bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Machine Learning to Predict Laboratory Test Results
Authors: Luo Yuan , Szolovits Peter , Dighe Anand S , Baron Jason M 
Published: June 2016

Abstract

Objectives
While clinical laboratories report most test results as individual numbers, findings, or observations, clinical diagnosis usually relies on the results of multiple tests. Clinical decision support that integrates multiple elements of laboratory data could be highly useful in enhancing laboratory diagnosis.

Methods
Using the analyte ferritin in a proof of concept, we extracted clinical laboratory data from patient testing and applied a variety of machine-learning algorithms to predict ferritin test results using the results from other tests. We compared predicted with measured results and reviewed selected cases to assess the clinical value of predicted ferritin.

Results
We show that patient demographics and results of other laboratory tests can discriminate normal from abnormal ferritin results with a high degree of accuracy (area under the curve as high as 0.97, held-out test data). Case review indicated that predicted ferritin results may sometimes better reflect underlying iron status than measured ferritin.

Conclusions
These findings highlight the substantial informational redundancy present in patient test results and offer a potential foundation for a novel type of clinical decision support aimed at integrating, interpreting, and enhancing the diagnostic value of multianalyte sets of clinical laboratory test results.
A novel approach for selecting combination clinical markers of pathology applied to a large retrospective cohort of surgically resected pancreatic cysts
Authors: Masica David L , Dal Molin Marco , Wolfgang Christopher L , Tomita Tyler , Ostovaneh Mohammad R , Blackford Amanda , Moran Robert A , Law Joanna K , Barkley Thomas , Goggins Michael , Irene Canto Marcia , Pittman Meredith , Eshleman James R , Ali Syed Z , Fishman Elliot K , Kamel Ihab R , Raman Siva P , Zaheer Atif , Ahuja Nita , Makary Martin A , Weiss Matthew J , Hirose Kenzo , Cameron John L , Rezaee Neda , He Jin , Joon Ahn Young , Wu Wenchuan , Wang Yuxuan , Springer Simeon , Diaz Luis L , Papadopoulos Nickolas , Hruban Ralph H , Kinzler Kenneth W , Vogelstein Bert , Karchin Rachel , Marie Lennon Anne 
Published: June 2016

Objective: Our objective was to develop an approach for selecting combinatorial markers of pathology from diverse clinical data types. We demonstrate this approach on the problem of pancreatic cyst classification.
Materials and Methods: We analyzed 1026 patients with surgically resected pancreatic cysts, comprising 584 intraductal papillary mucinous neoplasms, 332 serous cystadenomas, 78 mucinous cystic neoplasms, and 42 solid-pseudopapillary neoplasms. To derive optimal markers for cyst classification from the preoperative clinical and radiological data, we developed a statistical approach for combining any number of categorical, dichotomous, or continuous-valued clinical parameters into individual predictors of pathology. The approach is unbiased and statistically rigorous. Millions of feature combinations were tested using 10-fold cross-validation, and the most informative features were validated in an independent cohort of 130 patients with surgically resected pancreatic cysts.
Results: We identified combinatorial clinical markers that classified serous cystadenomas with 95% sensitivity and 83% specificity; solid-pseudopapillary neoplasms with 89% sensitivity and 86% specificity; mucinous cystic neoplasms with 91% sensitivity and 83% specificity; and intraductal papillary mucinous neoplasms with 94% sensitivity and 90% specificity. No individual features were as accurate as the combination markers. We further validated these combinatorial markers on an independent cohort of 130 pancreatic cysts, and achieved high and well-balanced accuracies. Overall sensitivity and specificity for identifying patients requiring surgical resection was 84% and 81%, respectively.
Conclusions: Our approach identified combinatorial markers for pancreatic cyst classification that had improved performance relative to the individual features they comprise. In principle, this approach can be applied to any clinical dataset comprising dichotomous, categorical, and continuous-valued parameters.
The Teachers of Quality Academy: A Learning Community Approach to Preparing Faculty to Teach Health Systems Science
Authors: Baxley Elizabeth G. , Lawson Luan , Garrison Herbert G. , Walsh Danielle , Lazorick Suzanne , Lake Donna , Higginson Jason 
Published: June 2016

Problem
Although efforts to integrate health systems science (HSS) topics, such as patient safety, quality improvement (QI), interprofessionalism, and population health, into health professions curricula are increasing, the rate of change has been slow.

