bluuebunny/crossref_metadata_2025_split huggingface dataset:
Achieving Equity in Hospital Performance Assessments Using Composite Race-Specific Measures of Risk-Standardized Readmission and Mortality Rates for Heart Failure
Authors: Mentias Amgad , Peterson Eric D. , Keshvani Neil , Kumbhani Dharam J. , Yancy Clyde W. , Morris Alanna A. , Allen Larry A. , Girotra Saket , Fonarow Gregg C. , Starling Randall C. , Alvarez Paulino , Desai Milind Y. , Cram Peter , Pandey Ambarish 
Published: April 2023

Background:
The contemporary measures of hospital performance for heart failure hospitalization and 30-day risk-standardized readmission rate (RSRR) and risk-standardized mortality rate (RSMR) are estimated using the same risk adjustment model and overall event rate for all patients. Thus, these measures are mainly driven by the care quality and outcomes for the majority racial and ethnic group, and may not adequately represent the hospital performance for patients of Black and other races.

Methods:
Fee-for-service Medicare beneficiaries from January 2014 to December 2019 hospitalized with heart failure were identified. Hospital-level 30-day RSRR and RSMR were estimated using the traditional race-agnostic models and the race-specific approach. The composite race-specific performance metric was calculated as the average of the RSRR/RMSR measures derived separately for each race and ethnicity group. Correlation and concordance in hospital performance for all patients and patients of Black and other races were assessed using the composite race-specific and race-agnostic metrics.

Results:
The study included 1 903 232 patients (75.7% White [n=1 439 958]; 14.5% Black [n=276 684]; and 9.8% other races [n=186 590]) with heart failure from 1860 hospitals. There was a modest correlation between hospital-level 30-day performance metrics for patients of White versus Black race (Pearson correlation coefficient: RSRR=0.42; RSMR=0.26). Compared with the race-agnostic RSRR and RSMR, composite race-specific metrics for all patients demonstrated stronger correlation with RSRR (correlation coefficient: 0.60 versus 0.74) and RSMR (correlation coefficient: 0.44 versus 0.51) for Black patients. Concordance in hospital performance for all patients and patients of Black race was also higher with race-specific (versus race-agnostic) metrics (RSRR=64% versus 53% concordantly high-performing; 61% versus 51% concordantly low-performing). Race-specific RSRR and RSMR metrics (versus race-agnostic) led to reclassification in performance ranking of 35.8% and 39.2% of hospitals, respectively, with better 30-day and 1-year outcomes for patients of all race groups at hospitals reclassified as high-performing.

Conclusions:
Among patients hospitalized with heart failure, race-specific 30-day RSMR and RSRR are more equitable in representing hospital performance for patients of Black and other races.
Preeclampsia Prevention by Timed Birth at Term
Authors: Magee Laura A. , Wright David , Syngelaki Argyro , von Dadelszen Peter , Akolekar Ranjit , Wright Alan , Nicolaides Kypros H. 
Published: April 2023

Background:
Most preeclampsia occurs at term. There are no effective preventative strategies. We aimed to identify the optimal preeclampsia screening and timing of birth strategy for prevention of term preeclampsia.

Methods:
This secondary analysis was of data from a prospective nonintervention cohort study of singleton pregnancies delivering at ≥24 weeks, without major anomalies, at 2 United Kingdom maternity hospitals. At routine visits at 11 to 13 weeks’ (57 131 pregnancies screened, 1138 term preeclampsia developed) or 35 to 36 weeks’ gestation (29 035 pregnancies screened, 619 term preeclampsia), with patient-specific preeclampsia risks determined by: United Kingdom National Institute for Health and Care Excellence guidance, and the Fetal Medicine Foundation competing-risks model. For each screening strategy, timing of birth for term preeclampsia prevention was evaluated at gestational time points that were fixed (37, 38, 39, 40 weeks) or dependent on preeclampsia risk by the competing-risks model at 35 to 36 weeks. Main outcomes were proportion of term preeclampsia prevented, and number-needed-to-deliver to prevent one term preeclampsia case.

Results:
The proportion of term preeclampsia prevented was the highest, and number-needed-to-deliver lowest, for preeclampsia screening at 35 to 36 (rather than 11–13) weeks. For delivery at 37 weeks, fewer cases of preeclampsia were prevented for National Institute for Health and Care Excellence (28.8%) than the competing-risks model (59.8%), and the number-needed-to-deliver was higher (16.4 versus 6.9, respectively). The risk-stratified approach (at 35–36 weeks) had similar preeclampsia prevention (by 57.2%) and number-needed-to-deliver (8.4), but fewer women would be induced at 37 weeks (1.2% versus 8.8%).

