bluuebunny/crossref_metadata_2025_split huggingface dataset:
0963 Everyday Discrimination Is Associated with Sleep-Related Impairments Among Blacks During the COVID-19 Pandemic
Authors: Alfonso Ana Gabriela Sanchez , Blanc Judite , Oliveira Bruno , Chery Maurice , Locklear Clarence , Seixas Azizi , Jean-Louis Girardin 
Published: May 2023

Abstract

Introduction
Sleep is influenced by a set of multilevel factors including race and ethnicity. There is overwhelming evidence supporting that sleep quality is poorer within nonwhite groups. Race-based stressors and discrimination are believed to be among the logical explanation of these widespread racial/ethnic disparities in sleep health. This study aimed to highlight the effects of discrimination on sleep related impairments among Black adults.

Methods
Our sample included 280 Blacks and African Americans enrolled in two NIH-funded community-based sleep studies: ESSENTIAL and MOSAIC. Participants were recruited between January 2020 and April 2022 in the New York City or Tri-State area (n=101; 36%) and South Florida (n=179; 64%). Data were gathered on demographics, sleep disturbance, activity, stress, and support using the Insomnia Severity Index (ISI), PROMIS Sleep-Related Impairment (SRI) questionnaire (short form 8a), Godin Leisure-Time Exercise questionnaire, Everyday Discrimination Scale, stressful life events experienced within the past year, and the Multidimensional Scale of Perceived Social Support (MSPSS). Correlation analyses were conducted among continuous variables to explore associations among sleep, activity, support, discrimination, and stress. Controlling for age, race/ethnicity, and sex, multilinear regression analysis was conducted to examine the relationship between stressful life event exposure, discrimination, social support, and activity on sleep impairment.

Results
Of the 280 participants, 63% were female (n = 177) and the mean age was 43.4 years. A total of 36% (n = 101) were from the New York City/Tri-State area, while 64% (n = 179) were from the South Florida region. Controlling for age, race/ethnicity, physical activity, non-race related stressors, social support, and sex, everyday discrimination was the strongest predictor of sleep related impairments (SRI) [β = -0.198, p &lt; 0.05]. Sex was positively associated with SRI scores [β = 0.167, p = 0.05]. On average, women reported higher SRI scores.

Conclusion
In this study, we found that among Blacks and African Americans in the New York City, Tri-State areas, and South Florida areas, during the Covid-19 pandemic, greater discrimination experience was associated with higher level of sleep-related impairments.

Support (if any)
K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007
Feeding incremental amounts of ground flaxseed: effects on diversity and relative abundance of ruminal microbiota and enteric methane emissions in lactating dairy cows
Authors: Almeida Kleves V , Resende Tales L , Silva Luiz Henrique P , Dorich Christopher D , Pereira Andre B D , Soder Kathy J , Brito Andre F 
Published: May 2023

Abstract
We evaluated the effects of incremental amounts of ground flaxseed (GFX) on diversity and relative abundance of ruminal microbiota taxa, enteric methane (CH4) emissions, and urinary excretion of purine derivatives (PD) in lactating dairy cows in a replicated 4 × 4 Latin square design. Twenty mid-lactation Jersey cows were used in the study. Of these 20 cows, 12 were used for ruminal sampling, 16 for enteric CH4 measurements, and all for spot urine collection. Each period lasted 21 d with 14 d for diet adaptation and 7 d for data and sample collection. Diets were formulated by replacing corn meal and soybean meal with 0%, 5%, 10%, and 15% of GFX in the diet’s dry matter. Ruminal fluid samples obtained via stomach tubing were used for DNA extraction. Enteric CH4 production was measured using the sulfur hexafluoride tracer technique. Diets had no effect on ruminal microbiota diversity. Similarly, the relative abundance of ruminal archaea genera was not affected by diets. In contrast, GFX decreased or increased linearly the relative abundance of Firmicutes (P &lt; 0.01) and Bacteroidetes (P &lt; 0.01), respectively. The relative abundance of the ruminal bacteria Ruminococcus (P &lt; 0.01) and Clostridium (P &lt; 0.01) decreased linearly, and that of Prevotella (P &lt; 0.01) and Pseudobutyrivibrio (P &lt; 0.01) increased linearly with feeding GFX. A tendency for a linear reduction (P = 0.055) in enteric CH4 production (from 304 to 256 g/d) was observed in cows fed increasing amounts of GFX. However, neither CH4 yield nor CH4 intensity was affected by treatments. Diets had no effect on the urinary excretion of uric acid, allantoin, and total PD. Overall, feeding GFX decreased linearly the relative abundance of the ruminal bacterial genera Ruminococcus and Clostridium and enteric CH4 production, but no change was seen for CH4 yield and CH4 intensity, or urinary excretion of total PD, suggesting no detrimental effect of GFX on microbial protein synthesis in the rumen.
Bovine neonatal microbiome origins: a review of proposed microbial community presence from conception to colostrum
Authors: Messman Riley D , Lemley Caleb O 
Published: May 2023

