bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study
Authors: Pavlovic Noelle , Ndumele Chiadi E. , Abshire Saylor Martha , Szanton Sarah L. , Lee Christopher S. , Shah Amil M. , Chang Patricia P. , Florido Roberta , Matsushita Kunihiro , Himmelfarb Cheryl , Leoutsakos Jeannie Marie
Published: January 2024

BACKGROUND:

Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes.

METHODS:

We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011–2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression.

RESULTS:

Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue.

CONCLUSIONS:

We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
Role of Biomarkers of Myocardial Injury to Predict Adverse Outcomes in Hypertrophic Cardiomyopathy
Authors: Zhang Yu , Liu Minghao , Zhang Channa , Zou Yubao , Kang Lianming , Song Lei
Published: January 2024

BACKGROUND:

Serum troponins and CK-MB (creatine kinase-MB) are readily detectable and reliable cardiac-specific biomarkers of subclinical myocardial injury. This study explores the roles of cTnI (cardiac troponin I) and CK-MB in hypertrophic cardiomyopathy (HCM).

METHODS:

This study included 1045 patients with HCM who had baseline cTnI and CK-MB measurements at Fuwai Hospital between 1999 and 2019. Patients were excluded if they had undergone percutaneous coronary intervention or coronary artery bypass grafting, or had renal failure. Five end points were studied: all-cause death, cardiovascular death, noncardiovascular death, sudden cardiac death, and other cardiovascular death. Cox regression was used to assess the associations of cTnI and CK-MB levels with outcomes.

RESULTS:

Nine hundred seventy patients with available follow-up data were finally analyzed (mean age, 49.3 years; 36.4% female). During the median 4.3-year follow-up period, 87 patients reached the end points. Higher cTnI (per 0.05 ng/mL increase) and CK-MB (per 1 IU/L increase) levels were associated with increased risks of all-cause death (cTnI: adjusted hazard ratio [HR], 1.038,
P
<0.001; CK-MB: adjusted HR, 1.021,
P
=0.004), cardiovascular death (cTnI: adjusted HR, 1.040,
P
<0.001; CK-MB: adjusted HR, 1.025,
P
=0.006), and sudden cardiac death (cTnI: adjusted HR, 1.045,
P
<0.001; CK-MB: adjusted HR, 1.032,
P
=0.001). Patients with elevated levels of both cTnI and CK-MB had worse prognoses than patients with an elevated level of either biomarker alone and patients who did not have an elevated level of either biomarker. Addition of the binary indicator elevation of both cTnI and CK-MB significantly improved the discrimination and reclassification abilities of the standard HCM Risk- sudden cardiac death model (C statistics:
P
=0.002; net reclassification improvement, 0.652; integrated discrimination improvement, 0.064).

CONCLUSIONS:

Comprehensive evaluations of biomarkers of myocardial injury, cTnI and CK-MB, have considerable value for predicting adverse outcomes among patients with HCM. Routine cTnI and CK-MB assessments may help to guide implantable cardioverter defibrillator implantation for primary prevention in HCM.
Atlas of Cell Repertoire Within Neointimal Lesions Is Metabolically Altered in Hypertensive Rats
Authors: Sun Xiaolei , Wu Junru , Zhang Xiaolin , Xie Cheng , Wei Haijun , Li Pengyun , Yang Yan , Yuan Hong , Cai Jingjing , Xiao Qingzhong , Cheng Jun , Xu Qingbo
Published: January 2024

BACKGROUND:

High blood pressure has been suggested to accelerate vascular injury-induced neointimal formation and progression. However, little is known about the intricate relationships between vascular injury and hypertension in the context of arterial remodeling.

METHODS:

Single-cell RNA-sequencing analysis was used to depict the cell atlas of carotid arteries of Wistar Kyoto rats and spontaneously hypertensive rats with or without balloon injury.

RESULTS:

We found that hypertension significantly aggravated balloon injury-induced arterial stenosis. A total of 36 202 cells from carotid arteries with or without balloon injury were included in single-cell RNA-sequencing analysis. Cell composition analysis showed that vascular injury and hypertension independently induced distinct aortic cell phenotypic alterations including immune cells, endothelial cells (ECs), and smooth muscle cells. Specifically, our data showed that injury and hypertension-induced specific EC phenotypic alterations, and revealed a transition from functional ECs to hypermetabolic, and eventually dysfunctional ECs in hypertensive rats upon balloon injury. Importantly, our data also showed that vascular injury and hypertension-induced different smooth muscle cell phenotypic alterations, characterized by deferential expression of synthetic signatures. Interestingly, pathway analysis showed that dysregulated metabolic pathways were a common feature in monocytes/macrophages, ECs, and smooth muscle cells in response to injury and hypertension. Functionally, we demonstrate that inhibition of mitochondrial respiration significantly ameliorated injury-induced neointimal formation in spontaneously hypertensive rats.

