bluuebunny/crossref_metadata_2025_split huggingface dataset:
Payment Methods and Demographics Influence Patterns of Dental Service Utilization
Authors: Pendleton Matthew , Moss Mark E. , Wu Qiang , Tempel Rob , Garcia Raul , Al-Dajani Mahmoud 
Published: June 2023

Objective:
To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM).

Design:
This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis.

Setting:
Nine dental clinic sites across the state of North Carolina.

Participants:
In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study.

Main Outcome Measures:
In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method.

Results:
Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay (P < .001). Payment method is associated with the dental service type utilized by an individual (P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants.

Conclusions:
Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.
A randomized clinical trial of on-demand oral pre-exposure prophylaxis does not modulate lymphoid/myeloid HIV target cell density in the foreskin
Authors: Rametse Cosnet L. , Webb Emily L. , Herrera Carolina , Alinde Berenice , Besethi Asiphe , Motaung Bongani , Mbangiwa Tshepiso , Leach Lloyd , Sebaa Shorok , Pillay Azure-Dee A.P. , Seiphetlo Thabiso B. , Malhangu Boitshoko , Petkov Stefan , Else Laura , Mugaba Susan , Namubiru Patricia , Odoch Geoffrey , Opoka Daniel , Serwanga Jennifer , Ssemata Andrew S. , Kaleebu Pontiano , Khoo Saye , Lebina Limakatso , Martinson Neil , Chiodi Francesca , Fox Julie , Gray Clive M. 
Published: June 2023

Objectives:
As topical Pre-Exposure Prophylaxis (PrEP) has been shown to cause immune modulation in rectal or cervical tissue, our aim was to examine the impact of oral PrEP on lymphoid and myeloid changes in the foreskin in response to dosing and timing of drug administration.

Design:
HIV-negative males (n = 144) were recruited in South Africa and Uganda into an open-label randomised controlled trial in a 1:1:1:1:1:1:1:1:1 ratio to control arm (with no PrEP) or one of eight arms receiving emtricitabine-tenofovir disoproxil fumarate (F/TDF) or emtricitabine-tenofovir alafenamide (F/TAF) at one of two different doses, 5 h or 21 h before undergoing voluntary medical male circumcision (VMMC).

Methods:
After dorsal-slit circumcision, foreskin tissue-sections were embedded into Optimal Cutting Temperature media and analysed, blinded to trial allocation, to determine numbers of CD4+CCR5+, CD1a+ cells and claudin-1 expression. Cell densities were correlated with tissue-bound drug metabolites and p24 production after ex vivo foreskin challenge with HIV-1bal.

Results:
There was no significant difference in CD4+CCR5+ or CD1a+ cell numbers in foreskins between treatment arms compared with the control arm. Claudin-1 expression was 34% higher (p = 0.003) in foreskin tissue from participants receiving PrEP relative to controls. There was no correlation of CD4+CCR5+, CD1a+ cell numbers, or claudin-1 expression with tissue-bound drug metabolites, nor with p24 production after ex vivo viral challenge.

Conclusion:
Oral doses and timing of on-demand PrEP and in situ drug metabolite levels in tissue have no effect on numbers or anatomical location of lymphoid or myeloid HIV target cells in foreskin tissue.
Network typologies predict future molecular linkages in the network of HIV transmission in Florida
Authors: Rich Shannan N. , Cook Robert L. , Mavian Carla N. , Garrett Karen , Spencer Emma C. , Salemi Marco , Prosperi Mattia 
Published: June 2023

Objective:
HIV molecular transmission network typologies have previously demonstrated associations to transmission risk; however, few studies have evaluated their predictive potential in anticipating future transmission events. To assess this, we tested multiple models on statewide surveillance data from the Florida Department of Health.

Design:
This was a retrospective, observational cohort study examining the incidence of new HIV molecular linkages within the existing molecular network of persons with HIV (PWH) in Florida.

Methods:
HIV-1 molecular transmission clusters were reconstructed for PWH diagnosed in Florida from 2006–2017 using the HIV-TRAnsmission Cluster Engine (HIV-TRACE). A suite of machine-learning models designed to predict linkage to a new diagnosis were internally and temporally externally validated using a variety of demographic, clinical, and network-derived parameters.

