bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency department visit frequency and health care costs following implementation of an integrated practice unit for frequent utilizers
Authors: Wang Ruixuan , Lukose Kiran , Ensz Olga S. , Revere Lee , Hammarlund Noah 
Published: June 2024

AbstractObjectivesThe integrated practice unit (IPU) aims to improve care for patients with complex medical and social needs through care coordination, medication reconciliation, and connection to community resources. This study examined the effects of IPU enrollment on emergency department (ED) utilization and health care costs among frequent ED utilizers with complex needs.MethodsWe extracted electronic health records (EHR) data from patients in a large health care system who had at least four distinct ED visits within any 6‐month period between March 1, 2018, and May 30, 2021. Interrupted time series (ITS) analyses were performed to evaluate the impact of IPU enrollment on monthly ED visits and health care costs. A control group was matched to IPU patients using a propensity score at a 3:1 ratio.ResultsWe analyzed EHRs of 775 IPU patients with a control group of 2325 patients (mean [±SD] age 43.6 [±17]; 45.8% female; 50.9% White, 42.3% Black). In the single ITS analysis, IPU enrollment was associated with a decrease of 0.24 ED visits (p < 0.001) and a cost reduction of $466.37 (p = 0.040) in the first month, followed by decreases of 0.11 ED visits (p < 0.001) and $417.61 in costs (p < 0.001) each month over the subsequent year. Our main results showed that, compared to the matched control group, IPU patients experienced 0.20 more ED visits (p < 0.001) after their fourth ED visit within 6 months, offset by a reduction of 0.02 visits (p < 0.001) each month over the next year. No significant immediate or sustained increase in costs was observed for IPU‐enrolled patients compared to the control group.ConclusionsThis quasi‐experimental study of frequent ED utilizers demonstrated an initial increase in ED visits following IPU enrollment, followed by a reduction in ED utilization over subsequent 12 months without increasing costs, supporting IPU's effectiveness in managing patients with complex needs and limited access to care.
Bisphosphonate effectiveness in patients with cirrhosis: An emulated clinical trial
Authors: Tapper Elliot B. , Martinez Beanna , Jepsen Peter , Chen Xi , Parikh Neehar D. 
Published: June 2024

SummaryBackgroundFalls and fractures are common and morbid for patients with cirrhosis. Bisphosphonates are recommended for the prevention of fractures for people with osteoporosis cirrhosis; however, data supporting effectiveness in cirrhosis are lacking.AimWe sought to emulate a clinical trial of bisphosphonates in cirrhosis.MethodsWe used national Medicare data (2008–2020) to examine the 5‐year risk of fractures in patients who did or did not receive bisphosphonates with a new‐user design among people diagnosed with cirrhosis and osteoporosis. We balanced treated and untreated with inverse probability of treatment weighting, evaluated intention‐to‐treat and as‐treated effects, and examined both control exposures (statin use) and outcomes (decompensation) to test causal relationships.ResultsThere were 253 and 20,888 new users and non‐users of bisphosphonates, respectively. The median age was 74 years. The most common bisphosphonate used was alendronate (73.6%). Bisphosphonates significantly reduced fractures overall (27.5% vs. 33.0%, p = 0.0004) in the intention‐to‐treat analysis, particularly for people <65 years (sHR 0.56) old, men (sHR 0.64) and those with non‐alcohol related liver disease (sHR 0.85). Though there were fewer arm (20.7% vs. 26.4%, p < 0.0001) and femur (28.9% vs. 31.2%, p = 0.005), there were more spinal (25.8% vs. 19.0%), rib (40.0% vs. 32.2%) and skull (10.1% vs. 8.7%) fractures. In the as‐treated analysis, cumulative bisphosphonate exposure significantly reduced fractures, sHR 0.95 95% CI (0.91, 0.98). Treatment was inconsistent; bisphosphonate users spent 29.9% person‐years of follow‐up on the drug.ConclusionIn a nationally representative cohort of elderly patients with cirrhosis, bisphosphonates reduced fractures overall. Efforts to increase uptake and drug continuation are needed.
A qualitative exploration of children's lives with rare diseases
Authors: Buckle Niamh , Rogers Yvonne , O'Toole Doris , McNulty Sandra , Kroll Thilo , Gibbs Lisa , Somanadhan Suja 
Published: June 2024

