bluuebunny/crossref_metadata_2025_split huggingface dataset:
A taxonomy of hospitals participating in Medicare accountable care organizations
Authors: Bazzoli Gloria J. , Harless David W. , Chukmaitov Askar S. 
Published: March 2017

Background:
Medicare was an early innovator of accountable care organizations (ACOs), establishing the Medicare Shared Savings Program (MSSP) and Pioneer programs in 2012–2013. Existing research has documented that ACOs bring together an array of health providers with hospitals serving as important participants.

Purpose:
Hospitals vary markedly in their service structure and organizational capabilities, and thus, one would expect hospital ACO participants to vary in these regards. Our research identifies hospital subgroups that share certain capabilities and competencies. Such research, in conjunction with existing ACO research, provides deeper understanding of the structure and operation of these organizations. Given that Medicare was an initiator of the ACO concept, our findings provide a baseline to track the evolution of ACO hospitals over time.

Methodology/Approach:
Hierarchical clustering methods are used in separate analyses of MSSP and Pioneer ACO hospitals. Hospitals participating in ACOs with 2012–2013 start dates are identified through multiple sources. Study data come from the Centers for Medicare and Medicaid Services, American Hospital Association, and Health Information and Management Systems Society.

Results:
Five-cluster solutions were developed separately for the MSSP and Pioneer hospital samples. Both the MSSP and Pioneer taxonomies had several clusters with high levels of health information technology capabilities. Also distinct clusters with strong physician linkages were present. We examined Pioneer ACO hospitals that subsequently left the program and found that they commonly had low levels of ambulatory care services or health information technology.

Conclusion:
Distinct subgroups of hospitals exist in both the MSSP and Pioneer programs, suggesting that individual hospitals serve different roles within an ACO. Health information technology and physician linkages appear to be particularly important features in ACO hospitals.

Practice Implications:
ACOs need to consider not only geographic and service mix when selecting hospital participants but also their vertical integration features and management competencies.
Head-down Posture in Glaucoma Suspects Induces Changes in IOP, Systemic Pressure, and PERG That Predict Future Loss of Optic Nerve Tissue
Authors: Porciatti Vittorio , Feuer William J. , Monsalve Pedro , Triolo Giacinto , Vazquez Luis , McSoley John , Ventura Lori M. 
Published: March 2017

Purpose:
To obtain pilot data on posture-induced changes of intraocular pressure (IOP), systemic pressure, and pattern electroretinogram (PERG) predictive of future optic nerve tissue loss glaucoma suspects (GSs).

Methods:
Mean peripapillary retinal fiber layer thickness (RNFLT) was measured with optical coherence tomography 2 times/year in 28 GS aged 58±8.9 years over 5.0±0.73 years. All patients had a baseline PERG, IOP, and brachial blood pressure measurements in the seated and −10 degrees head-down-body-tilt (HDT) position. Outcome measures were seated/HDT PERG amplitude and phase, IOP, mean arterial blood pressure, and estimated ocular perfusion pressure. An additional group of 11 similarly aged controls aged 56.9±13 years was tested for comparison.

Results:
Although all GS had initial RNFLT in the normal range, 9/28 of them developed significant (P<0.05) loss of mean RNFLT [thinners (T)] over the follow-up period as opposed to 19/28 who did not [nonthinners (NT)]. Significant (P<0.05) differences between similarly aged controls, NT, and T were found in PERG amplitude, PERG phase, mean arterial blood pressure, IOP, and ocular perfusion pressure. A nominal logistic regression using baseline PERG and hemodynamic variables was able to distinguish T from NT with an area under receiving operator characteristic of 0.89 (SE, 0.07).

