JAMA network open
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Multicenter Study
Internal and External Validation of a Machine Learning Risk Score for Acute Kidney Injury.
Acute kidney injury (AKI) is associated with increased morbidity and mortality in hospitalized patients. Current methods to identify patients at high risk of AKI are limited, and few prediction models have been externally validated. ⋯ In this study, the machine learning algorithm demonstrated excellent discrimination in both internal and external validation, supporting its generalizability and potential as a clinical decision support tool to improve AKI detection and outcomes.
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The optimum duration of adjuvant trastuzumab among patients with early breast cancer is uncertain but of great therapeutic relevance. ⋯ In this study, a shorter duration of adjuvant trastuzumab was noninferior to its 1-year administration and resulted in lower rates of cardiac toxic effects. These results suggest that a shorter duration may be the preferred option for patients with low-risk disease or a predisposition to cardiac toxic effects.
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Bisphenol A (BPA) is a major public health concern because of its high-volume industrial production, ubiquitous exposure to humans, and potential toxic effects on multiple organs and systems in humans. However, prospective studies regarding the association of BPA exposure with long-term health outcomes are sparse. ⋯ In this nationally representative cohort of US adults, higher BPA exposure was significantly associated with an increased risk of all-cause mortality. Further studies are needed to replicate these findings in other populations and determine the underlying mechanisms.
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Population-based mortality rates are important indicators of overall health status. Mortality rates may reflect underlying disparities in access to health care, quality of care, racial and geographical variations, and other socioeconomic factors associated with health. However, there is limited information on historical trends in mortality rates between older Black and White adults living in urban compared with rural communities. ⋯ Rural and urban socioeconomic differences were associated with mortality rate disparities among both White and Black women. However, rural vs urban disparities in mortality rates among men remained significant, especially among Black men living in rural counties. Notably, the current mortality rate of Black men living in rural areas is similar to that of White men living in urban and rural areas in the mid-1980s. Understanding the intersectional factors associated with health disparities may help to inform public health and clinical interventions.
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Coronavirus disease 2019 (COVID-19) is a major threat to nursing homes. During the COVID-19 pandemic wave that hit France in March and April 2020, staff members of some French nursing homes decided to confine themselves with their residents on a voluntary basis to reduce the risk of entry of the severe acute respiratory syndrome coronavirus 2 into the facility. ⋯ In this cohort study of French nursing homes during the COVID-19 pandemic, mortality rates related to COVID-19 were lower among nursing homes that implemented staff confinement with residents compared with those in a national survey. These findings suggest that self-confinement of staff members with residents may help protect nursing home residents from mortality related to COVID-19 and residents and staff from COVID-19 infection.