bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P196: Hand Grip Strength, Gait Speed And Incident Heart Failure In Older Adults
Authors: Manzo Veronica , Naveed Mahim , Newman Anne , Bartz Traci , Butler Javed , Hirsch Calvin , Murthy Venkatesh , Kizer Jorge
Published: April 2022

Title:
Hand Grip Strength, Gait Speed and Incident Heart Failure in Older Adults

Introduction:
Heart failure (HF) is predominantly a disorder of older adults. Its cardinal feature, decreased exercise tolerance, results from both central (cardiac) and peripheral (skeletal muscle) dysfunction. Skeletal muscle weakness and frailty are common aspects of aging that are associated with vascular disease and may predispose to HF onset. Although simple measures of physical function like hand grip strength and gait speed have been linked to disability and mortality, their individual associations with incident HF in elders remain unclear. The relationship of these measures with onset of HF subtypes has not been previously studied.

Hypothesis:
We tested the hypothesis that lower grip strength and gait speed are independently associated with higher risk of HF and its subtypes (preserved [HFpEF] and reduced [HFrEF]).

Methods:
A total of 7,144 participants free of prevalent HF with available muscle measures were pooled from two prospective older cohorts, the Cardiovascular Health Study (n=4584) and the Health, Aging, and Body Composition Study (Health ABC) (n=2560). Grip strength was assessed by dynamometry, and gait speed based on a short-distance walk (calibrated to ~4 m in both studies). In a secondary analysis, we evaluated thigh muscle strength, assessed by isokinetic dynamometry in Health ABC only. Incident HF and its subtypes were adjudicated with similar methods in both studies. Cox models were fitted to estimate risks of incident HF after adjustment for potential confounders (age, sex, race/ethnicity, body mass index, smoking, alcohol, systolic blood pressure, antihypertensive medication, diabetes, coronary heart disease, cerebrovascular disease, peripheral artery disease, atrial fibrillation, forced expiratory volume in 1 second, albumin, estimated glomerular filtration rate).

Results:
Median age was 72, 42.2% were male, and 22.9% Black. Lower gait speed was significantly associated with higher incident HF (HR per SD = 1.16 [95% CI = 1.10-1.23]) after full adjustment, but this was not observed for lower grip strength (HR per SD = 1.02 [0.95-1.10]). Gait speed showed consistent inverse associations with both HF subtypes: HFpEF: HR per SD = 1.23 [1.10-1.36]); HFrEF (HR per SD = 1.15 [1.03-1.27]). Thigh muscle strength was not significantly associated with incident HF in Health ABC (HR per SD = 1.11 [0.95-1.30]). There was no evidence of effect modification by race or by cohort.

Conclusion:
In two prospective cohorts of older adults of mixed race, lower gait speed, but not strength, was associated with higher risk of HF and its subtypes. Whether this readily obtainable measure of functional capacity could be used for HF risk stratification and targeting of preventive interventions will require further study.
Abstract P199: Association Of High Left Ventricular Ejection Fraction With Incident Heart Failure, And Impact Of Adiposity On Ejection Fraction
Authors: Gona Philimon N , Lee Jane J , Chi Gerald , Gafane-Matemane Lebo , O'Donnell Christopher J , Manning Warren J , Chuang Michael L
Published: April 2022

Introduction:
High left ventricular ejection fraction (LVEF) has been associated with excess cardiovascular disease (CVD) morbidity and mortality among women with CVD. We sought to determine if high EF is associated with incident heart failure (HF) in a community-dwelling cohort of adults. Secondarily, we examined relationships between various adiposity measures and high EF, as obesity is associated with HF with preserved EF.