Conclusions:
Risk-stratified timing of birth at term may more than halve the risk of term preeclampsia.
Generalization Analysis of Pairwise Learning for Ranking With Deep Neural Networks
Authors: Huang Shuo , Zhou Junyu , Feng Han , Zhou Ding-Xuan 
Published: April 2023

Abstract
Pairwise learning is widely employed in ranking, similarity and metric learning, area under the ROC curve (AUC) maximization, and many other learning tasks involving sample pairs. Pairwise learning with deep neural networks was considered for ranking, but enough theoretical understanding about this topic is lacking. In this letter, we apply symmetric deep neural networks to pairwise learning for ranking with a hinge loss ϕh and carry out generalization analysis for this algorithm. A key step in our analysis is to characterize a function that minimizes the risk. This motivates us to first find the minimizer of ϕh-risk and then design our two-part deep neural networks with shared weights, which induces the antisymmetric property of the networks. We present convergence rates of the approximation error in terms of function smoothness and a noise condition and give an excess generalization error bound by means of properties of the hypothesis space generated by deep neural networks. Our analysis is based on tools from U-statistics and approximation theory.
Sensitivity to Control Signals in Triphasic Rhythmic Neural Systems: A Comparative Mechanistic Analysis via Infinitesimal Local Timing Response Curves
Authors: Yu Zhuojun , Rubin Jonathan E. , Thomas Peter J. 
Published: April 2023

Abstract
Similar activity patterns may arise from model neural networks with distinct coupling properties and individual unit dynamics. These similar patterns may, however, respond differently to parameter variations and specifically to tuning of inputs that represent control signals. In this work, we analyze the responses resulting from modulation of a localized input in each of three classes of model neural networks that have been recognized in the literature for their capacity to produce robust three-phase rhythms: coupled fast-slow oscillators, near-heteroclinic oscillators, and threshold-linear networks. Triphasic rhythms, in which each phase consists of a prolonged activation of a corresponding subgroup of neurons followed by a fast transition to another phase, represent a fundamental activity pattern observed across a range of central pattern generators underlying behaviors critical to survival, including respiration, locomotion, and feeding. To perform our analysis, we extend the recently developed local timing response curve (lTRC), which allows us to characterize the timing effects due to perturbations, and we complement our lTRC approach with model-specific dynamical systems analysis. Interestingly, we observe disparate effects of similar perturbations across distinct model classes. Thus, this work provides an analytical framework for studying control of oscillations in nonlinear dynamical systems and may help guide model selection in future efforts to study systems exhibiting triphasic rhythmic activity.
The Impact of a Job Crafting Intervention on Wellbeing in Health Care Leaders
Authors: Zmijewski Polina , Lindeman Brenessa , Rogers David A 
Published: April 2023

Background Job Crafting is a strategy undertaken by highly motivated individuals to modify their own work. Educating individuals about the benefits of this approach has recently been explored in other professions as a wellbeing intervention. Objective We aimed to demonstrate that a Job Crafting intervention for health care leaders would result in improved wellbeing, lower burnout, and enhanced job resources. Methods Fourteen health care leaders across 6 departments at one academic medical center participated in a two-part workshop on Job Crafting between January 1, 2019 and December 31, 2020. Participants completed electronic surveys before and 4-6 weeks after the sessions. Pre- and post-intervention scores were compared using Wilcoxon signed rank sum tests. Results Eighty-six percent of participants stated the sessions were useful and applicable to their jobs, with 93% stating they were a valuable use of time and would recommend sessions to others. Participant Job Crafting behaviors increased following the intervention, with 46% increasing structural and social resources ( P = .03) and 85% decreasing Hindrance Demands ( P = .02). Increased meaning in work was identified by 38% post-intervention ( P = .04). No statistically significant differences were identified in Distress Scores at high risk for burnout pre- and post-intervention (86% for both), but 30% of participants had an absolute improvement (decrease) in their Distress Score. Conclusions A Job Crafting intervention was associated with high rates of satisfaction among participants and was successful in increasing Job Crafting behaviors and perceptions of meaningful work, but did not result in a change in risk for burnout in the short follow-up period.
Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience
Authors: Staibano Phillip , Khattak Shahzaib , Amin Faizan , Engels Paul T. , Sommer Doron D. 
Published: April 2023