Conclusions:
Baseline PERG, IOP, and systemic blood pressure, together with their changes upon HDT, may have predictive value for future loss of optic nerve tissue in GS. This study supports the rationale for a full-scale clinical trial to identify patients at high risk of development of glaucoma.
Optical Coherence Tomography and Glaucoma Progression: A Comparison of a Region of Interest Approach to Average Retinal Nerve Fiber Layer Thickness
Authors: Thenappan Abinaya , De Moraes Carlos Gustavo , Wang Diane L. , Xin Daiyan , Jarukasetphon Ravivarn , Ritch Robert , Hood Donald C. 
Published: March 2017

Purpose:
To determine whether the change in the retinal nerve fiber layer (RNFL) thickness in a region of interest (ROI) is a better measure of glaucoma progression than the change in average circumpapillary (cp) RNFL thickness.

Methods:
Disc cube scans were obtained with frequency domain optical coherence tomography from 60 eyes of 60 patients (age, 61.7±12.7 y) with early or suspected glaucoma and controlled intraocular pressure. The average time between 2 test dates was 3.2±1.8 years. En-face images of the scans from the 2 tests were aligned based on the blood vessels, and cp images were derived for an annulus 100 μm wide and 3.4 mm in diameter, centered on the disc. An ROI was defined as the portion of the circumpapillary retinal nerve fiber layer (cpRNFL) plot within the temporal disc that extended below the 1% confidence interval for ≥5 degrees. Trend analysis using multilevel mixed-effects models was used to compare the rates of change between ROI width and average cpRNFL thickness.

Results:
In total, 26 of the 60 eyes had a total of 33 ROIs. The ROI width significantly increased between the 2 test dates (median, 4.9 degrees; Q1=1.03 degrees, Q3=10.5 degrees). In comparison, the average cpRNFL thickness did not decrease significantly over the same period (median, −0.7 μm; Q1=−2.7 μm, Q3=2.7 μm). Mixed-effects linear models confirmed significant ROI progression (P=0.015), but not average cpRNFL (P=0.878).

Conclusions:
In this population, RNFL thinning in a ROI is a better measure of progression than is average cpRNFL thickness change.
Determinants of Peripapillary and Macular Vessel Densities Measured by Optical Coherence Tomography Angiography in Normal Eyes
Authors: Rao Harsha L. , Pradhan Zia S. , Weinreb Robert N. , Reddy Hemanth B. , Riyazuddin Mohammed , Sachdeva Sonia , Puttaiah Narendra K. , Jayadev Chaitra , Webers Carroll A.B. 
Published: March 2017

Purpose:
The aim of this study was to evaluate the effect of subject-related (age, sex, and systemic hypertension and diabetes), eye-related (refractive error, optic disc size), and technology-related (signal strength index, SSI of the scans) determinants on the peripapillary and macular vessel densities measured with optical coherence tomography angiography (OCTA) in normal eyes.

Methods:
In a cross-sectional study, 181 normal eyes of 107 subjects (45 men, 62 women, median age: 50 y, range: 18 to 77 y) underwent OCTA imaging. Linear mixed models were used to analyze the effect of the determinants on the peripapillary and macular vessel densities measured with OCTA.

Results:
It was found that age and optic disc size did not affect the vessel densities of any of the regions (P>0.05 for all associations). En face optic disc (coefficient: 1.67, P<0.001) and most of the peripapillary vessel densities were higher in female individuals. En face disc (coefficient=−1.88, P=0.02) and most of the peripapillary vessel densities were lower, whereas the parafoveal vessel density was higher (coefficient=2.32, P=0.01), in subjects with hypertension. Most of the vessel densities were lower in subjects with diabetes. SSI showed a statistically significant association with the vessel densities of all regions (coefficients: 0.14 to 0.27 for peripapillary and 0.20 to 0.27 for macular sectors).