Methods:
1794 participants aged 65±9y (53% women) of the Framingham Offspring cohort underwent cardiac MRI 2002-2006 to determine LV EF and mass (LVM). Anthropometric measures and clinical covariates were collected at the adjacent Offspring cycle 7 visit. Adiposity measures included body mass index (BMI) and waist circumference (WC). A healthy referent subset (no hypertension, diabetes, smoking, or history of CVD) was used to determine sex-specific upper 90
th
percentile cutpoints (P90) for high EF. Cox proportional hazards regression models were used to assess event-free survival for the outcome of HF (adjudicated by 3 physician investigators). Multivariable-adjusted (MV) logistic regression analysis was used to determine clinical factors associated with high EF. Adiposity measures were considered categorically (as BMI≥30kg/m
2
and WC > 102 or 88 cm (men, women)) and as continuous variables.

Results:
P90 cutpoints for high EF were 72.5% (men) and 75.1% (women). Prevalence of high EF was 16.0% (men) and 14.7% (women). Over median 13.2 years of follow up there were 68 incident HF events. In MV-adjusted Cox models accounting for age, sex, hypertension, smoking, diabetes, and indexed LVM, the HF outcome was associated with greater age (hazard ratio, HR=3.13/10y, 95%CI 2.30 - 4.27), LVMi (HR=1.24/5g per m
2
, CI 1.12 - 1.36) and high EF (HR=2.26, CI 1.35 - 3.77). MV-adjusted logistic regression models showed high EF was associated with each measure of adiposity. High BMI (≥30) had odds ratio (OR) = 1.38 (CI 1.04 - 1.84), high WC (>102 or 88): OR=1.55 (1.12 - 2.09), continuous BMI: OR=1.03 (CI 1.01 - 1.06), continuous WC: OR=1.02 (1.01 - 1.03). In each of these models ORs for age ranged 1.52 to 1.54, hypertension 1.74 to 1.86.

Conclusion:
High EF was associated with greater hazard of incident heart failure in middle-aged and older adults. High EF was associated with increasing age, hypertension, and greater adiposity (measured by either BMI or WC). This work extends prior findings in women with CVD to a community-dwelling cohort of both sexes. Further work is needed to determine whether general or central measures of obesity are more strongly associated with high EF.
Abstract P201: Social Determinants Of Health Modulate Risk Of Heart Failure Development In A Federally Qualified Health Center Population
Authors: Joshi Tejas , Rivera Adovich , Plank Megan , Rusie Laura , Beach Lauren B
Published: April 2022

Introduction:
Social determinants of health (SDoH) are known predictors of heart failure, though their incorporation into existing risk models is limited, and these models are not widely implemented. In particular, there are limited studies of heart failure risk within federally qualified health centers (FQHCs) tailored to quantify the effects of several SDoH including sexual and gender minority status, socioeconomic factors, and neighborhood characteristics.

Hypothesis:
We assessed the hypothesis that risk factors among several SDoH domains would modulate heart failure risk when controlled for traditional biologic risk factors and significantly improve the performance of a predictive model among patients at Howard Brown Health, a FQHC.

Methods:
We retrospectively identified all patients at Howard Brown Health from January 1, 2012 through December 31, 2019 using electronic health records. The association between risk factors and heart failure diagnosis, defined as having one heart failure-associated ICD code, was assessed by multivariate logistic regression. Missing data were imputed with the R mice package. Neighborhood-level data were obtained from the 2019 American Community Survey. Machine learning was used to predict heart failure with several algorithms including gradient boosting machine via the R caret package.

Results:
Among 99,047 patients, 130 (0.13%) had heart failure. On multivariate logistic regression, these patients were significantly more likely than peers to be older (OR 0.0002, p<0.001), smoke (OR = 0.0035, p<0.001), have diabetes (OR 0.3, p<0.001), have dyslipidemia (OR 0.3, p<0.001), have hypertension (OR 0.001, p<0.001) or have coronary heart disease (OR 0.8, p<0.001. Non-Hispanic whites were at lower risk than non-Hispanic blacks (OR 0.0008, p<0.01) and at higher risk than Hispanic patients (OR -0.0006, p<0.05). Patients with lower household incomes, government insurance or no insurance, or those who lived in neighborhoods with lower median household incomes were also all more likely to have heart failure (all p<0.05). The machine learning predictive models incorporating SDoH and without SDoH respectively had sensitivities of 87% and 82%, specificities of 85% and 80%, positive predictive values of 99.98% and 99.98%, and negative predictive values of 0.9% and 0.8%.

