bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Unequal Burden of COVID-19 Deaths in Counties With High Proportions of Black and Hispanic Residents
Authors: Glance Laurent G. , Thirukumaran Caroline P. , Dick Andrew W. 
Published: March 2021

Background:
Understanding the current burden of coronavirus disease 2019 (COVID-19) deaths in vulnerable populations will help inform efforts by policymakers to address disparities in COVID-19 outcomes.

Objective:
The objective of this study was to examine the association between COVID-19 deaths and the county-level proportions of non-Hispanic Black and Hispanic residents.

Research Design and Methods:
A retrospective study using COVID-19 mortality data from USA Facts linked to data from the US Census Bureau, the Health Resources & Services Administration Area Health Resources file, and the US Census Bureau. Negative binomial regression was used to estimate the association between the total county COVID-19 deaths during consecutive 30-day intervals and the proportion of non-Hispanic Blacks and Hispanic residents after adjusting for resident demographics, comorbidity burden, rurality, social determinants of health, and health care resources.

Results:
In April, counties (n=179) with >40% Blacks had 6-fold higher death rates than counties (n=1521) with <2% Blacks [incident rate ratio (IRR)=6.58, 95% confidence interval (CI): 3.29–13.2, P<0.001]. These counties had higher death rates until October, but were no different than referent counties in November. In April, death rates in counties with >40% Hispanic residents were similar to death rates in counties with <2% Hispanic residents. Death rates in these counties peaked in August (IRR=3.14, 95% CI: 1.69–5.82, P<0.001) but were also no different than referent counties in November. These effects were robust after adjusting for county-level characteristics. Before August, death rates differed little by insurance status, but since then, counties with >15% uninsurance rates had up to 2-fold higher mortality rates (IRR=1.97, 95% CI: 1.19–3.27, P<0.001) than counties with <5% uninsurance rates.

Conclusion:
Counties with high concentrations of non-Hispanic Blacks were disproportionately affected by COVID-19 throughout most of the pandemic, but other social determinants of health such as health insurance are now playing a more prominent role than race and ethnicity.
Racial and Ethnic Differences in Multimorbidity Changes Over Time
Authors: Quiñones Ana R. , Newsom Jason T. , Elman Miriam R. , Markwardt Sheila , Nagel Corey L. , Dorr David A. , Allore Heather G. , Botoseneanu Anda 
Published: March 2021

Background:
Our understanding of how multimorbidity progresses and changes is nascent.

Objectives:
Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

Design, Setting, and Participants:
Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

Measures:
Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

Results:
Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

Conclusions and Relevance:
Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
Association of Serious Hypoglycemic Events in Older Adults With Changes in Glycemic Performance Measures
Authors: Tseng Chin-Lin , Pogach Leonard M. , Lu Shou-En , Soroka Orysya , Aron David C. 
Published: March 2021

Background:
Reducing serious hypoglycemic events is a Federal-wide objective. Despite studies of trends for rates of serious hypoglycemia in existing literature, rigorous evaluation of links between the observed trends and changes in professional guidelines or performance measures for glycemic control is lacking.

Objective:
To evaluate whether changes in professional society guidelines and performance measures for glycemic control correspond to changes in rates of serous hypoglycemia.

Research Design:
This was a retrospective observational study. We merged Veterans Health Administration (VHA) and Medicare patient-level databases of VHA patients and identified those aged 65 years and above and receiving hypoglycemic agents. We derived age-adjusted and sex-adjusted annual rates and constructed piecewise Poisson regression models adjusting for age and sex to assess time trends of the rates.

Subjects:
VHA patients, 2002–2015.

Measures:
The main outcome was the annual rates (2004–2015) of serious hypoglycemia, defined as hypoglycemia-related emergency department visits or hospitalizations. Secondary outcomes were annual rates of hemoglobin (Hb) A1c level <7% and >9%. Age and sex were additional variables.

Results:
The annual rate for hypoglycemia decreased by 4.8% (rate ratio: 0.952; 95% confidence interval, 0.949–0.956) for 2008–2015 but did not change (1.001; 0.994–1.001) in 2004–2008. In 2008–2015, the annual rate for HbA1c <7% decreased by 5.0% (0.950; 0.949–0.951) but for HbA1c >9%, increased by 7.9% (1.079; 1.076–1.082).

