bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of clinical risk models vs. clinician’s assessment for prediction of coronary artery disease among predominantly female population
Authors: Havistin Ruby , Ivanov Alexander , Patel Pavan , Crenesse-Cozien Natalia , Ho Jean , Khan Saadat , Brener Sorin J. , Sacchi Terrence J. , Heitner John F. 
Published: August 2021

Introduction
Multiple risk models are used to predict the presence of obstructive coronary artery disease (CAD) in patients with chest pain. We aimed to compare the performance of these models to an experienced cardiologist’s assessment utilizing coronary angiography (CA) as a reference.

Materials and methods
We prospectively enrolled patients without known CAD referred for elective CA. We assessed pretest probability of CAD using the following risk models: Diamond–Forrester (original and updated), Duke Clinical score, ACC/AHA, CAD consortium (basic and clinical) and PROMISE minimal risk tool. All patients completed self-administrative Rose angina questionnaire. Independently, an experienced cardiologist assessed the patients to provide a binary prediction of obstructive CAD prior to CA. Obstructive CAD was defined as >80% stenosis in epicardial coronary arteries by visual assessment, or fractional flow reserve <0.80 in intermediate lesions (30–80%).

Results
A total of 150 patients were recruited (100 women, 50 men). Mean age was 58 (32–78) years. Obstructive CAD was found in 31 patients (21%). The area under the curve (AUC) for all the clinical risk prediction models (except the Duke Clinical Score, AUC 0.73, P = 0.07) was significantly lower compared with the clinician’s assessment (AUC 0.51–0.65 vs. 0.81, respectively, P < 0.01). The clinician’s assessment had sensitivity comparable to the Duke Clinical score, which was higher than all other clinical models. There was no difference in prediction performance on the basis of sex in this predominantly female population.

Discussion/Conclusion
In stable patients with chest pain and suspected CAD, current clinical risk models which are universally based upon the characteristics of the chest pain, show suboptimal performance in predicting obstructive CAD. These findings have important clinical implications, as current appropriateness criteria for recommending CA are on the basis of these risk models.
Factors Associated With Depression in Breast Cancer Patients in Saudi Arabia
Authors: Dewan Mashael F. , Lyons Karen S. , Song MinKyoung , Hassouneh Dena 
Published: August 2021

Background
Depressive symptoms in Arab women with breast cancer (AWBC) in Saudi Arabia can be influenced by spirituality, religiosity, social support, and breast cancer's stigma. Understanding the role of these factors can raise awareness and help create policies to improve care for breast cancer patients. Yet, there is limited research addressing the impact of these factors on depressive symptoms in AWBC.

Objective
The aim of this study was to investigate factors influencing depressive symptoms in AWBC in Saudi Arabia.

Methods
A cross-sectional design and convenience sampling were used to recruit 59 AWBC from oncology departments in Jeddah, Saudi Arabia, who were receiving active treatment to participate in this study. Participants completed an online survey or paper-based survey including questions on sociodemographics, social support, spirituality, religiosity, depressive symptoms, and breast cancer's stigma. Pearson correlation and multiple regression analysis were used to examine the influence of numerous factors on depressive symptoms in AWBC; Student t test statistic was used to distinguish the depressive symptom scores between online and paper-based survey.

Results
The average age of participants was 49 years (SD = 8.31). The mean (SD) of depressive symptoms was 20.52 (12.36). Pearson correlation analyses indicated that cancer patients with high levels of depressive symptoms were associated with low levels of spiritualty and religiosity, and high levels of breast cancer stigma.

Conclusions
Religiosity and spirituality work as protective factors against depressive symptoms in AWBC.

Implications for Practice
Including religiosity and spirituality in the intervention plan should be considered when caring for AWBC.
Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults
Authors: Nyamathi Adeline , Salem Benissa E. , Shin Sanghyuk S. , Jones Adrianna A. , Garfin Dana R. , Yadav Kartik , Chang Alicia H. , White Kathryn , Morisky Donald 
Published: August 2021

Background
Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults.

