bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dying at Home Due to Coronavirus Disease 2019
Authors: Edwards Jessie K , Wohl David Alain 
Published: August 2022

Abstract

Background
Coronavirus disease 2019 (COVID-19) is a leading cause of US deaths and when severe requires admission to a hospital; however, 9% of US COVID-19 deaths before 2022 occurred at home.

Methods
Death certificate data were used to examine the cumulative probability of dying at home from COVID-19 and from any cause in North Carolina, including by race and ethnicity.

Results
Between March 1, 2020 and December 31, 2021, 22 646 COVID-19 deaths were recorded in North Carolina; of these, 1771 (7.8%) occurred at home. Cumulative risk of dying at home with COVID-19 increased from 3.3/100 000 on December 31, 2020 to 13.0/100 000 on December 31, 2021. After standardizing each racial/ethnic group, cumulative at-home COVID-19 mortality among Hispanic people compared to White people was 9.9/100 000 versus 2.3/100 000, respectively, at year-end 2020 (difference, 7.6/100 000; 95% confidence interval [CI], 5.6–9.6) and 19.0/100 000 versus 11.4/100 000 at year-end 2021 (difference, 7.6; 95% CI, 4.9–10.4). At-home mortality among Black people was also elevated compared to White people (difference, 5.6/100 000; 95% CI, 3.7–7.4) at year-end 2021. Rates of dying at home from any cause increased overall but were greatest among Hispanic people.

Conclusions
By the end of 2021, the risk of dying at home from COVID-19 increased, especially for persons of color. The risk of dying at-home from any cause also increased for all but more so for Hispanic persons. These findings suggest perennial barriers to care prevent those with progressive COVID-19 from accessing medical attention and the need for initiatives that extend healthcare access for those disproportionately impacted by COVID-19 to prevent avoidable death.
A Quantitative Model of Dynamic Moral Hazard
Authors: Ai Hengjie , Kiku Dana , Li Rui 
Published: August 2022

AbstractWe develop an equilibrium model with moral hazard, which arises because some productivity shocks are privately observed by firm managers only. We characterize the optimal contract and its implications for firm size, growth, and managerial pay-performance sensitivity and exploit them to quantify the severity of the moral hazard problem. Our estimation suggests that unobservable shocks are relatively modest and account for about 10$\%$ of the total variation of firm output. Nonetheless, moral-hazard-induced incentive pay is quantitatively significant and accounts for 50$\%$ of managerial compensation. Eliminating moral hazard would result in about a 1$\%$ increase in aggregate output.
Optimizing the Internal Cell Structure of the Radon Monitor Based on Electrostatic Collection Method
Authors: Fan Zhongkai , Xie Lin , Lin Fen , Hu Tao , Mo Yixiang , Yuan Hongzhi , Tan Yanliang 
Published: August 2022

Abstract
As Rn-222 decays, an alpha particle is emitted and the residual polonium nucleus recoils in the opposite direction. At the end of the recoil path, 88% of the polonium atoms have a positive charge and 12% are neutral. The electric potential distribution in the 60 ml hemispherical internal cell of the radon monitor based on electrostatic collection is studied for reducing the combined probability of the positively charged Po-218 and the OH− produced by the ionization of water vapour in the air. The COMSOL software is used to simulate the electric potential distribution in the internal cell of the radon monitor based on the electrostatic collection method at 27°C, a pressure of 0.1 Mpa. For improving the collection efficiency of Po-218 ions, the average collection time along vertical and oblique lines is calculated when the upper surface of the internal cell is plastic, uncharged metal and charged metal, respectively. Assuming that the gas in the internal cell is uniformly distributed, the results show that if the upper surface of the hemispherical internal cell is plastic or uncharged metal, the electric potential formed in the internal cell is more uniform, and it is beneficial to reduce the total collection time of the positively charged Po-218 ions, thereby improving collection efficiency. The simulation results can be used as an effective reference for optimizing the design of the internal cell structure of the radon monitor based on electrostatic collection method.
Influence factors and calculation model of the adhesion strength of clayey soil for EPB shield tunnelling
Authors: Wang Shuying , Liu Pengfei , Zhong Jiazheng , Ni Zhunlin , Qu Tongming 
Published: August 2022

