bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Sustained Physical Activity During the COVID-19 Pandemic in People With Parkinson Disease in Sweden
Authors: Moulaee Conradsson David , Leavy Breiffni , Hagströmer Maria , Franzén Erika 
Published: July 2023

Background and Purpose:
During the first wave of the COVID-19 pandemic, people with Parkinson disease (PwPD) reported deterioration in health and physical activity. The aim of this study was to describe 1-year changes in physical activity and perceived health in PwPD during the COVID-19 pandemic and to identify predictors of sustained physical activity.

Methods:
This study compared perceived health and sensor-derived physical activity (Actigraph GT3x) in PwPD between the first (June to July 2020) and third waves (June to July 2021) of the pandemic. Multiple logistic regression analyses were used to predict sustained physical activity across the study period using personal factors, disease severity, and functioning as independent variables.

Results:
Sixty-three PwPD (mean age 71.0 years, 41% females) completed both baseline and 1-year follow-up (26 lost to follow-up). PwPD showed a decrease in average number of steps per day (Δ415 steps, P = 0.048), moderate-to-vigorous-physical activity (Δ7 minutes, P = 0.007) and increase in sedentary time (Δ36 minutes, P<.001) between baseline and 1-year follow-up. While self-perceived walking impairments and depressive symptoms increased significantly, balance confidence decreased between baseline and 1-year follow-up, no significant changes occurred for self-rated health, quality of life, or anxiety. Significant predictors of sustained physical activity levels were 15 years or more of education (odds ratio [OR] = 7.38, P = 0.013) and higher perceived walking ability (OR = 0.18, P = 0.041).

Discussion and Conclusion:
Among PwPD with mild to moderate disease severity living in Sweden, factors associated with reduced physical activity levels during the COVID-19 pandemic included older age, lower education levels, and greater perceived walking difficulties.
At the Intersection of Intersectionality
Authors: Iwai Yoshiko , Yu Alice Yunzi L. , Thomas Samantha M. , Downs-Canner Stephanie , Beasley Georgia M. , Sudan Ranjan , Fayanju Oluwadamilola M. 
Published: July 2023

Objective:
We sought to compare representation of intersectional (i.e., racial/ethnic and gender) identities among surgical faculty versus medical students.

Summary Background Data:
Health disparities are pervasive in medicine, but diverse physicians may help the medical profession achieve health equity.

Methods:
Data from the AAMC for 140 programs (2011/2012-2019/2020) were analyzed for students and full-time surgical faculty. Underrepresented in medicine (URiM) was defined as Black/African American; American Indian/Alaskan Native; Hispanic/Latino/Spanish Origin; or Native Hawaiian/Other Pacific Islander. Non-White included URiM plus Asian, multiracial, and non-citizen permanent residents. Linear regression was used to estimate the association of year and proportions of URiM and non-White female and male faculty with proportions of URiM and non-White students.

Results:
Medical students were comprised of more White (25.2% vs. 14.4%), non-White (18.8% vs. 6.6%), and URiM (9.6% vs. 2.8%) women and concomitantly fewer men across all groups versus faculty (all P<0.01). While the proportion of White and non-White female faculty increased over time (both p≤0.001), there was no significant change among non-White URiM female faculty, nor among non-White male faculty, regardless of whether they were URiM or not. Having more URiM male faculty was associated with having more non-White female students (estimate =+14.5% students/100% increase in faculty, 95% CI 1.0-28.1%, P=0.04), and this association was especially pronounced for URiM female students (estimate =+46.6% students/100% increase in faculty, 95% CI 36.9-56.3%, P<0.001).

Conclusion:
URiM faculty representation has not improved despite a positive association between having more URiM male faculty and having more diverse students.
Novel Application of a Dynamic, In-Room Survey Platform to Measure Surgical Team Satisfaction
Authors: Witmer Hunter D. D. , Morris-Levenson Joshua A. , Keçeli Çağla , Godley Frederick A. , Dhiman Ankit , Adelman Daniel , Turaga Kiran K. 
Published: July 2023

Objective:
This study aims to elucidate the potential usage of continuous feedback regarding team satisfaction and correlations with operative performance and patient outcomes.

Background:
Continuous, actionable assessment of teamwork quality in the operating room (OR) is challenging. This work introduces a novel, data-driven approach to prospectively and dynamically assess healthcare provider (HCP) satisfaction with teamwork in the OR.

