bluuebunny/crossref_metadata_2025_split huggingface dataset:
All Public Health is Local
Authors: Knaus William A. , Kehoe Shaneis , Lindley Chris 
Published: July 2022

Background:
During the coronavirus disease-2019 (COVID-19) pandemic cumulative United States COVID-19 deaths per capita were higher than all other large, high-income nations, but with substantial variation across the country.

Objective:
The aim was to detail the public health response during the pandemic in Eagle County, Colorado.

Research Design and Measures:
Observational study using pre-COVID-19 county public health metrics. Pandemic actions were recorded from a narrative summary of daily phone consultations by a county-wide taskforce and interviews. Outcomes obtained from local, state, and nationally reported databases.

Methods:
Eagle County began with a life expectancy of 85.9, low all-cause age-adjusted death rates equal for both White and Latinx populations, a high household median income, and other prepandemic advantages. It also launched an innovative, independent county-wide taskforce lead by experienced mid-level managers. The taskforce implemented rapid communication of decision consequences, made immediate course corrections without traditional organizational approvals or contradictory political pressures.

Results:
Eagle County was first in Colorado to obtain Personal Protective Equipment and to establish a drive-through testing facility. The COVID-19 case fatality rate was 0.34%. The sole intensive care unit never reached maximum capacity. By March 2022, Eagle County had administered at least 1 vaccine dose to 100% of the population and 83% were fully vaccinated.

Conclusions:
It is not possible to directly attribute superior outcomes to either the baseline characteristics of Eagle County or its innovative taskforce design and deployment. Rather this report highlights the potential impact that improving the baseline health status of US citizens and permitting novel problem-solving approaches by local public health officials might have for the next pandemic.
Characterization of Biomarkers of Hemostasis and Bleeding-Related Outcomes in Children With Cirrhosis
Authors: Jarasvaraparn Chaowapong , Rusch Courtney , Nadler Michelle , Drobish Julie , Stoll Janis , Doyle Maria Bernadette , Khan Adeel , Kulkarni Sakil 
Published: July 2022

Objectives:
We aimed to evaluate differences in laboratory tests, bleeding, transfusions, and thrombosis between (1) children without and with cirrhosis and (2) children and adults with cirrhosis, and to correlate thromboelastography (TEG) parameters with biomarkers of hemostasis, bleeding, and transfusions in children and adults with cirrhosis.

Methods:
This single-center, retrospective study included 20 children without cirrhosis, 40 children with cirrhosis, and 40 adults with cirrhosis who underwent a liver transplant (LT). We collected demographic data, preoperative laboratory values, and intraoperative TEG parameters. Biomarkers of hemostasis just prior to the start of LT surgery were analyzed including international normalized ratio (INR), platelet, fibrinogen level, R time, K time, alpha angle (α), and maximum amplitude (MA). We also collected outcome data including blood loss, transfusion requirements, and thrombosis.

Results:
A significantly higher proportion of children with cirrhosis had abnormal PT (P = 0.001), platelet (P = 0.001), K time (P = 0.02), and MA (P = 0.05) compared to children without cirrhosis. The incidences of thrombosis, bleeding events, blood loss or PRBC transfusion were not significantly different between these 2 groups. A significantly higher proportion of adults with cirrhosis had abnormal R time (P = 0.01) and alpha angle (P = 0.01) than children with cirrhosis.

Conclusions:
Children with cirrhosis had defects in fibrinogen and platelets compared to children without cirrhosis at time of LT; however, these abnormalities did not translate into higher rates of bleeding in the former. Adults with cirrhosis had more defects in clotting factors compared to children with cirrhosis.
Absence of Differential Cyclin D1 Immunohistochemical Protein Expression in Nevi and Melanoma Evaluated by Digital Image Analysis
Authors: Koh Stephen S. , Lau Sean K. , Cassarino David S. 
Published: July 2022

Background:
Distinction of superficial spreading melanoma (SSM) from compound nevi (CN) sometimes poses difficult diagnostic challenges. Herein, we studied cyclin D1 protein expression by immunohistochemistry in SSM and CN and evaluated the results by digital image analysis.

Design:
A total of 13 CN and 12 SSM cases were retrospectively reviewed and cyclin D1 immunohistochemistry was performed. Immunohistochemical stained slides were evaluated by digital imaging analysis that included quantification and staining intensity of the cyclin D1 expressing dermal cells.

