bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discontinuity of Medicaid Coverage
Authors: Ji Xu , Wilk Adam S. , Druss Benjamin G. , Lally Cathy , Cummings Janet R. 
Published: July 2017

Background:
Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression.

Objective:
Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression.

Subjects:
A total of 139,164 adults (18–64) with major depression was identified using the 2003–2004 Medicaid Analytic eXtract Files.

Methods:
We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification.

Outcome Measures:
Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs.

Results:
Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-values<0.001).

Conclusions:
Among depressed adults, those experiencing coverage disruptions have, on average, significantly greater use of costly ED/inpatient services than those with continuous coverage. Maintenance of continuous Medicaid coverage may help prevent acute episodes requiring high-cost interventions.
Risk of Pancreatic Cancer After a Primary Episode of Acute Pancreatitis
Authors: Rijkers Anton P. , Bakker Olaf J. , Ahmed Ali Usama , Hagenaars Julia C.J.P. , van Santvoort Hjalmar C. , Besselink Marc G. , Bollen Thomas L. , van Eijck Casper H. 
Published: July 2017

Objective
Acute pancreatitis may be the first manifestation of pancreatic cancer. The aim of this study was to assess the risk of pancreatic cancer after a first episode of acute pancreatitis.

Methods
Between March 2004 and March 2007, all consecutive patients with a first episode of acute pancreatitis were prospectively registered. Follow-up was based on hospital records audit, radiological imaging, and patient questionnaires. Outcome was stratified based on the development of chronic pancreatitis.

Results
We included 731 patients. The median follow-up time was 55 months. Progression to chronic pancreatitis was diagnosed in 51 patients (7.0%). In this group, the incidence rate per 1000 person-years for developing pancreatic cancer was 9.0 (95% confidence interval, 2.3–35.7). In the group of 680 patients who did not develop chronic pancreatitis, the incidence rate per 1000 person-years for developing pancreatic cancer in this group was 1.1 (95% confidence interval, 0.3–3.3). Hence, the rate ratio of pancreatic cancer was almost 9 times higher in patients who developed chronic pancreatitis compared with those who did not (P = 0.049).

Conclusions
Although a first episode of acute pancreatitis may be related to pancreatic cancer, this risk is mainly present in patients who progress to chronic pancreatitis.
Effect of a Training Strategy in Improving Medication Fallacies During Pediatric Cardiopulmonary Resuscitation: A Before-and-After Study From a Developing Country
Authors: Sankar Jhuma , Das Rashmi Ranjan , Mahapatro Samarendra , Sankar M. Jeeva 
Published: July 2017

Objective
This study aims to evaluate the effect of structured training on resident performance in improving medication fallacies during pediatric cardiopulmonary resuscitation (CPR).

Methods
This before-and-after study was conducted in the pediatric acute care areas of tertiary care teaching hospitals of a developing country from August to December 2015. Case records of children younger than 18 years who underwent CPR were reviewed. Senior residents rotating through pediatric emergency department and pediatric intensive care unit were evaluated for their knowledge. Incidence of medication fallacies in pediatric CPR and change in the knowledge scores of residents posted in these areas were the main outcome measures.

Results
One-hundred records were evaluated (pre-intervention, 54; post-intervention, 46). In the pre-intervention period, 25 had medication fallacies (documentation, 16; dosing, 9). In the post-intervention period, 7 fallacies pertaining to documentation (not dosing) were found. The incidence of severe fallacies decreased from 20% pretraining to 0% posttraining. The mean (SD) knowledge scores of residents increased from 7.9 (2.9) pretraining to 13 (1.4) posttraining. On univariate analysis, fallacies were found to be less if the resident was formally trained (pediatric advanced life support certified), if the patient was older, and during morning and night shifts as compared with evening shift. On multivariate analysis, however, only status of training (posttraining) (adjusted odds ratio, 0.12; 95% confidence interval, 0.02–0.68) and the morning shift (adjusted odds ratio, 0.03; 95% confidence interval, 0.001–0.72) remained significant with lower incidence of fallacies associated with these variables.