AbstractBackgroundRare diseases encompass a diverse group of debilitating and sometimes life‐threatening conditions that affect a small percentage of the population, posing a significant public health challenge. Despite their rarity, around 70% of these diseases afflict children, yet limited research has focused on their experiences. This study aimed to gain insights into the day‐to‐day challenges children living with rare diseases face.MethodsWe conducted semistructured one‐to‐one interviews with 11 children and young people (7–16 years) diagnosed with a range of rare diseases, purposively sampled from a tertiary pediatric healthcare setting in Ireland. We analyzed the interview transcripts, and themes were devised inductively.ResultsTwo themes were identified: “Knowledge and Understanding of Rare Diseases” and “Fitting in Versus Feeling Different.” These themes emerged across various settings—the home, hospital, school, and social environments—to illustrate the impact of rare diseases on the participants' daily lives. A conceptual framework was developed to illustrate how the children's knowledge, experiences, and emotions shape their identity in a rare disease context.ConclusionsOur analysis revealed a complex interplay between the participants' sense of belonging and their awareness of being different, influenced by the manifestations and demands of their rare conditions or illnesses. This duality in their identity was most pronounced in social settings, where the participants felt the most significant impact of their rare diseases. Understanding this interplay sheds light on the unique social challenges children with rare medical conditions face. Raising awareness about these conditions could mitigate these children's social challenges, fostering a more inclusive society for those with rare diseases.
Mothers speak less to infants during detected real‐world phone use
Authors: Mikhelson Miriam , Luong Adrian , Etz Alexander , Micheletti Megan , Khante Priyanka , de Barbaro Kaya 
Published: June 2024

AbstractThe current study is the first to document the real‐time association between phone use and speech to infants in extended real‐world interactions. N= 16 predominantly White (75%) mother–infant dyads (infants aged M = 4.1 months, SD = 2.3; 63% female) shared 16,673 min of synchronized real‐world phone use and Language Environment Analysis audio data over the course of 1 week (collected 2017–2020) for our analyses. Maternal phone use was associated with a 16% decrease in infants' speech input, with shorter intervals of phone use (1–2 min) associated with a greater 26% decrease in speech input relative to longer periods. This work highlights the value of multimodal sensing to access dynamic, within‐person, and context‐specific predictors of speech to infants in real‐world settings.
Association between modified frailty index and postoperative delirium in patients after cardiac surgery: A cohort study of 2080 older adults
Authors: Cheng Hongtao , Ling Yitong , Li Qiugui , Li Xinya , Tang Yonglan , Guo Jiayu , Li Jing , Wang Zichen , Ming Wai‐kit , Lyu Jun 
Published: June 2024

AbstractAimTo evaluate the association between frailty and postoperative delirium (POD) in elderly cardiac surgery patients.MethodsA retrospective study was conducted of older patients admitted to the intensive care unit after cardiac surgery at a tertiary academic medical center in Boston from 2008 to 2019. Frailty was measured using the Modified Frailty Index (MFI), which categorized patients into frail (MFI ≥3) and non‐frail (MFI = 0–2) groups. Delirium was identified using the confusion assessment method for the intensive care unit and nursing notes. Logistic regression models were used to examine the association between frailty and POD, and odds ratios (OR) with 95% confidence intervals (CI) were calculated.ResultsOf the 2080 patients included (median age approximately 74 years, 30.9% female), 614 were frail and 1466 were non‐frail. The incidence of delirium was significantly higher in the frail group (29.2% vs. 16.4%, p < 0.05). After adjustment for age, sex, race, marital status, Acute Physiology Score III (APSIII), sequential organ failure assessment (SOFA), albumin, creatinine, hemoglobin, white blood cell count, type of surgery, alcohol use, smoking, cerebrovascular disease, use of benzodiazepines, and mechanical ventilation, multivariate logistic regression indicated a significantly increased risk of delirium in frail patients (adjusted OR: 1.61, 95% CI: 1.23–2.10, p < 0.001, E‐value: 1.85).ConclusionsFrailty is an independent risk factor for POD in older patients after cardiac surgery. Further research should focus on frailty assessment and tailored interventions to improve outcomes.
Impact of moderate‐intensity aerobic exercise in combined hypoxic and hot conditions on endothelial function
Authors: Morishima Takuma , Yamaguchi Keiichi , Goto Kazushige 
Published: June 2024

AbstractThere is no study that has investigated the impact of exercise in a combined hypoxic and hot environment on endothelial function. Therefore, we tested whether aerobic exercise in a combined hypoxic and hot conditions induces further enhancement of endothelial function. Twelve healthy males cycled at a constant workload (50% of their maximal oxygen uptake under normoxic/thermoneutral conditions) for 30 min in four different environments: exercise under normoxic condition (NOR: fraction of inspiratory oxygen or FiO2 = 20.9%, 20°C), exercise under hypoxic condition (HYP: FiO2 = 14.5%, 20°C), exercise under hot condition (HOT: FiO2 = 20.9%, 30°C), and exercise under combined hypoxia and hot conditions (HH: FiO2 = 14.5%, 30°C). Before, during, and after exercise, cardiovascular variables (e.g., heart rate, blood flow, and shear rate), blood variables, and endothelial function evaluated by flow‐mediated dilation (FMD) were assessed. Heart rates were significantly higher throughout the HH trial's experimental period than the other trials (p < 0.05). However, in the HH trial, brachial artery blood flow and shear rate did not differ from those in other trials after exercise. Plasma catecholamines (epinephrine, norepinephrine, and dopamine) elevations in response to exercise were significantly higher in the HH trial than in the other three trials (p < 0.05). No considerable differences were observed in FMD responses among trials before and after the exercise. In conclusion, aerobic exercise in a combined hot and hypoxic environment further activated sympathetic nervous activity but did not considerably enhance blood flow, shear rate, or endothelial function.
Relation of changes in peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) during bronchoconstriction
Authors: Csonka Leon L. , Tikkakoski Antti , Vuotari Liisa , Karjalainen Jussi , Lehtimäki Lauri 
Published: June 2024

