bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asthma Cases Treated With Inhaled Anesthetics or Extracorporeal Membrane Oxygenation: A Virtual Pediatric Systems Database Study of Outcomes
Authors: Pineda Erika Y. , Sallam Mohammad , Breuer Ryan K. , Perez Geovanny F. , Wrotniak Brian , Swayampakula Anil Kumar 
Published: April 2023

OBJECTIVES:
Extracorporeal membrane oxygenation (ECMO) and/or inhaled anesthetics (IAs) are considered in the management of asthma when refractory to conventional therapy. We aimed to compare the outcomes of these two modalities in asthma PICU care and determine associated survival to hospital discharge among patients in a United States database.

DESIGN:
Retrospective analysis using the Virtual Pediatric Systems (VPS, LLC) database.

SETTING:
PICUs participating in the VPS database.

PATIENTS:
Patients less than 18 years old with diagnosis of asthma treated with IA and/or ECMO from January 2010 to December 2020.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 221 patients were included; 149 (67%) received ECMO, 62 (28%) received IA, and 10 (5%) received both interventions. We failed to identify any difference between the ECMO and IA groups in demographics, Pediatric Index of Mortality 2 percentage, Pediatric Risk of Mortality 3 score, Pediatric Logistic Organ Dysfunction score, or pre-intervention pH and Paco
2 levels. Use of ECMO versus IA was associated with lower pre-intervention Pao
2 (60 torr [7.99 kPa] vs 78 torr [10.39 kPa]; p < 0.001) and higher utilization of high-frequency oscillatory ventilation. We failed to identify an association between type of intervention (IA vs ECMO) and greater odds of survival (57/62 [92%] vs 128/149 [86%]; odds ratio [OR], 1.87; 95% CI, 0.67–5.21; p = 0.23). However, these data do not exclude the possibility that IA use is associated with more than five-fold greater odds of survival. ECMO use was associated with longer duration of intervention (5 vs 1.3 d; p < 0.001) and PICU length of stay (LOS) (13 vs 7 d; p < 0.001). As expected, ECMO versus IA was also associated with greater odds of undergoing bronchoscopy (34% vs 11%; OR, 3.7; 95% CI, 1.5–9.4; p = 0.004).

CONCLUSIONS:
In the VPS database of asthma management cases, we failed to identify an association between ECMO versus IA use and survival to hospital discharge. However, ECMO was associated with longer duration of intervention and PICU LOS.
Biomarker-Based Risk Stratification in Pediatric Sepsis From a Low-Middle Income Country*
Authors: Ishaque Sidra , Famularo Stephen Thomas , Saleem Ali Faisal , Siddiqui Naveed Ur Rehman , Kazi Zaubina , Parkar Sadia , Hotwani Aneeta , Thomas Neal J. , Thompson Jill Marie , Lahni Patrick , Varisco Brian , Yehya Nadir 
Published: April 2023

Objectives:
Most biomarker studies of sepsis originate from high-income countries, whereas mortality risk is higher in low- and middle-income countries. The second version of the Pediatric Sepsis Biomarker Risk Model (PERSEVERE-II) has been validated in multiple North American PICUs for prognosis. Given differences in epidemiology, we assessed the performance of PERSEVERE-II in septic children from Pakistan, a low-middle income country. Due to uncertainty regarding how well PERSEVERE-II would perform, we also assessed the utility of other select biomarkers reflecting endotheliopathy, coagulopathy, and lung injury.

Design:
Prospective cohort study.

Setting:
PICU in Aga Khan University Hospital in Karachi, Pakistan.

Patients:
Children (< 18 yr old) meeting pediatric modifications of adult Sepsis-3 criteria between November 2020 and February 2022 were eligible.

Interventions:
None.

Measurements and Main Results:
Plasma was collected within 24 hours of admission and biomarkers quantified. The area under the receiver operating characteristic curve for PERSEVERE-II to discriminate 28-day mortality was determined. Additional biomarkers were compared between survivors and nonsurvivors and between subjects with and without acute respiratory distress syndrome. In 86 subjects (20 nonsurvivors, 23%), PERSEVERE-II discriminated mortality (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.72–0.94) and stratified the cohort into low-, medium-, and high-risk of mortality. Biomarkers reflecting endotheliopathy (angiopoietin 2, intracellular adhesion molecule 1) increased across worsening risk strata. Angiopoietin 2, soluble thrombomodulin, and plasminogen activator inhibitor 1 were higher in nonsurvivors, and soluble receptor for advanced glycation end-products and surfactant protein D were higher in children meeting acute respiratory distress syndrome criteria.