CONCLUSIONS:

This study provides the cell landscape changes of the main aortic cell phenotypic alterations in response to injury and hypertension. Our findings suggest that targeting cellular mitochondrial respiration could be a novel therapeutic for patients with hypertension undergoing vascular angioplasty.
Treatment Variability Among Patients Hospitalized for Chronic Limb‐Threatening Ischemia: An Analysis of the 2016 to 2018 US National Inpatient Sample
Authors: Foley Katelyn M. , Kennedy Kevin F. , Lima Fabio V. , Secemsky Eric A. , Banerjee Subhash , Goodney Philip P. , Shishehbor Mehdi H. , Soukas Peter A. , Hyder Omar N. , Abbott J. Dawn , Aronow Herbert D.
Published: January 2024

Background

Little is known about treatment variability across US hospitals for patients with chronic limb‐threatening ischemia (CLTI).

Methods and Results

Data were collected from the 2016 to 2018 National Inpatient Sample. All patients aged ≥18 years, admitted to nonfederal US hospitals with a primary diagnosis of CLTI, were identified. Patients were classified according to their clinical presentation (rest pain, skin ulceration, or gangrene) and were further characterized according to the treatment strategy used. The primary outcome of interest was variability in CLTI treatment, as characterized by the median odds ratio. The median odds ratio is defined as the likelihood that 2 similar patients would be treated with a given modality at 1 versus another randomly selected hospital. There were 15 896 (weighted n=79 480) hospitalizations identified where CLTI was the primary diagnosis. Medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, and amputation alone were used in 4057 (25%), 5390 (34%), 3733 (24%), and 2716 (17%) patients, respectively. After adjusting for both patient‐ and hospital‐related factors, the median odds ratio (95% CI) for medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, any revascularization, and amputation alone were 1.28 (1.19–1.38), 1.86 (1.77–1.95), 1.65 (1.55–1.74), 1.37 (1.28–1.45), and 1.42 (1.27–1.55), respectively.

Conclusions

Significant variability in CLTI treatment exists across US hospitals and is not fully explained by patient or hospital characteristics.
Atherosclerosis and Hippocampal Volumes in Older Adults: The Role of Age and Blood Pressure
Authors: Kapasi Alifiya , Capuano Ana W. , Lamar Melissa , Leurgans Sue E. , Evia Arnold M. , Bennett David A. , Arfanakis Konstantinos , Schneider Julie A.
Published: January 2024

Background

Lower hippocampal volume is associated with late‐life cognitive decline and is an important, but nonspecific marker for clinical Alzheimer's dementia. Cerebrovascular disease may also be associated with hippocampal volume. Here we study the role of intracranial large vessel disease (atherosclerosis) in association with hippocampal volume and the potential role of age, average late‐life blood pressure across all visits, and other factors (sex, apolipoprotein ε4 [
APOE
ε4], and diabetes).

Methods and Results

Data came from 765 community‐based older people (91 years old on average at death; 72% women), from 2 ongoing clinical‐pathologic cohort studies. Participants completed baseline assessment, annual standardized blood pressure measurements, vascular risk assessment for diabetes, and blood draws to determine
APOE
genotype, and at death, brains were removed and underwent ex vivo magnetic resonance imaging and neuropathologic evaluation for atherosclerosis pathology and other cerebrovascular and neurodegenerative pathologies. Linear regression models examined the association of atherosclerosis and hippocampal to hemisphere volume ratio and whether age at death, blood pressure, and other factors modified associations. In linear regression models adjusted for demographics and neurodegenerative and other cerebrovascular pathologies, atherosclerosis severity was associated with a lower hippocampal to hemisphere volume ratio. In separate models, we found the effect of atherosclerosis on the ratio of hippocampal to hemisphere volume was attenuated among advanced age at death or having higher systolic blood pressure (interaction terms
P
≤0.03). We did not find confounding or interactions with sex, diabetes, or
APOE
ε4.

Conclusions

Atherosclerosis severity is associated with lower hippocampal volume, independent of neurodegenerative and other cerebrovascular pathologies. Higher systolic blood pressures and advanced age attenuate associations.
Microvascular Dysfunction and Whole‐Brain White Matter Connectivity: The Maastricht Study
Authors: Beran Magdalena , van Gennip April C.E. , Stehouwer Coen D.A. , Jansen Jacobus F.A. , Gupta Monideepa D. , Houben Alfons J.H.M. , Berendschot Tos T.J.M. , Webers Carroll A.B. , Wesselius Anke , Schalkwijk Casper G. , Backes Walter H. , de Jong Joost J.A. , van der Kallen Carla J.H. , van Greevenbroek Marleen M.J. , Köhler Sebastian , Vonk Jet M.J. , Geerlings Mirjam I. , Schram Miranda T. , van Sloten Thomas T.
Published: January 2024

Background

Microvascular dysfunction is involved in the development of various cerebral disorders. It may contribute to these disorders by disrupting white matter tracts and altering brain connectivity, but evidence is scarce. We investigated the association between multiple biomarkers of microvascular function and whole‐brain white matter connectivity.

