bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in charges and association with defaults on medical payments in uninsured Americans: a disproportionate burden in ethnic minorities – a retrospective observational study
Authors: Linde Sebastian , Egede Leonard E 
Published: May 2022

ObjectiveTo evaluate whether medical event charges are associated with uninsured patients’ probability of medical payment default and whether there exist racial/ethnic disparity gaps in medical payment defaults.DesignWe use logistic regression models to analyse medical payment defaults. Our adjusted estimates further control for a rich set of patient and medical visit characteristics, region and time fixed effects.SettingUninsured US adult (non-elderly) population from 2002 to 2017.ParticipantsWe use four nationally representative samples of uninsured patients from the Medical Expenditure Panel Survey across office-based (n=39 967), emergency (n=3269), outpatient (n=1739) and inpatient (n=340) events.Primary and secondary outcome measuresPayment default, medical event charges and medical event payments.ResultsRelative to uninsured non-Hispanic white (NHW) patients, uninsured non-Hispanic black (NHB) patients are 142% (p<0.01) more likely to default on medical payments for office-based visits, 27% (p<0.05) more likely to default on emergency department visit payments and 82% (p<0.1) more likely to default on an outpatient visit bill. Hispanic patients are 46% (p<0.01) more likely to default on an office-based visit, but 25% less likely to default on emergency department visit payments than NHW patients. Within our fully adjusted model, we find that racial/ethnic disparities persist for office-based visits. Our results further suggest that the probabilities of payment defaults for office-based, emergency and outpatient visits are all significantly (p<0.01) and positively associated with the medical event charges billed.ConclusionsMedical event charges are found to be broadly associated with payment defaults, and we further note disproportionate payment default disparities among NHB patients.
Multisite sentinel surveillance of self-harm in New Zealand: protocol for an observational study
Authors: Fortune Sarah , Hetrick Sarah , Sharma Vartika , McDonald Gabrielle , Scott Kate M , Mulder Roger T , Hobbs Linda 
Published: May 2022

IntroductionNew Zealand (NZ) has a persistently high rate of suicide, particularly among young people. Hospital presentation for self-harm (SH) is one of the strongest predictors of death by suicide. Improving the monitoring of SH and suicide is a key recommendation for suicide prevention by WHO. This study will establish the first ever sentinel surveillance for SH at several large hospitals and a monthly survey of all practicing paediatricians in NZ. The study will provide robust information about the epidemiology of SH, factors associated with SH and the types of interventions required for those presenting to hospital with SH.Method and analysisThis observational study will establish SH surveillance in the emergency departments of three public hospitals for the first time in NZ, where study population will include individuals of all ages who present with SH or suicidal ideation. The study methodology is in line with the WHO Best Practice guidelines and international collaborators in Australia and Europe. Electronic triage records will be reviewed manually by the research team to identify potential cases that meet inclusion criteria. For all eligible cases, variables of interest will be extracted from routine clinical records by the research team and recorded on a secure web-based survey application. Additionally, SH surveillance data for the national paediatric population (<15 years) will be obtained via the New Zealand Paediatric Surveillance Unit (NZPSU); paediatricians will report on included cases using the same variables using a secure survey application. A deidentified dataset will be produced for aggregated statistical analysis.Ethics and disseminationThe University of Otago Health Ethics Committee granted ethical approval for this study in addition to local ethics approval at participating hospital sites. The study findings will be disseminated to relevant stakeholders in NZ, in addition to international audiences through publications in peer-reviewed scientific journals and conference presentations.
Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti
Authors: Bhangdia Kayleigh Pavitra , Iyer Hari S , Joseph Jean Paul , Dorne Rubin Lemec , Mukherjee Joia , Fadelu Temidayo 
Published: May 2022