Results:
Cyclin D1 expression was observed in all CN and SSM. CN-positive staining was present in 30% to 93% of the dermal nevocytes, more positive in the upper (mean 85%), than lower half (mean 57%). SSM-positive staining was present in 44% to 96% of the dermal lesion, more positive in the upper (mean 88%) than lower half (mean 49%). When analyzed based on 3+ strong staining intensity, similar regional differences in cyclin D1 expression were observed.

Conclusions:
Digital image analysis of Cyclin D1 expression showed no differences between CN and SSM. Quantity and regional distribution of cyclin D1 positivity were found to be similar in both lesions. Our findings argue against the routine use of cyclin D1 immunohistochemistry as a diagnostic tool for differentiating CN from SSM.
What Outcomes Are Most Important to Patients Following a Lower Extremity Limb-threatening Injury?
Authors: Wong Alison , Burke Cynthia E. , Bangura Abdulai , O’Hara Nathan N. , Mundy Lily , O’Toole Robert V. , Pensy Raymond A. 
Published: July 2022

Objective:
To determine what outcomes are most important to patients after a limb-threatening injury, and if those preferences vary based on the patients’ treatment (salvage vs amputation), health, demographics, or time since injury.

Background:
The preferences that motivate the patients’ choice of treatment following a limb-threatening injury are poorly understood. Discrete choice experiments (DCEs) are a robust survey methodology to quantify preferences.

Methods:
Patients with a history of traumatic limb-threatening injury, January 2010 to December 2020, completed a survey with our DCE and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. The DCE attributes included recovery time, function, appearance, cost, and time in hospital. We used conditional logit modeling to estimate the relative importance of each attribute on a scale of 0% to 100%, determine willingness to pay for improvements in the included attributes, and assess variation in preferences based on patient characteristics, including PROMIS score.

Results:
A total of 150 patients completed the survey (104 limb salvage, 46 amputation; mean age, 48±16 years; 79% male). Regaining preinjury function [relative importance=41%; 95% confidence interval (CI), 37%–45%] and minimizing costs (24%; 95% CI, 21%–28%) were of greatest importance. Changes in appearance were least important (7%; 95% CI, 5%–9%). The hierarchy of preferences did not vary between those who had limb salvage or amputation, but patient age, physical and mental health, and income were associated with preference variation.

Conclusions:
Patients with limb-threatening injuries most valued gains in function and reduced out-of-pocket costs.
Safety of Intraoperative Blood Salvage During Liver Transplantation in Patients With Hepatocellular Carcinoma
Authors: Aijtink Virginia J. , Rutten Vera C. , Meijer Beatrice E.M. , de Jong Renate , Isaac John L. , Polak Wojciech G. , Perera M. Thamara P.R. , Sneiders Dimitri , Hartog Hermien 
Published: July 2022

Objective:
The effects of intraoperative blood salvage (IBS) on time to tumor recurrence, disease-free survival and overall survival in hepatocellular carcinoma (HCC) patients undergoing liver transplantation were assessed to evaluate the safety of IBS.

Background:
IBS is highly effective to reduce the use of allogeneic blood transfusion. However, the safety of IBS during liver transplantation for patients with HCC is questioned due to fear of disseminating malignant cells.

Methods:
Comprehensive searches through June 2021 were performed in 8 databases. The methodological quality of included studies was assessed using the Robins-I tool. Meta-analysis with the generic inverse variance method was performed to calculate pooled hazard ratios (HRs) for disease-free survival, HCC recurrence and overall survival.

Results:
Nine studies were included (n=1997, IBS n=1200, no-IBS n=797). Use of IBS during liver transplantation was not associated with impaired disease-free survival [HR=0.90, 95% confidence interval (CI)=0.66–1.24, P=0.53, IBS n=394, no-IBS n=329], not associated with increased HCC recurrence (HR=0.83, 95% CI=0.57–1.23, P=0.36, IBS n=537, no-IBS n=382) and not associated with impaired overall survival (HR=1.04, 95% CI=0.79–1.37, P=0.76, IBS n=495, no-IBS n=356).

