bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Overdose Risk in Patients Returning to the Emergency Department for Pain
Authors: Sheikh Sophia , Booth-Norse Ashley , Holden David , Henson Morgan , Dodd Caroline , Edgerton Eric , James Divya , Kalynych Colleen , Smotherman Carmen , Hendry Phyllis 
Published: February 2021

Abstract

Objective
Using the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) in patients returning to the emergency department (ED) for pain and discharged with an opioid prescription, we assessed overall opioid overdose risk and compared risk in opioid naive patients to those who are non-opioid naive.

Design
This was a secondary analysis from a prospective observational study of patients ≥ 18 years old returning to the ED within 30 days. Data were collected from patient interviews and chart reviews. Patients were categorized as Group 1 (not using prescription opioids) or Group 2 (consuming prescription opioids). Statistical analyses were performed using Fisher’s exact and Wilcoxon’s rank sum tests. Risk class and probability of overdose was determined using Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD).

Results
Of the 389 enrollees who returned to the ED due to pain within 30 days of an initial visit, 67 (17%) were prescribed opioids. The majority of these patients were in Group 1 (60%). Both Group 1 (n = 40) and Group 2 (n = 27) held an average CIP-RIOSORD risk class of 3. Race significantly differed between groups; the majority of Group 1 self-identified as African American (80%) (P = .0267). There were no differences in age, gender, or CIP-RIOSORD risk class between groups. However, Group 2 had nearly double the number of predictive factors (median = 1.93) as Group 1 (median = 1.18) (P = .0267).

Conclusions
A substantial proportion of patients (25%) were high risk for opioid overdose. CIP-RIOSORD may prove beneficial in risk stratification of patients discharged with prescription opioids from the ED.
Handgrip Strength in People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
Authors: Holden Mackenzie , Fyfe Madeline , Poulin Camille , Bethune Brianna , Church Chloe , Hepburn Paula , Afreixo Vera , Brooks Dina , Oliveira Ana 
Published: February 2021

Abstract

Objective
The purpose of this study was to systematically review the association between handgrip strength (HGS) and mortality, morbidity, and health-related quality of life (HRQL) in individuals with chronic obstructive pulmonary disease (COPD).

Methods
The following databases were used: CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, SPORTDiscus, and PsycINFO. Studies published between 2000 and 2020 in English, Portuguese, or French that examined the association of HGS with mortality, morbidity, and HRQL in individuals with stable COPD were selected. Two authors independently extracted data and assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. The study effects were pooled using random effects meta-analysis models after assessing heterogeneity. The search generated 710 studies, and 18 were included in the review. Studies evaluated a total of 12,046 individuals with stable COPD (mean percent of the predicted forced expiratory volume in 1 second = 34%–80%) using over 10 diverse protocols for HGS measurement. Statistically significant, small, and negative relationships were found between HGS and mortality (r = −0.03; 95% CI = −0.05 to −0.02). Independent of the outcome measure used to assess morbidity, the estimate of the overall relationship was small to moderate and negative: Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Index Updated (r = −0.42; 95% CI = −0.61 to −0.03); exacerbations (r = −0.02; 95% CI = −0.04 to −0.00); and hospitalizations (r = −0.69; 95% CI = −1.70 to 0.32). Similarly, for HRQL, independent of the outcome measure, the estimate of the overall relationship was small to fair and negative: COPD Assessment Test (weighted r = −0.22; 95% CI = −0.32 to −0.12), Chronic Respiratory Disease Questionnaire domains (−0.24 &lt; r &lt; −0.14), EuroQol Five-Dimension Questionnaire (utility score) (r = −0.17; 95% CI = −0.26 to −0.07), EuroQol Five-Dimension Questionnaire domains (−0.32 &lt; r &lt; −0.06), and St George Respiratory Questionnaire total (r = −0.26; 95% CI = −0.33 to −0.17). The quality of the evidence ranged from low to very low across outcomes.

