bluuebunny/crossref_metadata_2025_split huggingface dataset:
Income Inequities and Medicaid Expansion are Related to Racial and Ethnic Disparities in Delayed or Forgone Care Due to Cost
Authors: Clark Cheryl R. , Ommerborn Mark J. , A. Coull Brent , Pham Do Quyen , Haas Jennifer S. 
Published: March 2016

Background:
Monitoring political and social determinants of delayed or forgone care due to cost is necessary to evaluate efforts to reduce racial and ethnic disparities in access to care. Our objective was to examine the extent to which state Medicaid expansion decisions and personal household income may be associated with individual-level racial and ethnic disparities in delayed or forgone care due to cost, at baseline, before the implementation of the Affordable Care Act.

Methods:
We used 2012 Behavioral Risk Factor Surveillance System survey data to examine racial and ethnic differences in delayed or forgone care due to cost in states that do and do not plan Medicaid expansion. We examined personal household income as a social factor that could contribute to racial and ethnic disparities in delayed or forgone care.

Results:
We found that personal income differences were strongly related to disparities in delayed or forgone care in places with and without plans to expand Medicaid. In addition, while delayed or forgone care disparities between non-Hispanic whites and non-Hispanic blacks were lowest in places with plans to expand Medicaid access, disparities between non-Hispanic whites and Hispanics did not differ by state Medicaid expansion plans.

Conclusions:
As access to insurance improves for diverse groups, health systems must develop innovative strategies to overcome social determinants of health, including income inequities, as barriers to accessing care for Hispanic and non-Hispanic blacks. Additional efforts may be needed to ensure Hispanic groups achieve the benefits of investments in health care access.
Interpersonal Subtypes of Anxiety Disorder Patients
Authors: Pitman Seth R. , Hilsenroth Mark J. 
Published: March 2016

Abstract
We attempted to replicate earlier findings of interpersonal subtypes in patients with anxiety disorder (Psychotherapy. 2011;48:304–310) and examine whether these subtypes are characterized by different types of pathology and respond differently to treatment. Interpersonal problems were measured by the Inventory of Interpersonal Problems (Inventory of Interpersonal Problems Manual. San Antonio, TX: Psychological Cooperation; 2000) in a sample of 31 patients with anxiety disorder. Results demonstrated the existence of 4 interpersonal subtypes. The subtypes did not differ in severity of anxiety and global levels of symptoms at pretreatment or in Reliable Change Index of anxiety symptoms over the course of treatment. However, they were significantly different in terms of overall interpersonal problems (p = 0.004). Regarding treatment variables, half of the patients in the nonassertive cluster discontinued treatment prematurely. The number of psychotherapy sessions attended was significantly different across the 4 clusters (p = 0.04), with socially avoidant patients attending significantly greater number of sessions.
Reaching Adolescents for Prevention
Authors: Bernstein Judith , Dorfman David , Lunstead Julie , Topp Deric , Mamata Hosana , Jaffer Sara , Bernstein Edward 
Published: March 2016

Objectives
Almost 200,000 adolescents visit US emergency departments (EDs) yearly for conditions involving underage drinking but receive no follow-up referral. Other health risk behaviors resulting in sexually transmitted infections, car crashes, and assault-related injury are common among adolescents. A pediatric ED (PED) visit presents an opportunity to discuss and promote prevention. We report here on implementation of a new PED navigator/extender role, the Health Promotion Advocate (HPA).

Methods
Health Promotion Advocates surveyed patients to identify health risks, stresses, and needs. A positive screen triggered a brief conversation containing the following elements: permission to discuss risks/needs; exploration of context (a typical day in your life); brief feedback (information and norms); exploration of benefits and consequences of risk behaviors; assessment of readiness to change; calling up assets, instilling hope; discussing challenges of change; negotiating a menu of options and prescription for change; referrals to primary care, community resources; and treatment services as indicated.

Results
During 2009-2013, HPAs screened 2149 PED patients aged 14 to 21 years and referred 834 for an array of services (eg, primary care, mental health, insurance, personal safety, human immunodeficiency virus testing, general education diploma (GED), employment, housing, and food pantries) to address reported health risks; 785 screened positive for at-risk substance use (53% female, 36% without primary care). Among them, 636 received a brief intervention; 546 were referred to specialized substance abuse treatment. Two case studies are presented to illustrate the engagement and referral process.

