bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicare Accountable Care Organization Treatment of Serious Mental Illness
Authors: Newton Helen , Colla Carrie H. , Busch Susan H. , Tomaino Marisa , Hardy Brianna , Brunette Mary F. , Agravat Devang , Meara Ellen 
Published: December 2024

Objective:
Characterize the association between Medicare Accountable Care Organizations’ (ACOs) behavioral health integration capability and quality and utilization among adults with serious mental illness (SMI).

Background:
Controlled research supports the efficacy of integrating physical and mental health care for adults with SMI, yet little is known about the organizations integrating care and associations between integration capability and quality.

Methods:
We surveyed Medicare ACOs (2017–2018 National Survey of ACOs, response rate 69%) and linked responses to 2016–2017 fee-for-service Medicare claims for beneficiaries with SMI. We examined the cross-sectional association between ACO-reported integration capability (tertiles of a 14-item index) and 7 patient-level quality and utilization outcomes. We fit generalized linear models for each outcome as a function of ACO integration capability, adjusting for ACO and beneficiary characteristics.

Results:
Study sample included 274,928 beneficiary years (199,910 unique beneficiaries) attributed to 265 Medicare ACOs. ACOs with high behavioral health integration capability (top-tertile) served more dual-eligible beneficiaries (67.8%) than bottom-tertile (63.7%) and middle-tertile ACOs (63.3%). Most beneficiaries received follow-up 30 days after mental health hospitalization and chronic disease monitoring–exceeding national quality benchmarks–but beneficiaries receiving care from top-tertile (vs bottom-tertile) ACOs were modestly less likely to receive follow-up [−2.17 percentage points (pp), P < 0.05], diabetes monitoring (−2.19 pp, P < 0.05), and cardiovascular disease monitoring (−6.07 pp, P < 0.05). Integration capability was not correlated with utilization.

Conclusions:
ACOs serving adults with substantial physical and mental health needs were more likely to report comprehensive integration capability but were not yet meeting the primary care needs of many adults with SMI.
Systematic Review and Meta-Analysis of Prevalence and Risk Factors for Psychological Birth Trauma
Authors: Xu Yaxuan , Wang Wenjuan , Zhou Lihua , Xu Wenli , Wang Hui , Zhang Fengying , Wang Xiaoqin , Zhang Hanmei 
Published: December 2024

Abstract

Background
Psychological birth trauma is common among women in labor and has severe implications for maternal and infant health. Although the prevalence and risk factors of psychological birth trauma have been widely reported, these findings have not been systematically synthesized, limiting screening and interventions.

Objective
This study aimed to determine the pooled prevalence of and risk factors for psychological birth trauma.

Methods
The Cochrane Library, Web of Science, PubMed, Embase, and Scopus databases were systematically searched between their inception and October 1, 2023. Pooled prevalence, odds ratio, and 95% confidence intervals were calculated using fixed or random effects models using Stata 15.0.

Result
The pooled prevalence rate of psychological birth trauma was 19%. We performed subgroup analysis based on age, parity, region, and measurement tools. The results showed differences in the prevalence of psychological birth trauma between these subgroups, suggesting the need for clinical personalization in different populations. The pooled odds ratio showed that fear of childbirth, cesarean section, operative vaginal birth, pain during labor, and dissatisfaction with support from midwives were significantly associated with psychological birth trauma.

Discussion
The study found that the pooled prevalence of psychological birth trauma was 19%. PBT risk factors are diverse, and understanding the prevalence and risk factors for psychological birth trauma has important implications for health care and social care systems.
Predictors of Decisional Capacity in Alzheimer’s Disease Biomarker Test Candidates
Authors: Kim Jeong Eun , Sereika Susan M. , Tamres Lisa K. , Lingler Jennifer H. 
Published: December 2024

Abstract

Background
Deciding to learn one’s Alzheimer’s disease (AD) biomarker status is a high-stakes endeavor that requires comprehending and deliberating about complex and nuanced information. Assessing capacity to consent to AD biomarker testing and disclosure is further complicated when candidates have cognitive impairment and present with family care partners.

