bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronos: An Efficient Asynchronous Byzantine Ordered Consensus
Authors: Zhang Zongyang , Zhang Lingyue , Wang Zhuo , Li Yichen , Lu Rongxing , Yu Yong 
Published: April 2023

Abstract
Byzantine ordered consensus, introduced by Zhang et al. (OSDI 2020), is a new consensus primitive that additionally guarantees a correctness specification of transaction order, allowing nodes to assign fairly an ordering indicator to the committed transaction. Zhang et al. also presented a concrete Byzantine ordered consensus protocol called Pompē in the partially synchronous network model. However, Pompē cannot prevent an adversary from manipulating message delivery time. In this paper, we present Chronos, the first Byzantine ordered consensus protocol in the asynchronous network model, where an adversary can arbitrarily manipulate message delivery time. To construct Chronos, we propose a variant of asynchronous common subset called signal asynchronous common subset protocol, which guarantees the liveness of Chronos. We implement both Chronos and its baseline HoneyBadgerBFT using Go language and deploy them on 100 Amazon t3.medium instances distributed throughout 10 regions across the world. The experimental results show that Chronos is more efficient than HoneyBadgerBFT for small network, achieving peak throughput of 59 368 tx/s when the batch size is 100 000 and the number of nodes is 4, while the peak of HoneyBadgerBFT is 57 077 tx/s.
Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome: the BIOMArCS cohort
Authors: Gürgöze Muhammed T , Akkerhuis K Martijn , Oemrawsingh Rohit M , Umans Victor A W M , Kietselaer Bas , Schotborgh Carl E , Ronner Eelko , Lenderink Timo , Aksoy Ismail , van der Harst Pim , Asselbergs Folkert W , Maas Arthur C , Oude Ophuis Anton J , Krenning Boudewijn , de Winter Robbert J , The Salem H K , Wardeh Alexander J , Hermans Walter R M , Cramer G Etienne , van Gorp Ina , de Rijke Yolanda B , van Schaik Ron H N , Boersma Eric 
Published: April 2023

Abstract

Aims
Evidence regarding the role of serial measurements of biomarkers for risk assessment in post-acute coronary syndrome (ACS) patients is limited. The aim was to explore the prognostic value of four, serially measured biomarkers in a large, real-world cohort of post-ACS patients.

Methods and results
BIOMArCS is a prospective, multi-centre, observational study in 844 post-ACS patients in whom 12 218 blood samples (median 17 per patient) were obtained during 1-year follow-up. The longitudinal patterns of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal-pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and growth differentiation factor 15 (GDF-15) were analysed in relation to the primary endpoint (PE) of cardiovascular mortality and recurrent ACS using multivariable joint models. Median age was 63 years, 78% were men and the PE was reached by 45 patients. The average biomarker levels were systematically higher in PE compared with PE-free patients. After adjustment for 6-month post-discharge Global Registry of Acute Coronary Events score, 1 standard deviation increase in log[hs-cTnT] was associated with a 61% increased risk of the PE [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.02–2.44, P = 0.045], while for log[GDF-15] this was 81% (HR 1.81, 95% CI 1.28–2.70, P = 0.001). These associations remained significant after multivariable adjustment, while NT-proBNP and hs-CRP were not. Furthermore, GDF-15 level showed an increasing trend prior to the PE (Structured Graphical Abstract).

Conclusion
Longitudinally measured hs-cTnT and GDF-15 concentrations provide prognostic value in the risk assessment of clinically stabilized patients post-ACS.

