bluuebunny/crossref_metadata_2025_split huggingface dataset:
Level of Care Appropriateness in VA Inpatient Surgery Cases
Authors: Neugaard Britta , Politi Ruth , McCay Christy 
Published: March 2023

Purpose of Study:
Within the Veterans Health Administration, utilization management (UM) focuses on reducing unnecessary or inappropriate hospitalizations by applying evidence-based criteria to evaluate whether the patient is placed in the right level of care. This study examined inpatient surgery cases to classify reasons for not meeting criteria and to identify the appropriate level of care for admissions and subsequent bed days of care.

Primary Practice Settings:
There were 129 VA Medical Centers in which inpatient UM reviews were performed during that time, of which 109 facilities had UM reviews conducted in Surgery Service.

Methodology and Sample:
All admissions to surgery service during fiscal year 2019 (October 1, 2018 to September 30, 2019) that had a UM review entered in the national database were extracted, including current level of care, recommended level of care, and reasons for not meeting criteria. The following demographic and diagnostic fields were supplemented from a national data warehouse: age, gender, marital status, race, ethnicity, and service connection status. Data were analyzed with descriptive statistics. Characteristics of patient demographics were compared using the χ2 test for categorical variables and the Student's t test.

Results:
A total of 363,963 reviews met conditions to be included in the study: 87,755 surgical admission reviews and 276,208 continued stay reviews. There were 71,274 admission reviews (81.22%) and 198,521 (71.87%) continued stay reviews that met the InterQual criteria. The primary reason for not meeting admission criteria was clinical variance (27.70%), followed by inappropriate level of care (26.85%). The leading reason for not meeting continued stay criteria was inappropriate level of care (27.81%), followed by clinical instability (25.67%). Of the admission reviews not meeting admission criteria, 64.89% were in the wrong level of care and 64.05% of continued stay reviews were also in the wrong level of care. Half of the admission reviews not meeting criteria had a recommended level of care as home/outpatient (43.51%), whereas nearly one-third (28.81%) continued stay reviews showed a recommended level of care of custodial care or skilled nursing.

Implications for Case Management Practice:
This study identified system inefficiencies through admission and continued stay reviews of surgical inpatients. Patients admitted for ambulatory surgery or for preoperative testing prior to day of surgery resulted in avoidable bed days of care that may have contributed to patient flow issues and limited the available hospital beds for other patients. Through early collaboration with case management and care coordination professionals, alternatives can be explored that safely address the patient needs, such as temporary lodging options. There may be conditions or complications that can be anticipated on the basis of patient history. Proactive efforts to address these conditions may help avoid unnecessary bed days and extended lengths of stay.
Assessment of Veterans Affairs Case Managers Using a Leadership Conceptual Framework
Authors: Perla Lisa Y. , Barry Erin S. , Grunberg Neil E. 
Published: March 2023

Purpose/Objectives:
Case management in Veterans Affairs (VA) depends on leadership skills such as effective communication, excellent resource management, self-governance, patient advocacy, and a distinctly professional attitude. VA registered nurses (RNs) and social workers (SWs) also provide case management services, a role and service, which is pivotal to veteran satisfaction and effective health care coordination.
The leader–follower framework (LF2) was used to assess and compare the responses of RNs, SWs, and case managers (CMs) on the annual VA All Employee Survey (AES) to provide insight regarding VA case management performance, which has influenced veteran satisfaction.

Primary Practice Setting:
VA CMs work in a variety of clinical settings, which, in recent years, includes the use of telehealth modalities because of COVID-19. VA CMs remain flexible working in environments where and when veterans require their services while promoting safe, effective, and equitable health care services.

Findings/Conclusions:
RNs and SWs indicated greater agreement and satisfaction scores in 2019 compared with 2018 on questions related to the leadership element of character and questions regarding mutual respect between VA senior leaders and the respondents. In contrast, RNs and SWs indicated less agreement and satisfaction scores on questions related to the leadership elements of competence, context, communication, personal, interpersonal, team, organizational, and greater burnout in 2019 than in 2018. RN response scores in 2018 and 2019 were greater and burnout scores were less than SWs. Additionally, the one-way analysis of variance indicated no difference for RNs and SWs who were performing the duties of a CM.