Objective
The objective of this analysis was to identify predictors of decisional capacity for an amyloid Positron Emission Tomography (PET) disclosure study among persons with mild cognitive impairment (MCI) and their family care partners.

Methods
This analysis used an analytical correlational design, using baseline data from a randomized controlled trial of amyloid PET results disclosure. Simple linear regression was used to examine predictors of decisional capacity. Focusing on persons with MCI, the predictor variables of interest were sociodemographic characteristics, level of knowledge of MCI/AD, global cognition, and neuropsychological tests of language and executive functioning. Dyadic analyses were conducted with data from 82 dyads of persons with MCI and care providers using the Actor Partner Interdependence Model to assess for presence of actor and partner effects among key variables.

Results
Capacity to consent scores demonstrated sufficient capacity for all participants to consent to the study. For persons with MCI, lower age, higher mental status scores, MCI/AD knowledge scores, and better performance on measures of language and executive functioning were predictors of decisional capacity. The model revealed positive actor relations for MCI/AD knowledge with decisional capacity for both persons with MCI and family care partners and negative partner relationships for family care partners MCI/AD knowledge with the decisional capacity of persons with MCI.

Discussion
Assessment of decisional capacity is imperative when considering participation in AD research, including studies with high-stakes procedures like biomarker results disclosure. Our findings highlight that not only do individual characteristics put persons with MCI at risk for lower decisional capacity, but dyadic effects from family care partners may also be present.
Frailty and Self-Care Maintenance Mediated by Social Support and Depression in Older Adults With Heart Failure
Authors: Bu Na , Leng Min , Cao Guorong , Dou Chao , Hou Rongchun , Lu Xiaohong , Xu Hong 
Published: December 2024

Abstract

Background
Older adults with heart failure often exhibit poor self-care maintenance. Frailty could exacerbate self-care, leading to deteriorating health. Social support and depression may play a role in self-care maintenance in older adults with heart failure combined with frailty. Confirming this potential mechanistic relationship could provide valuable reference for nurses to formulate and improve the targeted intervention strategies and health education programs for older adults with heart failure.

Objectives
This study analyze the relationship between frailty and self-care maintenance in older adults with heart failure and determined the sequential mediation effect of social support and depression. Its goal was to provide valuable theoretical insights for formulating targeted clinical nursing interventions for older adults with heart failure.

Methods
A cross-sectional study was conducted from July 2023 to February 2024, during which older adults with heart failure were recruited using a convenience sampling method from the cardiovascular department of a tertiary class A hospital in Qingdao, China. A total of 241 completed the Tilburg Frailty Indicator, the Self-Care of Heart Failure Index, the Social Support Rating Scale, and the Patient Health Questionnaire–9. T-tests and one-way analysis of variance were used to examine differences in self-care maintenance among participants with distinct characteristics; correlation analysis was used to ​identify variable relationships within the study. The mediation model was tested using the SPSS PROCESS macro and the bootstrap method.

Results
Frailty was negatively correlated with self-care maintenance, and both social support and depression were significantly related to frailty and self-care maintenance. Social support and depression not only independently mediated the relationship between frailty and self-care maintenance but also exhibited a significant sequential mediation effect.

Discussion
The frailty of older adults with heart failure and its correlation with self-care maintenance is a complex and multidimensional phenomenon. Frailty not only directly influenced self-care maintenance in participants but also indirectly affected it through the mediating factors of social support and depression. Future research should emphasize innovative, targeted interventions to enhance social support quality and accessibility and alleviate depression, ultimately boosting patients’ self-care capabilities and elevating their quality of life.
Integration in Mixed Methods Research With an Exemplar Explanatory Sequential Study
Authors: Hwang Youri , Knobf M. Tish , Sadler Lois S. 
Published: December 2024

Abstract

Background
Integration—a hallmark of mixed methods research (MMR)—is crucial throughout the entire research process. Despite its importance, integration remains an elusive concept often inadequately addressed by researchers, with many publications focusing solely on the final stages of data analysis and interpretation.

