. Comfort perception was recorded. Orthotic dimensions were compared using paired t tests, and comfort perception were compared using one-way multiple analysis of variance and Bonferroni post hoc tests.

Results:
Three-dimensional–printed orthoses were wider, have higher arch heights, and heel cup heights compared with traditionally made FOs (medium to large effect sizes). There was a difference in comfort perception between the three orthotic conditions, F(12,62) = 1.99, P = 0.04; Wilk Λ = 0.521, η

p

2

= 0.279. Post hoc tests show that there is no difference in comfort perception between the 3D-printed and traditionally made FOs. Both FOs were significantly more comfortable than no orthoses.

Conclusions:
Three-dimensional printing seems to be a viable alternative orthotic fabrication option. Future studies should compare the biomechanical effects of 3D-printed and traditionally made FOs.
Postradiation Optic Atrophy Is Associated With Intraocular Pressure and May Manifest With Neuroretinal Rim Thinning
Authors: Dalvin Lauren A. , Deufel Christopher L. , Corbin Kimberly S. , Petersen Ivy A. , Olsen Timothy W. , Roddy Gavin W. 
Published: November 2021

Background:
To determine risk factors for postradiation optic atrophy (PROA) after plaque radiotherapy for uveal melanoma.

Methods:
A single center, retrospective cohort study of patients diagnosed with uveal melanoma involving choroid and/or ciliary body treated with plaque between January 1, 2008, and December 31, 2016. Outcomes included development of PROA with pallor alone or with concomitant neuroretinal rim thinning (NRT). Cox regression analysis was performed to identify risk factors for PROA.

Results:
Of 78 plaque-irradiated patients, PROA developed in 41 (53%), with concomitant NRT in 15 (19%). Risk factors for PROA of any type included presentation with worse visual acuity (odds ratio [95% confidence interval] 5.6 [2.3–14.1], P < 0.001), higher baseline intraocular pressure (IOP; 14 vs 16 mm Hg) (1.1 [1.0–1.2], P = 0.03), shorter tumor distance to optic disc (1.3 [1.2–1.5], P < 0.001) and foveola (1.2 [1.1–1.3], P < 0.001), subfoveal subretinal fluid (3.8 [2.0–7.1], P < 0.001), greater radiation prescription depth (1.3 [1.1–1.6], P = 0.002), dose to fovea (point dose) (1.01 [1.01–1.02], P < 0.001), and mean (1.02 [1.02–1.03], P < 0.001) and maximum dose to optic disc per 1 Gy increase (1.02 [1.01–1.03], P < 0.001). On multivariate modeling, dose to disc, baseline IOP, and subfoveal fluid remained significant. Subanalysis revealed risk factors for pallor with NRT of greater mean radiation dose to disc (1.03 [1.01–1.05], P = 0.003), higher maximum IOP (17 vs 20 mm Hg) (1.4 [1.2–1.7], P < 0.001), and subfoveal fluid (12 [2–63], P = 0.004).

Conclusion:
PROA may result in NRT in addition to optic disc pallor. Risk factors for PROA included higher radiation dose to optic disc, higher baseline IOP, and subfoveal fluid. Higher maximum IOP contributed to concomitant NRT.
Factorial validity and internal consistency of a practitioners’ checklist for therapists in rehabilitation
Authors: Ohura Tomoko , Tsuyama Tsutomu , Furusawa Mai , Iitsuka Terufumi 
Published: November 2021

ABSTRACT

Aims:
The current study aimed to assess the validity and internal consistency of a 20-item checklist to help provide rehabilitation based on effective and clear goal setting.

Methods:
A questionnaire survey was conducted regarding rehabilitation practices followed by physical, occupational, and speech-language therapists over the past month. The questionnaire was based on a checklist covering the following four areas, each comprising five items: goal setting based on patient and family intent and therapist perspective including long-term and short-term goals; therapist's specialized analysis and focalization of problems using the International Classification of Functioning, Disability and Health to clarify work processes and behaviors that hinder high-priority activities; proposal of plans considering the evidence and environment, which clarifies options for resolution methods (plans) and evidence; and formulation and implementation of plans including patient and family intent, which determines plan frequency and implementation period. The checklist was prepared based on medical records and previous studies by two occupational therapists who had experience in providing hospital and home-visit rehabilitation. To test the factorial validity of the 20-item checklist, confirmatory factor analysis was performed, and Cronbach's α coefficients were calculated.

Results:
The participants’ mean age was 28 (25–75th percentile, range: 25–32) years. Of the 385 participants, 163 were home-visit rehabilitation therapists. Our model revealed a fair fit to data (χ2 statistic = 602.0) and standardized path coefficients ranged from 0.67 to 0.95. Path coefficients were at least 0.41 for all 20 items. Cronbach's α for goal setting, problem analysis, problem solving method proposals, and formulation and implementation of specific plans were 0.896, 0.890, 0.935, and 0.925, respectively.

