bluuebunny/crossref_metadata_2025_split huggingface dataset:
Testing for Cryptococcosis at a Major Commercial Laboratory—United States, 2019–2021
Authors: Benedict Kaitlin , Gold Jeremy A W , Dietz Stephanie , Anjum Seher , Williamson Peter R , Jackson Brendan R 
Published: May 2022

Abstract

Background
Cryptococcosis is a serious opportunistic fungal disease, and the proportion of cases among patients with immunosuppressive conditions other than HIV or organ transplant has increased. Understanding laboratory testing patterns for cryptococcosis is useful for estimating its true burden and developing testing guidance.

Methods
We identified cryptococcosis tests (cryptococcal antigen [CrAg], cryptococcal antibody, and fungal cultures) performed at a major national commercial laboratory ordered during March 1, 2019–October 1, 2021, and analyzed test results, patient and provider features, reasons for testing, geography, and temporal trends.

Results
Among 29 180 serum CrAg tests, 4422 (15.2%) were positive, and among 10 724 cerebrospinal fluid (CSF) CrAg tests, 492 (4.6%) were positive. Frequent reasons for serum CrAg testing in nonhospital settings (10 882 tests) were HIV (44.6%) and cryptococcosis (17.0%); other underlying conditions were uncommonly listed (&lt;10% total). Serum CrAg positivity declined from 25.6% in October 2019 to 11.3% in September 2021. The South had the highest positivity for serum CrAg tests (16.6%), CSF CrAg tests (4.7%), and fungal cultures (0.15%). Among 5009 cryptococcal antibody tests, 5 (0.1%) were positive.

Conclusions
Few outpatient serum CrAg tests were performed for patients with immunocompromising conditions other than HIV, suggesting potential missed opportunities for early detection. Given the high positive predictive value of CrAg testing, research is needed to improve early diagnosis, particularly in patients without HIV. Conversely, the low yield of antibody testing suggests that it may be of low value. The decline in CrAg positivity during the COVID-19 pandemic warrants further investigation.
Real-world evidence on methotrexate-free subcutaneous tocilizumab therapy in patients with rheumatoid arthritis: 24-week data from the SIMPACT study
Authors: Nagy György , Géher Pál , Tamási László , Drescher Edit , Keszthelyi Péter , Pulai Judit , Czirják László , Szekanecz Zoltán , Kiss Gergely , Kovács László 
Published: May 2022

Abstract

Objectives
The aim of the SIMPACT study was to evaluate the efficacy and safety of MTX-free s.c. tocilizumab (TCZ) therapy in RA patients.

Methods
SIMPACT was an open-label, non-controlled, non-randomized, non-interventional study, in which RA patients for whom the treating physicians ordered s.c. TCZ were observed during a 24-week treatment period in Hungarian centres. Although the use of MTX was avoided during the study period, other conventional synthetic DMARDs, oral CSs and NSAIDs were allowed. Study endpoints included the change in DAS28 and clinical activity index (CDAI) scores, the proportion of patients achieving remission in the whole population and in subgroups defined based on prior RA treatment history, and age, weight or biological sex post hoc. The extent of supplementary medication use was monitored.

Results
Three hundred and thirty-seven RA patients were enrolled in 18 study centres. TCZ therapy significantly decreased the disease activity measured by both DAS28 (P = 0.0001) and CDAI (P = 0.0001). Clinical response was more pronounced in biologic-naïve patients and was lower in patients &gt;75 years of age. In the whole population, DAS28 ESR or CRP and CDAI remission rates were 70.10%, 78.95% and 33.59%, respectively. In patients &lt;45 years of age, the CDAI remission rate doubled (67.86%). A significant decrease in the frequency of co-administered medication was reported, including oral CSs and DMARDs.

Conclusion
Real-world clinical evidence on s.c. TCZ reported here is in line with the efficacy outcomes of randomized clinical trials. Subgroup analysis revealed that TCZ was more effective in biologic-naïve patients and in those &lt;75 years old.

