bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Comments on the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) Survey Reflect Improvements in Provider Behaviors From Coaching
Authors: Quigley Denise D. , Predmore Zachary , Martino Steven , Qureshi Nabeel , Hays Ron D. 
Published: June 2023

Goal:
Patient experience survey data are used to examine the patient-centeredness of care, identify areas for improvement, and monitor interventions aimed to enhance the patient experience. Most healthcare organizations measure patient experience using Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Studies have documented the use of CAHPS closed-ended survey responses for completing public reports, monitoring internal feedback and performance, identifying areas of improvement, and evaluating interventions to improve care. However, limited evidence exists on the utility of patients' comments on CAHPS surveys for evaluating provider-level interventions. To explore this potential, we examined comments on the CAHPS Clinician and Group (CG-CAHPS) 2.0 visit survey before and after a provider intervention. The “shadow coaching” intervention had been shown to improve provider performance and patient experience scores on the CG-CAHPS overall provider rating and provider communication composite.

Methods:
We examined how patient comments on the CG-CAHPS survey differed before and after shadow coaching of 74 providers. We described the valence (tone), content, and actionability of 1,935 comments—1,051 collected before coaching and 884 collected after coaching—to see how these aspects changed before and after providers were coached.

Principal Findings:
Patient comments reflected improved CG-CAHPS scores after shadow coaching. The proportion of positive comments increased, and comments about doctors were more positive. Comments about time spent in the examination room decreased, apparently reflecting the decreased proportion of negative comments after coaching. Comments regarding three of the four aspects of provider communication asked on the CG-CAHPS survey were more positive after coaching (provider listens carefully, shows respect, spends enough time); the valence of comments about the fourth aspect (provider explains things in a way that is easy to understand) did not change. Also, comments describing an overall positive evaluation of the practice increased. Comments were generally less actionable after coaching, perhaps reflecting the increased positivity of the comments.

Practical Applications:
Patient comments collected before the provider intervention reflected overall improvements in provider behavior, as indicated by medium-to-large statistically significant improvements in CG-CAHPS composite scores. These results suggest that patient comments from the CG-CAHPS survey can be used as input for quality improvement or an evaluation of provider-level interventions. Tracking the valence and content of comments about providers before and after an intervention to improve care is a practical method to learn how provider behavior changes.
Influence of Maternal Adverse Childhood Experiences on Birth Outcomes in American Indian and non-Hispanic White Women
Authors: Goldstein Ellen , Brown Roger L. 
Published: June 2023

Abstract

Purpose:
Maternal adverse childhood experiences (ACEs) are an antecedent risk during prenatal and postpartum periods. We examined race-based differences of the mediating influences of antepartum health risks (prenatal depression, high blood pressure, gestational diabetes) on associations between ACEs and maternal and birth outcomes (postpartum depression, preterm birth, low birthweight) among American Indian and non-Hispanic White women.

Methods:
Public use data from the South Dakota Pregnancy Risk Assessment Monitoring System PRAMS (2017-2019) were used for this secondary analysis of postpartum women. ACEs and depression were measured based on self-report survey results. Antepartum risks and birth outcomes were extracted from birth certificate data. A moderated mediation logit model estimated direct, indirect, and moderating effects by race, controlling for maternal characteristics and perinatal risks to understand ACEs' impact on pregnancy and birth outcomes between groups.

Results:
The sample included 2,343 postpartum women. American Indian versus non-Hispanic White women had a higher mean ACE score (3.37 vs. 1.64) and substantial disparities. Race-based differences were attributed to social, economic, and health-related factors. Adjusting for proportional differences, members of both groups with ACEs demonstrated significantly increased odds of prenatal and postpartum depression. ACEs influenced postpartum depression and preterm birth through the indirect effect of prenatal depression in both races. Prenatal depression indirectly influenced the relationship between ACEs and low birthweight in non-Hispanic White women.

Clinical Implications:
ACEs were associated with higher levels of prenatal depression, which may negatively influence maternal and birth outcomes in American Indian and non-Hispanic White women. Improving perinatal outcomes must emphasize psychosocial care along with medical care to address the high burden of maternal ACEs in the United States.
Either High or low Risk
Authors: Perri Giampaolo , Marchegiani Giovanni , Partelli Stefano , Andreasi Valentina , Luchini Claudio , Bariani Elena , Bannone Elisa , Fermi Francesca , Mattiolo Paola , Falconi Massimo , Salvia Roberto , Bassi Claudio 
Published: June 2023

Background:
Pancreatic acinar content has been associated with pancreas-specific complications after pancreatoduodenectomy (PD). The aim of this study was to improve the prediction ability of intraoperative risk stratification by integrating the pancreatic acinar score.

