bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining Cause of Death During Coronavirus Disease 2019 Pandemic
Authors: Nada Khaled M. , Hsu En-shuo , Seashore Justin , Zaidan Mohammed , Nishi Shawn P. , Duarte Alexander , Sharma Gulshan 
Published: April 2021

Objectives:
Controversy exists whether the cause of death due to severe acute respiratory syndrome coronavirus 2 is directly related to the infection or to underlying conditions. The purpose of this study is to assess the relationship of severe acute respiratory syndrome coronavirus 2 infection with the cause of death in hospitalized patients.

Design:
Retrospective observational study; deidentified discharge summaries of deceased patients were reviewed by two intensivists and classified as coronavirus disease 2019–related (caused by severe acute respiratory syndrome coronavirus 2) or coronavirus disease 2019–unrelated (not caused by severe acute respiratory syndrome coronavirus 2 or indeterminate) deaths. For classification disagreement, a separate group of three intensivists reviewed the discharge summaries and arbitrated to determine the cause of death.

Setting:
Single-center study performed at the University of Texas Medical Branch.

Patients:
All adult patients (> 18 yr) admitted from March 10, 2020, to October 22, 2020, with positive severe acute respiratory syndrome coronavirus 2 test results who expired during their hospitalization were identified.

Interventions:
None.

Measurements and Main Results:
Patient demographics, comorbidities, prescribed medications, and ventilatory support data were collected. Comparison between groups was performed using t test and chi-square test. During the study period, 1,052 patients were admitted within 14 days of severe acute respiratory syndrome coronavirus 2–positive test results, of whom 100 expired during the hospitalization. Deceased patients were predominantly male and older than 65 years. Obesity (body mass index ≥ 30 kg/m2) was present in 41%, and common comorbidities included hypertension (47%), diabetes (30%), and heart failure (20%). Death was classified as directly caused by severe acute respiratory syndrome coronavirus 2 in 85% and not caused by severe acute respiratory syndrome coronavirus 2 in 5%. An indeterminate cause of death in 10% was due to insufficient information or an atypical presentation. The observed interrater agreement on the cause of death classification was 81%.

Conclusions:
In this single-center study, the majority of deaths in severe acute respiratory syndrome coronavirus 2–positive hospitalized patients were related to a typical or atypical presentation of coronavirus disease 2019 disease.
Genetic variants predictive of reproductive aging are associated with vasomotor symptoms in a multiracial/ethnic cohort
Authors: Zhao Wei , Smith Jennifer A. , Yu Miao , Crandall Carolyn J. , Thurston Rebecca C. , Hood Michelle M. , Ruiz-Narvaez Edward , Peyser Patricia A. , Kardia Sharon L.R. , Harlow Sioban D. 
Published: April 2021

Abstract

Objective:
Vasomotor symptoms (VMS), hot flashes, and night sweats are cardinal symptoms of the menopausal transition. Little is known about genetic influences on VMS. This study evaluated whether previously identified genetic factors predictive of VMS, age at menarche, and age at menopause were associated with VMS in a multiracial/ethnic cohort.

Methods:
For 702 White, 306 Black, 126 Chinese, and 129 Japanese women from the Study of Women's Health Across the Nation (SWAN) Genomic Substudy, we created polygenic risk scores (PRSs) from genome-wide association studies of VMS and ages at menarche and menopause. PRSs and single nucleotide polymorphisms (SNPs) from a previously identified VMS locus (tachykinin receptor 3 [TACR3]) were evaluated for associations with frequent VMS (VMS ≥6 days in the past 2 weeks at any visit) and with VMS trajectories (persistently low, early onset, final menstrual period onset, persistently high).

Results:
The C-allele of rs74827081 in TACR3 was associated with reduced likelihood of frequent VMS in White women (odds ratio [OR] = 0.49 [95% CI, 0.29-0.83]). With higher menarche PRS (later menarche), Black women were less likely (OR = 0.55 [95% CI, 0.38-0.78]) to report frequent VMS. With higher PRS for age at menarche, Black women were also less likely to have a persistently high VMS trajectory (OR = 0.55 [95% CI, 0.34-0.91]), whereas White women (OR = 0.75 [95% CI, 0.58-0.98]) were less likely to have a final menstrual period onset trajectory (vs persistently low). Chinese women with higher menopause PRS were more likely to have frequent VMS (OR = 2.29 [95% CI, 1.39-3.78]). Associations were substantively similar after excluding rs74827081 C-allele carriers.