Clinical Trial Registration
The Netherlands Trial Register. Currently available at URL https://trialsearch.who.int/; Unique Identifiers: NTR1698 and NTR1106.
Bridge to recovery using an Impella 2.5 device in a 3-year-old child
Authors: Kuschnerus Kira , Starck Christoph , Potapov Evgenij , Cho Mi-Young 
Published: April 2023

Abstract
Mechanical support options for children and small adolescents with acute left ventricular failure are often limited to extracorporeal life support (ECLS) and subsequent left ventricular assist device implantation. We report a case of a 3-year-old child weighing 12 kg with acute humoral rejection after cardiac transplantation not adequately responding to medical therapy who presented in persistent low cardiac output syndrome. We successfully stabilized the patient by implanting a Impella 2.5 device via a 6-mm Hemashield prosthesis on the right axillary artery. The patient was bridged to recovery.
Association of body mass index with 30-day mortality and red blood cell transfusions in open heart surgery
Authors: Räsänen Jenni , Ellam Sten , Hartikainen Juha , Juutilainen Auni , Halonen Jari 
Published: April 2023

Abstract

OBJECTIVES
Obesity is associated with increased burden of cardiovascular risk factors, morbidity and mortality. However, several studies have counterintuitively shown better outcome after cardiac surgery in obese than in normal weight patients, a phenomenon known as obesity paradox. Furthermore, obesity has been linked with decreased need of red blood cell (RBC) transfusions. The purpose of this study was to evaluate the impact of body mass index (BMI) on 30-day mortality and RBC transfusions in patients undergoing cardiac surgery, a clinically important topic with conflicting previous data.

METHODS
We retrospectively investigated 1691 patients who underwent coronary and/or valve or aortic root surgery using cardiopulmonary bypass between 2013 and 2016. The patients were categorized by BMI based on the World Health Organization classification. For analysis, logistic regression was used with adjustment for potential confounding factors.

RESULTS
Of the patients, 28.7% were normal weight, 43.3% overweight, 20.5% mildly obese and 7.5% severely obese. Thirty-day mortality was 1.9% without significant differences between the BMI groups. 41.0% of patients received RBC transfusion. Overweight [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.56–0.99, P = 0.045], mildly (OR 0.65, 95% CI 0.46–0.92, P = 0.016) and severely obese (OR 0.41, 95% CI 0.24–0.70, P = 0.001) patients needed less frequently RBC transfusions than patients with normal weight.

CONCLUSIONS
Obesity was not associated with 30-day mortality but was associated with lower use of RBC transfusions in cardiac surgery.
The relationship of income on stroke incidence in Finland and China
Authors: Yao Honghui , Junna Liina , Hu Yaoyue , Sha Xinping , Martikainen Pekka 
Published: April 2023

Abstract

Background
Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China.

Methods
Changde Social Health Insurance Database (N=571 843) and Finnish population register (N=4 046 205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence.

Results
The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576–0.696] and HR 0.572 (95% CI 0.540–0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276–0.739) and HR 0.633 (95% CI 0.406–0.708) for China.

Conclusions
Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.
Epidemiology of bacterial co-infections and risk factors in COVID-19-hospitalized patients in Spain: a nationwide study
Authors: López-Herrero R , Sánchez-de Prada L , Tamayo-Velasco A , Lorenzo-López M , Gómez-Pesquera E , Sánchez-Quirós B , de la Varga-Martínez O , Gómez-Sánchez E , Resino S , Tamayo E , Álvaro-Meca A 
Published: April 2023

Abstract

Background
We performed a nationwide population-based retrospective study to describe the epidemiology of bacterial co-infections in coronavirus disease 2019 (COVID-19)-hospitalized patients in Spain in 2020. We also analyzed the risk factors for co-infection, the etiology and the impact in the outcome.

Methods
Data were obtained from records in the Minimum Basic Data Set (MBDS) of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health and annually published with 2 years lag. COVID-19 circulated in two waves in 2020: from its introduction to 31st June and from 1st July to 31st December. The risk of developing a healthcare-associated bacterial co-infection and the risk for in-hospital and intensive care unit (ICU) mortality in co-infected patients was assessed using an adjusted logistic regression model.