Methods and Results

Cross‐sectional data from The Maastricht Study, a Dutch population‐based cohort (n=4326; age, 59.4±8.6 years; 49.7% women). Measures of microvascular function included urinary albumin excretion, central retinal arteriolar and venular calibers, composite scores of flicker light–induced retinal arteriolar and venular dilation, and plasma biomarkers of endothelial dysfunction (intercellular adhesion molecule‐1, vascular cell adhesion molecule‐1, E‐selectin, and von Willebrand factor). White matter connectivity was calculated from 3T diffusion magnetic resonance imaging to quantify the number (average node degree) and organization (characteristic path length, global efficiency, clustering coefficient, and local efficiency) of white matter connections. A higher plasma biomarkers of endothelial dysfunction composite score was associated with a longer characteristic path length (β per SD, 0.066 [95% CI, 0.017–0.114]) after adjustment for sociodemographic, lifestyle, and cardiovascular factors but not with any of the other white matter connectivity measures. After multiple comparison correction, this association was nonsignificant. None of the other microvascular function measures were associated with any of the connectivity measures.

Conclusions

These findings suggest that microvascular dysfunction as measured by indirect markers is not associated with whole‐brain white matter connectivity.
Cholesterol Crystal Dissolution Rate of Serum Predicts Outcomes in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Al‐Kassou Baravan , Al‐Kassou Lara , Mahn Thorsten , Lütjohann Dieter , Shamekhi Jasmin , Willemsen Nicola , Niepmann Sven Thomas , Baldus Stephan , Kelm Malte , Nickenig Georg , Latz Eicke , Zimmer Sebastian
Published: January 2024

Background

Aortic stenosis has pathophysiological similarities with atherosclerosis, including the deposition of cholesterol‐containing lipoproteins. The resulting cholesterol crystals activate the NLRP3 (NOD‐like receptor protein 3) inflammasome, leading to inflammation and cardiovascular diseases. We aimed to investigate the cholesterol crystal dissolution rate (CCDR) of serum in patients with aortic stenosis and to assess the prognostic value of this biomarker.

Methods and Results

The study included 348 patients with aortic stenosis undergoing transcatheter aortic valve replacement. The CCDR was measured using flow cytometry to enumerate cholesterol crystals that were added to a serum solution, at baseline and after 2 hours of incubation. Based on the median CCDR, the cohort was stratified into high and low cholesterol crystal dissolvers. The incidence of the primary end point, a composite of 1‐year all‐cause mortality and major vascular complication, was significantly lower in the high CCDR group (7.3 per 100 person‐years) compared with the low CCDR group (17.0 per 100 person‐years,
P
=0.01). This was mainly driven by a lower 1‐year mortality rate in patients with a high CCDR (7.3 versus 15.1 per 100 person‐years,
P
=0.04). Unplanned endovascular interventions were significantly less frequent in high cholesterol crystal dissolvers (12.8 versus 22.6 per 100 person‐years,
P
=0.04). Although low‐density lipoprotein cholesterol levels were comparable in both groups (101.8±37.3 mg/dL versus 97.9±37.6 mg/dL,
P
=0.35), only patients with a low CCDR showed a benefit from statin treatment. In multivariate analysis, low CCDR (hazard ratio, 2.21 [95% CI, 0.99–4.92],
P
=0.04) was significantly associated with 1‐year mortality.

Conclusions

The CCDR is a novel biomarker associated with outcome in patients with aortic stenosis undergoing transcatheter aortic valve replacement. It may provide new insights into patients' anti‐inflammatory capacity and additional prognostic information beyond classic risk assessment.
Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock
Authors: Jentzer Jacob C. , Drakos Stavros G. , Selzman Craig H. , Owyang Clark , Teran Felipe , Tonna Joseph E.
Published: January 2024

Background

Venoarterial extracorporeal membrane oxygenation (ECMO) provides full hemodynamic support for patients with cardiogenic shock, but optimal timing of ECMO initiation remains uncertain. We sought to determine whether earlier initiation of ECMO is associated with improved survival in cardiogenic shock.

Methods and Results

We analyzed adult patients with cardiogenic shock who received venoarterial ECMO from the international Extracorporeal Life Support Organization (ELSO) registry from 2009 to 2019, excluding those cannulated following an operation. Multivariable logistic regression evaluated the association between time from admission to ECMO initiation and in‐hospital death. Among 8619 patients (median, 56.7 [range, 44.8–65.6] years; 33.5% women), the median duration from admission to ECMO initiation was 14 (5–32) hours. Patients who had ECMO initiated within 24 hours (n=5882 [68.2%]) differed from those who had ECMO initiated after 24 hours, with younger age, more preceding cardiac arrest, and worse acidosis. After multivariable adjustment, patients with ECMO initiated >24 hours after admission had higher risk of in‐hospital death (adjusted odds ratio, 1.20 [95% CI, 1.06–1.36];
P
=0.004). Each 12‐hour increase in the time from admission to ECMO initiation was incrementally associated with higher adjusted in‐hospital mortality rate (adjusted odds ratio, 1.06 [95% CI, 1.03–1.10];
P
<0.001). The association between longer time to ECMO and worse outcomes appeared stronger in patients with lower shock severity.