Objectives
The authors aim to synthesize methodologic discussions of the mixed method research integration process and provide an illustration of integration across all phases of an exemplar explanatory sequential study.

Methods
Integration in MMR includes four distinct dimensions encompassing philosophical assumptions and paradigms, methodological methods, and dissemination of integrated study findings. This paper presents our integrated study findings, illustrated by a research study conducted to investigate sleep health among women with breast cancer.

Results
Integration of quantitative and qualitative data analyses is demonstrated through consistently matching the guiding paradigm with design choice, meta-inferences, and visual joint displays. The connecting displays linking quantitative and qualitative data, compare sleep characteristics scores, and the relationship between anxiety and vasomotor symptoms. The results highlight the significance of visual tools in enhancing the analytic processes and providing a comprehensive understanding of complex clinical phenomena.

Discussion
Integrating across all stages of mixed method research studies presents many challenges. The proposed four-dimension model of integration contributes to understanding the unique value of fully integrated mixed methods results. The exemplary study findings confirm the value of integration in achieving a nuanced and comprehensive understanding of a significant clinical problem.
The Impact of Educational Handouts on the Compliance Rate for Bariatric Patient Follow-Up Appointments
Authors: Fedirko Nicolas , Wilson Kristi Jo , Buterakos Roxanne , Pechta Alyssa 
Published: December 2024

Background and Objectives:
Compliance rates for follow-up appointments are an issue for postoperative sleeve gastrectomy (SG) patients. Without consistent reinforcement and monitoring of patient progress, patients tend to gain the weight back, all of the medical improvements made are lost, and the ability to access patients for potential complications is denied. Patients need much reinforcement during their forever bariatric lifestyle, and the lack of consistent reminders may contribute to follow-up noncompliance and recidivism in SG patients. As time progresses, the follow-up appointment compliance rate decreases. Decreased follow-up can lead to a higher risk for complications such as asymptomatic esophagitis, and current recommendations suggest that esophagogastroduodenoscopy screening should occur 3 years postoperatively. After 1 year, the follow-up compliance decreases dramatically so that by the 3-year postoperative period, very few patients are being seen and scheduled for interventions such as an esophagogastroduodenoscopy. The objective of this quality improvement project was to evaluate the effectiveness of a patient educational handout on SG bariatric patient follow-up visit compliance.

Methods:
A quasi-experimental design and retrospective chart review was chosen. An educational handout was developed. Preintervention retrospective chart review consisted of 441 SG patients expecting a follow-up in 12 to 48 months. Postintervention included 3 months of the handout intervention with data collection totaling 198 patients.

Results:
Follow-up compliance for 4 year visits noted 0% preintervention/12.2% postintervention (P = .008), for 3 year visits 13.4% preintervention/12% postintervention (P = .846), for 2 year visits 26.3% preintervention/28.6% postintervention (P = .755), for 18 months visits 26.3% preintervention/32.6% postintervention (P = .365), and for 12 months visits 54.2% preintervention/34.1% postintervention (P = .011).

Conclusion:
In this quality improvement project, educational handouts did not have a statistical impact on follow-up compliance.
Immunomodulatory effects of tumor Lactate Dehydrogenase C (LDHC) in breast cancer
Authors: Naik Adviti , Thomas Remy , Al-Khalifa Aljazi , Qasem Hanan , Decock Julie 
Published: December 2024