Results
The incidence of bacterial co-infection in COVID-19 hospitalized patients was 2.3%. The main risk factors associated with bacterial co-infection were organ failure, obesity and male sex. Co-infection was associated with worse outcomes including higher in-hospital, in-ICU mortality and higher length of stay. Gram-negative bacteria caused most infections. Causative agents were similar between waves, although higher co-infections with Pseudomonas spp. were detected in the first wave and with Haemophilus influenzae and Streptococcus pneumoniae in the second.

Conclusions
Co-infections are not as common as those found in other viral respiratory infections; therefore, antibiotics should be used carefully. Screening for actual co-infection to prescribe antibiotic therapy when required should be performed.
Pain Management in Older Adults Before and During the First Year of COVID-19 Pandemic: Prevalence, Trends, and Correlates
Authors: Manhapra Ajay , Fortinsky Richard H , Berg Karina M , Ross Joseph S , Rhee Taeho Greg 
Published: April 2023

Abstract

Background
There is limited knowledge on whether and how health care access restrictions imposed by the coronavirus disease of 2019 pandemic have affected utilization of both opioid and nonpharmacological treatments among US older adults living with chronic pain.

Methods
We compared prevalence of chronic pain and high impact chronic pain (ie, chronic pain limiting life or work activities on most days or every day in the past 6 months) between 2019 (pre-pandemic) and 2020 (first year of pandemic) and utilization of opioids and nonpharmacological pain treatments among adults aged ≥65 years enrolled in the National Health Interview Survey, a nationally representative sample of noninstitutionalized civilian U.S. adults.

Results
Of 12 027 survey participants aged ≥65 (representing 32.6 million noninstitutionalized older adults nationally), the prevalence of chronic pain was not significantly different from 2019 (30.8%; 95% confidence interval [CI], 29.7%–32.0%) to 2020 (32.1%; 95% CI, 31.0%–33.3%; p = .06). Among older adults with chronic pain, the prevalence of high impact chronic pain was also unchanged (38.3%; 95% CI, 36.1%–40.6% in 2019 versus 37.8%; 95% CI, 34.9%–40.8% in 2020; p = .79). Use of any nonpharmacological interventions for pain management decreased significantly from 61.2% (95 CI, 58.8%–63.5%) in 2019 to 42.1% (95% CI, 40.5%–43.8%) in 2020 (p &lt; .001) among those with chronic pain, as did opioid use in the past 12 months from 20.2% (95% CI, 18.9%–21.6%) in 2019 to 17.9% (95% CI, 16.7%–19.1%) in 2020 (p = .006). Predictors of treatment utilization were similar in both chronic pain and high-impact chronic pain.

Conclusion
Use of pain treatments among older adults with chronic pain declined in the first year of coronavirus disease of 2019 pandemic. Future research is needed to assess long-term effects of coronavirus disease of 2019 pandemic on pain management in older adults.
Clinical encounter heterogeneity and methods for resolving in networked EHR data: a study from N3C and RECOVER programs
Authors: Leese Peter , Anand Adit , Girvin Andrew , Manna Amin , Patel Saaya , Yoo Yun Jae , Wong Rachel , Haendel Melissa , Chute Christopher G , Bennett Tellen , Hajagos Janos , Pfaff Emily , Moffitt Richard 
Published: April 2023

Abstract

Objective
Clinical encounter data are heterogeneous and vary greatly from institution to institution. These problems of variance affect interpretability and usability of clinical encounter data for analysis. These problems are magnified when multisite electronic health record (EHR) data are networked together. This article presents a novel, generalizable method for resolving encounter heterogeneity for analysis by combining related atomic encounters into composite “macrovisits.”

Materials and Methods
Encounters were composed of data from 75 partner sites harmonized to a common data model as part of the NIH Researching COVID to Enhance Recovery Initiative, a project of the National Covid Cohort Collaborative. Summary statistics were computed for overall and site-level data to assess issues and identify modifications. Two algorithms were developed to refine atomic encounters into cleaner, analyzable longitudinal clinical visits.

