bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incident and long-term opioid therapy among patients with psychiatric conditions and medications: a national study of commercial health care claims
Authors: Quinn Patrick D. , Hur Kwan , Chang Zheng , Krebs Erin E. , Bair Matthew J. , Scott Eric L. , Rickert Martin E. , Gibbons Robert D. , Kroenke Kurt , D'Onofrio Brian M. 
Published: December 2016

Abstract
There is growing evidence that opioid prescribing in the United States follows a pattern in which patients who are at the highest risk of adverse outcomes from opioids are more likely to receive long-term opioid therapy. These patients include, in particular, those with substance use disorders (SUDs) and other psychiatric conditions. This study examined health insurance claims among 10,311,961 patients who filled prescriptions for opioids. Specifically, we evaluated how opioid receipt differed among patients with and without a wide range of preexisting psychiatric and behavioral conditions (ie, opioid and nonopioid SUDs, suicide attempts or other self-injury, motor vehicle crashes, and depressive, anxiety, and sleep disorders) and psychoactive medications (ie, antidepressants, benzodiazepines, hypnotics, mood stabilizers, antipsychotics, and medications used for SUD, tobacco cessation, and attention-deficit/hyperactivity disorder). Relative to those without, patients with all assessed psychiatric conditions and medications had modestly greater odds of subsequently filling prescriptions for opioids and, in particular, substantially greater risk of long-term opioid receipt. Increases in risk for long-term opioid receipt in adjusted Cox regressions ranged from approximately 1.5-fold for prior attention-deficit/hyperactivity disorder medication prescriptions (hazard ratio [HR] = 1.53; 95% confidence interval [CI], 1.48-1.58) to approximately 3-fold for prior nonopioid SUD diagnoses (HR = 3.15; 95% CI, 3.06-3.24) and nearly 9-fold for prior opioid use disorder diagnoses (HR = 8.70; 95% CI, 8.20-9.24). In sum, we found evidence of greater opioid receipt among commercially insured patients with a breadth of psychiatric conditions. Future studies assessing behavioral outcomes associated with opioid prescribing should consider preexisting psychiatric conditions.
Brain activity for tactile allodynia: a longitudinal awake rat functional magnetic resonance imaging study tracking emergence of neuropathic pain
Authors: Chang Pei-Ching , Centeno Maria Virginia , Procissi Daniel , Baria Alex , Apkarian A. Vania 
Published: December 2016

Abstract
Tactile allodynia, a condition in which innocuous mechanical stimuli are perceived as painful, is a common feature of chronic pain. However, how the brain reorganizes in relation to the emergence of tactile allodynia is still largely unknown. This may stem from the fact that experiments in humans are cross-sectional in nature, whereas animal brain imaging studies typically require anaesthesia rendering the brain incapable of consciously sensing or responding to pain. In this longitudinal functional magnetic resonance imaging study in awake rats, we tracked brain activity with the development of tactile allodynia. Before injury, innocuous air-puff stimuli evoked a distributed sensory network of activations, including contralateral somatosensory cortices, thalamus, insula, and cingulate cortex. Moreover, the primary somatosensory cortex displayed a graded response tracking air-puff stimulus intensities. After neuropathic injury, and for stimuli in which the intensity exceeded the paw withdrawal threshold (evoking tactile allodynia), the blood oxygenation level-dependent response in the primary somatosensory cortex was equivalent to that evoked by the identical stimulus before injury. In contrast, nucleus accumbens and prefrontal brain areas displayed abnormal activity to normally innocuous stimuli when such stimuli induced tactile allodynia at 28 days after peripheral nerve injury, which had not been the case at 5 days after injury. Our data indicate that tactile allodynia-related nociceptive inputs are not observable in the primary somatosensory cortex BOLD response. Instead, our data suggest that, in time, tactile allodynia differentially engages neural circuits that regulate the affective and motivational components of pain.
Sex differences in the efficacy of psychological therapies for the management of chronic and recurrent pain in children and adolescents: a systematic review and meta-analysis
Authors: Boerner Katelynn E. , Eccleston Christopher , Chambers Christine T. , Keogh Edmund 
Published: December 2016