Conclusions
Health Promotion Advocates working as PED team members can extend PED services beyond the scope of the presenting complaint.
Factors Associated With Poor Outcome in Childhood Swimming Pool Submersions
Authors: Shenoi Rohit P. , Koerner Christine E. , Cruz Andrea T. , Frost Mary H. , Jones Jennifer L. , Camp Elizabeth A. , Alam Sartaj , Fraser John J. 
Published: March 2016

Objectives
The aims of the study were to determine factors associated with poor outcome in childhood swimming pool submersions and to study the association of bystander resuscitation with clinical outcome.

Methods
This was a retrospective study of swimming pool submersion victims younger than 18 years in a metropolitan area from 2003 to 2007. Submersion, prehospital, and victim data were obtained from hospital, Emergency Medical Services, and fatality records. Outcome based on survival at hospital discharge was favorable (baseline/mild impairment) or poor (death/severe impairment). Logistic regression determined factors associated with poor outcome.

Results
There were 260 submersions. Outcomes were available for 211 (81%). The median age was 4 years; 68% were males. Most incidents occurred at single residential pools (48%) and multiresidential pools (35%). Mortality was 23%; 75% had favorable outcomes. Favorable outcomes occurred in 8.6% (3/35) of victims with absent pulse at the scene. Descriptive analyses revealed significant differences in submersions that occurred on weekdays, during the summer, submersions lasting 5 minutes or more, with on-scene apnea or cardiac arrest needing cardiopulmonary resuscitation, rescuer type, and transfer to tertiary care. Logistic regression revealed that poor outcome was significantly associated with prolonged submersions and those that occurred on a weekday. Furthermore, hospitalization reduced the odds of a poor outcome by 81% when compared with victims who were not hospitalized. Bystander resuscitation was not significantly associated with outcome.

Conclusions
Childhood swimming pool submersions, which occur on weekdays and with prolonged submersion times, are associated with poor outcome. Bystander resuscitation is not significantly associated with outcome.
The Utility of Cranial Ultrasound for Detection of Intracranial Hemorrhage in Infants
Authors: Elkhunovich Marsha , Sirody Joseph , McCormick Taylor , Goodarzian Fariba , Claudius Ilene 
Published: March 2016

Objective
The objective of this study was to evaluate the sensitivity and specificity of cranial ultrasound (CUS) for detection of intracranial hemorrhage (ICH) in infants with open fontanels.

Methods
This was a retrospective study of infants younger than 2 years who had a CUS performed for the evaluation of potential ICH. We excluded patient with CUSs that were done for reasons related to prematurity, transplant or oncologic evaluations, routine follow-up or preoperative screen, or congenital and known perinatal anomalies. Two clinicians independently classified each of the patients with ICH into significant or insignificant based on the radiology reports.

Results
Of 4948 CUS studies performed during the 5-year study period, 283 studies fit the inclusion criteria. Patient age ranged from 0 to 458 days, with a median of 33 days. There were 39 total cases of ICH detected, with 27 significant bleeds and 12 insignificant bleeds. Using computed tomography, magnetic resonance imaging, or clinical outcome as criterion standard, the overall ultrasound sensitivity and specificity for bleed were 67% (confidence interval [CI], 50%–81%) and 99% (CI, 97%–100%), respectively. For those with significant bleeds, the overall sensitivity was 81% (CI, 62%–94%), and for those with insignificant bleeds, it was 33% (CI, 1%–65%).

Conclusions
The sensitivity of CUS is inadequate to justify its use as a screening tool for detection of ICH in young infants.
Hospital Quality and Performance of a Complex Surgical Procedure after Traumatic Digit Amputation
Authors: Swiatek Peter R. , Pandit Anita , Chung Kevin C. , Mahmoudi Elham 
Published: March 2016

Background:
Traumatic digit amputations are prevalent injuries that have long-term disabling consequences. Although replantation after traumatic digit amputation is a complex procedure, the aesthetic, functional, and long-term economic benefits of replantation render it preferable to revision amputation when clinically indicated. The authors adapted the Donabedian quality-of-care conceptual framework to examine the association between hospital outcome quality measured by observed-to-expected mortality ratio and the treatment received after traumatic digit amputation. The authors hypothesized that the probability of undergoing replantation is higher in hospitals with lower observed-to-expected mortality ratios.