Trial registration
ClinicalTrials.gov, http://www.clinicaltrials.gov, NCT02402686.
Invited review: strategic adoption of antibiotic-free pork production: the importance of a holistic approach
Authors: Patience John F , Ramirez Alejandro 
Published: May 2022

AbstractThe discovery of the use of antibiotics to enhance growth in the 1950s proved to be one of the most dramatic and influential in the history of animal agriculture. Antibiotics have served animal agriculture, as well as human and animal medicine, well for more than seven decades, but emerging from this tremendous success has been the phenomenon of antimicrobial resistance. Consequently, human medicine and animal agriculture are being called upon, through legislation and/or marketplace demands, to reduce or eliminate antibiotics as growth promotants and even as therapeutics. As explained in this review, adoption of antibiotic-free (ABF) pork production would represent a sea change. By identifying key areas requiring attention, the clear message of this review is that success with ABF production, also referred to as “no antibiotics ever,” demands a multifaceted and multidisciplinary approach. Too frequently, the topic has been approached in a piecemeal fashion by considering only one aspect of production, such as the use of certain feed additives or the adjustment in health management. Based on the literature and on practical experience, a more holistic approach is essential. It will require the modification of diet formulations to not only provide essential nutrients and energy, but to also maximize the effectiveness of normal immunological and physiological capabilities that support good health. It must also include the selection of effective non-antibiotic feed additives along with functional ingredients that have been shown to improve the utility and architecture of the gastrointestinal tract, to improve the microbiome, and to support the immune system. This holistic approach will require refining animal management strategies, including selection for more robust genetics, greater focus on care during the particularly sensitive perinatal and post-weaning periods, and practices that minimize social and environmental stressors. A clear strategy is needed to reduce pathogen load in the barn, such as greater emphasis on hygiene and biosecurity, adoption of a strategic vaccine program and the universal adoption of all-in-all-out housing. Of course, overall health management of the herd, as well as the details of animal flows, cannot be ignored. These management areas will support the basic biology of the pig in avoiding or, where necessary, overcoming pathogen challenges without the need for antibiotics, or at least with reduced usage.
Climate change impacts shifting landscape of the dairy industry in Hawai‘i
Authors: Adhikari Mandeep , Longman Ryan J , Giambelluca Thomas W , Lee C N , He Yanghua 
Published: May 2022

Abstract
Proper knowledge and understanding of climatic variability across different seasons are important in farm management. To learn more about the potential effects of climate change on dairying in Hawaii, we conducted a study on site-specific climate characterization using several variables including rainfall, wind speed (WS), solar radiation, and temperature, at two dairy farms located on Hawai`i Island, Hawai`i, in Ookala named “OK DAIRY” and in Upolu Point named “UP DAIRY.” Temperature–humidity index (THI) and WS variations in the hottest four months (June to September) were analyzed to determine when critical thresholds that affect animal health are exceeded. Rainfall data were used to estimate the capacity of forage production in 6-mo wet (November to April) and dry (May to October) seasons. Future projections of temperature and rainfall were assessed using mid- and end-century gridded data products for low (RCP 4.5) and high emissions (RCP 8.5) scenarios. Our results showed that the “OK DAIRY” site received higher rainfall than the “UP DAIRY” site, favoring grass growth and forage availability. In addition, the “UP DAIRY” site was more stressful for animals during the summer (THI 69 to 73) than the “OK DAIRY” site (THI 67 to 70) as the THI exceeded the critical threshold of 68, which is conducive for high-lactating cattle. On the “UP DAIRY” site, the THI did not drop below 68 during the summer nights, which created fewer opportunities for cattle to recover from heat stress. Future projections indicated that air temperature would increase 1.3 to 1.8 °C by mid-century and 1.6 to 3.2 °C by the end-century at both farms, and rainfall will increase at the “OK DAIRY” site and decrease at the “UP DAIRY” site by the end-century. The agriculture and livestock industries, particularly the dairy and beef subsectors in Hawai`i, are vulnerable to climate changes as higher temperatures and less rainfall will have adverse effects on cattle. The findings in this study demonstrated how both observed and projected changes in climate support the development of long-term strategies for breeding and holistic livestock management practices to adapt to changing climate conditions.
A Revised Markov Model Evaluating Oophorectomy at the Time of Hysterectomy for Benign Indication
Authors: Rush Shannon K. , Ma Xiuyu , Newton Michael A. , Rose Stephen L. 
Published: May 2022

OBJECTIVE:
To perform an updated Markov modeling to assess the optimal age for bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign indication.