Conclusions:
Biologic comorbidities portend the highest heart failure risk. Race and economic factors, including neighborhood level variables, predict the highest heart failure risk among measured SDoH in this FQHC population. A machine learning model is able to predict heart failure with biologic comorbidities, and SDoH improve model performance. In conclusion, future research incorporating SDoH—in particular race and economic characteristics—into risk assessments or predictive modeling may aid early detection and prevention of heart failure and reduce health disparities.
Abstract P204: Association Of Plasma Proteome With Inflammatory Markers Crp And Glyca And Their Responses To Exercise Training
Authors: Barber Jacob , Cai Guoshuai , Dev Prasun K , Robbins Jeremy M , Rao Prashant , Mi Michael , Ghosh Sujoy , Clish Clary , Katz Daniel H , Gerszten Robert E , Bouchard Claude , Sarzynski Mark A
Published: April 2022

Introduction:
C-reactive protein (CRP) and GlycA are established biomarkers of inflammation. Regular exercise tends to decrease CRP and GlycA levels. However, the molecules underlying CRP and GlycA and their responses to exercise training are less known.

Hypothesis:
We hypothesized that distinct protein signatures exist for both baseline levels and exercise responsiveness of CRP and GlycA, however with some overlap of proteins across signatures.

Methods:
Measures were performed before and after 20 weeks of exercise training in 652 Black and White adults from the HERITAGE Family Study. 4,979 circulating proteins were measured using SomaScan. High-sensitivity CRP was measured using automated assays. GlycA was quantified by NMR spectroscopy (LabCorp). Linear mixed models were used to test: 1) Association of
baseline
proteins with
baseline
hsCRP and GlycA and 2) Association of
change
in protein with
changes
in hsCRP and GlycA. Models were adjusted for age, sex, race, BMI, with family membership as a random variable, with change models also adjusting for baseline trait value. Significance was determined as FDR<0.05.

Results:
Baseline levels (r=0.51, p<0.0001) and change (r=0.31, p<0.0001) of hsCRP and GlycA were moderately correlated. hsCRP did not change with training, while GlycA trended towards decreasing (Table 1). Across time points, 388 and 1746 unique proteins were associated with hsCRP and GlycA, respectively, with substantial overlap across traits and time points (Table 1). The CRP protein was the top association in 3 of 4 models (range: 1.4x10
-40
< p < 1.2x10
-08
), with serum amyloid A-2 and A-1 (SAA2, SAA) among the top 6 hits for 3 of 4 models (Table 1).

Conclusions:
More unique proteins were associated with GlycA levels at both timepoints, with most hsCRP proteins overlapping with GlycA proteins. Overall, a substantial number of proteins are associated with CRP and GlycA levels regardless of when they are measured, which has potential implications for using proteins as signatures of these inflammatory biomarkers.
Abstract P206: Proteomic And Metabolomic Signatures Of Plasma Triglyceride-related Trait Responses To Regular Exercise
Authors: Barber Jacob L , Cai Guoshuai , Robbins Jeremy M , Rao Prashant , Mi Michael , Ghosh Sujoy , Clish Clary , Katz Daniel H , Gerszten Robert E , Bouchard Claude , Sarzynski Mark A
Published: April 2022

Introduction:
Elevated plasma triglycerides (TG) are associated with risk of cardiovascular disease and are modifiable through lifestyle interventions such as regular exercise. However, TG responses to regular exercise are characterized by significant inter-individual differences.

Hypothesis:
We hypothesized that baseline levels of circulating proteins and metabolites are associated with TG response to exercise and can predict exercise-induced changes in plasma TG traits.