Conclusion:
Based on the assessment of therapists’ practice over 1 month using the developed checklist, the factorial validity and internal consistency of these checklist items were considered acceptable. Education based on these checklist items might support goal setting and planning and improve patient outcomes.
Borderline personality disorder and ageing: myths and realities
Authors: D’Agostino Alessandra , Pepi Raffaele , Starcevic Vladan 
Published: November 2021

Purpose of review
Although mental health issues in ageing individuals have been receiving more attention, borderline personality disorder (BPD) in older adults and the elderly has been relatively neglected. This article aims to review the current state of knowledge about BPD in these age groups.

Recent findings
Studies have consistently reported decreasing prevalence rates of BPD among ageing individuals. This may be attributed to the ageing process itself and/or different clinical features due to which meeting the diagnostic criteria for BPD becomes more difficult. Ageing individuals with BPD often present in a way that makes them look ‘atypical’ compared to younger individuals with the same condition. In particular, this pertains to somewhat attenuated and less overt manifestations of impulsivity. However, the basic pattern of overall symptoms instability continues to characterize ageing individuals with BPD, in addition to depressive symptoms, feeling of emptiness, anger, unstable interpersonal relationships, turbulent responses when needs are not met, various somatic complaints and other symptoms.

Summary
Clinicians should be aware of different clinical features of BPD as patients get older. Diagnostic criteria for BPD may need to be revised to reflect this reality, allow accurate diagnosis and minimize the risk of overlooking BPD in ageing individuals.
Inferring ongoing cancer evolution from single tumour biopsies using synthetic supervised learning
Authors: Ouellette Tom W. , Awadalla Philip 
Published: November 2021

AbstractVariant allele frequencies (VAF) encode ongoing evolution and subclonal selection in growing tumours. However, existing methods that utilize VAF information for cancer evolutionary inference are compressive, slow, or incorrectly specify the underlying cancer evolutionary dynamics. Here, we provide a proof-of-principle synthetic supervised learning method, TumE, that integrates simulated models of cancer evolution with Bayesian neural networks, to infer ongoing selection in bulk-sequenced single tumour biopsies. Analyses in synthetic and patient tumours show that TumE significantly improves both accuracy and inference time per sample when detecting positive selection, deconvoluting selected subclonal populations, and estimating subclone frequency. Importantly, we show how transfer learning can leverage stored knowledge within TumE models for related evolutionary inference tasks — substantially reducing data and computational time for further model development and providing a library of recyclable deep learning models for the cancer evolution community. This extensible framework provides a foundation and future directions for harnessing progressive computational methods for the benefit of cancer genomics and, in turn, the cancer patient. TumE is publicly available for use at https://github.com/tomouellette/TumE.
Genomic variation in the tea leafhopper reveals the basis of adaptive evolution
Authors: Zhao Qian , Shi Longqing , He Weiyi , Li Jinyu , You Shijun , Chen Shuai , Lin Jing , Wang Yibin , Zhang Liwen , Yang Guang , Vasseur Liette , You Minsheng 
Published: November 2021

ABSTRACTThe tea green leafhopper (TGL), Empoasca onukii, is of biological and economic interest. Despite numerous studies, the mechanisms underlying its adaptation and evolution remain enigmatic. Here, we used previously untapped genome and population genetics approaches to examine how this pest so rapidly has adapted to different environmental variables and thus has expanded geographically. We complete a chromosome-level assembly and annotation of the E. onukii genome, showing notable expansions of gene families associated with adaptation to chemoreception and detoxification. Genomic signals indicating balancing selection highlight metabolic pathways involved in adaptation to a wide range of tea varieties grown across ecologically diverse regions. Patterns of genetic variation among 54 E. onukii samples unveil the population structure and evolutionary history across different tea-growing regions in China. Our results demonstrate that the genomic change in key pathways, including those linked to metabolism, circadian rhythms and immune system function, may underlie the successful spread and adaptation of E. onukii. This work highlights the genetic and molecular bases underlying the evolutionary success of a species with broad economic impact, and provides insight into insect adaptation to host plants, which will ultimately facilitate more sustainable pest management.
Matrix-assisted laser desorption ionization time-of-flight mass spectrometry identification of methanogens of clinical interest
Authors: Guindo Cheick Oumar , Amir Lynda , Couderc Carine , Drancourt Michel , Grine Ghiles 
Published: November 2021

ABSTRACTMethanogens, the archaea uniquely detoxifying fermentative hydrogen into methane in the digestive tract, are increasingly detected in pathology situations, rendering their rapid identification mandatory. We improved the experimental protocol to identify broth-cultured methanogens by matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI- TOF-MS). A database incorporating 34 reference spectra derived from 16 methanogen reference strains representative of eight species, supported further identification of 21 Methanobrevibacter smithii and 14 Methanobrevibacter oralis isolates broth-cultured from human stool and oral fluid, respectively, with scores > 2. In addition, MALDI-TOF-MS differentiated five Methanobrevibacter smithii genotypes incorporated in the study. Data here reported found MALDI-TOF-MS as a first line identification method for methanogens recovered from microbiota and clinical samples.