bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duplex Ultrasound Volumetric Flow Analysis before and after Hemodialysis in Patients with Brachio-cephalic Fistulae
Authors: Chowdhury Shakila , Goss David , Mistry Hiren , Stephenson Matthew A. , Seed Paul , Deane Colin , Valenti Domenico 
Published: May 2013

Purpose The United Kingdom Renal Association recommends duplex ultrasound to monitor arteriovenous fistula (AVF) flow rates during surveillance. Significant flow rate changes should prompt further investigation or treatment to avoid a failing fistula. Hemodialysis is known to alter the hemorrheologic and physiologic factors with a potential impact on measured flow rates. The aim of this study was to determine the difference in flow rate measured with duplex ultrasound before and after a single hemodialysis session in patients with brachial-cephalic fistulae. Methods Patients with brachial-cephalic AVFs in our dialysis populations who were undergoing regular hemodialysis without recent intervention (less than six weeks) were invited to participate. Flow measurements were made pre-and post-hemodialysis using a Zonare ultrasound machine. The vascular scientist was always blinded to the pre-hemodialysis flow. Results A total of 157 patients were identified with brachial-cephalic fistulae. Following exclusions, 119 patients were eligible. However, a further 58 were excluded because they declined or did not attend leaving 61 patients in the study. Paired t test showed a statistically significant reduction in flow rate of 105 mL/min (P=0.026) post-hemodialysis which equates to a −6.9% change in flow (95% C.I. −12.7 to −0.8%). Bland-Altman analysis showed limits of flow rate agreement between −599 mL/min and +810 mL/min (+/-1.96 s.d.). Conclusions Whilst we have shown a statistically significant change in flow rate post-hemodialysis, this is small and should be taken in the context of previously accepted interobserver variability. Therefore, the practical and financial considerations of implementing an AVF surveillance programme are likely to outweigh the minimal benefit of consistency that would be enabled by strict protocol of pre-hemodialysis flow measurements.
Acute Cardiorenal Syndrome by High Flow Arteriovenous Fistula after Kidney Transplantation
Authors: Nickel Peter , Gül Safak , Puhl Gero , Poellinger Alexander , Schindler Ralf 
Published: May 2013

Purpose The aim of this work was to increase recognition of high flow arteriovenous fistulas in kidney transplant patients. Case Here, we report the case of a 22-year-old man with repeated hospitalizations for cardiomegaly and chronic pericardial effusion after kidney transplantation. Eventually, high flow of his arteriovenous fistula was recognized 5.5 years after transplantation when he developed acute cardiorenal syndrome. Access flow reduction markedly improved kidney graft function along with reversion of cardiomegaly, which was impressively demonstrated by follow-up chest-x-rays. Conclusion Arteriovenous fistulas should be monitored regularly after kidney transplantation to avoid congestive heart failure and other serious complications.
SPACE TEMPORAL VARIABILITY NORMALIZED DIFFERENCE VEGETATION INDEXIN THE SEMIARID PERNAMBUCANO BASED ON IMAGE TM / LANDSAT 5
Authors: Silva Madson T. 
Published: May 2013

Rainfall is one of climate elements that influence the spatial and temporal variation of plant cover in any region and, in particular, in the caatinga semiarid Northeast. Before this, there was a need to examine relations of seasonal rainfall in the semiarid region of the State of Pernambuco with classes of use and soil cover and changes in vegetation Index (NDVI) for Normalized Difference, using principal component analysis and remote sensing techniques, being these determinations the main goals of this work. Four images of the Thematic Mapper (TM) sensor, the satellite Landsat 5, dated 12/12/1991, 12/9/1996, 12/13/2003 and 11/27/2009, formed the experimental unit, whose variables were estimated using the algorithm Surface Energy Balance Algorithms for Land (SEBAL), in addition to the daily rainfall data of 1996 and 2009 and the series 1975 to 2010. The main results indicated that the amount and distribution of rain influenced on the surface temperature and the values of the indexes of reflection and NDVI, excelling by high recovery power plant, as the coverage that occurred in the year 1996, and expressed by the greatest value of NDVI. It is concluded that remote sensing techniques associated with those of main components were efficient to quantify the spatio-temporal variability of climate and vegetation index of the normalized difference of semiarid conditions.
Hepatocellular Carcinoma in Metabolic Dysfunction-Associated Steatotic Liver Disease
Authors: Rodriguez Luis A. , Schmittdiel Julie A. , Liu Liyan , Macdonald Brock A. , Balasubramanian Sreepriya , Chai Krisna P. , Seo Suk I. , Mukhtar Nizar , Levin Theodore R. , Saxena Varun 
Published: July 2024