Conclusion
Although heterogeneity was present among HGS measurement protocols, small to moderate associations were found, indicating that those with lower HGS have an increased likelihood of death, a higher risk of increased COPD morbidity (as assessed with Body Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity indexes), and poorer HRQL.
Early predictors of renal outcome in patients with proliferative lupus nephritis: a 36-month cohort study
Authors: Luís Mariana S F , Bultink Irene E M , da Silva José A P , Voskuyl Alexandre E , Inês Luís S 
Published: February 2021

AbstractObjectivesTo identify predictors of complete renal response (CRR) and renal flares in SLE patients with active proliferative LN.MethodsThis was a retrospective cohort study over 36 months including patients with biopsy-proven proliferative LN (class III/IV), from two European tertiary centres. CRR and renal flare were defined as proteinuria &lt;0.5 g/day with normal renal function and proteinuria &gt;1 g/day after CRR attainment, respectively. Demographic, clinical and analytic parameters were evaluated as early predictors of renal outcome, using survival analysis. Candidate variables were tested as predictors for CRR at time 0, 3 and 6 months after starting induction treatment. Potential predictors for renal flare were evaluated at time of reaching CRR. Variables with P &lt; 0.10 on univariate analysis with log-rank tests were further tested with multivariate Cox proportional hazards regression models.ResultsWe included 104 patients [81.7% female, mean (s.d.) age at baseline 32.0 (13.3) years]. Over follow-up, 91.7% reached CRR, within a median time of 6.0 months. Proteinuria &lt;2 g/day at baseline [hazard ratio (HR) = 1.80, 95% CI 1.16, 2.79, P &lt; 0.01] and 3 months (HR = 2.32, 95% CI 1.24, 4.32, P &lt; 0.01) after starting induction therapy were independent predictors of CRR. Renal flares occurred in 18.4% of patients reaching CRR, after a mean time of 16.5 (8.6) months. Age up to 25 years at time of LN diagnosis (HR = 5.41, 95% CI 1.72, 16.97, P &lt; 0.01) and positive anti-RNP (HR = 3.52, 95% CI 1.21, 10.20, P = 0.02) were independent predictors of renal flares.ConclusionIn patients with SLE and proliferative LN, factors assessed at baseline and 3 months from starting induction treatment can predict CRR and renal flares once CRR is achieved.
IMAGE QUALITY AND POTENTIAL DOSE REDUCTION USING ADVANCED MODELED ITERATIVE RECONSTRUCTION (ADMIRE) IN ABDOMINAL CT - A REVIEW
Authors: Kataria B , Nilsson Althén J , Smedby Ö , Persson A , Sökjer H , Sandborg M 
Published: February 2021

Abstract
Traditional filtered back projection (FBP) reconstruction methods have served the computed tomography (CT) community well for over 40 years. With the increased use of CT during the last decades, efforts to minimise patient exposure, while maintaining sufficient or improved image quality, have led to the development of model-based iterative reconstruction (MBIR) algorithms from several vendors. The usefulness of the advanced modeled iterative reconstruction (ADMIRE) (Siemens Healthineers) MBIR in abdominal CT is reviewed and its noise suppression and/or dose reduction possibilities explored. Quantitative and qualitative methods with phantom and human subjects were used. Assessment of the quality of phantom images will not always correlate positively with those of patient images, particularly at the higher strength of the ADMIRE algorithm. With few exceptions, ADMIRE Strength 3 typically allows for substantial noise reduction compared to FBP and hence to significant (≈30%) patient dose reductions. The size of the dose reductions depends on the diagnostic task.
Social Exclusion and Resilience: Examining Social Network Stratification among People in Same-Sex and Different-Sex Relationships
Authors: Fischer Mirjam M 
Published: February 2021