Conclusions

Longer delays from admission to ECMO initiation were associated with higher a mortality rate in a large‐scale, international registry. Our analysis supports optimization of door‐to‐support time and the avoidance of inappropriately delayed ECMO initiation.
Silencing HDAC1 Expression Regulates Extracellular Regulated Protein Kinases/Mitogen-Activated Protein Kinase Signaling Activation and Enhances Chemosensitivity of Ovarian Carcinoma
Authors: Xu Jia , Li Yan , Wang Haixu , Qi Chunlei , Guo Qian , Cai Guoqing , Qiao Guyuan
Published: January 2024

Objective: Cisplatin (DDP)-based therapy is frequently employed as a first-line chemotherapy for ovarian carcinoma (OC). ERK/mitogen-activated protein kinase (MAPK), as a widely studied axis with cancer-promoting action, is reported to be essential in mediating chemoresistance
in many cancer cells. This study investigated the effect of HDAC1 expression on the chemosensitivity of OC via regulation of the ERK/MAPK axis. Methods: Fifty-eight cases of OC and adjacent tissue specimens were acquired, as well as the survival data of patients with OC in the Cancer
Genome Atlas. To detect HDAC1 in tissues, a HDAC1-DNA probe was constructed, and patients with different HDAC1 levels were analyzed for survival. HDAC1 levels were also detected in SKOV3 and SKOV3/DDP cells. HDAC1 siRNA was used to interfere with HDAC1 expression, after which the sensitivity
to DDP sensitivity and changes in apoptosis of tumor cells were detected using the MTT assay and flow cytometry, respectively. Western blotting quantified the expression of ERK/MAPK axis-related proteins. Results: HDAC1 was highly expressed in OC tissues, with a high expression significantly
related to adverse outcomes of patients. Compared with that in SKOV3 cells, SKOV3/DDP cells showed decreased sensitivity to DDP and increased HDAC1 expression. After transfection of HDAC1-siRNA, SKOV3/DDP cell sensitivity to DDP increased, p38 MAPK, ERK1/2, and JNK phosphorylation levels decreased,
and the apoptosis rate increased markedly; transfection with an ERK agonist reversed the inhibitory action of HDAC1-siRNA against cells. Conclusions: Silencing HDAC1 expression significantly reduced the chemoresistance of DDP-resistant OC cell lines and promoted apoptosis, and its mechanism
is related to inhibition of ERK/MAPK activation.
C–C Motif Chemokine Ligand 4 Positive (CCL4+) Neutrophils Negatively Influence the Tumor Immune Microenvironment by Regulating Macrophages
Authors: Liu Maoxi , Wei Qiang , Han Junliang , Cao Hailei , Yang Wenhui
Published: January 2024

Epidemiological studies have revealed that the incidence of most cancers increases with age. However, the relationship between the two remains obscure owing to the complexity and heterogeneity of the tumor microenvironment (TME). By analyzing 10 × single-cell ribonucleic-acid
sequencing data derived from subcutaneous tumor tissues in old (17–22 months) and young (6–8 weeks) mice, we found an increase in C–C Motif Chemokine Ligand 4 positive (CCL4+) neutrophils in aged mice compared with those in their younger counterparts. The expression
levels of genes encoding protumor chemokines, such as CXCL2, CCL3, and CCL4, were significantly higher in old mice. Kyoto Encyclopedia of Genes and Genomes analysis showed that the differentially expressed genes were enriched mainly in NF-κB signaling, a well-established
facilitator of tumor progression and metastasis. We also observed a multiple communication between neutrophils and immnunosuppressive immune cells. CCL4+ neutrophils adversely enriched in the TME, interacted with Spp1+ macrophages, promoted progression and metastasis. Our findings
provided novel insights in the role of CCL4+ neutrophils in tumor pathogenesis and progression.
Robust Polar Amplification in Ice-Free Climates Relies on Ocean Heat Transport and Cloud Radiative Effects
Authors: England Mark R. , Feldl Nicole
Published: January 2024

A fundamental divide exists between previous studies that conclude that polar amplification does not occur without sea ice and studies that find that polar amplification is an inherent feature of the atmosphere independent of sea ice. We hypothesize that a representation of climatological ocean heat transport is key for simulating polar amplification in ice-free climates. To investigate this, we run a suite of targeted experiments in the slab ocean aquaplanet configuration of CESM2-CAM6 with different profiles of prescribed ocean heat transport, which are invariant under CO2 quadrupling. In simulations without climatological ocean heat transport, polar amplification does not occur. In contrast, in simulations with climatological ocean heat transport, robust polar amplification occurs in all seasons. What is causing this dependence of polar amplification on ocean heat transport? Energy-balance model theory is incapable of explaining our results and in fact would predict that introducing ocean heat transport leads to less polar amplification. We instead demonstrate that shortwave cloud radiative feedbacks can explain the divergent polar climate responses simulated by CESM2-CAM6. Targeted cloud locking experiments in the zero ocean heat transport simulations are able to reproduce the polar amplification of the climatological ocean heat transport simulations, solely by prescribing high-latitude cloud radiative feedbacks. We conclude that polar amplification in ice-free climates is underpinned by ocean–atmosphere coupling, through a less negative high latitude shortwave cloud radiative feedback that facilitates enhanced polar warming. In addition to reconciling previous disparities, these results have important implications for interpreting past equable climates and climate projections under high-emissions scenarios.