Abstract
In recent years, there has been an influx of research evaluating the roles of the reproductive tract microbiota in modulating reproductive performance. These efforts have resulted in a breadth of research exploring the bovine reproductive tract microbiota. The female reproductive tract microbiota has been characterized during the estrus cycle, at timed artificial insemination, during gestation, and postpartum. Additionally, there are recently published studies investigating in-utero inoculation of the bovine fetus. However, critical review of the literature to understand how the microbial shifts during a dam’s lifecycle could impact neonatal outcomes is limited. This review demonstrates a consistency at the phyla level throughout both the maternal, paternal, and neonatal microbiomes. Moreover, this review challenges the current gestational inoculation hypothesis and suggests instead a maturation of the resident uterine microbiota throughout gestation to parturition. Recent literature is indicative of microbial composition influencing metabolomic parameters that have developmental programming effects in feed utilization and metabolic performance later in life. Thus, this review enumerates the potential origins of neonatal microbial inoculation from conception, through gestation, parturition, and colostrum consumption while introducing clear paucities where future research is needed to better understand the ramifications of the reproductive microbiome on neonates.
Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials*
Authors: Jones Jennifer R. A. , Karahalios Amalia , Puthucheary Zudin A. , Berry Michael J. , Files D. Clark , Griffith David M. , McDonald Luke A. , Morris Peter E. , Moss Marc , Nordon-Craft Amy , Walsh Timothy , Berney Sue , Denehy Linda 
Published: May 2023

OBJECTIVE:
To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs).

DATA SOURCES:
Data of individual patients from four critical care physical rehabilitation RCTs.

STUDY SELECTION:
Eligible trials were identified from a published systematic review.

DATA EXTRACTION:
Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial.

DATA SYNTHESIS:
Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation.

CONCLUSIONS:
The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.
Metformin may be a viable adjunctive therapeutic option to potentially enhance immune reconstitution in HIV-positive immunological non-responders
Authors: Zaongo Silvere D. , Chen Yaokai 
Published: May 2023

Abstract
Incomplete immune reconstitution remains a global challenge for human immunodeficiency virus (HIV) treatment in the present era of potent antiretroviral therapy (ART), especially for those individuals referred to as immunological non-responders (INRs), who exhibit dramatically low CD4+ T-cell counts despite the use of effective antiretroviral therapy, with long-term inhibition of viral replication. In this review, we provide a critical overview of the concept of ART-treated HIV-positive immunological non-response, and also explain the known mechanisms which could potentially account for the emergence of immunological non-response in some HIV-infected individuals treated with appropriate and effective ART. We found that immune cell exhaustion, combined with chronic inflammation and the HIV-associated dysbiosis syndrome, may represent strategic aspects of the immune response that may be fundamental to incomplete immune recovery. Interestingly, we noted from the literature that metformin exhibits properties and characteristics that may potentially be useful to specifically target immune cell exhaustion, chronic inflammation, and HIV-associated gut dysbiosis syndrome, mechanisms which are now recognized for their critically important complicity in HIV disease-related incomplete immune recovery. In light of evidence discussed in this review, it can be seen that metformin may be of particularly favorable use if utilized as adjunctive treatment in INRs to potentially enhance immune reconstitution. The approach described herein may represent a promising area of therapeutic intervention, aiding in significantly reducing the risk of HIV disease progression and mortality in a particularly vulnerable subgroup of HIV-positive individuals.
Spray Cryotherapy for Benign Large Airway Stenosis
Authors: Ratwani Ankush P. , Lentz Robert J. , Chen Heidi , Schwartz Evan , Roller Lance , Shojaee Samira , Shepherd Wes , Noor ul Husnain Shaikh M. , Senitko Michal , Guo Yanglin , Cumbo-Nacheli Gustavo , Raziq Fazal I. , Sachdeva Ashutosh , Holden Van , Gharaibeh Kamel , Benn Bryan S. , Ferguson J. Scott , Rickman Otis B. , Yarmus Lonny , Maldonado Fabien ,   on behalf of the Interventional Pulmonary Outcomes Group (IPOG)
Published: May 2023

Background:
Benign airway stenosis (BAS) represents a significant burden on patients, providers, and healthcare systems. Spray cryotherapy (SCT) has been proposed as an adjunctive treatment to reduce BAS recurrence. We sought to examine safety and practice variations of the latest SCT system when used for BAS.

