bluuebunny/crossref_metadata_2025_split huggingface dataset:
Among Medicare beneficiaries, Affordable Care Act coverage expansions reduced utilization of ambulatory care, particularly among duals
Authors: Sachs Rebecca , Duchovny Noelia , Varcie Joshua , White Chapin 
Published: May 2024

Abstract
We leveraged local area variation in the size of the Affordable Care Act (ACA) expansions of Medicaid and nongroup coverage and measured changes in Medicare utilization and spending from 2010 through 2018 using the universe of Medicare fee-for-service claims. We found that the ACA coverage expansions led to decreases in the share of Medicare beneficiaries receiving ambulatory care and decreases in spending per beneficiary on ambulatory care. The reductions in ambulatory care were larger among beneficiaries enrolled in both Medicare and Medicaid (“duals”). Our results suggest that coverage expansions may lead to congestion and reduced access to physicians for those who are continuously insured.
Genomic prediction and genome-wide association study using combined genotypic data from different genotyping systems: application to apple fruit quality traits
Authors: Minamikawa Mai F , Kunihisa Miyuki , Moriya Shigeki , Shimizu Tokurou , Inamori Minoru , Iwata Hiroyoshi 
Published: May 2024

Abstract
With advances in next-generation sequencing technologies, various marker genotyping systems have been developed for genomics-based approaches such as genomic selection (GS) and genome-wide association study (GWAS). As new genotyping platforms are developed, data from different genotyping platforms must be combined. However, the potential use of combined data for GS and GWAS has not yet been clarified. In this study, the accuracy of genomic prediction (GP) and the detection power of GWAS increased for most fruit quality traits of apples when using combined data from different genotyping systems, Illumina Infinium single-nucleotide polymorphism array and genotyping by random amplicon sequencing-direct (GRAS-Di) systems. In addition, the GP model, which considered the inbreeding effect, further improved the accuracy of the seven fruit traits. Runs of homozygosity (ROH) islands overlapped with the significantly associated regions detected by the GWAS for several fruit traits. Breeders may have exploited these regions to select promising apples by breeders, increasing homozygosity. These results suggest that combining genotypic data from different genotyping platforms benefits the GS and GWAS of fruit quality traits in apples. Information on inbreeding could be beneficial for improving the accuracy of GS for fruit traits of apples; however, further analysis is required to elucidate the relationship between the fruit traits and inbreeding depression (e.g. decreased vigor).
Active Adaptive Strategies of Mallard Feet in Response to Changes in Wetness and Compactness of the Sand Terrain
Authors: Han Dianlei , Hu Jinrui , Liu Hairui , Ren Lizhi , Tong Zhiqian 
Published: May 2024

Synopsis
Mallards (Anas platyrhynchos) exhibit exceptional locomotive abilities in diverse terrains, such as beaches, swamps, and tidal flats. This capability is primarily attributed to their unique webbed toe structure and cooperative locomotion posture of their feet. Therefore, this study aims to further delve into the active adaptive strategies of mallard feet in response to diverse external environmental conditions. Six adult male mallards were selected for this research. Their locomotion on sandy surfaces with differing wetness levels and varying degrees of compaction were captured using a high-speed camera, and analysis of instantaneous and continuous changes in the primary joint angles of the mallards’ feet, including the toe-webbed opening and closing angles, the tarsometatarsal-phalangeal joint (TMTPJ), and the intertarsal joint (ITJ). It was found that on loose sandy surfaces, increasing wetness expanded the ground contact area of the mallards’ feet. This led to greater flexion at the TMTPJ joint during mid-stance, accompanied by decreased flexion of the ITJ during touch-down and mid-stance. Conversely, on compacted sand, increasing wetness resulted in a reduced foot effect area and lessened ITJ flexion at both touch-down and mid-stance. Furthermore, on looser sand, the ground contact area of the mallards’ feet decreased, with an increase in ITJ buckling at touch-down. During the swing phase, sand wetness and compactness effected minimally on the feet of the mallards. On dry and loose sand ground, mallards will contract their second and fourth toes with webbing upon ground contact, covering and compacting the sand beneath, while increasing ITJ flexion to mitigate sinking. This adaptation reduces the energy expended on sand and enhances body stability. In wet and compacted sand conditions, mallards expand their second and fourth toes upon ground contact and reduce ITJ flexion. Therefore, this coordinated foot and ITJ locomotion offers mallards a natural advantage when moving on various environmental media.
Activated clotting time value as an independent predictor of postoperative bleeding and transfusion
Authors: Pereira Rafael Maniés , Magueijo Diogo , Guerra Nuno Carvalho , Correia Catarina Jacinto , Rodrigues Anabela , Nobre Ângelo , Brito Dulce , Moita Luís Ferreira , Velho Tiago R 
Published: May 2024

