bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financial Viability of Emergency Department Observation Unit Billing Models
Authors: Baugh Christopher W. , Suri Pawan , Caspers Christopher G. , Granovsky Michael A. , Neal Keith , Ross Michael A. 
Published: May 2018

AbstractBackgroundOutpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition‐specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs, and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a “two‐service” model of separate professional billing for both emergency and observation services. The majority of EDOUs use the “one‐service” model, where a single composite professional fee is billed for both emergency and observation services. The financial implications of these models are not well understood.MethodsWe created a Monte Carlo simulation by building a model that reflects current clinical practice in the United States and uses inputs gathered from the most recently available peer‐reviewed literature, national survey, and payer data. Using this simulation, we modeled annual staffing costs and payments for professional services under two common models of care in an EDOU. We also modeled cash flows over a continuous range of daily EDOU patient encounters to illustrate the dynamic relationship between costs and revenue over various staffing levels.ResultsWe estimate the mean (±SD) annual net cash flow to be a net loss of $315,382 (±$89,635) in the one‐service model and a net profit of $37,569 (±$359,583) in the two‐service model. The two‐service model is financially sustainable at daily billable encounters above 20, while in the one‐service model, costs exceed revenue regardless of encounter count. Physician cost per hour and daily patient encounters had the most significant impact on model estimates.ConclusionsIn the one‐service model, EDOU staffing costs exceed payments at all levels of patient encounters, making a hospital subsidy necessary to create a financially sustainable practice. Professional groups seeking to staff and bill for both emergency and observation services are seldom able to do so due to EDOU size limitations and the regulatory hurdles that require setting up a separate professional group for each service. Policymakers and health care leaders should encourage universal adoption of EDOUs by removing restrictions and allowing the two‐service model to be the standard billing option. These findings may inform planning and policy regarding observation services.
Emotional hyper‐reactivity and cardiometabolic risk in remitted bipolar patients: a machine learning approach
Authors: Dargél A. A. , Roussel F. , Volant S. , Etain B. , Grant R. , Azorin J.‐M. , M'Bailara K. , Bellivier F. , Bougerol T. , Kahn J.‐P. , Roux P. , Aubin V. , Courtet P. , Leboyer M. ,   the FACE‐BD Collaborators, Kapczinski F. , Henry C. 
Published: May 2018

ObjectiveRemitted bipolar disorder (BD) patients frequently present with chronic mood instability and emotional hyper‐reactivity, associated with poor psychosocial functioning and low‐grade inflammation. We investigated emotional hyper‐reactivity as a dimension for characterization of remitted BD patients, and clinical and biological factors for identifying those with and without emotional hyper‐reactivity.MethodA total of 635 adult remitted BD patients, evaluated in the French Network of Bipolar Expert Centers from 2010–2015, were assessed for emotional reactivity using the Multidimensional Assessment of Thymic States. Machine learning algorithms were used on clinical and biological variables to enhance characterization of patients.ResultsAfter adjustment, patients with emotional hyper‐reactivity (n = 306) had significantly higher levels of systolic and diastolic blood pressure (P < 1.0 × 10−8), high‐sensitivity C‐reactive protein (P < 1.0 × 10−8), fasting glucose (P < 2.23 × 10−6), glycated hemoglobin (P = 0.0008) and suicide attempts (P = 1.4 × 10−8). Using models of combined clinical and biological factors for distinguishing BD patients with and without emotional hyper‐reactivity, the strongest predictors were: systolic and diastolic blood pressure, fasting glucose, C‐reactive protein and number of suicide attempts. This predictive model identified patients with emotional hyper‐reactivity with 84.9% accuracy.ConclusionThe assessment of emotional hyper‐reactivity in remitted BD patients is clinically relevant, particularly for identifying those at higher risk of cardiometabolic dysfunction, chronic inflammation, and suicide.
Effects of management regimes on structure, composition and diversity of seasonally inundated herbaceous communities in the Mkomazi National Park, Tanzania
Authors: Nyakunga Oliver Castor , Del Vecchio Silvia , Buffa Gabriella 
Published: May 2018