Abstract
Social networks of minoritized societal groups may be exposed to a unique structural force, namely that of social exclusion. Using a national sample of people in same-sex and different-sex relationships in the Netherlands (N = 1,329), this study examines sexual orientation as stratifying factor in social networks. Specifically, it is a comparison of their size and composition. Overall, the networks are similar but a few differences stand out. People in same-sex relationships have larger networks than people in different-sex relationships, which are made up of fewer ties with the family-of-origin and more friends. This lends support to the families-of-choice hypothesis and suggests that people employ resilience strategies, such as alternative community building, to counteract social exclusion from families-of-origin. The results further show that men in same-sex relationships have the fewest same-gender ties in their networks out of both men and women in any relationship type. Overall, the results show that sexual orientation is a dimension worthwhile studying as a stratifying factor of social networks both standing alone and at the intersection with gender.
Incidence of insomnia and obstructive sleep apnea in active duty United States military service members
Authors: Moore Brian A , Tison Lynn M , Palacios Javier G , Peterson Alan L , Mysliwiec Vincent 
Published: February 2021

Abstract

Study Objectives
Epidemiologic studies of obstructive sleep apnea (OSA) and insomnia in the U.S. military are limited. The primary aim of this study was to report and compare OSA and insomnia diagnoses in active duty the United States military service members.

Method
Data and service branch densities used to derive the expected rates of diagnoses on insomnia and OSA were drawn from the Defense Medical Epidemiology Database. Single sample chi-square goodness of fit tests and independent samples t-tests were conducted to address the aims of the study.

Results
Between 2005 and 2019, incidence rates of OSA and insomnia increased from 11 to 333 and 6 to 272 (per 10,000), respectively. Service members in the Air Force, Navy, and Marines were diagnosed with insomnia and OSA below expected rates, while those in the Army had higher than expected rates (p &lt; .001). Female service members were underdiagnosed in both disorders (p &lt; .001). Comparison of diagnoses following the transition from ICD 9 to 10 codes revealed significant differences in the amounts of OSA diagnoses only (p &lt; .05).

Conclusion
Since 2005, incidence rates of OSA and insomnia have markedly increased across all branches of the U.S. military. Despite similar requirements for overall physical and mental health and resilience, service members in the Army had higher rates of insomnia and OSA. This unexpected finding may relate to inherent differences in the branches of the military or the role of the Army in combat operations. Future studies utilizing military-specific data and directed interventions are required to reverse this negative trend.
Social Work with Environmental Migrants: Exploring the Scope for Spiritually Sensitive Practice
Authors: Pandya Samta 
Published: February 2021

Abstract
This article reports a survey of social workers’ (N = 1,204) views on the scope for spiritually sensitive practice with environmental migrants. Results indicated some variations in models, assessment methods, techniques, and intervention goals. Social workers from North America and South America, females, Christians, and Hindus working with environmentally forced migrants, and with higher scores on personal spirituality measures, favored the strengths perspective and model of salutogenesis, spiritual life maps, and spiritual competencies open dialogue as assessment methods; meditation and mindfulness as congruous techniques; and intervention goals as comprehensibility–manageability–meaningfulness and positive coping. Social workers from the Asia-Pacific and African regions, males, Muslims, and Buddhists working with environmental emergency and environmentally induced economic migrants, and with lower personal spirituality scores, preferred the biopsychosocial model and transpersonal spectrum models, spiritual genograms and spiritual history assessment; techniques such as guided visualization, journal keeping, physical disciplines, and active imagination; and goals of interventions such as happiness and forgiveness.
Impact of Pleistocene Eustatic Fluctuations on Evolutionary Dynamics in Southeast Asian Biodiversity Hotspots
Authors: Sholihah Arni , Delrieu-Trottin Erwan , Condamine Fabien L , Wowor Daisy , Rüber Lukas , Pouyaud Laurent , Agnèse Jean-Francçois , Hubert Nicolas 
Published: February 2021

