tbuckley/cabot-search huggingface dataset:
Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries
Authors: Lama Assi, Ahmed F. Shakarchi, Orla C. Sheehan, Jennifer A. Deal, Bonnielin K. Swenor, Nicholas S. Reed
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Satisfaction with care is associated with improved quality of care and health outcomes. Sensory impairment can be a barrier to effective communication and access to care, and this may result in reduced satisfaction with care. <h3>Objective</h3> This study examined the association between sensory impairment and health care satisfaction among Medicare beneficiaries. <h3>Design, Setting, and Participants</h3> This cross-sectional study used data from the 2017 Medicare Current Beneficiary Survey (MCBS), a nationally representative in-person survey of Medicare beneficiaries. Functional sensory impairment was categorized as no sensory impairment, hearing impairment, vision impairment, and dual sensory impairment. Patient dissatisfaction included responses on quality of care, ease to get to a doctor, out-of-pocket costs paid, information given, and doctors' concern with overall health rather than an isolated symptom or disease. <h3>Exposures</h3> Self-reported functional sensory impairment. <h3>Main Outcomes and Measures</h3> Multivariable-adjusted odds ratios (ORs) of the association between dissatisfaction with care and sensory impairment. <h3>Results</h3> A total of 10 783 respondents representing 44 736 889 Medicare beneficiaries (8944 [85.3%] aged ≥65 years, 5733 [52.9%] women, and 8195 [75.5%] non-Hispanic White) were included. Dual sensory impairment compared with no sensory impairment was associated with the highest odds of dissatisfaction across outcomes, including quality of care (OR, 1.52; 95% CI, 1.12-2.08). Compared with no sensory impairment, having dual sensory impairment (OR, 1.82; 95% CI, 1.40-2.37), hearing impairment (OR, 1.67; 95% CI, 1.29-2.17), or vision impairment (OR, 1.56; 95% CI, 1.18-2.08) were associated with dissatisfaction with the information provided about what was wrong. Those with hearing impairment (OR, 1.38; 95% CI, 1.03-1.86) or dual sensory impairment (OR, 2.03; 95% CI, 1.55-2.66) were more likely to be dissatisfied with doctors' concern with overall health compared with those with no sensory impairment. Having dual sensory impairment or vision impairment only was associated with greater odds of dissatisfaction with ease to get to a doctor (dual sensory: OR, 1.69; 95% CI, 1.24-2.30; vision: OR, 1.63; 95% CI, 1.14-2.31) and out-of-pocket costs paid (dual sensory: OR, 1.27; 95% CI, 1.04-1.54; vision: OR, 1.31; 95% CI, 1.07-1.61). <h3>Conclusions and Relevance</h3> These findings contribute to the growing body of literature on sensory impairment and patient satisfaction and have implications for health care system planning and spending to provide patient-centered care for older adults.
Discovery of 4-arylthiophene-3-carboxylic acid as inhibitor of ANO1 and its effect as analgesic agent
Authors: Yuxi Wang, Jian Gao, Song Zhao, Yan Song, Han Huang, Guiwang Zhu, Peili Jiao, Xiangqing Xu, Guisen Zhang, Kewei Wang, Liangren Zhang, Zhenming Liu
Journal: Acta Pharmaceutica Sinica B (2020)

Anoctamin 1 (ANO1) is a kind of calcium-activated chloride channel involved in nerve depolarization. ANO1 inhibitors display significant analgesic activity by the local peripheral and intrathecal administration. In this study, several thiophenecarboxylic acid and benzoic acid derivatives were identified as novel ANO1 inhibitors through the shape-based virtual screening, among which the 4-arylthiophene-3-carboxylic acid analogues with the best ANO1 inhibitory activity were designed, synthesized and compound 42 (IC50 = 0.79 μmol/L) was finally obtained. Compound 42 selectively inhibited ANO1 without affecting ANO2 and intracellular Ca2+ concentration. Subsequently, the analgesic effect was investigated by intragastric administration in pain models. Compound 42 significantly attenuated allodynia which was induced by formalin and chronic constriction injury. Through homology modeling and molecular dynamics, the binding site was predicted to be located near the calcium-binding region between α6 and α8. Our study validates ANO1 inhibitors having a significant analgesic effect by intragastric administration and also provides selective molecular tools for ANO1-related research.