Significance Statement

Polar amplification is a robust feature of climate change in the modern-day climate. However, previous climate modeling studies fundamentally do not agree on whether polar amplification occurs in ice-free climates. In this study, we find in a state-of-the-art climate model that, if ocean heat transport is neglected, the response to an increase in CO2 is not polar amplified, whereas robust polar amplification occurs if ocean heat transport is included. Using targeted model experiments, we diagnose cloud radiative effects as the driver of this divergent behavior. We conclude that polar amplification is a robust feature of the atmosphere–ocean system. Our results have important implications for interpreting past warm climates and future projections under high-emissions scenarios.
Impact of the North Pacific Meridional Mode on the Tropical Pacific Modulated by the Interdecadal Pacific Oscillation
Authors: Liu Bowen , Gan Bolan , Jia Fan , Wu Lixin
Published: January 2024

The North Pacific meridional mode (NPMM) peaking in boreal spring influences El Niño–Southern Oscillation (ENSO) properties in the ensuing winter. Whether the precursory impact of NPMM on the spatial diversity of ENSO has decadal variation remains unknown. Using long-term reanalysis datasets, we find that the interdecadal Pacific oscillation (IPO) significantly modulates the NPMM forcing on two types of ENSO. During the positive IPO (+IPO) phase, a strengthened background Aleutian low and southward-shifted storm track, in comparison to the negative IPO (−IPO) phase, produce stronger basin-scale negative geopotential height tendency anomalies over the North Pacific through synoptic-scale eddy–mean flow interaction. Such strong background negative tendency facilitates an Aleutian low–like pressure monopole rather than a North Pacific Oscillation (NPO)-like pressure dipole in boreal spring, leading to a weak NPMM that cannot effectively promote development of either a central Pacific (CP) or an eastern Pacific (EP) ENSO. By contrast, the NPO-like dipole enhances in boreal spring during −IPO, corresponding to stronger and more frequently occurring NPMM events that induce a robust CP-ENSO-like response in boreal winter. Moreover, the −IPO-related tropical Pacific mean states and the associated positive feedbacks cause a strong decrease in mixed layer temperature variance in the equatorial eastern Pacific, but a slight increase in the central Pacific, thus further contributing to the enhanced correlation between NPMM and CP-ENSO. Therefore, −IPO has played a role in the stronger impact of NPMM on CP-ENSO since the 1990s, and the modulation effects of IPO should be considered in understanding the extratropical–tropical climatic connection and ENSO spatial diversity.
Limited Width of Tropical Cyclone–Induced Baroclinic Geostrophic Response
Authors: Lu Zhumin , Shang Xiaodong
Published: January 2024

Despite the large radius (R17) of gale-force wind of a tropical cyclone (TC), the observed TC-induced effects on mesoscale and large-scale ocean via the baroclinic geostrophic response are found to have a limited cross-track width; this strange but important phenomenon is interpreted here. Driven by the wind stress curl (WSC), the TC-induced geostrophic response is in fact regulated by along-track integration of the WSC (AIWSC). Constrained by atmospheric TC dynamics, the violent winds outside the radius (Rmax) of maximum wind of any TC must have nearly zero WSC. Consequently, the AIWSC function can be fit as a boxcar function with an extraordinarily large positive value between ±Rmax about the track. Based on this boxcar function, the theoretical estimate of the cross-track length scale of the baroclinic geostrophic response, Ld + Rmax, is presented, where Ld is the first-mode baroclinic Rossby deformation radius. Further, this scale is validated by numerical experiments to well explain the width of the altimetry-observed geostrophic response induced by any TC. Evidently, Ld + Rmax is far smaller than R17 and thus the baroclinic geostrophic response generally has a limited width. This study implies that, although for a TC the violent winds outside Rmax are generally ∼90% of all winds, in an open ocean these winds may be useless to perturb the ocean interior due to the nearly zero WSC.

Significance Statement

Despite the large radius of gale-force wind of a tropical cyclone, the effects of a tropical cyclone on mesoscale and large-scale ocean are confined in a limited cross-track width; this strange but important phenomenon is interpreted here. In essence, the effects are exerted by the wind stress curl rather than by the wind stress. However, constrained by atmospheric dynamics, a tropical cyclone has most of the positive wind stress curl in the inner core and nearly zero wind stress curl far away from the inner core. Consequently, albeit violent, the winds outside the inner core cannot make an appreciable contribution to the physical processes below the mixed layer.
Impact of Precipitation on Ocean Responses during a Tropical Cyclone
Authors: Liu Fu , Toumi Ralf , Zhang Han , Chen Dake
Published: January 2024