Abstract
Pleistocene climatic fluctuations (PCF) are frequently highlighted as important evolutionary engines that triggered cycles of biome expansion and contraction. Although there is ample evidence of the impact of PCF on biodiversity of continental biomes, the consequences in insular systems depend on the geology of the islands and the ecology of the taxa inhabiting them. The idiosyncratic aspects of insular systems are exemplified by the islands of the Sunda Shelf in Southeast Asia (Sundaland), where PCF-induced eustatic fluctuations had complex interactions with the geology of the region, resulting in high species diversity and endemism. Emergent land in Southeast Asia varied drastically with sea-level fluctuations during the Pleistocene. Climate-induced fluctuations in sea level caused temporary connections between insular and continental biodiversity hotspots in Southeast Asia. These exposed lands likely had freshwater drainage systems that extended between modern islands: the Paleoriver Hypothesis. Built upon the assumption that aquatic organisms are among the most suitable models to trace ancient river boundaries and fluctuations of landmass coverage, the present study aims to examine the evolutionary consequences of PCF on the dispersal of freshwater biodiversity in Southeast Asia. Time-calibrated phylogenies of DNA-delimited species were inferred for six species-rich freshwater fish genera in Southeast Asia (Clarias, Channa, Glyptothorax, Hemirhamphodon, Dermogenys, Nomorhamphus). The results highlight rampant cryptic diversity and the temporal localization of most speciation events during the Pleistocene, with 88% of speciation events occurring during this period. Diversification analyses indicate that sea-level-dependent diversification models poorly account for species proliferation patterns for all clades excepting Channa. Ancestral area estimations point to Borneo as the most likely origin for most lineages, with two waves of dispersal to Sumatra and Java during the last 5 myr. Speciation events are more frequently associated with boundaries of the paleoriver watersheds, with 60%, than islands boundaries, with 40%. In total, one-third of speciation events are inferred to have occurred within paleorivers on a single island, suggesting that habitat heterogeneity and factors other than allopatry between islands substantially affected diversification of Sundaland fishes. Our results suggest that species proliferation in Sundaland is not wholly reliant on Pleistocene sea-level fluctuations isolating populations on different islands. [Dispersal; diversification; eustatic fluctuations; freshwater fishes; insular systems; Milankovitch cycles; paleoenvironments; vicariance.]
Different climate sensitivity for radial growth, but uniform for tree-ring stable isotopes along an aridity gradient in Polylepis tarapacana, the world’s highest elevation tree species
Authors: Rodriguez-Caton Milagros , Andreu-Hayles Laia , Morales Mariano S , Daux Valérie , Christie Duncan A , Coopman Rafael E , Alvarez Claudio , Rao Mukund Palat , Aliste Diego , Flores Felipe , Villalba Ricardo 
Published: February 2021

Abstract
Tree growth is generally considered to be temperature limited at upper elevation treelines, yet climate factors controlling tree growth at semiarid treelines are poorly understood. We explored the influence of climate on stem growth and stable isotopes for Polylepis tarapacana Philipi, the world’s highest elevation tree species, which is found only in the South American Altiplano. We developed tree-ring width index (RWI), oxygen (δ18O) and carbon (δ13C) chronologies for the last 60 years at four P. tarapacana stands located above 4400 m in elevation, along a 500 km latitude aridity gradient. Total annual precipitation decreased from 300 to 200 mm from the northern to the southern sites. We used RWI as a proxy of wood formation (carbon sink) and isotopic tree-ring signatures as proxies of leaf-level gas exchange processes (carbon source). We found distinct climatic conditions regulating carbon sink processes along the gradient. Current growing-season temperature regulated RWI at northern-wetter sites, while prior growing-season precipitation determined RWI at arid southern sites. This suggests that the relative importance of temperature to precipitation in regulating tree growth is driven by site water availability. By contrast, warm and dry growing seasons resulted in enriched tree-ring δ13C and δ18O at all study sites, suggesting that similar climate conditions control carbon-source processes along the gradient. Site-level δ13C and δ18O chronologies were significantly and positively related at all sites, with the strongest relationships among the southern drier stands. This indicates an overall regulation of intercellular carbon dioxide via stomatal conductance for the entire P. tarapacana network, with greater stomatal control when aridity increases. This manuscript also highlights a coupling (decoupling) between physiological processes at leaf level and wood formation as a function of similarities (differences) in their climatic sensitivity. This study contributes to a better understanding and prediction of the response of high-elevation Polylepis woodlands to rapid climate changes and projected drying in the Altiplano.
A multigene phylogeny of the eristaline flower flies (Diptera: Syrphidae), with emphasis on the subtribe Criorhinina
Authors: Moran Kevin M , Skevington Jeffrey H , Kelso Scott , Mengual Ximo , Jordaens Kurt , Young Andrew D , Ståhls Gunilla , Mutin Valerii , Bot Sander , van Zuijen Menno , Ichige Katsuyoshi , van Steenis Jeroen , Hauser Martin , van Steenis Wouter 
Published: February 2021

