bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lifetime Cost and Quality-Adjusted Life-Years Across Management Options for Small- and Medium-Sized Sporadic Vestibular Schwannoma
Authors: Macielak Robert J. , Thao Viengneesee , Borah Bijan J. , Moriarty James P. , Marinelli John P. , Van Gompel Jamie J. , Carlson Matthew L. 
Published: July 2021

Objective:
Despite the growing emphasis on healthcare costs, limited data address this aspect of care within the vestibular schwannoma (VS) literature. We sought to determine which strategy confers the lowest lifetime cost and greatest quality-adjusted life-years (QALYs) for patients with small- to medium-sized sporadic VS tumors.

Study Design:
A Markov model was created to determine the most cost-effective management algorithm. Tumor characteristics, magnetic resonance imaging surveillance schedule, treatment outcomes, and health-related quality of life values were derived from previously published data. Cost estimates were based on CMS Fee Schedule reimbursement rates.

Setting:
Economic Evaluation Service within the Kern Center for the Science of Healthcare Delivery.

Patients:
Patients diagnosed with small- to medium-sized sporadic VS.

Interventions:
Upfront microsurgery following diagnosis, upfront radiosurgery following diagnosis, observation with microsurgery reserved for observed tumor growth, and observation with radiosurgery reserved for observed tumor growth.

Results:
Across patient ages at time of diagnosis ranging from 18 to 70 years, observation with subsequent radiosurgery used for tumor growth was the most cost-effective management algorithm while upfront microsurgery was the least. When presented with a hypothetical 50-year-old patient, the strategy with the lowest lifetime cost and highest QALYs was observation with subsequent radiosurgery reserved for tumor growth ($32,161, 14.11 QALY), followed by observation with microsurgery reserved for tumor growth ($34,503, 13.94 QALY), upfront radiosurgery ($43,456, 14.02 QALY), and lastly, upfront microsurgery ($47,252, 13.60 QALY). Sensitivity analyses varying mortality rates, estimated costs, health-related quality of life, and progression to nonserviceable hearing demonstrated consistent ranking among treatments.

Conclusions:
When considering initial management of small- and medium-sized sporadic VSs, neither lifetime cost nor QALYs support upfront microsurgery or radiosurgery, even for younger patients. Initial observation with serial imaging, reserving radiosurgery or microsurgery for patients exhibiting tumor growth, confers the greatest potential for optimized lifetime healthcare cost and QALY outcomes.
Real-life utility and diagnostic accuracy of a home-performed fecal calprotectin test to predict endoscopic activity in patients with inflammatory bowel disease under maintenance treatment with adalimumab
Authors: Orfanoudaki Eleni , Drygiannakis Ioannis , Theodoraki Eirini , Foteinogiannopoulou Kalliopi , Mantaka Aikaterini , Koutroubakis Ioannis E. 
Published: July 2021

Aims
The home-performed fecal calprotectin (FC) test has been proposed for the remote management of inflammatory bowel disease (IBD) patients. We present our real-world experience on the use of FC home testing in IBD patients under maintenance treatment with adalimumab.

Methods
Consecutive IBD patients on maintenance treatment with adalimumab were studied retrospectively on the basis of prospectively recorded data. FC calprotectin home test (IBDoc, Βühlmann Laboratories AG, Schönenbuch, Switzerland) was analyzed alongside sufficient information on baseline characteristics, follow-up data and treatment modifications, as well as serum biomarkers and endoscopic assessment data on the basis of validated endoscopic scores.

Results
From a total of 72 IBD patients under maintenance treatment with adalimumab, 65 (90%) showed compliance with performing the home FC test. FC values were significantly higher in patients who finally needed treatment modification (37%) compared with those who were maintained on stable treatment (63%) (761 μg/g [537–1000] vs. 108 [41–335], P < 0.0001). In the logistic regression analysis FC and erythrocyte sedimentation rate (ESR) were independently correlated with endoscopically active disease (odds ratio: 1.003; 95% confidence interval, 1.001–1.006, P < 0.01 and odds ratio: 1.058; 95% confidence interval, 1.013–1.105, P < 0.05). FC identified patients with endoscopically active disease more effectively than other biomarkers with an area under the receiver operating characteristic curve of 0.78. FC levels >413 μg/g had a sensitivity of 75% and a specificity of 76% in predicting active disease in endoscopy.