AbstractThe effects of management regimes on structural composition and diversity of seasonally inundated herbaceous communities were investigated in the Mkomazi National Park, Tanzania. Three sites were selected based on management regimes, that is “fire‐grazing” (FG), “fire‐no grazing” (FNG) and “no fire‐no grazing” (NFNG), and sampled in the 2015 wet season. The studied vegetation parameters resulted significantly different across the sites, with the exceptions of species abundance betweenNFNGversusFGandNFNGversusFNGsites and species evenness, which remained constant among sites. A significantly higher species richness, Shannon diversity Index, standing biomass and percentage vegetation cover was detected atFNGsite, than in the other sites. No significant differences arose when comparingFGandNFNGsites. Although the responses we found may in part be caused by confounding underlying variables such as variation in soil type, soil moisture or elevation, the patterns found may contribute to a more general understanding of the effects of management regimes in seasonally inundated savannah, as well as to sound approaches in environmental conservation and management. However, further research is needed to support our findings, replicating the study in other areas under the same or similar management conditions and in a wider array of ecosystems.
Validation of a computerized algorithm to quantify fetal heart rate deceleration area
Authors: Gyllencreutz Erika , Lu Ke , Lindecrantz Kaj , Lindqvist Pelle G. , Nordstrom Lennart , Holzmann Malin , Abtahi Farhad 
Published: May 2018

AbstractIntroductionReliability in visual cardiotocography interpretation is unsatisfying, which has led to the development of computerized cardiotocography. Computerized analysis is well established for antenatal fetal surveillance but has yet not performed sufficiently during labor. We aimed to investigate the capacity of a new computerized algorithm compared with visual assessment in identifying intrapartum fetal heart rate baseline and decelerations.Material and methodsIn all, 312 intrapartum cardiotocography tracings with variable decelerations were analyzed by the computerized algorithm and visually examined by two observers, blinded to each other and the computer analysis. The width, depth and area of each deceleration was measured. Four cases (>100 variable decelerations) were subjected to in‐depth detailed analysis. The outcome measures were bias in seconds (width), beats per minute (depth), and beats (area) between computer and observers using Bland–Altman analysis. Interobserver reliability was determined by calculating intraclass correlation and Spearman rank analysis.ResultsThe analysis (312 cases) showed excellent intraclass correlation (0.89–0.95) and very strong Spearman correlation (0.82–0.91). The detailed analysis of >100 decelerations in four cases revealed low bias between the computer and the two observers; width 1.4 and 1.4 seconds, depth 5.1 and 0.7 beats per minute, and area 0.1 and –1.7 beats. This was comparable to the bias between the two observers: 0.3 seconds (width), 4.4 beats per minute (depth) and 1.7 beats (area). The intraclass correlation was excellent (0.90–.98).ConclusionA novel computerized algorithm for intrapartum cardiotocography analysis is as accurate as gold standard visual assessment, with high correlation and low bias.
Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection
Authors: Bentley Jason P. , Burgner David P. , Shand Antonia W. , Bell Jane C. , Miller Jessica E. , Nassar Natasha 
Published: May 2018

AbstractIntroductionInfections are a leading cause of mortality and morbidity in preschool children. We aimed to assess the impact of the co‐occurrence of cesarean section, early birth and formula feeding on hospitalization with infection in early childhood.Material and methodsPopulation‐based retrospective record‐linkage cohort study of 488 603 singleton livebirths ≥32 weeks’ gestational age in New South Wales, Australia, 2007–2012. Multivariable Cox‐regression was used to estimate independent and combined adjusted associations of gestational age, mode of birth (vaginal or cesarean section by labor onset) and formula feeding with time to first and repeat hospitalization with infection for children less than five years of age.ResultsIn all, 95 346 (19.5%) children were hospitalized with infection, and of these 24.8% (23 615) more than once. Median age at first and repeat hospitalization was 1.1 and 1.7 years, respectively. Earlier gestation, modes of birth other than spontaneous vaginal, and formula feeding were independently associated with an increased risk of first and repeat hospitalization with infection. At 32–36 weeks’ gestation, co‐occurrence of perinatal factors (cf. spontaneous vaginal birth at 39+ weeks without formula feeding) was associated with a 2‐fold and 1.5‐fold increased risk of first and repeat hospitalization, respectively. For births at 37–38 weeks, the increased risk was 1.5‐fold and 1.25‐fold for first and repeat hospitalization, respectively.ConclusionsCesarean section, labor induction, birth at <39 weeks and formula feeding increase the risk of infection‐related hospitalization in childhood, which increases further when these factors co‐occur. Reducing early planned birth and supporting breastfeeding are potentially cost‐effective approaches to reducing the risk of hospitalization.
Effects of colostrum whey on immune function in the digestive tract of goats
Authors: Matsukawa Shoko , Ueno Kazutoshi , Sugino Toshihisa , Yoshimura Yukinori , Isobe Naoki 
Published: May 2018