Conclusions
Rates of medication fallacies in pediatric CPR declined with structured training. Documentation fallacies may not be eliminated completely with only 1-time training.
Medication Simulation Affects Health Provider Students' Attitudes About Adherence and Concordance
Authors: Perdue Tamara O. , Jackson J. Todd , Herring Christine , Garren Kathryn , Yocum R. Anthony , Swanson Melvin , Nye Ann Marie 
Published: July 2017

Introduction
Assisting polypharmacy patients with complex health regimens is a part of health provider responsibilities. The concepts of adherence and concordance contrast the traditional emphasis on patient compliance. However, health provider students may not be able to empathize with polypharmacy patients. The purpose of this study was to measure the effect of a medication simulation on medical, nursing, and pharmacy students' beliefs about adherence and concordance.

Methods
A prospective, quasi-experimental, pretest, and posttest design was used with institutional review board approval. The participants (N = 62) took four simulated medications (varied dosing schedules) for 1 week. Attitudes toward adherence and concordance were assessed before and after the intervention.

Results
Subjects averaged 24.6 years (SD = 4.32), 72.6% female, and 79% white. Most were medical students (n = 33, 53%), followed by nursing (n = 21, 34%) and pharmacy students (n = 8, 13%). There were significant changes [t(61) = 3.92, P < 0.001] in beliefs about adherence from time 1 (mean = 25.13, SD = 5.77) to time 2 (mean = 22.05, SD = 6.06), and about concordance (mean = 41.85, SD = 5.58 time 1) to (mean = 44.29, SD = 6.32 time 2) [t(61) = 3.31, P < 0.05], for the entire group. Most students (84%) predicted that they would be able to take four medications correctly for 1 week. Fifty-eight students (94%) found that adherence was ‘much harder’ or ‘a little harder’ than anticipated. Most (89%) felt that the simulation will impact their patient care.

Conclusions
Participation in a medication simulation exercise affected health provider students' attitudes toward adherence and concordant behaviors. These experiences may influence future patient interactions.
Design and Early Experience With a Real-World Surgical Registry
Authors: Weber LeBrun Emily E. , Lynch Lauren D. , Peterson Hanna V. , Pena Savannah Rose , Ruder Kara , Vasilopoulos Terrie 
Published: July 2017

Objectives
We describe the rationale, design, and methods and 6-year experience with a real-world surgical registry for female pelvic reconstructive and incontinence procedures and postoperative outcomes.

Methods
The primary goal of creating this registry was to establish the feasibility of prospective data capture for all urogynecologic procedures. Data captured included baseline demographics, surgical procedures, perioperative complications, and subjective and objective findings up to 36 months after surgery.

Results
The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry was developed over 3 years to include 194 unique variables for prospective data capture. The registry was implemented in December 2010, and data from 924 separate case events from a single surgeon were recorded, comprising 100% surgical case capture. Cases included a variety of procedures representing a comprehensive urogynecology practice on 804 unique patients. Patients who were asked to participate in long-term follow-up (n = 299) returned with attendance of 96% at 6 weeks, 64% at 6 months, 51% at 12 months, 39% at 24 months, and 22% at 36 months.

Conclusions
The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry effectively captured all urogynecologic procedures for the purpose of quality improvement. This real-world tool demonstrates that 100% case capture is feasible and provides valuable information for the highly motivated surgeon, although adequate long-term follow-up is limited. Additional research is needed to better understand the role of surgical registries for quality improvement and development of patient-centered strategies to increase long-term follow-up.
Good news, bad news: An analysis of 11,294 gunshot wounds (GSWs) over two decades in a single center
Authors: Manley Nathan R. , Fabian Timothy C. , Sharpe John P. , Magnotti Louis J. , Croce Martin A. 
Published: July 2017

INTRODUCTION
Gun violence is a substantial public health problem accounting for significant physical, psychological, and financial costs. Although aggregate data sources demonstrate decreasing rates of firearm violence, analyses from individual trauma centers have shown that mortality and injury severity from gunshot wounds (GSWs) are increasing. To evaluate the evolving characteristics of gun violence in our region, we studied all GSWs admitted to our trauma center over a 20-year period.