ImportanceIn the US, hepatocellular carcinoma (HCC) has been the most rapidly increasing cancer since 1980, and metabolic dysfunction–associated steatotic liver disease (MASLD) is expected to soon become the leading cause of HCC.ObjectiveTo develop a prediction model for HCC incidence in a cohort of patients with MASLD.Design, Setting, and ParticipantsThis prognostic study was conducted among patients aged at least 18 years with MASLD, identified using diagnosis of MASLD using International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes; natural language processing of radiology imaging report text, which identified patients who had imaging evidence of MASLD but had not been formally diagnosed; or the Dallas Steatosis Index, a risk equation that identifies individuals likely to have MASLD with good precision. Patients were enrolled from Kaiser Permanente Northern California, an integrated health delivery system with more than 4.6 million members, with study entry between January 2009 and December 2018, and follow-up until HCC development, death, or study termination on September 30, 2021. Statistical analysis was performed during February 2023 and January 2024.ExposureData were extracted from the electronic health record and included 18 routinely measured factors associated with MASLD.Main Outcome and MeasuresThe cohort was split (70:30) into derivation and internal validation sets; extreme gradient boosting was used to model HCC incidence. HCC risk was divided into 3 categories, with the cumulative estimated probability of HCC 0.05% or less classified as low risk; 0.05% to 0.09%, medium risk; and 0.1% or greater, high risk.ResultsA total of 1 811 461 patients (median age [IQR] at baseline, 52 [41-63] years; 982 300 [54.2%] female) participated in the study. During a median (range) follow-up of 9.3 (5.8-12.4) years, 946 patients developed HCC, for an incidence rate of 0.065 per 1000 person-years. The model achieved an area under the curve of 0.899 (95% CI, 0.882-0.916) in the validation set. At the medium-risk threshold, the model had a sensitivity of 87.5%, specificity of 81.4%, and a number needed to screen of 406. At the high-risk threshold, the model had a sensitivity of 78.4%, a specificity of 90.1%, and a number needed to screen of 241.Conclusions and RelevanceThis prognostic study of more than 1.8 million patients with MASLD used electronic health record data to develop a prediction model to discriminate between individuals with and without incident HCC with good precision. This model could serve as a starting point to identify patients with MASLD who may need intervention and/or HCC surveillance.
Prevalence of Independence at Home–Qualifying Beneficiaries in Traditional Medicare, 2014-2021
Authors: Lally Tom , Johnson Emily , Deligiannidis Konstantinos E. , Taler George , Boling Peter , Yao Aaron , Kubisiak Joanna , Lee Angelina , Kinosian Bruce 
Published: July 2024

ImportanceThe Centers for Medicare &amp;amp; Medicaid Services Innovation Center Independence at Home (IAH) demonstration, a test of home-based primary care operating in a value-based shared-savings payment model, ended December 2023 after a decade of consistently showing savings to Medicare. It is important to assess whether high-need, IAH-qualified beneficiaries continue to pose a growing challenge to traditional Medicare (TM) or if Medicare Advantage (MA), with programmatic features favorable to caring for this subset of the general Medicare population, can disproportionately provide such care.ObjectiveTo examine the size and share of IAH-qualified beneficiaries in TM and MA.Design, Setting, and ParticipantsThis cohort study used all Medicare claims data and MA encounter data for 2014 and 2021. IAH qualifying criteria were applied to the TM populations enrolled in Parts A and B in 2014 and 2021, and to MA enrollees in 2021. Growth in the number of IAH-qualified TM beneficiaries from 2014 to 2021 was calculated, and the proportions and numbers of IAH-qualified enrollees in the total 2021 TM and MA populations were compared. Data were analyzed between April and June 2023.Main Outcomes and MeasuresThe number and share of beneficiaries meeting IAH criteria in TM and MA; the share of TM spending among IAH-qualified beneficiaries.ResultsAmong 64 million Medicare beneficiaries in 2021, there were 30.55 million beneficiaries in TM with Parts A and B coverage, down from 33.82 million in 2014. The number of IAH-qualified beneficiaries in TM grew 51%, from 2.16 million to 3.27 million, while their proportionate share in TM grew 67% from 6.4% to 10.7% of TM between 2014 and 2021. IAH-qualified beneficiaries represented $155 billion in 2021 Medicare Parts A and B spending, 44% of all TM spending, up from 29% of total spending in 2014. In 2021, 2.15 million IAH-qualified beneficiaries represented 8.0% of Medicare Advantage enrollees. Combining TM and MA, 5.42 million IAH-qualified beneficiaries represented 9.3% of all Medicare beneficiaries, with 3.27 million (60.3%) being insured by TM.Conclusions and RelevanceIn this cohort study of IAH-qualified Medicare beneficiaries, the share of IAH-qualified beneficiaries in TM grew between 2014 and 2021, with 60% of Medicare high-need beneficiaries accounting for 44% of TM spending. The Centers for Medicare &amp;amp; Medicaid Services should continue to operate value-based programs like IAH that are specifically designed for these high-needs individuals.
Sodium Intake and Incident Atrial Fibrillation in Individuals With Vascular Disease
Authors: Johnson Linda S. , Mente Andrew , Joseph Philip , Conen David , Benz Alexander P. , McIntyre William F. , Drake Isabel , Engström Gunnar , Connolly Stuart J. , Yusuf Salim , Healey Jeffrey S. 
Published: July 2024