Results:
Of the 9,897 individuals who received a genotype within 12 months of diagnosis during 2012–2017, 2,611 (26.4%) were molecularly linked to another case within 1 year at 1.5% genetic distance. The best performing model, trained on two years of data, was high performing (area under the receiving operating curve = 0.96, sensitivity = 0.91, and specificity = 0.90) and included the following variables: age group, exposure group, node degree, betweenness, transitivity, and neighborhood.

Conclusions:
In the molecular network of HIV transmission in Florida, individuals’ network position and connectivity predicted future molecular linkages. Machine-learned models using network typologies performed superior to models using individual data alone. These models can be used to more precisely identify subpopulations for intervention.
Shaken or Stirred? The Inconsistencies of Manual Contrast Media Dilution in Endovascular Interventions
Authors: McDermott Michael C. , Hendriks Babs M.F. , Wildberger Joachim E. , de Boer Sanne W. 
Published: June 2023

Objective
The growing need to reduce administered contrast media (CM) volumes for patient, economic, and sustainability reasons has led to clinics manually diluting with saline. The efficacy of this practice is not robustly explored in literature. The objective of this study was to determine the concentration accuracy and homogeneity of manually diluted CM in endovascular procedures.

Materials and Methods
Phase I: Eleven radiological technologists were asked to fill a CM injector 3 times with 50% diluted CM (iopromide 300 mg I/mL). The dilution was injected (12 mL/s) through a Coriolis flowmeter, with CM concentration and total volume calculated. Interoperator, intraoperator, and intraprocedural variations were calculated as coefficients of variability. Contrast media dose reporting accuracy was determined. Phase II: The study was repeated after implementation of a standardized dilution protocol with 5 representative operators.

Results
Phase I: The average injected concentration among 11 operators was 68% ± 16% CM (n = 33; range, 43%–98%), as compared with the target of 50% CM. The interoperator variability was 16%, the intraoperator variability was 6% ± 3%, and the intraprocedural variability was 23% ± 19% (range, 5%–67%). This led to overdelivery of CM compared with intended patient dose by 36% on average. Phase II: After standardization, injections averaged 55% ± 4% CM (n = 15; range, 49%–62%), with interoperator variability of 8%, intraoperator variability of 5% ± 1%, and intraprocedural variability of 1.6% ± 0.5% (range, 0.4%–3.7%).

Conclusions
Manual CM dilution can lead to substantial interoperator and intraoperator, as well as intraprocedural variability in injected concentration. This can result in underreporting of administered CM doses to patients. It is recommended that clinics assess their current standard of care regarding CM injections for endovascular interventions and evaluate potential corrective actions if appropriate.
International Liver Transplantation Society Global Census: First Look at Pediatric Liver Transplantation Activity Around the World
Authors: Rodriguez-Davalos Manuel I. , Lopez-Verdugo Fidel , Kasahara Mureo , Muiesan Paolo , Reddy Mettu S. , Flores-Huidobro Martinez Angel , Xia Qiang , Hong Johnny C. , Niemann Claus U. , Seda-Neto Joao , Miloh Tamir A. , Yi Nam-Joon , Mazariegos George V. , Ng Vicky L. , Esquivel Carlos O. , Lerut Jan , Rela Mohamed ,   for the Pediatric Liver Transplantation Global Census Group
Published: June 2023

Background.
Over 16 000 children under the age of 15 died worldwide in 2017 because of liver disease. Pediatric liver transplantation (PLT) is currently the standard of care for these patients. The aim of this study is to describe global PLT activity and identify variations between regions.

Methods.
A survey was conducted from May 2018 to August 2019 to determine the current state of PLT. Transplant centers were categorized into quintile categories according to the year they performed their first PLT. Countries were classified according to gross national income per capita.

Results.
One hundred eight programs from 38 countries were included (68% response rate). 10 619 PLTs were performed within the last 5 y. High-income countries performed 4992 (46.4%) PLT, followed by upper-middle- (4704 [44·3%]) and lower-middle (993 [9·4%])-income countries. The most frequently used type of grafts worldwide are living donor grafts. A higher proportion of lower-middle-income countries (68·7%) performed ≥25 living donor liver transplants over the last 5 y compared to high-income countries (36%; P = 0.019). A greater proportion of programs from high-income countries have performed ≥25 whole liver transplants (52.4% versus 6.2%; P = 0.001) and ≥25 split/reduced liver transplants (53.2% versus 6.2%; P < 0.001) compared to lower-middle-income countries.