Objectives
We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment.

Methods
We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety.

Results
The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (<50 years old) were less likely to complete 3HP treatment compared to those who were older. Neither drug use, depression, nor anxiety was associated with 3HP treatment completion. Decrease in anxiety was observed at 3 months, but not at 6 months, compared to baseline.

Discussion
To our knowledge, the pilot study is the first to evaluate an effective RN/CHW-delivered, community-based intervention, which can reduce the burden of active TB for homeless adults.
Noninvasive Detection of Intracranial Hypertension by Novel Ultrasound Time-Harmonic Elastography
Authors: Kreft Bernhard , Tzschätzsch Heiko , Shahryari Mehrgan , Haffner Paula , Braun Jürgen , Sack Ingolf , Streitberger Kaspar-Josche 
Published: August 2021

Objective
A method for measuring intracranial pressure (ICP) noninvasively has long been sought after in neurology and neurosurgery. Treatment failure in individuals presenting with unspecific symptoms such as headache, gait disturbance, or visual impairment occurring in response to increased ICP can lead to irreversible brain injury, progressive disability, and death. Guidelines for diagnostic ICP measurement recommend intracranial placement of pressure tip catheters or lumbar puncture (LP) despite their invasiveness and possible complications. As ICP fluctuations are closely associated with changes in brain stiffness, ultrasound elastography could be a valid method to detect ICP noninvasively and with short examination times.

Materials and Methods
In this pilot study, we have investigated the use of time-harmonic shear waves, introduced into the brain by an external shaker, and measured in real-time by transtemporal ultrasound, for deducing a noninvasive imaging marker sensitive to elevated ICP. To this end, we developed cerebral ultrasound time-harmonic elastography for the noninvasive quantification of shear wave speed (SWS) as a surrogate marker of cerebral stiffness in a short examination time of a few minutes.

Results
We found that SWS in patients enrolled for LP with confirmed intracranial hypertension was 1.81 ± 0.10 m/s, distinguishing them from healthy volunteers with excellent diagnostic accuracy (1.55 ± 0.08 m/s; P < 0.001; area under the curve, 0.99). Interestingly, values in symptomatic patients decreased to normal stiffness immediately after LP (1.56 ± 0.06 m/s, P < 0.001). Moreover, invasively measured opening pressure correlated with SWS measured before LP and liquid volume drained through the spinal tap with the SWS difference between the 2 measurements.

Conclusions
Collectively, our results suggest a tight link between cerebral stiffness and ICP and demonstrate that intracranial hypertension can be detected noninvasively within short examination times, opening avenues for diagnostic applications of cerebral ultrasound time-harmonic elastography in neurology and emergency medicine.
Maintaining Social Distancing
Authors: Han Peggy K. , Fayazi Azadeh R. , Wiryawan Budi , Berg Marc D. 
Published: August 2021

Summary Statement
Respiratory failure and cardiopulmonary arrest in patients with SARS-CoV-2 infection require life-saving procedures that aerosolize virus and increase risk of transmission. To educate faculty, trainees, and staff on safe practices, a video with embedded questions was created demonstrating intubation and cardiopulmonary resuscitation in pediatric SARS-CoV-2+ patients. Just-in-time in situ simulations of these scenarios were also carried out while adhering to isolation and social distancing protocols. We demonstrated that use of simulation to train physicians and staff during the COVID-19 pandemic is possible and effective in improving confidence in performance of the procedures.
Robotic Ventral Hernia Repair
Authors: Kudsi Omar Yusef , Gokcal Fahri , Bou-Ayash Naseem , Crawford Allison S. , Chang Karen , Chudner Alexandra , La Grange Sara 
Published: August 2021

Objective:
To describe the outcomes of RVHR with varying prosthetic reinforcement techniques.

Summary of Background Data:
As a recent addition to minimally invasive hernia repair, more data is needed to establish the long-term benefits of RVHR and to identify potential predictors of adverse outcomes.

