bluuebunny/crossref_metadata_2025_split huggingface dataset:
One-Year Functional Outcomes After Invasive Mechanical Ventilation for Older Adults With Preexisting Long-Term Care-Needs*
Authors: Ohbe Hiroyuki , Ouchi Kei , Miyamoto Yuki , Ishigami Yuichiro , Matsui Hiroki , Yasunaga Hideo , Sasabuchi Yusuke 
Published: February 2023

OBJECTIVES:
To examine 1-year functional outcomes after invasive mechanical ventilation for adults greater than or equal to 65 years with preexisting long-term care-needs.

DESIGN:
We used medical and long-term care administrative databases. The database included data on functional and cognitive impairments that were assessed with the national standardized care-needs certification system and were categorized into seven care-needs levels based on the total daily estimated care minutes. Primary outcome was mortality and care-needs at 1 year after invasive mechanical ventilation. Outcome was stratified by preexisting care-needs at the time of invasive mechanical ventilation: no care-needs, support level 1–2 and care-needs level 1 (estimated care time 25–49 min), care-needs level 2–3 (50–89 min), and care-needs level 4–5 (≥90 min).

SETTING:
A population-based cohort study in Tochigi Prefecture, one of 47 prefectures in Japan.

PATIENTS:
Among people greater than or equal to 65 years old registered between June 2014 and February 2018, patients who received invasive mechanical ventilation were identified.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Among 593,990 eligible people, 4,198 (0.7%) received invasive mechanical ventilation. The mean age was 81.2 years, and 55.5% were male. The 1-year mortality rates after invasive mechanical ventilation in patients with no care-needs, support level 1–2 and care-needs level 1, care-needs level 2–3, and care-needs level 4–5 at the time of invasive mechanical ventilation were 43.4%, 54.9%, 67.8%, and 74.1%, respectively. Similarly, those with worsened care-needs were 22.8%, 24.2%, 11.4%, and 1.9%, respectively.

CONCLUSIONS:
Among patients in preexisting care-needs levels 2–5 who received invasive mechanical ventilation, 76.0–79.2% died or had worsened care-needs within 1 year. These findings may aid shared decision-making among patients, their families, and heath care professionals on the appropriateness of starting invasive mechanical ventilation for people with poor functional and cognitive status at baseline.
Refractive Error and Anterior Chamber Depth as Risk Factors in Primary Angle Closure Disease: The Chinese American Eye Study
Authors: Zhou Sarah , Pardeshi Anmol A. , Burkemper Bruce , Apolo Galo , Cho Austin , Jiang Xuejuan , Torres Mina , McKean-Cowdin Roberta , Varma Rohit , Xu Benjamin Y. 
Published: February 2023

Précis:
The risk of primary angle closure disease (PACD) rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Refractive error (RE) is useful for angle closure risk stratification in the absence of biometric data.

Purpose:
To assess the role of RE and anterior chamber depth (ACD) as risk factors in PACD.

Methods:
Chinese American Eye Study participants received complete eye examinations including refraction, gonioscopy, amplitude-scan biometry, and anterior segment ocular coherence tomography imaging. PACD included primary angle closure suspect (≥3 quadrants of angle closure on gonioscopy) and primary angle closure/primary angle closure glaucoma (peripheral anterior synechiae or intraocular pressure >21 mm Hg). Logistic regression models were developed to assess associations between PACD and RE and/or ACD adjusted for sex and age. Locally weighted scatterplot smoothing curves were plotted to assess continuous relationships between variables.

Results:
Three thousand nine hundred seventy eyes (3403 open angle and 567 PACD) were included. The risk of PACD increased with greater hyperopia [odds ratio (OR) = 1.41 per diopter (D); P < 0.001] and shallower ACD (OR = 1.75 per 0.1 mm; P < 0.001). Hyperopia (≥ + 0.5 D; OR = 5.03) and emmetropia (−0.5 D to +0.5 D; OR = 2.78) conferred a significantly higher risk of PACD compared with myopia (≤0.5 D). ACD (standardized regression coefficient = −0.54) was a 2.5-fold stronger predictor of PACD risk compared with RE (standardized regression coefficient = 0.22) when both variables were included in one multivariable model. The sensitivity and specificity of a 2.6 mm ACD cutoff for PACD were 77.5% and 83.2% and of a +2.0 D RE cutoff were 22.3% and 89.1%.