Implications for Case Management Practice:
The responses of RNs indicated greater satisfaction and less burnout than SWs and were consistent whether RNs and SWs were in case management roles or not. These are important findings and concerning trends warranting further discussion and research.
Mapping Critical Thinking, Clinical Reasoning, and Clinical Judgment Across the Curriculum
Authors: Noll Kelley , Hunt Caralise , Jones Meghan 
Published: March 2023

Background:
Critical thinking, clinical reasoning, and clinical judgment are skills nurses use when caring for clients. However, teaching and evaluation of clinical judgment are challenging for faculty.

Problem:
Before revising a curriculum, it is necessary to map current practices and determine a framework for revisions.

Approach:
Faculty mapped critical thinking, clinical reasoning, and clinical judgment activities across the 5-semester traditional baccalaureate program. Use of an external consultant helped faculty to determine additional activities that could be used to assess clinical judgment in classroom and clinical settings. Faculty worked together to develop teaching strategies and Next Generation National Council Licensure Examination (NCLEX) item types for assessing clinical judgment.

Conclusion:
Using the National Council of State Boards of Nursing Clinical Judgment Model as an educational framework can guide faculty in curriculum mapping, revisions, and development of clinical judgment activities and assessment.
Ankle contracture in people with acquired brain injury (ABI), intervention, and outcome following inpatient neurorehabilitation categorized by severity
Authors: Ashford Stephen , Elsmore Charlotte , Steed Aideen , Diggins Alexia , Walden-Smith Alice , Williams Heather 
Published: March 2023

Background:
Acquired brain injury frequently causes difficulty with moving and walking, which if not actively managed, can lead to secondary contracture and deformity. Intervention to manage ankle contracture may include conservative methods (eg, serial casting, standing) or more invasive methods (eg, Achilles-tendon lengthening surgery).

Methods:
Data were extracted from the UK Rehabilitation Outcomes Collaborative database for all admissions from 2015 to 2018 with a diagnosis of acquired brain injury from 1 tertiary rehabilitation center. Clinical records were reviewed to identify the 101/357 (28%) with ankle contracture. Categorization according to the degree of contracture was performed, as mild (>plantigrade), moderate (<plantigrade to −20°), or severe (>−21°) based on ankle range of movement. Data were analyzed to determine the change in the range of movement, function, outcome, and categorize intervention type. Primary measures: range of movement, UK Functional Independence Measure+Functional Assessment Measure, and Functional Ambulatory Category.

Results:
In the cohort, significant improvement in range of movement occurred following treatment (54.17; P=0.000). Treatment interventions applied included stretch interventions such as serial casting. Standing programmes, orthotics, and task practice were the most frequently applied interventions. Achilles-tendon lengthening surgery was used in a small number of cases (n=13). A statistically significant change in the range of movement was not seen in the mild category (1.05; P=0.29) but was in the moderate (5.436; P=0.001) and severe categories (10.4; P=0.001). Improvement in locomotion was noted in all 3 groups (6.10; P=0.001) but was most pronounced in the moderate and severe groups.

Discussion:
Improved functional outcome was observed in mild contracture with less change in joint range. In those categorized as moderate and severe, greater improvement in joint range of movement as well as function were identified following intervention.
OCT5k: A dataset of multi-disease and multi-graded annotations for retinal layers
Authors: Arikan Mustafa , Willoughby James , Ongun Sevim , Sallo Ferenc , Montesel Andrea , Ahmed Hend , Hagag Ahmed , Book Marius , Faatz Henrik , Cicinelli Maria Vittoria , Fawzi Amani A , Podkowinski Dominika , Cilkova Marketa , de Almeida Deanna , Zouache Moussa , Ramsamy Ganesham , Lilaonitkul Watjana , Dubis Adam M 
Published: March 2023