Conclusions:
Most of the peripapillary vessel densities were higher in female subjects. Hypertension and diabetes also affected the vessel densities. Vessel densities in all the regions were significantly higher in scans with higher SSI. These results should be considered when interpreting the vessel densities in retinal diseases and glaucoma.
Anterior Segment Optical Coherence Tomography for Targeted Transconjunctival Suture Placement in Overfiltering Trabeculectomy Blebs
Authors: Heisler Morgan , Quong Whitney L. , Lee Sieun , Han Sherry , Beg Mirza F. , Sarunic Marinko V. , Mackenzie Paul J. 
Published: March 2017

Purpose:
To demonstrate the utility of swept-source anterior segment optical coherence tomography (SS-AS-OCT) in guiding placement of transconjunctival sutures in hypotonous patients after a trabeculectomy.

Patients and Methods:
This is a longitudinal case series of 10 eyes from 10 patients who required transconjunctival sutures after a trabeculectomy. SS-AS-OCT was used to aid in the placement of the sutures to improve the function of the overfiltering bleb.

Results:
SS-AS-OCT reliably identified localized areas of overfiltering, allowing for targeted suture placement in 8 eyes. The 2 eyes in which localized areas of overfiltering were not found required further surgical intervention.

Conclusions:
SS-AS-OCT enhances transconjunctival suturing for overfiltering blebs when focal fluid accumulation is visualized.
Value of Intravitreal Gas Injection With Ahmed Valve Implantation in the Prevention of Suprachoroidal Hemorrhage in Aphakic, Aniridic, and Vitrectomized Glaucomatous Eyes: A Pilot Study
Authors: El-Saied Heba M.A. , Adullatif Abdussalam M. 
Published: March 2017

Purpose:
The aim of this study was to assess the value of intravitreal injection of nonexpansile C3F8 12% in the prevention of suprachoroidal hemorrhage (SCH) after Ahmed valve implantation for the treatment of secondary glaucoma in vitrectomized, aphakic, and aniridic eyes following blunt trauma.

Patients and Methods:
This is a case series of 5 patients who presented with traumatic secondary glaucoma in vitrectomized, aphakic, and aniridic eyes. Vitrectomy was performed in all eyes after trauma for the treatment of the vitreous hemorrhage. Ahmed valve implantation with complete filling of the vitreous cavity with nonexpansile C3F8 was carried out 2±0.2 months after vitrectomy. The outcome measures were evaluating the value of intraoperative filling of the vitreous cavity with gas in preventing SCH after Ahmed valve implantation and the ability of Ahmed valve implantation to control the intraocular pressure (IOP) in vitrectomized, aphakic, and aniridic eyes. All patients were examined up to 6 months.

Results:
Inspite of the multiple risk factors present in our patients in the form of aphakia, vitrectomized eyes, and aniridia, no patient developed postoperative hypotony or SCH during the postoperative period. The gas was absorbed over 2 months and the IOP was maintained during the early postoperative period. Mean postoperative IOP was 15.2±1.09, 12.2±1.09, 18.4±7.12, 15.2±2.28, and 14.8±1. 09 mm Hg at 1 day, 1 week, 1 month, 3 months, and 6 months, respectively. The final postoperative best-corrected visual acuity was 0.66±0.13.

Conclusions:
Complete filling of the vitreous cavity with nonexpansile gas can prevent postoperative SCH after Ahmed valve implantation in the treatment of secondary glaucoma in vitrectomized, aphakic, and aniridic eyes.
The Treatment of Possible Severe Infection in Infants
Authors: Molyneux Elizabeth M. , Dube Queen , Banda Francis M. , Chiume Msandeni , Singini Isaac , Mallewa Macpherson , Schwalbe Edward C. , Heyderman Robert S. 
Published: March 2017

Background:
The World Health Organization recommends benzylpenicillin and gentamicin as antimicrobial treatment for infants with sepsis in low-income settings, and ceftriaxone or cefotaxime as an alternative. In a meta-analysis from 13 low-income settings, Staphylococcus aureus, Klebsiella spp. and Escherichia coli accounted for 55% of infants with sepsis. In a review of bacterial meningitis, resistance to third generation cephalosporins was >50% of all isolates, and 44% of Gram-negative isolates were gentamicin resistant. However, ceftriaxone may cause neonatal jaundice, and gentamicin may cause deafness. Therefore, we compared parenteral benzylpenicillin plus gentamicin with ceftriaxone as first-line treatment, assessing outcome and adverse events.