Conclusion:
The risk of PACD rises rapidly with greater hyperopia while remaining relatively low for all degrees of myopia. Although RE is a weaker predictor of PACD than ACD, it remains a useful metric to identify patients who would benefit from gonioscopy in the absence of biometric data.
Retinal Nerve Fiber Layer Thickness in Patients With Obstructive Sleep Apnea
Authors: Devi Thounaojam S. , Agrawal Ajai , Gupta Neeti , Gupta Ravi , Samanta Ramanuj , Nishant Prateek 
Published: February 2023

Précis:
Average and superior quadrant retinal nerve fiber layer thickness (RNFLT) was lower in the more severe obstructive sleep apnea (OSA) group and inversely associated with apnea-hypopnea index (AHI). OSA may have an impact on RNFLT.

Purpose:
The purpose of this study was to study the RNFLT using optical coherence tomography (OCT) in patients with different severities of OSA.

Patients and Methods:
In this hospital-based prospective cross-sectional study, 90 (90 eyes) newly diagnosed OSA patients aged 18 years or above were enrolled. Based on the AHI, there were 38.8%, 30%, and 31.1% cases of mild (AHI≥5 to <15), moderate (AHI≥15 to <30), and severe (AHI≥30) OSA, respectively. All the participants underwent a comprehensive ocular examination. OCT was done using CIRRUS HD-OCT 500 to measure the RNFLT.

Results:
The average RNFLT among the 3 OSA groups was significantly different (P=0.002) and inversely associated with AHI (P=0.02, r
s=−0.16). Severe OSA had thinner average RNFLT than those with mild and moderate OSA (P=0.01 and 0.003, respectively). Among the 4 quadrants observed, only the superior quadrant RNFLT among the 3 OSA groups was significantly different (P<0.00001) and inversely associated with AHI (P=0.01, r
s=−0.17). Severe OSA had thinner superior quadrant RNFLT than those with moderate OSA (P<0.01). The differences in the intraocular pressure among the 3 OSA groups were statistically significant (P<0.0008). Patients with moderate and severe OSA had higher intraocular pressure than patients with mild OSA (P=0.002 and 0.001, respectively).

Conclusions:
Attention should be paid to the patients with OSA as it may have an impact on RNFLT. OSA patients should be screened for glaucoma as early detection of glaucoma can reduce vision loss in these patients.
Saroglitazar improves nonalcoholic fatty liver disease and metabolic health in liver transplant recipients
Authors: Siddiqui Mohammad Shadab , Parmar Deven , Shaikh Farheen , Forsgren Mikael , Patel Samarth , Bui Anh Tuan , Boyett Sherry , Patel Vaishali , Sanyal Arun J. 
Published: February 2023

NAFLD is common after liver transplantation (LT) and is associated with an increased metabolic burden. Currently, there is a paucity of investigations into the treatment of post-LT NAFLD. In the present study, we evaluated the safety and efficacy of saroglitazar, a novel dual peroxisome proliferator–associated receptor α/γ agonist, on the treatment of post-LT NAFLD and metabolic burden. This is a phase 2A, single-center, open-label, single-arm study in which patients with post-LT NAFLD received saroglitazar magnesium 4 mg daily for 24 weeks. NAFLD was defined by a controlled attenuation parameter ≥264 dB/m. The primary endpoint was the reduction in liver fat as measured by MRI proton density fat fraction (MRI-PDFF). Secondary MRI-based metabolic endpoints included visceral adipose tissue, abdominal subcutaneous adipose tissue volumes, muscle fat infiltration, and fat-free muscle volume. Saroglitazar treatment led to a reduction in MRI-PDFF from 10.3±10.5% at baseline to 8.1±7.6%. A relative 30% reduction from baseline MRI-PDFF value was noted in 47% of all patients and 63% of patients with baseline MRI-PDFF >5%. Reduction in serum alkaline phosphatase was an independent predictor of MRI-PDFF response. Saroglitazar did not decrease fat-free muscle volume nor increase muscle fat infiltration, but did lead to a mild increase in visceral adipose tissue and abdominal subcutaneous adipose tissue. The study drug was well tolerated and a mild nonsignificant increase in serum creatinine was noted. Saroglitazar did not affect the weight. The study provides preliminary data demonstrating the safety and metabolic benefits of saroglitazar in LT recipients and underscores the importance of future studies to establish its efficacy after LT.
Objective Comparison of Eyebrow Position after Internal and External Browpexy
Authors: Huang Po-Jen , Mao Shih-Hsuan , Yen Cheng-I , Yang Shih-Yi , Hsiao Yen-Chang , Yang Jui-Yung , Chang Shu-Yin , Chuang Shiow-Shuh , Chen Hung-Chang 
Published: February 2023