Conclusions:
Genetic factors predictive of reproductive aging are also associated with VMS, suggesting that VMS have a polygenic architecture. Further study in this area may help to identify new targets for novel VMS therapies.

Video Summary:
http://links.lww.com/MENO/A761.
Opportunistic Illnesses in Children With HIV Infection in the United States, 1997–2016
Authors: Nesheim Steven R. , Balaji Alexandra , Hu Xiaohong , Lampe Margaret , Dominguez Kenneth L. 
Published: April 2021

Background:
Among children with HIV infection, opportunistic illness (OI) rates decreased after introduction of highly active antiretroviral therapy (ART) in 1997. We evaluated whether such decreases have continued.

Methods:
Data from the Centers for Disease Control and Prevention’s National HIV Surveillance System for children with HIV living in the US during 1997–2016 was used to enumerate infants experiencing the first OI by birth year and OIs among all children <13 years of age (stratified by natality). We calculated the time to first OI among infants using Kaplan-Meier methods.

Results:
Among infants born during 1997–2016, 711 first OIs were diagnosed. The percentage of the first OIs diagnosed in successive 5-year birth periods was: 60.0% (1997–2001), 24.6% (2002–2006), 11.3% (2007–2011), and 3.4% (2012–2016). For every OI, the number of first cases decreased nearly annually. Time to first OI increased in successive birth periods. Among children <13 years of age, 2083 OI were diagnosed, including Pneumocystis jiroveci pneumonia, candidiasis, recurrent bacterial infection, wasting syndrome, cytomegalovirus, lymphocytic interstitial pneumonitis, tuberculosis, nontuberculous mycobacteriosis and herpes simplex virus. The rate (#/1000 person-years) decreased overall (60–7.2) and for all individual OIs. Earlier during 1997–2016, rates for all OIs were higher among foreign-born than US-born children but later became similar for all OIs except tuberculosis.

Conclusions:
Among children with HIV in the US, numbers and rates of all OIs decreased during 1997–2016. Earlier, OI rates were highest among non-US-born children but were later comparable with those among US-born children for all OIs except tuberculosis.
Patient Characteristics and Acute PT and OT Utilization During the Initial Surge of COVID-19
Authors: Myszenski Adele , Bello Romina , Melican Cynthia , Pfitzenmaier Nanette 
Published: April 2021

Objective:
To describe the characteristics of patients and investigate the utilization of physical (PT) and occupational therapy (OT) intervention for those with a positive coronavirus disease-2019 (COVID-19) diagnosis compared with other patient populations during the first 6 weeks of the novel coronavirus pandemic.

Methods:
A retrospective, observational study of adult inpatients with a length of stay of 1 or more days at an urban hospital in Detroit, Michigan. Individuals with a COVID-19 diagnosis were compared with a cohort within similar diagnostic categories (respiratory, fever, and sepsis) but without COVID-19. Outcome measures included PT or OT intervention on 1 or more days, the timing of initial PT or OT visit, the average number of visits and units per patient, length of stay, discharge to home, and readmission within 30 days.

Results:
Individuals with COVID-19 had lower rates of discharge to home (P = .001), higher rates of readmission within 30 days of hospital discharge (P = .01), increased hospital length of stay (P = .001), and waited an average of 3.1 days longer for therapy evaluations than subjects in the comparison group (P = .001). The percentage of subjects who had one or more PT or OT visits during their hospital stays was comparable between groups. Once therapy was initiated, the average number of visits per patient and dosing of units in 15-minute increments were similar between the 2 groups.

