Miracle-dz/UniFAR-FTUs huggingface dataset:
Henry Ford Health Scholarly Commons Henry Ford Health Scholarly Commons Door-to-unload: left ventricular unloading before reperfusion in ST- Door-to-unload: left ventricular unloading before reperfusion in ST-elevation myocardial infarction elevation myocardial infarction

ST-elevation myocardial infarction treatment in the modern era has focused on minimizing time of ischemia by reducing door-to-balloon time to limit infarct size and improve survival. Although there have been significant improvements in minimizing time to coronary reperfusion, the incidence of heart failure following a myocardial infarction has remained high. Preclinical studies have shown that unloading the left ventricle for 30 min prior to coronary reperfusion can reduce infarct size and promote myocardial recovery. The DTU-STEMI randomized prospective trial will test the hypothesis that left ventricular unloading for at least 30 min prior to coronary reperfusion will improve infarct size and heart failure-related events as compared with the current standard of care. Lay abstract: Improvements in the treatment of heart attacks over the years have focused on rapidly opening the blocked vessel to limit the amount of heart muscle damage. Although there have been significant improvements in minimizing the time to treatment using various options from medications to balloons and stents, there continues to be a high incidence of heart failure following a heart attack with larger heart attacks leading to more heart failure. Recent studies in animal models have shown that unloading the work of the heart with a temporary heart pump can decrease the size of the heart attack and improve heart muscle recovery. The door-to-unload research program continues to investigate the treatment strategy of unloading the heart for at least 30 min prior to opening the blocked vessel to improve patient outcomes. with the Impella CP and IR or DR after 30 min of unloading. The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days. Assessment of infarct size by cardiac MRI was used to assess efﬁcacy of the unloading strategy. The pilot trial concluded that 30 min of LV unloading with the Impella CP followed by coronary reperfusion is feasible in patients with STEMI. Importantly, there were no prohibitive safety signals to preclude an adequately powered pivotal trial of unloading before reperfusion compared with standard of care with IR. The favorable results of the pilot trial paved the way for the currently enrolling Primary Unloading and Delayed Reperfusion in ST-Elevation Myocardial Infarction: STEMI-DTU trial.
Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review.

OBJECTIVE The authors sought to identify scalable evidence-based suicide prevention strategies. METHODS A search of PubMed and Google Scholar identified 20,234 articles published between September 2005 and December 2019, of which 97 were randomized controlled trials with suicidal behavior or ideation as primary outcomes or epidemiological studies of limiting access to lethal means, using educational approaches, and the impact of antidepressant treatment. RESULTS Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior. Meta-analyses find that antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered. Ketamine reduces suicidal ideation in hours but is untested for suicidal behavior prevention. Cognitive-behavioral therapy and dialectical behavior therapy prevent suicidal behavior. Active screening for suicidal ideation or behavior is not proven to be better than just screening for depression. Education of gatekeepers about youth suicidal behavior lacks effectiveness. No randomized trials have been reported for gatekeeper training for prevention of adult suicidal behavior. Algorithm-driven electronic health record screening, Internet-based screening, and smartphone passive monitoring to identify high-risk patients are understudied. Means restriction, including of firearms, prevents suicide but is sporadically employed in the United States, even though firearms are used in half of all U.S. suicides. CONCLUSIONS Training general practitioners warrants wider implementation and testing in other nonpsychiatrist physician settings. Active follow-up of patients after discharge or a suicide-related crisis should be routine, and restricting firearm access by at-risk individuals warrants wider use. Combination approaches in health care systems show promise in reducing suicide in several countries, but evaluating the benefit attributable to each component is essential. Further suicide rate reduction requires evaluating newer approaches, such as electronic health record-derived algorithms, Internet-based screening methods, ketamine's potential benefit for preventing attempts, and passive monitoring of acute suicide risk change.
Recurrent Stroke Incidence and Etiology in Patients with Embolic Stroke of Undetermined Source and Other Stroke Subtypes