Conclusions
These first real-life results indicate that in IBD patients under maintenance treatment with adalimumab FC home test is a valuable tool with high compliance rates that performs better than the other biomarkers in predicting disease endoscopic activity.
Efficacy and safety of endoscopic resection techniques of large colorectal lesions: experience of a referral center in Italy
Authors: Papparella Luigi Giovanni , Barbaro Federico , Pecere Silvia , Gibiino Giulia , Burrelli Scotti Giorgia , Napoli Marco , Boskoski Ivo , Petruzziello Lucio , Costamagna Guido 
Published: July 2021

Background
Endoscopic mucosal resection and submucosal dissection (ESD) are treatments of choice for superficial neoplastic colorectal lesions. Only a few studies have compared these techniques.

Aim
To compare the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR), ESD and hybrid-endoscopic submucosal dissection (H-ESD) of large colorectal lesions in a Western endoscopic center.

Methods
This is a retrospective analysis on a prospective medical database of consecutive colorectal superficial lesions larger than 20 mm, resected by EPMR, ESD or H-ESD collected from 2015 to 2019.

Results
Two hundred twenty-nine colorectal lesions were included. All lesions were completely endoscopically resected, 65.9% by EPMR, 19.7% by ESD and 14.4% by H-ESD. Endoscopic control after the index procedure was available for 86.5% patients. Among these patients, 80% had a second follow-up colonoscopy. The overall recurrence rate was 13.2, 0 and 6.1% for EPMR, ESD and H-ESD respectively, with a significant difference between EPMR and ESD. All recurrences were endoscopically treated during follow-up procedures. Risk of complications was not significantly different between the three groups.

Conclusions
EPMR, ESD and H-ESD are effective and safe procedures. Recurrence rate in EPMR was higher but can be managed endoscopically with high success rates. EPMR is faster and technically simpler so should be considered a potential first-line therapy for colorectal superficial neoplastic lesions.
An overview of nuclear medicine research in the UK and the landscape for clinical adoption
Authors: Young Jennifer D. , Jauregui-Osoro Maite , Wong Wai-Lup , Cooper Margaret S. , Cook Gary , Barrington Sally F. , Ma Michelle T. , Blower Philip J. , Aboagye Eric O. 
Published: July 2021

Background and objectives
Nuclear medicine contributes greatly to the clinical management of patients and experimental medicine. This report aims to (1) outline the current landscape of nuclear medicine research in the UK, including current facilities and recent or ongoing clinical studies and (2) provide information about the available pathways for clinical adoption and NHS funding (commissioning) of radiopharmaceuticals.

Methods
Evidence was obtained through database searches for UK-based nuclear medicine clinical studies and by conducting a questionnaire-based survey of UK radiopharmaceutical production facilities. A recent history of clinical commissioning, either through recommendations from the National Institute for Health and Care Excellence (NICE) or through NHS specialised services commissioning, was compiled from publicly available documents and policies.

Results
The collected data highlighted the UK’s active nuclear medicine research community and recent investment in new facilities and upgrades. All commissioning routes favour radiopharmaceuticals that have marketing authorisation and since 2017 there has been a requirement to demonstrate both clinical and cost-effectiveness. Whilst radiopharmaceuticals for molecular radiotherapy are well suited to these commissioning pathways, diagnostic radiotracers have not historically been assessed in this manner.

Conclusions
We hope that by collating this information we will provide stimulus for future discussion and consensus statements around this topic.
Correlation of 4′-[methyl-11C]-thiothymidine PET with Ki-67 immunohistochemistry separately in patients with newly diagnosed and recurrent gliomas
Authors: Norikane Takashi , Mitamura Katsuya , Yamamoto Yuka , Hatakeyama Tetsuhiro , Miyake Keisuke , Toyohara Jun , Nishiyama Yoshihiro 
Published: July 2021

Objective
4′-[methyl-11C]-thiothymidine (4DST) uptake on PET was correlated with proliferative activity separately in patients with newly diagnosed and recurrent gliomas.

