bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defects in Value Associated With Hospital-Acquired Conditions: How Improving Quality Could Save U.S. Healthcare $50 Billion
Authors: Padula William V. , Pronovost Peter J. 
Published: August 2024

Abstract
Hospital-acquired conditions in the United States are considered avoidable complications but remain common statistics reflecting on health system performance and are a leading cause of patient fatality. Currently, over 3.7 million patients experience a hospital-acquired condition in the United States each year, which costs the U.S. healthcare delivery system an excess of $48 billion. Evidence-based clinical practice guidelines for common hospital-acquired conditions (e.g., infections, falls, pressure injuries) to reduce risk to the patient. In each of these instances, preventing the outcome with these guidelines costs less than treating the outcome, in addition to keeping the patient safe from harm. By applying the framework of defects in value to hospital-acquired conditions, we estimate that U.S. health systems could avert this $48 billion in spending on treating harmful hospital-acquired conditions; more so, these systems of care could recuperate over $35 billion after investing proportionally in a system that delivers greater quality by preventing hospital-acquired conditions over treating them. Currently, the Centers for Medicare and Medicaid Services only withholds reimbursements for hospital-acquired conditions and penalizes health systems with high rates of these outcomes. However, payers do not offer any reward-based incentives for hospital-acquired condition prevention. A series of policy and health system solutions, including tracking of hospital-acquired condition rates in electronic health records, identifying centers of excellence at reducing rates of harm with the use of clinical practice guidelines, and rewarding them monetarily for reduced rates could create equal-sided risk and opportunity to engage health systems in improved performance.
Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals: Outcomes of a Functional Resonance Analysis Method (FRAM) Study
Authors: Meulman Meggie D. , Merten Hanneke , van Munster Barbara , Wagner Cordula 
Published: August 2024

Objectives
Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]).

Methods
Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30).

Results
Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses’ perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints.

Conclusions
The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.
The anxiety care continuum and its association with viral suppression among persons with HIV
Authors: Zalla Lauren C. , Hutton Heidi E. , Fojo Anthony T. , Falade-Nwulia Oluwaseun O. , Jones Joyce L. , Keruly Jeanne C. , Snow LaQuita N. , Moore Richard D. , Lesko Catherine R. 
Published: August 2024

Objective:
It is unclear how often anxiety is diagnosed and treated and whether anxiety treatment is associated with improved viral suppression in persons with HIV. In this study, we characterized the anxiety care continuum and its association with viral suppression in a large urban HIV clinic in the United States.

Design:
Observational cohort study.

Methods:
We described the anxiety care continuum by combining data on self-reported anxiety symptoms, engagement in mental health care, clinical diagnoses and prescriptions from 1967 persons receiving HIV care and treatment in Baltimore, Maryland, from 2014 to 2023. We examined cross-sectional associations with viral suppression. All analyses were stratified by sex and race/ethnicity; a secondary analysis adjusted for age, years in care, and depressive symptoms.

Results:
Nearly one in five patients reported mild-severe symptoms of anxiety but were not currently receiving mental health care or pharmacologic treatment for anxiety; 6% of patients reported anxiety symptoms but were receiving treatment, and 7% had been treated for anxiety that was currently in remission. The prevalence of viral suppression ranged from 87% to 89% across the anxiety care continuum except among patients with untreated moderate-severe anxiety, only 81% of whom were virally suppressed [95% confidence interval (CI): 80, 83]. In adjusted models, untreated moderate-severe anxiety remained associated with viral nonsuppression across demographic groups.

Conclusion:
We observed a robust association between untreated anxiety and viral nonsuppression in a large urban cohort of persons with HIV. Screening for anxiety may identify patients with unmet mental health care needs who face barriers to maintaining viral suppression.
Risk Factors for Rapid Cognitive Decline in Amyloid-Negative Individuals Without Cognitive Impairment or With Early-Stage Cognitive Loss in Screening Tests
Authors: Park Yong-Jin , Choi Joon Young , Lee Kyung-Han , Seo Sang Won , Moon Seung Hwan 
Published: August 2024

Purpose
Although rapid cognitive decline (RCD) is an important unfavorable prognostic factor, not much is known about it, especially in amyloid-negative individuals. The purpose of this study was to investigate risk factors for RCD in amyloid-negative individuals.

Patients and Methods
We retrospectively enrolled 741 individuals who were either cognitively unimpaired or had early-stage cognitive ability loss and who underwent 18F-florbetaben (FBB) (n = 402) or 18F-flutemetamol (FMM) (n = 339) PET/CT. Based on visual and semiquantitative (SUV ratio [SUVR]–based) analysis, the following amyloid-negative groups were established: visual-negative FBB (n = 232), visual-negative FMM (n = 161), SUVR-negative FBB (n = 104), and SUVR-negative FMM (n = 101). Univariable and multivariable logistic regression analyses were performed for RCD using 5 SUVRs, 5 cortical thicknesses, and 5 neuropsychological domains and clinico-demographic factors.