Conclusions:
Based on available observational data, use of IBS during liver transplantation in patients with HCC does not result in impaired disease-free survival, increased HCC recurrence or impaired overall survival. Therefore, use of IBS during liver transplantation for HCC patients is a safe procedure.
Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery
Authors: Anandalwar Seema P. , Milliren Carly , Graham Dionne A. , Newland Jason G. , He Katherine , Hills-Dunlap Jonathan L. , Kashtan Mark A. , Rangel Shawn J. 
Published: July 2022

Objective:
To quantify procedure-level inappropriate antimicrobial prophylaxis utilization as a strategy to identify high-priority targets for stewardship efforts in pediatric surgery.

Background:
Little data exist to guide the prioritization of antibiotic stewardship efforts as they relate to prophylaxis utilization in pediatric surgery.

Methods:
This was a retrospective cohort analysis of children undergoing elective surgical procedures at 52 children’s hospitals from October 2015 to December 2019 using the Pediatric Health Information System database. Procedure-level compliance with consensus guidelines for prophylaxis utilization was assessed for indication, antimicrobial spectrum, and duration. The relative contribution of each procedure to the overall burden of noncompliant cases was calculated to establish a prioritization framework for stewardship efforts.

Results:
A total of 56,845 cases were included with an overall inappropriate utilization rate of 56%. The most common reason for noncompliance was unindicated utilization (43%), followed by prolonged duration (32%) and use of excessively broad-spectrum agents (25%). Procedures with the greatest relative contribution to noncompliant cases included cholecystectomy and repair of inguinal and umbilical hernias for unindicated utilization (63.2% of all cases); small bowel resections, gastrostomy, and colorectal procedures for use of excessively broad-spectrum agents (70.1%) and pectus excavatum repair and procedures involving the small and large bowel for prolonged duration (57.6%). More than half of all noncompliant cases were associated with 5 procedures (cholecystectomy, small bowel procedures, inguinal hernia repair, gastrostomy, and pectus excavatum).

Conclusions:
Cholecystectomy, inguinal hernia repair, and procedures involving the small and large bowel should be considered high-priority targets for antimicrobial stewardship efforts in pediatric surgery.
Distal Pancreatectomy Fistula Risk Score (D-FRS)
Authors: De Pastena Matteo , van Bodegraven Eduard A. , Mungroop Timothy H. , Vissers Frederique L. , Jones Leia R. , Marchegiani Giovanni , Balduzzi Alberto , Klompmaker Sjors , Paiella Salvatore , Tavakoli Rad Shazad , Groot Koerkamp Bas , van Eijck Casper , Busch Olivier R. , de Hingh Ignace , Luyer Misha , Barnhill Caleb , Seykora Thomas , Maxwell T Trudeau , de Rooij Thijs , Tuveri Massimiliano , Malleo Giuseppe , Esposito Alessandro , Landoni Luca , Casetti Luca , Alseidi Adnan , Salvia Roberto , Steyerberg Ewout W. , Abu Hilal Mohammad , Vollmer Charles M. , Besselink Marc G. , Bassi Claudio 
Published: July 2022

Objective:
To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively.

Background:
POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet.

Methods:
Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014–2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007–2016) to assess discrimination and calibration in an internal-external validation procedure.

Results:
Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11–1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32–1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78–0.88) and 0.73 (95% CI: 0.70–0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%–25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74–0.85).

Conclusions:
The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com. The 3 distinct risk groups allow for personalized treatment and benchmarking.
Titanium Clip-dental Floss Traction-assisting Endoscopy in Patients With Difficulty in Cannulation Into the Duodenal Peridiverticular Papilla
Authors: Lv Shangdong , Zhang Wenlong , Hu Peng , Shi Binyao , Wang Aidong 
Published: July 2022

Objective:
To assess titanium clip-dental floss traction-assisting endoscopy in patients with difficulty in cannulation into the papilla located at the lower, left or right side of the periampullary diverticulum.

Materials and Methods:
Sixty-eight patients who had difficulty in cannulation into the papilla located at the lower, left, or right side of the periampullary diverticulum upon endoscopic retrograde cholangiopancreatography (ERCP) were recruited at Taizhou Hospital from July 2016 to June 2020. A random number table was used to divide the patients into an intervention (with titanium clip-dental floss traction) group and a control group (n=34 in each group). Patients in both groups underwent ERCP. The cannulation time, cannulation success rate, incidence of postprocedural complications after ERCP, hospitalization time, and hospitalization expenses in the 2 groups were compared.