Objectives: Novel coronavirus-19 (COVID-19) has led to over 6 million fatalities globally. An estimated 75% of COVID-19 patients who require critical care admission develop acute respiratory distress syndrome (ARDS) needing invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO). Due to prolonged ventilation requirements, these patients often also require tracheostomy. We performed a review of clinical outcomes in COVID-19 patients on ECMO at a high-volume tertiary care center in Hamilton, Ontario, Canada. Methodology: We performed a retrospective case series, including 24 adult patients diagnosed with COVID-19 who required IMV, veno-venous (ECMO), and tracheostomy. All patients were included from April to December 2021. We extracted demographic and clinical variables pertaining to the tracheostomy procedure and ECMO therapy. We performed descriptive statistical analyses. This study was approved by the Hamilton Integrated Research Ethics Board (14217-C). Results: We included 24 consecutive patients with COVID-19 who required tracheostomy while undergoing ECMO therapy. The mean age was 49.4 years [standard deviation (SD): 7.33], the majority of patients were male (75%), with mean body mass index of 32 (SD: 8.81). Overall mortality rate was 33.3%. Percutaneous tracheostomy was performed most frequently (83.3%) and, similar to open tracheostomy, was associated with a low rate of perioperative bleeding complications. Within surviving patients, the mean time to IMV weaning and decannulation was 60.2 (SD: 24.6) and 49.4 days (SD: 21.8), respectively. Conclusion: Percutaneous tracheostomy appears to be safe in COVID-19 patients on ECMO and holding anticoagulation 24 hours prior to and after tracheostomy may limit bleeding events in these patients.
Understanding components and predictors of delay of first treatment for mental health problems: A hospital-based study in China
Authors: Xie Guanqing , Zhou Wei , Xiao Shuiyuan , Wang Yao 
Published: April 2023

Background: Understanding components and predictors of delay of first treatment for mental health problems are crucial to inform interventions for earlier treatment. However, Chinese-context knowledge of this theme is still limited. Methods: We conducted an inpatient survey among 206 patients with various mental disorders in China. Delay of first utilization of mental healthcare (Delay-Total) and its two components of help-seeking delay (Delay-H) and referral delay (Delay-R) were assessed in terms of occurrence and duration. Binary logistic regression was performed to test predictors of Delay-Total, Delay-H and Delay-R, and multiple linear regression was used to test predictors of delay durations. Results: Overall, 66.0% patients experienced Delay-Total, with a duration range of 0 to 353 months; 49.5% patients had Delay-H (duration range = 0–207 months) and 29.6% with Delay-R (duration range = 0–323 months). Multivariate logistic regression analysis found that the diagnosis of severe mental disorders was a consistent predictor for a reduced chance of Delay-Total, Delay-H and Delay-R. Multiple linear regression analysis demonstrated that younger age of disorder onset and disorder onset before 2016 were significantly associated with longer delay. Conclusions: Delay of first treatment for mental health problems is still common in China. However, the development of mental health policy and services promotes shorter treatment delay. The diagnosis of common mental disorders and younger age of onset are risk factors of the occurrence and duration of delay, respectively. Thus, education of the public and non-mental-healthcare professionals are needed for better disorder recognition and more efforts should be inputted to support youngsters’ utilization of mental healthcare.
Validation of the prognostic scoring system for in-hospital mortality prediction in cardiogenic shock patients requiring veno-arterial extracorporeal membrane oxygenation
Authors: Cheewatanakornkul Sirichai , Duangpakdee Pongsanae , Khwannimit Bodin , Bhurayanontachai Rungsun , Geater Sarayut Lucien , Geater Alan Frederick 
Published: April 2023