Abstract
Sex differences in chronic pain are reported to emerge during adolescence, although it is unclear if this includes responses to treatment. We conducted a meta-analysis to examine whether sex differences were present on outcome variables at pretreatment and whether the efficacy of psychological therapies for pediatric chronic pain differs between boys and girls at posttreatment and follow-up time points. Searches were conducted, extending 2 existing Cochrane reviews of randomized controlled trials examining the efficacy of psychological therapies for chronic and recurrent pain in children and adolescents. Forty-six articles were eligible for inclusion, and data were extracted regarding pain, disability, anxiety, and depression in boys and girls at pretreatment, posttreatment, and follow-up time points. No published study reported outcome data separately by sex, so authors of all studies were contacted and 17 studies provided data. Twice as many girls (n = 1760) were enrolled into clinical trials of psychological therapies for pediatric chronic pain than boys (n = 828). Girls reported higher depression and anxiety at pretreatment than boys. Girls with headache also reported significantly greater pretreatment pain severity. Treatment gains were consistent across the sexes. One exception was for posttreatment disability in children with nonheadache pain conditions; girls exhibited a significant effect of treatment relative to control condition (standardized mean difference = −0.50 [−0.80, −0.20], P < 0.01), but no such effect was observed for boys (standardized mean difference = −0.08 [−0.44, 0.28], P = 0.66). Future research should examine whether mechanisms of treatment efficacy differ between boys and girls and consider the impact of pretreatment sex differences on response to treatment.
Defining Entry-Level Practice in Acute Care Physical Therapist Practice
Authors: Greenwood Kristin , Stewart Eric , Hake Melissa , Milton Erin , Mitchell Lauren , Sanders Babette 
Published: December 2016

Background and Purpose:
The requirements of an entry-level physical therapist to practice in acute care are not well defined. The Academy of Acute Care Physical Therapy convened the Minimum Skills Task Force to define entry-level practice in acute care. The purpose of this report is to discuss the process and outcome of the development of the Core Competencies for Entry-level Practice in Acute Care Physical Therapy.

Methods:
A task force of acute care clinicians and educators was assembled to develop this document. This document was created through a multistep process consisting of a review of limited existing literature and educational documents, reviews from 4 physical therapists with extensive specialized expertise in acute care physical therapy, and solicitation of Academy of Acute Care Physical Therapy member feedback through 2 webinar forums.

Results:
The final document was adopted by the Academy of Acute Care Physical Therapy in December 2015. The Core Competencies for Entry-Level Practice in Acute Care Physical Therapy identifies the necessary knowledge, actions, and behaviors that are required of an entry-level clinician in the acute care environment.

Conclusion:
The task force charged with the process and creation of the Core Competencies for Entry-Level Practice in Acute Care Physical Therapy met the challenge of integrating best available research, clinical experience, member feedback of all levels of experience, and expert feedback to develop this document. Further research on the benefits of this document to guide preparation for the entry-level clinician is needed.
Vitamin C Deficiency, High-Sensitivity C-Reactive Protein, and Cardiac Event-Free Survival in Patients With Heart Failure
Authors: Song Eun Kyeung , Kang Seok-Min 
Published: December 2016

Background:
Vitamin C is related to lower levels of high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker that predicts cardiovascular disease. Whether vitamin C deficiency is associated with hsCRP and cardiac events in heart failure (HF) patients has not been examined.

Purpose:
The aim of this study is to determine the relationships among vitamin C intake, serum levels of hsCRP, and cardiac events.

Methods:
A total of 200 HF patients completed a 3-day food diary to determine vitamin C deficiency and provided blood to measure serum levels of hsCRP. Patients were followed for 2 years to obtain data on cardiac event-free survival. Moderation analyses with hierarchical logistic and Cox regressions were used for the data analysis.

