Tag: pubmed

Anesthesiology. 2023 Jul 5. doi: 10.1097/ALN.0000000000004675. Online ahead of print.

ABSTRACT

BACKGROUND: Insured patients who receive out-of-network care may receive a “balance bill” for the difference between the practitioner’s charge and their insurer’s contracted rate. In 2017, California banned balance billing for anesthesia care. We examined the association between California’s law and subsequent payments for anesthesia care. We hypothesized that following the law’s implementation, there would be no change in-network payment amounts, and that out-of-network payment amounts and the portion of claims occurring out-of-network would decline.

METHODS: We used average, quarterly, California county-level payment data (2013-2020) derived from a claims database of commercially-insured patients. Using a difference-in-differences approach, we estimated the change in payment amounts for intraoperative/intrapartum anesthesia care, along with the portion of claims occurring out-of-network, following the law’s implementation. The comparison group was office visit payments, expected to be unaffected by the law. We prespecified that we would refer to differences of ≥10% as policy significant.

RESULTS: Our sample consisted of 43,728 procedure code-county-quarter-network combinations aggregated from 4,599,936 claims. The law’s implementation was associated with a significant 13.6% decline in payments for out-of-network anesthesia care (95%CI -16.5 to -10.6%; p<0.001), translating to an average $108 decrease across all procedures (95%CI -$149 to -$64). There was a statistically significant 3.0% increase in payments for in-network anesthesia care (95%CI 0.9 to 5.1%; p=0.007), translating to an average $87 increase (95%CI $64 to $110), which may be notable in some circumstances but did not meet our threshold for identifying a change as policy significant. There was a non-statistically significant increase in the portion of claims occurring out-of-network (10.0%, 95%CI -4.1 to 24.2%, p=0.155).

CONCLUSIONS: California’s balance billing law was associated with significant declines in out-of-network anesthesia payments in the first three years following implementation. There were mixed statistical and policy significant results for in-network payments and the proportion of out-of-network claims.

PMID:37406154 | DOI:10.1097/ALN.0000000000004675

AIDS Educ Prev. 2023 Jul;35(Supplement A):39-51. doi: 10.1521/aeap.2023.35.suppA.39.

ABSTRACT

Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.

PMID:37406144 | DOI:10.1521/aeap.2023.35.suppA.39

Sci Transl Med. 2023 Jul 5;15(703):eadh0004. doi: 10.1126/scitranslmed.adh0004. Epub 2023 Jul 5.

ABSTRACT

Broadly neutralizing antibodies (bNAbs) may provide an alternative to standard antiretroviral treatment (ART) for controlling HIV-1 replication and may have immunotherapeutic effects against HIV-1 reservoirs. We conducted a prospective clinical trial with two HIV-1 bNAbs (VRC01LS and 10-1074) in children (n = 25) who had previously initiated small-molecule ART treatment before 7 days of age and who continued treatment for at least 96 weeks. Both bNAbs were dosed intravenously every 4 weeks, overlapping with ART for at least 8 weeks and then continued for up to 24 weeks or until detectable viremia of HIV-1 RNA rose above 400 copies per milliliter in the absence of ART. Eleven (44%) children maintained HIV-1 RNA below 400 copies per milliliter through 24 weeks of bNAb-only treatment; 14 (56%) had detectable viremia above 400 copies per milliliter at a median of 4 weeks. Archived HIV-1 provirus susceptible to 10-1074, lower birth HIV-1 DNA reservoir in peripheral blood mononuclear cells, sustained viral suppression throughout early life, and combined negative qualitative HIV-1 DNA polymerase chain reaction and negative HIV-1 serology at entry were associated with maintaining suppression on bNAbs alone. This proof-of-concept study suggests that bNAbs may represent a promising treatment modality for infants and children living with HIV-1. Future studies using newer bNAb combinations with greater breadth and potency are warranted.

PMID:37406137 | DOI:10.1126/scitranslmed.adh0004

Proc Natl Acad Sci U S A. 2023 Jul 11;120(28):e2304981120. doi: 10.1073/pnas.2304981120. Epub 2023 Jul 5.

ABSTRACT

How the behavior of cells emerges from their constituent subcellular biochemical and physical parts is an outstanding challenge at the intersection of biology and physics. A remarkable example of single-cell behavior occurs in the ciliate Lacrymaria olor, which hunts for its prey via rapid movements and protrusions of a slender neck, many times the size of the original cell body. The dynamics of this cell neck is powered by a coat of cilia across its length and tip. How a cell can program this active filamentous structure to produce desirable behaviors like search and homing to a target remains unknown. Here, we present an active filament model that allows us to uncover how a “program” (time sequence of active forcing) leads to “behavior” (filament shape dynamics). Our model captures two key features of this system-time-varying activity patterns (extension and compression cycles) and active stresses that are uniquely aligned with the filament geometry-a “follower force” constraint. We show that active filaments under deterministic, time-varying follower forces display rich behaviors including periodic and aperiodic dynamics over long times. We further show that aperiodicity occurs due to a transition to chaos in regions of a biologically accessible parameter space. We also identify a simple nonlinear iterated map of filament shape that approximately predicts long-term behavior suggesting simple, artificial “programs” for filament functions such as homing and searching space. Last, we directly measure the statistical properties of biological programs in L. olor, enabling comparisons between model predictions and experiments.