Abstract 14143: Percutaneous Coronary Intervention in Very Elderly Patients With Prior Coronary Artery Bypass Grafts Presenting With Acute Myocardial Infarction
Authors: Derek Q Phan, Ara ROSTOMIAN, Mingsum Lee, naing a moore, prakash mansukhani, vicken aharonian, Somjot S Brar, Ray Zadegan
Journal: Circulation (2020)

Introduction: There is limited data on the benefits of percutaneous coronary intervention (PCI) in very elderly patients with prior coronary artery bypass grafts (CABG). Therefore, we sought to evaluate the outcomes of PCI versus medical therapy alone in very elderly patients with prior CABG who present with acute myocardial infarction (AMI). Methods: Retrospective study of patients ≥ 80 years old with prior CABG who underwent invasive coronary angiography for AMI at Kaiser Permanente Los Angeles Medical Center between June 2009 and February 2019. Patients were treated with PCI or medical therapy alone. Inverse Probability Treatment of Weighting (IPTW) was used to balance baseline characteristics between treatment groups and cox proportional hazard regression analysis was utilized. Outcomes evaluated were all-cause mortality and non-fatal MI. Results: There were 347 patients (average age 83.6±3.2 years, 18% female) analyzed. Of these 167 (48%) underwent PCI. Compared to medical therapy alone, the PCI group was more likely to have left main disease (15% vs 2.8%, p&lt;0.01) and higher ejection fraction (48.0± vs 44.4± %, p=0.02); but less likely to have history of atrial fibrillation (31.7% vs 45.6%, p&lt;0.01). To adjust for significant differences between groups, IPTW was utilized to balance covariates (all p&gt;0.05). At a median follow-up of 27.6 months (interquartile range 9.7-52 months), there were no significant differences in all-cause mortality (Hazard Ratio [HR] 0.93, 95% Confidence Interval [CI] 0.88-1.32, p=0.5), and non-fatal MI (HR 0.95, 95% CI 0.72-1.26, p=0.7). Conclusion: PCI did not improve clinical outcomes over medical therapy alone in very elderly patients ≥ 80 years of age with prior CABG presenting with AMI. Further studies are needed to delineate the role of PCI in this high-risk unique population.
Abstract 296: Adult Swine Model of Ventricular Fibrillation Arrest for Resuscitation with Perfluorocarbon Emulsions
Authors: Travis W Murphy, Jiepei Zhu, Travis Parsons, Bruce D Spiess, Torben K Becker
Journal: Circulation (2020)

Background: The purpose of this study was to develop a model of ventricular fibrillation arrest with reliable outcomes and minimally invasive methods to study the use of perfluorocarbon emulsions (PFC) as agents to prevent ischemia-reperfusion injury after cardiac arrest as quantified by known biomarkers. Methods: Female Yorkshire swine underwent anesthesia and minimally invasive instrumentation for monitoring under ultrasound. Cardiac arrest was induced with spinal needle insertion at the apex and right parasternal space. Ventricular fibrillation was reliably obtained in all animals on initial attempts. A three-minute circulatory arrest state was observed. Administration of PFC was concurrent with resuscitation including closed chest compressions, epinephrine, amiodarone, and defibrillation at 1J/kg. Primary endpoint was induction of cardiac arrest and tolerance of PFC with return of spontaneous circulation. Blood levels of glial fibrillary acidic protein (GFAP) and ubiquitin C-Terminal Hydrolase-L1 (UCLH1) were secondary end points for three animals. Results: Six of six animals were induced into ventricular fibrillation on initial attempt and two of three survival experiments were able to obtain spontaneous circulation. PFC with pretreatment was tolerated well and no signs of increased pulmonary pressures. GFAP, UCHL1 were significantly lower in intervention animals compared to controls. Conclusions: The results obtained from this preliminary study and technical refinements via additional donated animals have allowed us to make modifications in the choice of PFC, vascular access, and anticoagulation plan. This model provides a consistent method for inducing ventricular fibrillation with minimally invasive techniques. The PFC tested was well tolerated. More robust evaluation of PFC as resuscitative agents is needed with appropriately powered studies.