Methods:
We measured circulating proteins (n=4979 proteins) and metabolites (n=300) in 650 Black and White adults of the HERITAGE Family Study who completed 20 weeks of exercise training and had complete data on TG traits. We investigated two TG-related traits that significantly improved with training: fasting TG and large TG-rich lipoprotein particle concentration (LTRLP). The association between
baseline
analyte values and exercise-induced
changes
in TG traits were examined using linear mixed models adjusted for age, sex, race, BMI, baseline trait value, and the random effect of family membership. Significance was determined as FDR<0.05. Molecular signatures of TG trait responses were generated via elastic net regression tuned using leave-one-out cross validation.

Results:
Regular exercise significantly reduced plasma TG (-1.03±1.3 mmol/L, p=0.01) and LTRLP (-0.24±2.2 nmol/L, p= 0.007), with their training-induced changes moderately correlated (r=0.4, p<0.0001). We identified largely distinct panels of baseline analytes associated with changes in TG and LTRLP (
Table 1
). Similarly, elastic net regression yielded distinct models of 99 analytes for TG and 315 analytes for LTRLP responses to exercise with accuracy of RMSE=1.28 mmol/L for TG and 2.16 nmol/L for the LTRLP model.

Conclusions:
We identified panels of proteins and metabolites associated with exercise-induced changes in TG traits and demonstrate, within our data, circulating analytes hold promise for predicting the exercise responsiveness of plasma TG-related traits.
Abstract P217: Cardiovascular Events Among Adults Who Qualify For Statin Therapy Based On Age Alone Alone: A Reasons For Geographical And Racial Differences In Stroke (REGARDS) Study
Authors: Kong Nathan , Sakhuja Swati , Colantonio Lisandro , Levitan Emily B , Lloyd-Jones Donald , Cushman Mary , Muntner Paul , Polonsky Tamar S
Published: April 2022

Background:
Predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk in the Pooled Cohort equation increases substantially with age. Some older adults have estimated ASCVD risk ≥7.5% without elevated risk factors; it is unclear whether the observed ASCVD risk is high in this group. We compared the incidence of ASCVD between adults with an estimated 10-year ASCVD risk ≥7.5% based on age alone vs those with elevated risk factors.

Methods:
Adults ages 45-79 enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study without a history of ASCVD, diabetes mellitus, or statin use were included (i.e, a primary prevention subset). Ten-year ASCVD risk was estimated using the Pooled Cohort Risk Equation. Participants were categorized into 3 groups according to the predicted ASCVD risk: <7.5%, “age-only” ≥7.5%, and “elevated factors” ≥7.5%. Participants with “age-only” risk ≥7.5% were nonsmokers with untreated SBP <130 mmHg, total cholesterol <200 mg/dL, and HDL-C ≥50 mg/dL for women or ≥40 mg/dL for men. All other participants with predicted ASCVD ≥7.5% were considered “elevated factors” ≥7.5%. Incident ASCVD was defined as ischemic or hemorrhagic stroke, nonfatal MI, or CHD death.

Results:
Among 10,742 participants, 891 ASCVD events occurred over a median follow-up of 11.1 (7.1 - 13.0) years. The “age-only” risk ≥7.5% group included 352 (3.3%) participants with mean age 69.9 ± 5.0. The risk <7.5%, and “elevated factors” risk ≥7.5% had a mean age of 56.3 ± 5.9, and 66.3 ± 7.1 years, respectively. Compared to the risk <7.5% group, the “age-only” and “elevated factors” risk ≥7.5% group experienced 2.6-fold and 3.6-fold higher event rates, respectively (Table).

Conclusions:
Few adults in this primary prevention population had predicted risk ≥7.5% based on age alone. Even without elevated risk factors, adults with predicted ASCVD risk ≥7.5% based on age alone experienced substantial event rates consistent with their predicted risk.
Abstract P219: Associations Between Endogenous Sex Hormone Levels And Adipokine Levels In The Multi-ethnic Study Of Atherosclerosis (MESA)
Authors: Varma Bhavya , Ogunmoroti Oluseye , Ndumele Chiadi E , Kazzi Brigitte , Rodriquez Carla , Osibogun Olatokunbo I , Allison Matthew A , Bertoni Alain G , Michos Erin D
Published: April 2022

Background:
Differences in sex hormone levels contribute to sex differences in cardiovascular disease (CVD). Adipokines, which are central to cardiometabolic disease, differ by sex and have divergent associations with CVD. However the link between sex hormones and adipokines is not well established. We hypothesized that an androgenic sex hormone profile is associated with higher leptin & resistin and lower adiponectin levels among postmenopausal women and men.

