tbuckley/cabot-search huggingface dataset:
Efficacy and Feasibility of Intradialytic Plantar Electrical Stimulation in Patients With Diabetes: A Randomized Double-Blind Controlled Trial
Authors: Myeounggon Lee, Abdullah Hamad, Mehrnaz Azarian, Jaewon Beom, Abderrahman Ouattas, Mohammad Dehghan Rouzi, Naima Rodriguez, Nhi Quach, Rania Ibrahim, Mincy Mathew, Talal Talal, Fadwa Al-Ali, Bijan Najafi
Journal: Diabetes Care (2024)

OBJECTIVE This study investigates the efficacy and feasibility of electrical stimulation (E-Stim) on sensory fibers of the plantar region during hemodialysis sessions, aiming to improve mobility in patients with diabetes by providing a connection between E-Stim and enhanced mobility with minimal patient effort required. RESEARCH DESIGN AND METHODS Participants age ≥18 years with diabetes undergoing hemodialysis and able to walk at least 10 m with or without aid were recruited and divided into an intervention group receiving 1-h intradialytic E-Stim three times a week and a control group using an identical nonfunctional device for 12 weeks. Gait, physical activity, patient-reported outcomes, and the technology acceptance model were assessed to evaluate the intervention’s effectiveness and acceptance. RESULTS Out of 117 initial participants, 97 completed the study. Significant improvements were observed in the intervention group compared with the control group in gait performance (stride time at dual-task and fast walking), physical activity (stand to walk and sit to stand), quality of life, plantar numbness, and cognitive function after 12 weeks. The intervention group showed that magnitudes of improvement on gait performance and physical activity metrics were associated with enhancements in quality of life and cognitive function, respectively. The intervention group also reported higher usefulness and usage satisfaction, with a greater willingness to continue using E-Stim at home. CONCLUSIONS The 12-week intradialytic E-Stim intervention is a feasible and effective method to enhance gait performance, physical activity level, cognitive function, and other patient-reported outcomes in patients undergoing hemodialysis, representing a practical, low-risk therapy option for those unable to engage in traditional exercise programs.
Initiation of Intermittently Scanned Continuous Glucose Monitoring Is Associated With Reduced Hospitalization for Acute Diabetes Events and Cardiovascular Complications in Adults With Type 1 Diabetes
Authors: Katarina Eeg-Olofsson, David Nathanson, Tim Spelman, Mattias Kyhlstedt, Erik Bülow, Fleur Levrat-Guillen, Jan Bolinder
Journal: Diabetes Care (2024)

OBJECTIVE We assessed the impact of intermittently scanned continuous glucose monitoring (isCGM) compared with blood glucose monitoring (BGM) on rates of hospitalization for metabolic and vascular complications of diabetes and on HbA1c levels for adults with type 1 diabetes. RESEARCH DESIGN AND METHODS This retrospective study using data from the Swedish National Diabetes Register and the Swedish National Patient Register comprised adults with type 1 diabetes and an isCGM initiation date after 1 June 2017 and matched control individuals using BGM. Hospital admission rates were calculated per 100 person-years of follow-up. RESULTS We identified 11,822 adults with type 1 diabetes and an isCGM index date after 1 June 2017 and HbA1c baseline values 3–8 months prior to the index date. Compared with 3,007 BGM users, isCGM users had a significantly lower relative risk of hospitalization for hypoglycemia (0.32; 95% CI 0.14, 0.74), diabetic ketoacidosis (0.55; 0.35, 0.87), stroke (0.48; 0.37, 0.64), acute myocardial infarction (0.64; 0.46, 0.91), atrial fibrillation (0.59; 0.38, 0.94), heart failure (0.25; 0.16, 0.39), peripheral vascular disease (0.21; 0.07, 0.62), kidney disease (0.48; 0.35, 0.66), or hospitalization for any reason (0.32; 0.29, 0.35). Compared with BGM users, change in mean HbA1c for isCGM users was −0.30% (−3.3 mmol/mol) at 6 months and −0.24% (−2.6 mmol/mol) at 24 months (both P &amp;lt; 0.001). CONCLUSIONS This study shows that adults with type 1 diabetes in Sweden who initiate isCGM have significantly reduced hospitalization rates for acute diabetes events, kidney disease, and cardiovascular complications, along with improved glucose control, compared with BGM users.