Conclusions:
PERSEVERE-II performs well in septic children from Aga Khan University Hospital, representing the first validation of PERSEVERE-II in a low-middle income country. Patients possessed a biomarker profile comparable to that of sepsis from high-income countries, suggesting that biomarker-based enrichment strategies may be effective in this setting.
Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus
Authors: Rochlin Danielle H. , Sheckter Clifford C. , Brazio Philip S. , Coriddi Michelle R. , Dayan Joseph H. , Mehrara Babak J. , Matros Evan 
Published: April 2023

Introduction
Surgical treatment of lymphedema has outpaced coding paradigms. In the setting of ambiguity regarding coding for physiologic procedures [(lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT)], we hypothesized that there would be variation in commercial reimbursement based on coding pattern.

Methods
We performed a cross-sectional analysis of 2021 nationwide hospital pricing data for 21 Current Procedural Terminology (CPT) codes encompassing excisional (direct excision, liposuction), physiologic (LVB, VLNT), and ancillary (lymphangiography) procedures. Within-hospital ratios (WHRs) and across-hospital ratios (AHRs) for adjusted commercial rates per CPT code quantified price variation. Mixed effects linear regression modeled associations of commercial rate with public payer (Medicare and Medicaid), self-pay, and chargemaster rates.

Results
270,254 commercial rates, including 95,774 rates for physiologic procedures, were extracted from 2,863 hospitals. Lymphangiography codes varied most in commercial price (WHR 1.76 – 3.89, AHR 8.12 – 44.38). For physiologic codes, WHRs ranged from 1.01 (VLNT; free omental flap) to 3.03 (LVB; unlisted lymphatic procedure), and AHRs ranged from 5.23 (LVB; lymphatic channel incision) to 10.36 (LVB; unlisted lymphatic procedure). Median adjusted commercial rates for excisional procedures ($3,635.84) were higher than for physiologic procedures ($2,560.40; p<0.001). Commercial rate positively correlated with Medicare rate for all physiologic codes combined, though regression coefficients varied by code.

Conclusions
Commercial payer-negotiated rates for physiologic procedures were highly variable both within and across hospitals, reflective of variation in CPT codes. Physiologic procedures may be undervalued relative to excisional procedures. Consistent coding nomenclature should be developed for physiologic and ancillary procedures.
Use of Virtual Touch Tissue Quantification Elastography Technique in Fetal Lung Maturation
Authors: Arslan Harun , Küçükbaş Gökçe Naz , Türkoğlu Saim , Akdemir Zülküf , Yokuş Adem , Gündüz Ali Mahir , Karaman Erbil , Şahin Hanım Güler 
Published: April 2023

Abstract
This study is an analysis of fetal lung stiffness by virtual touch tissue quantification (VTTQ) elastography to predict fetal lung maturation. Evaluation of fetal lungs was first performed in B mode, and fetal lungs were analyzed at 3 different periods at third trimester in each pregnant woman, at 28 to 31, 32 to 36, and 37 to 41 weeks. Fetal lung elastography was performed at regions with the least acoustic shadow and far from ribs and heart. Each fetal lung assessment were done by taking mean lung stiffness obtained by measuring stiffness of both left and right fetal lungs. T test analysis showed no significant difference in fetal lung stiffness between male and female fetuses among 3 gestational periods. Analysis of variance was performed to evaluate fetal lung stiffness of the fetuses at 3 different gestational periods (28–31, 32–36, and 37–41 weeks). This analysis showed significant difference (P < 0.01). Duncan multiple comparison analysis did not show significant difference in fetal lung stiffness between 28 and 31 weeks and 32 and 36 weeks, whereas fetal lung stiffness of fetuses at 37 to 41 weeks were significantly greater (P < 0.01). This study is first step to analyze fetal lung maturation noninvasively using VTTQ elastography technique by measuring fetal lung stiffness.
False Absence of the Anterior Communicating Artery and a Median Artery of Corpus Callosum
Authors: Rusu Mugurel Constantin , Lazăr Mihai , Toader Corneliu 
Published: April 2023