ImportanceNumerous prospective cohort studies have reported a J-shaped association of urinary sodium excretion with cardiovascular events and mortality.ObjectiveTo study the association between sodium intake and incident atrial fibrillation (AF).Design, Setting, and ParticipantsThis cohort study included participants in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND) multicenter, randomized clinical trials comparing the effect of ramipril 10 mg daily with telmisartan 80 mg daily, or their combination (ONTARGET) or 80 mg telmisartan daily with placebo (TRANSCEND) for the outcome of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. ONTARGET and TRANSCEND included 31 546 participants with vascular disease or high-risk diabetes, and this study excluded participants without a urine sample for sodium measurement, missing data for key covariates, a history of AF, or AF detected in the first year after enrollment. Analyses were performed in July 2023 to May 2024.ExposureEstimated sodium intake from a morning fasting urine sample (Kawasaki formula).Main Outcomes and MeasuresThe main outcome was incident AF. The association between estimated sodium intake and incident AF was modeled using multivariable adjusted Cox regression and cubic splines.ResultsA total of 27 391 participants (mean [SD] age, 66.3 [7.2] years; 19 310 [70.5%] male) were included. Mean (SD) estimated sodium intake was 4.8 (1.6) g/d. During a mean (SD) follow-up of 4.6 (1.0) years, 1562 participants (5.7%) had incident AF. After multivariable adjustment, a J-shaped association between sodium intake and AF risk was observed (P for nonlinearity = .03). Sodium intake of 8 g/d or greater (3% of participants) was associated with incident AF (hazard ratio, 1.32; 95% CI, 1.01-1.74) compared with sodium intake of 4 to 5.99 g/d. Cubic splines showed that sodium intake greater than 6 g/d (19% of participants) was associated with a 10% increased AF risk per additional 1-g/d sodium intake (hazard ratio, 1.10; 95% CI, 1.03-1.18), but with no further lowering of AF risk at lower levels of sodium intake.Conclusions and RelevanceIn this cohort study of sodium intake and AF risk, there was a J-shaped association between sodium intakes and AF risk in patients with cardiovascular disease or diabetes. Lowering sodium intake for AF prevention is best targeted at individuals who consume high sodium diets.
Geographic Trends in Ophthalmology Resident Physician Compensation and Cost-of-Living Expenses
Authors: Cohen Samuel A. , Sridhar Jayanth , Tseng Victoria L. 
Published: July 2024