Absolute and Functional Iron Deficiency in the US, 2017-2020
Authors: Yahya M. K. Tawfik, Hayley Billingsley, Ankeet S. Bhatt, Iman Aboelsaad, Omar S. Al-Khezi, Pamela L. Lutsey, Leo F. Buckley
Journal: JAMA Network Open (2024)

Importance The prevalence of absolute and functional iron deficiency among adults in the US is unknown. Objective To estimate the prevalence of absolute and iron deficiency and iron supplement use in the US across age, sex, and comorbidity categories. Design, Setting, and Participants This cross-sectional study analyzed data from the National Health and Nutritional Examination Survey (NHANES) 2017 to 2020 prepandemic cycle. Participants included noninstitutionalized, civilian women and men aged 18 years or older who had available serum ferritin, iron, and unsaturated iron binding capacity measurements. Data analysis was performed from March 21, 2023, to July 5, 2024. Exposure Absolute iron deficiency and functional iron deficiency. Main Outcomes and Measures Absolute iron deficiency was defined as serum ferritin less than 30 ng/mL regardless of transferrin saturation. Functional iron deficiency was defined as serum ferritin greater than or equal to 30 ng/mL with transferrin saturation less than 20%. The prevalence of absolute and functional iron deficiency was estimated among all adults in the US and separately among women and men according to age category (&amp;amp;gt;18 years to &amp;amp;lt;50 years, 50-65 years, and ≥65 years) using recommended sample weights and sampling design factors to provide estimates representative of the national, noninstitutionalized civilian population. The 95% CIs were calculated using the Korn-Graubard method. Results A total of 8021 US adults (mean age, 48 years; 95% CI, 47-49 years; 52% [95% CI, 50%-53%] female) were included in this analysis. An estimated 14% (95% CI, 13%-15%) of adults in the US met the criteria for absolute iron deficiency, and an estimated 15% (95% CI, 14%-17%) met the criteria for functional iron deficiency. Among US adults without anemia, heart failure, chronic kidney disease, or current pregnancy, the estimated prevalence of absolute iron deficiency was 11% (95% CI, 10%-11%), and that of functional iron deficiency was 15% (95% CI, 14%-17%). The prevalence of functional iron deficiency exceeded that of absolute iron deficiency in all US adults except women younger than 50 years. Iron supplement use ranged from 22% (95% CI, 12%-37%) to 35% (95% CI, 29%-42%) of women with iron deficiency and 12% (95% CI, 5%-21%) to 18% (95% CI, 8%-32%) of men with iron deficiency depending on age. Conclusions and Relevance These findings suggest that absolute and functional iron deficiency affect a large proportion of American adults even in the absence of anemia, heart failure, or chronic kidney disease. Further research on the role of functional iron deficiency in adverse health outcomes and on iron deficiency screening strategies is needed.