Conclusions.
This study represents, to our knowledge, the most geographically comprehensive report on PLT activity and a first step toward global collaboration and data sharing for the greater good of children with liver disease; it is imperative that these centers share the lead in PLT.
The Association Between Frailty and Chronic Lung Allograft Dysfunction After Lung Transplantation
Authors: Singer Jonthan P. , Gao Ying , Huang Chiung-Yu , Kordahl Rose C. , Sriram Anya , Hays Steven R. , Kukreja Jasleen , Venado Aida , Calabrese Daniel R. , Greenland John R. 
Published: June 2023

Background.
After lung transplantation, both frailty and chronic lung allograft dysfunction (CLAD) commonly develop, and when they do, are associated with poorer outcomes. Given their potential shared mechanisms, we sought to explore the temporal relationship between frailty and CLAD onset.

Methods.
In a single center, we prospectively measured frailty by the short physical performance battery (SPPB) repeatedly after transplant. Because of the nature of the relationship between frailty and CLAD is unknown, we tested the association between frailty, modeled as a time-dependent predictor, and CLAD development as well as CLAD development, modeled as a time-dependent predictor, and frailty development. To do so, we used Cox proportional cause-specific hazards and conditional logistic regression models adjusted for age, sex, race, diagnosis, cytomegalovirus serostatus, posttransplant body mass index, and acute cellular rejection episodes as time-dependent covariates. We tested SPPB frailty as a binary (≤9 points) and continuous predictor (12-point scale); as an outcome, we defined frailty as SPPB ≤9.

Results.
The 231 participants were a mean age of 55.7 y (SD 12.1). After adjusting for covariates, the development of frailty within 3 y after lung transplant was associated with cause-specific CLAD risk (adjusted cause-specific hazard ratio: 1.76; 95% confidence interval [CI], 1.05-2.92 when defining frailty as SPPB ≤9 and adjusted cause-specific hazard ratio: 1.10, 95% CI, 1.03-1.18 per 1-point worsening in SPPB). CLAD onset did not appear to be a risk factor for subsequent frailty (odds ratio, 4.0; 95% CI, 0.4-197.0).

Conclusions.
Studying the mechanisms underlying frailty and CLAD could provide new insights into the pathobiology of both and potential targets for intervention.
Recurrence-free Survival After Liver Transplantation Versus Surgical Resection for Hepatocellular Carcinoma: Role of High-risk MRI Features
Authors: Cha Dong Ik , Kim Jong Man , Jeong Woo Kyoung , Yi Nam-Joon , Choi Gyu-Seong , Rhu Jinsoo , Lee Kwang-Woong , Sinn Dong Hyun , Hwang Jeong Ah , Lee Won Jae , Kim Kyunga , Suh Kyung-Suk , Joh Jae-Won 
Published: June 2023

Background.
This study aimed to evaluate recurrence-free survival (RFS) and overall survival (OS) after liver transplantation (LT) or liver resection (LR) for hepatocellular carcinoma (HCC) and perform subgroup analysis for HCC with high-risk imaging findings for recurrence on preoperative liver magnetic resonance imaging (MRI; high-risk MRI features).

Methods.
We included patients with HCC eligible for both LT and LR and received either of the treatments between June 2008 and February 2021 from 2 tertiary referral medical centers after propensity score-matching. RFS and OS were compared between LT and LR using Kaplan-Meier curves with the log-rank test.

Results.
Propensity score-matching yielded 79 patients in the LT group and 142 patients in the LR group. High-risk MRI features were noted in 39 patients (49.4%) in the LT group and 98 (69.0%) in the LR group. The Kaplan-Meier curves for RFS and OS were not significantly different between the 2 treatments among the high-risk group (RFS, P = 0.079; OS, P = 0.755). Multivariable analysis showed that treatment type was not a prognostic factor for RFS and OS (P = 0.074 and 0.937, respectively).