Approach
The Teachers of Quality Academy (TQA), Brody School of Medicine at East Carolina University, was established in January 2014 with the dual goal of preparing faculty to lead frontline clinical transformation while becoming proficient in the pedagogy and curriculum design necessary to prepare students in HSS competencies. The TQA included the completion of the Institute for Healthcare Improvement Open School Basic Certificate in Quality and Safety; participation in six 2-day learning sessions on key HSS topics; completion of a QI project; and participation in three online graduate courses.

Outcomes
Twenty-seven faculty from four health science programs completed the program. All completed their QI projects. Nineteen (70%) have been formally engaged in the design and delivery of the medical student curriculum in HSS. Early into their training, TQA participants began to apply new knowledge and skills in HSS to the development of educational initiatives beyond the medical student curriculum.

Next Steps
Important next steps for TQA participants and program planners include further incorporation as faculty advisors and contributors to the full implementation of the longitudinal HSS curriculum; expanded involvement with the Leaders in Innovative Care Scholars student leadership distinction track; continued in-depth evaluation of the impact of TQA participation on patient care, teaching, and role modeling; and the recruitment of the next cohort of TQA participants.
Attending Physician Adherence to a 29-Component Central Venous Catheter Bundle Checklist During Simulated Procedures*
Authors: Barsuk Jeffrey H. , Cohen Elaine R. , Nguyen Duyhuu , Mitra Debi , O’Hara Kelly , Okuda Yasuharu , Feinglass Joe , Cameron Kenzie A. , McGaghie William C. , Wayne Diane B. 
Published: June 2016

Objectives:
Central venous catheter insertions may lead to preventable adverse events. Attending physicians’ central venous catheter insertion skills are not assessed routinely. We aimed to compare attending physicians’ simulated central venous catheterinsertion performance to published competency standards.

Design:
Prospective cohort study of attending physicians’ simulated internal jugular and subclavian central venous catheter insertion skills versus a historical comparison group of residents who participated in simulation training.

Setting:
Fifty-eight Veterans Affairs Medical Centers from February 2014 to December 2014 during a 2-day simulation-based education curriculum and two academic medical centers in Chicago.

Subjects:
A total of 108 experienced attending physicians and 143 internal medicine and emergency medicine residents.

Intervention:
None.

Measurements and Main Results:
Using a previously published central venous catheter insertion skills checklist, we compared Veterans Affairs Medical Centers attending physicians’ simulated central venous catheter insertion performance to the same simulated performance by internal medicine and emergency medicine residents from two academic centers. Attending physician performance was compared to residents’ baseline and posttest (after simulation training) performance. Minimum passing scores were set previously by an expert panel. Attending physicians performed higher on the internal jugular (median, 75.86% items correct; interquartile range, 68.97–86.21) and subclavian (median, 83.00%; interquartile range, 59.00–86.21) assessments compared to residents’ internal jugular (median, 37.04% items correct; interquartile range, 22.22–68.97) and subclavian (median, 33.33%; interquartile range, 0.00–70.37; both p < 0.001) baseline assessments. Overall simulated performance was poor because only 12 of 67 attending physicians (17.9%) met or exceeded the minimum passing score for internal jugular central venous catheter insertion and only 11 of 47 (23.4%) met or exceeded the minimum passing score for subclavian central venous catheter insertion. Resident posttest performance after simulation training was significantly higher than attending physician performance (internal jugular: median, 96%; interquartile range, 93.10–100.00; subclavian: median, 100%; interquartile range, 96.00–100.00; both p < 0.001).

