Digital Commons Network^™

Protocol For Personalised Prediction Of Persistent Postsurgical Pain, Katherine J Holzer, Harutyun Alaverdyan, Ziqi Xu, Madelyn R Frumkin, Karen A Frey, Stephen H Gregory, Thomas L Rodebaugh, Chenyang Lu, Christopher R King, Denise Head, Thomas Kannampallil, Simon Haroutounian

2020-Current year OA Pubs

INTRODUCTION: Persistent postsurgical pain (PPSP) affects up to 15% of patients after major surgery, impairing physical function, quality of life and increasing risk for long-term opioid use. Current PPSP prediction models rely on static or retrospective data and fail to incorporate dynamic perioperative factors. The Personalised Prediction of Persistent Postsurgical Pain (P5) study aims to develop individualised, multimodal prediction models by integrating preoperative behavioural, psychophysical and neurocognitive assessments and high-frequency symptom monitoring.

METHODS AND ANALYSIS: P5 is a prospective, single-centre cohort study enrolling 2500 adults aged 18-75 undergoing major surgery at a tertiary academic hospital. Participants complete baseline surveys, cognitive …

Time Trends In The Male To Female Ratio For Autism Incidence: Population Based, Prospectively Collected, Birth Cohort Study, Caroline Fyfe, Henric Winell, Joseph Dougherty, David H Gutmann, Alexander Kolevzon, Natasha Marrus, Kristina Tedroff, Tychele N Turner, Lauren A Weiss, Benjamin H K Yip, Weiyao Yin, Sven Sandin

2020-Current year OA Pubs

OBJECTIVES: To examine changes in the male to female ratio in diagnoses of autism spectrum disorder (ASD) over a 35 year period, providing temporal trends in diagnosis (incidence rate), the male to female ratio, and the age-cohort specific cumulative male to female ratio (cMFR).

DESIGN: Population based, prospectively collected birth cohort study.

PARTICIPANTS: 2 756 779 liveborn children recorded in the Swedish medical birth register between 1985 and 2020.

SETTING: Sweden.

MAIN OUTCOME MEASURE: Age-period cohort analysis investigating associations between ASD and age at diagnosis, calendar period, birth cohort, and sex, quantified by incidence rate ratios and associated two sided …

Intercalated Bacterial Biofilms Are Intrinsic Internal Components Of Calcium-Based Kidney Stones, William C Schmidt, Henry L Schreiber, Rachael E S Hammann, Chloe L P Obernuefemann, Karla Bergeron, Aleksandra Klim, Daniel Wong, Kefu Du, Scott J Hultgren, Et Al.

2020-Current year OA Pubs

Calcium oxalate stones comprise greater than 70% of all kidney stones. In the current conceptual framework, the initial stone nidus is thought to include the aggregation of inorganic crystallites, the formation of which is favored by elevated concentrations of dissolved constituents. Here, we show that this highly prevalent stone type comprises a form of organic-inorganic polycrystalline biocomposite with integrated bacterial biofilms. Evidence from electron microscopy and fluorescence microscopy reveal the unanticipated internal structure of kidney stones from human patients, where bacterial biofilms are intercalated between polycrystalline mineral layers, even in stones identified as "noninfectious" clinically, including those in patients without …

Rev-Erb-Alpha And -Beta Coordinately Regulate Astrocyte Reactivity And Proteostatic Function, Collin J Nadarajah, Michelle Y Li, Elsa I Quillin, Kevin Boyer, Julie M Dimitry, Yining Chen, Melvin W King, Ibrahim O Saliu, Jiyeon Lee, Patrick W Sheehan, Albert A Davis, Mitchell A Lazar, Guoyan Zhao, Erik S Musiek

2020-Current year OA Pubs

The molecular circadian clock is a ubiquitous transcriptional-translational feedback loop that regulates CNS function, glial responses, and neurodegenerative pathology. The nuclear receptors REV-ERB-α (

Rapid Urinary Lipoarabinomannan Test With Laboratory-Level Sensitivity For Tuberculosis Detection: A Performance Evaluation, Qisheng Jiang, Harisha Ramachandraiah, Carolyn Duncan, Sumanth Gandra, Ige A George, Jingyi Luan, Marcos Perez, Lorraine Lillis, David S Boyle, Scott Crick, Morten Ruhwald, Srikanth Singamaneni