Background A few prognostic scoring systems have been developed for predicting mortality in patients with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), albeit with variations in performance. This study aimed to assess and compare various mortality prediction models in a cohort of patients receiving VA-ECMO following cardiogenic shock or arrest. Methods We retrospectively analyzed 77 patients with cardiogenic shock who were placed on VA-ECMO support between March 2014 and August 2021. The APACHE II, SAPS II, SAVE, Modified SAVE, ENCOURAGE, and ECMO-ACCEPTS scores were calculated for each patient to predict the in-hospital mortality. Results Fifty-six (72.7%) patients died. All prediction model scores, except the ECMO-ACCEPTS, differed significantly between non-survivors and survivors as follows: ENCOURAGE, 23 versus 16 ( p < 0.001); SAVE, −6 versus −3 ( p = 0.008); Modified SAVE, −5 versus 0 ( p = 0.005); APACHE II, 32 versus 22 ( p = 0.009); and SAPS II, 67 versus 49 ( p = 0.002). The ENCOURAGE score demonstrated the best discriminatory ability with an area under the receiver–operating characteristic curve of 0.81 (95% confidence interval: 0.7–0.81). All prognostic scoring systems possessed limited calibration ability. However, the SAPS II, SAVE, and ENCOURAGE scores had lower Akaike and Bayesian information criteria values, which were consistent with the results of the Hosmer–Lemeshow C statistic test, indicating better performance than the other scores. Conclusions The ENCOURAGE score can help predict in-hospital mortality in all subsets of VA-ECMO patients, even though it was originally designed to predict intensive care unit mortality in the post-acute myocardial infarction setting.
Correlation of signal transducer and activator of transcription-3 and β-catenin expression in laryngeal squamous cell carcinoma
Authors: Sun Yajing , Lu Xiuying , Li Hui , Li Xiaoming 
Published: April 2023

Objective The specific roles of phosphorylated signal transducer and activator of transcription-3 (p-STAT3) and β-Catenin in laryngeal squamous cell carcinoma (LSCC) remain unclear. Methods In this study, the correlations between p-STAT3, β-Catenin, and clinicopathological characteristics were investigated using tissues and clinical data from 124 LSCC cases. Immunohistochemistry and immunofluorescence assays were used to examine p-STAT3 and β-Catenin expression and localization in these samples. Kaplan–Meier survival and Cox regression analyses were performed to evaluate the prognostic significance of these proteins. LSCC cell lines were treated with a STAT3 inhibitor (dihydroartemisinin) or activator (interleukin-6) to explore the mechanism of p-STAT3 and β-Catenin. Results There was an inverse correlation between p-STAT3 and β-Catenin expression in the LSCC samples. Patients with high p-STAT3 and low β-Catenin expression levels had significantly worse overall survival. Multivariate Cox regression analysis revealed that lymph node metastasis and β-Catenin expression were both independently correlated with unfavorable overall survival. Cell treatment with the p-STAT3 inhibitor inhibited the nuclear accumulation of β-Catenin, while p-STAT3 activator treatment could promote β-Catenin translocation to the nucleus. Conclusion Overall, our data indicate that p-STAT3 expression is associated with LSCC by promoting β-Catenin degradation.
Adaptation of adult right ventricular scoring systems to pediatric patients undergoing continuous LVAD implantation: Feasible or not?
Authors: Kocabeyoglu Sinan Sabit , Kervan Umit , Sert Dogan Emre , Karahan Mehmet , Kavurt Ahmet Vedat , Koca Serhat 
Published: April 2023

Purpose: The aim of this study is to investigate the efficacy of adaptation of right ventricular (RV) risk scores used in adult patients to pediatric age group undergoing LVAD implantation. Methods: Twenty-two pediatric patients who underwent LVAD implantation were retrospectively reviewed from January 2014 to September 2018. Preoperative patient characteristics, hemodynamic parameters, and echocardiographic data were collected. Adult RV risk scores were calculated for all patients. Effects of all the parameters on RV function were also investigated. Study endpoints were RVF and in-hospital mortality. Results: Eleven (50%) of 22 patients were male. The mean age of the patients was 13.4 ± 3.8 years. The mean body surface area of the patients was 1.4 ± 0.4 m2. In five patients BiVAD implantation was performed. Of these five BiVAD patients two underwent successful heart transplant; two weaned from temporary RVAD and last patient died due to multi-organ failure. Four patients showed signs of early RVF; one patient was transplanted successfully while on medical support. Three patients developing RVF did not respond medical therapy necessitating ECMO and died in the early postoperative period. All risk scores and potential predictive factors were evaluated individually and in combination of several parameters. No significant predictor for RVF in pediatric patients that underwent LVAD implantation was found ( p > 0.05). Conclusion: Neither an adult risk score nor a predictive factor was successful in predicting RVF, alone or in combination due to limited number of patients and events. Large further investigations are needed to identify the predictors or scoring system in pediatric population.
Anti-osteoporosis Effect of Cynaropicrin against Ovariectomy-induced Osteoporosis in Rats
Authors: Ye Hanlu , Wang Ke , Li Kai 
Published: April 2023