AbstractWe present the first multigene phylogeny focused on Eristalinae (Diptera: Syrphidae) utilizing a dataset containing 120 flower fly species from across all four subfamilies and representing 13 out of 16 tribes. Eight genes were used in the construction of the phylogeny: mitochondrial cytochrome c oxidase subunit I and the nuclear genes 28S ribosomal DNA, Alanylt RNA Synthetase, the carbamoyl phosphate synthase domain of CAD, Period, RNA-binding Protein 15 (RBP–15, 5’), Casein Kinase 1 and TULP for a total of ~6.7 kB of data. Eristalinae is recovered as paraphyletic with strong support for the elevation of Cerioidini, Merodontini and Volucellini to subfamilial status. Deineches, Flukea and Malometasternum render Criorhinina paraphyletic with respect to the type genus Criorhina. A clade with Criorhina, Matsumyia and Sphecomyia is strongly supported. The generic concept of Criorhina is paraphyletic, while Sphecomyia is monophyletic and Matsumyia is monophyletic but requires expansion. Evidence supports the resurrection of Romaleosyrphus and the creation of new genera. Criorhinina (stat. rev.) is restricted to contain Criorhina, Matsumyia, Romaleosyrphus and Sphecomyia. Thirteen changes to the higher classification of Syrphidae are proposed.
Successful Community Discharge Among Older Adults With Traumatic Brain Injury in Skilled Nursing Facilities
Authors: Evans Emily , Gutman Roee , Resnik Linda , Zonfrillo Mark R. , Lueckel Stephanie N. , Kumar Raj G. , DeVone Frank , Dams-O'Connor Kristen , Thomas Kali S. 
Published: February 2021

Objective:
To identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI).

Setting:
Skilled nursing facilities.

Participants:
Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI.

Design:
Retrospective cohort study using Medicare administrative data merged with the National Trauma Data Bank using a multilayered Bayesian record linkage approach.

Main Outcome Measure:
Successful community discharge: discharged alive within 100 days of SNF admission and remaining in the community for 30 days or more without dying or admission to a healthcare facility.

Results:
Medicaid enrollment, incontinence, decreased independence with activities of daily living, and cognitive impairment were associated with lower odds of successful discharge, whereas race “other” was associated with higher odds of successful discharge. Injury factors including worse injury severity (Glasgow Coma Scale and Abbreviated Injury Scale scores) and fall-related injury mechanism were not associated with successful discharge.

Conclusion:
Among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning. Acute injury severity indices may have limited utility in predicting discharge disposition once a patient is admitted to an SNF for post–acute care.
Incorporating the Laplacian Filter with a Three-Stream Multi-Channel Convolutional Neural Network for Improved Abnormality Detection in Knee MRIs
Authors: Kumar Rahul , Bhansali Rohan 
Published: February 2021

AbstractDespite ACL and meniscus tears being among the most common movement induced injuries, they are often the most difficult to diagnose due to the variable severity with which these tears occur. Typically, magnetic resonance imaging (MRI) scans are used for diagnosing ligament tears, but performing and analyzing these scans is time consuming and expensive due to the necessitation of a radiologist or professional orthopedic specialist. Consequently, we developed a custom three-stream convolutional neural network (CNN) architecture that contains multiple channels to automate the diagnosis of ACL and meniscus tears from MRI scans. Our algorithm utilizes the sagittal, coronal, and axial slices to maximize feature extraction. Furthermore, we apply the Laplace Operator on the MRI scan images to evaluate and compare its propensity in different medical imaging modalities. The algorithm attained an accuracy of 92.80%, significantly higher than that of orthopedic diagnosis accuracy. Our results point towards the feasibility of shallow, multi-channel CNNs and the ability of the Laplace Operator to improve performance metrics for MRI scan diagnosis.