Result:
The cannulation time was 15.3±4.1 minutes in the intervention group, which was less than that in the control group (25.7±6.5 min). The cannulation success rate was 77±12.1% in the intervention group, which was higher than that in the control group (43±16.7%). Postprocedural complications occurred in 2 patients in the intervention group and 6 patients in the control group, with no significant differences. The hospitalization time and expenses were 3.8±2.6 days and 11.1±6 thousand yuan in the intervention group, respectively, and 6.1±3.7 days and 18.2±8 thousand yuan in the control group, respectively. The differences were statistically significant (P<0.05).

Conclusion:
Titanium clip-dental floss traction-assisting endoscopy achieved excellent efficacy in patients with difficulty in cannulation into the papilla located at the lower, left or right side of the periampullary diverticulum. The cannulation success rate was improved after treatment, with good safety and prognosis.
Functional analysis across model systems implicates ribosomal proteins in growth and proliferation defects associated with hypoplastic left heart syndrome
Authors: Nielsen Tanja , Kervadec Anaïs , Theis Jeanne L. , Missinato Maria A. , Marchant James , Lynott Michaela , Lamba Aashna , Zeng Xin-Xin I. , Berenguer Marie , Walls Stanley M. , Schroeder Analyne , Birker Katja , Duester Greg , Grossfeld Paul , Nelson Timothy J. , Olson Timothy M. , Ocorr Karen , Bodmer Rolf , Vogler Georg , Colas Alexandre R. 
Published: July 2022

AbstractHypoplastic left heart syndrome (HLHS) is the most lethal congenital heart disease (CHD). The pathogenesis of HLHS is poorly understood, and due to the likely oligogenic complexity of the disease, definitive HLHS-causing genes have not yet been identified. Postulating impaired cardiomyocyte proliferation as a likely important contributing mechanism to HLHS pathogenesis, and we conducted a genome-wide siRNA screen to identify genes affecting proliferation of human iPSC-derived cardiomyocytes (hPSC-CMs). This yielded ribosomal protein (RP) genes as the most prominent class of effectors of CM proliferation. In parallel, whole genome sequencing and rare variant filtering of a cohort of 25 HLHS proband-parent trios with poor clinical outcome revealed enrichment of rare variants of RP genes. In addition, in a familial CHD case we identified a rare, predicted-damaging promoter variant affectingRPS15Athat was shared between the HLHS proband and a distant relative with CHD. Functional testing with an integrated multi-model system approach reinforced the idea that RP genes are major regulators of cardiac growth and proliferation, thus potentially contributing to the hypoplastic phenotype observed in HLHS patients. Cardiac knockdown (KD) of RP genes with promoter or coding variants (RPS15A, RPS17, RPL26L1, RPL39, RPS15) reduced proliferation in generic hPSC-CMs and caused malformed hearts, heart-loss or even lethality inDrosophila. In zebrafish, diminishedrps15afunction caused reduced CM numbers, heart looping defects, or weakened contractility, while reducedrps17orrpl39function caused reduced ventricular size or systolic atrial dysfunction of the atrium, respectively. Importantly, genetic interactions betweenRPS15Aand core cardiac transcription factorsTBX5in CMs,Drosocross, pannierandtinmanin flies, andtbx5andnkx2-7(nkx2-5paralog) in fish, support a specific role for RP genes in heart development. Furthermore,RPS15AKD-induced heart/CM proliferation defects were significantly attenuated byp53KD in both hPSC- CMs and zebrafish, and by Hippo activation (YAP/yorkieoverexpression) in developing fly hearts. Based on these findings, we conclude that RP genes play novel critical roles in cardiogenesis and constitute an emerging class of gene candidates likely involved in HLHS and other CHDs.
PERSISTENT IMMUNITY AFTER MILD SARS CoV-2 INFECTION - THE CoNAN-LONG TERM STUDY -
Authors: Schnizer Clara , Andreas Nico , Vivas Wolfgang , Kamradt Thomas , Baier Michael , Kiehntopf Michael , Glöckner Stefan , Scherag André , Löffler Bettina , Kolanos Steffi , Guerra Joel , Pletz Mathias W. , Weis Sebastian ,   the CoNAN study group
Published: July 2022