Conclusion:
The cooccurrence of decreasing rates for HbA1c<7% and serious hypoglycemia since 2008 supports the possibility that withdrawal of a <7% HbA1c measure in 2008 impacted clinical practice and patient outcomes.
Intensified Assisted Partner Notification Implementation in Botswana Increased Partner Identification but Not HIV Case-Finding: Findings Highlight the Need for Improved Data Monitoring
Authors: Grande Matias , Mawandia Shreshth , Bakae Odirile , Tau Lenna , Mogomotsi Goabaone P. , Ngombo Modise , Norman Tebogo , Ledikwe Jenny , Golden Matthew R. 
Published: March 2021

Background:
How to implement and monitor assisted partner services (APS) programs for HIV infection as they go to scale-up is uncertain.

Setting:
Forty Botswana Ministry of Health clinics, 2018–2020.

Methods:
We compared 2 APS implementation phases. During phase 1, training, supervision, and data collection were minimal; only newly diagnosed HIV-positive persons received APS, and APS recipients notified partners themselves or jointly with counselors. Phase 2 included the following: intensified training and supervision; APS provision to previously diagnosed, untreated persons; structured interview records; and counselors offering to notify partners directly.

Results:
Five thousand one hundred seventy-five and 1265 newly diagnosed HIV-positive persons received APS in phases 1 and 2, respectively. Comparing the phases, program reach (percentage of newly diagnosed cases receiving APS) increased from 86% to 93%, the contact index (sex partners named per case) increased from 0.85 to 1.32, and the percentage of cases with an identified HIV-positive partner increased from 12.6% to 60% (P < 0.001, all outcomes). The testing index (partners tested per case) was higher in phase 1 (0.56 vs. 0.45, P = 0.05), whereas the case-finding index (partners testing HIV-positive per case) did not change (0.13 vs. 0.14, P = 0.50). Five hundred seventy-eight (76%) of 756 HIV-positive partners in phase 2 were previously diagnosed; cases identified only 15% of these partners as HIV-positive at their initial interview.

Conclusions:
APS scale-up increased reach, the contact index, and the identification of previously diagnosed sex partners but not HIV case-finding. Improved, more comprehensive data likely explain the absence of increased case-finding, highlighting the need for more comprehensive data collection.
Antiretroviral Drug Transporters and Metabolic Enzymes in Circulating Monocytes and Monocyte-Derived Macrophages of ART-Treated People Living With HIV and HIV-Uninfected Individuals
Authors: Hoque Tozammel M. D. , Cattin Amélie , Whyte-Allman Sana-Kay , Winchester Lee , Fletcher Courtney V. , Routy Jean-Pierre , Ancuta Petronela , Bendayan Reina 
Published: March 2021

Abstract:
Membrane-associated drug transport proteins and drug metabolic enzymes could regulate intracellular antiretroviral (ARV) drug concentrations in HIV-1 target cells such as myeloid cells. We investigated the expression of these transporters and enzymes in monocyte subsets and monocyte-derived macrophages (MDMs) isolated from peripheral blood mononuclear cells (PBMCs) of HIV-uninfected individuals (HIV-negative) and people living with HIV receiving viral suppressive antiretroviral therapy (ART; HIV+ART) and examined plasma and intracellular ARV concentrations. Monocytes were isolated from PBMCs of 12 HIV-negative and 12 HIV+ART donors and differentiated into MDMs. The mRNA and protein expression of drug transporters and metabolic enzymes were analyzed by quantitative real-time polymerase chain reaction and flow cytometry, respectively. ARV drug concentrations were quantified in plasma, PBMCs, monocytes, and MDMs by LC-MS/MS. The mRNA expression of relevant ARV transporters or metabolic enzymes, ABCB1/P-gp, ABCG2/BCRP, ABCC1/MRP1, ABCC4/MRP4, SLC22A1/OCT1, SLC29A2/ENT2, CYP2B6, CYP2D6, and UGT1A1, was demonstrated in monocytes and MDMs of 2 to 4 HIV-negative donors. P-gp, BCRP, and MRP1 proteins were differentially expressed in classical, intermediate, and nonclassical monocytes and MDMs of both HIV+ART and HIV-negative donors. Intracellular concentrations of ARVs known to be substrates of these transporters and metabolic enzymes were detected in monocytes of HIV+ART donors but were undetectable in MDMs. In this study, we demonstrated the expression of drug transporters and metabolic enzymes in monocytes and MDMs of HIV-negative and HIV+ART individuals, which could potentially limit intracellular concentrations of ARVs and contribute to residual HIV replication. Further work is needed to assess the role of these transporters in the penetration of ARVs in tissue macrophages.
Rescue Improvement Conference
Authors: Ervin Jennifer N. , Vitous C. Ann , Wells Emily E. , Krein Sarah L. , Friese Christopher R. , Ghaferi Amir A. 
Published: March 2021