METHODS
A retrospective analysis of all newly admitted patients with GSWs was performed from 1996 to 2016. Our trauma registry was used to collect data on demographics, mortality, injury severity, body regions injured, and geographic location of injury. Homicide data were obtained from local law enforcement.

RESULTS
A total of 11,294 patients with GSWs were reviewed. The number of GSWs treated per biennium increased from 1,349 in 1996–1997 to 1,484 in 2014–2015, with a 59% increase occurring from 2010–2011 to 2014–2015. Overall mortality was 14.6% and decreased from 15.8% in 1996–1997 to 10.2% in 2014–2015 (p < 0.0001). Mean Injury Severity Score was 12.6 and the percentage of patients who suffered GSWs to ≥3 Abbreviated Injury Scale body regions increased from 2.5% in 1996–1997 to 7.7% in 2014–2015 (p < 0.0001). Local firearm homicide data show a 118% increase from 2010 to 2016.

CONCLUSIONS
In contrast to other recent studies, we found that mortality decreased whereas the number of patients treated for GSWs and those with multicompartmental injuries increased. The decrease in mortality suggests improved trauma systems as well as an increase in nonfatal GSWs that dilutes overall mortality. Wounding in multiple body regions suggests more effective weaponry, including increased magazine size. The recent increase in local homicides parallels trends in registry data and illustrates worsening gun violence in our region. Further research is needed to understand local and regional determinants of increased gun violence to better guide prevention strategies.

LEVEL OF EVIDENCE
Epidemiological study, level III.
The renaissance man of burn surgery: Basil A. Pruitt, Jr.
Authors: Capek Karel D. , Foncerrada Guillermo , Clayton R. Patrick , Sljivich Michaela , Voigt Charles D. , Hundeshagen Gabriel , Cambiaso-Daniel Janos , Porter Craig , Guillory Ashley , Herndon David N. 
Published: July 2017

ABSTRACT
Dr. Basil A. Pruitt Jr., a consummate clinical and translational surgeon-scientist, has spent over half a century at the forefront of an advancing standard of burn care. Commanding the US Army Institute for Surgical Research in San Antonio, he trained generations of leading burn clinicians and allied scientists. At his direction, there were forged discoveries in resuscitation from shock, treatment of inhalation injury, control of burn-related infections, prevention of iatrogenic complications, and understanding the sympathetic, endocrine, and immune responses to burn injury. Most consequentially, this team was among the first to recognize and define alterations in the basal metabolic rate and thermoregulation consequent to burn injury. These investigations prompted groundbreaking insights into the coordinated nervous, autonomic, endocrine, immune, and metabolic outflows that a severely burned patient uses to remain alive and restore homeostasis. Marking his scientific consequence, many of his reports continue to bear fruit when viewed through a contemporary lens. This article summarizes some of the major findings of his career thus far and is intended to complement a Festschrift recently held in his honor.
Risk factors for deep vein thrombosis and pulmonary embolism after traumatic injury: A competing risks analysis
Authors: Van Gent Jan-Michael , Calvo Richard Yee , Zander Ashley L. , Olson Erik J. , Sise C. Beth , Sise Michael J. , Shackford Steven R. 
Published: July 2017

BACKGROUND
Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is typically reported as a composite measure of the quality of trauma center care. Given that recent data suggesting postinjury DVT and PE are distinct clinical processes, a better understanding may result from analyzing them as independent, competing events. Using competing risks analysis, we evaluated our hypothesis that the risk factors and timing of postinjury DVT and PE are different.

METHODS
We examined all adult trauma patients admitted to our Level I trauma center from July 2006 to December 2011 who received at least one surveillance duplex ultrasound of the lower extremities and who were at high risk or greater for DVT. Outcomes included DVT and PE events, and time-to-event from admission. We used competing risks analysis to evaluate risk factors for DVT while accounting for PE as a competing event, and vice versa.