ABSTRACTThe thickness and appearance of retinal layers are essential markers for diagnosing and studying eye diseases. Despite the increasing availability of imaging devices to scan and store large amounts of data, analyzing retinal images and generating trial endpoints has remained a manual, error-prone, and time-consuming task. In particular, the lack of large amounts of high-quality labels for different diseases hinders the development of automated algorithms. Therefore, we have compiled 5016 pixel-wise manual labels for 1672 optical coherence tomography (OCT) scans featuring two different diseases as well as healthy subjects to help democratize the process of developing novel automatic techniques. We also collected 4698 bounding box annotations for a subset of 566 scans across 9 classes of disease biomarker. Due to variations in retinal morphology, intensity range, and changes in contrast and brightness, designing segmentation and detection methods that can generalize to different disease types is challenging. While machine learning-based methods can overcome these challenges, high-quality expert annotations are necessary for training. Publicly available annotated image datasets typically contain few images and/or only cover a single type of disease, and most are only annotated by a single grader. To address this gap, we present a comprehensive multi-grader and multi-disease dataset fortraining machine learning-based algorithms. The proposed dataset covers three subsets of scans (Age-related Macular Degeneration, Diabetic Macular Edema, and healthy) and annotations for two types of tasks (semantic segmentation and object detection).
Toward overcoming pyrethroid resistance in mosquito control: the role of sodium channel blocker insecticides
Authors: Niklas Beata , Rydzewski Jakub , Lapied Bruno , Nowak Wieslaw 
Published: March 2023

ABSTRACTDiseases spread by mosquitoes lead to death of 700,000 people each year. The main way to reduce transmission is vector control by biting prevention with chemicals. However, the most commonly used insecticides lose efficacy due to the growing resistance. Voltage-gated sodium channels (VGSCs), membrane proteins responsible for the depolarizing phase of an action potential, are targeted by a broad range of neurotoxins, including pyrethroids and sodium channel blocker insecticides (SCBIs). Reduced sensitivity of the target protein due to the point mutations threatened malaria control with pyrethroids. Although SCBIs – indoxacarb (a pre-insecticide bioactivated to DCJW in insects) and metaflumizone – are used in agriculture only, they emerge as promising candidates in mosquito control. Therefore, a thorough understanding of molecular mechanisms of SCBIs action is urgently needed to break the resistance and stop disease transmission. In this study, by performing an extensive combination of equilibrium and enhanced sampling molecular dynamics simulations (3.2 μs in total), we found the DIII-DIV fenestration to be the most probable entry route of DCJW to the central cavity of mosquito VGSC. Our study revealed that F1852 is crucial in limiting SCBI access to their binding site. Result explain the role of the F1852T mutation found in resistant insects and the increased toxicity of DCJW compared to its bulkier parent compound, indoxacarb. We also delineated residues that contribute to both SCBIs and non-ester pyrethroid etofenprox binding and thus could be involved in the target site cross-resistance.Abstract Figure
High Variability of Body Mass Index Independently Associated with Incident Heart Failure
Authors: Liu Chang , Chiang Yiyun , Hui Qin , Zhou Jin J. , Wilson Peter W.F. , Joseph Jacob , Sun Yan V. 
Published: March 2023

AbstractBackgroundHeart failure (HF) is a serious condition with increasing prevalence, high morbidity, and increased mortality. Obesity is an established risk factor for cardiovascular diseases, including HF. Fluctuation in body mass index (BMI) has shown a higher risk of cardiovascular outcomes. We investigated the association between BMI variability and incident HF.MethodsIn the UK Biobank, we established a prospective cohort after excluding participants with prevalent HF or cancer at enrollment. A total of 99,368 White (British, Irish, and any other white background) participants with ≥ 3 BMI measures during > 2 years preceding enrollment were included, with a median follow-up of 12.5 years. The within-participant variability of BMI was evaluated using standardized standard deviation (SD) and coefficient of variation (CV). The association of BMI variability with incident HF was assessed using Fine and Gray’s competing risk model, and adjusted for age, sex, smoking history, alcohol consumption, diabetes, hypertension, history of heart attack, stroke, atrial fibrillation, lipids, estimated glomerular filtration rate and mean BMI per individual.ResultsIn the fully adjusted model, higher BMI variability measured in both SD and CV were significantly associated with higher risk in HF incidence (SD: Hazard Ratio [HR] 1.05, 95% Confidence Interval [CI] 1.02 - 1.07, p = 0.0002; CV: HR 1.06, 95% CI 1.04 - 1.09, p < 0.0001).ConclusionsLongitudinal health records capture BMI fluctuation, which independently predicts HF incidence. Integration of long-term BMI and other routinely measured health factors may improve risk prediction of HF and other cardiovascular outcomes.
Microbiome diversity: A barrier to the environmental spread of antimicrobial resistance?
Authors: Klümper Uli , Gionchetta Giulia , Catao Elisa C. P. , Bellanger Xavier , Dielacher Irina , Fang Peiju , Galazka Sonia , Goryluk-Salmonowicz Agata , Kneis David , Okoroafor Uchechi , Radu Elena , Szadziul Mateusz , Szekeres Edina , Teban-Man Adela , Coman Cristian , Kreuzinger Norbert , Popowska Magdalena , Vierheilig Julia , Walsh Fiona , Woegerbauer Markus , Bürgmann Helmut , Merlin Christophe , Berendonk Thomas U. 
Published: March 2023