The anterior communicating artery (AComA) normally joins the anterior cerebral arteries (ACAs) when they change their directions from horizontal to vertical. Each postcommunicating segment of the ACAs commonly sends off the callosomarginal artery (CMA) and continues as the pericallosal artery. While documenting the archived computed tomography angiogram of a 61-year-old male patient, a rare anatomic variant was found to be associated with a previously unreported one. Both ACAs had symmetrical horizontal and vertical segments, but the AComA was absent from the usual location. The right ACA continued as CMA without sending off a pericallosal artery. A median artery of corpus callosum (MACC) left from the horizontal segment of the left ACA. Then the left ACA continued as CMA. At 1.9 cm from its origin, the MACC was united to the right CMA by a high, interhemispheric AComA. Therefore, an AComA should be regarded as absent only after documenting the bilateral anastomoses within the interhemispheric fissure. A third interhemispheric main artery, such as a rarely occurring MACC, could be accurately documented by computed tomography angiogram to avoid unpleasant intraoperative hemorrhage or to establish a personalized endovascular route to the anterior cerebral system.
SCGAN: Sparse CounterGAN for Counterfactual Explanations in Breast Cancer Prediction
Authors: Zhou Siqiong , Islam Upala J. , Pfeiffer Nicholaus , Banerjee Imon , Patel Bhavika K. , Iquebal Ashif S. 
Published: April 2023

AbstractImaging phenotypes extracted via radiomics of magnetic resonance imaging have shown great potential in predicting the treatment response in breast cancer patients after administering neoadjuvant systemic therapy (NST). Understanding the causal relationships between the treatment response and Imaging phenotypes, Clinical information, and Molecular (ICM) features are critical in guiding treatment strategies and management plans. Counterfactual explanations provide an interpretable approach to generating causal inference. However, existing approaches are either computationally prohibitive for high dimensional problems, generate unrealistic counterfactuals, or confound the effects of causal features by changing multiple features simultaneously. This paper proposes a new method called Sparse CounteRGAN (SCGAN) for generating counterfactual instances to reveal causal relationships between ICM features and the treatment response after NST. The generative approach learns the distribution of the original instances and, therefore, ensures that the new instances are realistic. We propose dropout training of the discriminator to promote sparsity and introduce a diversity term in the loss function to maximize the distances among generated counterfactuals. We evaluate the proposed method on two publicly available datasets, followed by the breast cancer dataset, and compare their performance with existing methods in the literature. Results show that SCGAN generates sparse and diverse counterfactual instances that also achieve plausibility and feasibility, making it a valuable tool for understanding the causal relationships between ICM features and treatment response.
How enhanced surveillance is helping Zanzibar get one step closer to malaria elimination: description of the operational platforms and resources for real-time case-based malaria surveillance
Authors: Mkali Humphrey R. , Lalji Shabbir M. , Al-mafazy Abdul-wahid , Joseph Joseph J. , Mwaipape Osia S. , Ali Abdullah S. , Abbas Faiza B. , Ali Mohamed H. , Hassan Wahida S. , Reaves Erik J. , Kitojo Chonge , Serbantez Naomi , Kabula Bilali I. , Nyinondi Ssanyu S. , McKay Mike , Cressman Gordon , Ngondi Jeremiah M. , Reithinger Richard 
Published: April 2023