Methods:
This was an open randomized trial carried out in the Queen Elizabeth Central Hospital, Blantyre, Malawi, from 2010 to 2013. Infants <60 days of age with possible severe sepsis received either benzylpenicillin and gentamicin or ceftriaxone. Adverse events and outcomes were recorded until 6 months post discharge.

Results:
Three-hundred forty-eight infants were included in analyses. Outcome in the benzylpenicillin and gentamicin and ceftriaxone groups was similar; deaths were 13.7% and 16.5% and sequelae were 14.5% and 11.2%, respectively. More infants in the penicillin/gentamicin group required phototherapy: 15% versus 5%, P = 0.03. Thirteen (6%) survivors had bilateral hearing loss. There was no difference between the treatment groups. By 6 months post discharge, 11 more infants had died, and 17 more children were found to have sequelae.

Conclusions:
Ceftriaxone and gentamicin are safe for infants in our setting. Infants should receive long-term follow-up as many poor outcomes occurred after hospital discharge.
International Image Concordance Study to Compare a Point-of-Care Tampon Colposcope With a Standard-of-Care Colposcope
Authors: Mueller Jenna L. , Asma Elizabeth , Lam Christopher T. , Krieger Marlee S. , Gallagher Jennifer E. , Erkanli Alaattin , Hariprasad Roopa , Malliga J.S. , Muasher Lisa C. , Mchome Bariki , Oneko Olola , Taylor Peyton , Venegas Gino , Wanyoro Anthony , Mehrotra Ravi , Schmitt John W. , Ramanujam Nimmi 
Published: March 2017

Objective
Barriers to cervical cancer screening in low-resource settings include lack of accessible, high-quality services, high cost, and the need for multiple visits. To address these challenges, we developed a low-cost, intravaginal, optical cervical imaging device, the point-of-care tampon (POCkeT) colposcope and evaluated whether its performance is comparable with a standard-of-care colposcope.

Materials and Methods
There were 2 protocols, which included 44 and 18 patients. For the first protocol, white-light cervical images were collected in vivo, blinded by device, and sent electronically to 8 physicians from high-, middle-, and low-income countries. For the second protocol, green-light images were also collected and sent electronically to the highest performing physician from the first protocol who has experience in both a high- and low-income country. For each image, physicians completed a survey assessing cervix characteristics and severity of precancerous lesions. Corresponding pathology was obtained for all image pairs.

Results
For the first protocol, average percent agreement between devices was 70% across all physicians. The POCkeT and standard-of-care colposcope images had 37% and 51% agreement with pathology for high-grade squamous intraepithelial lesions (HSILs), respectively. Investigation of HSIL POCkeT images revealed decreased visibility of vascularization and lack of contrast in lesion margins. After changes were made for the second protocol, the 2 devices achieved similar agreement to pathology for HSIL lesions (55%).

Conclusions
Based on the exploratory study, physician interpretation of cervix images acquired using a portable, low-cost POCkeT colposcope was comparable to a standard-of-care colposcope.
Efficacy, Durability, and Safety of Complete Endoscopic Mucosal Resection of Barrett Esophagus
Authors: Tomizawa Yutaka , Konda Vani J.A. , Coronel Emmanuel , Chapman Christopher G. , Siddiqui Uzma D. 
Published: March 2017

Goals:
To report the rate of eradication and recurrence of both neoplasia and intestinal mucosa and the rate of adverse events for complete endoscopic resection (CER) of Barrett esophagus (BE).

Background:
There is limited composite data on the clinical efficacy of CER of BE with high-grade dysplasia or neoplasia.