ABSTRACTBackgroundImmunotherapy has significantly improved outcomes for cancer patients; however, its clinical benefits vary among patients and its effectiveness across breast cancer subtypes remains uncertain. To enhance its efficacy, it is important to gain more insight into tumor-intrinsic immunomodulatory factors that could be used as therapeutic targets. We previously identified Lactate Dehydrogenase C (LDHC) to be a promising anti-cancer target due to its role in regulating cancer cell genomic integrity. In this study, we investigated the effects of tumor LDHC expression on immune responses.MethodsTIMER AND TIDE deconvolution methods were used to investigate the relationship between tumorLDHCexpression, immune cell infiltration and T cell dysfunction. Multiplex cytokine assays and flow cytometry analyses of breast cancer cell monocultures, and direct and indirect cancer cell-immune cell co-culture models were performed to assess the effect of LDHC knockdown on the secretion of inflammatory mediators and the expression of immune checkpoint molecules. T cell activity was determined by IFN-γ ELISPot assays and 7-AAD viability flow cytometry of cancer cells in direct co-culture.ResultsTIMER and TIDE analyses revealed that tumorLDHCexpression is associated with T cell dysfunction in breast cancer and worse post-immunotherapy survival in melanoma. Depletion of LDHC in three breast cancer cell lines (MDA-MB-468, BT-549, HCC-1954) enhanced T cell activation and cytolytic function (4-hour direct co-culture). Analysis of cancer cell monocultures revealed an increase in secreted pro-inflammatory cytokines (IFN-γ, GM- CSF, MCP-1, CXCL1), a decrease in immunosuppressive factors (IL-6, Gal-9) and a reduction in tumor cell surface PD-L1 expression following LDHC knockdown. Using 72-hour direct co- cultures with LDHC-silenced cancer cells, we observed a decrease in tumor-promoting cytokines (IL-1β, IL-4 and IL-6) and an increase in the tumor-inhibiting cytokine CXCL1. Furthermore, LDHC knockdown reduced the number of CD8+ T cells expressing PD-1 and CTLA-4, as well as the cell surface expression of CTLA-4, TIGIT, TIM3, and VISTA.ConclusionsOur findings suggest that targeting LDHC may improve anti-tumor immune responses by modulating the secretion of pro- and anti-tumorigenic cytokines and impairing immune checkpoint signaling. Further studies are needed to elucidate the molecular mechanisms by which LDHC modulates these responses in breast cancer.
Age is an intrinsic driver of inflammatory responses to malaria
Authors: Loughland Jessica R. , Dooley Nicholas , Pava Zuleima , SheelaNair Arya , Andrew Dean , Tipping Peta , Bourke Peter , Engwerda Christian , Lopez J. Alejandro , Piera Kim , William Timothy , Barber Bridget E , Grigg Matthew , Anstey Nicholas M , Minigo Gabriela , Boyle Michelle J. 
Published: December 2024

AbstractAge is a critical factor influencing the host immune response to infection and disease pathogenesis. In malaria, the risk of severe disease increases with age in non-immune individuals. Malaria severity is in part driven by inflammation, but the specific cells and mechanisms contributing to age-dependent disease risk are incompletely understood. Here, we assessed inflammatory cytokines in non-immune children and adults with clinical malaria, and the phenotypic, functional and transcriptional differences of in vitro innate cell responders to malaria parasites in naive children and adults. During naturally acquired malaria, age was associated with increased plasma levels of inflammatory chemokines CCL2, CCL3, CXCL8, CXLC9, along with CRP, and IDO, which were associated with clinical symptoms. In malaria naive individuals, classical monocyte and Vδ2+γδ T cell responses from adults were characterized by higher inflammatory cytokine production, and transcriptional activation following stimulation with malaria parasites. Classical monocyte responses in adults were dominated by CCL2 production, while in children the response had increased IL10 production and enrichment in IL10 signaling pathways upon parasite stimulation. This heightened inflammatory response in adults was not mitigated by parasite induced Tregs. Taken together, these findings identify cellular mechanisms of age-dependent host responses that play crucial roles in driving inflammatory responses in malaria.
Inference-based time-resolved cortical stability and chaos analysis for focal epileptic seizures
Authors: Zhao Yun , Grayden David B. , Boley Mario , Liu Yueyang , Karoly Philippa J. , Cook Mark J. , Kuhlmann Levin 
Published: December 2024

