bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using REDCap and Apple ResearchKit to integrate patient questionnaires and clinical decision support into the electronic health record to improve sexually transmitted infection testing in the emergency department
Authors: Ahmad Fahd A , Payne Philip R O , Lackey Ian , Komeshak Rachel , Kenney Kenneth , Magnusen Brianna , Metts Christopher , Bailey Thomas 
Published: September 2019

Abstract

Objective
Audio-enhanced computer-assisted self-interviews (ACASIs) are useful adjuncts for clinical care but are rarely integrated into the electronic health record (EHR). We created a flexible framework for integrating an ACASIs with clinical decision support (CDS) into the EHR. We used this program to identify adolescents at risk for sexually transmitted infections (STIs) in the emergency department (ED). We provide an overview of the software platform and qualitative user acceptance.

Materials and Methods
We created an ACASI with a CDS algorithm to identify adolescents in need of STI testing. We offered it to 15- to 21-year-old patients in our ED, regardless of ED complaint. We collected user feedback via the ACASI. These were programmed into REDCap (Research Electronic Data Capture), and an iOS application utilizing Apple ResearchKit generated a tablet compatible representation of the ACASI for patients. A custom software program created an HL7 (Health Level Seven) message containing a summary of responses, CDS recommendations, and STI test orders, which were transmitted to the EHR.

Results
In the first year, 1788 of 6227 (28.7%) eligible adolescents completed the survey. Technical issues led to decreased use for several months. Patients rated the system favorably, with 1583 of 1787 (88.9%) indicating that they were “somewhat” or “very comfortable” answering questions electronically and 1291 of 1787 (72.2%) preferring this format over face-to-face interviews or paper questionnaires.

Conclusions
We present a novel use for REDCap to combine patient-answered questionnaires and CDS to improve care for adolescents at risk for STIs. Our program was well received and the platform can be used across disparate patients, topics, and information technology infrastructures.
DNA persistence in predator saliva from multiple species and methods for optimal recovery from depredated carcasses
Authors: Piaggio Antoinette J , Shriner Susan A , Young Julie K , Griffin Doreen L , Callahan Peggy , Wostenberg Darren J , Gese Eric M , Hopken Matthew W 
Published: September 2019

AbstractMolecular forensics is an important component of wildlife research and management. Using DNA from noninvasive samples collected at predation sites, we can identify predator species and obtain individual genotypes, improving our understanding of predator–prey dynamics and impacts of predators on livestock and endangered species. To improve sample collection strategies, we tested two sample collection methods and estimated degradation rates of predator DNA on the carcasses of multiple prey species. We fed carcasses of calves (Bos taurus) and lambs (Ovis aires) to three captive predator species: wolves (Canis lupus), coyotes (C. latrans), and mountain lions (Puma concolor). We swabbed the carcass in the field, as well as removed a piece of hide from the carcasses and then swabbed it in the laboratory. We swabbed all tissue samples through time and attempted to identify the predator involved in the depredation using salivary DNA. We found the most successful approach for yielding viable salivary DNA was removing hide from the prey and swabbing it in the laboratory. As expected, genotyping error increased through time and our ability to obtain complete genotypes decreased over time, the latter falling below 50% after 24 h. We provide guidelines for sampling salivary DNA from tissues of depredated carcasses for maximum probability of detection.
Topical Review: Enhancing Understanding of the Clinical Meaningfulness of Outcomes to Assess Treatment Benefit from Psychological Therapies for Children with Chronic Pain
Authors: Palermo Tonya M , Kashikar-Zuck Susmita , Lynch-Jordan Anne 
Published: September 2019

Abstract

Objective
Despite the availability of measures for assessing physical, psychological, and health impact in children with chronic pain, there are not established guidelines for interpretation of children’s pain outcomes following psychological treatment. The purpose of this topical review is to discuss clinical significance as a neglected area of consideration in pediatric chronic pain assessment and to make recommendations on how the field can move toward benchmarking on core outcome domains.

Method
We review definitions of clinical significance and examples of several methodologies that have been used in other populations or are emerging in pediatric chronic pain including anchor-based methods, distribution-based methods, or multimethod approaches.