Abstract

OBJECTIVES
Activated clotting time (ACT) is commonly used to monitor anticoagulation during cardiac surgeries. Final ACT values may be essential to predict postoperative bleeding and transfusions, although ideal values remain unknown. Our aim was to evaluate the utility of ACT as a predictor of postoperative bleeding and transfusion use.

METHODS
Retrospective study (722 patients) submitted to surgery between July 2018–October 2021. We compared patients with final ACT &lt; basal ACT and final ACT ≥ basal ACT and final ACT &lt; 140 s with ≥140 s. Continuous variables were analysed with the Wilcoxon rank-sum test; categorical variables using Chi-square or Fisher's exact test. A linear mixed regression model was used to analyse bleeding in patients with final ACT &lt; 140 and ≥140. Independent variables were analysed with binary logistic regression models to investigate their association with bleeding and transfusion.

RESULTS
Patients with final ACT ≥ 140 s presented higher postoperative bleeding than final ACT &lt; 140 s at 12 h (P = 0.006) and 24 h (**P = 0.004). Cardiopulmonary bypass (CPB) time [odds ratio (OR) 1.009, 1.002–1.015, 95% confidence interval (CI)] and masculine sex (OR 2.842,1.721–4.821, 95% CI) were significant predictors of bleeding. Patients with final ACT ≥ 140 s had higher risk of UT (OR 1.81, 1.13–2.89, 95% CI; P = 0.0104), compared to final ACT &lt; 140 s. CPB time (OR 1.019,1.012–1.026, 95% CI) and final ACT (OR 1.021,1.010–1.032, 95% CI) were significant predictors of transfusion. Female sex was a predictor of use of transfusion, with a probability for use of 27.23% (21.84–33.39%, 95% CI) in elective surgeries, and 60.38% (37.65–79.36%, 95% CI) in urgent surgeries, higher than in males.

CONCLUSIONS
Final ACT has a good predictive value for the use of transfusion. Final ACT ≥ 140 s correlates with higher risk of transfusion and increased bleeding. The risk of bleeding and transfusion is higher with longer periods of CPB. Males have a higher risk of bleeding, but females have a higher risk of transfusion.
Informing the Need for a SARS-CoV-2 Booster Based on the Immune Responses Among Young Healthy Adults to Variants Circulating in Late 2023
Authors: Nguyen Huy C , Lal Kerri G , Balinsky Corey A , Hontz Robert D , Lin Jin , Beye Matthew J , Smith Lauren , Pan Li , Cheng Ying , Fox Isabella , Lizewski Stephen E , Foo Hayley S , Krebs Shelly J , Sun Peifang , Letizia Andrew G 
Published: May 2024

Abstract

Background
COVID-19 remains a global public health challenge due to new immune-evasive SARS-CoV-2 variants and heterogeneous immunity.

Methods
In this cross-sectional study, we evaluated the adaptive immune responses in US active duty personnel who completed a COVID-19 primary vaccine series and had heterogenous SARS-CoV-2 vaccination and infection histories to 3 previously dominant variants (ancestral, Delta, BA.5) and 3 circulating variants (XBB.1.5, EG.5, and BA.2.86) in late 2023. Analyses were based on the most recent exposure in terms of timing (within or beyond 12 months) and type (vaccine or infection).

Results
Significant reduction was observed in binding antibodies, neutralization antibodies, memory B cells, and CD8+ T cells against circulating variants when compared with previous variants. The reduction in antibody response was more pronounced in those whose most recent exposure was &gt;12 months from enrollment. In contrast, the CD4+ T-cell response was largely consistent across all tested variants. The type of most recent exposure was not a significant factor in determining the magnitude of current immune responses.