Methods:
We performed an analysis of 1822 adults in MESA who had sex hormones and adipokines measured. Sex hormones [Testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG)] were measured at exam 1; free T was estimated. Serum adipokines [leptin, resistin, adiponectin] were measured at visits 2 or 3, an average of 2.6 yrs later. We used multivariable linear regression to examine the cross-sectional associations between sex hormones and adipokines.

Results:
The mean age was 63 (10), 48% were women; 41% White, 13% Chinese American, 20% Black, 26% Hispanic.
Leptin:
After adjusting for demographics (model 1), higher free T & E2 and lower SHBG were associated with greater leptin levels in women and men; higher DHEA was associated with lower leptin in men (
Table
). With full covariate adjustment (model 3), this remained statistically significant for E2 & SHBG in women and for DHEA in men.
Adiponectin:
With demographic adjustment, higher free T, E2, DHEA & lower SHBG were associated with lower adiponectin in women, and higher free T & lower SHBG with lower adiponectin in men. After full covariate adjustment, these same relationships were slightly attenuated but remained significant for women and men.

Resistin:
no association in either sex.

Conclusion:
A more androgenic profile (higher free T & lower SHBG) was independently associated with lower adiponectin in men and women. Higher E2 & lower SHBG in women, and lower DHEA in men, were associated with leptin. These findings may provide mechanistic insight into the interplay between sex hormones, adipokines and CVD risk.
Abstract P225: Depressive Symptoms Are Not Associated With Clinically Important Levels Of Home Blood Pressure In The Electronic Framingham Heart Study
Authors: Lee Jasmine , Wang Xuzhi , Liu Chunyu , Pathiravasan Chathurangi H , Benjamin Emelia J , McManus David D , Murabito Joanne M
Published: April 2022

Introduction:
Depressive symptoms are common and share many biopsychosocial mechanisms with hypertension, but cross-sectional studies on their association have produced inconsistent results. The emergence of digital home blood pressure (BP) measurements may provide additional insight into the relationship.

Hypothesis:
We hypothesized that depressive symptoms would be modestly associated with higher home BP and hypertension prevalence in participants of the electronic Framingham Heart Study (eFHS).

Methods:
FHS participants who attended research exam 3 (2016-2019) were invited to enroll in eFHS. They downloaded a smartphone app and were provided a digital BP cuff to measure their weekly BP for up to 1 year. Participants who had at least 3 home BPs were included. Depressive symptoms were measured at the exam using the Center for Epidemiological Studies Depression Scale (CES-D) scored 0-60. We used linear mixed regression models to test the association of CES-D score (independent) with home SBP and DBP (dependent) and a logistic regression model to evaluate the association of depressive symptoms (defined as CES-D ≥16) with prevalent hypertension, adjusting for age, sex, cohort, lifestyle factors, diabetes, and CVD.

Results:
The study sample included 855 eFHS participants (mean age 53 years, 59% women, 9% multi-ethnic). The prevalence of depressive symptoms was 7% (CES-D score mean±SD, 5.7±6.6). The mean SBP and DBP were 119 and 76 mmHg; the prevalence of hypertension was 48%. CES-D score was modestly associated with home BP; a 1 SD higher CES-D corresponded with 0.9 and 0.6 mmHg higher mean SBP and DBP respectively (Table). Depressive symptoms were not significantly associated with home BP or hypertension prevalence (OR=3.16, 95% CI, 0.96-10.43). Antidepressant use attenuated the relationship.