AbstractBackgroundIn the environment, microbial communities are constantly exposed to invasion by antimicrobial resistant bacteria (ARB) and their associated antimicrobial resistance genes (ARGs) that were enriched in the anthroposphere. A successful invader has to overcome the biotic resilience of the habitat, which is more difficult with increasing biodiversity. The capacity to exploit resources in a given habitat is enhanced when communities exhibit greater diversity, reducing opportunities for invaders, leading to a lower persistence. In the context of antimicrobial resistance (AMR) dissemination, exogenous ARB reaching a natural community may persist longer if the biodiversity of the autochthonous community is low, increasing the chance of ARGs to transfer to community members. Reciprocally, high microbial diversity could serve as a natural long-term barrier towards invasion by ARB and ARGs.ResultsTo test this hypothesis, a sampling campaign across seven European countries was carried out to obtain 172 environmental samples from sites with low anthropogenic impact. Samples were collected from contrasting environments: stationary structured forest soils, or dynamic river biofilms and sediments. Microbial diversity and relative abundance of 27 ARGs and 5 mobile genetic element marker genes were determined. In soils, higher diversity, evenness and richness were all significantly negatively correlated with the relative abundance of the majority (>85%) of ARGs. Furthermore, the number of detected ARGs per sample was inversely correlated with diversity. However, no such effects were found for the more dynamic, regularly mixed rivers. Conclusions: In conclusion, we demonstrate that diversity can serve as barrier towards AMR dissemination in the environment. This effect is mainly observed in stationary, structured environments, where long-term, diversity-based resilience against invasion can evolve. Such barrier effects can in the future be exploited to limit the environmental proliferation of AMR.
Genomic characterization of the antiviral arsenal of Actinobacteria
Authors: Georjon H. , Tesson F. , Shomar H. , Bernheim A. 
Published: March 2023

AbstractPhages are ubiquitous in nature, and bacteria with very different genomics, metabolisms, and lifestyles are subjected to their predation. Yet, the defense systems that allow bacteria to resist their phages have rarely been explored experimentally outside a very limited number of model organisms. Actinobacteria are a phylum of GC-rich gram-positive bacteria, which often produce an important diversity of secondary metabolites. Despite being ubiquitous in a wide range of environments, from soil to fresh and sea water but also the gut microbiome, relatively little is known about the anti-phage arsenal of Actinobacteria. In this work, we used DefenseFinder to systematically detect 131 anti-phage defense systems in 22,803 fully sequenced prokaryotic genomes, among which 2,253 Actinobacteria of more than 700 species. We show that, like other bacteria, Actinobacteria encode many diverse anti-phage systems that are often encoded on mobile genetic elements. We further demonstrate that most detected defense systems are absent or rarer in Actinobacteria than in other bacteria, while a few rare systems are enriched (notably gp29-gp30 and Wadjet). We characterize the spatial distribution of anti-phage systems onStreptomyceschromosomes and show that some defense systems (e.g. RM systems) tend to be encoded in the core region, while others (e.g. Lamassu and Wadjet) are enriched towards the extremities. Overall, our results suggest that Actinobacteria might be a source of novel anti-phage systems and provide clues to characterize mechanistic aspects of known anti-phage systems.
S:D614G and S:H655Y are gateway mutations that act epistatically to promote SARS-CoV-2 variant fitness
Authors: Yurkovetskiy Leonid , Egri Shawn , Kurhade Chaitanya , Diaz-Salinas Marco A. , Jaimes Javier A. , Nyalile Thomas , Xie Xuping , Choudhary Manish C. , Dauphin Ann , Li Jonathan Z. , Munro James B. , Shi Pei-Yong , Shen Kuang , Luban Jeremy 
Published: March 2023