IntroductionWhile travel distance and time are important proxies of physical access to health facilities, obtaining valid measures with an appropriate modelling method remains challenging in many settings. We compared five measures of geographic accessibility in Haiti, producing recommendations that consider available analytic resources and geospatial goals.MethodsEight public hospitals within the ministry of public health and population were included. We estimated distance and time between hospitals and geographic centroids of Haiti’s section communes and population-level accessibility. Geographic feature data were obtained from public administrative databases, academic research databases and government satellites. We used validated geographic information system methods to produce five geographic access measures: (1) Euclidean distance (ED), (2) network distance (ND), (3) network travel time (NTT), (4) AccessMod 5 (AM5) distance (AM5D) and (5) AM5 travel time (AM5TT). Relative ranking of section communes across the measures was assessed using Pearson correlation coefficients, while mean differences were assessed using analysis of variance (ANOVA) and pairwise t-tests.ResultsAll five geographic access measures were highly correlated (range: 0.78–0.99). Of the distance measures, ED values were consistently the shortest, followed by AM5D values, while ND values were the longest. ND values were as high as 2.3 times ED values. NTT models generally produced longer travel time estimates compared with AM5TT models. ED consistently overestimated population coverage within a given threshold compared with ND and AM5D. For example, population-level accessibility within 15 km of the nearest studied hospital in the Center department was estimated at 68% for ED, 50% for AM5D and 34% for ND.ConclusionWhile the access measures were highly correlated, there were significant differences in the absolute measures. Consideration of the benefits and limitations of each geospatial measure together with the intended purpose of the estimates, such as relative proximity of patients or service coverage, are key to guiding appropriate use.
Explorative–descriptive study on the effects of COVID-19 on access to antiretroviral therapy services: the case of a teaching hospital in Ghana
Authors: Abraham Susanna Aba Aba , Doe Patience Fakornam , Osei Berchie Gifty , Agyare Elizabeth , Ayisi Addo Stephen , Obiri-Yeboah Dorcas 
Published: May 2022

ObjectiveTo explore how the COVID-19 pandemic affected access to antiretroviral therapy (ART) services from the perspective of the persons living with HIV (PLWH).DesignThe study adopted an exploratory-descriptive qualitative design that used in-depth interviews as the technique for the data collection. Data analysis was done using conceptual content analysis, following the traditions of Elo and Kyngäs on deductive and Hsieh on inductive content analysis.SettingART clinic, Cape Coast Teaching Hospital, Ghana.ParticipantsTwelve participants who had at least 1 year history of accessing ART care before the COVID-19 pandemic and at least one clinic visit during the pandemic were purposively sampled from the ART clinic.ResultsFive concepts of accessing healthcare proposed by Penchansky and Thomas were explored: accessibility, availability, affordability, accommodation and acceptability. The ART unit in the study setting remained open for service delivery throughout the pandemic. However, fear of contracting the virus while patronising services affected the participants’ decision to use the facility. Although all the participants in this study reportedly honoured their refill appointments, they indicated knowledge of other PLWH defaulting. With reference to the availability of resources, a shortage of antiretrovirals was reported, affecting the refill appointment intervals. In spite of the challenges, several strategies were implemented to accommodate the patients’ needs while protecting them from contracting the virus by instituting the stipulated COVID-19 protocols. The study found that some of the strategies impacted the acceptability and affordability of the services as transportation costs increased. Varying levels of accessibility to health workers providing ART services in the study setting was also recorded.ConclusionStrategies were implemented to accommodate the effects of the pandemic on ART provision. However, these had deficiencies that must be addressed using appropriate Differentiated Service Delivery (DSD) interventions that will ensure continuous access to service delivery in the ongoing and any similar future occurrences.
Association of subclinical atherosclerosis and cognitive decline: a community-based cross-sectional study
Authors: Lu Yao , Zhu Yidan , Ma Yanjun , Li Chenglong , Hua Rong , Zhong Baoliang , Wang Hongyu , Xie Wuxiang 
Published: May 2022