ABSTRACTTesting and treating asymptomatic populations has the potential to reduce the population’s parasite reservoir and reduce malaria transmission. Zanzibar’s electronic malaria case notification (MCN) platform collects detailed socio-demographic and epidemiological data from all confirmed malaria cases to inform programmatic decision-making. This Field Action Report describes the design and operationalization process of the platform, as well as other malaria surveillance resources that are enabling Zanzibar to progress toward malaria elimination.The MCN platform consists of an interactive short message service (SMS) system for case notification, a software application for Android mobile devices, a visual question set and workflow manager, a back-end database server, and a web browser-based application for data analytics, configuration, and management. Malaria case data were collected from August 2012 to December 2021 and reported via SMS from all public and private health facilities to a central database, and then to District Malaria Surveillance Officers’ mobile devices. Data included patient names, shehia and date of diagnosis, which enabled the officers to track patients, ideally within 24 hours of reporting. Patients’ household members were tested for malaria using conventional rapid diagnostic tests (RDTs). Treatment using artemisinin-based combination therapy was provided for persons testing positive.Between 2012 and 2021, a total of 48,899 index malaria cases were confirmed at health facilities, 22,152 (45.3%) of whom within 24 hours of reporting; 41,886 (85.7%) cases were fully investigated and followed up to household level. A total of 111,811 additional household members were tested with RDTs, of whom 10,602 (9.5%) were malaria positive.The MCN platform reports malaria case data in near real-time, enabling prompt testing and treatment of members in index case households. Along with routine testing and treatment and other preventive interventions, combined with comprehensive reactive-case detection efforts, the continued use of the MCN platform is likely to reduce malaria transmission and malaria morbidity even further, thereby enhancing malaria elimination in Zanzibar.
Usability and acceptability of a corneal-plane α-opic light logger in a 24-hour field trial
Authors: Balajadia Eljoh , Garcia Sophie , Stampfli Janine , Schrader Björn , Guidolin Carolina , Spitschan Manuel 
Published: April 2023

AbstractExposure to light fundamentally influences human physiology and behaviour by synchronising our biological clock to the external light-dark cycle and controlling melatonin production. In addition to well-controlled laboratory studies, more naturalistic approaches to examining these “non-visual” effects of light have been developed in recent years. As naturalistic light exposure is quite unlike well-controlled stimulus conditions in the laboratory, it is critical to measure light exposure in a person-referenced way, the ‘spectral diet’. To this end, light loggers have been developed to capture personalised light exposure. As an alternative to light sensors integrated into wrist-worn actimeters, pendants or brooch-based light loggers, a recently developed wearable light logger laterally attached to spectacle frames enables the measurement of biologically relevant quantities in the corneal plane. Here, we examine the usability and acceptability of using the light logger in an undergraduate student sample (n=18, mean±1SD: 20.1±1.7 yrs; 9 female; Oxford, UK) in real-world conditions during a 24-hour measurement period. We probed the acceptability of the light logger using rating questionnaires and open-ended questions. Our quantitative results show a modest acceptability of the light logger. A thematic analysis of the open-ended questions reveals that the form factor of the device, in particular, size, weight and stability, and reactions from other people to the wearer of the light logger, were commonly mentioned aspects. In sum, the results indicate the miniaturisation of light loggers and “invisible” integration into extant everyday objects as key areas for future technological development, facilitating the availability of light exposure data for developing personalised intervention strategies in both research, clinical and consumer contexts.
Acute heart failure patients with a high red blood cell distribution width-to-albumin ratio have an increased risk of all-cause mortality
Authors: Wang Shiwei , Xiao Qiang , Lin Quanqiang , Li Yuanmin 
Published: April 2023

AbstractBackgroundMany studies have shown that specific blood markers, such as red cell distribution width (RDW) and albumin levels, can provide valuable information about the prognosis of patients with acute heart failure (AHF). In light of these findings, the current study aims to investigate the relationship between another blood marker, RDW to albumin ratio (RAR), and the prognosis of AHF patients.MethodsData on patients diagnosed with AHF were extracted from the MIMIC-IV database version 2.1. Patients were divided into three groups based on RAR tertiles.Multiple imputation was used for missing data, and pooled analysis was performed for imputed data sets. This study used Cox regression analysis to evaluate the impact of RAR on Clinical Outcomes in AHF patients. To further assess the prognostic ability of RDW, RAR, and albumin, the study also used time-dependent receiver operating characteristic (time-ROC) analysis.ResultsThis study enrolled 1432 patients with AHF, with a mean age of 72.4 years and a mean RAR of 5.07 ± 1.51% /g/dl. Patients with AHF had increased all-cause mortality when their RAR was higher (HR = 1.16, 95% CI: 1.10 ∼ 1.23, P < 0.001), and RAR and mortality from all causes were linearly related in patients with AHF (P non-linearity = 0.643). Based on time-ROC curves, it was discovered that RAR had a higher prognostic accuracy compared to RDW and albumin.ConclusionsAn increased level of RAR was associated with a poor all-cause mortality prognosis for patients with AHF, and there is a significant linear relationship. RAR was a better predictor of all-cause mortality in AHF patients than RDW and albumin.
Development of a Novel Serological Assay for the Detection of Mpox Infection in Vaccinated Populations
Authors: Yates Jennifer L. , Hunt Danielle T. , Kulas Karen E. , Chave Karen , Styer Linda , Chakravarthi Sandhya T. , Cai Gianna Y. , Bermúdez-González Maria C. , Kleiner Giulio , Altman Deena , Srivastava Komal ,   PVI study group, Simon Viviana , Feihel Dennis , McGowan Joseph , Hogrefe Wayne , Noone Philip , Egan Christina , Slifka Mark K. , Lee William T. 
Published: April 2023