A Patient With Dizziness, Chest Pain, Rash, and Nail Changes
Authors: Myron Zhang, Shari R. Lipner
Journal: JAMA (2020)

A 40-year-old woman with dizziness and imbalance, a petechial rash on her palms and soles, and a right thumbnail splinter hemorrhage had acute right cerebellar infarcts with a left atrial mass on CT angiogram. What is the diagnosis and what would you do next?
Macro and micro sleep architecture and cognitive performance in older adults
Authors: Ina Djonlagic, Sara Mariani, Annette L. Fitzpatrick, Veerle M. G. T. H. Van Der Klei, Dayna A. Johnson, Alexis C. Wood, Teresa Seeman, Ha T. Nguyen, Michael J. Prerau, José A. Luchsinger, Joseph M. Dzierzewski, Stephen R. Rapp, Gregory J. Tranah, Kristine Yaffe, Katherine E. Burdick, Katie L. Stone, Susan Redline, Shaun M. Purcell
Journal: Nature Human Behaviour (2020)
Evaluation of the Use of Combined Artificial Intelligence and Pathologist Assessment to Review and Grade Prostate Biopsies
Authors: David F. Steiner, Kunal Nagpal, Rory Sayres, Davis J. Foote, Benjamin D. Wedin, Adam Pearce, Carrie J. Cai, Samantha R. Winter, Matthew Symonds, Liron Yatziv, Andrei Kapishnikov, Trissia Brown, Isabelle Flament-Auvigne, Fraser Tan, Martin C. Stumpe, Pan-Pan Jiang, Yun Liu, Po-Hsuan Cameron Chen, Greg S. Corrado, Michael Terry, Craig H. Mermel
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Expert-level artificial intelligence (AI) algorithms for prostate biopsy grading have recently been developed. However, the potential impact of integrating such algorithms into pathologist workflows remains largely unexplored. <h3>Objective</h3> To evaluate an expert-level AI-based assistive tool when used by pathologists for the grading of prostate biopsies. <h3>Design, Setting, and Participants</h3> This diagnostic study used a fully crossed multiple-reader, multiple-case design to evaluate an AI-based assistive tool for prostate biopsy grading. Retrospective grading of prostate core needle biopsies from 2 independent medical laboratories in the US was performed between October 2019 and January 2020. A total of 20 general pathologists reviewed 240 prostate core needle biopsies from 240 patients. Each pathologist was randomized to 1 of 2 study cohorts. The 2 cohorts reviewed every case in the opposite modality (with AI assistance vs without AI assistance) to each other, with the modality switching after every 10 cases. After a minimum 4-week washout period for each batch, the pathologists reviewed the cases for a second time using the opposite modality. The pathologist-provided grade group for each biopsy was compared with the majority opinion of urologic pathology subspecialists. <h3>Exposure</h3> An AI-based assistive tool for Gleason grading of prostate biopsies. <h3>Main Outcomes and Measures</h3> Agreement between pathologists and subspecialists with and without the use of an AI-based assistive tool for the grading of all prostate biopsies and Gleason grade group 1 biopsies. <h3>Results</h3> Biopsies from 240 patients (median age, 67 years; range, 39-91 years) with a median prostate-specific antigen level of 6.5 ng/mL (range, 0.6-97.0 ng/mL) were included in the analyses. Artificial intelligence–assisted review by pathologists was associated with a 5.6% increase (95% CI, 3.2%-7.9%;<i>P</i> &lt; .001) in agreement with subspecialists (from 69.7% for unassisted reviews to 75.3% for assisted reviews) across all biopsies and a 6.2% increase (95% CI, 2.7%-9.8%;<i>P</i> = .001) in agreement with subspecialists (from 72.3% for unassisted reviews to 78.5% for assisted reviews) for grade group 1 biopsies. A secondary analysis indicated that AI assistance was also associated with improvements in tumor detection, mean review time, mean self-reported confidence, and interpathologist agreement. <h3>Conclusions and Relevance</h3> In this study, the use of an AI-based assistive tool for the review of prostate biopsies was associated with improvements in the quality, efficiency, and consistency of cancer detection and grading.