METHODS:
We performed a literature review that assessed hazard ratios (HRs) for mortality by disease, age, hysterectomy with or without BSO, and estrogen therapy use. Base mortality rates were derived from national vital statistics data. A Markov model from reported HRs predicted the proportion of the population staying alive to age 80 years by 1-year and 5-year age groups at time of surgery, from age 45 to 55 years. Those younger than age 50 years were modeled as either taking postoperative estrogen or not; those 50 and older were modeled as not receiving estrogen. Computations were performed with R 3.5.1, using Bayesian integration for HR uncertainty.

RESULTS:
Performing salpingo-oophorectomy before age 50 years for those not taking estrogen yields a lower survival proportion to age 80 years than hysterectomy alone before age 50 years (52.8% [Bayesian CI 40.7–59.7] vs 63.5% [Bayesian CI 62.2–64.9]). At or after age 50 years, there were similar proportions of those living to age 80 years with hysterectomy alone (66.4%, Bayesian CI 65.0–67.6) compared with concurrent salpingo-oophorectomy (66.9%, Bayesian CI 64.4–69.0). Importantly, those taking estrogen when salpingo-oophorectomy was performed before age 50 years had similar proportions of cardiovascular disease, stroke, and people living to age 80 years as those undergoing hysterectomy alone or those undergoing hysterectomy and salpingo-oophorectomy at age 50 years and older.

CONCLUSION:
This updated Markov model argues for the consideration of concurrent salpingo-oophorectomy for patients who are undergoing hysterectomy at age 50 and older and suggests that initiating estrogen in those who need salpingo-oophorectomy before age 50 years mitigates increased mortality risk.
County-Level Associations Between Pregnancy-Related Mortality Ratios and Contextual Sociospatial Indicators
Authors: Barrera Chloe M. , Kramer Michael R. , Merkt Peter T. , Petersen Emily E. , Brantley Mary D. , Eckhaus Lindsay , Beauregard Jennifer L. , Goodman David A. 
Published: May 2022

OBJECTIVE:
To characterize county-level differences in pregnancy-related mortality as a function of sociospatial indicators.

METHODS:
We conducted a cross-sectional multilevel analysis of all pregnancy-related deaths and all live births with available ZIP code or county data in the Pregnancy Mortality Surveillance System during 2011–2016 for non-Hispanic Black, Hispanic (all races), and non-Hispanic White women aged 15–44 years. The exposures included 31 conceptually-grounded, county-specific sociospatial indicators that were collected from publicly available data sources and categorized into domains of demographic; general, reproductive, and behavioral health; social capital and support; and socioeconomic contexts. We calculated the absolute difference of county-level pregnancy-related mortality ratios (deaths per 100,000 live births) per 1-unit increase in the median absolute difference between women living in counties with higher compared with lower levels of each sociospatial indicator overall and stratified by race and ethnicity.

RESULTS:
Pregnancy-related mortality varied across counties and by race and ethnicity. Many sociospatial indicators were associated with county-specific pregnancy-related mortality ratios independent of maternal age, population size, and Census region. Across domains, the most harmful indicators were percentage of low-birth-weight births (absolute ratio difference [RD] 6.44; 95% CI 5.36–7.51), percentage of unemployed adults (RD 4.98; 95% CI 3.91–6.05), and food insecurity (RD 4.92; 95% CI 4.14–5.70). The most protective indicators were higher median household income (RD −2.76; 95% CI −3.28 to −2.24), percentage of college-educated adults (RD −2.28; 95% CI −2.81 to −1.75), and percentage of owner-occupied households (RD −1.66; 95% CI −2.29 to −1.03). The magnitude of these associations varied by race and ethnicity.

CONCLUSION:
This analysis identified sociospatial indicators of pregnancy-related mortality and showed an association between pregnancy-related deaths and place of residence overall and stratified by race and ethnicity. Understanding county-level context associated with pregnancy-related mortality may be an important step towards building public health evidence to inform action to reduce pregnancy-related mortality at local levels.
Association of Pharmacist Prescription of Contraception With Breaks in Coverage
Authors: Rodriguez Maria I. , Manibusan Brynna , Kaufman Menolly , McConnell K. John 
Published: May 2022

OBJECTIVE:
To assess whether pharmacist prescription of combined hormonal contraception is associated with 12-month contraceptive continuation rates or breaks in contraceptive coverage.