Methods:
A training and a validation cohort underwent PD with subsequent histologic assessment of pancreatic section margins for acinar content (Ac), fibrosis (Fc), and fat. Intraoperative risk stratification (pancreatic texture, duct diameter) and pancreas-specific complications (postoperative hyperamylasemia [POH], post pancreatectomy acute pancreatitis [PPAP], pancreatic fistula [POPF]) were classified according to ISGPS definitions.

Results:
In the validation cohort (n= 373), the association of pancreas-specific complications with higher Ac and lower Fc was replicated (all P<0.001). In the entire cohort (n= 761), the ISGPS classification allocated 275 (36%) patients into intermediate-risk classes B (POH 32%/PPAP 3%/POPF 17%) and C (POH 36%/PPAP 9%/POPF 33%). Using the acinar score (Ac ≥60% and/or Fc ≤10%), intermediate-risk patients could be dichotomized into a low- (POH 5%/PPAP 1%/POPF 6%) and a high- (POH 51%/PPAP 9%/POPF 38%) risk group (all P<0.001). The acinar score AUC for POPF prediction was 0.70 in the ISGPS intermediate-risk classes. Overall, 239 (31%) patients were relocated into the high-risk group from lower ISGPS risk classes using the acinar score.

Conclusions:
The risk of pancreas-specific complications appears to be dichotomous - either high or low - according to the acinar score, a tool to better target the application of mitigation strategies in cases of intermediate macroscopic features.
Clinical Practice Guideline Recommendations For Pediatric Multisystem Trauma Care
Authors: Freire Gabrielle C. , Beno Suzanne , Yanchar Nathalie , Weiss Matthew , Stang Antonia , Stelfox Thomas , Bérubé Melanie , Beaulieu Emilie , Gagnon Isabelle J , Zemek Roger , Berthelot Simon , Tardif Pier-Alexandre , Moore Lynne 
Published: June 2023

Objective:
To systematically review clinical practice guidelines (CPG) for pediatric multisystem trauma, appraise their quality, synthesize the strength of recommendations and quality of evidence, and identify knowledge gaps.

Summary Background Data:
Traumatic injuries are the leading cause of death and disability in children, who require a specific approach to injury care. Difficulties integrating CPG recommendations may cause the observed practice and outcome variation in pediatric trauma care.

Methods:
We conducted a systematic review using Medline, Embase, Cochrane library, Web of Science, ClinicalTrials and grey literature, from January 2007 to November 2022. We included CPGs targeting pediatric multisystem trauma with recommendations on any acute care diagnostic or therapeutic interventions. Pairs of reviewers independently screened articles, extracted data, and evaluated the quality of CPGs using AGREE II.

Results:
We reviewed 19 CPGs, and 11 were considered high quality. Lack of stakeholder engagement and implementation strategies were weaknesses in guideline development. We extracted 64 recommendations: 6 (9%) on trauma readiness and patient transfer, 24 (38%) on resuscitation, 22 (34%) on diagnostic imaging, 3 (5%) on pain management, 6 (9%) on ongoing inpatient care and 3 (5%) on patient and family support. Forty-two (66%) recommendations were strong or moderate, but only 5 (8%) were based on high quality evidence. We did not identify recommendations on trauma survey assessment, spinal motion restriction, inpatient rehabilitation, mental health management, or discharge planning.

Conclusions:
We identified 5 recommendations for pediatric multisystem trauma with high quality evidence. Organizations could improve CPGs by engaging all relevant stakeholders and considering barriers to implementation. There is a need for robust pediatric trauma research, to support recommendations.
Efficacy of Pelvic Floor Ultrasound for Assessing Transobturator Tape Sling Procedure
Authors: Hu Yang , Zhu Shuxu , Lou Yelin , Zhang Heng , Huang Ting , Xie Liping 
Published: June 2023

Importance
Complications after midurethral sling, which require a high degree of clinical suspicion for timely diagnosis, accurate evaluation, and proper intervention, are closely associated with surgical success or failure.