Results
Atomic inpatient encounters data were found to be widely disparate between sites in terms of length-of-stay (LOS) and numbers of OMOP CDM measurements per encounter. After aggregating encounters to macrovisits, LOS and measurement variance decreased. A subsequent algorithm to identify hospitalized macrovisits further reduced data variability.

Discussion
Encounters are a complex and heterogeneous component of EHR data and native data issues are not addressed by existing methods. These types of complex and poorly studied issues contribute to the difficulty of deriving value from EHR data, and these types of foundational, large-scale explorations, and developments are necessary to realize the full potential of modern real-world data.

Conclusion
This article presents method developments to manipulate and resolve EHR encounter data issues in a generalizable way as a foundation for future research and analysis.
Using AI-generated suggestions from ChatGPT to optimize clinical decision support
Authors: Liu Siru , Wright Aileen P , Patterson Barron L , Wanderer Jonathan P , Turer Robert W , Nelson Scott D , McCoy Allison B , Sittig Dean F , Wright Adam 
Published: April 2023

Abstract

Objective
To determine if ChatGPT can generate useful suggestions for improving clinical decision support (CDS) logic and to assess noninferiority compared to human-generated suggestions.

Methods
We supplied summaries of CDS logic to ChatGPT, an artificial intelligence (AI) tool for question answering that uses a large language model, and asked it to generate suggestions. We asked human clinician reviewers to review the AI-generated suggestions as well as human-generated suggestions for improving the same CDS alerts, and rate the suggestions for their usefulness, acceptance, relevance, understanding, workflow, bias, inversion, and redundancy.

Results
Five clinicians analyzed 36 AI-generated suggestions and 29 human-generated suggestions for 7 alerts. Of the 20 suggestions that scored highest in the survey, 9 were generated by ChatGPT. The suggestions generated by AI were found to offer unique perspectives and were evaluated as highly understandable and relevant, with moderate usefulness, low acceptance, bias, inversion, redundancy.

Conclusion
AI-generated suggestions could be an important complementary part of optimizing CDS alerts, can identify potential improvements to alert logic and support their implementation, and may even be able to assist experts in formulating their own suggestions for CDS improvement. ChatGPT shows great potential for using large language models and reinforcement learning from human feedback to improve CDS alert logic and potentially other medical areas involving complex, clinical logic, a key step in the development of an advanced learning health system.
Nutrient profile, amino acid digestibility, true metabolizable energy, and indispensable amino acid scoring of whole hemp seeds for use in canine and feline diets
Authors: Finet Shannon , He Fei , Utterback Pam L , Parsons Carl M , de Godoy Maria R C 
Published: April 2023

AbstractThe use of various hemp-derived products has been rapidly growing in the human nutrition industry and has sparked great interest in using these ingredients for companion animals as well. Thorough research is needed to determine the ingredient and safety standards required for AAFCO approval of hemp ingredients. In order to be effectively incorporated into pet food products, we must determine the nutrient content, quality, and utility of these ingredients in pet species. The objective of this study was to evaluate the nutrient composition of seeds from four different varieties of hemp, NWG 452, NWG 331, NWG 2730, X-59, and determine protein quality and true metabolizable energy using a cecectomized rooster model. The seeds were similar in macronutrient composition, with small variations in acid hydrolyzed fat, crude protein, total dietary fiber and gross energy content, as well as amino acid and long-chain fatty acid profiles. All essential amino acids were present in concentrations that exceeded the NRC (2006) recommended allowances for adult dogs and cats at maintenance with the exception of tryptophan. The long-chain fatty acid profile presented a favorable ratio of omega-6 to omega-3 fatty acids of close to 3.5:1. The results of the cecectomized rooster assay indicated no significant difference in the standardized amino acid digestibility of the indispensable amino acids among the seed varieties (P &gt; 0.05). A significant difference in the true metabolizable energy corrected for nitrogen was observed among the seeds (P &lt; 0.05), following the pattern of higher acid hydrolyzed fat and lower total dietary fiber content resulting in higher metabolizable energy. An adapted calculation of digestible indispensable amino acid score was made to determine protein quality of the hemp seeds using AAFCO nutrient profiles and NRC recommended allowances for adult dogs and cats at maintenance as reference points. The resulting scores determined tryptophan to be the first limiting amino acid and indicate that hemp seeds alone do not meet all the amino acid requirements for adult dogs and cats at maintenance, and would need a complimentary protein source for practical use in companion animal diets. The data from this study suggest that hemp seeds may provide a beneficial source of fat, protein, and dietary fiber, with consideration to differences in nutrient profile among seed varieties. However, further investigation in vivo is needed to determine the safety and efficacy of utilizing hemp in the diets of both canines and felines.
Development of Prepositioned Burn Care-specific Disaster Resources for a Burn Mass Casualty Incident
Authors: Kearns Randy D , Flores Carl A , Arledge Frances , Hargrove Paige , Prats Rosanne , Kanter Joseph , Sittig Kevin , Barrios Joey , Phelan Herb A , Carter Jeffrey E 
Published: April 2023