Voice-Activated Cognitive Behavioral Therapy for Insomnia
Authors: Claire M. Starling, Daniel Greenberg, Daniel Lewin, Callen Shaw, Eric S. Zhou, Daniel Lieberman, Jiling Chou, Hannah Arem
Journal: JAMA Network Open (2024)

Importance Insomnia symptoms affect an estimated 30% to 50% of the 4 million US breast cancer survivors. Previous studies have shown the effectiveness of cognitive behavioral therapy for insomnia (CBT-I), but high insomnia prevalence suggests continued opportunities for delivery via new modalities. Objective To determine the efficacy of a CBT-I–informed, voice-activated, internet-delivered program for improving insomnia symptoms among breast cancer survivors. Design, Setting, and Participants In this randomized clinical trial, breast cancer survivors with insomnia (Insomnia Severity Index [ISI] score &amp;amp;gt;7) were recruited from advocacy and survivorship groups and an oncology clinic. Eligible patients were females aged 18 years or older who had completed curative treatment more than 3 months before enrollment and had not undergone other behavioral sleep treatments in the prior year. Individuals were assessed for eligibility and randomized between March 2022 and October 2023, with data collection completed by December 2023. Intervention Participants were randomized 1:1 to a smart speaker with a voice-interactive CBT-I program or educational control for 6 weeks. Main Outcomes and Measures Linear mixed models and Cohen d estimates were used to evaluate the primary outcome of changes in ISI scores and secondary outcomes of sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and sleep efficiency. Results Of 76 women enrolled (38 each in the intervention and control groups), 70 (92.1%) completed the study. Mean (SD) age was 61.2 (9.3) years; 49 (64.5%) were married or partnered, and participants were a mean (SD) of 9.6 (6.8) years from diagnosis. From baseline to follow-up, ISI scores changed by a mean (SD) of −8.4 (4.7) points in the intervention group compared with −2.6 (3.5) in the control group ( P &amp;amp;lt; .001) (Cohen d , 1.41; 95% CI, 0.87-1.94). Sleep diary data showed statistically significant improvements in the intervention group compared with the control group for sleep quality (0.56; 95% CI, 0.39-0.74), wake after sleep onset (9.54 minutes; 95% CI, 1.93-17.10 minutes), sleep onset latency (8.32 minutes; 95% CI, 1.91-14.70 minutes), and sleep efficiency (−0.04%; 95% CI, −0.07% to −0.01%) but not for total sleep time (0.01 hours; 95% CI, −0.27 to 0.29 hours). Conclusions and Relevance This randomized clinical trial of an in-home, voice-activated CBT-I program among breast cancer survivors found that the intervention improved insomnia symptoms. Future studies may explore how this program can be taken to scale and integrated into ambulatory care. Trial Registration ClinicalTrials.gov Identifier: NCT05233800
Race and Sex Disparities Among Emergency Medicine Chief Residents
Authors: Jennifer W. Tsai, Mytien Nguyen, Sarah N. Dudgeon, William McDade, Jung G. Kim, Pooja Agrawal, Dowin Boatright
Journal: JAMA Network Open (2024)

Importance Physicians who belong to minoritized racial and ethnic groups remain underrepresented and underpromoted. Serving as a chief resident is an important position of leadership and prestige, and indicates a benchmark for future professional success. However, it is unknown if disparities in race and/or sex exist in the chief resident selection process. Objective To describe race, ethnicity, and sex of emergency medicine (EM) chief residents and determine the association of racial identity and the intersectionality of race and sex for selecting chief residents in US emergency medicine departments. Design, Setting, and Participants This cohort study analyzed data collected from the Association of American Medical Colleges and the Electronic Residency Application Service in the graduating classes of 2017 and 2018. Data were analyzed between December 2021 and January 2023. Main Outcomes and Measures Relative risk (RR) of selection for chief residency for Black, Asian, and Hispanic EM residents in comparison with White counterparts. Results Among 3408 studied residents, 738 (21.7%) served as chief resident (2253 male [66.1%]; 451 Asian [13.2%], 144 Black [4.2%], 158 Hispanic [4.6%], 239 more than 1 race [7.0%], 46 other [1.3%], and 2370 White [69.5%]). Of chiefs, 81 (11.0%) identified as Asian, 17 (2.3%) as Black, and 26 (3.5%) Hispanic. Asian residents were 78% (95% CI, 63%-96%) as likely to be promoted to chief resident compared with White peers, and Black residents were 51% (95% CI, 32%-80%) as likely as White residents. In our fully adjusted model, racial differences remained significant for Black residents, who were half as likely as white residents to be selected for chief residency (adjusted risk ratio [aRR], 0.55; 95% CI, 0.36-0.82). Overall, White women were most likely to be selected for chief residency and 20% more likely to be selected than White men counterparts (aRR, 1.20; 95% CI, 1.03-1.39). In comparison, women underrepresented in medicine (a category that included residents identified as Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander) were least likely to be selected for chief promotion, and 50% as likely to be selected for chief resident compared with White men (aRR, 0.50; 95% CI, 0.06-0.66). Conclusions and Relevance In this 2024 nationally representative study of EM residents, chief promotion was lower among residents identifying as Asian or Black, and in particular, women underrepresented in medicine. This study’s findings suggest further review of chief resident selection process by residency programs and accreditation bodies is needed to ensure workforce equity for promotion and opportunities for leadership.