Results
Few measures across pediatric chronic pain outcome domains have established clinical significance of scores to interpret meaningful change following treatment limiting the interpretability of findings from clinical trials. In the context of clinical practice, several efforts to examine clinical significance to improve the translation of evidence-based measurement into standard clinical decision-making exist.

Conclusions
Recommendations are provided to encourage additional validation efforts of outcome measures in pediatric chronic pain and to encourage authors to report clinical significance in clinical trials of psychological interventions for pediatric chronic pain.
Fractal statistics in young star clusters: structural parameters and dynamical evolution
Authors: Hetem Annibal , Gregorio-Hetem Jane 
Published: September 2019

ABSTRACT
We used fractal statistics to quantify the degree of observed substructures in a sample of 50 embedded clusters and more evolved open clusters (&lt; 100 Myr) found in different galactic regions. The observed fractal parameters were compared with N-body simulations from the literature, which reproduce star-forming regions under different initial conditions and geometries that are related to the cluster's dynamical evolution. Parallax and proper motion from Gaia-DR2 were used to accurately determine cluster membership by using the Bayesian model and cross-entropy technique. The statistical parameters $\mathcal {Q}$, $\overline{m}$ and $\overline{s}$ were used to compare observed cluster structure with simulations. A low level of substructures ($\mathcal {Q} \lt $ 0.8) is found for most of the sample that coincides with simulations of regions showing fractal dimension D ∼ 2–3. Few clusters (&lt;20 per cent) have uniform distribution with a radial density profile (α &lt; 2). A comparison of $\mathcal {Q}$ with mass segregation (ΛMSR) and local density as a function of mass (ΣLDR) shows the clusters coinciding with models that adopt supervirial initial conditions. The age–crossing time plot indicates that our objects are dynamically young, similar to the unbound associations found in the Milky Way. We conclude that this sample may be expanding very slowly. The flat distribution in the $\mathcal {Q}$–age plot and the absence of trends in the distributions of ΛMSR and ΣLDR against age show that in the first 10 Myr the clusters did not change structurally and seem not to have expanded from a much denser region.
Insights into the physics when modelling cold gas clouds in a hot plasma
Authors: Sander Bastian , Hensler Gerhard 
Published: September 2019

ABSTRACT
This paper aims at studying the reliability of a few frequently raised, but not proven, arguments for the modelling of cold gas clouds embedded in or moving through a hot plasma and at sensitizing modellers to a more careful consideration of unavoidable acting physical processes and their relevance. At first, by numerical simulations we demonstrate the growing effect of self-gravity on interstellar clouds and, by this, moreover argue against their initial set-up as homogeneous. We apply the adaptive-mesh refinement code flash with extensions to metal-dependent radiative cooling and external heating of the gas, self-gravity, mass diffusion, and semi-analytic dissociation of molecules, and ionization of atoms. We show that the criterion of Jeans mass or Bonnor–Ebert mass, respectively, provides only a sufficient but not a necessary condition for self-gravity to be effective, because even low-mass clouds are affected on reasonable dynamical time-scales. The second part of this paper is dedicated to analytically study the reduction of heat conduction by a magnetic dipole field. We demonstrate that in this configuration, the effective heat flow, i.e. integrated over the cloud surface, is suppressed by only 32 per cent by magnetic fields in energy equipartition and still insignificantly for even higher field strengths.
UBR5 interacts with the replication fork and protects DNA replication from DNA polymerase η toxicity
Authors: Cipolla Lina , Bertoletti Federica , Maffia Antonio , Liang Chih-Chao , Lehmann Alan R , Cohn Martin A , Sabbioneda Simone 
Published: September 2019