PMID:37406100 | DOI:10.1073/pnas.2304981120

J Infect Dev Ctries. 2023 Jun 30;17(6):846-853. doi: 10.3855/jidc.17284.

ABSTRACT

INTRODUCTION: The analysis of factors associated with multibacillary leprosy is important for the development of strategies to mitigate the disease, which persists as a public health problem in Brazil and the world. The objective of this study was to verify the associations between sociodemographic and clinical-epidemiological variables and multibacillary leprosy in the state of northeastern Brazil.

METHODOLOGY: This is a cross-sectional, analytical, and retrospective study, with a quantitative approach, carried out in 16 municipalities in the southwest of Maranhão State, northeastern Brazil. All cases of leprosy reported between January 2008 and December 2017 were considered. Sociodemographic and clinical-epidemiological variables were analyzed using descriptive statistics. The identification of the risk factors associated with multibacillary leprosy was conducted using Poisson regression models. The prevalence ratios and respective 95% confidence intervals were estimated using regression coefficients at a 5% significance level.

RESULTS: A total of 3,903 leprosy cases were analyzed. Individuals older than 15 years, males, with less than 8 years of education, with level I, II, or “not evaluated” disability, and with type 1 or 2 or both reactional states were more likely to have multibacillary leprosy. Therefore, these characteristics may be considered risk factors. No protective factors were identified.

CONCLUSIONS: The investigation revealed important associations between risk factors and multibacillary leprosy. The findings can be considered during the creation of strategies to control and combat the disease.

PMID:37406066 | DOI:10.3855/jidc.17284

J Infect Dev Ctries. 2023 Jun 30;17(6):840-845. doi: 10.3855/jidc.17897.

ABSTRACT

INTRODUCTION: Blood transfusion saves millions of lives year around the world; it is the most important life-saving option for blood recipients. However, this act is not without risks as contaminated blood may be the source of transfusion-transmissible infections (TTI). This is a retrospective and comparative study on the prevalence of acquired human immunodeficiency syndrome, viral hepatitis B, C and syphilis in blood donors from Bejaia province (Algeria).

METHODOLOGY: This study is designed to estimate the risk of TTIs among blood donors and the demographic associated factors. It was carried out in the serology laboratories of Bejaia blood transfusion center and Khalil Amrane university hospital. Data were collected from the archived results of screening tests for HBV, HCV, HIV and syphilis, mandatory for all blood donations, from January 2010 to December 2019. The association was considered statistically significant at p < 0.05.

RESULTS: Among 140,168 donors from Bejaia province, 78,123 represent the urban population and 62,045 the rural population. Over 10 years, results of serological tests revealed a prevalence of 0.077%, 0.083%, 0.102%, and 0.132%, respectively for HIV, HCV, HBV, and Treponema pallidum. Trends of hepatitis B and syphilis were decreasing; however, hepatitis C was increasing.

CONCLUSIONS: HIV and syphilis prevalence have been variable, with significant peaks in 2013 and 2014, respectively. Globally, the low rates reported in this study confirm the effectiveness of the preventive policy applied by the health authorities. However, among the rural population, special attention is required to stem any resurgence of hepatitis C and syphilis.

PMID:37406062 | DOI:10.3855/jidc.17897

J Infect Dev Ctries. 2023 Jun 30;17(6):832-839. doi: 10.3855/jidc.17221.

ABSTRACT

INTRODUCTION: We compared the diagnostic values of individual and composite biomarkers used in the prediction of bacteremia in adult emergency department patients.

METHODOLOGY: First-hour blood levels of C- reactive protein, procalcitonin, interleukin-6, lactate, lipopolysaccharide-binding protein and white blood cell count were collected from a 30-person control group and 47 adult patients. Patients included in this study were admitted to the emergency department on suspicion of sepsis. We categorized patients according to presence/absence of sepsis and bacteremia. Our control group was categorized as S-B -, septic patients with bacteremia were S+B+, and septic patients without bacteremia were S+B-.

RESULTS: All biomarkers showed a statistically significant elevation when S+B- and S+B+ groups were compared with the S-B-. When S+B+ group was compared with the S+B- group only procalcitonin and lactate levels had statistically significant elevation (p < 0.005). Regression analysis demonstrated that lactate and procalcitonin were independently associated with having bacteremia in the state of sepsis and Hosmer-Lemeshow score was 0.772. The areas under the curve (AUC) values of biomarkers procalcitonin, lactate, C-reactive protein, combined 1 (procalcitonin+ lactate), and combined 2 (procalcitonin + lactate + C-reactive protein) were 0.773, 0.744, 0.523, 0.806, and 0.829 respectively.

CONCLUSIONS: Combination of tests such as combined 1 or combined 2 were highly predictive of bacteremia in adult septic patients. Combined 2 demonstrated the best predictive performance and could be utilized as a tool to assist diagnosis of bacteremia before culture results are available.