2020-Current year OA Pubs

UNLABELLED: Developing rapid, non-sputum-based tests is a global priority to improve the diagnosis and timely treatment of tuberculosis (TB). In this study, we evaluated the detection limit, precision, stability, and lot-to-lot variation of a next-generation rapid diagnostic test (RDT), the plasmonic fluor (PF)-enhanced urinary lipoarabinomannan lateral flow assay (PF-LAM). We also assessed the diagnostic performance of PF-LAM, Alere Determine TB LAM Ag (AlereLAM), and electrochemiluminescence LAM assay (EclLAM), a highly sensitive laboratory-based test by comparing with microbiology reference standard (MRS) that includes molecular testing (Xpert MTB/RIF) and culture. Two sub-studies were conducted using banked urine samples. First, a preclinical study …

Generational Trends In Reproductive Factors Among Women In The Us: Implications For Breast Cancer Incidence, Lin Yang, Adetunji T Toriola

2020-Current year OA Pubs

BACKGROUND: Reproductive factors are key breast cancer risk factors, yet contemporary generational patterns remain unclear. We aimed to evaluate trends in reproductive factors among US women born between 1910 and 2000.

METHODS: We conducted a serial, cross-sectional analysis of reproductive factors using data from the US National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2020. Female participants were grouped by birth cohorts (1910-1930, then by 10-year to 2000). Self-reported data were used to derive age at menarche, prevalence of age at menarche <  12 years, age at natural menopausal, prevalence of first live birth after age 30, and lifetime number of live births.

RESULTS: Data on 28,481 US women were analyzed. From birth cohort 1910-1930 to 1990-2000, the …

Slc7a8 Is Essential For Metabolic Fitness And Function Of Th2 Cells, Santosh K Panda, Do-Hyun Kim, Pritesh Desai, Shitong Wu, Patrick Fernandes Rodrigues, Raki Sudan, Yizhou Liu, Haerin Jung, Intelly Lee, Susan Gilfillan, Marina Cella, Steven J Van Dyken, Marco Colonna

2020-Current year OA Pubs

Amino acids are essential for the activation and function of CD4 T helper (Th) cells, which differentiate into Th1, Th2, Th17, and Treg subsets to coordinate immune responses. While specific amino acid transporters have been identified for Th1, Th17, and Tregs, a transporter regulating Th2 cells remains unknown. This study identifies SLC7A8 as a Th2-specific amino acid transporter in the Th compartment. We found that Slc7a8 expression is upregulated in Th2 cells compared with other T helper subsets, and Slc7a8 deficiency impairs Th2 cell proliferation and cytokine production. Furthermore, SLC7A8 was found to be crucial for an effective type 2 …

Amyloidosis Of Bridging Veins Is A Pathologic Feature Of Alzheimer's Disease, Leon C D Smyth, Daan Verhaege, Elio Standen-Bloom, Yue Wu, Steffen E Storck, Pavle Boskovic, Benjamin A Plog, Tornike Mamuladze, Jose A Mazzitelli, Zhuoying Wang, Daniel D Lee, Gwendalyn J Randolph, Katherine E Schwetye, Song Hu, Jonathan Kipnis, Et Al.

2020-Current year OA Pubs

Alzheimer's disease (AD) is characterized by the accumulation of extracellular aggregated amyloid beta, resulting from impaired waste clearance. We recently identified new cerebrospinal fluid (CSF) efflux structures termed arachnoid cuff exit (ACE) points and speculated that these may be impacted in AD, leading to impaired waste clearance function. Using 5XFAD mice, we found progressive amyloidosis of bridging veins at ACE points. Indeed, in 5XFAD mice, there is impaired CSF efflux to the dura mater, impaired CSF flow along bridging veins, and impaired blood flow through bridging veins. These observations suggest that ACE point amyloidosis plays a role in waste clearance …

Estimated Effectiveness Of 2024-2025 Covid-19 Vaccination Against Severe Covid-19, Kevin C Ma, Jennie H Kwon, Et Al.

