bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Versus Actual Risks of 30-Day Readmission in Patients With Cardiovascular Disease
Authors: Xu Hanzhang , Farmer Heather R. , Granger Bradi B. , Thomas Kevin L. , Peterson Eric D. , Dupre Matthew E. 
Published: January 2021

Background:
Cardiovascular disease (CVD) is the leading cause of hospitalization in the United States, and patients with CVD are at a high risk of readmission after discharge. We examined whether patients’ perceived risk of readmission at discharge was associated with actual 30-day readmissions in patients hospitalized with CVD.

Methods:
We recruited 730 patients from the Duke Heart Center who were admitted for treatment of CVD between January 1, 2015, and August 31, 2017. A standardized survey was linked with electronic health records to ascertain patients’ perceived risk of readmission, and other sociodemographic, psychosocial, behavioral, and clinical data before discharge. All-cause readmission within 30 days after discharge was examined.

Results:

Nearly 1-in-3 patients perceived a high risk of readmission at index admission and those who perceived a high risk had significantly more readmissions within 30 days than patients who perceived low risks of readmission (23.6% versus 15.8%,
P
=0.016). Among those who perceived a high risk of readmission, non-White patients (odds ratio [OR], 2.07 [95% CI, 1.28–3.36]), those with poor self-rated health (OR, 2.30 [95% CI, 1.38–3.85]), difficulty accessing care (OR, 2.72 [95% CI, 1.24–6.00]), and prior hospitalizations in the past year (OR, 2.13 [95% CI, 1.21–3.74]) were more likely to be readmitted. Among those who perceived a low risk of readmission, patients who were widowed (OR, 2.69 [95% CI, 1.60–4.51]) and reported difficulty accessing care (OR, 1.89 [95% CI, 1.07–3.33]) were more likely to be readmitted.

Conclusions:
Patients who perceived a high risk of readmission had a higher rate of 30-day readmission than patients who perceived a low risk. These findings have important implications for identifying CVD patients at a high risk of 30-day readmission and targeting the factors associated with perceived and actual risks of readmission.
Gaps in Evidence‐Based Therapy Use in Insured Patients in the United States With Type 2 Diabetes Mellitus and Atherosclerotic Cardiovascular Disease
Authors: Nelson Adam J. , Ardissino Maddalena , Haynes Kevin , Shambhu Sonali , Eapen Zubin J. , McGuire Darren K. , Carnicelli Anthony , Lopes Renato D. , Green Jennifer B. , O’Brien Emily C. , Pagidipati Neha J. , Granger Christopher B. 
Published: January 2021

Background
Evidence‐based therapies are generally underused for cardiovascular risk reduction; however, less is known about contemporary patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease.

Methods and Results
Pharmacy and medical claims data from within Anthem were queried for patients with established atherosclerotic cardiovascular disease and type 2 diabetes mellitus. Using an index date of April 18, 2018, we evaluated the proportion of patients with a prescription claim for any of the 3 evidence‐based therapies on, or covering, the index date ±30 days: high‐intensity statin, angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, and sodium glucose cotransporter‐2 inhibitor or glucagon‐like peptide‐1 receptor agonist. The potential benefit of achieving 100% adoption of all 3 evidence‐based therapies was simulated using pooled treatment estimates from clinical trials. Of the 155 958 patients in the sample, 24.7% were using a high‐intensity statin, 53.1% were using an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, and 9.9% were using either an sodium glucose cotransporter‐2 inhibitor or glucagon‐like peptide‐1 receptor agonists. Overall, only 2.7% of the population were covered by prescriptions for all 3 evidence‐based therapies, and 37.4% were on none of them. Over a 12‐month period, 70.6% of patients saw a cardiologist, while only 18% saw an endocrinologist. Increasing the use of evidence‐based therapies to 100% over 3 years of treatment could be expected to reduce 4546 major atherosclerotic cardiovascular events (myocardial infarction, stroke, or cardiovascular death) in eligible but untreated patients.

Conclusions
Alarming gaps exist in the contemporary use of evidence‐based therapies in this large population of insured patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. These data provide a call to action for patients, providers, industry, regulators, professional societies, and payers to close these gaps in care.
Genetic Etiology of Left‐Sided Obstructive Heart Lesions: A Story in Development
Authors: Parker Lauren E. , Landstrom Andrew P. 
Published: January 2021

