bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost and Cost Savings of Navigation Services to Avoid Rehospitalization for a Comorbid Substance Use Disorder Population
Authors: Orme Stephen , Zarkin Gary A. , Dunlap Laura J. , Nordeck Courtney D. , Schwartz Robert P. , Mitchell Shannon G. , Welsh Christopher , O’Grady Kevin E. , Gryczynski Jan 
Published: June 2022

Background:
A randomized clinical trial found that patient navigation for hospital patients with comorbid substance use disorders (SUDs) reduced emergency department (ED) and inpatient hospital utilization compared with treatment-as-usual.

Objective:
To compare the cost and calculate any cost savings from the Navigation Services to Avoid Rehospitalization (NavSTAR) intervention over treatment-as-usual.

Research Design:
This study calculates activity-based costs from the health care providers and uses a net benefits approach to calculate the cost savings generated from NavSTAR. NavSTAR provided patient navigation focused on engagement in SUD treatment, starting before hospital discharge and continuing for up to 3 months postdischarge.

Subjects:
Adult hospitalized medical/surgical patients with comorbid SUD for opioids, cocaine, and/or alcohol.

Cost Measures:
Cost of the 3-month NavSTAR patient navigation intervention and the cost of all inpatient days and ED visits over a 12-month period.

Results of Base Case Analysis:
NavSTAR generated $17,780 per participant in cost savings. Ninety-seven percent of bootstrapped samples generated positive cost savings, and our sensitivity analyses did not change our results.

Limitations:
Participants were recruited at one hospital in Baltimore, MD through the hospital’s addiction consultation service. Findings may not generalize to the broader population. Outpatient health care cost data was not available through administrative records.

Conclusion:
Our findings show that patient navigation interventions should be considered by payors and policy makers to reduce the high hospital costs associated with comorbid SUD patients.
Racial and Ethnic Variation in Presentation, Diagnosis, Treatment, and Outcome of Pediatric Crohn Disease: A Single Center Study
Authors: Britto Savini Lanka , Qian Justin , Ihekweazu Faith Dorsey , Kellermayer Richard 
Published: June 2022

Objectives:
Disparities in health care for racial/ethnic minority children in the United States who are burdened by pediatric Crohn’s disease (PCD) are not well understood.

Methods:
A retrospective review of the Texas Children’s Hospital ImproveCareNow database from 2007 to 2015 was performed. CD patients with a minimum of 2-year follow-up were included if the onset of symptoms attributable to inflammatory bowel disease was clearly documented. We primarily aimed to identify race and ethnicity associations in diagnostic delay, presentation, treatment, and 2-year outcomes. We also examined early versus late diagnosis (ie, over 6 months from disease onset) associations with these variables unrelated to race/ethnicity.

Results:
One hundred and sixty-six PCD patients [57.8% non-Hispanic White (NH-White), 18.1% African American (AA), and 15.7% Hispanic] met selection criteria. Time to diagnosis was shorter in Hispanic patients (P < 0.01) and they were older at diagnosis than NH-White patients (P = 0.0164). AA patients (33%, P < 0.01) and Hispanic patients (35%, P < 0.05) had lower rates of granuloma detection than NH-White patients (63%). AA patients had lower rates of steroid-free remission (SFR) at 2 years than NH-White patients (P < 0.05). Higher ESR and lower hemoglobin levels were associated with early diagnosis (P < 0.01). Early diagnosis was associated with higher rates of surgery within 2 years of diagnosis (P < 0.05). Diagnostic fecal calprotectin levels inversely associated with SFR at 2 years (P < 0.05). Early use of biologics positively, and early use of corticosteroids negatively correlated with 2-year SFR (P < 0.05).