Conclusions:
This study demonstrates highly variable simulated central venous catheter insertion performance among a national cohort of experienced attending physicians. Hospitals, healthcare systems, and governing bodies should recognize that even experienced physicians require periodic clinical skill assessment and retraining.
Association Among ICU Congestion, ICU Admission Decision, and Patient Outcomes*
Authors: Kim Song-Hee , Chan Carri W. , Olivares Marcelo , Escobar Gabriel J. 
Published: June 2016

Objectives:
To employ automated bed data to examine whether ICU occupancy influences ICU admission decisions and patient outcomes.

Design:
Retrospective study using an instrumental variable to remove biases from unobserved differences in illness severity for patients admitted to ICU.

Setting:
Fifteen hospitals in an integrated healthcare delivery system in California.

Patients:
Seventy thousand one hundred thirty-three episodes involving patients admitted via emergency departments to a medical service over a 1-year period between 2008 and 2009.

Interventions:
None.

Measurements and Main Results:
A third of patients admitted via emergency department to a medical service were admitted under high ICU congestion (more than 90% of beds occupied). High ICU congestion was associated with a 9% lower likelihood of ICU admission for patients defined as eligible for ICU admission. We further found strong associations between ICU admission and patient outcomes, with a 32% lower likelihood of hospital readmission if the first inpatient unit was an ICU. Similarly, hospital length of stay decreased by 33% and likelihood of transfer to ICU from other units—including ICU readmission if the first unit was an ICU—decreased by 73%.

Conclusions:
High ICU congestion is associated with a lower likelihood of ICU admission, which has important operational implications and can affect patient outcomes. By taking advantage of our ability to identify a subset of patients whose ICU admission decisions are affected by congestion, we found that, if congestion were not a barrier and more eligible patients were admitted to ICU, this hospital system could save approximately 7.5 hospital readmissions and 253.8 hospital days per year. These findings could help inform future capacity planning and staffing decisions.
Concurrent and lagged relations between momentary affect and sedentary behavior in middle-aged women
Authors: Elavsky Steriani , Kishida Moé , Mogle Jacqueline A. 
Published: June 2016

Abstract

Objective:
The purpose of this study was to investigate the reciprocal relationship between sedentary behavior (SB) and momentary affect in the context of daily experiences.

Methods:
Community-dwelling midlife women (N = 121; age 40-60 y) were recruited for a 15-day daily diary study. The women rated their positive and negative affect when prompted on a personal digital assistant device four times per day and wore an accelerometer for objective assessment of SB. Multilevel models were estimated to test concurrent and lagged associations between momentary estimates of SB and affect.

Results:
In models that controlled for day of week, number of hot flashes, and total minutes of accelerometer wear time, greater concurrent positive affect was associated with fewer minutes spent being sedentary (β = −31, P < 0.01). Neither lagged positive nor negative affect predicted later SB; however, more sedentary minutes predicted lower positive affect at the next occasion (β = −0.04, P < 0.01).

Conclusions:
These results suggest that SB has negative affective consequences from moment to moment. The implications of reduced positive affect after prolonged bouts of SB for subsequent motivational, behavioral, or well-being outcomes remain to be determined.
Physical fitness improvement in overweight postmenopausal women who do not lose fat mass in response to exercise training
Authors: Myette-Côté Étienne , Archambault-Therrien Claudie , Brochu Martin , Dionne Isabelle J. , Riesco Eléonor 
Published: June 2016

Abstract

Objective:
The aim of this study was to examine if overweight postmenopausal women who do not experience fat mass loss after a 1-year aerobic exercise (AE) and resistance training (RT) program can still improve physical fitness.

Methods:
Thirty-one overweight women (body mass index 28-40 kg/m2 or waist circumference ≥88 cm) participated in three weekly supervised AE and RT sessions for 1 year. All women were categorized according to their fat mass changes after the intervention: 14 women were considered as responders (fat mass loss ≥5% of initial fat mass) and 17 as nonresponders (fat mass loss <5% of initial fat mass). The main outcome measures were absolute and relative body strength, peak aerobic capacity, lower limbs power, flexibility, and body composition (DXA). Total energy intake (3-day dietary record) and physical activity level (physical activity scale for the elderly questionnaire) were also measured before, halfway through and after the intervention.