RESULTS
Of 2,370 patients, 265 (11.2%) had at least one venous thromboembolism event, 235 DVT only, 19 PE only, 11 DVT and PE. Within 2 days of admission, 38% of DVT cases had occurred compared with 26% of PE. Competing risks modeling of DVT as primary event identified older age, severe injury (Injury Severity Score, ≥ 15), mechanical ventilation longer than 4 days, active cancer, history of DVT or PE, major venous repair, male sex, and prophylactic enoxaparin and prophylactic heparin as associated risk factors. Modeling of PE as the primary event showed younger age, nonsevere injury (Injury Severity Score, < 15), central line placement, and prophylactic heparin as relevant factors.

CONCLUSION
The risk factors for PE and DVT after injury were different, suggesting that they are clinically distinct events that merit independent consideration. Many DVT events occurred early despite prophylaxis, bringing into question the preventability of postinjury DVT. We recommend trauma center quality reporting program measures be revised to account for DVT and PE as unique events.

LEVEL OF EVIDENCE
Epidemiologic, level III.
Dissecting causal pathways using Mendelian randomization with summarized genetic data: application to age at menarche and risk of breast cancer
Authors: Burgess Stephen , Thompson Deborah J , Rees Jessica MB , Day Felix R , Perry John R , Ong Ken K 
Published: July 2017

AbstractMendelian randomization is the use of genetic variants as instrumental variables to estimate causal effects of risk factors on outcomes. The total causal effect of a risk factor is the change in the outcome resulting from intervening on the risk factor. This total causal effect may potentially encompass multiple mediating mechanisms. For a proposed mediator, the direct effect of the risk factor is the change in the outcome resulting from a change in the risk factor keeping the mediator constant. A difference between the total effect and the direct effect indicates that the causal pathway from the risk factor to the outcome acts at least in part via the mediator (an indirect effect). Here, we show that Mendelian randomization estimates of total and direct effects can be obtained using summarized data on genetic associations with the risk factor, mediator, and outcome, potentially from different data sources. We perform simulations to test the validity of this approach when there is unmeasured confounding and/or bidirectional effects between the risk factor and mediator. We illustrate this method using the relationship between age at menarche and risk of breast cancer, with body mass index (BMI) as a potential mediator. We show an inverse direct causal effect of age at menarche on risk of breast cancer (independent of BMI) and a positive indirect effect via BMI. In conclusion, multivariable Mendelian randomization using summarized genetic data provides a rapid and accessible analytic strategy that can be undertaken using publicly-available data to better understand causal mechanisms.
PIP30/FAM192A is a novel regulator of the nuclear proteasome activator PA28γ
Authors: Jonik-Nowak Beata , Menneteau Thomas , Fesquet Didier , Baldin Véronique , Bonne-Andrea Catherine , Méchali Francisca , Fabre Bertrand , Boisguerin Prisca , de Rossi Sylvain , Henriquet Corinne , Pugnière Martine , Ducoux-Petit Manuelle , Burlet-Schiltz Odile , Lamond Angus I. , Fort Philippe , Boulon Séverine , Bousquet Marie-Pierre , Coux Olivier 
Published: July 2017