Background and aimsGrowing burden of dementia was considered as a global public health priority as its epidemic scale rises with the world’s population increases in age. In the absence of effective treatment, early identification of decline in cognitive function and risk factors that lead to the onset of dementia is a critical issue. Subclinical atherosclerosis may be a potential risk factor for cognitive impairment and progression to dementia. Research is needed to identify which subclinical atherosclerosis risk factors can better predict cognitive decline.MethodsA total of 1554 participants (mean age 59.81±6.93 years) were enrolled from Beijing Research on Ageing and Vessel and underwent baseline evaluation. Carotid intima-media thickness, carotid plaque and brachial ankle pulse wave velocity (ba-PWV) were selected as subclinical atherosclerosis markers. Cognitive function assessment was conducted by standardised tasks to assess the associations with subclinical atherosclerosis markers.ResultsSignificant associations (p<0.001) were shown in the unadjusted models between all three subclinical atherosclerosis markers and cognitive function assessments. After adjusting for covariates, in the assessment of the association between carotid atherosclerosis and cognitive function, plaque numbers showed signiﬁcant associations in Montreal Cognitive Assessment (MoCA) (β=−0.15, p=0.006) and verbal memory scores (β=−0.13, p=0.013). While in the assessment of the association between arterial stiffness and cognitive function, ba-PWV showed signiﬁcant associations in MoCA (β=−0.09, p=0.009) and semantic fluency scores (β=−0.13, p=0.036).ConclusionsPositive associations shown between subclinical atherosclerosis and cognitive function. Subclinical atherosclerosis markers of plaque numbers were significantly associated with global cognitive functioning in MoCA, memory and semantic fluency, while ba-PWV was significantly associated with global cognitive functioning in MoCA and semantic fluency.
Characteristics and survival of patients with cancer with intended off-label use—a cohort study
Authors: Schmitt Andreas Michael , Walter Martin , Herbrand Amanda Katherina , Jörger Markus , Moffa Giusi , Novak Urban , Hemkens Lars , Kasenda Benjamin 
Published: May 2022

ObjectiveTo describe the characteristics and the survival of patients with cancer with intended off-label use (OLU) cancer treatment and reimbursement request.DesignCohort study using medical record data.SettingThree major cancer centres in Switzerland.Participants519 patients with cancer and a reimbursement request for OLU between January 2015 and July 2018.Main outcomesCharacteristics of patients with cancer with and without access to intended OLU. Characteristics included the Glasgow prognostic score (GPS) which includes C reactive protein and albumin and discriminates prognostic groups.ResultsOLU was intended for 519 (17%) of 3046 patients with cancer, as first-line treatment in 51% (n=264) and second-line in 31% (n=162). Of the 519 patients, 63% (n=328) were male, 63% (n=329) had solid cancer and 21% (n=111) had a haematological malignancy. Their median overall survival was 23.6 months (95% CI: 19.0 to 32.5). Access to OLU had 389 (75%) patients who were compared with patients without access on average 4.9 years younger (mean; 95% CI: 1.9 to 7.9 years), had a better overall prognosis according to the GPS (51% with GPS of 0 vs 39%; OR: 1.62 (95% CI: 1.01 to 2.59)), had less frequently solid cancer (62% vs 71%; OR: 0.66 (95% CI: 0.41 to 1.05)) and advanced stage cancer (53% vs 70%; OR: 0.48 (95% CI: 0.30 to 0.75)), were more frequently treatment-naive (53% vs 43%; OR: 1.55 (95% CI 1.01 to 2.39)) and were more frequently in an adjuvant/neoadjuvant treatment setting (14% vs 5%; OR: 3.39 (95% CI: 1.45 to 9.93)). Patients with access to OLU had a median OS of 31.1 months versus 8.7 months for patients without access (unadjusted HR: 0.54; (95% CI: 0.41 to 0.70)).ConclusionContrary to the common assumption, OLU in oncology is typically not primarily intended for patients with exhausted treatment options. Patient characteristics largely differ between patients with and without access to intended OLU. More systematic evaluations of the benefits and harms of OLU in cancer care and the regulation of its access is warranted.
Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: a scoping review protocol
Authors: Hill Michella , Miles Alecka , Flanagan Belinda , Mills Brennen , Hopper Luke 
Published: May 2022