Objective:
To understand the effectiveness of Rescue Improvement Conference, a forum that addresses FTR.

Summary of Background Data:
Every year over 150,000 patients die after elective surgery in the United States. FTR is the phenomenon whereby delayed recognition and/or response to serious surgical complications leads to a progressive cascade of adverse events culminating in death. Rescue Improvement Conference is an adapted version of the Ottawa-style morbidity and mortality conference, designed to address common contributors to FTR: ineffective communication and inadequate problem solving.

Methods:
Mixed methods data were used to evaluate Rescue Improvement Conference, a bi-monthly forum that was first introduced in our academic medical center in 2018. Conference effectiveness data were collected via survey and open-text responses after 5 conferences between September 2018 and February 2020. We focused on 5 indicators of effectiveness: educational value, conference takeaways, discussion time, changes to surgical practice, and actionable opportunities for improvement. Twelve surgical faculty and house staff also provided feedback during semi-structured interviews. Qualitative data were analyzed using thematic analysis.

Results:
Conference attendees (N = 140) felt that Rescue Improvement Conference was effective—all 5 indicators had mean scores above 5 on Likert scales. The qualitative data supports the quantitative findings, and 3 additional themes emerged: Rescue Improvement Conference enables the representation of diverse voices, promotes interdisciplinary collaboration, and encourages multilevel problem solving.

Conclusions:
Rescue Improvement Conference has the potential to support other surgical departments in developing system-level strategies to recognize and manage postoperative complications by providing stakeholders a forum to identify and discuss factors that contribute to FTR.
Risk of Breast Cancer in Selected Women With Atypical Ductal Hyperplasia Who do not Undergo Surgical Excision
Authors: Kilgore Lyndsey J. , Yi Min , Bevers Therese , Coyne Robin , Marita Lazzaro , Lane Deanna , Albarracin Constance , Bedrosian Isabelle 
Published: March 2021

Objective:
To review breast cancer incidence in women with ADH diagnosed by CNB and managed nonoperatively.

Background:
ADH found on CNB is associated with an upgrade to carcinoma in 10%–50% of women, thus surgical excision remains the standard of care. Safety of nonoperative management is unknown.

Methods:
ADH patients diagnosed between January 2004 and October 2018 were identified. Subsequent breast cancer events were compared between those who were excised and those who met predetermined criteria of low risk and were thus observed. Subsequent breast cancer events were classified as index site event if identified in the same quadrant as prior ADH. Multivariable logistic regression models were used to assess potential predictors of subsequent breast cancer events.

Results:
Four hundred seventy-eight women with 483 ADH lesions were identified; 309 were observed and 174 underwent excision. Median follow-up was 5.2 years. Prior breast cancer history was the only factor associated with subsequent breast cancer risk (odds ratio 2.25, 95% confidence interval 1.04–4.87). After excluding patients with a breast cancer history, there was no association of age, race, chemoprevention, or surgical excision of ADH with future cancer risk. 21/387 patients without a breast cancer history developed a subsequent cancer; 10 (7.3%) in the surgical group and 11 (4.4%) in the observed (P = 0.2). Two cancers were identified at the index site in the surgery group (2/137, 1.5%) and three in those observed (3/250, 1.2%).