ABSTRACTPA28γ is a nuclear activator of the 20S proteasome involved in the regulation of several essential cellular processes, such as cell proliferation, apoptosis, nuclear dynamics and cellular stress response. Unlike the 19S regulator of the proteasome, which specifically recognizes ubiquitylated proteins, PA28γ promotes the degradation of several substrates by the proteasome in an ATP- and ubiquitin-independent manner. However its exact mechanisms of action are unclear and likely to involve additional partners that remain to be identified. Here we report the identification of the first cofactor of PA28γ, PIP30/FAM192A. PIP30 binds directly and specifically via its C-terminal end and in an interaction stabilized by casein kinase 2 phosphorylation to both free and 20S proteasome-associated PA28γ. Its recruitment to proteasome-containing complexes depends on PA28γ and its expression increases the association of PA28γ with the 20S proteasome in cells. Further dissection of its possible roles shows that PIP30 alters PA28γ-dependent activation of peptide degradation by the 20S proteasomein vitroand negatively controls in cells the presence of PA28γ in Cajal Bodies by inhibition of its association with the key Cajal body component coilin. Altogether, our data show that PIP30 deeply affects PA28γ interactions with cellular proteins, including 20S proteasome, demonstrating that it is an important regulator of PA28γ in cells and thus a new player in the control of the multiple functions of the proteasome within the nucleus.Significance StatementThe 20S proteasome is a key actor of the control of protein levels and integrity in cells. To perform its multiple functions, it works with a series of regulators, among which a nuclear complex called PA28γ. In particular, PA28γ participates in the regulation of cell proliferation and nuclear dynamics. We describe here the characterization of a novel protein, PIP30/FAM192A, which binds tightly to PA28γ and favors its interaction with the 20S proteasome while inhibiting its association with coilin, a central component of nuclear Cajal bodies. Thus PIP30/FAM192A critically controls the interactome and consequently the functions of PA28γ, and appears to be a new player in the fine regulation of intracellular proteostasis in the cell nucleus.
Hospitalizations associated with respiratory syncytial virus (RSV) and influenza in children, including children having a diagnosis of asthma
Authors: Goldstein E. , Finelli L. , O’Halloran A. , Liu P. , Karaca Z. , Steiner C. , Viboud C. , Lipsitch M. 
Published: July 2017

AbstractBackgroundThere is uncertainty about the burden of hospitalization associated with RSV and influenza in children, including those with underlying medical conditions.MethodsWe applied previously developed methodology (Goldstein et al., Epidemiology 2012) to HealthCare Cost and Utilization Project (HCUP) hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003-2010.ResultsThe estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460-519) present anywhere in the discharge diagnosis were 2381 (95% CI(2252,2515)) in age <1y; 710.6(609.1,809.2) (age 1y); 395(327.7,462.4) (age 2y); 211.3(154.6,266.8) (age 3y); 111.1(62.4,160.1) (age 4y); 72.3(29.3,116.4) (ages 5-6y); 35.6(9.9,62.2) (ages 7-11y); and 39(17.5,60.6) (ages 12-17y).The corresponding rates of influenza-associated hospitalization were lower, ranging from 181(142.5,220.3) in age <1y to 17.9(11.7,24.2) in ages 12-17y. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups under 5y ranged between 3.1(2.1,4.7) (age <1y) to 6.7(4.2,11.8) (age 2y); the corresponding risks for influenza-related hospitalization ranged from 2.8(2.1,4) (age <1y) to 4.9(3.8,6.4) (age 3y).ConclusionsRSV-associated hospitalization rates in young children are high and decline rapidly with age. Young children with an asthma diagnosis should be target groups for RSV and influenza-related mitigation efforts, possibly including RSV prophylaxis for the youngest children.
Virtual Reality system for freely-moving rodents
Authors: Del Grosso Nicholas A. , Graboski Justin J. , Chen Weiwei , Blanco-Hernández Eduardo , Sirota Anton 
Published: July 2017

ABSTRACTSpatial navigation, active sensing, and most cognitive functions rely on a tight link between motor output and sensory input. Virtual reality (VR) systems simulate the sensorimotor loop, allowing flexible manipulation of enriched sensory input. Conventional rodent VR systems provide 3D visual cues linked to restrained locomotion on a treadmill, leading to a mismatch between visual and most other sensory inputs, sensory-motor conflicts, as well as restricted naturalistic behavior. To rectify these limitations, we developed a VR system (ratCAVE) that provides realistic and low-latency visual feedback directly to head movements of completely unrestrained rodents. Immersed in this VR system, rats displayed naturalistic behavior by spontaneously interacting with and hugging virtual walls, exploring virtual objects, and avoiding virtual cliffs. We further illustrate the effect of ratCAVE-VR manipulation on hippocampal place fields. The newly-developed methodology enables a wide range of experiments involving flexible manipulation of visual feedback in freely-moving behaving animals.