Results:
Seventy-eight patients (39%) had vitamin C deficiency and 100 (50%) had an hsCRP level higher than 3 mg/L. Vitamin C deficiency was associated with an hsCRP level higher than 3 mg/L in the hierarchical logistic regression (odds ratio, 2.40; 95% confidence interval, [1.13–5.10]; P = .023). Vitamin C deficiency (hazard ratio, 1.68; 95% CI, 1.05–2.69, P = .029) and hsCRP level higher than 3 mg/L (hazard ratio, 1.79; 95% CI, 1.07–3.01; P = .027) predicted shorter cardiac event-free survival in hierarchical Cox regression. The interaction of hsCRP level higher than 3 mg/L and vitamin C deficiency produced a 2.3-fold higher risk for cardiac events (P = .002) in moderation analysis. Higher level of hsCRP predicted shorter cardiac event-free survival only in patients with vitamin C deficiency (P = .027), but not in those with vitamin C adequacy.

Conclusion:
Vitamin C deficiency moderated the relationship between inflammation and cardiac events in patients with HF. Future study is required to determine whether adequate intake of vitamin C could play a protective role against the impact of inflammation on cardiac events in HF patients.
Sex Differences in the Effect of Atomoxetine on the QT Interval in Adult Patients With Attention-Deficit Hyperactivity Disorder
Authors: Suzuki Yutaro , Tajiri Misuzu , Sugimoto Atsunori , Orime Naoki , Hayashi Taketsugu , Egawa Jun , Sugai Takuro , Inoue Yoshimasa , Someya Toshiyuki 
Published: December 2016

AbstractBackgroundThe effects of atomoxetine on QT in adults remain unclear. In this study, we examined whether the use of atomoxetine to treat attention-deficit hyperactivity disorder in adults is associated with QT prolongation.MethodsForty-one subjects with attention-deficit hyperactivity disorder were enrolled in this study. Participants were administered 40, 80, or 120 mg atomoxetine daily and were maintained on their respective dose for at least 2 weeks. We conducted electrocardiographic measurements and blood tests, measuring plasma atomoxetine concentrations after treatment. Electrocardiograms of 24 of the patients were also obtained before atomoxetine treatment. The QT interval was corrected using Bazett (QTcB) and Fridericia (QTcF) correction formulas.ResultsIn these 24 patients, only the female patients had prolonged QTcB (P= 0.039) after atomoxetine treatment. There was no correlation between plasma atomoxetine concentrations and the corrected QT interval (QTc), or between atomoxetine dosage and the QTc. However, in female patients, there was a significant positive correlation between atomoxetine dosage and the QTcB (r= 0.631,P= 0.012), and there was a marginally significant positive correlation between atomoxetine dosage and the QTcF (r= 0.504,P= 0.055). In male patients, there was no correlation between atomoxetine dosage and the QTcB or QTcF intervals. There was no correlation between plasma atomoxetine concentrations and the QTc in either female or male patients.ImplicationsClinicians should exhibit caution when prescribing atomoxetine, particularly for female patients.
Hippocrates Quoted “If an Empyema Does Not Rupture, Death Will Occur”
Authors: Hardavella Georgia , Papakonstantinou Nikolaos A. , Karampinis Ioannis , Papavasileiou Gerasimos , Ajab Shereen , Shafaat Mohammed , Malagaris Stavros , Anastasiou Nikolaos 
Published: December 2016

Background:
The aim of this study was to evaluate the safety and efficacy of medical thoracoscopy through a single port [single-port medical thoracoscopy (S-MT)] for the treatment of empyema thoracis in its early stages.

Methods:
We performed a retrospective analysis reviewing the medical records of 84 patients referred for empyema and treated by medical thoracoscopy at our Thoracic Departments from January 2001 until November 2014. S-MT was performed under local anesthesia with neuroleptoanalgesia and spontaneous breathing using a single 1-cm incision for debridement and lavage of the pleural cavity.