Publisher Correction: DOR activation in mature oligodendrocytes regulates α-ketoglutarate metabolism leading to enhanced remyelination in aged mice
Authors: Guojiao Huang, Zhidan Li, Xuezhao Liu, Menglong Guan, Songlin Zhou, Xiaowen Zhong, Tao Zheng, Dazhuan Xin, Xiaosong Gu, Dezhi Mu, Yingkun Guo, Lin Zhang, Liguo Zhang, Q Richard Lu, Xuelian He
Journal: Nature Neuroscience (2024)
Rural-Urban Disparities in Hospital Services and Outcomes for Children With Medical Complexity
Authors: JoAnna K. Leyenaar, Seneca D. Freyleue, Mary Arakelyan, Andrew P. Schaefer, Erika L. Moen, Andrea M. Austin, David C. Goodman, A. James O’Malley
Journal: JAMA Network Open (2024)

Importance Limited availability of inpatient pediatric services in rural regions has raised concerns about access, safety, and quality of hospital-based care for children. This may be particularly important for children with medical complexity (CMC). Objectives To describe differences in the availability of pediatric services at acute care hospitals where rural- and urban-residing CMC presented for hospitalization; identify rural-urban disparities in health care quality and in-hospital mortality; and determine whether the availability of pediatric services at index hospitals or the experience of interfacility transfer modified rural-urban differences in outcomes. Design, Setting, and Participants This retrospective cohort study examined all-payer claims data from Colorado, Massachusetts, and New Hampshire from 2012 to 2017. Analysis was conducted from May 2023 to July 2024. Participants included CMC younger than 18 years residing in these states and hospitalized during the study period. Exposures Rural or urban residence was determined using Rural-Urban Commuting Area codes. Hospitals were categorized as children’s hospitals or general hospitals with comprehensive, limited, or no dedicated pediatric services using American Hospital Association survey data. Interfacility transfers between index and definitive care hospitals were identified using health care claims. Main Outcomes and Measures In-hospital mortality, all-cause 30-day readmission, medical-surgical safety events, and surgical safety events were operationalized using Agency for Healthcare Research and Quality measure specifications. Results Among 36 943 CMC who experienced 79 906 hospitalizations, 16 525 (44.7%) were female, 26 034 (70.5%) were Medicaid-insured, and 34 008 (92.1%) were urban-residing. Rural-residing CMC were 6.55 times more likely to present to hospitals without dedicated pediatric services (rate ratio [RR], 6.55 [95% CI, 5.86-7.33]) and 2.03 times more likely to present to hospitals without pediatric beds (RR, 2.03 [95% CI, 1.88-2.21]) than urban-residing CMC, with no significant differences in interfacility transfer rates. In unadjusted analysis, rural-residing CMC had a 44% increased risk of in-hospital mortality (RR, 1.44 [95% CI, 1.03-2.02]) with no significant differences in other outcomes. Adjusting for clinical characteristics, the difference in in-hospital mortality was no longer significant. Index hospital type was not a significant modifier of observed rural-urban outcomes, but interfacility transfer was a significant modifier of rural-urban differences in surgical safety events. Conclusions and Relevance In this cohort study, rural-residing CMC were significantly more likely to present to hospitals without dedicated pediatric services. These findings suggest that efforts are justified to ensure that all hospital types are prepared to care for CMC.