Aims: This study aimed at clarifying the incidence of recurrent stroke and its etiology in patients with embolic stroke of undetermined source (ESUS) and other stroke subtypes in both the acute and chronic periods. Methods: A total of 645 patients who were admitted with acute ischemic stroke (IS) between March 2015 and August 2019 were enrolled. Among them, 511 patients with ESUS, cardioembolism (CE), large artery atherosclerosis (LAA), or small vessel disease (SVD) were analyzed in this study. After discharge, 391 patients who visited the outpatient clinic were followed up until August 2020. The outcome was stroke recurrence. Results: In the acute admission, recurrence rates were 7.6%, 8.1%, 18.8%, and 2.2% in patients with ESUS, CE, LAA, and SVD, respectively, and there were significant differences between the groups. The subtype of recurrence was almost identical to that of the index stroke. In the outpatient clinic, the annual recurrence rates were 4.4%, 4.3%, 6.0%, and 2.9% in ESUS, CE, LAA, and SVD, respectively, and no difference was observed. Subtypes of recurrence in outpatients with ESUS included ESUS, intracerebral hemorrhage (ICH), and SVD. Patients with ESUS and SVD had a higher risk of ICH during follow-up. Conclusions: Although the risk of recurrence was comparable between patients with ESUS and CE and intermediate between patients with LAA and SVD, in the acute admission unit, the risk in outpatients was similar among all subtypes. ESUS was the most recurrent stroke subtype in outpatients with ESUS. The risk of hemorrhagic stroke was significant in patients with SVD and ESUS.
Ceramide Scores Predict Cardiovascular Risk in the Community

Supplemental Digital Content is available in the text. Objective: Cardiovascular disease remains a leading cause of mortality worldwide. Ceramide scores have been associated with adverse outcomes in patients with established coronary artery disease. The prognostic value of ceramide score has not been assessed in the general population. We tested the hypothesis that ceramide scores are associated with major adverse cardiac events (MACE) in a community-based cohort with average coronary artery disease burden at enrollment. Approach and results: In a prospective community-based cohort, we performed passive follow-up using a record linkage system to ascertain the composite outcome of MACE, defined as acute myocardial infarction, coronary revascularization (bypass grafting or percutaneous intervention), stroke, or death. Ceramides were analyzed as log-transformed continuous variables, ratios or scores, and quartiles with adjustment for confounders. We analyzed 1131 subjects, 52% females, mean age±(SD) 64±9 years. After a median follow-up of 13.3 years (Q1, 12.7; Q3, 14.4), 486 patients experienced a MACE: myocardial infarction (80), coronary artery bypass surgery (34), percutaneous coronary intervention (62), stroke (94), and all-cause death (362). Ceramide ratios were significantly associated with MACE independently of LDL-c (low-density lipoprotein cholesterol) and conventional coronary artery disease risk factors. Those in the highest quartile of ceramide score had nearly 1.5-fold risk of MACE, hazard ratio, 1.47 (95% CI, 1.12–1.92). There was a dose-response association across quartiles of ceramide ratios and MACE. Conclusions: Elevated ceramide score is a robust predictor of cardiovascular disease and MACE in the community. The risk conferred by the ceramide score has a dose-response behavior and is independent of conventional risk factors.
Caught in the Crossroad: An Intersectional Examination of African American Women Intimate Partner Violence Survivors’ Help Seeking