Abstract
Disaster preparedness for a burn mass casualty incident (BMCI) must consider the needs of the first responders and community hospitals, who may be the first to receive those patients. Developing a more comprehensive statewide burn disaster program includes meeting with regional healthcare coalitions (HCCs) to identify gaps in care.
Quarterly HCC meetings, which link local hospitals, emergency medical services (EMS) agencies, and other interested parties, are held around the state. We rely on the HCC’s regional meetings to serve as a platform for conducting focus group research to identify gaps specific to a BMCI and to inform strategy development.
One of the deficiencies identified, particularly in rural areas that infrequently manage burn injuries, was a lack of burn-specific wound care dressings that could support the initial response. Relying on this process, a consensus was created for equipment types and quantities, including a kit for storage. Furthermore, maintenance, supply replacement, and scene delivery processes were developed for these kits that could augment a BMCI response.
The feedback from the focus groups reminded us that many systems report having infrequent opportunities to provide care for patients with burn injuries. In addition, several types of burn-specific dressings are expensive. With the infrequent occurrence, EMS agencies and rural hospitals reported that it was doubtful their agency/hospital would have more than a minimal stock of burn injury supplies. Therefore, developing supply caches that can be quickly mobilized and deployed to the impacted area was one of the deficiencies we identified and addressed through this process.
Species-specific differences in the egg exochorium of the sympatric taxa Triatoma costalimai and Triatoma jatai (Hemiptera: Reduviidae: Triatominae)
Authors: Müller Josiane Nogueira , Freitas Simone Patrícia Carneiro , Teves Simone Caldas , Santos-Mallet Jacenir Reis , Lopes Catarina Macedo , Gonçalves Teresa Cristina Monte 
Published: April 2023

Abstract
Triatoma costalimai and Triatoma jatai are related species, which occur in sympatry in Paranã, Tocantins, Brazil, in rocky outcrops and in peridomicile and intradomicile environments. This study compared morphologic and morphometric aspects of the eggs of these species using optical microscopy (OM) and scanning electron microscopy (SEM). Operculum cells (OP) and egg body (EB) were drawn and photographed, their surfaces were measured, and spots were quantified. Statistical analyses were performed using ANOVA and t-tests. OM showed an egg exochorium with spots in T. costalimai and a predominance of short lines in T. jatai. We found significant differences in egg length and width, which were larger in T. costalimai. SEM analysis showed that the operculum of both species had cells with straight and/or rounded rims, with a smooth aspect, random spots, and predominantly pentagonal shape. In the EB, hexagonal cells were predominant, with indices exceeding 60% in both species. Triatoma costalimai cells were flat, with a discrete definition of the rims, whereas T. jatai cells were smooth with well-defined rims. Statistical tests showed significant differences for EB, where T. costalimai cells were larger and have more spots than T. jatai. The eggs can thus be differentiated, thereby contributing to integrative taxonomy.