Conclusions:
Race and ethnicity may influence the diagnosis, treatment, and outcomes of PCD. This recognition presents a nidus toward establishing equity in PCD care.
Impact of Neurodevelopmental Disorders on Bowel Management Outcomes in Children with Functional Constipation
Authors: Seidler Gabriella R. , Knaus Maria E. , Beyene Tariku J. , Ahmad Hira , Lu Peter L. , Gasior Alessandra C. , Halaweish Ihab , Wood Richard J. 
Published: June 2022

Objectives:
Patients experiencing functional constipation (FC) can participate in structured bowel management programs (BMPs) to manage constipation or fecal incontinence when standard management fails. We sought to evaluate the efficacy of BMPs for children with FC with and without neurodevelopmental disorders.

Methods:
We performed a retrospective review of children with FC who participated in our BMP from 2014 to 2021. Stool/urinary continence, bowel regimen, surgical history, parent-reported outcomes measures (PROMs: Cleveland Clinic Constipation Score, Baylor Continence Scale, Vancouver Symptom Score for Dysfunctional Elimination), and Pediatric Quality of Life Inventory (PedsQL) were assessed pre- and at least 9 months post-BMP.

Results:
The cohort included 156 patients with a median age of 9 years and follow-up of 627 days (IQR: 389–808 days). Two sub-cohorts included patients with FC only (69%) and FC plus a neurodevelopmental disorder (31%): 59% attention-deficit/hyperactivity disorder, 33% autism spectrum disorder, and 8% obsessive-compulsive disorder. Both groups had significantly improved follow-up bowel movement frequency and continence (39%–90% neurodevelopmental, 44%–82% FC only, P < 0.001) and urinary continence (65%–90% neurodevelopmental, 69%–91% FC only, P < 0.02). There was a significant improvement in most of the PROMs at follow-up. Both groups experienced a clinically meaningful improvement in overall PedsQL scores (pre- and postBMP difference of >4.5).

Conclusions:
Patients with FC with and without a neurodevelopmental disorder had significant improvement in stool and urinary continence after undergoing a BMP. Further studies are needed to see if this improvement is durable over a longer period of time in this challenging cohort.
Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life
Authors: Calvo-Schimmel Alejandra , Paul Steven M. , Cooper Bruce A. , Shin Joosun , Harris Carolyn , Oppegaard Kate , Hammer Marilyn J. , Cartwright Frances , Conley Yvette P. , Kober Kord M. , Levine Jon D. , Miaskowski Christine 
Published: June 2022

Background
Anxiety and sleep disturbance are frequent symptoms during chemotherapy.

Objectives
Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups.

Methods
Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles.

Results
Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life.

Conclusions
More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms.

Implications for Practice
Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.
Potential Anti-Inflammatory and Anti-Coagulation Effects of One-Time Application of Remote Ischemic Conditioning in Patients With Subacute/Chronic Cerebral Arteriostenosis and Venostenosis
Authors: Song Si-ying , Jiao Bao-lian , Lan Duo , Liu Yun-huan , Wan Shu-ling , Guo Yi-bing , Ding Yu-chuan , Ji Xun-ming , Meng Ran 
Published: June 2022

Background:
Remote ischemic conditioning (RIC) is an extremely simple, non-invasive, and cost-effective method with a neuroprotective effect. This study aimed to evaluate the immediate effects of one-time application of RIC on inflammation and coagulation in patients with chronic cerebral vascular stenosis, and compare the different effects of RIC on cerebral arteriostenosis and cerebral venostenosis.

Method:
A total of 47 patients with defined cerebral arteriostenosis (n=21) or venostenosis (n=26) were prospectively enrolled. RIC intervention was given once with 5 cycles of inflating and deflating for 5 minutes alternately. Blood was sampled 5 minutes before and after RIC for inflammatory and thrombophilia biomarkers. Differences in inflammatory and thrombotic variables at differing time points in the group were assessed using paired t tests or Wilcoxon matched-pairs signed-rank test.