METHODS:
We conducted a retrospective cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016, to December 31, 2018. We captured contraceptive use using diagnosis and National Drug Classification codes. We used logistic regression to measure the association between prescription by a pharmacist and 12-month contraceptive continuation rates and breaks in contraceptive coverage. Model covariates included age, rurality, and payer.

RESULTS:
Our study sample consisted of 172,325 contraceptive users, of whom 1,512 (0.9%) received their prescriptions from a pharmacist. Pharmacists were significantly more likely than clinicians to prescribe to women between the ages of 25 and 34 years (50.5% vs 36.9%, P<.05), in urban settings (88.4% vs 81.7%, P<.05), and with commercial insurance (89.2% vs 59.5%, P<.05). We found that the rate of 12 months contraceptive continuation was higher among the population receiving a pharmacist prescription (34.3% vs 21.0%, P<.01). In an adjusted model, the odds of contraceptive continuation at 12 months were 61.0% higher for individuals with any pharmacist prescription (adjusted odds ratio [aOR] 1.61, 95% CI 1.44–1.79) compared with those with clinician prescriptions. Over 6 months, most contraceptive users in both groups experienced a break in coverage, defined as a gap of 1–29 days between prescriptions (61.6% vs 61.9%, P=.89). Breaks in contraceptive use were not significantly associated with prescriber type (aOR 1.03, 95% CI 0.90–1.18).

CONCLUSION:
Compared with clinician prescriptions, pharmacist prescription of contraception is associated with increased odds of 12-month contraceptive continuation rates. However, the frequency of breaks in contraceptive coverage was similar among pharmacist and clinic-based prescribers.

FUNDING SOURCE:
Arnold Ventures.
Association of Body Mass Index With the Use of Health Care Resources in Low-Risk Nulliparous Pregnancies After 39 Weeks of Gestation
Authors: Costantine Maged M. , Sandoval Grecio J. , Grobman William A. , Reddy Uma M. , Tita Alan T.N. , Silver Robert M. , El-Sayed Yasser Y. , Wapner Ronald J. , Rouse Dwight J. , Saade George R. , Thorp John M. , Chauhan Suneet P. , Chien Edward K. , Casey Brian M. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network
Published: May 2022

OBJECTIVE:
To compare health care medical resource utilization in low-risk nulliparous pregnancies according to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) categories.

METHODS:
This is a secondary analysis of a multicenter randomized controlled trial of induction of labor between 39 0/7 39 and 4/7 weeks of gestation compared with expectant management in low-risk nulliparous pregnant people, defined as those without standard obstetric indications for delivery at 39 weeks. Body mass index at randomization was categorized into four groups (lower than 25, 25–29, 30–39, and 40 or higher). The primary outcome of this analysis was time spent in the labor and delivery department from admission to delivery. Secondary outcomes included length of stay (LOS) postdelivery, total hospital LOS, and antepartum, intrapartum, and postpartum resource utilization, which were defined a priori. Multivariable generalized linear modeling and logistic regressions were performed, and 99% CIs were calculated.

RESULTS:
A total of 6,058 pregnant people were included in the analysis; 640 (10.6%) had BMIs of lower than 25, 2,222 (36.7%) had BMIs between 25 and 29, 2,577 (42.5%) had BMIs of 30–39, and 619 (10.2%) had BMIs of 40 or higher. Time spent in the labor and delivery department increased from 15.1±9.2 hours for people with BMIs of lower than 25 to 23.5±13.6 hours for people with BMIs of 40 or higher, and every 5-unit increase in BMI was associated with an average 9.8% increase in time spent in the labor and delivery department (adjusted estimate per 5-unit increase in BMI 1.10, 99% CI 1.08–1.11). Increasing BMI was not associated with an increase in antepartum resource utilization, except for blood tests and urinalysis. However, increasing BMI was associated with higher odds of intrapartum resource utilization, longer total hospital LOS, and postpartum resource utilization. For example, every 5-unit increase in BMI was associated with an increase of 26.1% in the odds of antibiotic administration, 57.6% in placement of intrauterine pressure catheter, 5.1% in total inpatient LOS, 31.0 in postpartum emergency department visit, and 23.9% in postpartum hospital admission.