Abstract
When earth pressure balance (EPB) shield tunnels are constructed through clayey ground, the soil adheres to the cutter, cutterhead and chamber bulkhead due to the high adhesion strength between the steel and the clay, thus clogging the shield. To investigate the influence of different factors on the adhesion strength, this study used montmorillonite, kaolin and mixtures of the two as test soils. The adhesion strength between the steel and clay is determined with a customized rotary shear apparatus. The results show that when the consistency index of the soil specimen is less than 1, the adhesion strength between the steel and clay increases with the consistency index. As the consistency index decreases, the effect of the normal pressure on the adhesion strength gradually weakened. As the contact angle of the shear plate increases, thus reducing the hydrophilicity, the adhesion strength decreases. When the soil specimens with different plasticity index values have the same consistency index value, the adhesion strengths are similar. The adhesion strength increases gradually with increasing surface roughness. Based on grey incidence analysis, the order of the factors affecting the adhesion strength is as follows: normal pressure &gt; consistency index &gt; contact angle &gt; plasticity index ≈ surface roughness. The normal pressure, consistency index and contact angle all have important effects on the adhesion strength between steel and clay. However, because there are no large differences in the contact angle among the metal materials, the approximate adhesion strength can be calculated by considering the effects of only the normal pressure and consistency index. The measures that are effective for preventing EPB shield clogging are increasing the soil softness and decreasing the hydrophilicity of the cutterhead by applying new materials for the cutters and cutterhead.
Analysis of the potential role of fission yeastPP2Ain spindle assembly checkpoint inactivation
Authors: Deng Da‐Jie , Wang Xi , Yue Kai‐Ye , Wang Yamei , Jin Quan‐Wen 
Published: August 2022

AbstractAs a surveillance mechanism, the activated spindle assembly checkpoint (SAC) potently inhibits the E3 ubiquitin ligase APC/C (anaphase‐promoting complex/cyclosome) to ensure accurate chromosome segregation. Although the protein phosphatase 2A (PP2A) has been proposed to be both, directly and indirectly, involved in spindle assembly checkpoint inactivation in mammalian cells, whether it is similarly operating in the fission yeastSchizosaccharomycer pombehas never been demonstrated. Here, we investigated whether fission yeast PP2A is involved in SAC silencing by following the rate of cyclin B (Cdc13) destruction at SPBs during the recovery phase innda3‐KM311cells released from the inhibition of APC/C by the activated spindle checkpoint. The timing of the SAC inactivation is only slightly delayed when two B56 regulatory subunits (Par1 and Par2) of fission yeast PP2A are absent. Overproduction of individual PP2A subunits either globally in thenda3‐KM311arrest‐and‐release system or locally in the synthetic spindle checkpoint activation system only slightly suppresses the SAC silencing defects in PP1 deletion (dis2Δ) cells. Our study thus demonstrates that the fission yeast PP2A is not a key regulator actively involved in SAC inactivation.
Retinoic acid regulates pyruvate dehydrogenase kinase 4 (Pdk4) to modulate fuel utilization in the adult heart: Insights from wild‐type and β‐carotene 9′,10′ oxygenase knockout mice
Authors: Holloway Chelsee , Zhong Guo , Kim Youn‐Kyung , Ye Hong , Sampath Harini , Hammerling Ulrich , Isoherranen Nina , Quadro Loredana 
Published: August 2022