Precipitation plays a crucial role in modulating upper-ocean salinity and the formation of the barrier layer, which affects the development of tropical cyclones (TCs). This study performed idealized simulations to investigate the influence of precipitation on the upper ocean. Precipitation acts to suppress the wind-induced sea surface reduction and generates an asymmetric warming response with a rightward bias. There is substantial vertical change with a cooling anomaly in the subsurface, which is about 3 times larger than the surface warming. The mean tropical cyclone heat potential is locally increased, but the net effect across the cyclone footprint is small. The impact of precipitation on the ocean tends to saturate for extreme precipitation, suggesting a nonlinear feedback. A prevailing driver of the model behavior is that the freshwater flux from precipitation strengthens the stratification and increases current shear in the upper ocean, trapping more kinetic energy in the surface layer and subsequently weakening near-inertial waves in the deep ocean. This study highlights the competing roles of TC precipitation and wind. Because the TC category is weaker than category 3, the warming anomaly is caused by reduced vertical mixing, whereas for stronger storms, the advection process is most important.
Acute Alcohol Intoxication-Related Metabolic and Biochemical Disturbances in Adolescents: A Matched Case-Control Study
Authors: Hanalioglu Damla , Ozkocer Cansu , Can Ozalp Esra , Dikmen Zeliha Gunnur , Pinar Asli , Teksam Ozlem
Published: January 2024

We aimed to investigate clinical and laboratory characteristics of acute alcohol intoxication (AAI) in adolescents who presented to the pediatric emergency department (ED) at a tertiary referral center from 2006 to 2019. All consecutive adolescents with AAI (n = 335) and their sex- and age-matched control subjects (n = 335) with undetectable ethanol levels were included in this case-matched study. Mean serum ethanol level was 156.4 ± 58.4 (range: 50.8-341.2) mg/dL in the acute alcohol intoxication (AAI) group. Glasgow coma scores were lower in AAI group (14 [14-15] vs 15 [15-15], P < .001). Acidosis (16.3%), hyperlactatemia (60.9%), hypoglycemia (1.7%), hypernatremia (2.2%), hypokalemia (12.3%), hyperchloremia (20.4%), hypocalcemia (13.9%), hypermagnesemia (9.7%), and hyperalbuminemia (10.4%) were significantly more common in the AAI group than the control group. Blood pH, lactate, Na+, K+, Ca++, Mg++, albumin, blood urea nitrogen (BUN), and uric acid levels were correlated with serum ethanol levels. This study shows that AAI frequently leads to mild to moderate metabolic/biochemical derangements in adolescents.
Effects of In-Vehicle Touchscreen Location on Driver Task Performance, Eye Gaze Behavior, and Workload During Conditionally Automated Driving: Nondriving-Related Task and Take-Over
Authors: Ban Gayoung , Park Woojin
Published: January 2024

Objective

This study investigated the effects of nondriving-related task (NDRT) touchscreen location and NDRT difficulty level on the driver task performance, eye gaze behavior, and workload during SAE Level 3 conditionally automated driving. Two driver tasks were considered: a visuomanual NDRT and a take-over task.

Background

Touchscreens are expected to play important roles inside automated vehicles. However, few studies have investigated the driver-touchscreen interaction during automated driving.

Method

A driving simulator experiment was conducted. The experimental task consisted of two successive subtasks: an NDRT followed by a take-over task. NDRT touchscreen location (Upper Left, Upper Right, and Lower Right) and NDRT difficulty level (Easy and Hard) were the independent variables. A set of driver task performance, eye gaze behavior, and perceived workload measures were employed for each subtask as the dependent variables.

Results

NDRT touchscreen location significantly affected both the NDRT and the take-over task performance. Lower Right was superior to Upper Right in the NDRT performance but was inferior in the take-over task performance. NDRT touchscreen location affected the perceived physical workload of the NDRT. NDRT difficulty level affected the perceived workload of the take-over task.

Conclusion

The research findings enhance our understanding of how NDRT touchscreen location and NDRT difficulty level impact the driver task performance during conditionally automated driving, and, further provide useful design implications and knowledge.

Application

The study results would inform the NDRT touchscreen interface design and the NDRT design for conditionally automated vehicles.
“The uncooperative nearest relative and admission under sections 2 and 3 of the Mental Health Act 1983”
Authors: Andoh Benjamin
Published: January 2024

Compulsory admission of patients to hospital for assessment and for treatment is governed by sections 2 and 3, respectively, of the Mental Health Act 1983. The nearest relative of a patient plays an important role in the admission of a patient under those two sections. The term, ‘uncooperative nearest relative’, is used to describe the nearest relative who objects unreasonably to the making of an application for treatment under section 3 of the Act. The uncooperative nearest relative and admission under sections 2 and 3 is a topic that has been treated in the literature but not to the same extent as this article does. This article aims to contribute to the literature by looking at not only the nearest relative and sections 2 and 3 of the Act generally but also at two problems concerning the uncooperative nearest relative that have been lurking in the background over the years and then proposing solutions for them.
Does Schooling Increase Political Belief Accuracy?
Authors: Di Leo Riccardo , Giani Marco
Published: January 2024