Conclusions.
The advantage of LT over LR for RFS may be less evident among patients with high-risk MRI features.
Differentiating Urgent from Elective Cases Matters in Minority Populations: Developing an Ordinal “Desirability of Outcome Ranking” to Increase Granularity and Sensitivity of Surgical Outcomes Assessment
Authors: Jacobs Michael A , Schmidt Susanne , Hall Daniel E , Stitzenberg Karyn B , Kao Lillian S , Wang Chen-Pin , Manuel Laura S , Shireman Paula K 
Published: June 2023

BACKGROUND:
Surgical analyses often focus on single or binary outcomes; we developed an ordinal Desirability of Outcome Ranking (DOOR) for surgery to increase granularity and sensitivity of surgical outcome assessments. Many studies also combine elective and urgent procedures for risk adjustment. We used DOOR to examine complex associations of race/ethnicity and presentation acuity.

STUDY DESIGN:
NSQIP (2013 to 2019) cohort study assessing DOOR outcomes across race/ethnicity groups risk-adjusted for frailty, operative stress, preoperative acute serious conditions, and elective, urgent, and emergent cases.

RESULTS:
The cohort included 1,597,199 elective, 340,350 urgent, and 185,073 emergent cases with patient mean age of 60.0 ± 15.8, and 56.4% of the surgeries were performed on female patients. Minority race/ethnicity groups had increased odds of presenting with preoperative acute serious conditions (adjusted odds ratio [aORs] range 1.22 to 1.74), urgent (aOR range 1.04 to 2.21), and emergent (aOR range 1.15 to 2.18) surgeries vs the White group. Black (aOR range 1.23 to 1.34) and Native (aOR range 1.07 to 1.17) groups had increased odds of higher/worse DOOR outcomes; however, the Hispanic group had increased odds of higher/worse DOOR (aOR 1.11, CI 1.10 to 1.13), but decreased odds (aORs range 0.94 to 0.96) after adjusting for case status; the Asian group had better outcomes vs the White group. DOOR outcomes improved in minority groups when using elective vs elective/urgent cases as the reference group.

CONCLUSIONS:
NSQIP surgical DOOR is a new method to assess outcomes and reveals a complex interplay between race/ethnicity and presentation acuity. Combining elective and urgent cases in risk adjustment may penalize hospitals serving a higher proportion of minority populations. DOOR can be used to improve detection of health disparities and serves as a roadmap for the development of other ordinal surgical outcomes measures. Improving surgical outcomes should focus on decreasing preoperative acute serious conditions and urgent and emergent surgeries, possibly by improving access to care, especially for minority populations.
Prevalence and Outcome of Adults with Congenital Heart Disease and Coronary Artery Disease
Authors: Li Haiyang , Yan Yan , Wang Shipan , Sun Mingyu , Qian Sichong , Xue Yuan , Zhang Hongjia 
Published: June 2023

ABSTRACTBACKGROUNDLittle is known about the prevalence of outcome in patients with coronary artery disease (CAD) among adults with congenital heart disease (ACHD). The objectives of this study were to determine rates of ACHD and factors associated with outcomes among adults with CAD in a contemporary cohort within the China.METHODSUsing pragmatic data from the Prospective Registry of the Current Status of Care for Patients with Coronary Artery Disease database, between January and May 2022, we stratified all CAD patients with comorbid ACHD or not. Using logistic regression method, we explored the risk factors associated with lower risk of mortality and stroke. We constructed a matching sub-cohort as sensitive analysis.RESULTSOf 10,517 evaluable patients 189 (1.8%) were with a diagnosis of ACHD, and were more female, more frequent with a history of atrial fibrillation, had a lower hemoglobin level at admission but less likely to have hypertension or smoking history than those without ACHD. In-hospital mortality before discharge was higher in patients with ACHD compared with no ACHD in the whole population (1.06% vs. 0.28%, p=0.05) and matched population (1.06% vs. 0.13%, p=0.04). Acute myocardial infarction (54.8%) represented the most common cause of death among all cohort, whereas 100% deaths among ACHD were due to ischemic stroke (2 cases).CONCLUSIONSACHD was associated with a higher rate of mortality, which stroke complications contribute most. Future studies are needed to improve the acknowledge of underlying stroke mechanisms and prognosis in this special population.
Integrative Multi-omic Profiling of Two Human Decedents Receiving Pig Heart Xenografts Reveals Strong Perturbations in Early Immune-Cell and Cellular Metabolism Responses
Authors: Schmauch Eloi , Piening Brian , Xia Bo , Zhu Chenchen , Stern Jeffrey , Zhang Weimin , Dowdell Alexa , Loza Bao-Li , Mohebnasab Maede , Gragert Loren , Khalil Karen , Camellato Brendan , de Oliveira Michelli Faria , O’Brien Darragh , Weldon Elaina , Lin Xiangping , Gao Hui , Kagermazova Larisa , Kim Jacqueline , Loupy Alexandre , Heguy Adriana , Taylor Sarah , Zhu Florrie , Gao Sarah , Gandla Divya , Reddy Kriyana , Chang Andrew , Michael Basil , Jiang Lihua , Jian Ruiqi , Narula Navneet , Linna-Kuosmanen Suvi , Kaikkonen-Määttä Minna , Lorber Marc , Kellis Manolis , Tatapudi Vasishta , Ayares David , Griesemer Adam , Mangiola Massimo , Pass Harvey , Snyder Michael P. , Montgomery Robert A. , Boeke Jef D. , Keating Brendan J. 
Published: June 2023

