bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ex Vivo Heart Perfusion for Cardiac Transplantation Allowing for Prolonged Perfusion Time and Extension of Distance Traveled for Procurement of Donor Hearts: An Initial Experience in the United States
Authors: Isath Ameesh , Ohira Suguru , Levine Avi , Pan Stephen , Aggarwal-Gupta Chhaya , Lanier Gregg M. , Wolfe Kevin , Spielvogel David , Gass Alan , Kai Masashi 
Published: February 2023

Background.
Scarcity of donor hearts continues to be a challenge for heart transplantation (HT). The recently Food and Drug Administration–approved Organ Care System (OCS; Heart, TransMedics) for ex vivo organ perfusion enables extension of ex situ intervals and thus may expand the donor pool. Because postapproval real-world outcomes of OCS in HT are lacking, we report our initial experience.

Methods.
We retrospectively reviewed consecutive patients who received HT at our institution in the post–Food and Drug Administration approval period from May 1 to October 15, 2022. Patients were divided into 2 groups: OCS versus conventional technique. Baseline characteristics and outcomes were compared.

Results.
A total of 21 patients received HT during this period, 8 using OCS and 13 conventional techniques. All hearts were from donation after brain death donors. The indication for OCS was an expected ischemic time of >4 h. Baseline characteristics in the 2 groups were comparable. The mean distance traveled for heart recovery was significantly higher in the OCS group (OCS, 845 ± 337, versus conventional, 186 ± 188 mi; P < 0.001), as was the mean total preservation time (6.5 ± 0.7 versus 2.5 ± 0.7 h; P < 0.001). The mean OCS time was 5.1 ± 0.7 h. In-hospital survival in the OCS group was 100% compared with 92.3% in the conventional group (P = 0.32). Primary graft dysfunction was similar in both groups (OCS 12.5% versus conventional 15.4%; P = 0.85). No patient in the OCS group required venoarterial extracorporeal membrane oxygenation support after transplant compared with 1 in the conventional group (0% versus 7.7%; P = 0.32). The mean intensive care unit length of stay after transplant was comparable.

Conclusions.
OCS allowed utilization of donors from extended distances that otherwise would not be considered because ischemic time would be prohibitive by conventional technique.
Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia
Authors: Kouloutbani Komanthi , Venetsanou Fotini , Karteroliotis Konstantinos E. , Politis Antonios 
Published: February 2023

Background:
Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management.

Methods:
Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis.

Results:
The meta-analyses revealed that exercise significantly limits NPS [mean difference: −5.28, (95% CI, −9.46, −1.11), P = 0.01] and symptoms of depression [standardized mean difference: −0.16, (95% CI, −0.29, −0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively.

Conclusions:
Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.
Research Priorities of Individuals and Caregivers With Lewy Body Dementia
Authors: Holden Samantha K. , Bedenfield Noheli , Taylor Angela S. , Bayram Ece , Schwilk Chris , Fleisher Jori , Duda John , Shill Holly , Paulson Henry L. , Stacy Kelly , Wood Julia , Corsentino Pamela , Sha Sharon J. , Litvan Irene , Irwin David J. , Quinn Joseph F. , Goldman Jennifer G. , Amodeo Katherine , Taylor John-Paul , Boeve Bradley F. , Armstrong Melissa J. 
Published: February 2023

Introduction:
Lewy body dementia (LBD) is common, yet under-recognized and under-researched. To plan studies with the highest impact, engagement of the community personally affected by these conditions is essential.

Methods:
A web-based survey of people living with LBD and current and former caregivers of people with LBD queried research priorities through forced ranking and exploration of burden of LBD symptoms. Specific caregiving needs in LBD and perceptions of research participation were also investigated.

Results:
Between April 7, 2021 and July 1, 2021, 984 responses were recorded. Top research priorities included disease-modifying therapies and improved disease detection and staging. People with LBD were interested in pathophysiology and more bothered by motor symptoms; caregivers were interested in risk factors and symptomatic therapies and more bothered by neuropsychiatric symptoms. Few available LBD treatments and resources were rated as helpful, and many valuable services were never received. Previous participation in LBD research was infrequent, but interest was high.