Abstract
Accurate DNA replication is critical for the maintenance of genome integrity and cellular survival. Cancer-associated alterations often involve key players of DNA replication and of the DNA damage-signalling cascade. Post-translational modifications play a fundamental role in coordinating replication and repair and central among them is ubiquitylation. We show that the E3 ligase UBR5 interacts with components of the replication fork, including the translesion synthesis (TLS) polymerase polη. Depletion of UBR5 leads to replication problems, such as slower S-phase progression, resulting in the accumulation of single stranded DNA. The effect of UBR5 knockdown is related to a mis-regulation in the pathway that controls the ubiquitylation of histone H2A (UbiH2A) and blocking this modification is sufficient to rescue the cells from replication problems. We show that the presence of polη is the main cause of replication defects and cell death when UBR5 is silenced. Finally, we unveil a novel interaction between polη and H2A suggesting that UbiH2A could be involved in polη recruitment to the chromatin and the regulation of TLS.
Structural insights into synthetic ligands targeting A–A pairs in disease-related CAG RNA repeats
Authors: Mukherjee Sanjukta , Błaszczyk Leszek , Rypniewski Wojciech , Falschlunger Christoph , Micura Ronald , Murata Asako , Dohno Chikara , Nakatani Kazuhiko , Kiliszek Agnieszka 
Published: September 2019

Abstract
The trinucleotide repeat expansion disorders (TREDs) constitute of a group of &gt;40 hereditary neurodegenerative human diseases associated with abnormal expansion of repeated sequences, such as CAG repeats. The pathogenic factor is a transcribed RNA or protein whose function in the cell is compromised. The disorders are progressive and incurable. Consequently, many ongoing studies are oriented at developing therapies. We have analyzed crystal structures of RNA containing CAG repeats in complex with synthetic cyclic mismatch-binding ligands (CMBLs). The models show well-defined interactions between the molecules in which the CMBLs mimic nucleobases as they form pseudo-canonical base pairs with adenosine residues and engage in extensive stacking interactions with neighboring nucleotides. The binding of ligands is associated with major structural changes of the CAG repeats, which is consistent with results of biochemical studies. The results constitute an early characterization of the first lead compounds in the search for therapy against TREDs. The crystallographic data indicate how the compounds could be further refined in future biomedical studies.
A Phase II Study of Neoadjuvant Stereotactic Radiosurgery for Large Brain Metastases: Clinical Trial Protocol
Authors: Takami Hirokazu , Nassiri Farshad , Moraes Fabio Y , Zadeh Gelareh , Bernstein Mark , Conrad Tatiana , Berlin Alejandro , Laperriere Normand , Millar Barbara-Ann , Shultz David Benjamin , Kongkham Paul 
Published: September 2019

Abstract

BACKGROUND
Brain metastases which require resection are treated with surgery followed by whole brain radiation therapy or postoperative cavity boost stereotactic radiosurgery (POCBS). Recently a novel strategy using neoadjuvant stereotactic radiosurgery (NaSRS) followed by resection was reported, demonstrating lower rates of postoperative leptomeningeal dissemination (LMD) and symptomatic radiation toxicity compared to a comparative cohort of patients treated with postoperative SRS.

OBJECTIVE
To determine if the rate of symptomatic radiation toxicity at 1 yr in patients who receive NaSRS differs significantly from historical rates for patients treated with POCBS.

METHODS
This is a multi-center, non-randomized, open phase II clinical trial. A total of 30 patients with up to 10 brain metastases, at least 1 of which is appropriate for surgical resection, will be enrolled for over 4 yr. All enrolled patients will be assigned to receive NaSRS followed by surgery.

EXPECTED OUTCOME
This study will clarify whether symptomatic radiation toxicity caused by NaSRS is significantly decreased compared to historical rates associated with POCBS. Secondary endpoints will include 1-yr local control (LC) of the treated lesion, 1-yr rates of LMD, median survival and 2-yr rates of progression-free and overall survival. Tertiary analyses will include correlation between LC and radiation toxicity with pretreatment clinical factors, serum markers, radiomic features, and molecular assessments of the resected tumors.

DISCUSSION
This prospective study will determine the toxicity associated with NaSRS and provide additional quantitative metrics of efficacy for future comparative trials.
Cost of Readmissions Following Anterior Cervical Discectomy and Fusion: Insights from the Nationwide Readmissions Database
Authors: Goyal Anshit , Bhandarkar Archis R , Alvi Mohammed Ali , Kerezoudis Panagiotis , Yolcu Yagiz U , Habermann Elizabeth B , Sebastian Arjun S , Bydon Mohamad 
Published: September 2019

Abstract

BACKGROUND
Postoperative readmissions are a significant driver of variation in bundled care costs associated with cervical spine surgery.