SummaryIn 2022 the World Health Organization declared a Public Health Emergency for an outbreak of mpox, the zoonotic Orthopoxvirus (OPV) affecting at least 103 non-endemic locations world-wide. Serologic detection of mpox infection is problematic, however, due to considerable antigenic and serologic cross-reactivity among OPVs and smallpox-vaccinated individuals. In this report, we developed a high-throughput multiplex microsphere immunoassay (MIA) using a combination of mpox-specific peptides and cross-reactive OPV proteins that results in the specific serologic detection of mpox infection with 93% sensitivity and 98% specificity. The New York State Non-Vaccinia Orthopoxvirus Microsphere Immunoassay is an important diagnostic tool to detect subclinical mpox infection and understand the extent of mpox spread in the community through retrospective analysis.
Deprivation effect on COVID-19 cases incidence and severity: a geo-epidemiological study in PACA region, France
Authors: Gaubert Guillaume , Nauleau Steve , Franke Florian , Rebaudet Stanislas , Mosnier Emilie , Landier Jordi , Chaud Pascal , Malfait Philippe , Vandentorren Stéphanie , Huart Michael , Ramdani Alaa , Bendiane Marc-Karim , Danjou Fabrice , Gaudart Jean 
Published: April 2023

AbstractIntroductionThe spread of the COVID-19 pandemic, and its severity, is spatially heterogenous. At the individual level, the socioeconomic status (SES) profile is known to be associated with COVID-19 incidence and severity. The aim of this geo epidemiological study was to investigate the link between SES profile and potential confounders, and COVID-19 incidence and hospitalization rates, at a fine geographical scale.MethodsWe analyzed COVID-19 incidence and severity during two epidemic waves between September 2020 and June 2021, in Provence Alpes Côtes d’Azur, a 5 million inhabitants’ French region. The region is divided into sub-municipal areas that we have classified according to their SES profile. We then conducted a spatial analysis of COVID-19 indicators depending on SES profile, age structure, and health services provision. This analysis considered spatial autocorrelation between areas.ResultsCOVID-19 incidence rates in more deprived areas were similar to those in wealthiest ones. Hospitalization rates of COVID-19 cases in conventional care units were greater in more deprived vs wealthiest areas: Standardized Incidence Ratio (SIR) were respectively 1.34 [95% confidence interval 1.18 - 1.52] and 1.25 [1.13 - 1.38] depending on the epidemic wave. This gap was even greater regarding hospitalization rates of cases in critical care units: SIR = 1.64 [1.30 - 2.07] then 1.33 [1.14 - 1.55] depending on the epidemic wave. Hospitalization rates of COVID-19 cases in conventional care units were also greater in areas with high proportion of elderly people vs young people: SIR respectively 1.24 [1.11 - 1.38] and 1.22 [1.13 - 1.32] depending on the wave.ConclusionConsidering age structure and health services provision, a deprived SES profile is associated to a greater COVID-19 severity in terms of hospitals admissions, in conventional care units and in critical care units. This result implies targeting risk prevention efforts on these areas in pandemic situations, and highlights the need to develop access to healthcare to deprived populations in anticipation of periods of crisis.Key messagesWhat is already known on this topic- Socioeconomic status is associated to COVID-19 incidence and severity, at an individual scale or at a large spatial scale.What this study adds- We showed the positive relationship between deprivation and COVID-19 incidence and hospitalization rates at a fine sub-municipal geographical scale. We considered confusion factors like demographic structure and health services provision.How this study might affect research, practice or policy- These findings may help predict at a fine scale where the impact will be most severe in pandemic situations and make it possible to target risk prevention efforts on these areas.