AbstractDiagnosis of asthma can be confirmed based on variability in peak expiratory flow (PEF) or changes in forced expiratory volume in 1 s (FEV1) measured with spirometry. Our aim was to use methacholine challenge as a model of induced airway obstruction to assess how well relative changes in PEF reflect airway obstruction in comparison to relative changes in FEV1. We retrospectively studied 878 patients who completed a methacholine challenge test. To assess congruency along with differences between relative changes in FEV1 and PEF during airway obstruction, a regression analysis was performed, and a Bland & Altman plot was constructed. ROC analysis, sensitivity, specificity, positive and negative predictive values and κ‐coefficient were used to analyze how decrease in PEF predicts decrease of 10% or 15% in FEV1. The relative change in PEF was on average less than the relative change in FEV1. In the ROC analysis areas under the curve were 0.844 and 0.893 for PEF decrease to predict a 10% and 15% decrease in FEV1, respectively. The agreement between changes in PEF and FEV1 varied from fair to moderate. Airway obstruction detected by change in PEF was false in about 40% of cases when compared to change in FEV1. Change in PEF is not a very accurate measure of airway obstruction when compared to change in FEV1. Replacing peak flow metre with a handheld spirometer might improve diagnostic accuracy of home monitoring in asthma.
Terbinafine‐resistant T. indotineae due to F397L/L393S or F397L/L393F mutation among corticoid‐related tinea incognita patients
Authors: Tamimi Pegah , Fattahi Mahsa , Ghaderi Aliasghar , Firooz Alireza , Shirvani Fariba , Alkhen Ahmed , Zamani Shayan 
Published: June 2024

SummaryTinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug‐resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine‐resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)‐associated resistance mechanisms are evaluated. Lesions caused by terbinafine‐resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high‐level resistance. L393S was seen in isolates with low‐resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics‐based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.
A case of right aortic arch type II combined with Kommerell's diverticulum and left innominate vein beneath the aortic arch
Authors: Chen Ran , Cao Jing‐fang , Liu Lian‐di , Chen Si , Zheng Shuang 
Published: June 2024

AbstractThe combination of the right aortic arch and aberrant left subclavian artery (ALSA) with Kommerell's diverticulum (KD) is rare to coexist with the left innominate vein (LINV) beneath the aortic arch. It escalates the surgical risk undoubtedly and increases the difficulty of clinical procedures. We report one case diagnosed by Ultrasound and Computed Tomography Angiography (CTA).
Salt versus no salt restriction in heart failure a review
Authors: Raggi Paolo 
Published: June 2024

AbstractBackgroundFor decades standard teaching recommended salt intake (sodium) reduction in patients suffering from heart failure. Neurohumoral activation with subsequent fluid retention provided a solid rationale for this long‐standing recommendation. Until recently no large randomized clinical trial of sodium restriction was available, while some observational studies and metanalyses even suggested a worse outcome with strict sodium restriction in patients with heart failure.MethodsIn this narrative review we aimed to extricate from the literature whether strict sodium restriction is beneficial in patients with heart failure. We searched PubMed indexed articles between 2000 and 2023 for these terms: heart failure, salt, sodium, fluid intake.ResultsMost randomized trials were small and showed a wide heterogeneity of interventions. A single large, randomized clinical trial was stopped early due to futility. Overall, there is no evidence that severe sodium restriction reduces the incidence of mortality and hospitalization in patients with heart failure. Quality of life and functional class may improve slightly with sodium restriction.ConclusionMorbidity and mortality are not reduced with sodium restriction in patients with heart failure, although some symptomatic improvement may be expected.
Neurofilament light chain and profilin‐1 dynamics in 30 spinal muscular atrophy type 3 patients treated with nusinersen
Authors: Musso G. , Bello L. , Capece G. , Bozzoni V. , Caumo L. , Sabbatini D. , Zangaro V. , Sogus E. , Cosma C. , Petrosino A. , Sorarù G. , Plebani M. , Pegoraro E. 
Published: June 2024