Objectives
This study aimed to evaluate the efficacy and complications of tension-free midurethral sling for stress urinary incontinence (SUI) using pelvic floor ultrasound.

Study Design
This retrospective study included 152 female patients with SUI admitted to the Jinhua Central Hospital between January 2020 and December 2021 who were selected. All patients underwent midurethral transobturator tape sling procedures and were divided into success, voiding dysfunction, overactive bladder, and failure groups according to postoperative efficacy and complications. The pelvic floor ultrasound examination was performed before and after the surgery.

Results
The posterior vesicourethral angle difference (P < 0.01) was significantly lower after the surgery than before the surgery. The rate of bladder neck funneling (P < 0.01) and the area of bladder neck funneling (P < 0.01) were smaller after the surgery than before the surgery. The tape–longitudinal smooth muscle distance, the tape–symphysis pubis distance, the sling angle, and the tape–bladder neck/urethra increased successively in the voiding dysfunction, overactive bladder, success, and failure groups.

Conclusions
Pelvic floor ultrasound can accurately evaluate the postoperative efficacy and complications of transobturator tape sling procedures for SUI and can reasonably guide the management of complications. Therefore, it is an effective imaging method for postoperative follow-up after tension-free midurethral tape suspension.
Characterizing common and rare variations in non-traditional glycemic biomarkers using multivariate approaches on multi-ancestry ARIC study
Authors: Ray Debashree , Loomis Stephanie J. , Venkataraghavan Sowmya , Tin Adrienne , Yu Bing , Chatterjee Nilanjan , Selvin Elizabeth , Duggal Priya 
Published: June 2023

ABSTRACTGlycated hemoglobin, fasting glucose, glycated albumin, and fructosamine are biomarkers that reflect different aspects of the glycemic process. Genetic studies of these glycemic biomarkers can shed light on unknown aspects of type 2 diabetes genetics and biology. While there exists several GWAS of glycated hemoglobin and fasting glucose, very few GWAS have focused on glycated albumin or fructosamine. We performed a multi-phenotype GWAS of glycated albumin and fructosamine from 7,395 White and 2,016 Black participants in the Atherosclerosis Risk in Communities (ARIC) study on the common variants from genotyped/imputed data. We found 2 genome-wide significant loci, one mapping to known type 2 diabetes gene (ARAP1/STARD10,p= 2.8 × 10−8) and another mapping to a novel gene (UGT1A,p= 1.4 × 10−8) using multi-omics gene mapping strategies in diabetes-relevant tissues. We identified additional loci that were ancestry-specific (e.g.,PRKCAfrom African ancestry individuals,p= 1.7 × 10−8) and sex-specific (TEX29locus in males only,p= 3.0 × 10−8). Further, we implemented multi-phenotype gene-burden tests on whole-exome sequence data from 6,590 White and 2,309 Black ARIC participants. Eleven genes across different rare variant aggregation strategies were exome-wide significant only in multi-ancestry analysis. Four out of 11 genes had notable enrichment of rare predicted loss of function variants in African ancestry participants despite smaller sample size. Overall, 8 out of 15 loci/genes were implicated to influence these biomarkers via glycemic pathways. This study illustrates improved locus discovery and potential effector gene discovery by leveraging joint patterns of related biomarkers across entire allele frequency spectrum in multi-ancestry analyses. Most of the loci/genes we identified have not been previously implicated in studies of type 2 diabetes, and future investigation of the loci/genes potentially acting through glycemic pathways may help us better understand risk of developing type 2 diabetes.
COGNITIVE REJUVENATION IN OLD RATS BY HIPPOCAMPAL OSKM GENE THERAPY
Authors: Horvath Steve , Lacunza Ezequiel , Mallat Martina Canatelli , Portiansky Enrique L. , Gallardo Maria D. , Brooke Robert T. , Chiavellini Priscila , Pasquini Diana C. , Girard Mauricio , Lehmann Marianne , Yan Qi , Lu Ake T. , Haghani Amin , Gordevicius Juozas , Abba Martin , Goya Rodolfo G. 
Published: June 2023