Results:
Patients with cerebral arteriostenosis had a higher level of pre-RIC neutrophil-to-lymphocyte ratio (P=0.034), high-sensitivity C-reactive protein (P=0.037), and fibrinogen (P=0.002) than that with cerebral venostenosis. In the arterial group, levels of fibrinogen (P=0.023) decreased, and interleukin-6 levels were elevated (P=0.019) after a single RIC. Age was negatively related to interleukin-6, C-reactive protein, and fibrinogen.

Conclusion:
One-time RIC interventions may show seemingly coexisted proinflammatory and anti-coagulation effects of a single bout on patients with cerebral arteriostenosis. Older age was a negative predictor for multiple biomarkers in the cerebral arteriostensosis group. The protective effect of RIC on cerebral venostenosis patients needs to be further studied in a larger sample size.
Statin Usage Increases White Matter Hyperintensities
Authors: Goldstein Eric D. , Garg Gauri , Navarro Kayla , Wolcott Zoe , Yaghi Shadi , Wong Ka-Ho , McLean Kaitlin , de Havenon Adam H. 
Published: June 2022

Background:
Progression of white matter hyperintensities (WMHs), a radiographic marker of cerebral small vessel disease, occurs with uncontrolled conventional cerebrovascular risk factors. Less certain, however, is the influence of dyslipidemia and the impact of 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) on WMH progression. The goal of this study was to evaluate the influence of statins on the progression of WMH over a 4-year interval.

Methods:
We performed a post hoc analysis of the SPRINT-MIND database on those with serial volumetric WMH data. WMH progression was calculated as the difference in WMH volume between the 2 scans and then segmented into tertiles due to rightward skew. We defined statin usage as no therapy (0% of visits), partial therapy (1% to 99% of visits) or full therapy (100% of visits) as logged during study visits. Analysis of variance and χ2 tests were used for continuous and categorical variables with adjustments made for variables known to influence WMH development.

Results:
A total of 425 individuals were included in this study: 53% without statins use, 27% partial use, and 20% full use. Demographic characteristics and baseline WMH volumes were similar among the cohort. Those with full statin use were significantly more likely to be in the top tertile of WMH progression (adjusted odds ratio: 2.30, 95% confidence interval: 1.11-4.77, P=0.025), despite improvement in dyslipidemia.

Conclusions:
SPRINT-MIND participants prescribed a statin were nearly 2.5 times more likely to be within the top tertile of WMH progression over 4 years, despite adjustment for synergistic risk factors and improvement in low-density lipoprotein.
Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series
Authors: Saetang Patcharin , Samransamruajkit Rujipat , Singjam Kanokwan , Deekajorndech Tawatchai 
Published: June 2022

OBJECTIVES:
To evaluate the use of direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) as adjunctive therapy during pediatric patients with septic shock.

DESIGN:
Prospective observational study.

SETTING:
Nine-bed PICUs at university referral hospital.

PATIENTS:
Children (30 d to 15 yr) with septic shock and Pediatric Logistic Organ Dysfunction (PELOD)-2 score greater than or equal to 10 or Pediatric Risk of Mortality (PRISM) 3 score greater than or equal to 15, who were also receiving at least one inotrope.

INTERVENTION:
Patients received 2–4 hour treatment with PMX-DHP 20R column on 2 consecutive days.

MEASUREMENTS AND MAIN RESULTS:
We enrolled six children aged 21–167 months old (median, 99-mo old), with a body weight of 10–50 kg (median, 28 kg). All six patients had both PELOD-2 greater than or equal to 10 and PRISM-3 greater than or equal to 15, required invasive mechanical ventilation, and received standard treatment for septic shock before enrollment. We observed significant improvement in PELOD-2 score from baseline to 72 hours after the start of PMX-DHP (mean [95% CI] from 14.3 [12.2–16.5] to 6.0 [0.3–11.7]; p = 0.006). The vasoactive inotropic score (VIS) and lactate concentration also significantly decreased from baseline to 72 hours (VIS, 60 mmol/L [25–95 mmol/L] to 4.0 mmol/L [44.1–12 mmol/L]; p = 0.003; lactate, 2.4 mmol/L [1.0–3.8 mmol/L] to 1.0 mmol/L [0.5–1.5 mmol/L]; p = 0.01). Five of six patients survived. There was no device-related adverse event in these patients.