Conclusions
Administration of the XBB.1.5-based booster is likely to enhance cross-reactive humoral responses against SARS-CoV-2 circulating lineages. Ongoing surveillance of immune responses to emerging variants is needed for informing vaccine composition and timing.
pH selects for distinct N2O-reducing microbiomes in tropical soil microcosms
Authors: Sun Yanchen , Yin Yongchao , He Guang , Cha Gyuhyon , Ayala-del-Río Héctor L , González Grizelle , Konstantinidis Konstantinos T , Löffler Frank E 
Published: May 2024

Abstract
Nitrous oxide (N2O), a greenhouse gas with ozone destruction potential, is mitigated by the microbial reduction to dinitrogen catalyzed by N2O reductase (NosZ). Bacteria with NosZ activity have been studied at circumneutral pH but the microbiology of low pH N2O reduction has remained elusive. Acidic (pH &lt; 5) tropical forest soils were collected in the Luquillo Experimental Forest in Puerto Rico, and microcosms maintained with low (0.02 mM) and high (2 mM) N2O assessed N2O reduction at pH 4.5 and 7.3. All microcosms consumed N2O, with lag times of up to 7 months observed in microcosms with 2 mM N2O. Comparative metagenome analysis revealed that Rhodocyclaceae dominated in circumneutral microcosms under both N2O feeding regimes. At pH 4.5, Peptococcaceae dominated in high-N2O, and Hyphomicrobiaceae in low-N2O microcosms. Seventeen high-quality metagenome-assembled genomes (MAGs) recovered from the N2O-reducing microcosms harbored nos operons, with all eight MAGs derived from acidic microcosms carrying the Clade II type nosZ and lacking nitrite reductase genes (nirS/K). Five of the eight MAGs recovered from pH 4.5 microcosms represent novel taxa indicating an unexplored N2O-reducing diversity exists in acidic tropical soils. A survey of pH 3.5–5.7 soil metagenome datasets revealed that nosZ genes commonly occur, suggesting broad distribution of N2O reduction potential in acidic soils.
Impact of removing ESBL status labelling from culture reports on the use of carbapenems for non-bacteraemic patients diagnosed with ESBL-positive urinary tract infections
Authors: Menendez Alvarado Lourdes R , Margulis Landayan Alice , Williams Kelsey N , Frederick Corey M , Zhang Zhenwei , Gauthier Timothy P 
Published: May 2024

Abstract

Objectives
To evaluate carbapenem prescribing rates for initial definitive treatment of urinary tract infections and clinical outcomes before and after removing ESBL status labels on antibiotic susceptibility reports.

Methods
This was a retrospective cohort study of adult patients treated for at least 48 h for an ESBL-producing/ceftriaxone-resistant Enterobacterales urinary tract infection. ESBL status reporting ceased in September 2022 for a network of seven community hospitals within the USA. The primary endpoint was the rate of carbapenem prescribing for initial definitive treatment of urinary tract infections. Secondary endpoints included total days of therapy for initial definitive treatment with carbapenems, clinical cure rates, time to transition to oral antibiotic therapy for initial definitive treatment, rate of guideline-compliant therapy, rate of relapsed infection within 30 days, 30 day readmission rate, and 30 day all-cause in-hospital mortality.

Results
Of 3055 patients screened, 199 were included in the pre group and 153 were included in the post group. The rate of carbapenem prescribing for initial definitive treatment was 156 patients (78%) in the pre group, compared with 93 patients (61%) in the post group (P = &lt;0.01). Days of therapy for initial definitive therapy with carbapenem was 620 in the pre group compared with 372 in the post group (P &lt; 0.01). There was no difference between other secondary outcomes.

Conclusions
Removing ESBL status labels from laboratory reports reduced carbapenem use for initial definitive treatment of urinary tract infections from 78% to 61% (P &lt; 0.01) without impacting clinical outcomes.
Association between diabetes and subsequent malignancy risk among older breast cancer survivors
Authors: Hardell Kaitlyn N Lewis , Schonfeld Sara J , Ramin Cody , Vo Jacqueline B , Morton Lindsay M 
Published: May 2024

Abstract
Type II diabetes is associated with cancer risk in the general population but has not been well studied as a risk factor for subsequent malignancies among cancer survivors. We investigated the association between diabetes and subsequent cancer risk among older (66-84 years), 1-year breast cancer survivors within the linked Surveillance Epidemiology and End Results (SEER)-Medicare database using Cox regression analyses to quantify hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). Among 133 324 women, 29.3% were diagnosed with diabetes before or concurrent with their breast cancer diagnosis, and 10 452 women developed subsequent malignancies over a median follow-up of 4.3 years. Diabetes was statistically significantly associated with liver (HR = 2.35, 95% CI = 1.48 to 3.74), brain (HR = 1.94, 95% CI = 1.26 to 2.96), and thyroid cancer risks (HR = 1.38, 95% CI = 1.01 to 1.89). Future studies are needed to better understand the spectrum of subsequent cancers associated with diabetes and the role of diabetes medications in modifying subsequent cancer risk, alone or in combination with cancer treatments.
Digital Targeting: Artificial Intelligence, Data, and Military Intelligence
Authors: King Anthony 
Published: May 2024