Results:
At baseline, nonresponders participants had higher body mass index (P = 0.04). After the intervention, relative and absolute upper and lower body strength, peak aerobic capacity (all P < 0.005), and flexibility increased similarly in the nonresponders and responders groups (P = 0.01).

Conclusions:
Although some participants did not respond to exercise by decreasing fat mass, they still experienced important physical fitness benefits from AE and RT. These results suggest that body composition changes should not be the sole indicator of the benefits of exercise in overweight postmenopausal women.
The usability of a WeChat-based electronic questionnaire for collecting participant-reported data in female pelvic floor disorders: a comparison with the traditional paper-administered format
Authors: Sun Zhi-Jing , Zhu Lan , Liang Maolian , Xu Tao , Lang Jing-he 
Published: June 2016

Abstract

Objective:
WeChat is a promising tool for capturing electronic data; however, no research has examined its use. This study evaluates the reliability and feasibility of WeChat for administering the Pelvic Floor Impact Questionnaire Short Form 7 questionnaire to women with pelvic floor disorders.

Methods:
Sixty-eight pelvic floor rehabilitation women were recruited between June and December 2015 and crossover randomized to two groups. All participants completed two questionnaire formats. One group completed the paper version followed by the WeChat version; the other group completed the questionnaires in reverse order. Two weeks later, each group completed the two versions in reverse order. The WeChat version's reliability was assessed using intraclass correlation coefficients and test-retest reliability.

Results:
Forty-two women (61.8%) preferred the WeChat to the paper format, eight (11.8%) preferred the paper format, and 18 (26.5%) had no preference. The younger women preferred WeChat. Completion time was 116.5 (61.3) seconds for the WeChat version and 133.4 (107.0) seconds for the paper version, with no significant difference (P = 0.145). Age and education did not impact completion time (P > 0.05). Consistency between the WeChat and paper versions was excellent. The intraclass correlation coefficients of the Pelvic Floor Impact Questionnaire Short Form 7 and the three subscales ranged from 0.915 to 0.980. The Bland-Altman analysis and linear regression results also showed high consistency. The test-retest study had a Pearson's correlation coefficient of 0.908, demonstrating a strong correlation.

Conclusions:
WeChat-based questionnaires were well accepted by women with pelvic floor disorders and had good data quality and reliability.
Menopause is associated with articular cartilage degeneration: a clinical study of knee joint in 860 women
Authors: Lou Chao , Xiang Guangheng , Weng Qiaoyou , Chen Zhaojie , Chen Deheng , Wang Qingqing , Zhang Di , Zhou Bin , He Dengwei , Chen Hongliang 
Published: June 2016

Abstract

Objective:
The purpose of this study was to investigate the association between menopause and severity of knee joint cartilage degeneration using a magnetic resonance imaging-based six-level grading system, with six cartilage surfaces, the medial and lateral femoral condyle, the femoral trochlea, the medial and lateral tibia plateau, and the patella.

Methods:
The study cohort comprised 860 healthy women (age 36-83 y), and 5,160 cartilage surfaces were analyzed. Age, weight, height, age at natural menopause, and years since menopause (YSM) were obtained. Cartilage degeneration was assessed using a magnetic resonance imaging-based six-level grading system.

Results:
After removing the age, height, and weight effects, postmenopausal women had more severe cartilage degeneration than pre- and perimenopausal women (P < 0.001). A positive trend was observed between YSM and severity of cartilage degeneration (P < 0.05). Postmenopausal women were divided into seven subgroups by every five YSM. When YSM was less than 25 years, the analysis of covariance indicated a significant difference in medial tibia plateau, medial femoral condyle, trochlea, patella, and total surfaces (P < 0.05 or 0.01) between every two groups. When YSM was more than 25 years, the significant difference, however, disappeared in these four surfaces (P > 0.05). No significant difference was observed in lateral tibia plateau and lateral femoral condyle in postmenopausal women.