Results
In the amyloid-negative groups, a decline in language function was commonly identified as a significant risk factor for RCD (P = 0.0044 in the visual-negative FBB group, P = 0.0487 in the visual-negative FMM group, P = 0.0031 in the SUVR-negative FBB group, and P = 0.0030 in the SUVR-negative FMM group). In addition, declines in frontal/executive function, frontal SUVR, and parietal SUVR; a longer duration of education; and mild cognitive decline in the amyloid-negative groups were also significant risk factors for RCD.

Conclusions
Even in amyloid-negative individuals without cognitive impairment or with early-stage cognitive ability loss, those with decreased language and frontal/executive functions on neuropsychological testing are at risk of progression to RCD.
Circulating Metabolic Markers Identify Patients at Risk for Tumor Recurrence
Authors: Montcusí Blanca , Madrid-Gambin Francisco , Marin Silvia , Mayol Xavier , Pascual Marta , Cascante Marta , Pozo Óscar J. , Pera Miguel 
Published: August 2024

Objective:
To investigate the spermidine pathway capability to predict patients at risk for tumor recurrence following colorectal cancer (CRC) surgery.

Background:
Recurrence rates after CRC surgery remain at about 20% despite an optimal technique and adjuvant therapy when necessary. Identification of risk biomarkers of recurrence is an unmet need. The spermidine pathway is indispensable for cell proliferation and differentiation, and is suggested to accelerate tumor spread.

Methods:
This was a prospective cohort study of patients undergoing CRC surgery from 2015 to 2018. Plasma samples were collected before surgery and on postoperative day 4, and the spermidine pathway was assessed through mass spectrometry. Oncological outcomes were registered.

Results:
A total of 146 patients were included and 24 (16.4%) developed tumor recurrence. Higher levels of preoperative spermidine pathway components (spermidine, spermine, spermidine synthase enzyme, and spermine/arginine balance) were positively associated with recurrence. Surgery promoted a decrease in these pathway elements. The greater the decline was, the lower the risk of recurrence. Preoperative spermidine over the cut-off of 0.198 µM displayed a 4.69-fold higher risk of recurrence. The spermine synthase enzyme behaved in the opposite direction.

Conclusions:
The spermidine pathway is associated with tumor recurrence following CRC surgery and, after confirmation in larger cohorts, could be translated as a risk biomarker of recurrence into clinical practice.
Just because you’re paranoid doesn’t mean they won’t side with the plaintiff: Examining perceptions of liability about AI in radiology
Authors: Bernstein Michael H. , Sheppard Brian , Bruno Michael A. , Lay Parker S. , Baird Grayson L. 
Published: August 2024

AbstractBackgroundArtificial Intelligence (AI) will have unintended consequences for radiology. When a radiologist misses an abnormality on an image, their liability may differ according to whether or not AI also missed the abnormality.MethodsU.S. adults viewed a vignette describing a radiologist being sued for missing a brain bleed (N=652) or cancer (N=682). Participants were randomized to one of five conditions. In four conditions, they were told an AI system was used. Either AI agreed with the radiologist, also failing to find pathology (AI agree) or did find pathology (AI disagree). In the AI agree+FOR condition, AI agreed with the radiologist and an AI false omission rate (FOR) of 1% was presented. In the AI disagree+FDR condition, AI disagreed and an AI false discovery rate (FDR) of 50% was presented. There was also a no AI control condition. Otherwise, vignettes were identical. Participants indicated whether the radiologist met their duty of care as a proxy for whether they would side with defense (radiologist) or plaintiff in trial.ResultsParticipants were more likely to side with the plaintiff in the AI disagree vs. AI agree condition (brain bleed: 72.9% vs. 50.0%, p=0.0054; cancer: 78.7% vs. 63.5%, p=0.00365) and in the AI disagree vs. no AI condition (brain bleed: 72.9% vs. 56.3%, p=0.0054; cancer: 78.7% vs. 65.2%, p=0.00895). Participants were less likely to side with the plaintiff when FDR or FOR were provided: AI disagree vs AI disagree+FDR (brain bleed: 72.9% vs. 48.8%, p=0.00005; cancer: 78.7% vs. 73.1%, p=0.1507), and AI agree vs. AI agree+FOR (brain bleed: 50.0% vs. 34.0%, p=0.0044; cancer: 63.5% vs. 56.4%, p=0.1085).DiscussionRadiologists who failed to find an abnormality are viewed as more culpable when they used an AI system that detected the abnormality. Presenting participants with AI accuracy data decreased perceived liability. These findings have relevance for courtroom proceedings.
IDENTIFICATION OF IMMUNE RESPONSE AND RNA NETWORK OF RHEUMATOID ARTHRITIS AND MOLECULAR DOCKING OFCELASTRUS PANICULATUSAS POTENTIAL THERAPEUTIC AGENT
Authors: Swaminathan Venkataramanan , Arumainathan Jeyvisna 
Published: August 2024