Objectives: African American women are disproportionately impacted by intimate partner violence (IPV)-related homicide. They reflect the second highest prevalence rates and experience the highest rates of murder resulting from IPV victimization. Although most survivors note that they have experienced rejection and anticipatory stigma as barriers to their help seeking, African American women additionally experience racism and racial discrimination as obstacles that may further preclude their help seeking. This systematic review highlights African American women’s experiences of rejection from providers and the effects that it may have upon their ability to secure urgent aid. Method: A dearth of literature examines the subtle ways that African American women survivors experience rejection resulting from the interlocking nature of race, class, and gender oppression. Fundamental to developing more culturally salient interventions is more fully understanding their help-seeking experiences. A systematic review was conducted to provide a critical examination of the literature to understand the intersections of IPV and help-seeking behavior among African American women. A total of 85 empirical studies were identified and 21 were included in the systematic review. The review illuminates both the formal and semiformal help-seeking pathways. Results: We recommend integrating anti-Blackness racist praxis, incorporating African American women’s ways of knowing and centralizing their needs in an effort to improve the health and well-being of this population. Conclusions: Eliminating barriers to more immediately accessing the domestic violence service provision system is key to enhance social work practice, policy, and research with African American female survivors of IPV.
Elevated apolipoprotein A1 and HDL cholesterol associated with age-related macular degeneration: two population cohorts.

CONTEXT To enable prevention and treatment of age-related macular degeneration(AMD), understanding risk factors for AMD is important. OBJECTIVE We tested the hypotheses that elevated plasma apolipoprotein A1 and high-density lipoprotein(HDL) cholesterol, and low levels of low-density lipoprotein(LDL) cholesterol, are associated with increased risk of AMD. DESIGN AND SETTING From the Danish general population, we studied 106,703 and 16,032 individuals in the Copenhagen General Population Study(CGPS) and the Copenhagen City Heart Study(CCHS) with median follow-up of respectively 9 and 32 years. MAIN OUTCOME MEASURES 1,787 AMD in CGPS and 206 in CCHS. RESULTS Higher concentrations of plasma apolipoprotein A1 and HDL cholesterol, and lower concentrations of LDL cholesterol, were associated with higher risk of AMD in CGPS. After multifactorial adjustment, individuals in the highest versus lowest quartile of plasma apolipoprotein A1 and HDL cholesterol had hazard ratios for AMD of 1.40(95%CI:1.20-1.63) and 1.22(1.03-1.45). Corresponding hazard ratios for individuals in the lowest versus highest quartile of LDL cholesterol were 1.18(1.02-1.37). Per 100 mg/dL higher plasma apolipoprotein A1, 1 mmol/L(39 mg/dL) higher HDL, and 1 mmol/L(39mmol/L) lower LDL cholesterol, the hazard ratios for AMD were 1.53(1.31-1.80), 1.19(1.07-1.32), and 1.05(1.00-1.11), respectively, with similar results across strata of different risk factors. Higher concentrations of HDL cholesterol were also associated with higher risk of AMD in the CCHS. CONCLUSION Elevated plasma apolipoprotein A1 and HDL cholesterol, and lower LDL cholesterol, are associated with increased risk of age-related macular degeneration.
Effect of Salt and Sucrose Content on the Dielectric Properties of Salted Duck Egg White Protein Relevant to Radio Frequency Drying

The dielectric properties of salted duck egg dispersions were measured at the selected frequency range of 10 to 300 MHz by the open-ended coaxial probe method using a network analyzer. The effect of salt content (0–8%) and sucrose content (0–8%) on radio frequency drying (RFD) and the variation of the dielectric properties of the salted duck egg white samples were studied. These results showed that both dielectric constant and dielectric loss factor decreased with the increase of frequency, and the influence was more significant at the lower frequency ranges. At 27.14 MHz, the dielectric constant and dielectric loss factor were increased but the electric penetration depth was increased with the addition of salt and sucrose. The RFD drying rate was significant increased after the adding of salt and sucrose.
Recent molecules in the treatment of severe infections caused by ESBL-producing bacteria