Conclusions:
Patients acutely ill with COVID-19 hospitalized with the virus during the first 6 weeks of the pandemic remained in the intensive care unit and hospital longer than their counterparts without COVID-19 and had a delay in initiation of PT and OT intervention. PT and OT are important members of the care team for patients with the novel coronavirus. Understanding the descriptive characteristics of patients and therapy services during the initial surge could help improve utilization and patient outcomes.
Active Rehabilitation in a Patient During and After Venovenous Extracorporeal Membrane Oxygenation With a Diagnosis of COVID-19: A Case Report
Authors: Andersen Eric M. , Kelly Tara L. , Sharp Amanda , Keller-Ross Manda L. , Brunsvold Melissa E. 
Published: April 2021

Purpose:
The coronavirus disease-2019 (COVID-19) pandemic has resulted in an influx of critically ill patients requiring mechanical ventilation, some receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO). The benefits of early mobility while undergoing ECMO have been previously documented. However, the COVID-19 pandemic has presented physical therapists with novel challenges, balancing the risk of a widespread shortage of personal protective equipment (PPE) with the benefits of early mobility for patients on ECMO. The purpose of this case study is to report the successful rehabilitation of a critically ill patient with COVID-19 undergoing VV ECMO.

Methods:
This is a case description of a 38-year-old man who presented to the hospital with COVID-19 and subsequent intubation and cannulation for VV ECMO. Physical therapy was initiated while the patient remained critically ill on VV ECMO. Focused coordination and education were employed to limit PPE usage by limiting the number of essential staff/therapists that entered the room as well as changing the frequency of therapy sessions dependent on how the patient was progressing functionally.

Results:
On VV ECMO day 11, he was able to sit up and perform a sit-to-stand. ECMO decannulation occurred on hospital day 14 with extubation on hospital day 18. The patient progressed functionally while quarantined in the room until he was discharged home with supplemental oxygen after spending 29 days in the hospital.

Conclusion:
This case study demonstrates the clinical decision-making used to provide physical therapy services for a critically ill patient with COVID-19. High-level team coordination resulted in limiting the use of PPE as well as reducing staff exposure frequency during rehabilitation. Despite his severe critical illness, the patient was successfully discharged home within 30 days.
The evolution of guideline-directed medical therapy among decompensated HFrEF patients in sacubitril/valsartan era: Medical expenses and clinical effectiveness
Authors: Liang Huai-Wen , Liao Chia-Te , Lin Wen-Yu , Chung Fa-Po , Huang Jin-Long , Lee Ying-Hsiang , Lin Po-Lin , Chiou Wei-Ru , Hsu Chien-Yi , Chang Hung-Yu 
Published: April 2021

Background:
Over recent years, new evolution in guideline-directed medical therapy (GDMT) contributes to clinical benefits in patients with heart failure and reduced ejection fraction (HFrEF). The additional medical expenditure may be a concern due to the current financial constraint. This study aimed to investigate the medical costs and clinical effectiveness of contemporary GDMT in recently hospitalized HFrEF patients.

Methods:
Acutely decompensated hospitalized HFrEF patients from two multicenter cohorts of different periods were retrospectively analyzed. A propensity score matching was performed to adjust the baseline characteristics. Annual medication costs, risks of mortality, and recurrent heart failure hospitalizations (HFH) were compared.

Results:
Following 1:2 propensity score matching, there were 426 patients from the 2017-2018 cohort using sacubitril/valsartan, while 852 patients from 2013 to 2014 did not use so at discharge. Baseline characteristics were similar, whereas the sacubitril/valsartan users were more likely to receive beta-blockers, ivabradine and mineralocorticoid receptor antagonists at discharge (79.3% vs 60.4%, 23.2% vs 0%, and 64.1% vs 49.8%, p < 0.001). The 2017-2018 cohort produced more medication costs by 1277 United States dollar (USD) per person per year, while it resulted in lower rates of HFH and all-cause mortality (10.3 vs 20.3 and 48.8 vs 79.9 per 100 person-year, p < 0.001). Costs of preventing a mortality event and a HFH event with contemporary treatments were 15 758 USD (95% confidence interval [CI] 10 436-29 244) and 5317 USD (95% CI 3388-10 098), respectively.