2020-Current year OA Pubs

IMPORTANCE: As SARS-CoV-2 JN.1 lineage descendants continue to evolve, evaluating COVID-19 vaccine effectiveness (VE) against severe COVID-19 remains important to guide vaccination strategies.

OBJECTIVE: To estimate the VE of the 2024-2025 COVID-19 vaccines against COVID-19-associated hospitalization and severe in-hospital outcomes overall and by time since dose (7-89, 90-179, and ≥180 days), JN.1 descendant lineage (KP.3.1.1, XEC, LP.8.1), and spike protein mutations associated with immune evasion.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, test-negative, case-control study conducted by the Investigating Respiratory Viruses in the Acutely Ill Network included adult patients (aged ≥18 years) hospitalized between September 1, 2024, and April 30, 2025, …

Costs Of Single Maintenance And Reliever Therapy Vs Traditional Therapy For Asthma, Tri Pham, Abigail R Barker, Sarah A Eisenstein, Eliot Jost, Anna Volerman, Krutika Chauhan, Ross C Brownson, Timothy Mcbride, Mark D Huffman, Kaharu Sumino, Lynn B Gerald, Mario Castro, Anne E Dixon, James G Krings

2020-Current year OA Pubs

IMPORTANCE: Despite strong guideline support, single maintenance and reliever therapy (SMART) for asthma is underused in the US. Limited insurance coverage of SMART-compatible inhalers remains a major barrier to its adoption.

OBJECTIVE: To compare the annual asthma management costs of SMART vs traditional therapy from a US health care payer perspective.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used a probabilistic decision-tree model with Monte Carlo simulations to compare the total asthma management costs for patients prescribed SMART vs traditional therapy, conducting analyses from September 1, 2024, to March 13, 2025. Input data were extracted through a systematic review of …

Demographic And Clinicopathologic Factors Associated With Colorectal Adenoma Recurrence, Usman Ayub Awan, Qingyuan Song, Kristen K Ciombor, Adetunji T Toriola, Jungyoon Choi, Timothy Su, Xiao-Ou Shu, Kamran Idrees, Kay M Washington, Wei Zheng, Wanqing Wen, Zhijun Yin, Xingyi Guo

2020-Current year OA Pubs

IMPORTANCE: Current colorectal surveillance guidelines emphasize adenoma characteristics but overlook temporal, racial, and sex-based heterogeneity in recurrence risk, a gap that limits equitable and personalized care.

OBJECTIVE: To evaluate the associations of demographic factors, obesity, and adenoma features with recurrence risk over time in a large longitudinal surveillance cohort.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center.

EXPOSURES: Demographic variables included race and ethnicity, sex, obesity (body mass index >30), family history of colorectal cancer (CRC) or polyps, and age at …

A Multicomponent Strategy To Increase Human Papillomavirus Vaccination Rates In Primary Care: A Cluster Randomized Clinical Trial, Ruoyun Wang, Lei Liu, Sherry Dodd, Sharon Graham, Shannon Rook, Lauren Ericson, Katie Plax, Abigail Barker, Virginia Mckay, Michelle I Silver, Jason G Newland, Allison A King

2020-Current year OA Pubs

IMPORTANCE: Human papillomavirus (HPV) vaccination prevents multiple cancers, yet vaccination rates by the recommended age remain well below national goals.

OBJECTIVE: To evaluate the effectiveness of a multicomponent strategy in increasing HPV vaccination rates in primary care settings by 13 years of age.

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial with a parallel-group design and 1:1 allocation was conducted at 20 pediatrics primary care practices from a practice-based research network in the St Louis, Missouri, metropolitan area by clinicians delivering routine well-child visits within participating practices. The intervention was implemented over 24 months (July 1, 2020, to September …

Longitudinal Multiomic Signatures Of Ards And Sepsis Inflammatory Phenotypes Identify Pathways Associated With Mortality, Narges Alipanah-Lechner, Pratik Sinha, Et Al.