ABSTRACTBackgroundRheumatoid Arthritis (RA) is an acute autoimmune disease leading to critical joint damage and bone destruction, weakening extra-articular organs over time. The pathogenesis of RA is complex and still undiscovered. This study aims to identify immune response, microRNA-hub genes network (miRNA), and drug candidates against RA via bioinformatics analysis.MethodologyThree Gene Expression Omnibus (GEO) datasets were obtained from the NCBI database and classified into upregulated and downregulated differentially expressed genes (DEGs) using GEO2R tool. Gene enrichment analysis, protein-protein interaction network analysis, top 10 hub genes identification, miRNA-hub genes network analysis, and immune response identification were performed using various bioinformatic tools. Moreover,Celastrus paniculatusphytochemical compounds were retrieved and subjected to autodocking with upregulated and downregulated hub genes that are closely associated with RA. The drug-likeness and PreADMET analysis were performed.ResultsGSE30662, GSE766, GSE72100 datasets revealed 243 upregulated DEGs and 285 downregulated DEGs which exhibited RPS27A, UBB, UBC, UBA52, PSMD4, PSMD1, PSMD7, PSMB7, PSMD8, PSMA7 as top 10 upregulated hub genes and ACTB, TP53, AKT1, GAPDH, CTNNB1, EGFR, TNF, IL6, MYC, ANXA5 as top 10 downregulated hub genes. The miRNA network disclosed hsa-mir-23b-3p, as highly associated with upregulated hub genes whereas hsa-mir-34a-5p and hsa-mir-155-5p with downregulated hub genes. Additionally, immune responses of specific hub genes of RA were revealed while the docking analysis showed oleic acid and zeylasterone as novel drug candidates against RA.ConclusionThus, hsa-mir-23b-3p, hsa-mir-34a-5p, and hsa-mir-155-5p can serve as therapeutic targets of RA while oleic acid and zeylasterone become potential drug candidates against RA.
Next-Day Serum Glial Fibrillary Acidic Protein Levels to Aid Diagnosis of Sport-Related Concussion
Authors: O’Brien William T. , Hickey James W. , Mutimer Steven , Evans Lauren J. , Colman Blake D. , Xie Becca , Giesler Lauren P. , Major Brendan P. , Mitra Biswadev , Spitz Gershon , O’Brien Terence J. , Shultz Sandy R. , McDonald Stuart J. 
Published: August 2024

AbstractThe diagnostic utility of blood glial fibrillary acidic protein (GFAP) in sport-related concussion (SRC) is unclear. This study measured serum GFAP at either 16-24 hours (h), 24-32h, or 36-52h post-SRC in 156 Australian football players and compared levels with 98 control players without SRC. Median GFAP levels were higher in SRC cases at 16-24h (124.7 pg/mL; p<0.001) and 24-32h (96.2 pg/mL; p<0.001) compared to controls (66.0 pg/mL), but not at 36-52h (62.8 pg/mL). GFAP had an area under the curve of 0.83 at 16-24h and 0.72 at 24-32h. Serum GFAP at 16-24h can be a useful aid in SRC diagnosis.
IDENTIFYING PLAUSIBLE RANGES FOR DIFFERENTIAL VACCINE EFFICACY ACROSS HIGH- AND LOW-INCOME SETTINGS: A SYSTEMATIC REVIEW, DESCRIPTIVE META-ANALYSIS, AND ILLUSTRATIVE EVIDENCE ANALYSIS
Authors: Katama Esther Nyadzua , Gallagher Katherine E. , Shah Anoop , Nokes D. James , McAllister David A 
Published: August 2024