Discussion:
People with LBD and caregivers highlighted the need for research across all aspects of LBD, from pathophysiology and disease modification to prognosis, education, symptomatic treatments, and caregiver support. Funders should increase support for all aspects of LBD research to target the many needs identified by individuals and families living with LBD.
Unlocking the Power of EHRs: Harnessing Unstructured Data for Machine Learning-based Outcome Predictions
Authors: Noaeen Mohammad , Amini Somayeh , Bhasker Shveta , Ghezelsefli Zohreh , Ahmed Aisha , Jafarinezhad Omid , Hossein Abad Zahra Shakeri 
Published: February 2023

AbstractThe integration of Electronic Health Records (EHRs) with Machine Learning (ML) models has become imperative in examining patient outcomes due to the vast amounts of clinical data they provide. However, critical information regarding social and behavioral factors that affect health, such as social isolation, stress, and mental health complexities, is often recorded in unstructured clinical notes, hindering its accessibility. This has resulted in an over-reliance on clinical data in current EHR-based research, potentially leading to disparities in health outcomes. This study aims to evaluate the impact of incorporating patient-specific context from unstructured EHR data on the accuracy and stability of ML algorithms for predicting mortality, using the MIMIC III database. Results from the study confirmed the significance of incorporating patient-specific information into prediction models, leading to a notable improvement in the discriminatory power and robustness of the ML algorithms. Furthermore, the findings underline the importance of considering non-clinical factors related to a patient’s daily life, in addition to clinical factors, when making predictions about patient outcomes. These results have significant ramifications for improving ML in clinical decision support and patient outcome predictions.
Rapid emergence of transmissible SARS-CoV-2 variants in mild community cases
Authors: Crone Michael A , Hakki Seran , Zhou Jie , de Oliveira Carolina Rosadas , Madon Kieran J , Koycheva Aleksandra , Badhan Anjna , Jonnerby Jakob , Fenn Joe , Kundu Rhia , Barnett Jack L , Nevin Sean , Conibear Emily , Derqui-Fernandez Nieves , Pillay Timesh D , Varro Robert , Luca Constanta , Quinn Valerie , Ahmad Shazaad , Zambon Maria , Barclay Wendy S , Dunning Jake , Freemont Paul S , Taylor Graham P , Lalvani Ajit 
Published: February 2023

AbstractSARS-CoV-2 immune-escape variants have only been observed to arise in immunosuppressed COVID-19 cases, during prolonged viral shedding. Through daily longitudinal RT-qPCR, quantitative viral culture and sequencing, we observe for the first time the evolution of transmissible variants harbouring mutations consistent with immune-escape in mild community cases within 2 weeks of infection.
Classification performance bias between training and test sets in a limited mammography dataset
Authors: Hou Rui , Lo Joseph Y. , Marks Jeffrey R. , Hwang E. Shelley , Grimm Lars J. 
Published: February 2023

AbstractObjectivesTo assess the performance bias caused by sampling data into training and test sets in a mammography radiomics study.MethodsMammograms from 700 women were used to study upstaging of ductal carcinoma in situ. The dataset was repeatedly shuffled and split into training (n=400) and test cases (n=300) forty times. For each split, cross-validation was used for training, followed by an assessment of the test set. Logistic regression with regularization and support vector machine were used as the machine learning classifiers. For each split and classifier type, multiple models were created based on radiomics and/or clinical features.ResultsArea under the curve (AUC) performances varied considerably across the different data splits (e.g., radiomics regression model: train 0.58-0.70, test 0.59–0.73). Performances for regression models showed a tradeoff where better training led to worse testing and vice versa. Cross-validation over all cases reduced this variability, but required samples of 500+ cases to yield representative estimates of performance.ConclusionsIn medical imaging, clinical datasets are often limited to relatively small size. Models built from different training sets may not be representative of the whole dataset. Depending on the selected data split and model, performance bias could lead to inappropriate conclusions that might influence the clinical significance of the findings. Optimal strategies for test set selection should be developed to ensure study conclusions are appropriate.
Underlying Pressures that Black Mothers and Their Children Face: A Qualitative Assessment on the Effects of Racism/Discrimination and the COVID 19 Pandemic
Authors: Thomas Denisia N. , Rizzieri Ashley , Rodriguez Mayra 
Published: February 2023

ABSTRACTBackgroundPoverty, racism, discrimination, inadequate access to healthcare, and personal, everyday stressors lead to poor health outcomes, especially in African American families in the south. There is limited data on how these stressors are absorbed between the mother and child dyad.ObjectiveTo assess the effects of racism, everyday stressors (i.e. motherhood), and the COVID pandemic on African American/Black mothers and their children.MethodsUtilizing the Health Belief Model, a survey was developed to assess mother-child stressors relating to three different constructs: racism/discrimination, pandemic/covid-19, and parenting. We interviewed seven black mothers and their children (aged 4-10yo). The families were recruited from a pediatric office in the rural city of Alexander City, Alabama. Interviews took place in an intimate setting and lasted for 1.5-2 hours. Medical students conducted, recorded, and transcribed each interview. The interview assessed the association between the COVID-19 pandemic, personal traumatic events, and racism and discrimination in their everyday lives.ResultsThrough qualitative analysis; racism, daily activities, and the COVID-19 pandemic were demonstrated to be significant stressors for the mothers. Knowledge, school/work, actions, emotions, and seriousness/susceptibility displayed stressors not only in the mom as one would expect, but in the children as well. Using the resilience model, we assessed adversity, coping strategies, and self-efficacy. As one might expect, each situation caused a different level of anxiety; however, the coping strategies varied. Some moms took to smoking to cope with it while others chose suppression. The children’s coping ranged from inconsolable crying and using outlets such as phones to cope.ConclusionUltimately, our qualitative approach saw an association between the pandemic and discrimination. Mothers often felt the need to shield children from the emotions attached to discrimination, and ultimately were unable to. There is a need to explore resilience and assess these stressors and changes in perception over time.
Possible Role of P-selectin Adhesion in Long-COVID: A Case of Recovery After Long-COVID
Authors: Tarasev Michael , Gao Xiufeng , Ferranti Marta , Zaidi Aliya U. , Hines Patrick 
Published: February 2023