Results:
A total of 84 patients underwent S-MT for pleural empyema stage I (9 patients, 10.7%) or II (75 patients, 89.3%). Median age was 61.8 years (range, 18 to 84 y). Male to female ratio was 3.76. Surgery was performed 5 to 26 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in 71 patients (84.5% of cases). The rest 15.5% of cases required video-assisted thoracoscopic surgery or open decortication due to trapped-lung syndrome. Median operation time was 45 minutes (range, 30 to 94 min). No intraoperative complications occurred. In-hospital mortality was zero, whereas in-hospital morbidity rate was 16.7%. Median hospital stay was 7.8 days (range, 3 to 18 days). Recurrence rate was 4.8% as 4 patients experienced a relapse of empyema.

Conclusion:
It seems that S-MT is a minimally invasive, safe and effective procedure for the treatment of pleural empyema with very good results in early stages of the disease and reduced time of hospital stay.
C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis
Authors: Huang Si-Si , Xie Dong-Mei , Cai Yi-Jing , Wu Jian-Min , Chen Rui-Chong , Wang Xiao-Dong , Song Mei , Zheng Ming-Hua , Wang Yu-Qun , Lin Zhuo , Shi Ke-Qing 
Published: December 2016

Background and aims
Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC.

Materials and methods
A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan–Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child–Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves.

Results
The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan–Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69–11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69–3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child–Pugh score. The results were also confirmed by time-dependent decision curves.

Conclusion
CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child–Pugh score in HBV-DC mortality prediction.
An Examination of Claims-based Predictors of Overdose from a Large Medicaid Program
Authors: Cochran Gerald , Gordon Adam J. , Lo-Ciganic Wei-Hsuan , Gellad Walid F. , Frazier Winfred , Lobo Carroline , Chang Chung-Chou H. , Zheng Ping , Donohue Julie M. 
Published: December 2016

Background:
Health systems may play an important role in identification of patients at-risk of opioid medication overdose. However, standard measures for identifying overdose risk in administrative data do not exist.

Objective:
Examine the association between opioid medication overdose and 2 validated measures of nonmedical use of prescription opioids within claims data.

Research Design:
A longitudinal retrospective cohort study that estimated associations between overdose and nonmedical use.

Subjects:
Adult Pennsylvania Medicaid program 2007–2012 patients initiating opioid treatment who were: nondual eligible, without cancer diagnosis, and not in long-term care facilities or receiving hospice.

Measures:
Overdose (International Classification of Disease, ninth edition, prescription opioid poisonings codes), opioid abuse (opioid use disorder diagnosis while possessing an opioid prescription), opioid misuse (a composite indicator of number of opioid prescribers, number of pharmacies, and days supplied), and dose exposure during opioid treatment episodes.

Results:
A total of 372,347 Medicaid enrollees with 583,013 new opioid treatment episodes were included in the cohort. Opioid overdose was higher among those with abuse (1.5%) compared with those without (0.2%, P<0.001). Overdose was higher among those with probable (1.8%) and possible (0.9%) misuse compared with those without (0.2%, P<0.001). Abuse [adjusted rate ratio (ARR), 1.52; 95% confidence interval (CI), 1.10–2.10), probable misuse (ARR, 1.98; 95% CI, 1.46–2.67), and possible misuse (ARR, 1.76; 95% CI, 1.48–2.09) were associated with significantly more events of opioid medication overdose compared with those without.

Conclusions:
Claims-based measures can be used by health systems to identify individuals at-risk of overdose who can be targeted for restrictions on opioid prescribing, dispensing, or referral to treatment.
State-Level Surveillance of Underinsurance and Health Care-Related Financial Burden
Authors: Dumont Dora M. , Oh Junhie , Cooper Tara 
Published: December 2016

Background:
The Affordable Care Act (ACA) has reduced uninsurance, but underinsurance, health care-related financial burden, and dental uninsurance may not follow suit. Underinsurance is associated with reduced access to care, household debt, and bankruptcy but has been difficult to track without economic data.