Methods
A total of 29 patients, 18 with newly diagnosed gliomas and 11 with recurrent gliomas who underwent 4DST PET/computed tomography (CT) were available for a retrospective analysis of prospectively collected data. The maximum standardized uptake value (SUVmax) of tumor (T) and the mean SUV of normal contralateral hemisphere (N) were calculated, and the tumor-to-normal (T/N) ratio was determined. Proliferative tumor volume (PTV) and total lesion proliferation (TLP) were also calculated. Proliferative activity as indicated by the Ki-67 index was estimated in tissue specimens. Immunohistochemical findings were correlated with 4DST PET parameters.

Results
All gliomas but three newly diagnosed gliomas had 4DST uptake on PET. No significant differences in SUVmax, T/N ratio, PTV, or TLP were observed between the newly diagnosed and recurrent gliomas. In the former, correlations between SUVmax (r = 0.57, P = 0.02), T/N ratio (r = 0.51, P = 0.03), PTV (r = 0.74, P < 0.001), and TLP (r = 0.76, P < 0.001) and the Ki-67 index were found. In the latter, the results did not seem to suggest any correlations between any of the PET parameters and Ki-67 index.

Conclusion
Although preliminary, these results suggest that 4DST PET may be useful for the noninvasive evaluation of proliferation in patients with newly diagnosed gliomas. These data in a small recurrent patient population do not support a clear-cut correlation between 4DST uptake and proliferation.
Involvement of Jordanian Patients and Their Families in Decision Making Near End of Life, Challenges and Recommendations
Authors: Othman Elham H. , Khalaf Inaam Abdallah , Zeilani Ruqayya , Nabolsi Manar , Majali Sawsan , Abdalrahim Maysoon , Shamieh Omar 
Published: July 2021

This study aims to explore the challenges in involving patients and their families in decision making near end of life and to provide recommendations to overcome these challenges. A qualitative descriptive phenomenological approach was used with a purposive sample of 8 patients, 7 family caregivers, 7 nurses, and 6 physicians from 2 institutions that provide palliative and end-of-life care services in Jordan. Data were collected using interviews with patients and family caregivers and focus group discussions with nurses and physicians. Colaizzi's method was used to analyze the data.
The thematic analysis revealed 5 themes representing the participants' experiences of challenges with decision making near end of life. The identified challenges are (1) struggle with lack of information; (2) improper communication; (3) patient's or family's decision: the cultural taboo; (4) health care providers prefer staying in their comfort zone; and (5) the paradox of surviving and letting go. In addition, the participants endorsed several recommendations to raise public awareness of palliative and end-of-life care, amplify the patients' voice, and raise the bar of communication sensitivity.
Decision making near the end of life is a challenge. However, the current study highlighted several areas for improvement that can improve the process and optimize patients' and their families' involvement.
The Role of External Genital Lesions in Human Immunodeficiency Virus Seroconversion Among Men Participating in a Multinational Study
Authors: Sudenga Staci L. , Lotspeich Sarah C. , Nyitray Alan G. , Sirak Bradley , Shepherd Bryan E. , Messina Jane , Sereday Karen A. , Silva Roberto Carvalho , Abrahamsen Martha , Baggio Maria Luiza , Quiterio Manuel , Lazcano-Ponce Eduardo , Villa Luisa , Giuliano Anna R. 
Published: July 2021

Background
Studies in women have shown an increased risk of human immunodeficiency virus (HIV) acquisition with prior human papilloma virus (HPV) infection; however, few studies have been conducted among men. Our objective was to assess whether HPV-related external genital lesions (EGLs) increase risk of HIV seroconversion among men.

Methods
A total of 1379 HIV-negative men aged 18 to 70 years from the United States, Mexico, and Brazil were followed for up to 7 years and underwent clinical examination for EGLs and blood draws every 6 months. Human immunodeficiency virus seroconversion was assessed in archived serum. Cox proportional hazards and marginal structural models assessed the association between EGL status and time to HIV seroconversion.