ABSTRACT Introduction: The widespread increase in resistance to β-lactam antibiotics in Enterobacterales currently represents one of the main threats to human health worldwide. The primary mechanisms of resistance are the production of β-lactamase enzymes that are able to hydrolyze β-lactams. Areas covered: we summarize the most recent advances regarding the main characteristics and spectrum of activity of new available antibiotics and strategies for the treatment of ESBL-producing Enterobacterales infections. Expert opinion: ESBL-producing strains are recognized as a worldwide challenge in the treatment of both hospital- and community-acquired infections. Data from the literature point out the high mortality associated with severe infections due to ESBL strains, especially in patients who developed severe sepsis or septic shock, together with the importance of the source of infection and indicators of severity, as determinants of the patient’s outcome. Carbapenems are currently considered the first-line therapy, although the diffusion of resistant strains is an evolving problem and is mandatory the introduction in clinical practice of new drug regimens and treatment strategies, based on clinical data, local epidemiology, and microbiology. As a possible carbapenem-sparing strategy, ceftolozane–tazobactam and ceftazidime–avibactam appear the best-available carbapenem-sparing therapies. The definitive role of new drugs should be definitively assessed.
Impact of Medical Castration on Malignant Arrhythmias in Patients With Prostate Cancer

Background Medical castration, gonadotropin‐releasing hormone agonists, and antiandrogens have been widely applied as a treatment for prostate cancer. Sex steroid hormones influence cardiac ion channels. However, few studies have examined the proarrhythmic properties of medical castration. Methods and Results This study included 149 patients who underwent medical castration using gonadotropin‐releasing hormones with/without antiandrogen for prostate cancer. The changes in the ECG findings during the therapy and associations of the electrocardiographic findings with malignant arrhythmias were studied. The QT and corrected QT (QTc) intervals prolonged during the therapy compared with baseline (QT, 394±32 to 406±39 ms [P<0.001]; QTc, 416±27 to 439±31 ms [P<0.001]). The QTc interval was prolonged in 119 (79.9%) patients during the therapy compared with baseline. In 2 (1.3%) patients who had no structural heart disease, torsade de pointes (TdP) and ventricular fibrillation (VF) occurred ≥6 months after starting the therapy. In patients with TdP/VF, the increase in the QTc interval from the pretreatment value was >80 ms. However, in patients without TdP/VF, the prevalence of an increase in the QTc interval from the pretreatment value of >50 ms was 11%, and an increase in the QTc interval from the pretreatment value >80 ms was found in only 4 (3%) patients. Conclusions Medical castration prolongs the QT/QTc intervals in most patients with prostate cancer, and it could cause TdP/VFs even in patients with no risk of QT prolongation before the therapy. An increase in the QTc interval from the pretreatment value >50 ms might become a predictor of TdP/VF. Much attention should be paid to the QTc interval throughout all periods of medical castration to prevent malignant arrhythmias.
Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: Effect of cardiogenic shock on outcomes (IREMMI Registry)

To assess outcomes in patients with acute mitral regurgitation (MR) following acute myocardial infarction (AMI) who received percutaneous mitral valve repair (PMVR) with the MitraClip device and to compare outcomes of patients who developed cardiogenic shock (CS) to those who did not (non‐CS).
Influence of upper-limb muscle strength on the repeated change of direction ability in international-level wheelchair basketball players

ABSTRACT This study aims 1) to compare repeated change of direction ability (rCODA) and bench press (BP) between low (A category, ≤2.5) and high (B category, ≥3.0) sport classes and 2) to analyse the relationships between rCODA and BP performance in a sample of wheelchair basketball (WB) players. Seventeen world-class WB players volunteered participated in this study. All the players undertook two tests: the repeated (x12) Modified Agility T-test (rMAT) to measure the rCODA and the movement velocity in a BP test. No significant differences were observed between categories in the rMAT and BP. For the total sample, BP variables with a mean propulsive velocity of 1 m·s−1 (V1LOAD) largely correlated with all the full rMAT outcomes (r>-0.625; p< 0.05). Having a better BP could be favourable to perform repeated efforts and this seems particularly relevant in fatigue conditions, and especially for the B category players.
Long-term changes in kelp forests in an inner basin of the Salish Sea