CONCLUSIONS:
In this case series of treatment with PMX-DHP as adjunctive therapy in children with refractory septic shock and high baseline severity, we have shown that patient recruitment is feasible. We have also found that clinical hemodynamic and severity of illness scores at 72 hours may be potential end points for testing in future randomized controlled trials.
Pediatric Fracture Epidemiology and US Emergency Department Resource Utilization
Authors: Farrell Caitlin , Hannon Megan , Monuteaux Michael C. , Mannix Rebekah , Lee Lois K. 
Published: June 2022

Objective
Fractures are common childhood injuries that result in emergency department (ED) visits. National trends in pediatric fracture epidemiology and resource utilization are not well described. Our objective is to analyze national trends in pediatric fracture epidemiology, ED disposition, and ED resource utilization from 2010 to 2015.

Methods
This is an epidemiological study of fracture care in US EDs from 2010 to 2015 for children 0 to 18 years old using the Nationwide Emergency Department Sample. We calculated frequencies and national rates using weighted analyses and census data. We used the test for linear trend to analyze incidence, hospital admission, transfer, and procedural sedation over time. Multivariate logistic regression analyses identified encounter- and hospital-level predictors of transfer, admission, operative care, and use of procedural sedation.

Results
During the study period, from 2010 to 2015, a total of 5,398,827 children received ED care for fractures. The pediatric fracture rate was 11.5 ED visits/1000 persons (95% confidence interval [CI], 10.6–12.5) and decreased over time. The admission rate for pediatric fracture patients was 5% and stable over time. The transfer rate increased from 3.3 to 4.1/100 fracture visits (linear trend: odds ratio, 1.06; 95% CI, 1.03–1.09). Utilization of procedural sedation increased from 1.5% to 2.9% of fracture visits (linear trend: odds ratio, 1.17; 95% CI, 1.09–1.25). Predictors associated with disposition and resource utilization include patient age, fracture location, insurance type, hospital type, and region.

Conclusions
The national incidence rate of pediatric fractures decreased slightly. Emergency department resource utilization increased over time. With high national volume, understanding pediatric fracture epidemiology and resource utilization is important to the health care system.
“Public attitudes to sharing government data with private industry: a systematic scoping review”
Authors: Street Jackie , Carter Stacy , Fabrianesi Belinda , Bosward Rebecca , Carolan Lucy , Braunack-Mayer Annette 
Published: June 2022

AbstractBackgroundLinking and analysing large volumes of health data in electronic records, datasets, registries and biobanks can provide detailed insights into the health profiles of individuals, communities, regions and national populations. Good governance for data sharing can be challenging, particularly when private sector organisations are the recipients of public sector data. Many jurisdictions have responded by instituting new regulations and laws related to data protection, responding to calls to promote data sharing and manage associated risks. This review integrates and interprets five years of research on public and patient perspectives on sharing publicly-held health data with private industry for research and development. Our review question was: what are community attitudes towards the use of government administrative health data by private industry organisations for therapeutic development?MethodsWe developed two logic grids: first, used terms describing citizens or patients, big data, private health sector and views or perspectives, second, used terms describing big data, social licence and public interest. We conducted a systematic literature search using electronic databases; PubMed, Scopus, CINAHL, Web of Science. Searches were conducted using Google Advanced and Google Scholar to identify grey literatureResultsA total of 6,788 articles were screened based on title and abstract. Full text screening was conducted for 224 articles and a total of 33 publications were identified. Across all studies, support for sharing administrative health data with private sector organisations was low. Background knowledge and lack of trust that data use would lead to public benefit were the most important reasons for low level of support.ConclusionPolicymakers, data custodians and companies will need to establish robust safeguards including secure storage, anonymisation, monitoring and independent oversight, and institute and implement sanctions on misuse, if they are to secure legitimacy to share publicly-held health data with private industry for research and development.Registrationnone available.‘Contributions to the literature’Research shows governance for data sharing is challenging, particularly when private sector organisations are the recipients of public sector data. Globally jurisdictions have responded by instituting new regulations and laws related to data protection, data sharing and the associated risks.Bringing together research on ‘public attitudes towards the use of linked government administrative data by private sector organisations for therapeutic development’, this systematic review found that public support for sharing was low.These findings highlight key areas for policymakers, data custodians and companies to address before they can legitimately share publicly-held health data with private industry for research and development.
PGRL1A redox states alleviate photoinhibition in Arabidopsis during step changes in light intensity
Authors: Chaturvedi Amit Kumar , Dym Orly , Fluhr Robert 
Published: June 2022