Methods:
We used readily available state-level survey data to build a model that states can adopt to implement surveillance over underinsurance and health care-related financial burden, as well as assess related disparities and health profiles.

Results:
The state prevalence of underinsurance and dental uninsurance did not change in the first year of the ACA's individual mandate. Underinsurance was associated with poorer health-related quality-of-life measures: compared with the fully insured, underinsured adults had an adjusted odds ratio of 2.40 (95% CI, 1.71-3.38) of fair or poor general health.

Conclusion:
Tracking underinsurance and medical debt can help public health and health care access stakeholders evaluate which mechanisms (deductibles, co-pays, uncovered services, or is proportionately priced health care services and products) are barriers to care and improved health outcomes.
Bacterial pneumonia as an influenza complication
Authors: Martin-Loeches Ignacio , van Someren Gréve Frank , Schultz Marcus J. 
Published: December 2016

Purpose of review
The pathogenesis and impact of coinfection, in particular bacterial coinfection, in influenza are incompletely understood. This review summarizes results from studies on bacterial coinfection in the recent pandemic influenza outbreak.

Recent findings
Systemic immune mechanisms play a key role in the development of coinfection based on the complexity of the interaction of the host and the viral and bacterial pathogens. Several studies were performed to determine the point prevalence of bacterial coinfection in influenza. Coinfection in influenza is frequent in critically ill patients with Streptococcus pneumoniae being the most frequent bacterial pathogen and higher rates of potentially resistant pathogens over the years.

Summary
Bacterial pneumonia is certainly an influenza complication. The recent epidemiology findings have helped to partially resolve the contribution of different pathogens. Immunosuppression is a risk factor for bacterial coinfection in influenza, and the epidemiology of coinfection has changed over the years during the last influenza pandemic, and these recent findings should be taken into account during present outbreaks.
Diffusion-Weighted Imaging for Differentiating Uterine Leiomyosarcoma From Degenerated Leiomyoma
Authors: Li Hai Ming , Liu Jia , Qiang Jin Wei , Zhang Hao , Zhang Guo Fu , Ma FengHua 
Published: December 2016

Purpose
The study aimed to investigate magnetic resonance diffusion-weighted imaging (DWI) in the differentiation of uterine leiomyosarcoma (ULMS) from degenerated leiomyoma (DLM).

Methods
Sixteen patients with ULMSs and 26 patients with DLMs confirmed by surgery and pathology underwent conventional magnetic resonance imaging and DWI. The mean apparent diffusion coefficient (ADC) values of the 2 groups’ tumors were measured and compared using an independent-sample t test (b = 0.1000 s/mm2 [ADC1]; b = 0.800 s/mm2 [ADC2], respectively). A receiver operating characteristic curve was used to evaluate the diagnostic performance of DWI in the differentiation of ULMS from DLM. Intraobserver and interobserver agreements were evaluated using an intraclass correlation coefficient and Bland-Altman analysis.

Results
The mean ADC value in ULMSs (0.81 ± 0.14 × 10−3mm2/s [ADC1], 0.90 ± 0.11 × 10−3mm2/s [ADC2]) was significantly lower than that in DLMs (1.22 ± 0.22 × 10−3mm2/s [ADC1], 1.50 ± 0.22 × 10−3mm2/s [ADC2]) (P < 0.001, <0.001, respectively). The sensitivity, specificity, accuracy, and positive and negative predictive values for characterizing ULMS were 100%, 90%, 93%, and 83% and 100% [ADC1] and 100%, 93%, 96%, and 90% and 100% [ADC2]; respectively. Intraobserver and interobserver reproducibilities were excellent (intraclass correlation coefficient = 0.967–0.988; small variability and 95% limits of agreement).

Conclusions
Diffusion-weighted imaging is helpful in differentiating ULMS from DLM.