OBJECTIVE
To determine the factors predicting the cost of readmission episodes following elective anterior cervical discectomy and fusion (ACDF).

METHODS
We queried the Healthcare Cost and Utilization Project Nationwide Readmissions Database for patients undergoing elective ACDF during 2012 to 2015. Multivariable linear regression was performed to establish the factors associated with the cost of each 30-/90-d readmission episode.

RESULTS
A total of 139 877 and 113 418 patients met inclusion criteria for the evaluation of 30- and 90-d readmissions, respectively. Among these, the national rates of 30- and 90-d readmission after an elective ACDF were 3% and 6%, respectively. The median cost of a 30- and 90-d readmission episode was $6727 (IQR: $3844-$13 529) and $8507 (IQR: $4567-$17 460), respectively. Relative predictor importance analysis revealed that the number of procedures at index admission (IA), length of stay at IA, and time elapsed between index surgical admission and readmission were the top predictors of both 30- and 90-d readmission costs (all P < .001). Although cervical myelopathy accounted for only 3.6% of all 30-d readmissions, it accounted for the largest share (8%) of 30-d readmission costs.

CONCLUSION
In this analysis from a national all-payer database, we determined the factors associated with the cost of readmissions following elective ACDF. These results are important in assisting policymakers and payers with a better risk adjustment in bundled care payment systems and for surgeons in implementing readmission cost-reduction efforts.
Performance Obligations to Improve Delivery of Hospital-Initiated Smoking Cessation Interventions: A Before-and-After Evaluation
Authors: Mullen Kerri A , Walker Kathryn L , Hobler Laura A , Wells George A , Moroz Isabella A , Pipe Andrew L , Patzer Karen , Aitken Debbie A , Reid Robert D 
Published: September 2019

Abstract

Introduction
This study evaluated whether introducing performance obligations (a policy intervention) to service agreements between hospitals (n = 15) and their local health authority: (1) improved provision of an evidence-based tobacco cessation intervention (the “Ottawa Model” for Smoking Cessation) and (2) changed the quality of the cessation intervention being delivered.

Methods
Interrupted time series analysis was used to evaluate the change in the proportion of smoker patients provided the Ottawa Model 3 years before and 3 years after introducing the performance obligations. Changes in secondary outcomes related to program quality were described using mean differences, risk differences, and risk ratios, as appropriate.

Results
The proportion and number of patients provided the Ottawa Model doubled in the 3-year period following introduction of the new policy—from 3453 patients (33.7%) in the year before to 6840 patients (62.8%) in the final assessment year. This resulted in a signification slope change (+9.2%; 95% confidence interval [CI] 4.5%, 13.9%; p = .01) between the pre- and post-obligation assessment periods, signifying the policy had a positive impact on performance. Quality and effectiveness of the in-hospital intervention remained steady.

Conclusions
Implementation of performance obligations by a healthcare funder increased delivery of an evidence-based smoking cessation intervention across multiple hospitals. Given the known health and economic impacts of smoking cessation interventions, health authorities and hospitals should consider pairing adoption of systematic interventions, like the Ottawa Model, with policy to enhance reach and impact.

Implications
• The hospital-based Ottawa Model for Smoking Cessation (OMSC) intervention has been shown to increase smoking abstinence, while reducing mortality and healthcare utilization.
• The uptake of systematic, evidence-based interventions, like the OMSC, by hospitals has been relatively low despite the known positive impacts.
• The introduction of smoking cessation performance obligations by a healthcare funder resulted in more patients receiving an OMSC intervention while in hospital, with no corresponding change in intervention quality or effectiveness.
• Healthcare funders and hospitals should consider pairing the adoption of effective, systematic interventions, like the OMSC, with policy to enhance reach and impact.
First clear detection of the CCS Zeeman splitting toward the pre-stellar core, Taurus Molecular Cloud 1
Authors: Nakamura Fumitaka , Kameno Seiji , Kusune Takayoshi , Mizuno Izumi , Dobashi Kazuhito , Shimoikura Tomomi , Taniguchi Kotomi 
Published: September 2019