AbstractNon-motile plants have evolved regulatory mechanisms to maintain homeostasis for optimal growth. Responses to environmental changes in light are particularly important not only during the diurnal transition from night to day but also to react to light changes caused by passing clouds or by wind. Thioredoxins rapidly orchestrate redox control during environmental change by modifying cysteine residues. Here, we assign a function to regulatory cysteines of PGRL1A, a constituent of the ferredoxin-dependent cyclic electron flow (Fd-CEF) pathway and show their role in the regulation of proton motive force (PMF) and nonphotochemical quenching (NPQ). During step increase of low light intensity (10-60 μE*m-2*s-1), the intermolecular disulfide of the PGRL1A 59-kDa complex is reduced transiently within seconds to the 28 kDa form. In contrast, step increases to higher light intensity (60-600 μE*m-2*s-1) stimulated a stable partially reduced redox state in PGRL1A. Measurements of NPQ, PMF and resultant photosynthetic controls Y(ND) and Y(NA) were found to correlate with the redox state of PGRL1A during step increases in light intensity but not in PGRL1mutant plants pgrl1ab or PGRL1A cysteine mutant (PGRL1AC1,2A). Continuous light regimes did not affect mutant growth; however, fluctuating regimes of light intensity showed significant growth reduction in the mutants. Inhibitors of photosynthesis placed control of the PGRL1A redox state as dependent on the penultimate ferredoxin redox state that fuels reducing equivalents to the large set of chloroplasts thioredoxins. Our results showed that redox state changes in PGRL1A are crucial to the optimization of photosynthesis and are regulated by the photosynthetic electron flux.
Direct laser writing of 3D electrodes on flexible substrates
Authors: Brown Morgan A. , Zappitelli Kara M. , Singh Loveprit , Yuan Rachel C. , Bemrose Melissa A. , Brogden Valerie , Miller David J. , Cogan Stuart F. , Gardner Timothy J. 
Published: June 2022

AbstractThis report describes a 3D microelectrode array integrated on a thin-film flexible cable for neural recording in small animals. The micro electrode array fabrication process integrates traditional silicon thin-film processing techniques and direct laser writing of 3D structures at micron resolution via two-photon lithography. While direct laser writing of 3D printed electrodes has been described before, this report is the first to provide a method for high-aspect-ratio laser-written structures integrated with microfabricated electrical traces. One prototype is a 16-channel array composed of 350 μm long shanks spaced on a grid with 90 μm pitch. Other devices shown here include biomimetic mosquito-needles that penetrate through the dura of birds and porous electrodes designed to promote tissue ingrowth or enhance charge injection capacity for neural stimulation. These devices are just a few examples of a new design space that will enable high-channel-count 3D electrode arrays with features definable at single micrometer resolution. Using a custom laser writer, the 3D printing process is rapid (1 mm3/min). This high-speed printing combined with standard wafer-scale processes will enable efficient device fabrication and new studies examining the relationship between electrode geometry and electrode performance. We anticipate highest impact in small animal models, nerve interfaces, retinal implants, and other applications requiring small, high density 3D electrodes.