Study:
We performed a systematic review and meta-analysis of cohort studies that reported the clinical outcome of patients with BE who underwent CER and had at least 15-month follow-up after the time of elimination of BE. Main outcome of interests were pooled estimated rates of complete eradication of intestinal metaplasia and neoplasia, recurrence of intestinal metaplasia and neoplasia, and incidence of esophageal stricture, bleeding, and perforation.

Results:
We identified 8 studies reporting on 676 patients (high-grade dysplasia 54%) that met our criteria. Pooled estimated rates of complete eradication of intestinal metaplasia and complete eradication of intestinal neoplasia were 85.0% [95% confidence interval (CI), 79.4%-89.2%] and 96.6% (95% CI, 94.0%-98.1%), respectively, and rates of recurrence of intestinal metaplasia and recurrence of intestinal neoplasia were 15.7% (95% CI, 8.0%-28.4%) and 5.8% (95% CI, 3.9%-8.6%), respectively. Estimated incidences of adverse events were stricture 37.4 (95% CI, 24.4%-52.6%), bleeding 7.9% (95% CI, 4.4%-13.8%) and perforation 2.3% (95% CI, 1.3%-4.1%).

Conclusions:
CER achieves an 85% complete eradication rate of BE with recurrent rate of neoplasia of 6%. Estimated rate of postprocedural stricture was 37.4%. On the basis of this high rate of adverse events and significant heterogeneity in the studies included, the present meta-analysis cannot endorse CER as sole therapy for BE.
Delayed Bleeding Following Cold Snare Polypectomy for Small Colorectal Polyps in Patients Taking Antithrombotic Agents
Authors: Makino Toshiyuki , Horiuchi Akira , Kajiyama Masashi , Tanaka Naoki , Sano Kenji , Maetani Iruru 
Published: March 2017

Background:
This study compared the incidence of delayed bleeding following 2 methods of cold snare polypectomy for colorectal polyps in patients taking antithrombotic agents.

Methods:
Patients undergoing cold snare polypectomy for colorectal polyps ≤10 mm without discontinuation of antithrombotic agents were enrolled. This was a retrospective study of a prospectively collected cohort based on a historical comparison of 2 time periods. A traditional cold snare was used between January 2012 and December 2013 and a dedicated cold snare was used between January 2014 and December 2015. Patients’ and polyps’ characteristics, antithrombotic agents used, the snare used, the number of clips used, and adverse events were documented from a hospital online database. Delayed bleeding was defined as bleeding that required endoscopic treatment within 2 weeks after polypectomy. The submucosal layer of the resected polyps (6 to 10 mm) was histologically examined for the presence of injured arteries.

Results:
A total of 172 patients having 370 eligible polyps were enrolled; traditional cold snare group, N=100 (212 polyps) and dedicated cold snare group, N=72 (158 polyps). The patients’ and polyps’ characteristics were similar between the 2 groups. Hemostatic clips were used more often with the traditional than dedicated cold snares [33/100 (33%) vs. 13/72 (18%), P=0.044]. Delayed bleeding following cold snare polypectomy occurred in 1.2% (2/172); 0% (0/72) with dedicated snare versus 2% (2/100) with the traditional snare (P=0.63). The presence of histologically demonstrated injured submucosal arteries with the dedicated cold snare was significantly less than with the traditional cold snare [4.1% (4/98) vs. 16% (17/105), P=0.009].