Conclusions:
Menopause is associated with cartilage degeneration of knee joint. After menopause, cartilage showed progressive severe degeneration that occurred in the first 25 YSM, suggesting estrogen deficiency might be a risk factor of cartilage degeneration of the knee joint. Further studies are needed to investigate whether age or menopause plays a more important role in the progression of cartilage degeneration in the knee joint.
STRANGULATION-INDUCED CENTRAL RETINAL ARTERY OCCLUSION: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Greven Margaret A. , Moshfeghi Darius M. 
Published: June 2016

Purpose:
To describe a patient with central retinal artery occlusion following an episode of mechanical strangulation.

Methods:
A retrospective case report. An 83-year-old man presented with acute vision loss in his right eye after a strangling episode. Multimodal clinical imaging was performed.

Results:
Visual acuity in the affected right eye was no light perception. Examination revealed optic nerve edema and optic nerve pallor and also severe vascular attenuation and a cherry-red spot in the macula.

Conclusion:
Mechanical disruption of carotid plaque can lead to occlusion of the central retinal artery, which may portend a dismal visual prognosis.
Advances in Gamma Knife radiosurgery for pituitary tumors
Authors: Lee Cheng-Chia , Sheehan Jason P. 
Published: June 2016

Purpose of review
For the residual/recurrent pituitary adenomas, stereotactic radiosurgery (SRS) plays an important role in long-term tumor control and, for secretory adenomas, endocrine remission. The purpose of this review is to address the advances in SRS technique and detail the latest treatment strategies for various types of pituitary adenomas with a focus on recently published literature.

Recent findings
From recent publications, SRS may be considered as an upfront treatment in patients with an adenoma that resides largely in the cavernous sinus and for whom resection is unlikely to produce substantial reduction in the overall tumor volume. Early treatment (<6 months after prior resection) with SRS appears to decrease the rate of tumor progression of subtotally resected nonfunctioning pituitary macroadenomas. Some types of adenomas may appear more aggressive with a high recurrence rate, for example, silent corticotroph pituitary adenomas, or sparsely granulated somatotroph-cell adenomas, may be indicated for a high-radiation dose. Finally, whole-sellar radiation and fractionated SRS are the alternative strategies, and may be indicated for challenging cases.

Summary
The role of SRS for the pituitary adenoma is well established, and the treatment strategy is increasingly individualized based upon tumor histology, location, and volume. Hypopituitarism is the most complicated and can occur even years after SRS.
Infliximab Optimization Based on Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease
Authors: Hofmekler Tatyana , Bertha Madeline , McCracken Courtney , Martineau Benadette , McKinnon Elizabeth , Schoen Bess T. , McElhanon Barbara O. , Tenjarla Gayathri , Kugathasan Subra , Sauer Cary G. 
Published: June 2016

ABSTRACTBackground:Infliximab (IFX) is an effective treatment for the management of moderate to severe inflammatory bowel disease (IBD). Low‐serum IFX levels are associated with the development of antibodies to IFX (ATI), which subsequently associated with clinical relapse and increased morbidity. The primary purpose of this study is to examine the relation between dose and interval to IFX level. Secondary goal is to evaluate the relation between IFX level and ATI in a pediatric IBD population.Methods:We performed a retrospective chart review of all children diagnosed with IBD and treated with IFX at a tertiary care pediatric IBD center. We performed our analysis based on prescribed dosing intervals and rounded dose up to 5 or 10 mg/kg as indicated in clinical practice.Results:Our study included 278 samples from 129 children on IFX. ATI were detected in 37 samples (13.3%). Low IFX levels (<3 μg/mL) were detected in 37.2% of children receiving IFX. Samples with ATI present had significantly lower levels of IFX than samples in which ATI were not present. For the dose 5 mg/kg, Q6 dosing had significantly higher IFX levels than Q8 dosing (P = 0.009). Higher IFX levels were seen with interval shortening rather than dose escalation.Conclusions:We demonstrate that low IFX levels are associated with development of immunogenicity to IFX as measured by ATI. We demonstrate that interval shortening rather than dose escalation results in higher IFX levels. We suggest that given the high number of IFX levels below 3 μg/mL in patients, early IFX level evaluation or primary initiation of Q6 week dosing be considered.