AbstractBackground and PurposeThe aim was to investigate whether neurofilament light chain (NfL) and profilin‐1 (PFN‐1) might qualify as surrogate disease and treatment‐response biomarkers by correlating their concentrations dynamic with clinical status in a cohort of 30 adult spinal muscular atrophy type 3 patients during nusinersen therapy up to 34 months.MethodsNeurofilament light chain was measured in cerebrospinal fluid at each drug administration with a commercial enzyme‐linked immunosorbent assay (ELISA); PFN‐1 concentrations were tested in serum sampled at the same time points with commercial ELISA assays. Functional motor scores were evaluated at baseline, at the end of the loading phase and at each maintenance dose and correlated to biomarker levels. The concurrent effect of age and clinical phenotype was studied.ResultsNeurofilament light chain levels were included in the reference ranges at baseline; a significant increase was measured during loading phase until 1 month. PFN‐1 was higher at baseline than in controls and then decreased during therapy until reaching control levels. Age had an effect on NfL but not on PFN‐1. NfL was partially correlated to functional scores at baseline and at last time point, whilst no correlation was found for PFN‐1.ConclusionCerebrospinal fluid NfL levels did not qualify as an optimal surrogate treatment biomarker in adult spinal muscular atrophy patients with a long disease duration, whilst PFN‐1 might to a greater extent represent lower motor neuron pathological processes. The observed biomarker level variation during the first 2 months of nusinersen treatment might suggest a limited effect on axonal remodeling or rearrangement.
UK horse owners and veterinary practitioners' experiences of decision‐making for critical cases of colic
Authors: Burrell Katie L. , Burford John H. , England Gary C. W. , Freeman Sarah L. 
Published: June 2024

AbstractBackgroundThe survival of horses diagnosed with critical colic (requiring referral or euthanasia) relies on rapid and effective decision‐making by the owner and veterinary practitioner.ObjectivesTo explore UK horse owners' and veterinary practitioners' experiences of decision‐making for critical cases of equine colic.Study designQualitative study using a phenomenological approach.MethodsIndividual, semi‐structured telephone interviews were conducted with 14 horse owners and 13 veterinary practitioners (vets) who had experienced a critical decision (referral or euthanasia) for a horse with colic. A purposive, convenience sample of participants was recruited. Sessions explored participant's experience of colic, including recognition, help‐seeking behaviour, and challenges. Thematic analysis was performed on collected data.ResultsFour over‐arching themes were identified; ‘head’, ‘heart’, ‘practicalities’ and ‘impact’. Owners acknowledged responsibility for their horse's welfare but had different perspectives than vets on the importance of finance (‘head’). Both vets and owners described how the horse–human relationship (‘heart’) often led to conflict during decision‐making. The vet–client relationship was influential on decision‐making for both owners and vets; involving other people in decision‐making was described both positively and negatively by participants (‘heart’). ‘Practicalities’, such as lack of preparedness, transport issues and adverse weather conditions, were identified by both owners and vets as barriers. Owners described a ‘rollercoaster’ of emotions after a critical decision, with profound impacts on their mental wellbeing, feelings of guilt, and long‐term changes in behaviour (‘impact’), and a lack of support to manage these feelings.Main limitationsSmall sample size.ConclusionsThis study describes stakeholder decision‐making during critical cases of equine colic. Factors that commonly influenced decisions included an owner's previous knowledge and beliefs, social pressures, logistics and the relationship between the owner and vet. The study highlighted long‐term impacts on the owner, including their management and decisions for subsequent horses. These factors should be considered in shared decision‐making.
Unveiling the impact of soil methane sink on atmospheric methane concentrations in 2020
Authors: Zhou Xiaoqi , Xiao Wensheng , Cheng Li , Smaill Simeon J. , Peng Shushi 
Published: June 2024

AbstractIn 2020, anthropogenic methane (CH4) emissions decreased due to COVID‐19 containment policies, but there was a substantial increase in the concentration of atmospheric CH4. Previous research suggested that this abnormal increase was linked to higher wetland CH4 emissions and a decrease in the atmospheric CH4 sink. However, the impact of changes in the soil CH4 sink remained unknown. To address this, we utilized a process‐based model to quantify alterations in the soil CH4 sink of terrestrial ecosystems between 2019 and 2020. By implementing the model with various datasets, we consistently observed an increase in the global soil CH4 sink, reaching up to 0.35 ± 0.06 Tg in 2020 compared to 2019. This increase was primarily attributed to warmer soil temperatures in northern high latitudes. Our results emphasize the importance of considering the CH4 sink in terrestrial ecosystems, as neglecting this component can lead to an underestimation of both emission increases and reductions in atmospheric CH4 sink capacity. Furthermore, these findings highlight the potential role of increased soil warmth in terrestrial ecosystems in slowing the growth of CH4 concentrations in the atmosphere.