AbstractBackgroundLong-term outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are now recognized as an emerging public health challenge - a condition termed post-acute coronavirus 2019 syndrome (PACS) or Long-COVID. The pathophysiology of Long-COVID remains to be established, several mechanisms in study focus on the role of P-selectin, an inflammation-induced protein expressed by platelets and endothelial cells. Functional P-selectin activity, potentially implicated in COVID-19 and Long-COVID sequelae, was measured for a Long-COVID subject at 68 weeks from the SARS-CoV-2 infection after fully recover from the syndrome. It was compared with the results from the same subject at 20 weeks post-infection, when subject experienced severe Long-COVID symptoms.MethodsFlow adhesion of whole blood or isolated white blood cells to P-selectin (FA-WB-Psel and FA-WBC-Psel) was measured using a standardized microfluidics clinical assay; impedance aggregometry with a collagen agonist was measured using model 590 Chrono-Log impedance aggregometer; standard laboratory assays were performed to evaluate changes in blood chemistries.ResultsAfter recovery from Long-COVID, RBC count and D-dimer remained elevated and other blood chemistry results remained within the normal range as compared to 20 weeks post infection when severe Long-COVID symptoms were present. Total iron and transferrin-iron saturation percentage values that were elevated when symptoms were present, declined to normal range. Whole blood aggregometry results indicate an absence of previously present platelet hyperactivity. FA-WB-PSel that was significantly elevated during Long-COVID (590 ± 260 cells/mm2) was significantly reduced after its symptoms’ resolution (98 ± 38 cells/mm2). However, supplementation of whole blood with crizanlizumab did not result in any measurable inhibition of cell adhesion to P-selectin, similarly with previously reported. Similar to what was observed for the subject when Long-COVID symptoms were present, crizanlizumab, even at a dose 10-fold lower than clinical, induced pronounced inhibition of FA-WBC-Psel when tested in buffer, but not in patient’s own plasma.ConclusionsThis report documents the changes in leukocyte adhesion properties for a patient at more than a year from the initial infection after the gradual resolution of Long-COVID symptoms, as compared to when Long-COVID symptoms were present. Recovery from Long-COVID may be associated with normalization of platelet activity, but not necessarily with complete alleviation of endothelial activation. It remains to be determined to what extent changes in leukocyte adhesion to P-selectin may represent a new risk factor for a mechanism driving Long-COVID syndrome.
Vaccine-induced correlate of protection against fatal COVID-19 in the old and frail during waves of neutralization resistant variants of concern
Authors: Vikström Linnea , Fjällström Peter , Gwon Yong-Dae , Sheward Daniel J. , Wigren-Byström Julia , Evander Magnus , Bladh Oscar , Widerström Michael , Molnar Christian , Rasmussen Gunlög , Bennet Louise , Åberg Mikael , Björk Jonas , Tevell Staffan , Thålin Charlotte , Blom Kim , Klingström Jonas , Murrell Benjamin , Ahlm Clas , Normark Johan , Johansson Anders F , Forsell Mattias NE 
Published: February 2023