Citizens must hold accurate beliefs about politically relevant facts to preserve democratic representation, accountability and legislation. We theorize that, abstracting from one’s background, schooling per se does not trigger the epistemological sophistication that is necessary to get a grasp of the political world. In this article, we study whether schooling improves the accuracy of factual beliefs about the share of foreigners and unemployed, later in life. We derive an appealing metric of belief accuracy, matching survey respondents’ beliefs with the corresponding real-world datum at the time of the interview in their country, retrieving high levels of inaccuracy in both issues. More educated individuals display higher belief accuracy, most likely due to selection, rather than causality: compelling otherwise-dropouts to stay in school by extending compulsory education does not entail a significant effect on belief accuracy, in both issues. Taken together, cross-sectional and causal estimates suggest that education is necessary, but not sufficient, to contrast inaccurate beliefs.
The Effectiveness of Adolescent-Focused Therapy and Family-Based Therapy for Anorexia Nervosa
Authors: Stewart Marni P. , Baumann Oliver
Published: January 2024

Anorexia Nervosa is the most deadly mental illness due to the high mortality and relapse rates after reaching remission. The systematic review investigated the effectiveness of two empirically validated interventions (Family-Based Therapy [FBT] and Adolescent-Focused Therapy [AFT]) for an adolescent or young adult living with Anorexia Nervosa to reach partial or full remission and expected weight ratios. Twelve studies published between 1994 and 2015 were evaluated and indicated that FBT resulted in significant weight gain and higher partial and full remission rates than AFT, demonstrating its superiority in treating AN in adolescents and young adult samples, in one instance, at least up to 4 years. Despite FBT and AFT delivery, a significant proportion of participants did not achieve their target weight or full remission, indicating that both treatments may not be effective in all circumstances.
An Evaluation of Messages to Promote Parental Intent to Vaccinate Children Aged <12 Years Against COVID-19
Authors: Chan Isabella L. , Schwarz Kelsey , Weinstein Nicole , Mansergh Gordon , Nahhas Ramzi W. , Gelaude Deborah , Alexander Robert , Rodriguez Leslie , Strauss Warren , Repetski Torey , Sullivan Nancy , Long Everett , Evener Steve L. , Garbarino Adrienne , Kollar Laura M. Mercer
Published: January 2024

Objectives:

Effective health communication can increase intent to vaccinate. We compared 8 messages that may influence parents’ intent to vaccinate their children against COVID-19.

Methods:

In a cross-sectional survey of adults in the United States administered online in August 2021, 1837 parents and legal guardians were exposed to 8 messages (individual choice, gain/practical benefits, nonexpert, health care provider recommendation, altruism/community good, safety/effectiveness, safety, and effectiveness) to determine message reception and influence on intent to vaccinate their children. Parents responded to 10 questions using a Likert scale. We computed odds ratios (ORs) for each message, with an OR >1.0 indicating greater observed odds of participant agreement with the follow-up statement as compared with a reference message. We compared outcomes individually across messages with ordinal logistic regression fit using generalized estimating equations.

Results:

The individual choice message had the highest odds of agreement for understanding intent (OR = 2.10; 95% CI, 1.94-2.27), followed by the health care provider recommendation message (OR = 1.58; 95% CI, 1.46-1.71). The individual choice message had the highest odds of memorability, relatability, and trustworthiness. The altruism/community good message was at or near second best. The altruism/community good message had the highest or near-highest odds of increasing parents’ intent to vaccinate their children, asking friends and family for their thoughts, and searching for additional information. The message that most motivated parents to vaccinate their children depended on parental intent to vaccinate prior to being exposed to the tested messages.

Conclusions:

Messages with themes of individual choice, health care provider recommendation, and altruism/community good may be used in future message campaigns. Further research is needed to refine message concepts related to altruism/community good.
Schooling the Gospel: Village School Teachers as Agents of Mission in the Early Mizo Church
Authors: Behera Marina Ngursangzeli
Published: January 2024

In the study of early Mizo Christians as active agents in the Christianisation of the region the early Mizo pastors, the evangelists, the Church elders and the ‘Bible Women’ have been given more prominence. The contribution and role played by the teachers in the early mission schools have not really been the focus of the research. This article attempts to give an account of the early schools in Mizoram and focus on the role of the village primary school teachers. They are shown to be the main agents for transformation in the formative period of the history of the Mizo Church.
Actions for solutions: Financial behaviors, power (im)balance, and economic abuse among Chinese young adults in non-marital cohabitation
Authors: Li Xiaomin , Khan Muhammad Aamir , Xiao Jing Jian , Kong Dexia
Published: January 2024