Methods:
Patients who underwent RVHR over a 7-year period were evaluated. Robotic intraperitoneal onlay mesh (rIPOM), transabdominal preperitoneal (rTAPP), Rives-Stoppa (rRS), and transversus abdominis release (rTAR) techniques were compared. The main outcomes were 90-day FFC, and 5-year FFR, depicted through Kaplan-Meier curves stratified by repair type and date.

Results:
A total of 644 RVHRs were analyzed; 197 rIPOM, 156 rTAPP, 153 rRS, and 138 rTAR. There was a gradual transition from intraperitoneal to extraperitoneal mesh placement across the study period. Although rTAPP had the highest 90-day FFC (89.5%) it also had the lowest 5-year FFR (93.3%). Conversely, although rTAR demonstrated the lowest FFC (71%), it had the highest FFR (100%). Coronary artery disease, lysis of adhesions, incisional hernia, and skin-to-skin time (10 minutes. increment) were significant predictors of 90-day complications. Incisional hernia was the sole predictor of 5-year recurrence.

Conclusions:
This study provides an in-depth perspective of the largest series of RVHR. Based on this experience, rTAPP is no longer recommended due to its limited applicability and high recurrence rate. Both rIPOM and rRS offer encouraging short- and long-term outcomes, while rTAR is associated with the highest perioperative morbidity. Longer follow-up is needed to assess rTAR durability, despite a promising recurrence profile.
Serological Response to the BNT162b2 COVID-19 mRNA Vaccine in Adolescent and Young Adult Kidney Transplant Recipients
Authors: Haskin Orly , Ashkenazi-Hoffnung Liat , Ziv Noa , Borovitz Yael , Dagan Amit , Levi Shelly , Koren Gili , Hamdani Gilad , Levi-Erez Daniella , Landau Daniel , Alfandary Hadas 
Published: August 2021

Background.
Initial reports in adult kidney transplant recipients (KTR) indicate low immunogenicity after 2 doses of the BNT162b2 COVID-19 mRNA vaccine. We describe the immunogenicity of this vaccine compared to the serologic response in naturally infected COVID-19 positive adolescent and young adult KTR.

Methods.
For this prospective observational study, the study group included 38 KTR who received 2 doses of the tested vaccine, and the control group included 14 KTR who had a previous polymerase chain reaction–confirmed COVID-19 infection.

Results.
The mean age was 18 ± 3 y. Positive serologic responses were observed in 63% and 100% of the study and control groups, respectively (P = 0.01). Antibody titers were almost 30-fold higher in the control than the study group (median [interquartile range (IQR)]: 2782 [1908–11 000] versus 100.3 [4.7–1744] AU/mL, P < 0.001), despite the longer time from the COVID-19 infection to serologic testing compared to time from vaccination (median [IQR]: 157.5 [60–216] versus 37 [20.5–53] d, P = 0.011). Among vaccinated patients, higher proportions of those seronegative than seropositive were previously treated with rituximab (50% versus 8%, P = 0.01). Time from the second vaccine dose to serologic testing was longer in seropositive than seronegative patients (median [IQR]: 24.5 [15–40] versus 46 [27–56] d, P = 0.05). No patient developed symptomatic COVID-19 disease postvaccination.

Conclusions.
The BNT162b2 COVID-19 mRNA vaccine yielded higher positive antibody response in adolescent and young adult KTR than previously reported for adult KTR. Antibody titers after vaccination were significantly lower than following COVID-19 infection. Longer time may be required to mount appropriate humoral immunity to vaccination in KTR.
Salivary bacterial signatures in depression-obesity comorbidity are associated with neurotransmitters and neuroactive dipeptides
Authors: Aleti Gajender , Kohn Jordan N. , Troyer Emily A. , Weldon Kelly , Huang Shi , Tripathi Anupriya , Dorrestein Pieter C. , Swafford Austin D. , Knight Rob , Hong Suzi 
Published: August 2021