ABSTRACTObjectivesUnderstanding persistent cellular and humoral immune responses to SARS-CoV-2 will be of major importance to terminate the ongoing pandemic. Here we assessed long-term immunity in individuals with mild COVID-19 up to one year after a localized SARS-CoV-2 outbreak.MethodsCoNAN was a longitudinal population-based cohort study performed 1.5 months, 6 months and 12 months after a SARS-CoV-2 outbreak in a rural German community. We performed a time series of five different IgG immunoassays assessing SARS-CoV-2 antibody responses on serum samples from individuals that had been tested positive after a SARS-CoV-2 outbreak as well as in control individuals who had a negative PCR result. These analyses were complemented with the determination of spike-antigen specific THcell responses in the same individuals.ResultsAll infected participants presented as asymptomatic or mild cases. Participants initially tested positive for SARS-CoV-2 infection either with PCR, antibody testing, or both had a rapid initial decline in the serum antibody levels in all serological test but showed a persisting and robust THcell immunity as assessed by the detection of SARS-CoV-2 specificity of THcells for up to one year after infection.ConclusionOur data support the notion of a robust T cell immunity in mild and asymptomatic cases of SARS-CoV-2 up to one year after infection. We show that antibody titers decline over one year, but considering several test results, complete seroconversion is rare.Trial RegistrationGerman Clinical Trials Register DRKS00022416.FundingSondervermögen „Corona” of the Thuringian Ministry for Economic Affairs, Science and Digital Society. SV-Kapitel 82 30 Titel 68205 # 5526/32-4-2.
Effects of SARS-CoV-2 Alpha, Beta, and Delta variants, age, vaccination, and prior infection on infectiousness of SARS-CoV-2 infections
Authors: Qassim Suelen H. , Hasan Mohammad R. , Tang Patrick , Chemaitelly Hiam , Ayoub Houssein H. , Yassine Hadi M. , Al-Khatib Hebah A. , Smatti Maria K. , Abdul-Rahim Hanan F. , Nasrallah Gheyath K. , Al-Kuwari Mohamed Ghaith , Al-Khal Abdullatif , Coyle Peter , Gillani Imtiaz , Kaleeckal Anvar Hassan , Shaik Riyazuddin Mohammad , Latif Ali Nizar , Al-Kuwari Einas , Jeremijenko Andrew , Butt Adeel A. , Bertollini Roberto , Al-Romaihi Hamad Eid , Al-Thani Mohamed H. , Abu-Raddad Laith J. 
Published: July 2022

AbstractIn 2021, Qatar experienced considerable incidence of SARS-CoV-2 infection that was dominated sequentially by the Alpha, Beta, and Delta variants. Using the cycle threshold (Ct) value of an RT-qPCR-positive test to proxy the inverse of infectiousness, we investigated infectiousness of SARS-CoV-2 infections by variant, age, sex, vaccination status, prior infection status, and reason for testing in a random sample of 18,355 RT-qPCR-genotyped infections. Regression analyses were conducted to estimate associations with the Ct value of RT-qPCR-positive tests. Compared to Beta infections, Alpha and Delta infections demonstrated 2.56 higher Ct cycles (95% CI: 2.35-2.78), and 4.92 fewer cycles (95% CI: 4.67-5.16), respectively. The Ct value declined gradually with age and was especially high for children <10 years of age, signifying lower infectiousness of small children. Children <10 years of age had 2.18 higher Ct cycles (95% CI: 1.88-2.48) than those 10-19 years of age. Compared to unvaccinated individuals, the Ct value was higher among individuals who had received one or two vaccine doses, but the Ct value decreased gradually with time since the second-dose vaccination. Ct value was 2.07 cycles higher (95% CI: 1.42-2.72) for those with a prior infection than those without prior infection. The Ct value was lowest among individuals tested because of symptoms and was highest among individuals tested as a travel requirement. Delta was substantially more infectious than Beta. Prior immunity, whether due to vaccination or prior infection, is associated with lower infectiousness of breakthrough infections, but infectiousness increases gradually with time since the second-dose vaccination.