Conclusions:
Observation, rather than surgical excision, is safe in select women with ADH. National guidelines should consider observation for this select group of patients.
Blood Salvage and Autotransfusion With Single Leukoreduction Does Not Increase the Risk of Tumor Recurrence After Liver Transplantation for Advanced Hepatocellular Carcinoma
Authors: Kwon Ji-Hye , Han Sangbin , Kim Doyeon , Kuk Joon Hee , Cho Hyun , Kim Seonwoo , Yang Ju Dong , Kim Chul , Kim Jong Man , Choi Gyu Sung , Joh Jae-Won , Ko Justin S. , Gwak Mi Sook , Kim Gaabsoo 
Published: March 2021

Objective:
The aim of this study was to determine whether autotransfusion of salvaged blood with single leukoreduction is associated with post-transplant tumor recurrence in patients with advanced hepatocellular carcinoma (HCC).

Background:
Previous studies have consistently demonstrated the safety of autotransfusion of salvaged and leukoreduced blood during liver transplantation for HCC. However, the effects of this technique remained unknown for advanced HCC.

Methods:
Of 349 patients who underwent living donor liver transplantation for advanced HCC: 74 of 129 without autotransfusion were matched with 74 of 220 with autotransfusion using propensity score based on tumor biology, allogeneic transfusion, and others. Survival analysis was performed with death as a competing risk event. The primary outcome was HCC recurrence.

Results:
Recipients in autotransfusion group received 811 (497–1247) mL of salvaged blood with single leukoreduction. In the matched cohort, cumulative overall recurrence probability at 1/2/5 years after transplantation was 24.6%/ 38.3%/39.7% for nonautotransfusion group and 16.2%/23.1%/32.5% for autotransfusion group. There were no significant differences between the 2 groups in overall recurrence [hazard ratio (HR) = 0.72 (0.43–1.21)], intrahepatic recurrence [HR = 0.70 (0.35–1.40)], and extrahepatic recurrence [HR = 0.82 (0.46–1.47)]. Also, there were no significant differences in overall death [HR = 0.57 (0.29–1.12)], HCC-related death [HR = 0.59 (0.29–1.20)], and HCC-unrelated death [HR = 0.48 (0.09–2.65)].

Conclusions:
When allogeneic transfusion was matched, autotransfusion was not significantly related to HCC recurrence, with more favorable probabilities for autotransfusion, in patients with advanced HCC. Thus, blood salvage and autotransfusion could be safely used with single leukoreduction, without double-filtered leukoreduction, during liver transplantation for HCC with potential benefits from avoiding allogeneic red blood cell transfusion.
The Psychological and Financial Impact of Long-distance Travel for Liver Transplantation
Authors: Peretz David , Grubert Van Iderstine Micah , Bernstein Matthew , Minuk Gerald Y. 
Published: March 2021

Background.
Patients who travel long distances to undergo liver transplantation have limited opportunities to develop confidence in their new healthcare providers and experience fewer support visits from family and friends at the transplant site. The objectives of this study were to document the psychological and financial impact of having to travel long distances for liver transplantation in adult liver disease patients.

Methods.
This was a single-center, prospective study that used a 7-question survey, including Likert scales, patient recall, and administrative databases.

Results.
Ninety-six adult outpatient liver transplant recipients (59% males; mean age, 43.1 ± 2.1 y) participated in the survey. Approximately 70% (more so among males and higher educated patients) felt that they had sufficient time to develop confidence in their new healthcare providers and 87% felt that confidence in their local healthcare providers had not been diminished by undergoing the procedure elsewhere. Forty-four percent of patients felt that their overall liver transplant experience had been compromised by more limited opportunities for support visits, a perception that was twice as common in females. Median out-of-pocket expenses were under $5000, and inflation corrected costs to third-party payers have been stable for the past 20 y.