PMID:37406061 | DOI:10.3855/jidc.17221

J Infect Dev Ctries. 2023 Jun 30;17(6):782-790. doi: 10.3855/jidc.17911.

ABSTRACT

INTRODUCTION: Several previous studies have suggested a link between autoimmune activation and SARS-CoV-2 infection. This study aims to evaluate the excessive immune response via laboratory and radiological findings, treatment options, and previous acute phase reactants in patients with mild and moderate coronavirus disease 2019 (COVID-19) to identify the possible interaction between autoimmune response and SARS-CoV-2 infection.

METHODOLOGY: A total of 345 hospitalized patients with a diagnosis of definitive COVID-19 were evaluated retrospectively in terms of their clinical, laboratory, and radiological data, comorbidities, treatment options, and the values of C-reactive protein (CRP) of all patients in the last year before COVID-19 during admission to the hospital for any reason.

RESULTS: 162 (47%) of the patients were female and 183 (53%) were male. The mean age was 51.08 ± 15.52 years. Of all patients, 235 (68.1%) had mild disease and 110 (31.9%) had a moderate disease. There was a statistically significant difference between the two groups in terms of age, gender, the values of leukocytes, lymphocytes, and hemoglobin, the levels of AST, LDH, Na, Cl, Ca, CRP, ferritin and fibrinogen, duration of hospitalization, medical treatments as well as the CRP value of the patients in the last year. Male gender, shortness of breath, duration of hospitalization, the value of lymphocytes, and the levels of LDH, CRP, and fibrinogen were independent predictive factors for the severity of COVID-19.

CONCLUSIONS: The SARS-CoV-2 infection could act as a triggering factor for developing autoimmune and/or autoinflammatory dysregulation in genetically predisposed individuals.

PMID:37406059 | DOI:10.3855/jidc.17911

Immunohematology. 2023 Jul 5;39(2):55-60. doi: 10.21307/immunohematology-2023-009. eCollection 2023 Jun 1.

ABSTRACT

The aim of this study was to define risk factors for jaundice and anemia in newborns with a positive direct antiglobulin test (DAT) and/or with an incompatible crossmatch due to ABO incompatibility between mother and newborn. ABO incompatibility has become a more significant cause of hemolytic disease of the fetus and newborn since the introduction of effective anti-D prophylaxis. The condition is common and, if clinically significant at all, causes only mild jaundice, which can be treated with phototherapy (PT). However, rare and serious presentations, requiring transfusion therapy, have been noted. Clinical, laboratory, and immunohematologic data were collected retrospectively from medical records of ABO-incompatible newborns and their mothers over a 5-year period (2016-2020) from University Hospital Centre Zagreb. Two groups of newborns were compared: those who needed medical intervention because of hyperbilirubinemia or anemia and those who did not. Within the group of newborns requiring intervention, we also compared those with A and B blood groups. Over the 5-year period, 72 of 184 (39%) newborns required treatment. The treatment was PT in 71 (38%) newborns and erythrocyte transfusion in 2 (1%). In 112 (61%) newborns, ABO incompatibility was an accidental finding while performing blood group typing; these newborns did not require any therapy. In conclusion, we found a statistical, but not clinically significant, difference between the groups of treated and untreated newborns, related to the mode of delivery and DAT positivity within hours of delivery. There were no statistically significant differences in characteristics between the groups of treated newborns, except for two newborns with blood group A who received erythrocyte transfusions.

PMID:37405847 | DOI:10.21307/immunohematology-2023-009

Arch Med Sadowej Kryminol. 2022;72(4):183-199. doi: 10.4467/16891716AMSIK.22.021.17621.

ABSTRACT

The problems with obtaining expert opinions from court-appointed physicians in Poland have been known for a long time and are well-diagnosed. The reasons for this state of affairs are: an overall insufficient number of physicians compared to the general needs, uncompetitive remuneration levels, and the difficulty of reconciling professional and court-appointed expert duties, while taking into consideration the availability expected of experts. The ongoing generational transition may further exacerbate these problems. The purpose of this study was to investigate the latter phenomenon by comparing the age profile of court-appointed physicians with that of physicians in general. Information on the age of court-appointed physicians was obtained from the presidents of regional courts and the Central Register of Physicians, while general statistics on physicians were also acquired from the latter. Research allowed us to formulate the following conclusions: only 0.8% of all physicians in Poland serve a court-appointed expert function. Almost two-thirds of court-appointed physicians belong to the Baby Boomer generation (born in 1946-1964), nearly one-third to Generation X (1965-1980), and only one-sixteenth (6.10%) to Generation Y (1981-1996), or Millennials. The results obtained, as well as data from the literature, suggest that the current bad state of affairs regarding access to the opinions of court-appointed physicians will further deteriorate in the coming years due to generational changes, i.e., the replacement of Baby Boomers and Generation X, currently dominant among court-appointed experts, by Generation Y, i.e., Millennials, with a different attitude to life.

PMID:37405839 | DOI:10.4467/16891716AMSIK.22.021.17621