Background:Several brow lift techniques have been used to prevent brow ptosis after blepharoplasty. For example, both internal and external browpexies have been adopted worldwide. However, few studies have compared these two methods. We compared postoperative eyebrow position changes between upper eyelid skin excision, internal, and external browpexy.Methods:We retrospectively reviewed the cases of 87 patients who underwent upper blepharoplasty performed by a single clinician at our institute between April 2018 and June 2020. Patients with routine outpatient photographs taken before and after surgery were enrolled in the study. Image J was used to measure brow height at eight points in each eye. Brow height changes were compared among the three groups.Results:Routine photographs were available for 68 patients (133 eyes). Thirty-nine patients underwent internal browpexy (78 eyes), nine external browpexy (17 eyes), and 20 upper eyelid skin excisions (38 eyes). Three months after surgery, significant elevation was noted on the lateral side of the brow in the internal browpexy group and across the whole brow in the external browpexy group. In the upper eyelid skin excision group, whole brow ptosis was observed. Brow lift outcomes were better in the external than in the internal browpexy group, while both browpexy groups showed better outcomes than the upper eyelid skin excision group.Conclusions:Within 3 months of surgery, both internal and external browpexy provided significant brow lift effects, preventing brow ptosis due to blepharoplasty with skin excision. External browpexy had better brow-lift outcomes than did internal browpexy.
Heating pretreatment of the recipient site enhances survival of transplanted fat in a mouse model
Authors: Kim Sun Eung , Kim Yu Jin , Kim Yang Woo , Cheon Young Woo 
Published: February 2023

Background:
Despite several studies about the preparation of the recipient site in fat grafting, optimizing techniques with clinical usefulness is still necessary. Through previous animal studies reporting that heat can increase tissue VEGF and vascular permeability, we hypothesize that heating pretreatment of the recipient site will increase retention of grafted fat.

Methods:
Twenty 6-week-old female BALB/c mice had two pretreatment sites on their back, one for the experimental temperature (44℃ and 48℃) and the other for the control. A digitally controlled aluminum block was used to apply the contact thermal damage. Human fat (0.5ml) was grafted on each site and harvested on day 7, 14, and 49. The percentage volume and weight, histological changes, and peroxisome proliferator-activated receptor gamma expression, a key regulator of adipogenesis, were measured by water displacement method, light microscopy, and qRT-PCR, respectively.

Results:
The harvested percentage volumes were 74.0 ± 3.4%, 82.5 ± 5.0%, and 67.5 ± 9.6% for the control, 44℃-pretreatment, and 48℃-pretreatment groups, respectively. The percentage volume and weight of 44℃-pretreatment group was higher than the other groups (p < 0.05). The 44℃-pretreatment group exhibited significantly higher integrity with fewer cysts and vacuoles than the other groups. Both heating pretreatment groups showed markedly higher rates of vascularity than the control group (p < 0.017), and also increased the expression of PPARγ over 2-fold.

Conclusions:
Heating preconditioning of the recipient site during fat grafting can increase the retention volume and improve the integrity, which is partly explained by increased adipogenesis in a short-term mouse model.
“Neurocognitive Outcomes in Deformational Plagiocephaly: Is There an Association between Morphologic Severity and Results? “
Authors: Park Kitae E. , Chandler Ludmila , Ahmad Maham , Singh Anusha , Allam Omar , Mets Elbert , Bridgett David J. , Persing John A. , Alperovich Michael 
Published: February 2023