CONCLUSION:
Among low-risk nulliparous people, higher BMI was associated with longer time from admission to delivery, total hospital LOS, and more frequent utilization of intrapartum and postpartum resources.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01990612.
Use of Estrogen Therapy After Surgical Menopause in Women Who Are Premenopausal
Authors: Suzuki Yukio , Huang Yongmei , Melamed Alexander , Clair Caryn M. St. , Hou June Y. , Khoury-Collado Fady , Gockley Allison , Accordino Melissa , Hershman Dawn L. , Wright Jason D. 
Published: May 2022

OBJECTIVE:
To examine the use of estrogen therapy (ET) and patterns of follow-up evaluation for sequelae of estrogen deprivation among women who were premenopausal who underwent bilateral salpingo-oophorectomy (BSO) for benign gynecologic diseases.

METHODS:
The IBM Watson Health MarketScan Research Databases were used to identify women between age 18 and 50 years who underwent BSO from 2008 to 2019. Estrogen therapy was defined as any prescription of estrogen filled from 6 weeks before BSO to 36 months after BSO. Patterns of follow-up testing including bone mineral density and lipid testing were examined.

RESULTS:
We identified a total of 61,980 women who underwent BSO for benign indications. Overall, 64.5% (95% CI 64.1–64.9%) of women received ET. The rate of ET use within 36 months of surgery declined from a peak of 69.5% in 2008 to 58.2% in 2016. The median duration of continuous ET was 5.3 months. Estrogen therapy use declined with increasing age. The cumulative rate of ET use at 36 months after surgery was 79.1% (95% CI 76.9–81.1) in those aged 18–29 years, 75.9% (95% CI 74.5–77.3%) in those aged 30–34 years, 70.2% (95% CI 69.1–71.2%) in those aged 35–39 years, 66.1% (95% CI 65.3–66.9%) in those aged 40–44 years, and 60.0% (95% CI 59.4–60.6%) in those aged 45–50 years. In a multivariable model, women who underwent surgery more recently and those with medical comorbidities were less likely to receive ET, whereas younger women, those with Medicaid insurance, those outside of the northeast, and those who underwent concurrent hysterectomy were more likely to receive ET.

CONCLUSION:
Estrogen therapy use in women who are premenopausal who underwent BSO for benign gynecologic diseases has declined substantially over the past decade.
Apical Support Procedures at the Time of Hysterectomy for Benign Indications
Authors: Wang Rui , Tulikangas Paul , Harvie Heidi S. 
Published: May 2022

OBJECTIVE:
To assess the cost effectiveness of performing routine concurrent apical support procedures at the time of hysterectomy for benign indications.

METHODS:
We developed a Markov decision model from the health care sector perspective to compare concurrent apical support (ie, McCall culdoplasty) at the time of hysterectomy for benign indications compared with hysterectomy alone. We modeled Markov transitions between asymptomatic, prolapse without treatment, and treated prolapse states for 3 years. Our primary outcome was incremental cost-effectiveness ratio, defined as the difference between groups in mean cost (2019 U.S. dollars) divided by the difference in mean quality-adjusted life-years (QALYs). Model parameter estimates were taken from the published medical literature. Cost estimates were obtained from Medicare reimbursement rates and the literature. One-way, two-way, and probabilistic sensitivity analyses were performed.

RESULTS:
We assumed a base-case scenario of 13% posthysterectomy prolapse after hysterectomy alone and 2.1% after concurrent apical support, 5.8% and 0.9% undergoing subsequent surgical treatment for prolapse, respectively. Concurrent apical support at the time of hysterectomy had higher costs ($1,667 vs $1,423) but was more effective (2.34 vs 2.31 QALYs) than hysterectomy alone. Concurrent apical support was cost effective with an incremental cost-effectiveness ratio of $11,988/QALY, compared with general willingness-to-pay ranges of $50,000–150,000/QALY. In sensitivity analyses, concurrent apical support remained cost effective as long as the rate of posthysterectomy prolapse after concurrent apical support remained less than 8.7%. Monte Carlo simulation showed that concurrent apical support was cost effective in more than 60% of the simulated iterations.

CONCLUSION:
Apical support at the time of hysterectomy for benign indications is cost effective compared with hysterectomy alone from the health care sector perspective at 3 years. Our results suggest that encouraging concurrent apical support procedures at time of hysterectomy is a cost-effective strategy in preventing posthysterectomy vaginal prolapse.