AbstractBackgroundDepression and obesity, both of which are highly prevalent and inflammation underlies, often co- occur. Microbiome perturbations are implicated in obesity-inflammation-depression interrelationships, but how microbiome alterations contribute to underlying pathologic processes remains unclear. Metabolomic investigations to uncover microbial neuroactive metabolites may offer mechanistic insights into host-microbe interactions.MethodsUsing 16S sequencing and untargeted mass spectrometry of saliva, and blood monocyte inflammation regulation assays, we determined key microbes, metabolites and host inflammation in association with depressive symptomatology, obesity, and depressive symptomatology-obesity comorbidity.ResultsGram-negative bacteria with inflammation potential were enriched relative to Gram-positive bacteria in comorbid obesity-depression, supporting the inflammation-oral microbiome link in obesity-depression interrelationships. Oral microbiome was highly predictive of depressive symptomatology-obesity co-occurrences than obesity and depressive symptomatology independently, suggesting specific microbial signatures associated with obesity-depression co- occurrences. Mass spectrometry analysis revealed significant changes in levels of signaling molecules of microbiota, microbial or dietary derived signaling peptides and aromatic amino acids among host phenotypes. Furthermore, integration of the microbiome and metabolomics data revealed that key oral microbes, many previously shown to have neuroactive potential, co- occurred with potential neuropeptides and biosynthetic precursors of the neurotransmitters dopamine, epinephrine and serotonin.ConclusionsTogether, our findings offer novel insights into oral microbial-brain connection and potential neuroactive metabolites involved.
A randomised controlled trial to test the effects of fish aggregating devices and SBC activities promoting fish consumption in Timor-Leste: A study protocol
Authors: Tilley Alexander , Byrd Kendra A , Pincus Lauren , Klumpyan Katherine , Dobson Katherine , do Reis Lopes Joctan , Shikuku Kelvin Mashisia 
Published: August 2021

ABSTRACTTimor-Leste is one of the world’s most malnourished nations where micronutrient-deficient diets are a contributing factor to the prevalence of child stunting, currently estimated to be 45.6% of children under five. Fish are an important source of micronutrients and one that may assist the country’s predominantly rural population of agriculturalists to exit poverty and malnutrition. However, a small national fishing fleet producing low catch volumes place fish out of reach of most inland and upland populations where it is needed most. Fish consumption is very low in rural areas compared to coastal, regional, and global averages. This trial is a one-year, cluster-randomized, partially masked, controlled trial among families living in rural, inland Timor-Leste. This trial aims to test and compare the effects of two treatments, alone and in combination, on the frequency and volume of household fish consumption in upland areas as a proxy for improved dietary diversity and micronutrient intake. Treatment 1 is the installation of nearshore, moored fish aggregating devices (FADs) to improve catch rates with existing fishing gears. Treatment 2 is social and behaviour change (SBC) activities to promote fish consumption. Villages in inland communities will be randomized to receive treatment 1, treatment 2, both treatments, or neither treatment. Some households with one child under five will be recruited, and data will be collected at baseline (prior to the rollout of the treatments) and endline. Our study will determine the impact of an improved supply of fish, along with nutrition-oriented SBC activities, on the fish purchasing and consumption practices of rural, inland households. Findings from this study are urgently needed by small island developing states in order to make policy and investment decisions on how best to improve households’ diets using locally available, nutrient-dense foods such as fish. Investments such as these are needed to break the cycle of malnutrition.
Substance Use Onset in High-Risk 9-13 Year-Olds in the ABCD Study
Authors: Wade Natasha E. , Tapert Susan F. , Lisdahl Krista M. , Huestis Marilyn A. , Haist Frank 
Published: August 2021