Accuracy of UK Rapid Test Consortium (UK-RTC) “AbC-19 Rapid Test” for detection of previous SARS-CoV-2 infection in key workers: test accuracy study
Authors: Ranya Mulchandani, Hayley E Jones, Sian Taylor-Phillips, Justin Shute, Keith Perry, Shabnam Jamarani, Tim Brooks, Andre Charlett, Matthew Hickman, Isabel Oliver, Stephen Kaptoge, John Danesh, Emanuele Di Angelantonio, Anthony E Ades, David H Wyllie
Journal: BMJ (2020)

Abstract Objective To assess the accuracy of the AbC-19 Rapid Test lateral flow immunoassay for the detection of previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design Test accuracy study. Setting Laboratory based evaluation. Participants 2847 key workers (healthcare staff, fire and rescue officers, and police officers) in England in June 2020 (268 with a previous polymerase chain reaction (PCR) positive result (median 63 days previously), 2579 with unknown previous infection status); and 1995 pre-pandemic blood donors. Main outcome measures AbC-19 sensitivity and specificity, estimated using known negative (pre-pandemic) and known positive (PCR confirmed) samples as reference standards and secondly using the Roche Elecsys anti-nucleoprotein assay, a highly sensitive laboratory immunoassay, as a reference standard in samples from key workers. Results Test result bands were often weak, with positive/negative discordance by three trained laboratory staff for 3.9% of devices. Using consensus readings, for known positive and negative samples sensitivity was 92.5% (95% confidence interval 88.8% to 95.1%) and specificity was 97.9% (97.2% to 98.4%). Using an immunoassay reference standard, sensitivity was 94.2% (90.7% to 96.5%) among PCR confirmed cases but 84.7% (80.6% to 88.1%) among other people with antibodies. This is consistent with AbC-19 being more sensitive when antibody concentrations are higher, as people with PCR confirmation tended to have more severe disease whereas only 62% (218/354) of seropositive participants had had symptoms. If 1 million key workers were tested with AbC-19 and 10% had actually been previously infected, 84 700 true positive and 18 900 false positive results would be projected. The probability that a positive result was correct would be 81.7% (76.8% to 85.8%). Conclusions AbC-19 sensitivity was lower among unselected populations than among PCR confirmed cases of SARS-CoV-2, highlighting the scope for overestimation of assay performance in studies involving only PCR confirmed cases, owing to “spectrum bias.” Assuming that 10% of the tested population have had SARS-CoV-2 infection, around one in five key workers testing positive with AbC-19 would be false positives. Study registration ISRCTN 56609224.