ABSTRACTBackgroundRandomized clinical trials provide the highest standard of evidence about vaccine efficacy. Modelling exercises such as in evidence synthesis and health economic models where efficacy estimates are combined with other data to obtain effectiveness and cost-effectiveness estimates help inform policy decisions. The main challenge with such sensitivity analyses is in deciding on which assumptions to model.PurposeTo identify plausible ranges for differential vaccine efficacy across high- and low-income settings.Data Sources and Study SelectionMEDLINE, EMBASE, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO-ICTRP) were searched for multi-site randomized clinical trials of bacterial and viral vaccines for the period of 01/01/1990 to 31/12/2020. Articles were restricted to those where at least one trial had included a low- or lower-middle-income setting, published in English, and conducted in humans.MethodsA Bayesian random-effects meta-analysis was used to estimate the difference in vaccine efficacy in high-(high or upper middle) and low-(low or lower middle) income settings. A single hierarchical model that included all trials was used so that the degree to which estimates of vaccine efficacy against different diseases influenced one another was estimated from the observed data.ResultsAcross 65 eligible trials (37 high-income, 21 low-income, and 7 both) covering 7 pathogens, only one trial reported efficacy estimates stratified by setting. Trials were similar in terms of design across settings. There was evidence of heterogeneity by vaccine target, typhoid vaccine demonstrated higher vaccine efficacy in low-income settings than in high-income settings but for all other vaccines, the point estimates indicated efficacy was lower in low-income settings; however, all credible intervals crossed the null.ConclusionsThe percentage of trials in low-income settings poorly reflects the burden of disease experienced in low-income settings. While there is evidence of lower vaccine efficacy in low-income settings relative to high-income settings, the credible intervals were very wide. Vaccine efficacy trials should report treatment effects stratified by settings.
Achieving Inclusive Healthcare through Integrating Education and Research with AI and Personalized Curricula
Authors: Bahmani Amir , Cha Kexin , Alavi Arash , Dixit Amit , Ross Antony , Park Ryan , Goncalves Francesca , Ma Shirley , Saxman Paul , Nair Ramesh , Akhavan-Sarraf Ramin , Zhou Xin , Wang Meng , Contrepois Kévin , Than Jennifer Li Pook , Monte Emma , Rodriguez David Jose Florez , Lai Jaslene , Babu Mohan , Tondar Abtin , Rose Sophia Miryam Schüssler-Fiorenza , Akbari Ilya , Zhang Xinyue , Yegnashankaran Kritika , Yracheta Joseph , Dale Kali , Miller Alison Derbenwick , Edmiston Scott , McGhee Eva M , Nebeker Camille , Wu Joseph C. , Kundaje Anshul , Snyder Michael 
Published: August 2024

AbstractPrecision medicine promises significant health benefits but faces challenges such as the need for complex data management and analytics, interdisciplinary collaboration, and education of researchers, healthcare professionals, and participants. Addressing these needs requires the integration of computational experts, engineers, designers, and healthcare professionals to develop user-friendly systems and shared terminologies. The widespread adoption of large language models (LLMs) like GPT-4 and Claude 3 highlights the importance of making complex data accessible to non-specialists. The Stanford Data Ocean (SDO) strives to mitigate these challenges through a scalable, cloud-based platform that supports data management for various data types, advanced research, and personalized learning in precision medicine. SDO provides AI tutors and AI-powered data visualization tools to enhance educational and research outcomes and make data analysis accessible for users from diverse educational backgrounds. By extending engagement and cutting-edge research capabilities globally, SDO particularly benefits economically disadvantaged and historically marginalized communities, fostering interdisciplinary biomedical research and bridging the gap between education and practical application in the biomedical field.
Biofortification and Fortification of Wheat Flour: Qualitative analysis for implementation and acceptance
Authors: Yasin Rahima , Padhani Zahra A. , Mirani Mushtaque , Jamali Muhammad Khan , Memon Mahwish , Khatoon Sana , Rai Riya , Rahman Areeba , Attaullahjan Anushka , Das Jai K. 
Published: August 2024

AbstractBackgroundThis paper comprehensively investigates various aspects of dietary behaviors relating to the usage of wheat flour and sociocultural preferences embedded within rural communities and aims to bridge health gaps resulting from zinc deficiency by introducing zinc bio-fortified and fortified flour in Pakistan.MethodA household and a market study was conducted in Ghotki and Tando Muhammad Khan districts in Sindh, Pakistan. Various stakeholders involved in the wheat-flour industry including farmers, seed suppliers, owners of atta-chakkis and flour mills, grocers and flour merchants, bakers and hoteliers, consumers, and agronomists were interviewed to gauge their knowledge of bio-fortified and fortified wheat-flour.ResultsWheat-flour is a staple food item in Pakistan, however, agricultural output in Pakistan varies across all provinces. Factors that hinder agricultural productivity include a shortfall of essential resources such as irrigation water, superior quality seeds and fertilizers, and machinery. Farmers use primitive methods of farming as they do not have access to modern technologies, information, or training. Wheat flour market vendors and consumers lack awareness of bio-fortified and fortified wheat flour products and believe the only way to create a customer-base is by ensuring that fortified wheat products are available to all and competitively priced compared to traditional options. Additionally, participants misconstrue the process of fermentation and perceive it as unhealthy. The lack of financial resources and awareness restricts adequate promotion of nutrient-rich food products amongst stakeholders involved in the wheat flour industry. Mass awareness campaigns, education and government incentives could bridge the gaps present and encourage wider adoption of bio-fortified and fortified wheat flour.ConclusionPolicy makers and communities can draw on the recommendations made in this paper to introduce and promote zinc bio-fortified and fortified flour in settings where zinc deficiency is prevalent.