2020-Current year OA Pubs

BACKGROUNDCritically ill patients with acute respiratory distress syndrome (ARDS) and sepsis exhibit distinct inflammatory phenotypes with divergent clinical outcomes, but the underlying molecular mechanisms remain poorly understood. These phenotypes, derived from clinical data and protein biomarkers, were associated with metabolic differences in a pilot study.METHODSWe performed integrative multiomics analysis of blood samples from 160 patients with ARDS in the ROSE trial, randomly selecting 80 patients from each latent class analysis-defined inflammatory phenotype (hyperinflammatory and hypoinflammatory) with phenotype probability greater than 0.9. Untargeted plasma metabolomics and whole-blood transcriptomics at day 0 and day 2 were analyzed using multimodal factor analysis (MEFISTO). …

Phase 1 Study Of Inbrx-105, A Tnfrsf9 (4-1bb) And Pd-L1 Bispecific Antibody, In Patients With Select Solid Tumors, Jong Chul Park, Doug R Adkins, Et Al.

2020-Current year OA Pubs

PURPOSE: INBRX-105, a tetravalent, PD-L1-targeted TNFRSF9 (4-1BB) agonist, demonstrated preclinical antitumor activity. This first-in-human study evaluated INBRX-105 in solid tumors.

PATIENTS AND METHODS: This open-label, 4-part, phase 1 study evaluated INBRX-105 alone or with pembrolizumab in adults with locally advanced/metastatic, unresectable solid tumors (NCT03809624). INBRX-105 was administered intravenously once every 2 weeks or 4 weeks in parts 1 (single-agent dose escalation; 0.001-3 mg/kg) and 2 (single-agent expansion) or once every 3 weeks in parts 3 (combination dose escalation; INBRX-105 0.03-1.0 mg/kg) and 4 (combination expansion). Part 2 enrolled patients with checkpoint inhibitor-relapsed/refractory (CPI-R/R) tumors. Part 4 enrolled patients with CPI-R/R …

Divergent Humoral Immune Signatures In Response To Klebsiella Pneumoniae Bacteremia, Paeton L Wantuch, Nadia Wattad, David A Rosen

2020-Current year OA Pubs

OBJECTIVES: Klebsiella pneumoniae is an increasingly threatening global pathogen with high rates of antibiotic resistance and no licensed vaccines available. Despite its worldwide importance, little is known about the human adaptive immune response to K. pneumoniae infection.

METHODS: Herein we observed the longitudinal antibody responses of three immunocompetent patients hospitalized with K. pneumoniae bacteremia. We analyzed the human serum for antibody titers and in vitro functionality. Further, serum function was evaluated via an in vivo mouse model.

RESULTS: We found that in each case, anti-K. pneumoniae antibodies against the infecting strain were still detectable a year after the initial infection. …

Clinical Presentation, Risk Factors And Outcome Of Non-Tuberculous Mycobacteria Infection In Hematopoietic Stem-Cell Transplantation: A Multinational Case-Control Study, Mario Fernández-Ruiz, Sasinuch Rutjanawech, Carlos Mejía-Chew, Et Al.

2020-Current year OA Pubs

BACKGROUND: The clinical and microbiological features of infection due to non-tuberculous mycobacteria (NTM) after hematopoietic stem-cell transplantation (HSCT) remain poorly understood.

METHODS: We performed a retrospective, multinational case-control study that included HSCT recipients (≥12 years) diagnosed with NTM disease between January 2008 and December 2018. Controls were HSCT recipients with no evidence of NTM disease, matched (1:2 ratio) by participating center and post-transplant survival. Logistic regression on matched pairs was used to investigate risk factors for NTM disease.

RESULTS: We included 25 cases of NTM disease. The most common HSCT type was allogeneic from unrelated donor (72.0%) after myeloablative conditioning …

Seeg-Guided Responsive Neurostimulation To Treat Neocortical Epilepsy: A Multicenter Retrospective Study Of The Efficacy And Safety Of Depth Electrode-Mediated Neuromodulation, Sina Sadeghzadeh, Jon T Willie, Et Al.

2020-Current year OA Pubs

OBJECTIVES: Pivotal trials have established the effectiveness of the Responsive Neurostimulation System (RNS® System) in treating focal epilepsy. In clinical trials, depth leads were primarily used to treat mesial temporal seizure onsets while cortical strip leads were used to treat neocortical seizure onsets. Here, we systematically analyze the safety and efficacy of stereoelectroencephalography (sEEG)-guided depth leads to provide responsive stimulation to neocortical gray matter.