AbstractRegulation of the pyruvate dehydrogenase (PDH) complex by the pyruvate dehydrogenase kinase PDK4 enables the heart to respond to fluctuations in energy demands and substrate availability. Retinoic acid, the transcriptionally active form of vitamin A, is known to be involved in the regulation of cardiac function and growth during embryogenesis as well as under pathological conditions. Whether retinoic acid also maintains cardiac health under physiological conditions is unknown. However, vitamin A status and intake of its carotenoid precursor β‐carotene have been linked to the prevention of heart diseases. Here, we provide in vitro and in vivo evidence that retinoic acid regulates cardiac Pdk4 expression and thus PDH activity. Furthermore, we show that mice lacking β‐carotene 9′,10′‐oxygenase (BCO2), the only enzyme of the adult heart that cleaves β‐carotene to generate retinoids (vitamin A and its derivatives), displayed cardiac retinoic acid insufficiency and impaired metabolic flexibility linked to a compromised PDK4/PDH pathway. These findings provide novel insights into the functions of retinoic acid in regulating energy metabolism in adult tissues, especially the heart.
Dapagliflozin for patients with heart failure and reduced ejection fraction
Authors: Ferry Abigail 
Published: August 2022

ABSTRACT
The CDC estimates that national costs related to heart failure exceed $30 billion annually. Clinicians and researchers continue to aggressively pursue measures aimed at reducing morbidity and mortality among the 6.5 million adults affected by the disease. Dapagliflozin recently emerged as a promising FDA-approved therapy for patients with systolic heart failure, more commonly referred to as heart failure with reduced ejection fraction.
Direct-acting oral anticoagulants in patients with atrial fibrillation and valvular heart disease
Authors: Canales Natalie , Cao Tina , Fakourfar Neeloufar , Snee Mara , Tsu Laura 
Published: August 2022

ABSTRACT
Direct-acting oral anticoagulants (DOACs) are an effective alternative to warfarin for patients with atrial fibrillation (AF) who require thromboembolic risk reduction. This article discusses the newly acceptable use of DOACs in patients with valvular AF, including native valvular heart disease and patients with bioprosthetic valves.
Seven facts you need to know about continuous glucose monitors
Authors: Solano Laura 
Published: August 2022

ABSTRACT
This article reviews seven facets of continuous glucose monitors (CGMs): how they work, advantages for patients and clinicians, device limitations, effect on outcomes in patients with diabetes, who should be prescribed these devices, their cost, and their accuracy. Four major CGMs marketed today are compared: Abbott's FreeStyle Libre, Medtronic's Guardian, Dexcom's G6, and Senseonic's Eversense.
Increasing Access to Diabetes Education in Rural Alabama Through Telehealth
Authors: Ladner Kathleen A. , Berry Shaina R. , Hardy Jessica 
Published: August 2022

ABSTRACT:
The high prevalence of diabetes in Alabama and the limited diabetes education available to patients in that state suggest that new interventions are needed. To that end, the authors developed a project to assess whether the use of telehealth technology to deliver diabetes self-management education and support (DSMES) in a small group setting is an effective and acceptable way to increase access to such education by underserved individuals. Certified diabetes educators, RNs, and telehealth services at three rural county health departments in Alabama implemented a DSMES program. Data were collected from participant registration forms, pre- and postintervention surveys, and telehealth surveys to assess participants' baseline and postintervention diabetes knowledge, self-care, and sense of self-efficacy. Blood pressure, glycated hemoglobin (HbA1c) levels, and weight were also measured before and after the intervention. Forty-two people attended the DSMES program and participated in its evaluation. The findings demonstrated that for this sample, telehealth was an effective and acceptable way to conduct DSMES. The substantial improvements in health status, coupled with the fact that most participants had never participated in a DSMES program before, highlight the untapped potential of such programs to increase access to diabetes education in underserved areas.
Efforts Needed to Improve Real-World Effectiveness of HIV Prophylaxis
Authors: Rosenberg Karen 
Published: August 2022

According to this study:

Suboptimal consumption and frequent discontinuation of preexposure prophylaxis (PrEP) in men who are at high risk for HIV make PrEP less effective in real-world conditions than in clinical trials.Better monitoring of compliance is needed to make PrEP more effective, especially among young and socioeconomically deprived recipients.
Opioid and Sedative NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Non-Emergent Spine Surgery
Authors: Emara Ahmed K. , Sultan Assem , Grits Daniel , Savage Jason , Piuzzi Nicolas S. , Pelle Dominic W. 
Published: August 2022

Study Design.
Prospectively Captured Cohort.