IntroductionEmergency ambulance clinicians attend a wide range of prehospital emergencies, including out-of-hospital births (OOHBs). Intrapartum care comprises approximately 0.05% of emergency medical services’ caseload, with only ~10% of intrapartum cases progressing to birth in emergency ambulance clinician care. However, this low exposure rate potentially allows obstetric clinical skills and knowledge to decay, which may impact on patient care. Additionally, unplanned OOHBs are known to have a higher incidence of complications and adverse outcomes than their counterparts born in hospital, such as postpartum haemorrhage or hypothermia. This scoping review will explore OOHBs and associated complications in emergency ambulance clinician care, investigate birth parent, significant partner and clinician experiences regarding OOHBs, and consider barriers and challenges to optimal patient care, to identify future research opportunities and associated knowledge gaps for this patient cohort.Methods and analysisThis scoping review will follow the nine-step methodological framework suggested by the Joanna Briggs Institute and use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Five electronic databases (MEDLINE via EBSCO, CINAHL, Embase, Web of Science and Wiley Online) will be searched to identify articles for inclusion. The ‘participant, concept, context’ criteria will be used to identify suitable search words regarding OOHBs in emergency ambulance clinician care. The review will include peer-reviewed and preprint literature. Two reviewers will independently assess articles based on title and abstract for inclusion in the review. Data will be charted using a data extraction tool for consistency and provide a succinct descriptive summary of the results.Ethics and disseminationThis study does not require ethical review as all the information obtained will come from publicly available resources. Results will be disseminated via a peer-reviewed publication. This scoping review is preregistered with the Open Science Framework (https://osf.io/ta35q).
Defining the key intrahepatic gene networks in HCV infection driven by sex
Authors: Marchi Emanuele , Ramamurthy Narayan , Ansari M Azim , Harrer Caroline E ,   STOP-HCV, Barnes Eleanor , Klenerman Paul 
Published: May 2022

ObjectiveThe transcriptional response in the liver during HCV infection is critical for determining clinical outcomes. This issue remains relatively unexplored as tissue access to address this at scale is usually limited. We aimed to profile the transcriptomics of HCV-infected livers to describe the expression networks involved and assess the effect on them of major predictors of clinical outcome such as IFNL4 (interferon lambda 4) host genotype and sex.DesignWe took advantage of a large clinical study of HCV therapy accompanied by baseline liver biopsy to examine the drivers of transcription in tissue samples in 195 patients also genotyped genome-wide for host and viral single nucleotide polymorphisms. We addressed the role of host factors (disease status, sex, genotype, age) and viral factors (load, mutation) on transcriptional responses.ResultsWe observe key modules of transcription which can be impacted differentially by host and viral factors. Underlying cirrhotic state had the most substantial impact, even in a stable, compensated population. Notably, sex had a major impact on antiviral responses in concert with IL28B (interleukin 28B)/IFNL4 genotype, with stronger interferon and humoral responses in females. Males tended towards a dominant cellular immune response. In both sexes, there was a strong influence of the underlying host disease status and of specific viral mutations, and sex-specific expression quantitative trait loci were also observed.ConclusionThese features help define the major influences on tissue responses in HCV infection, impacting on the response to treatment and with broader implications for responses in other sex-biased infections.
Machine learning and acute stroke imaging
Authors: Sheth Sunil A , Giancardo Luca , Colasurdo Marco , Srinivasan Visish M , Niktabe Arash , Kan Peter 
Published: May 2022