Understanding the historical extent of biogenic habitats can provide insight into the nature of human impacts and inform restoration and conservation actions. Kelp forests form an important biogenic habitat that responds to natural and human drivers. Global concerns exist about threats to kelp forests, yet long term information is limited and research suggests that trends are geographically distinct. We examined distribution of the bull kelp Nereocystis luetkeana over 145 years in South Puget Sound (SPS), a semi-protected inner basin in a fjord estuary complex in the northeast Pacific Ocean. We synthesized 48 historical and modern Nereocystis surveys and examined presence/absence within 1-km shoreline segments along 452 km of shoreline. Over the last 145 years, Nereocystis has been documented in 26% of the shoreline segments. Its extent decreased 62% basin-wide between the 1870s and 2017, with extreme losses in the two out of three sub-basins (96% in Central and 83% in West). In recent years, almost all Nereocystis occurred in the East sub-basin. In the majority of segments where Nereocystis disappeared, the most recent observation was 4 decades ago, or earlier. Multiple natural and human factors that are known to impact kelp could have contributed to observed patterns, but limited data exist at the spatial and temporal scale of this study. In some areas, recent environmental conditions approached thresholds associated with decreased kelp performance. Longstanding Nereocystis losses occurred exclusively in areas with relatively low current velocities. Remaining Nereocystis predominantly occurred in areas where circulation is stronger. Exceptions to this pattern demonstrate that additional factors outside the scope of this study contributed to trajectories of Nereocystis persistence or loss.
Compassion Fatigue Among the Intimate Partner Violence and Sexual Assault Workforce: Enhancing Organizational Practice

Gaps in knowledge related to occupational stress among the intimate partner violence (IPV) and sexual assault (SA) workforce remain. This study examined associations between key risk factors for occupational stress and compassion fatigue among a sample of IPV/SA service providers in the Southwestern United States (N = 520). Results of the hierarchical regression analysis identified microaggressions, age, recent life stress, direct practice, and workload as factors associated with compassion fatigue. The findings point to the importance of incorporating trauma-informed organizational approaches to address microaggressions, reduce workload, and support staff experiencing recent stress and providing direct services.
The use of telemedicine for the diagnosis and treatment of sleep disorders: an American Academy of Sleep Medicine update.

None The COVID-19 pandemic led to widespread use of telemedicine and highlighted its importance in improving access to sleep care and advocating for sleep health. This update incorporates the lessons learned from such widespread utilization of telehealth to build on the AASM's 2015 Position Paper for the Use of Telemedicine. Important key factors in this update include an emphasis on quality and value, privacy and safety, health advocacy through sleep telemedicine, and future directions.
Levels and factors of social and physical distancing based on the Theory of Planned Behavior during the COVID-19 pandemic among Chinese adults

Abstract Social and physical distancing is important in controlling the COVID-19 pandemic and it impacts people’s financial/social well-being tremendously. This study tested the application of the Theory of Planned Behaviors (TPB) to three types of social/physical distancing indicators (i.e., the number of close physical contacts on a single day in public venues, the frequencies of avoiding social gathering, and the levels of physical distancing in public venues). A population-based random telephone survey interviewed 300 Hong Kong Chinese adults in April 2020 when gatherings involving >4 people were banned. The participants on average made 15.3 close physical contacts (<1.5 m and for >3 min) in a day (5.0 in public transportation). About 80% practiced social distancing (avoided/reduced social gatherings) and physical distancing in public spaces (e.g., avoidance of going out, visiting crowded places, and gatherings of >4 people) but only 35.4% avoided using public transportations. Positive but not negative attitudes (inconvenience and lack of necessity), perceived behavioral control, and subjective norm were significantly associated with the three social/physical distancing outcomes. The data suggest that the levels of social/physical distancing were relatively high in the Hong Kong general population, and it, in general, supports the application of TPB to understand factors of social distancing for preventing COVID-19. Health promotion should take the findings into account. Furthermore, cross-cultural and time-series studies are warranted to compare the levels of social/physical distancing across countries and further explore their effectiveness in controlling the COVID-19 pandemic.