Abstract/SummarySARS-CoV-2 variants bearing complex combinations of mutations that confer increased transmissibility, COVID-19 severity, and immune escape, were first detected after S:D614G had gone to fixation, and likely originated during persistent infection of immunocompromised hosts. To test the hypothesis that S:D614G facilitated emergence of such variants, S:D614G was reverted to the ancestral sequence in the context of sequential Spike sequences from an immunocompromised individual, and within each of the major SARS-CoV-2 variants of concern. In all cases, infectivity of the S:D614G revertants was severely compromised. The infectivity of atypical SARS-CoV-2 lineages that propagated in the absence of S:D614G was found to be dependent upon either S:Q613H or S:H655Y. Notably, Gamma and Omicron variants possess both S:D614G and S:H655Y, each of which contributed to infectivity of these variants. Among sarbecoviruses, S:Q613H, S:D614G, and S:H655Y are only detected in SARS-CoV-2, which is also distinguished by a polybasic S1/S2 cleavage site. Genetic and biochemical experiments here showed that S:Q613H, S:D614G, and S:H655Y each stabilize Spike on virions, and that they are dispensable in the absence of S1/S2 cleavage, consistent with selection of these mutations by the S1/S2 cleavage site. CryoEM revealed that either S:D614G or S:H655Y shift the Spike receptor binding domain (RBD) towards the open conformation required for ACE2-binding and therefore on pathway for infection. Consistent with this, an smFRET reporter for RBD conformation showed that both S:D614G and S:H655Y spontaneously adopt the conformation that ACE2 induces in the parental Spike. Data from these orthogonal experiments demonstrate that S:D614G and S:H655Y are convergent adaptations to the polybasic S1/S2 cleavage site which stabilize S1 on the virion in the open RBD conformation and act epistatically to promote the fitness of variants bearing complex combinations of clinically significant mutations.Abstract FigureHighlightsS:D614G is ubiquitous among SARS-CoV-2 B-lineage Spikes and is required for infectivity of the main Variants of ConcernIn an example of convergent evolution, SARS-CoV-2 A lineage viruses maintained transmission chains in the absence of S:D614G, but were instead dependent upon S:Q613H or S:H655YS:D614G and S:H655Y are both adaptations to the polybasic S1/S2 cleavage siteIncreased infectivity of S:D614G and S:H655Y is associated with a more open RBD conformation and increased steady-state levels of virion-associated S1
Expanding HIV Clinical Monitoring: The Role of CD4, CD8, and CD4/CD8 Ratio in Predicting Non-AIDS Events
Authors: Martínez-Sanz Javier , Álvarez Jorge Díaz , Rosas Marta , Ron Raquel , Iribarren José Antonio , Bernal Enrique , Gutiérrez Félix , García Federico , Cabello Noemi , Olalla Julián , Moreno Santiago , Serrano-Villar Sergio 
Published: March 2023

AbstractBackgroundWhile a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear.MethodsWe analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events.ResultsThe study included 4625 participants, of whom 4.3% experienced an SNAE during the follow-up period. A CD4/CD8 ratio <0.3 predicted an increased risk of SNAEs during the next five years (OR 1.63, 95%CI 1.03-2.58). The effect was stronger at a CD4/CD8 ratio cut-off of <0.2 (OR 3.09, 95%CI 1.57-6.07). Additionally, low CD4 count at cut-offs of <500 cells/μL predicted an increased risk of clinical events. Among participants with a CD4 count ≥500 cells/μL, a CD8 count ≥1500 cells/μL or a CD4/CD8 ratio <0.4 predicted increased SNAE risk.ConclusionsOur results support the use of the CD4/CD8 ratio and CD8 count as predictors of clinical progression. Patients with CD4/CD8 ratio <0.3 or CD8 count ≥1500/μL, regardless of their CD4 count, may benefit from closer monitoring and targeted preventive interventions.SummaryThis study found that a low CD4/CD8 ratio (<0.3) or a CD8 count ≥1500/μL after two years of antiretroviral therapy predicts an increased risk of serious non-AIDS events, regardless of CD4 count. These patients may benefit from closer follow-up.