Methods:
Satisfaction with teamwork quality for each case was assessed utilizing a validated prompt displayed on HappyOrNot® Terminals™ placed in all ORs, with separate panels for circulators, scrub nurses, surgeons, and anesthesia providers. Responses were cross-referenced with OR log data, team familiarity indicators, efficiency parameters and patient safety indicator events through continuous, semi-automated data marts. De-identified responses were analyzed via logistic regression modeling.

Results:
Over a 24-week period, 4,123 responses from 2,107 cases were recorded. The overall response rate per-case was 32.5%. Greater scrub nurse specialty experience was strongly associated with satisfaction (odds ratio 2.15, 95% CI 1.53—3.03, P<0.001). Worse satisfaction was associated with longer than expected procedure time (odds ratio 0.91, 95% CI 0.82—1.00, P=0.047), nighttime (0.67, 95% CI 0.55—0.82, P<0.001) and add-on cases (0.72, 95% CI 0.60—0.86, P<0.001). Higher material costs (22%, 95% CI 6—37%, P=0.006) were associated with greater team satisfaction. Cases with superior teamwork ratings were associated with a 15% shorter length of hospital stay (95% CI 4—25%, P=0.006).

Conclusions:
This study demonstrates for the feasibility of a dynamic survey platform to report actionable HCP satisfaction metrics in real-time. Team satisfaction is associated with modifiable team variables and some key operational outcomes. Leveraging qualitative measurements of teamwork as operational indicators may augment staff engagement and measures of performance.
Ondansetron for Low Anterior Resection Syndrome (LARS)
Authors: Popeskou Sotirios Georgios , Roesel Raffaello , Faes Seraina , Vanoni Alice , Galafassi Jacopo , di Tor Vajana Antonjacopo Ferrario , Piotet Laure-Meline , Christoforidis Dimitri 
Published: July 2023

Objective:
This study examines the efficacity and safety of Ondansetron, a serotonin receptor antagonist, to treat patients with LARS.

Background:
Low Anterior Resection Syndrome (LARS) after rectal resection is common and debilitating. Current management strategies include behavioural and dietary modifications, physiotherapy, antidiarrheal drugs, enemas and neuromodulation, but results are not always satisfactory.

Methods:
This is a randomized, multi-centric, double-blinded, placebo-controlled, cross-over study. Patients with LARS (LARS score >20) no longer than 2 years after rectal resection were randomised to receive either 4 weeks of Ondansetron followed by 4 weeks of placebo (O-P group) or 4 weeks of placebo followed by 4 weeks of Ondansetron (P-O group). The primary endpoint was LARS severity measured using the LARS score; secondary endpoints were incontinence (Vaizey score) and quality of life (IBS-QoL questionnaire). Patients’ scores and questionnaires were completed at baseline and after each 4-week treatment period.

Results:
Out of 46 randomized patients, 38 were included in the analysis. From baseline to the end of the first period, in the O-P group, the mean (SD) LARS score decreased by 25% (from 36.6 (5.6) to 27.3 (11.5)) and the proportion of patients with major LARS (score >30) went from 15/17 (88%) to 7/17 (41%), (P=0.001). In the P-O group, the mean (SD) LARS score decreased by 12% (from 37 (4.8) to 32.6 (9.1)), and the proportion of major LARS went from 19/21 (90%) to 16/21 (76%). After cross over, LARS scores deteriorated again in the O-P group receiving placebo, but further improved in the P-O group receiving Ondansetron. Mean Vaizey scores and IBS QoL scores followed a similar pattern.

Conclusion:
Ondansetron is a safe and simple treatment that appears to improve both symptoms and quality of life in LARS patients.
The Association of ACGME Milestones with Performance on American Board of Surgery Assessments
Authors: Weaver M. Libby , Carter Taylor , Yamazaki Kenji , Hamstra Stanley J. , Holmboe Eric , Chaer Rabih , Park Yoon Soo , Smith Brigitte K. 
Published: July 2023

Objective:
To determine the relationship between, and predictive utility of, Milestone ratings and subsequent American Board of Surgery(ABS) vascular in-training(VSITE), qualifying(VQE), and certifying examination(VCE) performance in a national cohort of vascular surgery trainees.

Summary Background Data:
Specialty board certification is an important indicator of physician competence. However, predicting future board certification examination performance during training continues to be challenging.