Methods:
Data from 106 qualified Level I and II trauma centers included in the 2007 to 2012 National Trauma Data Bank were used to estimate hospital-specific observed-to-expected mortality ratio. The authors then used a two-level logistic hierarchical model, adjusting for patient, clinical, and hospital characteristics, to examine whether observed-to-expected mortality ratio, as one of the commonly used hospital quality measures, is a predictor of the treatment received for 4169 patients with traumatic digit amputation.

Results:
Compared with trauma centers with high observed-to-expected mortality ratios, the probability of undergoing replantation was substantially higher in trauma centers with low observed-to-expected mortality ratios (OR, 5.09; 95 percent CI, 2.51 to 10.30; p < 0.001). Seeking care at hospitals with more than 400 beds increased the probability of digit replantation (OR, 2.08; 95 percent CI, 1.08 to 4.01; p = 0.029). Having no insurance decreased the odds of undergoing replantation (OR, 0.70; 95 percent CI, 0.53 to 0.91; p = 0.009).

Conclusions:
Hospital observed-to-expected mortality ratio was the greatest predictor of undergoing replantation after digit amputation injury. The observed-to-expected mortality ratio, as an outcome measure of hospital quality, is an important predictor of the treatment received.
Expenditures for Persons Living With HIV Enrolled in Medicaid, 2006–2010
Authors: Fleishman John A. , Monroe Anne K. , Voss Cindy C. , Moore Richard D. , Gebo Kelly A. 
Published: March 2016

Background:
Costs of care for persons living with HIV have been high historically. Cost estimates based on data from 1 health care site may underestimate total expenditures; using insurance claims avoids this limitation. We used Medicaid claims data to comprehensively assess payments for care for persons living with HIV between 2006 and 2010.

Methods:
Five sites from the HIV Research Network (HIVRN) provided information on patients with Medicaid coverage. Medicaid data were obtained from the sites' states (MD, NY, and MA) and 3 surrounding states and matched to HIVRN medical record–based data. Individuals less than 18, those with Medicare, and those in Medicaid managed care plans were excluded. Medicaid and HIVRN data were compared to ascertain concordance in capturing any inpatient event and any antiretroviral (ART) medication use.

Results:
Of 6892 unique HIVRN identifiers, 6196 (90%) were linked to Medicaid data. The analytic sample included 11,341 person-years of Medicaid claims data from 3695 individuals in fee-for-service (FFS) programs. The mean annual FFS payment for all services was $47,434; mean annual FFS payment for only medical services was $38,311. Concordance between Medicaid and HIVRN data was excellent for ART use, but HIVRN data did not record a substantial proportion of years in which Medicaid recorded inpatient use.

Conclusions:
Estimated Medicaid payment amounts in this study are higher than some previous estimates. More complete capture of expensive inpatient hospitalizations in Medicaid data may partially explain this finding. Although inpatient care and ART medications contribute the most, expenditures for nonmedical services are substantial.
Poorly Controlled HIV Infection: An Independent Risk Factor for Liver Fibrosis
Authors: Kim H. Nina , Nance Robin , Van Rompaey Stephen , Delaney Joseph C. , Crane Heidi M. , Cachay Edward R. , Geng Elvin , Boswell Stephen L. , Rodriguez Benigno , Eron Joseph J. , Saag Michael , Moore Richard D. , Kitahata Mari M. 
Published: March 2016

Background:
Liver disease is a major cause of mortality among HIV-infected persons. There is limited information about the extent to which HIV disease severity impacts liver disease progression.

Methods:
We determined the incidence and predictors of advanced hepatic fibrosis measured by the Fibrosis-4 index (≥3.25) in a large diverse population of HIV-infected patients without significant liver disease at baseline (Fibrosis-4 score <1.45) in care between January 2000 and March 2014. We used Cox proportional hazards analysis to examine factors associated with progression to Fibrosis-4 score ≥3.25.

Results:
Among 14,198 HIV-infected patients, hepatitis C virus (HCV) coinfection [adjusted hazard ratio (aHR) 1.9, 95% confidence interval (CI): 1.6 to 2.1], hepatitis B virus coinfection (aHR 1.5, 95% CI: 1.2 to 1.8), alcohol-use disorder (aHR 1.4, 95% CI: 1.2 to 1.6), and diabetes (aHR 1.9, 95% CI: 1.6 to 2.3) were associated with progression to advanced fibrosis in multivariable analysis. In addition, patients at each lower level of time-varying CD4 cell count had a significantly greater risk of progression, with ∼7-fold higher risk in those with CD4 <100 cells per cubic millimeter (aHR 6.9, 95% CI: 5.8 to 8.3) compared with CD4 ≥500 cells per cubic millimeter. An increasing gradient of risk was also observed among patients with higher time-varying HIV viral load (VL), with the greatest risk noted with VL ≥100,000 copies per milliliter (aHR 2.6, 95% CI: 2.2 to 3.1) compared with VL <500 copies per milliliter.