Results
Twenty-nine participants HIV seroconverted during follow-up. Older age was associated with a lower hazard of HIV seroconversion. We found no significant difference in the risk of HIV seroconversion between men with and without EGLs (adjusted hazard ratio, 0.94; 95% confidence interval, 0.32–2.74). Stratified analyses focusing on men that have sex with men found no association between EGLs and HIV seroconversion risk (hazards ratio, 0.63; 95% confidence interval, 0.00–1.86).

Conclusions
External genital lesions were not associated with higher risk for HIV seroconversion in this multinational population, although statistical power was limited as there were few HIV seroconversions. Results may differ in populations at higher risk for HIV.
Seasonal Trends in Pediatric Respiratory Illnesses
Authors: Tse Gabriel , McLean Lianne 
Published: July 2021

Objectives
Google Trends is an emerging tool that allows users to analyze search queries, showing when certain topics are searched most often. Multiple studies have compared Google Trends to epidemiological data of health conditions, but pediatric specific illnesses have not yet been investigated. An association between disease incidence and Google Trends data may help facilitate precision outreach in the form of digital resources and promotion. We sought to examine the relationship between Google Trends data and measured incidence of bronchiolitis and croup.

Methods
We carried out a Google Trends search using the terms “bronchiolitis” and “croup” on July 24, 2019. The number of positive respiratory syncytial virus and parainfluenza tests published by the Public Health Agency of Canada was used to estimate incidence of bronchiolitis and croup, respectively. Emergency department discharge data were used to measure the number of patients with bronchiolitis and croup presenting to a Canadian pediatric hospital. Data from January 1, 2015, to December 31, 2018, were used for analysis.

Results
Google Trends revealed clear seasonal variation in search volume for both bronchiolitis and croup in keeping with known epidemiological data for these conditions. For data on bronchiolitis, Google Trends correlated strongly with Canadian Public Health and our hospital data. A positive correlation was also found with croup.

Conclusions
Google Trends correlates with both laboratory-based and hospital incidence of respiratory viral diagnoses. This novel data source has implications for tracking disease epidemiology, tailoring health information, and providing precision outreach tools to patients and their families.
Pediatric Unintentional Fall-Related Injuries in a Statewide Trauma Registry
Authors: Davis Jonathan , Young Tracy , Casteel Carri , Peek-Asa Corinne , Torner James 
Published: July 2021

Objectives
The purpose of the study was to evaluate patterns of fall-related injury through childhood and identify risk factors for more severe fall-related injuries with the goal of informing targeted prevention strategies for different ages.

Methods
The study population consisted of pediatric patients in the Iowa Trauma Registry from January 1, 2010, to December 31, 2014, who sustained an unintentional fall-related injury (N = 3856 patients). Multinomial logistic regression analysis was used to predict injury severity. Adjusted odds ratios were calculated characterizing the relationship between fall severity and age, sex, race, and fall type.

Results
More males (62%) sustained a fall-related injury during the study period when compared with females (38%; P < 0.0001). Head injuries were the most common type of injury in the younger than 1 year age group (77%), whereas fractures were the predominant injury type in all other age groups, followed by head injuries. Those younger than 1 year (adjusted odds ratio, 4.0; 95% confidence interval, 2.36–6.90) and aged 15 to 18 years (adjusted odds ratio, 1.9; 95% confidence interval, 1.17–3.03) were more likely to have an Injury Severity Score of ≥16 than those aged 10 to 14 years.

Conclusions
Recommendations and prevention strategies need to focus on specific risk factors to reduce the harm of multilevel falls. As we have shown, patterns of fall injuries presenting to trauma hospitals differ by age, thus suggesting that prevention strategies focus on specific age groups.
Association of County-Level Availability of Pediatricians With Emergency Department Visits
Authors: Michelson Kenneth A. , Cushing Anna M. , Bucholz Emily M. 
Published: July 2021

Objectives
The relationship between pediatrician availability and emergency department (ED) attendance is uncertain. We determined whether children in counties with more pediatricians had fewer ED visits.