Abstract
Congenital heart disease is the most common congenital defect observed in newborns. Within the spectrum of congenital heart disease are left‐sided obstructive lesions (LSOLs), which include hypoplastic left heart syndrome, aortic stenosis, bicuspid aortic valve, coarctation of the aorta, and interrupted aortic arch. These defects can arise in isolation or as a component of a defined syndrome; however, nonsyndromic defects are often observed in multiple family members and associated with high sibling recurrence risk. This clear evidence for a heritable basis has driven a lengthy search for disease‐causing variants that has uncovered both rare and common variants in genes that, when perturbed in cardiac development, can result in LSOLs. Despite advancements in genetic sequencing platforms and broadening use of exome sequencing, the currently accepted LSOL‐associated genes explain only 10% to 20% of patients. Further, the combinatorial effects of common and rare variants as a cause of LSOLs are emerging. In this review, we highlight the genes and variants associated with the different LSOLs and discuss the strengths and weaknesses of the present genetic associations. Furthermore, we discuss the research avenues needed to bridge the gaps in our current understanding of the genetic basis of nonsyndromic congenital heart disease.
Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage
Authors: Mrochen Anne , Sprügel Maximilian I. , Gerner Stefan T. , Sembill Jochen A. , Lang Stefan , Lücking Hannes , Kuramatsu Joji B. , Huttner Hagen B. 
Published: January 2021

Background and Purpose:
The impact of platelets on hematoma enlargement (HE) of intracerebral hemorrhage (ICH) is not yet sufficiently elucidated. Especially the role of reduced platelet counts on HE and clinical outcomes is still poorly understood. This study investigated the influence of thrombocytopenia on HE, functional outcome, and mortality in patients with ICH with or without prior antiplatelet therapy (APT).

Methods:

Individual participant data of multicenter cohort studies (multicenter RETRACE program [German-Wide Multicenter Analysis of Oral Anticoagulation-Associated Intracerebral Hemorrhage] and single-center UKER-ICH registry [Universitätsklinikum Erlangen Cohort of Patients With Spontaneous ICH]) were grouped into APT and non-APT ICH patients according to the platelet count, that is, with or without thrombocytopenia (cells <150×10
9
/L). Of all patients, 51.5% (1124 of 2183) were on vitamin K antagonist. Imbalances in baseline characteristics including proportions of vitamin K antagonist patients were addressed using propensity score matching. Outcome analyses included HE (>33%), as well as mortality and functional outcome, after 3 months using the modified Rankin Scale, dichotomized into favorable (modified Rankin Scale score, 0–3) and unfavorable (modified Rankin Scale score, 4–6).

Results:

Of overall 2252 ICH patients, 11.4% (52 of 458) under APT and 14.0% (242 of 1725) without APT presented with thrombocytopenia on admission. The proportion of patients with HE was not significantly different between patients with or without thrombocytopenia among APT and non-APT ICH patients after propensity score matching (HE: APT patients: 9 of 40 [22.5%] thrombocytopenia versus 27 of 115 [23.5%] nonthrombocytopenia,
P
=0.89; non-APT patients: 54 of 174 [31.0%] thrombocytopenia versus 106 of 356 [29.8%] nonthrombocytopenia,
P
=0.77). In both (APT and non-APT) propensity score matching cohorts, there were no significant differences regarding functional outcome. Mortality after 3 months did not differ among non-APT patients, whereas the mortality rate was significantly higher for APT patients with thrombocytopenia versus APT patients with normal platelet count (APT: 29 of 46 [63.0%] thrombocytopenia versus 58 of 140 [41.4%] nonthrombocytopenia,
P
=0.01; non-APT: 95 of 227 [41.9%] thrombocytopenia versus 178 of 455 [39.1%] nonthrombocytopenia,
P
=0.49).

Conclusions:
Our study implies that thrombocytopenia does not affect rates of HE and functional outcome among ICH patients, neither in patients with nor without APT. In light of increased mortality, the significance of platelet transfusions for ICH patients with thrombocytopenia and previous APT should be explored in future studies.
Age-dependent walking and feeding of the assassin bug Amphibolus venator
Authors: Matsumura Kentarou , Iwaya Mana , Nagaya Naohisa , Fujisawa Ryusuke , Miyatake Takahisa 
Published: January 2021

Abstract
Animal behaviours often dependent on age. In many insect species, walking shows an age-dependent decline, and food intake may also be dependent on age. However, few studies have investigated the relationship between age and walking or food intake. In the present study, we compared walking traits and food intake among individuals of different ages in the assassin bug Amphibolus venator (Hemiptera, Reduviidae). The present results showed an age-dependent decline in walking, similar to findings in many animal species. On the other hand, food intake showed a positive correlation with age. Therefore, the decline in walking did not lead to a decline in feeding. The positive relationship between food intake and age may be related to the type of predation, sit-and-wait, used by A. venator via alterations in investment in reproductive traits with age.
Quantifying the Uncertainty of the Future Hydrological Impacts of Climate Change: Comparative Analysis of an Advanced Hierarchical Sensitivity in Humid and Semiarid Basins
Authors: Ju Jiali , Dai Heng , Wu Chuanhao , Hu Bill X. , Ye Ming , Chen Xingyuan , Gui Dongwei , Liu Haifan , Zhang Jin 
Published: January 2021