AbstractThe objective of the present study is to examine whether colostrum whey can have an effect on immune function in goats digestive tract. Two milliliters of colostrum whey (colostrum group) or water (control group) were administrated orally to goats every day for 3 weeks. Blood was collected twice a week for 3 weeks to measure immunoglobulin A (IgA), interleukin 8 (IL‐8), and IL‐10. At the end of the experimental period, the parotid glands, oral mucosa, lingua, esophagus, jejunum, and ileum were collected for immunohistochemical detection of IgA, cathelicidin‐7, and S100A8. The ratio of the length of IgA‐positive mucosal surface in the esophagus to the total esophageal length was significantly greater in the colostrum group than in the control group. The number of IgA‐positive cells in the labial gland and ileum in the colostrum group was significantly higher than that in the control group. There were no significant differences between the colostrum and control groups in the number of cathelicidin‐7‐positive cells in the jejunum and ileum and in the number of S100A8‐positive cells in the lingua, jejunum, and ileum. These results suggest that colostrum stimulates the recruitment of plasma cells into the labial gland, which then secrete more IgA into the saliva.
How do we manage iron deficiency after blood donation?
Authors: Kiss Joseph E. , Vassallo Ralph R. 
Published: May 2018

SummaryBlood donors and the RBCs and other components they willingly provide are essential in the delivery of healthcare in all parts of the world. Nearly 70% of donated blood comes from repeat or committed donors. The amount of iron removed in the 10 min or so it takes to withdraw a unit of blood (500 ml, plus 25 ml for testing) requires over 24 weeks to replace on a “standard” diet, i.e., without added iron in the form of supplements The cumulative effect of repeat blood donations without adequate iron replacement or a longer wait between donations results in iron deficiency (ID) in many donors, low haemoglobin deferral (~8% of donation attempts), and frank anaemia in some. Moreover, ID can be associated with side effects that can impact a blood donor's health, such as fatigue, cognitive changes and other neuromuscular symptoms. In an effort to better identify and prevent ID, blood collection agencies are recommending various strategies, including changes in the donation interval, donation frequency, testing of iron status and iron supplementation. In this review, we present the evidence basis for these strategies and suggest our own approaches to improving iron balance in blood donors.
Azacitidine in the ‘real‐world’: an evaluation of 1101 higher‐risk myelodysplastic syndrome/low blast count acute myeloid leukaemia patients in Ontario, Canada
Authors: Mozessohn Lee , Cheung Matthew C. , Fallahpour Saber , Gill Tripat , Maloul Asmaa , Zhang Liying , Lau Olivia , Buckstein Rena 
Published: May 2018