Methods:
We conducted a retrospective multicenter cohort study in seven academic institutions within the Interventional Pulmonary Outcomes Group. All patients who underwent at least one SCT session with a diagnosis of BAS at the time of procedure at these institutions were included. Demographics, procedure characteristics, and adverse events were captured through each center’s procedural database and electronic health record.

Results:
A total of 102 patients underwent 165 procedures involving SCT from 2013 to 2022. The most frequent etiology of BAS was iatrogenic (n = 36, 35%). In most cases, SCT was used prior to other standard BAS interventions (n = 125; 75%). The most frequent SCT actuation time per cycle was five seconds. Pneumothorax complicated four procedures, requiring tube thoracostomy in two. Significant post-SCT hypoxemia was noted in one case, with recovery by case conclusion and no long-term effects. There were no instances of air embolism, hemodynamic compromise, or procedural or in-hospital mortality.

Conclusion:
SCT as an adjunctive treatment for BAS was associated with a low rate of complications in this retrospective multicenter cohort study. SCT-related procedural aspects varied widely in examined cases, including actuation duration, number of actuations, and timing of actuations relative to other interventions.
Attitudes and knowledge of emergency doctors towards end-of-life care in the emergency department: a national survey
Authors: Saeed Saema , Mulcaire Jeffrey , Umana Etimbuk , Foley James , Browne Leonard , Keane Owen , Chionh Wen Wei , O’Leary Mary Jane , Deasy Conor ,   on behalf of Irish Trainee Emergency Research Network (ITERN) Collaborators
Published: May 2023

Background
Emergency departments (EDs) are seeing an increase in patients requiring end-of-life (EOL) care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland.

Objective
The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care.

Methods
This was a cross-sectional electronic survey of ED physicians working in Irish EDs and was facilitated through the Irish Trainee Emergency Research Network over a 6-week period. The questionnaire covered the following domains: demographic data, awareness of EOL Care, views and attitudes towards EOL care.

Results
Of a potential 679 respondents, 441 responses were received, of which 311 (response rate of 44.8%) had fully completed the survey across 23 participant sites. Majority of the respondents were under the age of 35 (62%), were male (58%) and at Senior House Officer level (36%). In terms of awareness, 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Only 30.2% respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of emergency medicine nurses and doctors in the care of the dying patient in ED with only 31.2% (95) being clear on this role. Significant differences were observed associated with clinical experience and physician grade.

Conclusion
This study has highlighted a lack of awareness and knowledge of EOL care particularly amongst less experienced emergency medicine doctors. Formalized training and education programs in the provision of EOL care in the ED will improve comfort levels and knowledge amongst the emergency medicine doctors and improve the quality of care provided.
Remote Ischemic Conditioning for Motor Recovery after Acute Ischemic Stroke
Authors: Yu Wantong , Ren Changhong , Du Jubao , Zhao Wenbo , Guo Wenting , Ji Xunming 
Published: May 2023

Background:
Remote ischemic conditioning (RIC) has shown an impressive neuroprotective effect on acute ischemic stroke (AIS) in animal experiments. But whether chronic RIC improves long-term functional outcomes remains unclear.

Materials and Methods:
We performed a non-randomized controlled trial. Eligible patients (aged 18 –80 y) with hemiplegia caused by AIS were allocated to the RIC group and the control group. All participants received normal protocol rehabilitation therapy. Patients in the RIC group underwent RIC twice daily for 90 days. The outcome included the 90-day Fugl-Meyer Assessment (FMA) scores and modified Rankin’s scale (mRS) scores, as well as changes in angiogenesis-related factors in serum from baseline to 90 days.

Results:
Twenty-seven patients were included in the analysis (13 in the RIC group and 14 in the control group). There was no significant difference in 90-day total FMA scores between the two groups. Lower limb FMA scores at day 90 were significantly higher in the RIC group (32.8±8.7 vs. 24.8±5.4, adjusted P=0.042). The proportion of favorable outcome (mRS<2) was higher in the RIC group than that in the control group, but no significant difference was detected (8 [61.5%] vs. 7 [50%], P=0.705). A significant increase has been found in the level of epidermal growth factor (EGF) in serum (9.4 [1.1 to 25.7] vs. −8.7 [−15.1 to 4.7], P=0.036) after chronic RIC procedure.