METHODS: Patients were stratified as strong responders (>median cohort seizure reduction %), weak responders (>0% and ≤median cohort seizure reduction %), and anti-responders (≤0%) based on percent seizure reduction at 1 year post-implant (1-Y). …

Loss Of Beta-Cell Identity And Function As A Mechanism Of Secondary Failure Of Sulfonylurea Therapy In Diabetes, Sumit Patel, Zihan Yan, Maria S Remedi

2020-Current year OA Pubs

Sulfonylureas, commonly used to treat type 2 diabetes (T2D), often lose effectiveness over time when used as monotherapy; however, the underlying mechanisms remain unclear. To investigate the mechanisms of sulfonylurea failure, glibenclamide-releasing pellets were implanted in KK mice, a polygenic model that spontaneously develops T2D. KK mice receiving placebo pellets (KK-Placebo) developed hyperglycemia, hyperinsulinemia, glucose intolerance, and insulin resistance. Notably, KK mice implanted with glibenclamide (KK-Glib) showed improved blood glucose levels during the first 7 days, returning to KK-Placebo levels thereafter. KK-Glib mice exhibited reduced plasma insulin levels and insulin secretion in response to a glucose challenge compared with the …

Supporting Emergency Department Patients Experiencing Homelessness, Antony Hsu, Michael A Light, Callan Fockele, Samantha Hay, Stephen Y Liang, Wendy Macias-Konstantopoulos, Carla B Brim, William Weber

2020-Current year OA Pubs

Homelessness is a growing public health crisis across the United States. Emergency physicians are uniquely positioned to address immediate medical concerns and the underlying social drivers of health for patients experiencing homelessness. Initiating coordination of care in the emergency department addresses their hierarchy of needs and can help support patient movement through the department. Practice adaptations described include early engagement; trauma-informed care approach; addressing unmet nonmedical needs; establishing safe dispositions; documenting homelessness, substance use disorder, and linkages to care; clinical practice adaptations; and palliative care approaches. Programs and initiatives outside of the emergency department described include street medicine and government …

Silent Messengers In The Nano-World: Harnessing Extracellular Vesicles As Theranostic Tools For Neonatal Surgical Conditions, Augusto Zani

2020-Current year OA Pubs

Extracellular vesicles (EVs) are lipid bilayer-enclosed nanoparticles secreted by all cells that mediate intercellular communication by transferring proteins, lipids, and nucleic acids. Among their cargo, microRNAs are key post-transcriptional regulators of organogenesis. In fetal lung development, EV-mediated signaling is essential for the coordination of epithelial, mesenchymal, endothelial, and immune cells. In congenital diaphragmatic hernia (CDH), disruption of these interactions leads to pulmonary hypoplasia and pulmonary hypertension, the primary causes of morbidity and mortality. Amniotic fluid stem cell-derived EVs (AFSC-EVs) have emerged as a promising cell-free therapy to restore this impaired communication. In rodent, rabbit, and human models of pulmonary hypoplasia, …

Palbociclib With Adjuvant Endocrine Therapy In Early Breast Cancer: 5-Year Follow-Up Analysis Of The Global Multicenter, Open-Label, Randomized Phase Iii Pallas Trial (Abcsg-42/Aft-05/Pre0109/Big-14-13), E L Mayer, K Clifton, Et Al.

2020-Current year OA Pubs

BACKGROUND: In the phase III PALLAS trial, the addition of 2 years of palbociclib to adjuvant endocrine therapy (ET) did not improve short-term invasive disease-free survival (iDFS) compared with ET alone in high-risk early-stage hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. In this article, we report 5-year efficacy outcomes, including updated iDFS and overall survival (OS).

PATIENTS AND METHODS: PALLAS is an international, open-label, randomized phase III trial evaluating the addition of 2 years of palbociclib to adjuvant ET in patients with stage II-III HR-positive/HER2-negative breast cancer. The primary endpoint was iDFS.