Objective.
To explore associations between the preoperative opioid-specific NarxCare Scores NCS(NCS-opioids) as well as sedative-specific NCS(NCS-sedatives) as measures of patients’ prescription drug use and (1)90-day postoperative readmission; (2)E.D. visits; (3)reoperation; (4)prolonged (>2 d) hospital length of stay(LOS); and (5)non-home discharge. In addition, we sought to evaluate the previously suggested 300+ threshold as a cutoff for moderate/high-risk designation.

Background.
The association between preoperative opioids and sedative use and healthcare utilization after non-emergent spine surgery is not well quantified. The NarxCare score (NCS) is a weighted scalar measure of opioids and sedatives that accounts for the number of prescribing providers, dispensing pharmacies, milligram equivalence doses, and overlapping prescription days.

Methods.
A total of 4,680 non-emergent spine surgery cases were included. Preoperative NCS-Opioids/Sedatives were captured. Bivariate and multivariable regression models were constructed to analyze associations between NCS-opioids/sedatives ranges and outcomes while accounting for baseline differences. Spline regression and propensity score matching (PSM) analyses were also implemented.

Results.
For NCS-opioid, multivariable regression demonstrated higher odds of prolonged LOS starting in the 400-499 NCS-opioids category (odds ratio(OR)1.44; 95% confidence interval(CI)[1.05-1.97];P=0.026) going into the 500+ category(OR:1.94; 95%CI[1.29-2.93];P=0.002). The 500+ categories exhibited higher odds of 90-day readmission (OR:1.77; 95%CI[1.01-3.09];P=0.045). PSM comparison demonstrated that patients within the 300+ category had higher incidence of prolonged LOS[n=455(44%) vs. n=537(52%); P<0.001], 90-day readmission [n=118(11%) vs. n=155(15%);P=0.019] and 90-day reoperation[n=51(4.9%) vs. n=74(7.2%); P=0.042]. For NCS-sedative; there was higher odds of prolonged LOS(OR:1.73; 95%CI[1.14- 2.63];P=0.010) and non-home discharge(OR:2.09; 95%CI:[1.22-3.63];P=0.008) within the 400-499 NCS-sedatives category. PSM comparison demonstrated significantly higher rates of prolonged LOS within the 300+ NCS-sedative cohort (vs. scores<300), [n=277(44%) vs. 319(50%);P=0.021].

Conclusion.
Spine surgery continues to advance towards patient-specific care. Higher NCS-Opioids/Sedatives values may predict up to a two-fold increase in postoperative healthcare utilization. High values should prompt an interdisciplinary approach to mitigate deleterious prescription drug use.
Deriving a Novel Score Predicting Progression in Early-Onset Scoliosis: A Multicenter Initiative
Authors: AlNouri Mason , Wada Kanichiro , Kumagai Gentaro , Asari Toru , Nitobe Yohshiro , Morishima Toshibumi , Uesato Ryoko , Aoki Megumi , Ishibashi Yasuyuki 
Published: August 2022

Study Design.
Retrospective multicenter.

Objective.
Develop a novel progression risk stratification scoring system for early-onset scoliosis.

Summary of Background Data.
There is a lack of investigations into variables affecting risk of curve progression in early-onset scoliosis, which prevents stratification. A novel risk score system is needed to help in progression risk estimation.