BackgroundIn recent years, machine learning (ML) has had notable success in providing automated analyses of neuroimaging studies, and its role is likely to increase in the future. Thus, it is paramount for clinicians to understand these approaches, gain facility with interpreting ML results, and learn how to assess algorithm performance.ObjectiveTo provide an overview of ML, present its role in acute stroke imaging, discuss methods to evaluate algorithms, and then provide an assessment of existing approaches.MethodsIn this review, we give an overview of ML techniques commonly used in medical imaging analysis and methods to evaluate performance. We then review the literature for relevant publications. Searches were run in November 2021 in Ovid Medline and PubMed. Inclusion criteria included studies in English reporting use of artificial intelligence (AI), machine learning, or similar techniques in the setting of, and in applications for, acute ischemic stroke or mechanical thrombectomy. Articles that included image-level data with meaningful results and sound ML approaches were included in this discussion.ResultsMany publications on acute stroke imaging, including detection of large vessel occlusion, detection and quantification of intracranial hemorrhage and detection of infarct core, have been published using ML methods. Imaging inputs have included non-contrast head CT, CT angiograph and MRI, with a range of performances. We discuss and review several of the most relevant publications.ConclusionsML in acute ischemic stroke imaging has already made tremendous headway. Additional applications and further integration with clinical care is inevitable. Thus, facility with these approaches is critical for the neurointerventional clinician.
Towards sustainable North American wood product value chains, part 2: computer vision identification of ring-porous hardwoods
Authors: Ravindran Prabu , Wade Adam C. , Owens Frank C. , Shmulsky Rubin , Wiedenhoeft Alex C. 
Published: May 2022

Wood identification is vitally important for ensuring the legality of North American hardwood value chains. Computer vision wood identification (CVWID) systems can identify wood without necessitating costly and time-consuming off-site visual inspections by highly trained wood anatomists. Previous work by Ravindran and colleagues presented macroscopic CVWID models for identification of North American diffuse porous hardwoods from 22 wood anatomically informed classes using the open-source XyloTron platform. This manuscript expands on that work by training and evaluating complementary 17-class XyloTron CVWID models for the identification of North American ring porous hardwoods — woods that display spatial heterogeneity in earlywood and latewood pore size and distribution and other radial growth-rate-related features. Deep-learning models trained using 4045 images from 452 ring-porous wood specimens from four xylaria demonstrated 98% five-fold cross-validation accuracy. A field model trained on all the training data and subsequently tested on 198 specimens drawn from two additional xylaria achieved top-1 and top-2 predictions of 91.4% and 100%, respectively, and images devoid of earlywood, latewood, or broad rays did not greatly reduce the prediction accuracy. This study advocates for continued cooperation between wood anatomy and machine-learning experts for implementing and evaluating field-operational CVWID systems.
Belief propagation for supply networks: efficient clustering of their factor graphs
Authors: Ritmeester Tim , Meyer-Ortmanns Hildegard 
Published: May 2022

AbstractWe consider belief propagation (BP) as an efficient and scalable tool for state estimation and optimization problems in supply networks such as power grids. BP algorithms make use of factor graph representations, whose assignment to the problem of interest is not unique. It depends on the state variables and their mutual interdependencies. Many short loops in factor graphs may impede the accuracy of BP. We propose a systematic way to cluster loops of naively assigned factor graphs such that the resulting transformed factor graphs have no additional loops as compared to the original network. They guarantee an accurate performance of BP with only slightly increased computational effort, as we demonstrate by a concrete and realistic implementation for power grids. The method outperforms existing alternatives to handle the loops. We point to other applications to supply networks such as gas-pipeline or other flow networks that share the structure of constraints in the form of analogues to Kirchhoff’s laws. Whenever small and abundant loops in factor graphs are systematically generated by constraints between variables in the original network, our factor-graph assignment in BP complements other approaches. It provides a fast and reliable algorithm to perform marginalization in tasks like state determination, estimation, or optimization issues in supply networks.Graphical abstract