Abstract
It is widely believed that we are on the brink of another military revolution. Today, states are actively seeking to harness the power of AI for military advantage. The question of AI is therefore of profound concern to security studies scholars concerned with global issues. Up to now, the literature has tended to concentrate on AI-enabled lethal autonomous weapons; scholars have been fascinated by the possible appearance of autonomous drone swarms and their implications for security, conflict, and war. This article takes an alternative view. It argues that AI has already begun to play a significant role in military operations and is likely to be more important in the future. However, the attention to lethal autonomous weapons is exaggerated. The armed forces have principally employed AI, not to automate weapons but to help process data. AI has been used to augment military intelligence. Above all, the armed forces have harnessed AI to accelerate and improve military targeting. The article explores two recent cases where the armed forces have used data and AI to target: COVID testing in Liverpool in 2020 and the US’s Security Assistance Group-Ukraine in the Ukraine War in 2022.
Optimizing crown density and volume estimation across two coniferous forest types in southern China via Boruta and Cubist methods
Authors: Ding Zhi-Dan , Sun Zhao , Xie Yun-Hong , Qiao Jing-Jing , Liang Rui-Ting , Chen Xin , Hussain Khadim , Sun Yu-Jun 
Published: May 2024

Abstract
Quantifying forest stand parameters is crucial in forestry research and environmental monitoring because it provides important factors for analyzing forest structure and comprehending forest resources. And the estimation of crown density and volume has always been a prominent topic in forestry remote sensing. Based on GF-2 remote sensing data, sample plot survey data and forest resource survey data, this study used the Chinese fir (Cunninghamia lanceolata (Lamb.) Hook.) and Pinus massoniana Lamb. as research objects to tackle the key challenges in the use of remote sensing technology. The Boruta feature selection technique, together with multiple stepwise and Cubist regression models, was used to estimate crown density and volume in portions of the research area’s stands, introducing novel technological methods for estimating stand parameters. The results show that: (i) the Boruta algorithm is effective at selecting the feature set with the strongest correlation with the dependent variable, which solves the problem of data and the loss of original feature data after dimensionality reduction; (ii) using the Cubist method to build the model yields better results than using multiple stepwise regression. The Cubist regression model’s coefficient of determination (R2) is all more than 0.67 in the Chinese fir plots and 0.63 in the P. massoniana plots. As a result, combining the two methods can increase the estimation accuracy of stand parameters, providing a theoretical foundation and technical support for future studies.
A scoping review of the current state of video in the use of training of cardiac surgeons in LMICs protocol
Authors: Garg Sakshi , Mojarad Sanam Maharaj , Shah Aishwarya , Kumar Niraj S 
Published: May 2024

Abstract

Background
The lack of quality cardiac surgery training programmes in low- and middle-income countries (LMICs) has been widely recognized as a significant barrier to delivering high-quality and accessible cardiac surgical care. This paper aims to discuss the potential role of leveraging video technology as an adjunct to cardiac surgery training in LMICs. Leveraging video technology allows cardiac surgeons in LMICs to potentially gain exposure quickly to a broader range of procedures, which they otherwise would not have received owing to the lack of facilities and trainers in their individual countries.

Objective
The primary aim of the review is to assess the current use of video-related modalities in surgeon training in LMICs. Secondary aims include identifying potential use of video-related modalities in cardiac surgeon training in LMICs and identifying barriers to use of video-related modalities in cardiac surgeon training in LMICs.

Design
This protocol has been designed in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A systematic search with the following terms ‘low-and-middle-income countries’, ‘video technologies’ and ‘education and cardiac surgery’ was carried on SCOPUS, MEDLINE, EMBASE and WHO Medical Indicus databases. Studies will be screened by two independent assessors using the designed inclusion and exclusion criteria, with conflicts resolved by a third party.