Methods:
This is a national longitudinal cohort study examining relational and predictive associations between ACGME Milestone ratings and performance on VSITE, VQE, and VCE for all vascular surgery trainees from 2015 through 2021. Predictive associations between Milestone ratings and VSITE were conducted using cross-classified random-effects regression. Cross-classified random-effects logistic regression was utilized to identify predictive associations between Milestone ratings and VQE and VCE.

Results:
Milestone ratings were obtained for all residents and fellows(n=1,118) from 164 programs during the study period(July 2015-June 2021), including 145,959 total trainee assessments. Medical Knowledge(MK) and Patient Care(PC) Milestone ratings were strongly predictive of VSITE performance across all post-graduate years(PGYs) of training, with MK ratings demonstrating a slightly stronger predictive association overall(MK Coefficient 17.26-35.76,β = 0.15- 0.23). All core competency ratings were predictive of VSITE performance in PGYs 4 and 5. PGY 5 MK were highly predictive of VQE performance(OR 4.73,[95% CI: 3.87-5.78],P<0.001). PC subcompetencies were also highly predictive of VQE performance in the final year of training(OR 4.14,[95% CI: 3.17-5.41],P<0.001). All other competencies were also significantly predictive of first-attempt VQE pass with ORs of 1.53 and higher. PGY 4 ICS ratings(OR 4.0,[95% CI: 3.06-5.21],P<0.001) emerged as the strongest predictor of VCE first-attempt pass. Again, all subcompetency ratings remained significant predictors of first-attempt pass on CE with ORs of 1.48 and higher.

Conclusions:
ACGME Milestone ratings are highly predictive of future VSITE performance, and first-attempt pass achievement on VQE and VCE in a national cohort of surgical trainees.
Propensity-Score Matched Analysis of Three Years Survival of Trans Carotid Artery Revascularization Versus Carotid Endarterectomy in the Vascular Quality Initiative Medicare-Linked Database
Authors: Zarrintan Sina , Elsayed Nadin , Patel Rohini J. , Clary Bryan , Goodney Philip P. , Malas Mahmoud B. 
Published: July 2023

Objective:
Carotid endarterectomy (CEA) remains the gold standard procedure for carotid revascularization. Transfemoral carotid artery stenting (TFCAS) was introduced as a minimally invasive alternative procedure in patients who are at high risk for surgery. However, TFCAS was associated with an increased risk of stroke and death compared to CEA.

Background:
Transcarotid artery revascularization (TCAR) has outperformed TFCAS in several prior studies and has shown similar perioperative and 1-year outcomes compared with CEA. We aimed to compare the 1-year and 3-year outcomes of TCAR versus CEA in the Vascular Quality Initiative (VQI)-Medicare-Linked [Vascular Implant Surveillance and Interventional Outcomes Network (VISION)] database.

Methods:
The VISION database was queried for all patients undergoing CEA and TCAR between September 2016 to December 2019. The primary outcome was 1-year and 3-year survival. One-to-one propensity-score matching (PSM) without replacement was used to produce 2 well-matched cohorts. Kaplan-Meier estimates, and Cox regression was used for analyses. Exploratory analyses compared stroke rates using claims-based algorithms for comparison.

Results:
A total of 43,714 patients underwent CEA and 8089 patients underwent TCAR during the study period. Patients in the TCAR cohort were older and were more likely to have severe comorbidities. PSM produced two well-matched cohorts of 7351 pairs of TCAR and CEA. In the matched cohorts, there were no differences in 1-year death [hazard ratio (HR)=1.13; 95% CI, 0.99–1.30; P=0.065]. At 3-years, TCAR was associated with slight increased risk of death (HR=1.16; 95% CI, 1.04–1.30; P=0.008). When stratifying by initial symptomatic presentation, the increased 3-year death associated with TCAR persisted only in symptomatic patients (HR=1.33; 95% CI, 1.08–1.63; P=0.008). Exploratory analyses of postoperative stroke rates using administrative sources suggested that validated measures of claims-based stroke ascertainment are necessary.