Conclusion:
This study investigated the role that RIC plays in AIS recovery, especially in motor function. RIC may have beneficial effects on lower limbs recovery by enhancing the EGF level. The effect of RIC on motor recovery should be further validated in future studies.
Nucleated Red Blood Cells Are Predictive of In-Hospital Mortality for Pediatric Patients
Authors: Gearhart Addison , Esteso Paul , Sperotto Francesca , Elia Eleni G. , Michelson Kenneth A. , Lipsitz Stu , Sun Mingwei , Knoll Christopher , Vanderpluym Christina 
Published: May 2023

Purpose
We sought to establish whether nucleated red blood cells (NRBCs) are predictive of disposition, morbidity, and mortality for pediatric patients presenting to the emergency department (ED).

Methods
A single-center retrospective cohort study examining all ED encounters from patients aged younger than 19 years between January 2016 and March 2020, during which a complete blood count was obtained. Univariate analysis and multivariable logistic regression were used to test the presence of NRBCs as an independent predictor of patient-related outcomes.

Results
The prevalence of NRBCs was 8.9% (4195/46,991 patient encounters). Patient with NRBCs were younger (median age 4.58 vs 8.23 years; P < 0.001). Those with NRBCs had higher rates of in-hospital mortality (30/2465 [1.22%] vs 65/21,741 [0.30%]; P < 0.001), sepsis (19% vs 12%; P < 0.001), shock (7% vs 4%; P < 0.001), and cardiopulmonary resuscitation (CPR) (0.62% vs 0.09%; P < 0.001). They were more likely to be admitted (59% vs 51%; P < 0.001), have longer median hospital length of stay {1.3 (interquartile range [IQR], 0.22–4.14) vs 0.8 days (IQR, 0.23–2.64); P < 0.001}, and median intensive care unit (ICU) length of stay (3.9 [IQR, 1.87–8.72] vs 2.6 days [IQR, 1.27–5.83]; P < 0.001). Multivariable regression revealed presence of NRBCs as an independent predictor for in-hospital mortality (adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.38–3.53; P < 0.001), ICU admission (aOR, 1.30; 95% CI, 1.11–1.51; P < 0.001), CPR (aOR, 3.83; 95% CI, 2.33–6.30; P < 0.001), and 30-day return to the ED (aOR, 1.15; 95% CI, 1.15–1.26; P < 0.001).

Conclusions
The presence of NRBCs is an independent predictor for mortality, including in-hospital mortality, ICU admission, CPR, and readmission within 30 days for children presenting to the ED.
Revisiting the Use of Ulysses Contracts in Xenotransplantation
Authors: Hurst Daniel J. , Padilla Luz , Schiff Tamar , Parent Brendan 
Published: May 2023

Background.
Xenotransplantation clinical trials may begin soon. A persistent risk of xenotransplantation, known for decades, is the possibility that a xenozoonotic infection could be transferred from a xenograft to its recipient and then to other human contacts. Because of this risk, guidelines and commentators have advocated for xenograft recipients to agree to either long-term or lifelong surveillance mechanisms.

Methods.
For the past few decades, one solution that has been proposed to ensure that xenograft recipients will comply with surveillance protocols is the use of a heavily modified Ulysses contract, which we review.

Results.
These contracts are most often used in psychiatry, and their application to xenotransplantation has been espoused several times with minimal criticism.

Conclusions.
In this article, we argue against the applicability of Ulysses contracts in xenotransplantation based upon (1) the telos of the advance directive that may not be applicable to this clinical context, (2) the suspect nature of enforcing Ulysses contracts in xenotransplantation, and (3) the ethical and regulatory hurdles that such enforcement would require. Although our focus is on the US regulatory landscape in preparation for clinical trials, there are applications globally.
Medicaid Expansions and Private Insurance ‘Crowd-Out’ (1999-2019)
Authors: Semprini Jason 
Published: May 2023

AbstractRecent Medicaid expansions have rekindled the debate around private insurance “crowd-out”. Prior research is limited by short-time horizons and state-specific analyses. Our study overcomes these limitations by evaluating twenty years of Medicaid expansions across the entire United States. We obtain data from the U.S. Census Bureau for all U.S. states and D.C. for private insurance coverage rates of adults 18-64, for years 1999-2019. After estimating a naïve, staggered Two-Way Fixed Effects Difference-in-Differences regression model, we implement four novel econometric methods to diagnose and overcome threats of bias from staggered designs. We also test for pre-treatment differential trends and heterogenous effects over time. Our findings suggest that Medicaid expansion was associated with a 1.5%-point decline in private insurance rates (p < 0.001). We also observe significant heterogeneity over time, with estimates peaking four years after expansion. The importance of a 1-2% point crowd-out, we leave for future research and debate.