Young adults are at high risk of experiencing economic abuse—a form of intimate partner violence (IPV)—and Chinese young adults in non-marital cohabitation are especially vulnerable. To reduce economic abuse, an important question to answer is: What factors are associated with economic abuse? After controlling for constructs (e.g., demographic information and other types of IPV) that were linked to economic abuse, we investigated how financial behaviors (i.e., individuals’ money management capability) were associated with power (im)balance (i.e., whether individuals shared equal influence with the romantic partner) and, in turn, economic abuse among non-marital cohabitating Chinese young adults. We also investigated whether associations among financial behaviors, power (im)balance, and economic abuse varied across young adults’ gender and SES. We used a Qualtrics survey to collect data from 445 non-marital cohabitating Chinese young adults (53.3% male vs. 46.7% female; 22.7% lower socioeconomic status [SES] vs. 77.3% higher-SES). A structural equation model was conducted to test the associations of research interests. We found that money management capability (e.g., spending within budget and tracking expenses) is associated with balanced power—the individual sharing equal influence with the partner in the decision-making process—and, in turn, less experience of being economically abused. These associations were statistically equivalent across gender and SES. Collectively, our findings suggested that promoting money management capability be a timely and new avenue for reducing economic abuse among Chinese young adults in non-marital cohabitation, possibly because this population faces common and severe economic abuse but generally lacks the opportunity to learn money management.
Can the General Public Be a Proxy for an “At-Risk” Group in a Patient Preference Study? A Disease Prevention Example in Rheumatoid Arthritis
Authors: DiSantostefano R. L. , Simons G. , Englbrecht M. , Humphreys Jennifer H. , Bruce Ian N. , Bywall K. Schölin , Radawski C. , Raza K. , Falahee M. , Veldwijk J.
Published: January 2024

Background

When selecting samples for patient preference studies, it may be difficult or impractical to recruit participants who are eligible for a particular treatment decision. However, a general public sample may not be an appropriate proxy.

Objective

This study compares preferences for rheumatoid arthritis (RA) preventive treatments between members of the general public and first-degree relatives (FDRs) of confirmed RA patients to assess whether a sample of the general public can be used as a proxy for FDRs.

Methods

Participants were asked to imagine they were experiencing arthralgia and had screening tests indicating a 60% chance of developing RA within 2 yrs. Using a discrete choice experiment, participants were offered a series of choices between no treatment and 2 unlabeled hypothetical treatments to reduce the risk of RA. To assess data quality, time to complete survey sections and comprehension questions were assessed. A random parameter logit model was used to obtain attribute-level estimates, which were used to calculate relative importance, maximum acceptable risk (MAR), and market shares of hypothetical preventive treatments.

Results

The FDR sample ( n = 298) spent more time completing the survey and performed better on comprehension questions compared with the general public sample ( n = 982). The relative importance ranking was similar between the general public and FDR participant samples; however, other relative preference measures involving weights including MARs and market share differed between groups, with FDRs having numerically higher MARs.

Conclusion

In the context of RA prevention, the general public (average risk) may be a reasonable proxy for a more at-risk sample (FDRs) for overall relative importance ranking but not weights. The rationale for a proxy sample should be clearly justified.

Highlights

Participants from the general public were compared to first-degree relatives on their preferences for rheumatoid arthritis (RA) preventive treatments using a discrete choice experiment. Preferences were similar between groups in terms of the most important and least important attributes of preventive treatments, with effectiveness being the most important attribute. However, relative weights differed. Attention to the survey and predicted market shares of hypothetical RA preventive treatments differed between the general public and first-degree relatives. The general public may be a reasonable proxy for an at-risk group for patient preferences ranks but not weights in the disease prevention context; however, care should be taken in sample selection for patient preference studies when choosing nonpatients.
Kernel-based diffusion approximated Markov decision processes for autonomous navigation and control on unstructured terrains
Authors: Xu Junhong , Yin Kai , Chen Zheng , Gregory Jason M , Stump Ethan A , Liu Lantao
Published: January 2024

We propose a diffusion approximation method to the continuous-state Markov decision processes that can be utilized to address autonomous navigation and control in unstructured off-road environments. In contrast to most decision-theoretic planning frameworks that assume fully known state transition models, we design a method that eliminates such a strong assumption that is often extremely difficult to engineer in reality. We first take the second-order Taylor expansion of the value function. The Bellman optimality equation is then approximated by a partial differential equation, which only relies on the first and second moments of the transition model. By combining the kernel representation of the value function, we design an efficient policy iteration algorithm whose policy evaluation step can be represented as a linear system of equations characterized by a finite set of supporting states. We first validate the proposed method through extensive simulations in 2 D obstacle avoidance and 2.5 D terrain navigation problems. The results show that the proposed approach leads to a much superior performance over several baselines. We then develop a system that integrates our decision-making framework with onboard perception and conduct real-world experiments in both cluttered indoor and unstructured outdoor environments. The results from the physical systems further demonstrate the applicability of our method in challenging real-world environments.
Integrating print reference materials, curated digital collections, and information needs
Authors: Makarova Olga , Ashcraft Katherine
Published: January 2024

The aim of this article is to explore the current research landscape of changing information needs and the need for digital access to library materials. Print reference sources—bibliographies in particular—are discussed and possible solutions for increasing their relevance and appeal as a stable reference point are presented. Several digital curated collections created with bibliographic reference materials are highlighted as a way of reintroducing these materials as a reliable and accessible source of information. The article concludes with future directions for the study of the use of print consultative sources and the main takeaways for adjusting reference and research assistance in an academic library.