Conclusion:
The higher adoption of GDMT was associated with greater medical expenses but better clinical outcomes in recently decompensated HFrEF patients.
Sleep Insufficiency and Baseline Preseason Concussion-Like Symptom Reporting in Youth Athletes
Authors: Terry Douglas P. , Jurick Sarah M. , Huebschmann Nathan A. , Silverberg Noah D. , Maxwell Bruce A. , Zafonte Ross , Berkner Paul D. , Iverson Grant L. 
Published: April 2021

Objective:
To examine the association between insufficient sleep and baseline symptom reporting in healthy student athletes.

Design:
Cross-sectional cohort study.

Setting:
Preseason testing for student athletes.

Participants:
Student athletes (n = 19 529) aged 13 to 19 years who completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), including the number of hours slept the night before, and denied having developmental/health conditions, a concussion in the past 6 months, and a previous history of 2 or more concussions.

Independent Variables:
Total hours of sleep the night before testing (grouped by ≤5, 5.5-6.5, 7-8.5, and ≥9 hours), gender, and concussion history.

Main Outcome Measures:
Symptom burden on the Post-Concussion Symptom Scale (modified to exclude sleep-related items), cognitive composite scores, and prevalence of athletes who reported a symptom burden resembling the International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS).

Results:
Fewer hours of sleep, gender (ie, girls), and 1 previous concussion (vs 0) were each significantly associated with higher total symptom scores in a multivariable model (F = 142.01, P < 0.001, R2 = 0.04). When a gender-by-sleep interaction term was included, the relationship between sleep and symptoms was stronger for girls compared with boys. In healthy athletes who slept ≤5 hours, 46% of girls and 31% of boys met the criteria for ICD-10 PCS compared with 16% of girls and 11% of boys who slept ≥9 hours. Sleep duration was not meaningfully associated with neurocognitive performance.

Conclusions:
Insufficient sleep the night before testing is an important factor to consider when interpreting symptom reporting, especially for girls. It will be helpful for clinicians to take this into account when interpreting both baseline and postinjury symptom reporting.
Application of CAD and 3D printing in the treatment of pediatric multiple mandible fractures
Authors: Du Yue , Yang Dongkun , Pang Yaqian , Liu Chang , Zhang Kai 
Published: April 2021

Abstract

Introduction:
Mandible fracture is the second most common facial bone fractures in pediatric patients. The goal of treatment is to restore the displaced bones to their pre-injury position by a stable method, and ensure normal facial development. This case report demonstrates the effective use of Computer-aided design (CAD), three-dimensional printing (3D printing) and rigid internal fixation in the treatment of multiple mandibular fractures in a child.

Patient concerns:
The patient was a 5-year-old female child with mandible fractures, teeth trauma, and facial lacerated wounds.

Diagnosis:
Pediatric multiple mandible fracture with abnormal occlusion.

Interventions:
Based on the CAD and 3D printing technology, we designed the shape and position of titanium plate to accurately protect the tooth germs. Articulator, mandible and maxillary model were utilized to construct the positioning biteplate for the purpose of fracture reduction and fixation.

Outcome:
A 3-year follow-up showed the effectiveness of this treatment. The permanent teeth and facial bones were observed developing normally. Normal occlusion and facial shape was achieved.

Conclusion:
This case report demonstrates the effective use of CAD, 3D printing and rigid internal fixation in the treatment of multiple mandibular fractures in a child. It also provides a reference for the treatment of jaw fractures in a single site. In our patient, this method was highly effective with less surgical trauma. There is not much research on the treatment of pediatric mandible fractures, and we believe the treatment method described in this case report will help avoid damage to the tooth germs and allow normal bone development in pediatric mandible fractures.
Abdominal A-lines as an ultrasonic sign for the evaluation of gastrointestinal flatulence
Authors: Li Ruiting , Shang You 
Published: April 2021

Abstract

Introduction:
A lot of critical illness can cause flatulence, which can give rise to gastrointestinal peristalsis disorder, gut barrier function damage, intestinal mucosal ischemia, and other conditions. Currently, in clinical practice, the suitable detection methods for gastrointestinal flatulence are lacking. The A-lines are the key characteristic defining the normal lung tissue ultrasound. The gastrointestinal tract is also the gas-bearing organ under certain conditions. When the patient has flatulence, will there be abdominal A-lines similar to lung ultrasound? In addition, whether the abdominal A-lines can be used to assess the severity of flatulence also needs proper investigation.