ABSTRACTImpaired performance in spatial learning and memory during aging in rats is associated with morphological and molecular changes in the brain, particularly in the hippocampus. Here, we assessed the cognitive performance of young (3.5 mo.) untreated rats and old (25.3 mo.) treated and control rats. Treatment was carried out by intrahippocampal injection of an adenovector that carries the GFP reporter gene as well as the 4 Yamanaka genes.Learning and spatial memory performance were assessed by means of the Barnes maze test. The learning performance of the OSKM-treated old rats was significantly improved compared to that of the control old counterparts. A marginal (P=0.06) improvement in the spatial memory was recorded in the treated versus control old rats. OSKM gene expression induced no pathological changes in the brain. The morphology and number of hippocampal cell populations like astrocytes and mature neurons did not show any changes with the treatment in the old rats as compared with the control old counterparts. The rat pan tissue DNAm age marker revealed that old OSKM gene-treated rats show a trend towards a decrease in epigenetic age. The Limma package was used to assess differential methylation by fitting linear models to the methylation data for specific group comparisons. Comparison of differential methylation between old treated and old control hippocampal DNA samples identified 671 differentially methylated CpGs probes (DPMs) in the DNA of OSKM-treated hippocampi (p<0.05). Assessment of the DPMs in old versus young controls revealed the presence of 1,279 hypomethylated CpGs near the promoter regions in young hippocampi (versus old controls) and 914 hypermethylated CpGs near the promoter in young hippocampi compared to old control hippocampi. We found a subset of 174 hypomethylated CpGs in the hippocampal DNA from old OSKM rats and young controls both compared with old control hippocampi. This means that in the hippocampal DNA there is a common set of CpGs which are hypermethylated during aging and are demethylated by the OSKM genes. This observation suggested that in these 174 CpGs the hypermethylation induced by aging is reversed by the demethylation effect of the OSKM genes on the same 174 CpGs. This observation can be interpreted as a rejuvenation effect of the OSKM genes of the old hippocampal methylome. Our results extend to the rat the evidence that viral vector-mediated delivery of the Yamanaka genes in the brain has strong regenerative effects without adverse side effects.
Evaluation of 3-D printed swabs for respiratory sampling and testing for SARS-CoV-2 during the early pandemic period
Authors: Hasan Zahra , Iqbal Angila , Ahmed Imran , Khan Moiz , Jabeen Kauser , Islam Nazneen , Khan Erum , Sayani Saleem 
Published: June 2023

AbstractAppropriate collection of respiratory samples is essential for accurate diagnostic testing of respiratory pathogens such as, SARS-CoV-2. Early in the pandemic, there was a shortage of nasopharyngeal (NP) swabs and difficulty in sampling suspected cases. Therefore, we developed a 3D printed nasal swab for anterior nares, paired with in-house viral transport medium (VTM). The utility of this 3D swab kit was investigated in comparison with the standard NP commercial swab and VTM, in 200 individuals between August and September 2021. Subjects were those presenting for diagnostic testing for SARS-CoV-2 using the RT-PCR (cobas Roche assay) assay. NP samples were taken from each subject using the standard NP and 3D swabs followed by RT-PCR on paired specimens. CT values for amplification of gene targets were evaluated to determine assay parameters based on viral load cut offs of ≤ CT 35 or, ≤ CT 37. For high to medium viral loads, 3D swab based PCR testing had a sensitivity of 93%, specificity of 99%, positive predictive value (PPV) of 98.5% and negative predictive value (NPV) of 96.2% respectively. For low viral loads, 3D swab testing had a sensitivity of 88%, specificity of 99%, with a PPV of 98.5% and NPV of 93.2%.%. 3D swab sampling of anterior nares was comparable with NP sampling using standard swabs for SARS-CoV-2 specimens with a medium to high viral load. Therefore, 3D swab based sampling is a reliable and convenient local solution for collecting respiratory samples for SARS-CoV-2 diagnostic testing.
AI Segmentation of Vestibular Schwannomas with Radiomic Analysis and Clinical Correlates
Authors: Milchenko Mikhail , Cross Kevin , Smith Harrison , LaMontagne Pamela , Chakrabarty Satrajit , Varagur Kaamya , Chatterjee Rano , Bhuvic Patel , Kim Albert , Marcus Daniel 
Published: June 2023