SummaryThe outcome of myelodysplastic syndrome (MDS) patients with uniformly higher‐risk disease treated with azacitidine (AZA) in the ‘real‐world’ remains largely unknown. We evaluated 1101 consecutive higher‐risk MDS patients (International Prognostic Scoring System intermediate‐2/high) and low‐blast count acute myeloid leukaemia (AML; 21–30% blasts) patients treated in Ontario, Canada. By dosing schedule, 24·7% received AZA for seven consecutive days, 12·4% for six consecutive days and 62·9% by 5‐2‐2. Overall, median number of cycles was 6 (range 1–67) and 8 (range 6–14) when restricted to the 692 (63%) patients who received at least 4 cycles. The actuarial median survival was 11·6 months [95% confidence interval (CI) 10·7–12·4) for the entire cohort and 18·0 months (landmark analysis; 95% CI 16·6–19·1 months) for those receiving at least 4 cycles. There was no difference in overall survival (OS) between the 3 dosing schedules (P = 0·87). In our large ‘real‐world’ evaluation of AZA in higher‐risk MDS/low‐blast count AML, we demonstrated a lower than expected OS. Reassuringly, survival did not differ by dosing schedules. The OS was higher in the 2/3 of patients who received at least 4 cycles of treatment, reinforcing the necessity of sustained administration until therapeutic benefits are realised. This represents the largest ‘real‐world’ evaluation of AZA in higher‐risk MDS/low‐blast count AML.
JAK2 V617F‐positive acute myeloid leukaemia (AML): a comparison between de novo AML and secondary AML transformed from an underlying myeloproliferative neoplasm. A study from the Bone Marrow Pathology Group
Authors: Aynardi Jason , Manur Rashmi , Hess Paul R. , Chekol Seble , Morrissette Jennifer J. D. , Babushok Daria , Hexner Elizabeth , Rogers Heesun J. , Hsi Eric D. , Margolskee Elizabeth , Orazi Attilio , Hasserjian Robert , Bagg Adam 
Published: May 2018

SummaryThe JAK2 V617F mutation is characteristic of most Philadelphia chromosome‐negative myeloproliferative neoplasms (MPNs) and occurs rarely in de novo acute myeloid leukaemia (AML). We sought to characterize AMLs that harbour this mutation and distinguish those that arise de novo (AML‐DN) from those that reflect transformation of an underlying MPN (AML‐MPN). Forty‐five patients with JAK2 V617F‐mutated AML were identified; 15 were AML‐DN and 30 were AML‐MPN. AML‐MPN cases were more likely to have splenomegaly (P = 0·02), MPN‐like megakaryocytes and higher mean JAK2 V617F VAF at diagnosis (P = 0·04). Mutations involving TET2 were exclusively identified in AML‐DN patients. Mutations of genes affecting DNA methylation were more common in AML‐DN (P < 0·01). A complex karyotype was more frequent in AML‐MPN cases than in AML‐DN (P < 0·01), with AML‐DN more likely to display a normal karyotype (P = 0·02). Bone marrow histology after recovery from induction chemotherapy in AML‐DN cases revealed no morphological evidence of any previously occult MPNs, while this was evident in most of the AML‐MPN specimens (P < 0·01). These findings in this largest study of JAK2 V617F‐mutated AMLs indicate that AML‐DN is distinct from AML‐MPN.
Romiplostim for the management of perioperative thrombocytopenia
Authors: Al‐Samkari Hanny , Marshall Ariela L. , Goodarzi Katayoon , Kuter David J. 
Published: May 2018

SummaryThrombocytopenic patients requiring invasive surgery have few options to improve their platelet count preoperatively. This is a single‐centre, retrospective review of thrombocytopenic patients receiving the thrombopoietin receptor agonist romiplostim perioperatively to allow for surgical interventions. Patient characteristics, romiplostim use, and surgical and safety outcomes (bleeding, thrombosis, transfusions) were collected and analysed. Forty‐seven patients underwent 51 surgical procedures (ranging from total hip arthroplasty to open cardiac surgery) with romiplostim support. Thrombocytopenia aetiologies included immune thrombocytopenia, chronic liver disease, haematological malignancy, drug‐related thrombocytopenia, and hereditary thrombocytopenia. Median (range) platelet counts improved, from 47 × 109/l (9–120 × 109/l) at romiplostim initiation to 164 × 109/l (28–603 × 109/l) at the time of surgery (P < 0·0001). A dose of 3 μg/kg per week for 2 doses increased the platelet count to >100 × 109/l in 79% of patients within 14 days. In 96% of cases, surgery proceeded on schedule without delay or cancellation. Four patients had bleeding events unrelated to thrombocytopenia and 1 patient developed deep venous thrombosis. Six patients required red cell transfusion and 3 patients required platelet transfusion perioperatively. In conclusion, romiplostim was effective in increasing platelet counts to allow surgery to proceed safely and on schedule. Bleeding and thromboembolic events were within acceptable limits for this surgical population.
Assessing preschoolers interactive behaviour: A validation study of the “Coding System for Mother–Child Interaction”
Authors: Baiao R. , Baptista J. , Carneiro A. , Pinto R. , Toscano C. , Fearon P. , Soares I. , Mesquita A. R. 
Published: May 2018