ImportanceGiven that resident physician financial strain has been associated with poor outcomes, objective metrics to forecast financial well-being may be useful to (1) applicants when evaluating ophthalmology residency programs and (2) programs when determining resident benefits.ObjectivesTo determine and compare the relative value of ophthalmology resident stipends plus benefits when adjusted for cost-of-living expenses and to analyze program characteristics associated with greater resident net incomes.Design, Setting, and ParticipantsIn this cross-sectional study, the American Medical Association’s Fellowship and Residency Electronic Interactive Database was used to identify US Accreditation Council for Graduate Medical Education–accredited ophthalmology residency programs. Resident physician stipends and stipends plus benefits as well as residency program characteristics from the 2023-2024 academic year were noted for all eligible programs. The Massachusetts Institute of Technology’s Living Wage Calculator’s required annual income (RAI) was selected as a surrogate to approximate cost-of-living expenses.ExposureResidency program characteristics, including affiliation, size, ranking, presence of housing benefit, and training year.Main Outcomes and MeasuresThe primary outcome was the annual stipend plus benefits income surplus (SPBIS) for each residency program, defined as the resident’s stipend plus benefits (SPB) minus the RAI for the county in which the residency program is located. Secondary outcomes included income surplus variation by program characteristics.ResultsOf 116 ophthalmology residency programs analyzed, 37 (31.9%) were located in the Northeast, 36 (31.0%) in the South, 29 (25.0%) in the Midwest, and 14 (12.1%) in the West. The mean (SD) postgraduate year 1 resident annual SPB was $65 397 ($8205), and the median (IQR) was $63 986 ($59 992-$69 698). After adjusting for the cost of living, the mean (SD) SPBIS was $27 459 ($5734) and the median (IQR) was $27 380 ($23 625-$31 796). Annual cost-of-living expenses varied by as much as $8628 (95% CI, $6310-$10 947) and SPBIS varied by as much as $6283 (95% CI, $3367-$9198) between regions. Resident SPB increased by a mean (SD) of 3.97% (0.98%) for each subsequent training year (range, 0.93%-7.26%). Annual SPBIS increased by a mean (SD) of 9.48% (3.60%) for each subsequent training year.Conclusions and RelevanceAfter adjusting for living costs, intraregional and interregional differences in SPBIS among ophthalmology residents can vary by thousands of dollars, impacting residents’ financial security. Further discussion regarding compensation may lead to innovative strategies that aim to improve resident well-being and performance.
Multivariate Canadian Downscaled Climate Scenarios for CMIP6 (CanDCS‐M6)
Authors: Sobie Stephen R. , Ouali Dhouha , Curry Charles L. , Zwiers Francis W. 
Published: July 2024

AbstractCanada‐wide, statistically downscaled simulations of global climate models from the Sixth Coupled Model Inter‐comparison Project (CMIP6) have been made available for 26 models using a new multivariate approach and an improved observational target dataset. These new downscaled scenarios comprise daily simulations of precipitation, maximum temperature, and minimum temperature at 1/12° resolution across Canada. Simulations from each of the 26 downscaled global climate models span a historical period (1950–2014), and three future Shared Socio‐economic Pathways (SSPs) representing low (SSP1 2.6), moderate (SSP2 4.5) and high (SSP5 8.5) future emissions from 2015 to 2100. Results from an evaluation of the multivariate downscaling method over Canada yield improved performance in replicating multivariate and compound climate indices compared to previously used univariate downscaling methods. This Multivariate Canadian Downscaled Climate Scenarios for CMIP6 (CanDCS‐M6) dataset is intended to facilitate climate impacts assessments, hydrologic modelling, and analysis tools for presenting climate projections.
Clonal competition assays identify fitness signatures in cancer progression and resistance in multiple myeloma
Authors: Haertle Larissa , Munawar Umair , Hernández Hipólito N. C. , Arroyo‐Barea Andres , Heckel Tobias , Cuenca Isabel , Martin Lucia , Höschle Carlotta , Müller Nicole , Vogt Cornelia , Bischler Thorsten , del Campo Paula L. , Han Seungbin , Buenache Natalia , Zhou Xiang , Bassermann Florian , Waldschmidt Johannes , Steinbrunn Torsten , Rasche Leo , Stühmer Thorsten , Martinez‐Lopez Joaquin , Martin Kortüm K. , Barrio Santiago 
Published: July 2024