ABSTRACTBackgroundTo inform future preventive measures including repeated vaccinations, we have searched for a clinically useful immune correlate of protection against fatal Covid-19 among nursing homes residents.MethodsWe performed repeated capillary blood sampling with analysis of S-binding IgG in an open cohort study with inclusion of nursing home residents in Sweden. We analyzed immunological and registry data collected from September 2021 with end of follow-up 31 August 2022. The study period included implementation of the 3rd and 4th mRNA monovalent vaccine doses and Omicron virus waves.FindingsA total of 3012 nursing home residents with median age 86 were enrolled. The 3rd mRNA dose elicited a 99-fold relative increase of S-binding IgG among 2606 blood-sampled individuals and corresponding increase of neutralizing antibodies. The 4th mRNA vaccine dose boosted the levels 3.8-fold. Half-life of S-binding IgG was 72 days. A total 528 residents acquired their first SARS-CoV-2 infection after the 3rd or the 4th vaccine dose and the 30-day mortality was 9.1%. We found no indication that levels of vaccine-induced antibodies protected against infection with Omicron VOCs. In contrast, the risk of death was inversely correlated to levels of S-directed IgG below the 20thpercentile. The risk plateaued at population average above lower 35th percentile of S-binding IgG.InterpretationIn the absence of neutralizing antibodies that protection from infection, quantification of S-binding IgG post vaccination may be useful to identify the most vulnerable for fatal Covid-19 among the oldest and frailest. This information is of importance for future strategies to protect vulnerable populations against neutralization resistant variants of concern.FundingSwedish Research Council, SciLife, Knut and Alice Wallenberg Foundation and Vinnova.
Exploring the impact of parity and its interaction with history of preterm delivery on gestational duration
Authors: Ytterberg Karin , Jacobsson Bo , Flatley Christopher , Juodakis Julius , Nilsson Staffan , Sole-Navais Pol 
Published: February 2023

AbstractDelivering preterm is the leading cause of death in neonates and children under five years of age. Both genetics and environmental factors play a role in timing of delivery, and these influences can be unique to a single pregnancy or shared across pregnancies of the same mother. The aim of this study was to understand how gestational duration is affected by parity and how parity modifies the association between history of preterm delivery and gestational duration. To investigate this, we analysed 1 118 318 spontaneous deliveries (1990 - 2012) from the Swedish Medical Birth Register, with access to pedigrees, using linear regressions and linear mixed models. We found that parity has a modest effect on the mean and a large effect on the variance of gestational duration. Interactions with a woman’s clinical and family history of preterm delivery revealed both pregnancy-specific and shared factors. For instance, the effect of a previous preterm delivery on gestational duration is present across pregnancies, but the magnitude of its effect is pregnancy specific. The access to pedigrees made it possible to apply linear mixed models, thus including all woman’s pregnancies in the model and accounting for unobserved mother-specific covariates. The linear mixed models highlighted a group effect bias when using linear regression to estimate the association between parity and gestational duration, likely caused by socioeconomic factors. Our study shed light on how parity affects gestational duration and modifies the effect of well-known risk factors of preterm delivery.
The Acceptability of Self-Collected Samples for STI Testing: A Qualitative Study Among Adults in Rakai, Uganda
Authors: Ogale Yasmin P. , Grabowski M. Kathryn , Nabakka Proscovia , Ddaaki William , Nakubulwa Rosette , Nakyanjo Neema , Nalugoda Fred , Kagaayi Joseph , Kigozi Godfrey , Denison Julie A. , Gaydos Charlotte , Kennedy Caitlin E. 
Published: February 2023

AbstractIntroductionSelf-collected samples (SCS) for sexually transmitted infection (STI) testing have been shown to be feasible and acceptable in high-resource settings. However, few studies have assessed the acceptability of SCS for STI testing in a general population in low-resource settings. This study explored the acceptability of SCS among adults in south-central Uganda.MethodsNested within the Rakai Community Cohort Study, we conducted semi-structured interviews with 36 symptomatic and asymptomatic adults who self-collected samples for STI testing. We analyzed the data using an adapted version of the Framework Method.ResultsOverall, participants did not find SCS physically uncomfortable. Reported acceptability did not meaningfully differ by gender or symptom status. Perceived advantages to SCS included increased privacy and confidentiality, gentleness, and efficiency. Disadvantages included the lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic.Most participants preferred provider-collected samples to SCS. Nevertheless, almost all said they would recommend SCS and would do it again in the future.ConclusionDespite a preference for provider-collection, SCS are acceptable among adults in this setting and support expanded access to STI diagnostic services.Key QuestionsWhat is already known on this topicTimely diagnosis is critical for STI control, with testing being the gold standard for diagnosis. Self-collected samples (SCS) for STI testing offer an opportunity to expand STI testing services and are well accepted in high-resource settings. However, patient acceptability of self-collected samples in low-resource settings is not well described.What this study addsWe found that SCS was acceptable to both male and female participants in our population, regardless of whether they reported STI symptoms. Perceived advantages to SCS included: increased privacy and confidentiality, gentleness, and efficiency; disadvantages included lack of provider involvement, fear of self-harm and the perception that SCS was unhygienic. Overall, most participants preferred provider collection over SCS.How this study might affect research, practice or policyPatient education addressing perceived disadvantages may increase SCS acceptability and support the use of SCS as a means to identify cases and control STIs in low-resource settings.