Conclusions:
Colorectal polyps ≤10 mm can be removed without an increase in delayed bleeding using dedicated cold snare polypectomy in patients taking antithrombotic agents.
Small-Intestinal Bacterial Overgrowth is Associated With Concurrent Intestinal Inflammation But Not With Systemic Inflammation in Crohn’s Disease Patients
Authors: Ricci José E.R. , Chebli Liliana A. , Ribeiro Tarsila C.d.R. , Castro Antonio C.S. , Gaburri Pedro D. , Pace Fabio H.d.L. , Barbosa Kátia V.B.D. , Ferreira Lincoln E.V.V.d.C. , Passos Maria d.C.F. , Malaguti Carla , Delgado Álvaro H.d.A. , Campos Jacqueline D. , Coelho André R. , Chebli Julio M.F. 
Published: March 2017

Goals:
We studied the prevalence and predictors of small-intestinal bacterial overgrowth (SIBO) in Crohn’s disease (CD) outpatients and the relationship between SIBO and intestinal and/or systemic inflammation.

Background:
The relationship of SIBO with systemic and intestinal inflammation in CD patients is unclear.

Study:
In this cross-sectional study, conducted between June, 2013 and January, 2015, 92 CD patients and 97 controls with nonchronic gastrointestinal complaints were assessed for the presence of SIBO using the H2/CH4 glucose breath test. Multivariate logistic regression was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein, and erythrocyte sedimentation rate), and biomarker of intestinal inflammation [fecal calprotectin concentration (FCC)].

Results:
The SIBO rate was significantly higher in CD patients than in controls (32.6% vs. 12.4%, respectively, P=0.0008). Patients with and without SIBO were comparable with regard to demographics, systemic inflammatory biomarkers, and disease characteristics, except for the stricturing phenotype being more common in SIBO-positive CD patients (43.3% vs. 19.3%, P=0.015). Notably, FCC was significantly higher in SIBO-positive patients (median of 485.8 vs.132.7 μg/g; P=0.004). Patients presenting increased FCC and stricturing disease had an odds of 9.43 (95% confidence interval, 3.04-11.31; P<0.0001) and 3.83 (95% confidence interval, 1.54-6.75; P=0.025) respectively, for SIBO diagnosis.

Conclusions:
In CD patients, SIBO is a highly prevalent condition. Stricturing phenotype and increased FCC were strongly and independently associated with the presence of SIBO. SIBO diagnostic work-up followed by directed treatment is recommended in CD patients who present stricturing disease, especially in those with concurrent intestinal inflammation.
Evaluation of Effects of Radiofrequency Ablation of Ex vivo Liver Using the 1-Fr Wire Electrode
Authors: Rustagi Tarun , Gleeson Ferga C. , Abu Dayyeh Barham K. , Topazian Mark D. , Levy Michael J. 
Published: March 2017

Background and Study Aims:
Percutaneous and intraoperative radiofrequency ablation (RFA) has become a valued tool in the management of primary and secondary hepatic lesions. A recent FDA-approved endoscopic ultrasound (EUS)-guided RFA probe now offers promise to help manage such lesions. However, there are no data to determine the ideal power setting and duration of ablation needed to effectively treat hepatic masses. The aim of the study was to evaluate the macroscopic zone of hepatic injury for EUS-RFA using a variety of settings within a fresh porcine hepatic specimen.

Methods:
RFA was performed using the Habib EUS-RFA needle (EMcision Ltd, London, UK) which is a 1-Fr wire (0.33 mm, 0.013 inch) with a working length of 190 cm. A step by step approach to deliver radiofrequency energy at 5, 10, 15, 20, and 50 W of power and 10, 30, 60, 90, 120, and 300 seconds, respectively, was followed. Macroscopic and microscopic findings of the ablation zone were evaluated at each setting.

Results:
The maximal zone (diameter, 8.2±0.14 mm; length, 20.85±0.21 mm) of coagulative necrosis was achieved using an ablation power of 10 W for duration of 90 seconds. Notably, increased power settings resulted in an unexpected and diminished effect on tissue destruction.

Conclusions:
Our findings support the use of 10 W power for 90 seconds for maximum ablation in the liver. Our data also provide initial guidance and alternate settings to be considered when performing EUS-RFA to adjust the ablation power and duration to match the lesion size, shape, and risk of injury to adjacent structures.