AbstractEpilepsy affects millions globally, with a significant subset of patients suffering from drug-resistant focal seizures. Understanding the underlying neurodynamics of seizure initiation and propagation is crucial for advancing treatment and diagnostics. In this study, we present a novel, inference-based approach for analyzing the temporal evolution of cortical stability and chaos during focal epileptic seizures. Utilizing a multi-region neural mass model, we estimate time-varying synaptic connectivity from intracranial electroencephalography (iEEG) data collected from individuals with drug-resistant focal epilepsy. Our analysis reveals distinct preictal and ictal phases characterized by shifts in cortical stability, heightened chaos in the ictal phase, and highlight the critical role of inter-regional communication in driving chaotic cortical behaviour. We demonstrate that cortical dynamics are consistently destabilized prior to seizure onset, with a transient reduction in instability at seizure onset, followed by a significant increase throughout the seizure. This work provides new insights into the mechanisms of seizure generation and offers potential biomarkers for predicting seizure events. Our findings pave the way for innovative therapeutic strategies targeting cortical stability and chaos to manage epilepsy.
Leveraging Deep Neural Network and Language Models for Predicting Long-Term Hospitalization Risk in Schizophrenia
Authors: Bao Yihang , Wang Wanying , Liu Zhe , Wang Weidi , Zhao Xue , Yu Shunying , Lin Guan Ning 
Published: December 2024

AbstractEarly warning of long-term hospitalization in schizophrenia (SCZ) patients at the time of admission is crucial for effective resource allocation and individual treatment planning. In this study, we developed a deep learning model that integrates demographic, behavioral, and blood test data from admission to forecast extended hospital stays using a retrospective cohort. By utilizing language models (LMs), our developed algorithm efficiently extracts 95% of the unstructured electronic health record data needed for this work, while ensuring data privacy and low error rate. This paradigm has also been demonstrated to have significant advantages in reducing potential discrimination and erroneous dependencies. By utilizing multimodal features, our deep learning model achieved a classification accuracy of 0.81 and an AUC of 0.9. Key risk factors identified included advanced age, longer disease duration, and blood markers such as elevated neutrophil-to-lymphocyte ratio, lower lymphocyte percentage, and reduced albumin levels, validated through comprehensive interpretability analyses and ablation studies. The inclusion of multimodal data significantly improved prediction performance, with demographic variables alone achieving an accuracy of 0.73, which increased to 0.81 with the addition of behavioral and blood test data. Our approach outperformed traditional machine learning methods, which were less effective in predicting long-term stays. This study demonstrates the potential of integrating diverse data types for enhanced predictive accuracy in mental health care, providing a robust framework for early intervention and personalized treatment in schizophrenia management.
Alternative dosing regimens of GLP-1 receptor agonists may reduce costs and maintain weight loss efficacy
Authors: Cengiz Anıl , Wu Calvin C. , Lawley Sean D. 
Published: December 2024

AbstractAimsTo discover alternative dosing regimens of incretin mimetics that simultaneously reduce costs and maintain weight loss efficacy. As a secondary objective, we used our results to explore how allocating a limited incretin mimetics budget could affect public health on a national scale.Materials and MethodsWe used mathematical modeling and simulation of semaglutide and tirzepatide. For semaglutide, we used a recent pharmacokinetic (PK) and pharmacodynamic (PD) model. For tirzepatide, we used a recent PK model and modeled PD by reparameterizing the semaglutide PD model to fit tirzepatide clinical data.ResultsReducing dose frequency does not commensurately reduce weight loss. For example, merely switching from one dose per week (q1wk) to one dose every two weeks (q2wk) maintains roughly 75% of the weight loss. Furthermore, if the decrease in dose frequency involves an appropriate increase in dose size, then approximately 100% of the weight loss is maintained. In addition, we compared offering incretin mimetics to (1) a fraction of obese US adults with q1wk dosing versus (2) twice as many obese US adults with q2wk dosing. Though scenarios (1) and (2) require the same budget, our analysis suggests that (2) reduces national obesity and mortality to a much greater degree.ConclusionOur study highlights the potential utility of alternative dosing regimens of incretin mimetics. Compared to standard once-weekly dosing, costs can be halved and weight loss maintained. These cost-saving results have implications for patients, physicians, insurers, and governments.