Abstract 224: Videographic Assessment of Pediatric Endotracheal Intubation in the Covid-19 Era: A Report From the Videography in Pediatric Resuscitation Collaborative
Authors: Tara L Neubrand, Karen O'Connell, Akira Nishisaki, Sage Myers, Benjamin Kerrey, Aaron Donoghue
Journal: Circulation (2020)

Introduction: Endotracheal intubation (ETI) of critically ill children is a high acuity, low frequency procedure in the pediatric emergency department that presents unique challenges to both pediatric and general acute care providers. COVID-19 and the associated requirements for PPE use, limitations of in-room personnel, communication difficulties, and reorganization of equipment have created new complexities. Objective: To use video review to compare intubator training level, first-attempt ETI success and presence of hypoxia during ETI attempts in the pediatric emergency department in the pre-COVID and COVID era. Methods: This is a retrospective multi-center case series of videorecordings of endotracheal intubations at the four tertiary care pediatric emergency departments comprising the VIPER Collaborative. All children undergoing emergent ETI between 1/1/2019-6/1/2020 in whom videorecordings were available were included for analysis. Data on patient age and intubator background was collected. Outcomes were first-attempt intubation success and hypoxia, defined as SpO2 &lt;90%. Data was compared before (PRE) and after (POST) implementation of COVID-19 airway protocols, which each PED adopted in March 2020. Univariate analysis comparing PRE and POST for both outcomes was done by c2 testing. Multivariate analysis with a generalized estimating equation to control for clustering by site was done to determine the independent association between PRE and POST and outcomes. Results: Between 1/1/2019 and 6/1/2020, a total of 272 patients underwent ETI (239 PRE, 33 POST). Overall first attempt success was 155/239 (65%) in PRE and 28/33 (85%) in POST (p=0.02). Hypoxia was noted in 15% of PRE patients and in 12% of POST patients. Analysis of the training level of the intubator was notable for a significant increase in the number of intubations performed by anesthesiologists (55% POST vs. 13% PRE, p&lt;0.001). In multivariate analysis controlling for intubator background, the POST phase was associated with greater first attempt success (AOR 2.4, 95% CI 1.6 – 3.7). Conclusion: Pediatric ETI in the COVID-19 era is associated with increased first attempt success when compared to the pre-COVID era.
Comparison of adult vs. paediatric inpatients with staphylococcal scalded skin syndrome: a retrospective database analysis
Authors: S. Patel, J.B. Cadwell, W.C. Lambert
Journal: British Journal of Dermatology (2020)

Dear Editor, Staphylococcal scalded skin syndrome (SSSS) is a rare dermatologic disease caused by toxigenic strains of Staphylococcus aureus. Adult SSSS is less common than pediatric cases of the disease, likely due to the development of immunity early in life, but has a higher fatality rate 1-3 . These facts hint at the different clinical nature of SSSS between patients of different ages.
Abstract 13306: Impella Combined With Extracorporeal Membrane Oxygenation Synergistically Unloads the Left Ventricle and Reduces Infarct Size in a Model of Myocardial Infarction With Cardiogenic Shock
Authors: Genya Sunagawa, Keita Saku, Takuya Nishikawa, Nobuhiro Suematsu, Toru Kubota, Kenji Sunagawa, Hiroyuki Tsutsui
Journal: Circulation (2020)

Introduction: Extracorporeal membrane oxygenation (ECMO) supports hemodynamics in cardiogenic shock (CS) at the expense of left ventricular (LV) overload. LV assist device (LVAD) also supports hemodynamics, whereas LVAD unloads LV. Therefore, the combination of ECMO and LVAD would augment hemodynamic support and unload LV. We hypothesized that the combination therapy in acute myocardial infarct (AMI) in CS could synergistically improve hemodynamics and unload LV, which, in turn, reduces infarct size. Methods: In protocol 1, we ligated coronary arteries and created AMI with CS in 5 mongrel dogs (15.1±0.3 kg). We transvascularly introduced Impella CP into LV. We kept the ECMO flow constant at 1.8L/min. We compared hemodynamics and the LV pressure-volume area (PVA, an index of LV oxygen consumption) under 3 conditions; Control, ECMO, and ECMO+Impella (ECPELLA) in each dog. In protocol 2 (n=15), we ligated coronary arteries for 180 min and then reperfused. We activated Impella CP and/or ECMO from 60 min after the coronary ligation to the end of the experiment. We allocated dogs into 3 groups, no support (Control), ECMO, and ECPELLA and compared infarct size at 180 min after reperfusion among 3 groups. Results: In protocol 1, both ECMO and ECPELLA increased arterial pressure compared to Control (Control: 63±9, ECMO: 88±10 and ECPELLA: 97±18 mmHg, p &lt; 0.05), and resolved the CS status. ECPELLA strikingly reduced PVA by 83% relative to Control (1500±326, 2038±357 and 258±182 mmHg*ml, p&lt;0.001). In protocol 2, ECPELLA markedly reduced the infarct size (15±8%) compared to Control (53±7%, p&lt;0.05) and ECMO (39±10%, p&lt;0.05). Conclusions: ECPELLA before reperfusion markedly improved hemodynamics, reduced PVA, and limited infarct size in a dog model of MI with CS. ECPELLA could prevent ECMO-induced LV overload and synergistically exert powerful anti-infarct effects in AMI with CS.