Preconception HbA<sub>1c</sub> Levels in Adolescents and Young Adults and Adverse Birth Outcomes
Authors: Katharine J. McCarthy, Shelley H. Liu, Joseph Kennedy, Hiu Tai Chan, Frances Howell, Natalie Boychuk, Victoria L. Mayer, Luciana Vieira, Bahman Tabaei, Kacie Seil, Gretchen Van Wye, Teresa Janevic
Journal: JAMA Network Open (2024)

Importance Subclinical hyperglycemia before pregnancy may be associated with the likelihood of maternal morbidity but is understudied among young people. Objective To explore the association of preconception hemoglobin A 1c (HbA 1c ) levels among adolescents and young adults with risk of gestational diabetes at first live birth. Design, Setting, and Participants This retrospective cohort study used linked 2009 to 2017 birth registry, hospital discharge, and New York City Department of Health A1C Registry data for birthing individuals aged 10 to 24 years with no history of diabetes and at least 1 preconception HbA 1c test in New York, New York. Statistical analysis was performed from August to November 2022. Exposure Preconception HbA 1c values categorized as no diabetes (HbA 1c &amp;amp;lt;5.7%) or prediabetes (HbA 1c ≥5.7% to &amp;amp;lt;6.5%). Main Outcomes and Measures The primary outcome was gestational diabetes at first birth. Secondary outcomes included hypertensive disorders of pregnancy, preterm birth, cesarean delivery, and macrosomia. Log binomial regression was used to estimate the relative risk (RR) of gestational diabetes at first birth by preconception HbA 1c level, adjusting for prepregnancy characteristics. The optimal HbA 1c threshold for gestational diabetes was examined using receiver operating curve regression. Results A total of 14 302 individuals (mean [SD] age, 22.10 [1.55] years) met study eligibility criteria. Of these, 5896 (41.0%) were Hispanic, 4149 (29.0%) were Black, 2583 (18.1%) were White, 1516 (10.6%) were Asian, and 185 (1.3%) had other or unknown race and ethnicity. Most (11 407 individuals [79.7%]) had normoglycemia before pregnancy, and 2895 individuals (20.2%) had prediabetes. Adjusting for prepregnancy characteristics, those with preconception prediabetes had more than twice the risk of gestational diabetes vs those with normoglycemia (adjusted RR [aRR], 2.21; 95% CI, 1.91-2.56). Preconception prediabetes was associated with small increases in the likelihood of a hypertensive disorder of pregnancy (aRR, 1.18; 95% CI, 1.03-1.35) and preterm delivery (aRR, 1.18; 95% CI, 1.02-1.37). The aRRs for cesarean delivery (aRR, 1.09; 95% CI, 0.99-1.20) and macrosomia (aRR, 1.13; 95% CI, 0.93-1.37) were increased but not statistically significant. The optimal HbA 1c threshold to identify gestational diabetes among adolescents and young adults was 5.6%. The threshold did not vary by obesity status but was slightly lower among Hispanic individuals (HbA 1c of 5.5%). Conclusions and Relevance In this study of adolescents and young adults with at least 1 preconception HbA 1c test, prediabetes was associated with increased likelihood of maternal cardiometabolic morbidity at first birth. Efforts to optimize cardiometabolic health before pregnancy may avert excess maternal risk.
Interleukin-34-orchestrated tumor-associated macrophage reprogramming is required for tumor immune escape driven by p53 inactivation
Authors: Zhigang Nian, Yingchao Dou, Yiqing Shen, Jintang Liu, Xianghui Du, Yong Jiang, Yonggang Zhou, Binqing Fu, Rui Sun, Xiaohu Zheng, Zhigang Tian, Haiming Wei
Journal: Immunity (2024)
Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome
Authors: Julie R. Gaither, Matthew J. Drago, Matthew R. Grossman, Yi Li, Veronika Shabanova, Xiao Xu, John M. Leventhal
Journal: JAMA Network Open (2024)

Importance Although cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants. Objective To examine hospital readmissions for infants with and without NOWS. Design, Setting, and Participants This retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024. Exposure Neonatal opioid withdrawal syndrome. Main Outcome and Measures Survey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth. Results Of the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (&amp;amp;gt;36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS ( P &amp;amp;lt; .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant. Conclusions and Relevance In this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.