AbstractAimA key aim of the Adolescent Brain Cognitive Development□ (ABCD) Study is to document substance use onset, patterns, and sequelae across adolescent development. However, substance use misreporting can obscure accurate drug use characterization. Hair toxicology provides objective historical substance use data but is rarely used in studies of youth. Here, we compare objective hair toxicology results with self-reported substance use in high-risk youth.MethodsA literature-based substance use risk algorithm prioritized 696 ABCD Study® participants for hair sample analysis at baseline, and 1 and 2-year follow-ups (spanning ages 9-13). Chi-square and t-tests assessed differences between participants’ demographics, positive and negative hair tests, risk-for-use algorithm scores, and self-reported substance use.ResultsHair testing confirmed that 17% of at-risk 9-13 year-olds had evidence of past 3-month use of one (n=97), two (n=14), three (n=2), or four (n=2) drug classes. After considering prescribed medication use, 10.3% had a positive test incongruent with self-report. No participant with a positive result self-reported recreational substance use that was consistent with their toxicology results. They also reported less sipping of alcohol (p < 0.001) and scored higher on the risk-for-use algorithm (p < 0.001) than those with negative toxicology results.Conclusions10% of at-risk 9-13 year-olds tested positive for at least one unreported substance, suggesting underreporting in this age range when participating in a research study. As hair testing prioritized youth with risk characteristics, the overall extent of underreporting will be calculated in future studies. Nonetheless, hair toxicology was key to characterizing substance use in high-risk youth.
An individual-level socioeconomic measure for assessing algorithmic bias in health care settings: A case for HOUSES index
Authors: Juhn Young J. , Ryu Euijung , Wi Chung-Il , King Katherine S. , Brufau Santiago Romero , Weng Chunhua , Sohn Sunghwan , Sharp Richard , Halamka John D. 
Published: August 2021

AbstractWhile artificial intelligence (AI) algorithms hold great potential for improving health and reducing health disparities, biased AI algorithms have a potential to negatively impact the health of under-resourced communities or racial/ethnic minority populations. Our study highlights the major role of socioeconomic status (SES) in AI algorithm bias and (in)completeness of electronic health records (EHRs) data, which is commonly used for algorithm development. Understanding the extent to which SES impacts algorithmic bias and its pathways through which SES operates its impact on algorithmic bias such as differential (in)completeness of EHRs will be important for assessing and mitigating algorithmic bias. Despite its importance, the role of SES in the AI fairness science literature is currently under-recognized and under-studied, largely because objective and scalable individual-level SES measures are frequently unavailable in commonly used data sources such as EHRs. We addressed this challenge by applying a validated individual-level socioeconomic measure that we call the HOUSES index. This tool allows AI researchers to assess algorithmic bias due to SES. Although our study used a cohort with a relatively small sample size, these study results highlight a novel conceptual strategy for quantifying AI bias by SES.
Size dependent regeneration capacity of functionalized Capra ear derived micro-tissue scaffolds for treatment of cartilage defects
Authors: Maity Pritiprasanna , Mukherjee Sumanta , Das Subahayan , Mandal Mahitosh , Dhara Santanu 
Published: August 2021

AbstractCartilage regeneration remains a great challenge in orthopedic treatment owing to their avascular in nature and lack of self-healing ability. Various clinical treatment options are widely used including osteochondral graft transplantation, micro-fracture, blood clot formation and tissue debridement to recover the damaged cartilage. In this circumstance, cartilage defect recovery via tissue engineered functional micro tissue delivery is becoming an emerging trend in musculoskeletal therapeutics. In this study, functional micro-scaffolds (MS) were generated from Capra ear cartilage, and were separated into size-wise groups. The scaffolds were decellularized via NaOH treatment. The cell adhesion study indicated that Capra adipose tissue derived mesenchymal stem cells (ADMSCs) adhesion is more in ~100 μm MSs in comparison to 150-300 μm MSs. It may be assumed that the cells are compatible to grow on fibrous surface area (100 μm) in comparison to dense surface (150-300 μm). Further, 100 μm MSs were transformed into functional micro tissues (FMTs) in presence of high density ADMSCs in a hanging droplet culture system. The FMTs was transferred to F127 block polymer hydrogel for 3D culture. After 21 d cultures, the FMT clusters were evaluated for quantitative gene expression. To assess the in vivo cartilage defect regeneration potential, FMTs were delivered to rabbit auricular cartilage defect for 15, 30 and 60 d studies. The H&E-stained histological analysis showed that the cartilage defect is almost healed in 60 d study in comparison to 15 and 30 d study.