Background:The neurodevelopmental impact of skull asymmetry and orthotic helmet therapy for deformational plagiocephaly (DP) have had limited investigation. This study assessed the long-term neurocognitive outcomes in DP patients and their association with orthotic helmet therapy and head shape abnormality.Methods:138 School-age children with a history of DP of whom 108 received helmet therapy were tested with a neurocognitive battery assessing academic achievement, intelligence quotient, and visual-motor function. Severity of presenting plagiocephaly was calculated using anthropometric and photometric measurements. Analysis of covariance was used to compare outcomes between helmeted and non-helmeted cohorts, unilateral plagiocephaly and concomitant brachycephaly, and left and right-sided plagiocephaly. The association between severity of plagiocephaly and neurocognitive outcome was assessed through a residualized change approach.Results:There were no significant differences in neurocognitive outcomes between the helmeted and non-helmeted DP cohorts or the unilateral plagiocephaly and brachycephaly cohorts. Left-sided DP patients performed significantly worse in motor coordination than right-sided patients (84.8 vs 92.7, ES=-0.50, p=0.03). There was a significant laterality by cephalic index (CI) interaction, with a negative association between CI and reading comprehension and spelling for left-sided patients. No significant associations were found between severity of presenting or post-treatment deformity and neurocognitive outcome.Conclusion:Pre- and post-treatment severity of plagiocephaly were not correlated with neurocognitive function at school age. Helmet therapy was not associated with better or worse long-term neurocognitive function. However, patients with left-sided DP demonstrated worse neurocognitive outcomes than right-sided patients in the domains of motor coordination and some types of academic achievement.
A Cautionary Tale: The Use of Propensity Matching to Evaluate Hemorrhage-Related Trauma Mortality in the American College of Surgeons TQIP Database
Authors: Harfouche Melike N , Feliciano David V , Kozar Rosemary A , DuBose Joseph J , Scalea Thomas M 
Published: February 2023

BACKGROUND:Propensity-matched methods are increasingly being applied to the American College of Surgeons TQIP database to evaluate hemorrhage control interventions. We used variation in systolic blood pressure (SBP) to demonstrate flaws in this approach.STUDY DESIGN:Patients were divided into groups based on initial SBP (iSBP) and SBP at 1 hour (2017 to 2019). Groups were defined as follows: iSBP 90 mmHg or less who decompensated to 60 mmHg or less (immediate decompensation [ID]), iSBP 90 mmHg or less who remained greater than 60 mmHg (stable hypotension [SH]), and iSBP greater than 90 mmHg who decompensated to 60 mmHg or less (delayed decompensation [DD]). Individuals with Head or Spine Abbreviated Injury Scale score 3 or greater were excluded. Propensity score was assigned using demographic and clinical variables. Outcomes of interest were in-hospital mortality, emergency department death, and overall length of stay.RESULTS:Propensity matching yielded 4,640 patients per group in analysis #1 (SH vs DD) and 5,250 patients per group in analysis #2 (SH vs ID). The DD and ID groups had 2-fold higher in-hospital mortality than the SH group (DD 30% vs 15%, p < 0.001; ID 41% vs 18%, p < 0.001). Emergency department death rate was 3 times higher in the DD group and 5 times higher in the ID group (p < 0.001), and length of stay was 4 days shorter in the DD group and 1 day shorter in the ID group (p < 0.001). Odds of death were 2.6 times higher for the DD vs SH group and 3.2 times higher for the ID vs SH group (p < 0.001).CONCLUSIONS:Differences in mortality rate by SBP variation underscore the difficulty of identifying individuals with a similar degree of hemorrhagic shock using the American College of Surgeons TQIP database despite propensity matching. Large databases lack the detailed data needed to rigorously evaluate hemorrhage control interventions.
Separable solutions to nonlinear anisotropic diffusion equation in elliptic coordinates
Authors: Tretiakova K. , Nec Y. 
Published: February 2023

Two- and three-dimensional exact solutions of the nonlinear diffusion equation are proved to exist in elliptic coordinates subject to an arbitrary piecewise constant azimuthal anisotropy. Degrees of freedom traditionally used to satisfy boundary conditions are instead employed to ensure continuity and conservation of mass across contiguity surfaces between subdomains of distinct diffusivities. Not all degrees of freedom are exhausted thereby, and conditions are given for the inclusion of higher harmonics. Degrees of freedom associated with one isotropic subdomain are always available to satisfy boundary conditions. The second harmonic is pivotal in the solution construction as well as the identification of partial symmetries in the domain partition. The anisotropy gives rise to an unconventional mixed type critical point that combines saddle and node-like characteristics.
This article is part of the theme issue ‘New trends in pattern formation and nonlinear dynamics of extended systems’.
Variety of flow patterns in a liquid bridge subjected to a gas stream
Authors: Gaponenko Y. , Yasnou V. , Mialdun A. , Bou-Ali M. M. , Nepomnyashchy A. , Shevtsova V. 
Published: February 2023