Conclusions:
In this large multi-institutional PSM analysis with robust Medicare-linked follow-up for survival analysis, the rate of death at 1 year was similar in TCAR and CEA regardless of symptomatic status. The slight increase in the risk of 3-year death in symptomatic patients undergoing TCAR is likely confounded by more severe comorbidities despite matching. A randomized controlled trial comparing TCAR to CEA is necessary to further determine the role of TCAR in standard-risk patients requiring carotid revascularization.
The ratio between SARS-CoV-2 RNA viral load and culturable viral titer differs depending on stage of infection
Authors: Porter Michael K. , Viloria Winnett Alexander , Hao Linhui , Shelby Natasha , Reyes Jessica A. , Schlenker Noah W. , Romano Anna E. , Tognazzini Colton , Feaster Matthew , Goh Ying-Ying , Gale Michael , Ismagilov Rustem F. 
Published: July 2023

AbstractAnalysis of incident, longitudinal RNA viral loads in saliva and nasal swabs and culturable viral titers in nasal swabs collected twice-daily by a tricenarian male infected with SARS-CoV-2 revealed the ratio between viral load and viral titer can be five orders of magnitude higher during early infection than late infection.
Bayesian genome-wide TWAS with reference transcriptomic data of brain and blood tissues identified 93 risk genes for Alzheimer’s disease dementia
Authors: Guo Shuyi , Yang Jingjing 
Published: July 2023

AbstractBackgroundTranscriptome-wide association study (TWAS) is an influential tool for identifying novel genes associated with complex diseases, where their genetic effects may be mediated through transcriptome. TWAS utilizes reference genetic and transcriptomic data to estimate genetic effect sizes on expression quantitative traits of target genes (i.e., effect sizes of a broad sense of expression quantitative trait loci, eQTL). These estimated effect sizes are then employed as variant weights in burden gene-based association test statistics, facilitating the mapping of risk genes for complex diseases with genome-wide association study (GWAS) data. However, most existing TWAS of Alzheimer’s disease (AD) dementia have primarily focused oncis-eQTL, disregarding potentialtrans-eQTL. To overcome this limitation, we applied the Bayesian Genome-wide TWAS (BGW-TWAS) method which incorporated bothcis- andtrans-eQTL of brain and blood tissues to enhance mapping risk genes for AD dementia.MethodsWe first applied BGW-TWAS to the Genotype-Tissue Expression (GTEx) V8 dataset to estimatecis- andtrans-eQTL effect sizes of the prefrontal cortex, cortex, and whole blood tissues. Subsequently, estimated eQTL effect sizes were integrated with the summary data of the most recent GWAS of AD dementia to obtain BGW-TWAS (i.e., gene-based association test) p-values of AD dementia per tissue type. Finally, we used the aggregated Cauchy association test to combine TWAS p-values across three tissues to obtain omnibus TWAS p-values per gene.ResultsWe identified 37 genes in prefrontal cortex, 55 in cortex, and 51 in whole blood that were significantly associated with AD dementia. By combining BGW-TWAS p-values across these three tissues, we obtained 93 significant risk genes including 29 genes primarily due totrans-eQTL and 50 novel genes. Utilizing protein-protein interaction network and phenotype enrichment analyses with these 93 significant risk genes, we detected 5 functional clusters comprised of both known and novel AD risk genes and 7 enriched phenotypes.ConclusionWe applied BGW-TWAS and aggregated Cauchy test methods to integrate bothcis- andtrans-eQTL data of brain and blood tissues with GWAS summary data to identify risk genes of AD dementia. The risk genes we identified provide novel insights into the underlying biological pathways implicated in AD dementia.
The Implementation and Evaluation of the James Hakim Leadership Development Program in Africa: process, lessons Learned, and Feedback from the Participants
Authors: Mubuuke Aloysius Gonzaga , Bercasio Alyssa , Yeboah Georgina , Kiguli-Malwadde Elsie , Kazembe Abigail , Forster Maeve , von Zinkernagel Deborah , Anderson Ellie , Sam-Woode Clara E. , Nkomazana Oathokwa , Mukwato Patricia Katowa , Reid Michael J A , de Villiers Marietjie 
Published: July 2023