Conclusions:
Lower CD4 cell count and higher HIV VL were significantly associated with progression to advanced hepatic fibrosis in a dose-dependent manner, independent of the risk associated with traditional factors: hepatitis C virus or hepatitis B virus coinfection, alcohol, and diabetes. Our findings suggest that early treatment of HIV infection could mitigate liver disease.
PrEP Adherence Patterns Strongly Affect Individual HIV Risk and Observed Efficacy in Randomized Clinical Trials
Authors: Dimitrov Dobromir T. , Mâsse Benoît R. , Donnell Deborah 
Published: March 2016

Background:
Randomized controlled trials (RCTs) suggest that the efficacy of tenofovir-based preexposure prophylaxis (PrEP) strongly depends on the consistency of PrEP use. We explore how the patterns of pill taking and waning of PrEP protection may affect PrEP efficacy for HIV prevention.

Methods:
A 2-arm RCT was simulated by mathematical models assuming that the prescribed daily doses were skipped periodically, randomly, or in large blocks. Risk-driven adherence, in which PrEP was taken when sex was expected, was also investigated. Three temporal PrEP protection profiles were explored: long (5 days), intermediate (3 days), and short (24 hours). Modeling results were compared to the efficacy observed in completed RCTs.

Results:
The expected PrEP efficacy was 60% with periodic, 50% with random, and 34% with block adherence when PrEP had a long protection profile and pills were taken only 50% of the days. Risk-driven pill taking resulted in 29% and 37% daily pills taken and efficacy of 43% and 51%, respectively, for long protection. High PrEP efficacy comparable with that observed in Partners PrEP and Centers for Disease Control and Prevention Botswana trials was simulated under long protection, high overall adherence, and limited block pill taking; the moderate efficacy observed in iPrEx and Bangkok trials was comparable with the 50% adherence scenarios under random pill taking and long protection.

Conclusions:
Pill-taking patterns may have a substantial impact on the protection provided by PrEP even when the same numbers of pills are taken. When PrEP retains protection for longer than a day, pill-taking patterns can explain a broad range of efficacies observed in PrEP RCTs.
Temporal Trends and Geographic Variations in Dementia Mortality in China Between 2006 and 2012
Authors: Yin Peng , Feng Xiaoqi , Astell-Burt Thomas , Page Andrew , Liu Jiangmei , Liu Yunning , Liu Shiwei , Wang Lijun , Wang Limin , Zhou Maigeng 
Published: March 2016

Objectives:
We aimed to explore the temporal trends and geographic variations in dementia mortality in China.

Materials and Methods:
Annual dementia mortality counts (years 2006 to 2012) in 161 counties and districts (Disease Surveillance Points, DSP) were extracted from the nationally representative China Mortality Surveillance System and stratified by 5-year age group (aged >65), sex, and time. These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in dementia mortality.

Results:
Dementia mortality varied over 2-fold between DSPs (median rate ratio: 2.59). Significant variation in DSP slopes through time (variance 0.075, SE 0.020) indicated spatiotemporal variations. Mortality rates were significantly higher in the east (rate ratio 2.28; 95% confidence intervals, 1.45-3.60) compared with the north. There was a declining trend in 2 (east and northwest) of the 7 regions. Dementia mortality decreased by 15% in urban areas but increased by 24% in rural areas.