Conclusions.
The principal psychological impact of travelling long distances for liver transplantation relates to the consequences of fewer support visits. Confidence in the new and local healthcare teams is not compromised by such travel in most patients. Out-of-pocket expenses are under $5000, and transplant costs to third-party payers have remained stable over the past 20 y.
Nontraditional Transesophageal Echocardiographic Views to Evaluate Hepatic Vasculature in Orthotopic Liver Transplantation and Liver Resection Surgery
Authors: Seman Mitchell T. , Alvord Jeremy M. , Gorlin Andrew W. , Poterack Karl A. , Frasco Peter E. , Verdiner Ricardo E. , Rosenfeld David M. , Khurmi Narjeet S. 
Published: March 2021

Background.
Utilization of intraoperative transesophageal echocardiography (TEE) during orthotopic liver transplantation (OLT) is expanding annually in high-volume transplant centers. During OLT intraoperative TEE is used to gather real-time information on cardiovascular function and intravascular volume status. Although standardized TEE views exist, there are nontraditional views described in the literature which have the potential to diagnose evolving pathology and define normal variants of hepatic vasculature.

Methods.
A literature review was completed utilizing the PubMed database for English-only, peer-reviewed publications discussing nontraditional use of intraoperative TEE during OLT and hepatic vascular-related surgeries from 2009 to 2019. Both case reports and review articles were considered.

Results.
The PubMed literature search offered 8 publications for analysis, including 7 case reports and 1 article review, revealing several nontraditional TEE views not included in a comprehensive transesophageal echocardiographic examination. These nontraditional views were generally obtained using modifications to the transgastric and bicaval views to visualize liver vasculature. We present the various techniques for obtaining these views from the 8 articles identified.

Conclusions.
At high-volume transplant centers, TEE use during OLT is increasing. Intraoperative TEE is a valuable tool to assess hepatic vascular structures critical to allograft/organ function without interruption of the surgical procedure. Nontraditional use of TEE to diagnose intraoperative noncardiac pathology in OLT appears underutilized and underreported. The modified hepatic and modified transgastric views we describe can be used to evaluate hepatic vasculature, influence surgical decision-making and ultimately improve patient care.
Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit
Authors: Lentine Krista L. , Alhamad Tarek , Cheungpasitporn Wisit , Tan Jane C. , Chang Su-Hsin , Cooper Matthew , Dadhania Darshana M. , Axelrod David A. , Schnitzler Mark A. , Ouseph Rosemary , Cabeza Rivera Franco H. , Kasiske Bertram L. , Woodside Kenneth J. , Parsons Ronald F. 
Published: March 2021

Background.
The impact of functional status on survival among simultaneous pancreas-kidney transplant (SPKT) candidates and recipients is not well described.

Methods.
We examined national Scientific Registry of Transplant Recipients (SRTR) data for patients listed for SPKT in the United States (2006–2019). Functional status was categorized by center-reported Karnofsky Performance Score (KPS). We used Cox regression to quantify associations of KPS at listing and transplant with subsequent patient survival, adjusted for baseline patient and transplant factors (adjusted hazard ratio, 95% LCLaHR95%UCL). We also explored time-dependent associations of SPKT with survival risk after listing compared with continued waiting in each functional status group.

Results.
KPS distributions among candidates (N = 16 822) and recipients (N = 10 316), respectively, were normal (KPS 80–100), 62.0% and 57.8%; capable of self-care (KPS 70), 23.5% and 24.7%; requires assistance (KPS 50–60), 12.4% and 14.2%; and disabled (KPS 10–40), 2.1% and 3.3%. There was a graded increase in mortality after listing and after transplant with lower functional levels. Compared with normal functioning, mortality after SPKT rose progressively for patients capable of self-care (aHR, 1.001.181.41), requiring assistance (aHR, 1.061.311.60), and disabled (aHR, 1.101.552.19). In time-dependent regression, compared with waiting, SPKT was associated with 2-fold mortality risk within 30 days of transplant. However, beyond 30 days, SPKT was associated with reduced mortality, from 52% for disabled patients (aHR, 0.260.480.88) to 70% for patients with normal functioning (aHR, 0.260.300.34).

Conclusions.
While lower functional status is associated with increased mortality risk among SPKT candidates and recipients, SPKT can provide long-term survival benefit across functional status levels in those selected for transplant.