Abstract 15065: Impact of Ablation Strategy on Left Ventricular Function Following Catheter Ablation in Patients With Long-standing Persistent Atrial Fibrillation and Heart Failure: Results From a Single-center Study
Authors: Sanghamitra Mohanty, CHINTAN G TRIVEDI, Faiz Baqai, Domenico G Della Rocca, Carola Gianni, Bryan MacDonald, Angel Mayedo, John Burkhardt, G Gallinghouse, Amin Al-ahmad, Rodney Horton, Mohamed Bassiouny, Luigi Di Biase, Andrea Natale
Journal: Circulation (2020)

Background: Ablation strategy for long-standing persistent atrial fibrillation (LSPAF) is highly variable with diverse outcomes. Objective: We evaluated the change in left ventricular ejection fraction (LVEF) with different ablation approaches in LSPAF patients with heart failure (HF). Methods: Consecutive LSPAF patients with HF (LVEF &lt;40%) undergoing their first catheter ablation at our center were included in the analysis. Based on the ablation strategy determined by the operators, patients were classified into two groups; group 1: received standard ablation (PV isolation+ isolation of left atrial posterior wall and superior vena cava) and group 2: standard ablation plus isolation of coronary sinus (CS) and left atrial appendage (LAA). High-dose isoproterenol challenge (20-30 μg for 10-15 min) was utilized to reveal LAA and CS triggers; electrical isolation was the procedural endpoint for LAA and CS ablation. If PVs were electrically silent due to presence of severe scar, LAA and CS were empirically isolated even in the absence of detectable triggers. LVEF was measured by transesophageal echocardiogram (TEE) performed at baseline and 6 months post-ablation. Patients were monitored for arrhythmia-recurrence off-antiarrhythmic drugs (AAD) as per our standard protocol. Results: Group 1 included 52 patients and group 2 had 106. Baseline characteristics were comparable across groups (age: 66.2 ± 7.3 and 64.4 ± 9.4; male: 41 (78.8%) and 87 (82.1%); BMI: 32.3 ± 6.8 and 30.4 ± 6.4 in group 1 and 2). Mean baseline LVEF (%) was 36.2±5.5 and 35.1±8.3 in group 1 and 2 respectively (p=NS). At the 6-month TEE, mean LVEF was significantly higher than the baseline value in group 2 (47.7±11 vs 35.1±8.3, p&lt;0.001), whereas in group 1, although there was a positive trend, the change was statistically non-significant (39.4±10 vs. 36.2±5.5, p=0.36). A total of 7 (13.5%) patients from group 1 and 89 (84%) from group 2 were arrhythmia-free off-AAD at 1.5 year of follow-up (p&lt;0.001). Conclusion: In our study population, ablation strategy including LAA and CS isolation along with the standard ablation resulted in significant improvement in the LVEF as well as higher rate of arrhythmia-free survival.