Conclusions:
Our findings indicate that regional inequalities in dementia mortality are salient, and the increase in mortality rates in rural areas is an emerging public health challenge in China. Tailored preventive health strategies should be in place to narrow down this avoidable and wholly unnecessary inequality.
Mechanisms for action prediction operate differently in observers with motor experience
Authors: Colling Lincoln J , Thompson William F , Sutton John 
Published: March 2016

AbstractRecent theoretical and empirical work has suggested an important role for the motor system in generating predictions about the timing of external events. We tested the hypothesis that motor experience with an observed action changes how observers generated predictions about these actions by comparing the performance of naïve and experienced observers on a task that required participants to predict the timing of particular critical points in an ongoing observed action. Crucially, we employed action and non-action stimuli with identical temporal dynamics, and we predicted that motor experience would enhance prediction accuracy specifically for actions and would have a reduced or negligible effect on enhancing prediction accuracy for non-action stimuli. Our results showed that motor experience did modulate prediction accuracy for action stimuli relative to non-action stimuli. No difference between conditions was observed for the naïve observers.
Quantification of Focal Outflow Enhancement using Differential Canalograms
Authors: Loewen Ralitsa T. , Brown Eric N. , Scott Gordon , Parikh Hardik , Schuman Joel S. , Loewen Nils A. 
Published: March 2016

AbstractPurpose:To quantify regional changes of conventional outflow caused by ab interno trabeculectomy (AIT).Methods:Gonioscopic, plasma-mediated ab interno trabeculectomy (AIT; Trabectome, Neomedix, Tustin, CA) was established in enucleated pig eyes. We developed a program to automatically quantify outflow changes (R, package eye-canalogram, github.com) using a fluorescent tracer reperfusion technique. Trabecular meshwork (TM) ablation was demonstrated with fluorescent spheres in 6 eyes before formal outflow quantification with two dye reperfusion canalograms in 6 further eyes. Eyes were perfused with a central, intracameral needle at 15 mmHg. Canalograms and histology were correlated for each eye.Results:The pig eye provided a model with high similarity to AIT in human patients. Histology indicated ablation of TM and unroofing of most Schlemm’s canal segments. Spheres highlighted additional circumferential and radial outflow beyond the immediate area of ablation. Differential canalograms showed that AIT caused an increase of outflow of 17±5 fold inferonasally (IN), 14±3 fold superonasally (SN) and also an increase in the opposite quadrants with a 2±1 fold increase superotemporally (ST) and 3±3 inferotemporally (IT). Perilimbal specific flow image analysis showed an accelerated nasal filling with an additional perilimbal flow direction into adjacent quadrants.Conclusion:A quantitative, differential canalography technique was developed that allows to quantify supraphysiological outflow enhancement by AIT.
Automated SWATH Data Analysis Using Targeted Extraction of Ion Chromatograms
Authors: Röst Hannes L. , Aebersold Ruedi , Schubert Olga T. 
Published: March 2016

SummaryTargeted mass spectrometry comprises a set of methods able to quantify protein analytes in complex mixtures with high accuracy and sensitivity. These methods, e.g., Selected Reaction Monitoring (SRM) and SWATH MS, use specific mass spectrometric coordinates (assays) for reproducible detection and quantification of proteins. In this protocol, we describe how to analyze in a targeted manner data from a SWATH MS experiment aimed at monitoring thousands of proteins reproducibly over many samples. We present a standard SWATH MS analysis workflow, including manual data analysis for quality control (based on Skyline) as well as automated data analysis with appropriate control of error rates (based on the OpenSWATH workflow). We also discuss considerations to ensure maximal coverage, reproducibility and quantitative accuracy.
Connecting the sequence-space of bacterial signaling proteins to phenotypes using coevolutionary landscapes
Authors: Cheng R. R. , Nordesjö O. , Hayes R. L. , Levine H. , Flores S. C. , Onuchic J. N. , Morcos F. 
Published: March 2016

AbstractTwo-component signaling (TCS) is the primary means by which bacteria sense and respond to the environment. TCS involves two partner proteins working in tandem, which interact to perform cellular functions while limiting interactions with non-partners (i.e., “cross-talk”). We construct a Potts model for TCS that can quantitatively predict how mutating amino acid identities affect the interaction between TCS partners and non-partners. The parameters of this model are inferred directly from protein sequence data. This approach drastically reduces the computational complexity of exploring the sequence-space of TCS proteins. As a stringent test, we compare its predictions to a recent comprehensive mutational study, which characterized the functionality of 204mutational variants of the PhoQ kinase inEscherichia coli. We find that our best predictions accurately reproduce the amino acid combinations found in experiment, which enable functional signaling with its partner PhoP. These predictions demonstrate the evolutionary pressure to preserve the interaction between TCS partners as well as prevent unwanted “crosstalk”. Further, we calculate the mutational change in the binding affinity between PhoQ and PhoP, providing an estimate to the amount of destabilization needed to disrupt TCS.