AbstractBackgroundThe preschool years are a period of great developmental achievements, which impact critically on a child's interactive skills. Having valid and reliable measures to assess interactive behaviour at this stage is therefore crucial. The aim of this study was to describe the adaptation and validation of the child coding of the Coding System for Mother–Child Interactions and discuss its applications and implications in future research and practice.MethodsTwo hundred twenty Portuguese preschoolers and their mothers were videotaped during a structured task. Child and mother interactive behaviours were coded based on the task. Maternal reports on the child's temperament and emotional and behaviour problems were also collected, along with family psychosocial information.ResultsInterrater agreement was confirmed. The use of child Cooperation, Enthusiasm, and Negativity as subscales was supported by their correlations across tasks. Moreover, these subscales were correlated with each other, which supports the use of a global child interactive behaviour score. Convergent validity with a measure of emotional and behavioural problems (Child Behaviour Checklist 1 ½–5) was established, as well as divergent validity with a measure of temperament (Children's Behaviour Questionnaire–Short Form). Regarding associations with family variables, child interactive behaviour was only associated with maternal behaviour.ConclusionsFindings suggest that this coding system is a valid and reliable measure for assessing child interactive behaviour in preschool age children. It therefore represents an important alternative to this area of research and practice, with reduced costs and with more flexible training requirements. Attention should be given in future research to expanding this work to clinical populations and different age groups.
Infant Motor Development in Autism Spectrum Disorder: A Synthesis and Meta‐analysis
Authors: West Kelsey L. 
Published: May 2018

Studies of infant motor development in autism spectrum disorder (ASD) have increased in recent years. This article synthesized this literature through meta‐analysis to assess (a) whether infant motor ability differs in ASD relative to neurotypical controls; and (b) whether motor ability and communication are related in infants with ASD. Study 1 aggregated data from 1,953 infants with ASD (ages 3.0–42.0 months), and Study 2 included 890 infants with ASD (age 6.0–42.9 months). Study 1 revealed that infant motor ability differed significantly in ASD compared with neurotypical infants—this difference was robust to variation in measurement and design. Furthermore, this group difference amplified as age increased. Study 2 indicated that within ASD, infant motor ability and communication are related.
Ethnicity, migration status and dental caries experience among adults in East London
Authors: Delgado‐Angulo Elsa K. , Marcenes Wagner , Harding Seeromanie , Bernabé Eduardo 
Published: May 2018

AbstractObjectiveTo assess the interrelationship between ethnicity, migration status and dental caries experience among adults in East London.MethodsWe analysed data from 1910 adults (16‐65 years) representing 9 ethnic groups, who took part in a community‐based health survey in East London. Participants completed a supervised questionnaire and were clinically examined by trained dentists. Dental caries was assessed with the number of decayed, missing and filled teeth (DMFT). The association of ethnicity, nativity status and migration history with DMFT was assessed in negative binomial regression models controlling for demographic, socioeconomic and behavioural factors.ResultsWhite migrants had greater DMFT than UK‐born adults, whereas every Asian and Black migrant group had lower DMFT than adults of the same ethnic group born in the UK (albeit significant only for Black Caribbean and Asian Others). Among foreign‐born adults, age at arrival (Rate Ratio: 1.03; 95% Confidence Interval: 1.01‐1.05) and length of residence (1.04; 95% CI: 1.02‐1.06) were positively associated with DMFT. A significant interaction between both factors was also found, with more pronounced differences between older and younger migrants at longer stay in the UK for White Others, Black Caribbean and Asian Others.ConclusionLarge inequalities in caries experience were found between foreign‐ and UK‐born adults, with considerable variation across ethnic groups. Looking beyond cultural explanations, in favour of social and environmental factors, may help to explain those inequalities.