AbstractVestibular schwannoma (VS) is a benign, slow growing tumor that may affect hearing and balance. It accounts for 7-8% of all primary brain tumors. Gamma knife radiosurgery (GKRS) is a common treatment option for VS. Magnetic resonance imaging (MRI) is employed for diagnosis, surgery planning, and follow-up of VS. Long-term follow-up determines efficacy of VS treatment. Identifying MRI-derived markers to improve management of VS is challenging. This study describes MRI processing pipeline that automatically segments VS and investigates stability and outcome predictive power of radiomic MRI features.We first preprocessed and segmented available pre-GKRS T1-weighted post-contrast MRI images in VS patients, using a Convolutional Neural Network (CNN) developed on DeepMedic framework. Then, we compared CNN and manual segmentations, extracted radiomic features from both manual and CNN segmentations of VS, and, finally, evaluated robustness of extracted features and clinical outcome analyses based thereof.We found that homogeneity, robust maximum intensity and sphericity were the most robust across segmentations. We also found that maximum and minimum intensities were most predictive of tumor growth across all segmentation methods and subject cohorts. We used retrospective post-GK SRS data collected in our institution to build the processing pipeline for unsupervised segmenting of VS. This pipeline is released as a Docker image integrated with XNAT (extensible neuroimaging archive toolkit), an established open research imaging database platform15. Generated segmentations can be viewed and edited in the XNAT-based online OHIF (Open Health Imaging Foundation) viewer16in real time.
WFIKKN2 is a bifunctional axon guidance cue that signals through divergent DCC family receptors
Authors: Nickerson Kelsey R. , Tom Irene , Cortés Elena , Abolafia Jane R. , Özkan Engin , Gonzalez Lino C. , Jaworski Alexander 
Published: June 2023

AbstractAxon pathfinding is controlled by attractive and repulsive molecular cues that activate receptors on the axonal growth cone, but the full repertoire of axon guidance molecules remains unknown. The vertebrate DCC receptor family contains the two closely related members DCC and Neogenin with prominent roles in axon guidance and three additional, divergent members – Punc, Nope, and Protogenin – for which functions in neural circuit formation have remained elusive. We identified a secreted Punc/Nope/Protogenin ligand, WFIKKN2, which guides mouse peripheral sensory axons through Nope-mediated repulsion. In contrast, WFIKKN2 attracts motor axons, but not via Nope. These findings identify WFIKKN2 as a bifunctional axon guidance cue that acts through divergent DCC family members, revealing a remarkable diversity of ligand interactions for this receptor family in nervous system wiring.One-Sentence SummaryWFIKKN2 is a ligand for the DCC family receptors Punc, Nope, and Prtg that repels sensory axons and attracts motor axons.
CRISPR/Cas9-mediated Generation ofCOL7A1-deficient Keratinocyte Model of Recessive Dystrophic Epidermolysis Bullosa
Authors: Alipour Farzad , Ahmadraji Mana , Yektadoust Elham , Mohammadi Parvaneh , Baharvand Hossein , Basiri Mohsen 
Published: June 2023

AbstractObjectiveRecessive dystrophic epidermolysis bullosa (RDEB) is a genetic skin fragility and ultimately lethal blistering disease caused by mutations in theCOL7A1gene which is responsible for coding type VII collagen. Investigating the pathological mechanisms and novel candidate therapies for RDEB could be fostered by new cellular models. Here, we developed multiple immortalizedCOL7A1-deficient keratinocyte cell lines using CRISPR/Cas9 technology as RDEB cellular model.Materials and MethodsIn this experimental study, we used transient transfection to expressCOL7A1-targeting gRNA and Cas9 in HEK001 immortalized keratinocyte cell line followed by enrichment with fluorescent-activated cell sorting (FACS) via GFP expressing cells (GFP+HEK001). Homogenous single-cell clones were then isolated, genotyped, and evaluated for type VII collagen expression. We performed a scratch assay to confirm the functional effect ofCOL7A1knockout.ResultsWe achieved 46.1% (p < 0.001) efficiency of indel induction in the enriched transfected cell population. Except for 4% of single nucleotide insertions, the remaining indels were deletions of different sizes. Out of nine single clones expanded, two homozygous and two heterozygousCOL7A1-deficient cell lines were obtained with defined mutation sequences. No off-target effect was detected in the knockout cell lines. Immunostaining and western blot analysis showed the lack of type VII collagen (COL7A1) protein expression in these cell lines. We also showed thatCOL7A1-deficient cells had higher motility compared with their wild-type counterparts.ConclusionWe reported the first isogenic immortalizedCOL7A1-deficient keratinocyte lines that provide a useful cell culture model to investigate aspects of RDEB biology and potential therapeutic options.