AbstractComparison and quantification of different uncertainties of future climate change involved in the modeling of a hydrological system are highly important for both hydrological modelers and policy-makers. However, few studies have accurately estimated the relative importance of different sources of uncertainty at different spatiotemporal scales. Here, a hierarchical sensitivity analysis framework (HSAF) incorporated with a variance-based global sensitivity analysis is developed to quantify the spatiotemporal contributions of different uncertainties in hydrological impacts of climate change in two different climatic (humid and semiarid) basins in China. The uncertainty sources include three emission scenarios (ESs), 20 global climate models (GCs), three hydrological models (HMs), and the associated sensitive hydrological parameters (PAs) screened and sampled by the Morris and Latin hypercube sampling methods, respectively. The results indicate that the overall trend of uncertainty is PA > HM > GC > ES, but their uncertainties have discrepancies in projections of different hydrological variables. The HM uncertainty in annual and monthly discharge projections is generally larger than the PA uncertainty in the humid basin than semiarid basin. The PA has greater uncertainty in extreme hydrological event (annual peak discharge) projections than in annual discharge projections for both basins (particularly for the humid basin), but contributes larger uncertainty to annual and monthly discharge projections in the semiarid basin than humid basin. The GC contributes larger uncertainty in all the hydrological variables projections in the humid basin than semiarid basin, while the ES uncertainty is rather limited in both basins. Overall, our results suggest there is greater spatiotemporal variability of hydrological uncertainty in more arid regions.
Near-Surface Reflection and Nonlinear Effects of Low-Mode Internal Tides on a Continental Slope
Authors: Xie Xiaohui , Chen Dake 
Published: January 2021

AbstractTwo sets of mooring data were collected at two sites (MA and MB) along a cross-slope section on the northeastern continental slope in the South China Sea (SCS). These data are used to investigate evolution and energy decay of low-mode semidiurnal (M2) internal tides on a subcritical slope with respect to M2. At the deep portion of the slope (~1250 m; MA), the M2 internal tides show upward energy propagation, while vertically standing M2 internal tides are often observed at shallow MB (~845 m). A two-dimensional linear internal tide model with realistic topography and stratification reproduces the observations, suggesting that low-mode M2 internal tides incident on subcritical slopes evolve into vertically propagating internal waves due to topographic scattering, propagate upward to the boundary, and reflect from the sea surface. The reflection point largely depends on the phase between the modal components of the incoming flux. In the near-surface reflection region, two kinds of nonlinear effects are observed to decay energy of the incoming internal tides. One is the resonant parametric subharmonic instability which transfers M2 internal tides to diurnal subharmonics M1 (=M2/2), but the instability is found to mainly depend on the incident waves. The other one is the nonresonant wave–wave interaction, producing two higher-harmonic M4 (=2M2) rays with opposite vertical propagation. A strong westward mean flow is observed in the interacting region, with amplitude comparable to that of the incident waves. This mean flow also appears to be generated by the nonlinear reflection of the M2 internal tides.
Preparation of SnIn4S8/TiO2 Nanotube Photoanode and Its Photocathodic Protection for Q235 Carbon Steel Under Visible Light
Authors: Li Hong , Song Weizhe , Cui Xingqiang , Li Yanhui , Hou Baorong , Cheng Lianjun , Zhang Pengfei 
Published: January 2021

AbstractTiO2 is an attractive semiconductor suitable for photocathodic protection, but its weak absorption of visible light and low quantum yield limit its usage. Here, a new heterostructured SnIn4S8 nanosheet/TiO2 nanotube photoanode was prepared and its photocathodic protection performance was analyzed. SnIn4S8 nanosheets were uniformly deposited on the surface of the TiO2 nanotube via a solvothermal treatment. The SnIn4S8/TiO2 composite exhibited better photocathodic protection performance compared with pure TiO2 nanotubes, owing to its good visible-light response and photogenerated carrier separation efficiency. Moreover, the composite exhibited a maximum photocurrent density of 100 μA cm−2 for a 6 h solvothermal reaction under visible light irradiation. The negative shift of the photoinduced potential of Q235 carbon steel connected to the composite could reach 0.45 V versus SCE. Therefore, the SnIn4S8/TiO2 composite can offer efficient photocathodic protection for Q235 carbon steel against corrosion in 3.5 wt% NaCl solution. This work provides a new approach for the development of high-efficient photoanode materials for the photocathodic protection of metals.
Implementation of an integrated care programme to avoid fragility fractures of the hip in older adults in 18 Bavarian hospitals – study protocol for the cluster-randomised controlled fracture liaison service FLS-CARE
Authors:   FLS-CARE study group, Geiger Isabel , Kammerlander Christian , Höfer Christine , Volland Ruth , Trinemeier Jörg , Henschelchen Martina , Friess Thomas , Böcker Wolfgang , Sundmacher Leonie 
Published: January 2021