Background Osteoporosis is a progressive bone disease, which is characterized by high bone resorption, and low bone density and mass. Osteoporosis elevates the risk of bone fragility and fracture, which leads to significant morbidity and poor life quality. Objectives The current study focuses to explore the anti-osteoporosis activity of cynaropicrin against the ovariectomized (OVX)-induced osteoporosis in rats. Materials and Methods The OVX method was performed on the female rats to induce osteoporosis and then treated with 10 and 20 mg/kg of cynaropicrin, respectively, for 16 weeks. The uterus and femur tissues were excised from rats after the sacrification. The biomechanical properties of femur bones were analyzed to detect the stiffness, maximum load, young modulus, and energy absorption. The levels of acid phosphatase (ACP), bone-gla-protein (BGP), and estradiol (E2) in the serum were analyzed. The status of TNF-α, IL-6, IL-1β, osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL) was analyzed in the serum samples of experimental rats. The femur tissues were examined by histopathological analysis. Results The cynaropicrin treatment effectively increased the uterine and femoral weight in the OVX rats. The stiffness, maximum load, young modulus, energy, and femoral length were effectively increased by the cynaropicrin treatment. Cynaropicrin decreased the levels of BGP and ACP and increased the E2 level. The Cr, Ca, and P levels were appreciably increased and TNF-α, IL-6 and IL-1β levels were decreased by cynaropicrin on the OVX rats. The cynaropicrin treatment also increased the OPG and reduced the RANKL in the OVX rats. The histological findings revealed that cynaropicrin improved the femur trabecular bone microarchitecture in the OVX rats. Conclusion Our findings revealed that cynaropicrin increased the femoral weight and length, restored bone turnover markers and mineral profiles, and decreased inflammatory markers.
Influence of Drying Condition on Nutritional and Chemical Profile of Garcinia pedunculata Roxb. Fruit
Authors: Bhattacharjee Swarnali , Ramakrishnan Elancheran , Deb Prashanta Kumar , Sarma Partha Pratim , Choudhury Debopriya , Kabilan Senthamaraikannan , Devi Rajlakshmi 
Published: April 2023

Background Garcinia pedunculata (GP) Roxb. is a traditional medicinal plant used for treating gastrointestinal disorders. The fruit is always consumed in dried form in cuisines and as medicine. Objectives To study the effect of drying conditions (shade, oven, and traditional sun drying) on the nutritional profile of GP while assessing the choice of solvent extraction for the maximum phytocompounds extraction; their in vitro biological activities and chemical profiling. Materials and Methods The fruits were cut into thin 0.9 ± 0.3 cm slices and dried in the shade (25–30°C), sun (34–40°C), and oven (70–80°C). The extraction was done using methanol, hydromethanol, ethanol, hydroethanol, and water. HPLC and LC-ESI-MS/MS were used to identify the bioactive compounds. Results In this study, the impact of three drying conditions has been investigated and established that shade-dried (ShD) has a better-preserved nutritional profile. In terms of phytochemical extraction, comparatively higher amounts of phenols (394.00 ± 12.28 mg Gallic acid equivalent (GAE)/g of dried sample) and flavonoids (72.62 ± 2.06 mg Quercetin/g of dried sample) were recorded in the shade-dried hydromethanolic extract (ShDMH), which was directly in line with the better antioxidant activity (IC50 for 1,1-diphenyl-2-picrylhydrazyl (DPPH), 647.99 ± 7.66 µg/mL, 2,2’-azino-bis(3-ethylbenzothiazoline)6-sulfonic acid (ABTS), 762.02 ± 18.74 µg/mL) and enzyme-inhibitory potential (IC50 for α- glucosidase 1908.06 ± 13.26 µg/mL and for lipase 613.59 ± 7.57 µg/mL) of this extract. Conclusion The conclusive evidence from this study indicates that shade drying and extraction with hydromethanolic solvent preserves most of the nutritional components and has a higher extraction yield with well-conserved phytochemical composition. Also, these bioactive compounds such as hydroxycitric acid, GB-1a, garcinone A, 9-hydroxycalabaxanthone, chlorogenic acid, and garcinol are present in these extracts. This fruit, although beneficial is still underutilized, and this outcome is believed to be significantly valuable for the further aspects of GP fruit-based nutraceutical or phytopharmaceutical development.