Conclusion
This review will provide a wide review on the available literature on the use of video in cardiac surgery training in LMICs, and act as a base to kickstart future research in this area.
Preoperative stereotactic radiosurgery for patients with 1–4 brain metastases: A single-arm phase 2 trial outcome analysis (NCT03398694)
Authors: Agrawal Namita , Shireman Jack M , Shiue Kevin , Kamer Aaron , Boyd LaKeisha , Zang Yong , Mukherjee Neel , Miller James , Kulwin Charles , Cohen-Gadol Aaron , Payner Troy , Lin Chih-Ta , Savage Jesse J , Lane Brandon , Bohnstedt Bradley , Lautenschlaeger Tim , Saito Naoyuki , Shah Mitesh , Watson Gordon , Dey Mahua 
Published: May 2024

Abstract

Background
Stereotactic radiosurgery (SRS) following surgical resection is the standard of care for patients with symptomatic oligo brain metastasis (BM), however, it is associated with 10–15% local failure. Targeting a resection cavity is imprecise, thus preoperative radiosurgery where the target is well-defined may be superior, however, the efficacy of preoperative SRS has not yet been tested in a clinical trial.

Methods
We conducted a phase 2, single-arm trial of preoperative SRS followed by surgical resection in patients with 1–4 symptomatic oligo BMs (NCT03398694) with the primary objective of measuring 6-month local control (LC). SRS was delivered to all patients utilizing a gamma knife or linear accelerator as per RTOG-9005 dosing criteria [Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys. 2000;47(2):291–298] based on tumor diameter with the exception that the largest lesion diameter treated was 5 cm with 15 Gy with all SRS treatment given in single fraction dosing.

Results
The trial screened 50 patients, 48 patients were treated under the protocol and 32 patients completed the entire follow-up period. Of all the patients who completed the follow-up period, the primary endpoint of 6-month LC was 100% (95% CI: 0.891–1.000; P = .005). Secondary endpoints, presented as medians, were overall survival (17.6 months), progression-free survival (5.3 months), distant in-brain failure (40.8% at 1 year), leptomeningeal failure (4.8% at 1 year), and radiation necrosis (7.7% at 1 year).

Conclusions
Our data confirms superior local control in patients who received preoperative SRS when compared to historical controls. Further study with a larger randomized cohort of patients is warranted to fully understand the benefits of preoperative SRS.
The Lifetime Health and Economic Burden of Smokeless Tobacco use in Bangladesh, India, and Pakistan: Results From ASTRAMOD
Authors: Coyle Kathryn , Singh Prashant Kumar , Kaushik Ravi , Huque Rumana , Khan Zohaib , Mehrotra Ravi , Siddiqi Kamran , Pokhrel Subhash 
Published: May 2024

Abstract

Introduction
Under the current policy landscapes, the lifetime health and economic burden of smokeless tobacco (ST) products, consumed by over 297 million ST users in South Asia, is unknown. The aim of this study was to estimate the lifetime health effects and costs attributable to current and future ST use in Bangladesh, India, and Pakistan where the majority of ST users live.

Aims and Methods
We developed a Markov-based state-transition model (ASTRAMOD) to predict the lifetime costs of treatment of four diseases (oral, pharyngeal, esophageal cancers, and stroke) and disability-adjusted life years (DALYs), attributable to the current and future use of ST under existing ST policy scenario. Country-specific Global Adult Tobacco Surveys, life tables, and meta-analyses of South Asian and South East Asian studies were used to populate the model. A probabilistic sensitivity analysis evaluated the uncertainty in model predictions.

Results
If there were no change in the current ST policies, the lifetime ST-attributable treatment costs would be over US$19 billion in India, over US$1.5 billion in Bangladesh, and over US$3 billion in Pakistan. For all countries, the attributable costs are higher for younger cohorts with costs declining with increasing age for those over 50. The model predicted that a typical 15-year-old male adoloscent would gain 0.07–0.18 life years, avert 0.07–0.19 DALYs, and generate a cost-savings of US$7–21 on healthcare spending if ST policies were changed to eliminate ST use.

Conclusions
Policy interventions aimed at decreasing the uptake of ST and increasing quitting success have the potential to substantially decrease the economic and health burden of ST.

Implications
This study provides the most comprehensive estimates of the lifetime health and economic burden of ST by 5-year age and sex cohorts. This is also the first study that highlights the scale of health and economic burden of ST in Bangladesh, India, and Pakistan if there were no changes in the current ST policies. Policymakers and practitioners can use the reported data to justify their decisions to improve current ST policies and practices in their country. Researchers can use the ASTRAMOD methodology to estimate the impact of future ST policy changes.