Abstract
Background
The economic and public health burden of fragility fractures of the hip in Germany is high. The likelihood of requiring long-term care and the risk of suffering from a secondary fracture increases substantially after sustaining an initial fracture. Neither appropriate confirmatory diagnostics of the suspected underlying osteoporosis nor therapy, which are well-recognised approaches to reduce the burden of fragility fractures, are routinely initiated in the German healthcare system. Therefore, the aim of the study FLS-CARE is to evaluate whether a coordinated care programme can close the prevention gap for patients suffering from a fragility hip fracture through the implementation of systematic diagnostics, a falls prevention programme and guideline-adherent interventions based on the Fracture Liaison Services model.

Methods
The study is set up as a non-blinded, cluster-randomised, controlled trial with unequal cluster sizes. Allocation to intervention group (FLS-CARE) and control group (usual care) follows an allocation ratio of 1:1 using trauma centres as the unit of allocation. Sample size calculations resulted in a total of 1216 patients (608 patients per group distributed over 9 clusters) needed for the analysis. After informed consent, all participants are assessed directly at discharge, after 3 months, 12 months and 24 months. The primary outcome measure of the study is the secondary fracture rate 24 months after initial hip fracture. Secondary outcomes include differences in the number of falls, mortality, quality-adjusted life years, activities of daily living and mobility.

Discussion
This study is the first to assess the effectiveness and cost-effectiveness/utility of FLS implementation in Germany. Findings of the process evaluation will also shed light on potential barriers to the implementation of FLS in the context of the German healthcare system. Challenges for the study include the successful integration of the outpatient sector as well as the future course of the coronavirus pandemic in 2020 and its influence on the intervention.

Trial registration
German Clinical Trial Register (DRKS) 00022237, prospectively registered 2020-07-09
Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity
Authors: Batsis John A. , Petersen Curtis L. , Clark Matthew M. , Cook Summer B. , Kotz David , Gooding Tyler L. , Roderka Meredith N. , Al-Nimr Rima I. , Pidgeon Dawna , Haedrich Ann , Wright K. C. , Aquila Christina , Mackenzie Todd A. 
Published: January 2021

Abstract
Background
Older adults with obesity residing in rural areas have reduced access to weight management programs. We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology.

Methods
A 6-month, non-randomized, non-blinded, single-arm study was conducted from October 2018 to May 2020 at a community-based aging center of adults aged ≥65 years with a body mass index (BMI) ≥30 kg/m2. Weekly dietitian visits focusing on behavior therapy and caloric restriction and twice-weekly physical therapist-led group strength, flexibility and balance training classes were delivered using video-conferencing to participants in their homes. Participants used a Fitbit Alta HR for remote monitoring with data feedback provided by the interventionists. An aerobic activity prescription was provided and monitored.

Results
Mean age was 72.9±3.9 years (82% female). Baseline anthropometric measures of weight, BMI, and waist circumference were 97.8±16.3 kg, 36.5±5.2 kg/m2, and 115.5±13.0 cm, respectively. A total of 142 participants were screened (n=27 ineligible), and 53 consented. There were nine dropouts (17%). Overall satisfaction with the trial (4.7+ 0.6, scale: 1 (low) to 5 (high)) and with Fitbit (4.2+ 0.9) were high. Fitbit was worn an average of 81.7±19.3% of intervention days. In completers, mean weight loss was 4.6±3.5 kg or 4.7±3.5% (p< 0.001). Physical function measures of 30-s sit-to-stand repetitions increased from 13.5±5.7 to 16.7±5.9 (p< 0.001), 6-min walk improved by 42.0±77.3 m (p=0.005) but no differences were observed in gait speed or grip strength. Subjective measures of late-life function improved (3.4±4.7 points, p< 0.001).

Conclusions
A technology-based obesity intervention is feasible and acceptable to older adults with obesity and may lead to weight loss and improved physical function.

Clinical trial registration
Registered on Clinicaltrials.gov #NCT03104205. Registered on April 7, 2017. First participant enrolled on October 1st, 2018.
Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey
Authors: Naz Lubna , Ghimire Umesh , Zainab Abida 
Published: January 2021

Abstract
Background
In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.

Methods
This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014–15. We followed the Anderson’s Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.

Results
Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5–4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82–1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84–1.13) and richest (AOR: 1.29, 95%CI 0.89–1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.

Conclusions
Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.