Abstract
We report the first clear detection of the Zeeman splitting of a CCS emission line at 45 GHz toward the nearby pre-stellar dense filament, Taurus Molecular Cloud 1 (TMC-1). We observed HC$_3$N non-Zeeman lines simultaneously with the CCS line, and did not detect any significant splitting of the HC$_3$N lines. Thus, we conclude that our detection of CCS Zeeman splitting is robust. The derived line-of-sight magnetic field strength is about $117 \pm 21 \, \mu$G, which corresponds to a normalized mass-to-magnetic flux ratio of 2.2 if we adopt an inclination angle of 45$^\circ$. Thus, we conclude that the TMC-1 filament is magnetically supercritical. Recent radiative transfer calculations of the CCS and HC$_3$N lines along the line of sight suggest that the filament is collapsing with a speed of $\sim$0.6 km s$^{-1}$, which is comparable to three times the isothermal sound speed. This infall velocity appears to be consistent with the evolution of a gravitationally infalling core.
Efficacy and Safety of Extracorporeal Shockwave Therapy for Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis
Authors: Wang Ying-Chun , Huang Hsuan-Ti , Huang Peng-Ju , Liu Zi-Miao , Shih Chia-Lung 
Published: September 2019

Abstract

Objective
The objective of this study was to assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) for treatment of knee osteoarthritis (OA) using a systemic review and meta-analysis.

Methods
An extensive search of relevant articles from electronic databases Pubmed, Embase, and Cochrane Library from inception to March 2019 was conducted. The treatment outcomes (visual analog scale [VAS] and the Western Ontario and McMaster Universities Arthritis Index [WOMAC]) of the included articles were pooled to calculate effect sizes. The assessment of heterogeneity among articles was evaluated using I2. Statistical analyses were conducted using RevMan software.

Results
The results showed that the ESWT group had significant improvement in pain relief compared with the control group through 12 months based on WOMAC and VAS scores. Compared with the baseline level, the patients had significant improvement in pain relief at most follow-up points (one week to 12 months) based on WOMAC and VAS scores. The patients showed significant improvement in physical function at six- and 12-month follow-up when compared with the control group and for all follow-up (one to 12 months) when compared with the baseline level. Additionally, only minor complications were observed after ESWT treatment.

Conclusions
The use of ESWT for treatment of knee OA had a beneficial effect on pain relief and physical function improvement for up to 12 months, and only minor complications occurred after ESWT treatment. However, there remains a lack of clarity regarding the frequency and dosage levels of ESWT required to achieve the maximum improvement.
Enhanced Itch Intensity Is Associated with Less Efficient Descending Inhibition Processing for Itch But Not Pain Attenuation in Chronic Dermatology Patients
Authors: Granot Michal , Yakov Sarit , Ramon Michal 
Published: September 2019

Abstract

Objectives
The study aims were 1) to investigate the direction of mutual inhibitory pathways on itch intensity by utilizing conditioned pain modulation paradigms for pain and itch attenuation and 2) to explore whether itch severity is affected by the individual pain sensitivity profile, as well as pain scores reported during the tests and the past week.

Design
Cross-sectional.

Setting
Testing was conducted at the Department of Dermatology, Rambam Health Care Campus.

Subjects
Forty patients suffering from chronic skin disorders associated with itch and treated in the Dermatology Clinic at Rambam Health Care Campus participated in the study.

Methods
Efficacy of descending inhibition was evaluated by two conditioned pain modulation (CPM) paradigms: by pruriception (CPMItch) induced by cold and heat as counterstimuli to inhibit itch intensity and by nociception (CPMPain). Severity and interference of clinical pain were assessed using the Brief Pain Inventory (BPI).

Results
Robust CPMItch responses were obtained following the various noxious stimulations. No associations were observed between CPMPain and CPMItch, itch severity, skin disease severity, and clinical pain symptoms. According to the linear regression model, itch severity was independently associated with less efficient CPMItch (B = –0.750, P &lt; 0.001) and more efficient CPMPain (B = 0.031, P = 0.016), which affects itch in opposing manners.

Conclusions
Findings indicate that the intrinsic capacity to inhibit pain and itch by exposure to exogenous noxious stimuli autonomously affects itch intensity in an opposing manner. These findings may shed new light on the mutual mechanistic similarity and dissimilarity between pain and itch and their hierarchy.