Patient concerns:
Two male patients with digestive tract tumors were transferred to department of Critical Care Medicine due to acute respiratory failure and hyperkalemia.

Diagnosis:
Gastrointestinal paralysis and flatulence after cavity viscera perforation.

Interventions:
The 2 patients with severe flatulence presented with abdominal A-lines during the ultrasound examination.

Outcomes:
Both the patients died when their families gave up further treatment.

Conclusion:
The abdominal A-lines reflect the ultrasound sign related to flatulence. Their range and location has been found to be consistent with the degree and position of gastrointestinal flatulence. In addition, in the future, it can be expected to be used to semi-quantitatively evaluate the degree and etiology of flatulence in combination with the other abdominal ultrasonographic signs.
Can Collaboration Between Nonprofit Hospitals and Local Health Departments Influence Population Health Investments by Nonprofit Hospitals?
Authors: Santos Tatiane , Lee Shoou-Yih D. , East Chloe , Lindrooth Richard C. 
Published: April 2021

Background:
The patient protection and Affordable Care Act (ACA) sought to improve population health by requiring nonprofit hospitals (NFPs) to conduct triennial community health needs assessments and address the identified needs. In this context, some states have encouraged collaboration between hospitals and local health department (LHD) to increase the focus of community benefit spending onto population health.

Objectives:
The aim was to examine whether a 2012 state law that required NFPs to collaborate with LHDs in local health planning influenced hospital population health improvement spending.

Research Design:
We merged Internal Revenue Service data on NFP community benefit spending with data on hospital, county and state-level characteristics and estimated a difference-in-differences specification of hospital population health spending in 2009–2016 that compared the difference between hospitals that were required to collaborate with LHDs to those that were not, before and after the requirement.

Measures:
The primary outcome was population health spending divided by operating expenses.

Results:
We found that the requirement for hospital-LHD collaboration was associated with increased mean population health spending of ∼$393,000–$786,000 (P=0.03). This association was significant in 2015–2016, perhaps reflecting the lag between assessments and implementation. Urban hospitals were responsible for most of the increased spending.

Conclusions:
Policymakers have sought to encourage hospitals to increase their investment in population health; however, overall community benefit spending on population health has remained flat. We found that requiring hospital-LHD collaboration was associated with increased hospital investment in population health. It may be that hospitals increase population health spending because collaboration improves expected effectiveness or increases hospital accountability.
Mechanical circulatory support in pre and postheart transplant period
Authors: Kolodziej Andrew R. , Vaidya Gaurang N. , Reddy Neeti , Birks Emma J. 
Published: April 2021

Purpose of review
Progression of heart failure (HF) and its unpredictable and volatile nature, often requires advanced therapies including heart transplant. Mechanical circulatory support plays an integral part in the advanced treatment options. This technology can be deployed in several ways, particularly in the preparation and patient optimization for heart transplants. This article discusses the use of temporary and durable devices and their deployment strategies in the pre and posttransplant period.

Recent findings
Recently temporary mechanical support devices have allowed us to improve survival to transplant as well as posttransplant. Early implementation of temporary devices both for stabilization of advanced HF patients being considered for transplant as well as those with posttransplant primary graft dysfunction (although utilization of extracorporeal membrane oxygenation has repeatedly shown to be associated with worse outcomes compared to the other devices discussed), is reflective of the degree of disease progression in these patients. The outcomes of patients supported with durable devices have significantly improved with advancing technology. HeartMate 3 device has not only been shown to improve survival as well as the quality of life but in comparison to its predecessor, has been shown to decrease the morbidity associated with this technology.

Summary
Both temporary and durable devices are now associated with improved survival and allow us to transplant patients in a more stable and safer manner with fewer adverse events. Based on the new United Network of Organ Sharing allocation system, it allows us to upgrade those who do not have the luxury of time to wait for a transplant. Primary graft dysfunction now also can be assisted with those devices, which is reflected in improved survival of posttransplant patients.