AbstractBackgroundEffective leadership is crucial for improving the quality of health professionals trained in Sub-Saharan Africa (SSA). However, many health professions training institutions lack formal faculty mentorship programs for leaders, leaving faculty to learn on the job without formal support. To address this gap, the African Forum for Research and Education in Health (AFREhealth) developed an innovative leadership capacity-strengthening program, named after the late educator and research, James Hakim. Objective: This article describes the design and implementation of the AFREhealth leadership training program and how it could bridge the leadership skills gap in health professions education in SSA. The objective of the article is to describe the program’s implementation process, share the experiences of participants, and discuss lessons learned.MethodsThe AFREhealth leadership training program was developed through consultative meetings, after a landscape review of existing leadership training programs. The program was designed to be delivered virtually over a 12-week period, and the curriculum included modules on leadership styles and personality, mentorship, change management, conflict management, budgeting, resource mobilization, building partnerships, inter-professional education & collaborative practice, and working on inter-professional teams. Training activities included weekly workshops, small group discussions, readings, reflective sessions with senior health leaders/experts, focused mentorship sessions, and a guided project design capstone. Surveys were conducted to obtain feedback from participants and assess the program’s impact on their ongoing leadership roles in their institutions.ResultsThe leadership training program was implemented twice in a 20-month period, with 68 trainees completing the program. Participants reported increased knowledge, skills, and confidence in attaining key leadership competencies. The virtual delivery of the training allowed for a wide pool of applicants to participate, and the curriculum was designed to be adaptable for other institutions.ConclusionThe AFREhealth leadership development program demonstrated the need for mentoring health professions education leaders in Africa and the effectiveness of virtual training methods. The innovative curriculum and delivery model provide a valuable resource for other institutions seeking to build leadership capacity in health professions education.
Towards Medical Billing Automation: NLP for Outpatient Clinician Note Classification
Authors: Crowson Matthew G. , Alsentzer Emily , Fiskio Julie , Bates David W. 
Published: July 2023

ABSTRACTObjectivesOur primary objective was to develop a natural language processing approach that accurately predicts outpatient Evaluation and Management (E/M) level of service (LoS) codes using clinicians’ notes from a health system electronic health record. A secondary objective was to investigate the impact of clinic note de-identification on document classification performance.MethodsWe used retrospective outpatient office clinic notes from four medical and surgical specialties. Classification models were fine-tuned on the clinic notes datasets and stratified by subspecialty. The success criteria for the classification tasks were the classification accuracy and F1-scores on internal test data. For the secondary objective, the dataset was de-identified using Named Entity Recognition (NER) to remove protected health information (PHI), and models were retrained.ResultsThe models demonstrated similar predictive performance across different specialties, except for internal medicine, which had the lowest classification accuracy across all model architectures. The models trained on the entire note corpus achieved an E/M LoS CPT code classification accuracy of 74.8% (CI 95: 74.1-75.6). However, the de-identified note corpus showed a markedly lower classification accuracy of 48.2% (CI 95: 47.7-48.6) compared to the model trained on the identified notes.ConclusionThe study demonstrates the potential of NLP-based document classifiers to accurately predict E/M LoS CPT codes using clinical notes from various medical and procedural specialties. The models’ performance suggests that the classification task’s complexity merits further investigation. The de-identification experiment demonstrated that de-identification may negatively impact classifier performance. Further research is needed to validate the performance of our NLP classifiers in different healthcare settings and patient populations and to investigate the potential implications of de-identification on model performance.
Fully Automated Sequential Immunofluorescence (seqIF) for Hyperplex Spatial Proteomics
Authors: Rivest François , Eroglu Deniz , Pelz Benjamin , Kowal Joanna , Kehren Alexander , Procopio Maria Giuseppina , Bordignon Pino , Pérès Emilie , Ammann Marco , Dorel Emmanuel , Scalmazzi Sylvain , Bruno Lorenzo , Ruegg Matthieu , Campargue Gabriel , Casqueiro Gilles , Arn Lionel , Fischer Jérôme , Brajkovic Saska , Joris Pierre , Cassano Marco , Dupouy Diego 
Published: July 2023

AbstractTissues are complex environments where different cell types are in constant interaction with each other and with non-cellular components. Preserving the spatial context during proteomics analyses of tissue samples has become an important objective for different applications, one of the most important being the investigation of the tumor microenvironment. Here, we describe a multiplexed protein biomarker detection method on the COMET instrument, coined sequential ImmunoFluorescence (seqIF). The fully automated method uses successive applications of antibody incubation and elution, and in-situ imaging enabled by an integrated microscope and a microfluidic chip that provides optimized optical access to the sample. We show seqIF data on different sample types such as tumor and healthy tissue, including 40-plex on a single tissue section that is obtained in less than 24 hours, using off-the-shelf antibodies. We also present extensive characterization of the developed method, including elution efficiency, epitope stability, repeatability and reproducibility, signal uniformity, and dynamic range, in addition to marker and panel optimization strategies. The streamlined workflow using off-the-shelf antibodies, data quality enabling quantitative downstream analysis, and ease of reaching hyperplex levels make seqIF suitable for immune-oncology research and other disciplines requiring spatial analysis, paving the way for its adoption in clinical settings.