Methods
We conducted a cross-sectional study of all ED visits among children younger than 18 years from 6 states. We obtained ED visit incidences by county and assessed the relationship to pediatrician density (pediatricians per 1000 children). Possible confounders included state, presence of an urgent care facility in the county, urban-rural status, and quartile of county-level characteristics: English-speaking, Internet access, White race, socioeconomic status, and public insurance. We estimated county-level changes in incidence by pediatrician density adjusting for state and separately for all possible confounders.

Results
Each additional pediatrician per 1000 children was associated with a 13.7% (95% confidence interval, −19.6% to −7.5%) decrease in ED visits in the state-adjusted model. In the full model, there was no association (−1.4%, 95% confidence interval, −7.2% to 4.8%). The presence of an urgent care, higher socioeconomic status score, urban status, and higher proportions of White race and nonpublic insurance were each associated with decreased ED visit rates.

Conclusions
Pediatrician density is not associated with decreased ED visits after adjusting for other county demographic factors. Increasing an area's availability of pediatricians may not affect ED attendance.
Gucy2d selectively marks inhibitory dynorphin neurons in the spinal dorsal horn but is dispensable for pain and itch sensitivity
Authors: Serafin Elizabeth K. , Burns Robert , Yoo Judy , Baccei Mark L. 
Published: July 2021

Abstract

Introduction:
Inhibitory neurons in the spinal dorsal horn can be classified based on expression of neurochemical marker genes. However, these marker genes are often expressed throughout the central nervous system, which poses challenges for manipulating genetically identified spinal neurons without undesired off-target effects.

Objectives:
We investigated whether Gucy2d, previously identified as a highly selective marker of dynorphin-lineage neurons in the dorsal horn, is expressed in other locations within the adult mouse spinal cord, dorsal root ganglia (DRG), or brain. In addition, we sought to molecularly characterize Gucy2d-expressing dorsal horn neurons and investigate whether the disruption of Gucy2d gene expression affects sensitivity to itch or pain.

Methods:
In situ hybridization experiments assessed Gucy2d mRNA expression in the adult mouse spinal cord, DRG, and brain, and its colocalization with Pax2, Bhlhb5, and Pde2a in dorsal horn neurons. Knockout mice lacking Gucy2d expression were compared with littermate controls to assess sensitivity to chloroquine-induced itch and dry skin-mediated chronic itch, as well as heat, cold, or mechanical stimuli.

Results:

Gucy2d is selectively expressed in dynorphin-lineage neurons in lamina I-III of the adult mouse spinal cord but not in the brain or DRG. Spinal Gucy2d-expressing neurons are inhibitory neurons that also express the transcription factor Bhlhb5 and the cGMP-dependent phosphodiesterase Pde2a. Gucy2d knockout mice did not exhibit altered responses to itch or pain.

Conclusions:
The selective expression of Gucy2d within a subpopulation of inhibitory dorsal horn neurons may yield a means to selectively manipulate inhibitory signaling at the level of the spinal cord without effects on the brain.
Mechanism of penetrating injury mediates the risk of long-term adverse outcomes for survivors of violent trauma
Authors: Pino Elizabeth C. , Fontin Francesca , James Thea L. , Dugan Elizabeth 
Published: July 2021

BACKGROUND
While hospital-based violence intervention programs are primarily designed to aid youth victims of gun violence at high risk for reinjury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing vs. gunshot wound).

METHODS
This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of all-cause mortality and violent reinjury within 3 years after surviving a penetrating injury.

RESULTS
Of the 4,280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent reinjuries (13.3%) within 3 years. Compared with gunshot wound victims, stab wound victims were 31% less likely to be reinjured with a gunshot wound (HR, 0.69; 95% CI, 0.51–0.93), 72% more likely to be reinjured with a stab wound (HR, 1.72; 95% CI, 1.21–2.43), and 49% more likely to be reinjured by assault (HR, 1.49; 95% CI, 1.14–1.94). While survivors of stabbing and firearm injuries were equally at risk for 3-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR, 3.75; 95% CI, 1.11–20.65).

CONCLUSION
Patients surviving a stab wound have a significantly higher risk of violent reinjury by stabbing or assault, and risk of death by drug/alcohol overdose. Hospital-based violence intervention programs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence―gunshot victims and stabbing/assault victims―with separate risk factors and outcomes, mediated by substance use disorder.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; level III.