ABSTRACTBackgroundRecent advances in xenotransplantation in living and decedent humans using pig xenografts have laid promising groundwork towards future emergency use and first in human trials. Major obstacles remain though, including a lack of knowledge of the genetic incompatibilities between pig donors and human recipients which may led to harmful immune responses against the xenograft or dysregulation of normal physiology. In 2022 two pig heart xenografts were transplanted into two brain-dead human decedents with a minimized immunosuppression regime, primarily to evaluate onset of hyper-acute antibody mediated rejection and sustained xenograft function over 3 days.MethodsWe performed multi-omic profiling to assess the dynamic interactions between the pig and human genomes in the first two pig heart-xenografts transplants into human decedents. To assess global and specific biological changes that may correlate with immune-related outcomes and xenograft function, we generated transcriptomic, lipidomic, proteomic and metabolomics datasets, across blood and tissue samples collected every 6 hours over the 3-day procedures.ResultsSingle-cell datasets in the 3-day pig xenograft-decedent models show dynamic immune activation processes. We observe specific scRNA-seq, snRNA-seq and geospatial transcriptomic changes of early immune-activation leading to pronounced downstream T-cell activity and hallmarks of early antibody mediated rejection (AbMR) and/or ischemia reperfusion injury (IRI) in the first xenograft recipient. Using longitudinal multiomic integrative analyses from blood in addition to antigen presentation pathway enrichment, we also observe in the first xeno-heart recipient significant cellular metabolism and liver damage pathway changes that correlate with profound physiological dysfunction whereas, these signals are not present in the other xenograft recipient.ConclusionsSingle-cell and multiomics approaches reveal fundamental insights into early molecular immune responses indicative of IRI and/or early AbMR in the first human decedent, which was not evident in the conventional histological evaluations.
Broca’s area, variation and taxic diversity in earlyHomofrom Koobi Fora (Kenya)
Authors: Beaudet Amélie , Jager Edwin de 
Published: June 2023

AbstractBecause brain tissues rarely fossilize, pinpointing when and how modern human cerebral traits emerged in the hominin lineage is particularly challenging. The fragmentary nature of the fossil material, coupled with the difficulty of characterizing such a complex organ, have been the source of long-standing debates. Prominent among them is the uncertainties around the derived or primitive state of the brain organization in the earliest representatives of the genusHomo, more particularly in key areas such as the Broca’s area. By revisiting a particularly well-preserved fossil endocast from the Turkana basin (Kenya) attributed to earlyHomo, here we confirm that humans in Africa had a primitive organization of the Broca’s area ca. 1.9 million years ago. Additionally, our description of KNM-ER 3732 adds further information about the variation pattern of the inferior frontal gyrus in fossil hominins, with implications for earlyHomotaxic diversity (i.e., one or twoHomospecies at Koobi Fora) and the nature of the mechanisms involved in the emergence of derived cerebral traits.