Methods.
A retrospective analysis was done at three centers, from 1995 to 2020. Scoliosis cases prior to age 10 years, were included. Medical identifier, date of birth, sex, primary diagnosis, curve type, date/modality of treatment, date of follow-up appointments, and Cobb angles, were collected. Five ranks were selected for stratification. Categories with the same ranks were discarded. Point scores started at 0, for lowest risk, and ended at 4, for highest risk. Iterations of variable combinations were conducted and clinical relevance was determined by evaluating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) based on score ranges for low and high risk of progression.

Results.
A total of 476(230 males,246 females) early-onset scoliosis patients were collected. Average age at diagnosis was 4.8years(SD±2.8 y). Average follow-up duration was 9.3years (SD±6.9 y, range: 5 mo to 38 y). Appointments totaled 2911, giving 2182 observations for the analysis. Patient observations numbered: 800(36.7%) ending in progression, 1265(58.0%) for non-progression, 117(5.4%) for inadequate follow-up, and 368(16.9%) for rapid progression. The risk scoring system contained 4 categories: etiology, age, curve magnitude, and curve type. Categorized point combinations totaled 755, giving 1975 iterations. Sensitivity, specificity, PPV, and NPV were calculated to be 85.8%, 96.5%, 89.7%, and 95.1%, respectively.

Conclusion.
A novel progression risk score for early-onset scoliosis was derived. The system can reliably differentiate between low and high-risk cases in clinical settings. Further validation in other regions may be important for verifying clinical relevance.

Level of Evidence.
3
In-Hospital Depressed Level of Consciousness and Long-Term Functional Outcomes in ICU Survivors*
Authors: Mart Matthew F. , Thompson Jennifer L. , Ely E. Wesley , Pandharipande Pratik P. , Patel Mayur B. , Wilson Jo Ellen , Williams Roberson Shawniqua , Birdrow Caroline I. , Raman Rameela , Brummel Nathan E. 
Published: August 2022

OBJECTIVES:
Among critically ill patients, acutely depressed level of consciousness is associated with mortality, but its relationship to long-term outcomes such as disability and physical function is unknown. We investigated the relationship of level of consciousness during hospitalization with long-term disability and physical function in ICU survivors.

DESIGN:
Multi-center observational cohort study.

SETTING:
Medical or surgical ICUs at five U.S. centers.

PATIENTS:
Adult survivors of respiratory failure or shock.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Depressed level of consciousness during hospitalization was defined using the Richmond Agitation Sedation Scale (RASS) score (including all negative scores) by calculating the area under the curve using linear interpolation. Sedative-associated level of consciousness was similarly defined for all hospital days that sedation was received. We measured disability in basic activities of daily living (BADLs), instrumental activities of daily living (IADLs), discharge destination, and self-reported physical function. In separate models, we evaluated associations between these measures of level of consciousness and outcomes using multivariable regression, adjusted for age, sex, race, body mass index, education level, comorbidities, baseline frailty, baseline IADLs and BADLs, hospital type (civilian vs veteran), modified mean daily Sequential Organ Failure Assessment score, duration of severe sepsis, duration of mechanical ventilation, and hospital length of stay. Of the 1,040 patients enrolled in the ICU, 781 survived to hospital discharge. We assessed outcomes in 624 patients at 3 months and 527 patients at 12 months. After adjusting for covariates, there was no association between depressed level of consciousness (total or sedation-associated) with BADLs or IADLs at either 3- or 12-month follow-up. There was also no association with self-reported physical function at 3 or 12 months or with discharge destination.

CONCLUSIONS:
Depressed level of consciousness, as defined by the RASS, was not associated with disability or self-reported physical function. Future studies should investigate additional modifiable in-hospital risk factors for disability and poor physical function following critical illness.
Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem
Authors: Fantaye Arone Wondwossen , Gnyra Catherine , Lochnan Heather , Wiesenfeld Lorne , Hendry Paul , Whiting Sharon , Kitto Simon 
Published: August 2022

Abstract:There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.