RESULTS: The trial enrolled …

"Another One Bite The Dust-It Happens So Much In Black Neighborhoods": Structural Barriers And Grassroots Resources Among Black Men Who Use Drugs Facing Fentanyl-Era Overdose And Treatment Disparities, Devin E Banks, Kaytryn D Campbell, Maria E Paschke, Rashmi Ghonasgi, Bridget Coffey, Jameala Jones, Brittany Blanchard, Ryan W Carpenter, Daje Bradshaw, Rachel P Winograd

2020-Current year OA Pubs

INTRODUCTION: Black men in the United States have been disproportionately impacted by fatal drug overdose since the proliferation of synthetic opioids like fentanyl. This community based participatory research study examined determinants of overdose risk and substance use treatment disparities among Black men based on their lived experience.

METHODS: Between February and December 2023, we enrolled 35 Black men reporting past-30-day opioid use to complete semi-structured qualitative interviews. Interviews were analyzed by a team of academic and community-based coders with lived experience using an inductive-deductive approach to thematic analysis.

RESULTS: Six key themes were identified. Four themes described racism-related inequities posing …

Effects Of Dual-Eligible Integrated Care Plans On Medicaid Enrollment And Retention: Evidence From The Implementation Of Medicare-Medicaid Plans, Eric T Roberts, Eliza Macneal, Kenton J Johnston, José F Figueroa

2020-Current year OA Pubs

Medicare and Medicaid are separate programs that together cover 13 million low-income older adults and people with disabilities, known as dual-eligible individuals. Concern about a lack of coordination across Medicare and Medicaid has prompted the development of Integrated Care Programs (ICPs). Although the primary goal of ICPs is to coordinate financing and care across Medicare and Medicaid, ICPs may also influence whether low-income individuals obtain or keep Medicaid. We evaluated whether the rollout of Medicare-Medicaid Plans (MMPs)-one of the largest ICPs-was associated with changes in Medicaid take-up and retention among Medicare beneficiaries residing in high-poverty zip codes. Using a stacked …

The Sport Publication Observational Research Tool (Sport): An Objective Tool To Score The Methodological Quality Of Observational Clinical Sports Medicine Research, Andrew W Kuhn, Paul M Inclan, Ameer A Haider, Michele N Christy, Robert Brophy, Matthew Smith, Matthew J Matava, Et Al.

2020-Current year OA Pubs

BACKGROUND: A critical component of conducting systematic reviews or meta-analyses is assessing the methodological quality and bias of included studies. Several methodological quality assessment tools have been developed; however, these tools may not be relevant to observational sports medicine research, which carries numerous unique nuances and biases.

PURPOSE: To develop the Sport Publication Observational Research Tool (SPORT), which evaluates and scores the methodological quality of observational sports medicine research.

STUDY DESIGN: Consensus statement.

METHODS: SPORT was developed through a modified Delphi approach involving members from the Herodicus Society and The FORUM. All active members were invited to participate in the …

Objective Selection Of Bone Mimetic Materials Using Impact Microindentation, Lucas R Budd, Rachana S Vaidya, Babak Jahani, Saideep Nakka, Alexander Proctor, Peter T Burks, Blake K Montgomery, Simon Y Tang

2020-Current year OA Pubs

BACKGROUND: Research and development for orthopedic medical devices, implants, surgical technique, and surgical education all require the appropriate selection of bone mimetic materials to align with the physiologic conditions. There is a critical need for an objective measure of material strength that can be collected, practically, on both bone mimetic materials and living human bone to improve mimetic material selection.

METHODS: This study stratifies commonly used synthetic materials in orthopedic research, as well as animal and human bone, using impact microindentation. The impact microindentation is performed with the OsteoProbe, an FDA-approved handheld medical device that can quantify material strength via …

Association Of Sleep Disturbance With Survival After Colorectal Cancer Diagnosis: Results From The Colocare Study, Anita R Peoples, Adetunji T Toriola, Et Al.

2020-Current year OA Pubs

INTRODUCTION: Sleep problems are common among cancer patients. The relationship between sleep disruption and clinical outcomes after colorectal cancer (CRC) diagnosis remains poorly understood. We investigated associations of sleep disruption with survival and recurrence in patients with CRC.