We present an experimental and two-phase computational study of convection in a liquid bridge (

P
r

=
14

) that develops under the action of a parallel gas flow. The study focuses on tracking the evolution of hydrothermal waves by increasing the applied temperature difference

Δ
T

and the temperature of gas moving at the velocity

0.1

m

s

−
1

. Our experiments revealed certain regularity in the change of oscillatory states with an increase in the control parameters. Above the instability threshold, the nonlinear dynamics passes through three oscillatory regimes, which are repeated in a somewhat similar way at higher values of the control parameters. They are periodic, quasi-periodic with two or three frequencies and multi-frequency state when the Fourier spectrum is filled with clusters of duplex, triplex or higher numbers of frequencies. Three-dimensional numerical simulation, complemented by a deep spectral analysis, sheds light on the evolution of the flow pattern observed in experiments. The developed methodology identified conditions for the existence of a multi-frequency regime such as the presence of a weak low-frequency mode that can modulate strong high-frequency modes, the existence of strong azimuthal modes with different wavenumbers and the

m
=
0

mode, and the structured combination of peaks in the Fourier spectrum.

This article is part of the theme issue ‘New trends in pattern formation and nonlinear dynamics of extended systems’.
Improving Clinical Decision Making with a Two-Stage Recommender System: A Case Study on MIMIC-III Dataset
Authors: Raza Shaina 
Published: February 2023

AbstractClinical decision-making is a challenging and time-consuming task that involves integrating a vast amount of patient data, including medical history, test results, and notes from clinicians. To assist this process, clinical recommender systems have been developed to provide personalized recommendations to healthcare practitioners. However, creating effective clinical recommender systems is complex due to the diversity and intricacy of clinical data and the need for customized recommendations. In this paper, we propose a two-stage recommender framework for clinical decision-making basedon the publicly available MIMIC dataset of electronic health records. The first stage of the framework employs a deep neural networkbased model to retrieve a set of candidate items, such as diagnosis, medication, and prescriptions, from the patient’s electronic health records. The model is trained to extract relevant information from clinical notes using a pre-trained language model. The second stage of the framework utilizes a deep learning model to rank and recommend the most pertinent items to healthcare providers. The model considers the patient’s medical history and the context of the current visit to offer personalized recommendations. To evaluate the proposed model, we compared it to various baseline models using multiple evaluation metrics. The findings indicate that the proposed model achieved a precision of 89% and a macro-average F1 score of approximately 84%, indicating its potential to improve clinical decision-making and reduce information overload for healthcare providers. The paper also discusses challenges, such as data availability, privacy, and bias, and suggests areas for future research in this field.
Detection and clearance of type-specific and phylogenetically related genital human papillomavirus infections in young women in new heterosexual relationships
Authors: Arthur Andrew W. , El-Zein Mariam , Burchell Ann N. , Tellier Pierre-Paul , Coutlée Francois , Franco Eduardo L. 
Published: February 2023

ABSTRACTBackgroundUnderstanding the natural history of human papillomavirus (HPV) infections is essential to effective cervical cancer prevention planning. We examined these outcomes in-depth among young women.MethodsThe HPV Infection and Transmission among Couples through Heterosexual Activity (HITCH) study is a prospective cohort of 501 college-age women who recently initiated a heterosexual relationship. We tested vaginal samples collected at six clinical visits over 24 months for 36 HPV types. Using rates and Kaplan-Meier analysis, we estimated time-to-event statistics with 95% confidence intervals (CIs) for detection of incident infections and liberal clearance of incident and present-at-baseline infections (separately). We conducted analyses at the woman- and HPV-levels, with HPV types grouped by phylogenetic relatedness.ResultsBy 24 months, we detected incident infections in 40.4%, CI:33.4-48.4 of women. Incident subgenus 1 (43.4, CI:33.6-56.4), 2 (47.1, CI:39.9-55.5) and 3 (46.6, CI:37.7-57.7) infections cleared at similar rates per 1000 infection-months. We observed similar homogeny in HPV-level clearance rates among present-at-baseline infections.ConclusionsOur woman-level analyses of infection detection and clearance agreed with similar studies. However, our HPV-level analyses did not clearly indicate that high oncogenic risk subgenus 2 infections take longer to clear than their low oncogenic risk and commensal subgenera 1 and 3 counterparts.