AbstractMultiple myeloma (MM) is a genetically heterogeneous disease and the management of relapses is one of the biggest clinical challenges. TP53 alterations are established high‐risk markers and are included in the current disease staging criteria. KRAS is the most frequently mutated gene affecting around 20% of MM patients. Applying Clonal Competition Assays (CCA) by co‐culturing color‐labeled genetically modified cell models, we recently showed that mono‐ and biallelic alterations in TP53 transmit a fitness advantage to the cells. Here, we report a similar dynamic for two mutations in KRAS (G12A and A146T), providing a biological rationale for the high frequency of KRAS and TP53 alterations at MM relapse. Resistance mutations, on the other hand, did not endow MM cells with a general fitness advantage but rather presented a disadvantage compared to the wild‐type. CUL4B KO and IKZF1 A152T transmit resistance against immunomodulatory agents, PSMB5 A20T to proteasome inhibition. However, MM cells harboring such lesions only outcompete the culture in the presence of the respective drug. To better prevent the selection of clones with the potential of inducing relapse, these results argue in favor of treatment‐free breaks or a switch of the drug class given as maintenance therapy. In summary, the fitness benefit of TP53 and KRAS mutations was not treatment‐related, unlike patient‐derived drug resistance alterations that may only induce an advantage under treatment. CCAs are suitable models for the study of clonal evolution and competitive (dis)advantages conveyed by a specific genetic lesion of interest, and their dependence on external factors such as the treatment.
Mothers' reflections on the diagnosis and birth of their child with Down syndrome: Variability based on the timing of the diagnosis
Authors: Lukowski Angela F. , Bohanek Jennifer G. 
Published: July 2024

AbstractPrevious research has examined parents' reflections on their child's Down syndrome diagnosis based on whether the diagnosis was provided prenatally or after birth, revealing few significant differences; by comparison, few studies have examined parents' reflections on the birth of the child in relation to the timing of the diagnosis. This study was conducted to examine whether mothers differentially reported on and rated the diagnosis, birth, and most recent birthday of their child with DS based on when the diagnosis was provided. Forty‐four American mothers of children with DS discussed the birth of their child, when they learned of their child's DS diagnosis, and their child's most recent birthday with a researcher. Participants also completed online questionnaires on which they rated the events and indicated how they felt about the events at the time of their occurrence and at the time of the study. The results revealed that participants who received a prenatal diagnosis of DS for their child reflected differently—and seemingly more positively—on their child's birth relative to participants who received a postnatal diagnosis. These differences were evident when considering participant ratings, emotion language used when discussing the events, and feeling states characterizing how participants felt about the events at the time of their occurrence and at the time of the study. Given these group differences, medical professionals should carefully consider the conditions under which they provide mothers with diagnostic information and support services after a child is born.
Temporal trends in respiratory pathogens following the COVID‐19 pandemic and climate variables: A unicentric retrospective evaluation of 24 pathogens in a temperate subtropical region
Authors: Decker Sérgio Renato da Rosa , Wolf Jonas Michel , Pille Arthur , Freese Luana , Petek Helena , de Oliveira Rocha Bruna , Giannini Gabriela Luchiari Tumioto , Bristot Giovana , Andreis Tiago Finger , de Oliveira Francine Hehn , Hoffmann Emerson dos Santos , Kunde Luciana , Kern Marcelo , Schmitz Paulo , Maccari Juçara , Nedel Wagner , Zavascki Alexandre Prehn , Rosa Regis Goulart , Mutlaq Mohamed Parrini , Nasi Luiz Antônio 
Published: July 2024

AbstractTemperature and humidity are studied in the context of seasonal infections in temperate and tropical zones, but the relationship between viral trends and climate variables in temperate subtropical zones remains underexplored. Our retrospective study analyzes respiratory pathogen incidence and its correlation with climate data in a subtropical zone. Retrospective observational study at Moinhos de Vento Hospital, South Brazil, aiming to assess seasonal trends in respiratory pathogens, correlating them with climate data. The study included patients of all ages from various healthcare settings, with data collected between April 2022 and July 2023. Biological samples were analyzed for 24 pathogens using polymerase chain reaction and hybridization techniques; demographic variables were also collected. The data was analyzed descriptively and graphically. Spearman tests and Poisson regression were used as correlation tests. Tests were clustered according to all pathogens, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), influenza viruses, rhinovirus, and respiratory syncytial virus (RSV). Between April 2022 and July 2023, 3329 tests showed a 71.6% positivity rate. Rhinovirus and RSV predominated, exhibiting seasonal patterns. Temperature was inversely correlated with the viruses, notably rhinovirus, but SARS‐CoV‐2 was positively correlated. Air humidity was positively correlated with all pathogens, RSV, rhinovirus, and atmospheric pressure with all pathogens and rhinovirus. Our results showed statistically significant correlations, with modest effect sizes. Our study did not evaluate causation effects. Despite the correlation between climate and respiratory pathogens, our work suggests additional factors influencing transmission dynamics. Our findings underscore the complex interplay between climate and respiratory infections in subtropical climates.