METHODS: CRC patients with stages I-IV (N = 895) were included in this study. Self-reported sleep disturbance was assessed presurgery using the sleep item from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core-30 and classified into "no/mild" or "moderate/severe" sleep disturbance. Cox-proportional hazard models were computed (HRs and 95% confidence intervals) to investigate associations of sleep disturbance …

Management Of Mechanical Ventilation In Emergency Medicine: A Scoping Review, Robert J Klemisch, Mitchell S Hymowitz, Ryan J Alcantara, Brendan F Mullan, Margaret L Davis, Rachel Blume, Nicholas J Johnson, Brian M Fuller

2020-Current year OA Pubs

OBJECTIVES: Invasive mechanical ventilation is used for approximately 250,000 emergency medicine (EM) patients annually and continues to increase. Despite rising volumes, EM clinicians receive limited training in ventilation management. Much of the existing evidence is derived from other environments, which may not fully apply to the unique conditions of EM. This scoping review broadly categorizes literature on invasive ventilation specific to EM patients and clinicians and identifies knowledge gaps to direct future research.

METHODS: Following Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews Checklist guidelines, this review comprehensively mapped the literature on optimizing invasive mechanical ventilation …

Lightweight Open-Source Large Language Models Versus Ctakes For Information Extraction From Discharge Summaries: Tobacco Smoking Status Test Case, David M Dávila-García, Matthew J Schuelke, Adam B Wilcox

2020-Current year OA Pubs

OBJECTIVES: To compare lightweight open-source large language models (LLMs) with cTAKES, a state-of-the-art natural language processing (NLP) system, in an information extraction task from hospitalization discharge summaries.

MATERIALS AND METHODS: Two readers annotated 250 randomly sampled adult discharge summaries (BJC HealthCare, 2018-2023) for tobacco smoking status as "Smoker," "Never smoker," "Unknown." Six LLMs (Llama-3 [1B-70B], gpt-oss-20B, MedGemma-27B) and cTAKES extracted smoking status from summaries. Performance was benchmarked against consensus annotations using weighted F1-score, macro F1-score, and per-class F1-scores and a noninferiority test.

RESULTS: Inter-reader agreement was excellent (κ = 0.91). LLM size (2.3-47.3 GB) and inference time (2.5-14.5 s/note) varied. …

Phenofit: A Framework For Determining Computable Phenotyping Algorithm Fitness For Purpose And Reuse, Laura K Wiley, Luke V Rasmussen, Rebecca T Levinson, Jennnifer Malinowski, Sheila M Manemann, Melissa P Wilson, Martin Chapman, Jennifer A Pacheco, Theresa L Walunas, Justin B Starren, Suzette J Bielinski, Rachel L Richesson

2020-Current year OA Pubs

BACKGROUND: Computational phenotyping from electronic health records (EHRs) is essential for clinical research, decision support, and quality/population health assessment, but the proliferation of algorithms for the same conditions makes it difficult to identify which algorithm is most appropriate for reuse.

OBJECTIVE: To develop a framework for assessing phenotyping algorithm fitness for purpose and reuse.

FITNESS FOR PURPOSE: Phenotyping algorithms are fit for purpose when they identify the intended population with performance characteristics appropriate for the intended application.

FITNESS FOR REUSE: Phenotyping algorithms are fit for reuse when the algorithm is implementable and generalizable-that is, it identifies the same intended population …

Association Of Self-Rated Health And Risk Of Incident Atrial Fibrillation: Findings From Three Cohorts, Parveen K Garg, Aniqa Alam, Harpreet S Bhatia, Jens Horn, Vegard Malmo, Jan Pal Loennechen, Scott Mu, Randi Foraker, Elizabeth Selvin, Imre Janszky, Susan R Heckbert, Alvaro Alonso

2020-Current year OA Pubs

BACKGROUND: Self-rated health (SRH) is easy to obtain and is known to be a good predictor for mortality and several comorbidities, including cardiovascular disease, but its relation to atrial fibrillation (AF) is largely unknown. We determined the association of SRH with risk of developing AF.

METHODS: We conducted a pooled cohort analysis of participants in the Atherosclerosis Risk in Communities Study (ARIC) (

RESULTS: Over a mean of 16±6, 9 ± 2, and 10±4 years of follow-up, 2340 (22.8 %), 1525 (3.5 %), and 879 (17.4 %) incident AF events occurred in ARIC, HUNT-3, and MESA respectively. Lower SRH categories …