Conclusion:
CES-D score had a small positive association with digital home BP, but it was not clinically substantive. The association of depression and hypertension risk warrants more data, which may be supported by mobile health.
Abstract P226: Lifetime Discrimination And Weight Change: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Authors: Ajibewa Tiwaloluwa , Carnethon Mercedes R , Kershaw Kiarri , Kiefe Catarina I , Forrester Sarah , Carson April P , Allen Norrina
Published: April 2022

Introduction:
Discrimination is a stressor often coped with through unhealthy behavioral responses that can lead to weight gain. Given that discrimination can be experienced by many different social groups, there is greater need to understand the role of discrimination and weight gain across racial and gender groups. This study assessed whether perceived lifetime discriminatory experiences are associated with weight and weight gain longitudinally among Black and White adults.

Hypothesis:
We hypothesized that greater self-reported perceptions of discrimination will be associated with greater weight and weight gain longitudinally, with greater lifetime discriminatory experiences among women and Black participants.

Methods:
Data from 2,906 adults (40.2 years of age; 45.2% Black; 56.8% female; 184.2 lbs.; 12.8% endorsing 3 or more domains of lifetime discrimination) from 2000-2001 (year 15) of the CARDIA study were included. Linear regression was used to examine the association between discrimination and weight cross-sectionally, and weight change between years 15 and 30 (2015-2016).

Results:
Black men (50.8%) and women (41.6%) reported racial discrimination as the most common form of discrimination they experienced (endorsed 3 or more domains), while White men (6.4%) and women (25.4%) reported SES and gender-discrimination as the most common form of discrimination they experienced, respectively. Racial and SES-discrimination were positively associated with weight, whereas racial-, gender-, SES-, or total lifetime discrimination were not associated with weight change (Table).

Conclusion:
Higher racial and class-based discrimination experiences were associated with higher weight, while longitudinal findings did not support our hypotheses. Given the more common experiences of perceived discrimination among women and Black participants, continued longitudinal studies into the pathways by which discrimination leads to weight gain in these groups early in life is vital.
Abstract P232: Associations Between Income And Education With ASCVD Risk, NHANES, 1999-2018
Authors: Nahodyl Lauren , Vilchez Lilliana , Mesa Robert A , Tremblay Julien , Elfassy Tali
Published: April 2022

Introduction:
Factors used to calculate cardiovascular disease (CVD) risk scores include age, sex, race, cholesterol, blood pressure, diabetes, and smoking status, but exclude social determinants of health (SDOH).

Objectives:
To determine whether SDOH factors are independently associated with CVD risk.

Methods:
The National Health and Nutrition Examination Survey is an annual, cross-sectional representative survey of the US adult population. We combined years 1999-2018 and included participants age 40-79 without CVD history, and with information to calculate CVD risk (n=23,877). Ten-year risk of ASCVD was calculated using the AHA/ACC pooled cohort equation. SDOH were conceptualized using self-reported educational attainment and income. We used linear regression models to estimate the association between SDOH and ASCVD risk adjusting for age, sex, race, marital status, and insurance. All analyses accounted for the complex survey design.

Results:
Among US adults, income of ≥ $100k was reported in 23% (SE: 1.1) of those with CVD risk <5%, but only 10% (SE: 0.9) of those with CVD risk ≥ 20%. Similarly, having graduated college was reported in 38% (SE: 1.1) of those with CVD risk < 5% but only 20% (SE: 0.9) of those with CVD risk ≥ 20%. From fully adjusted linear regression models, compared to those with highest income (>$100k), income < $25k was associated with a 5.3% (95% CI: 4.5, 6.1) greater CVD risk, while individuals at income levels $25k-$44.9k, $45-74.9k, and $75-$99.9k, experienced a 3.2% (95% CI: 2.4, 4.1), 1.5% (95% CI: 0.8, 1.5), and 1.1% (95% CI: 0.5, 1.7), greater CVD risk, respectively. Additionally, compared to college graduates, less than a high school education was associated with a 4.4% (95% CI: 3.7, 5.1) greater CVD risk, while high school graduates or some amount of college still experienced a 2.8% (95% CI: 2.3, 3.3) and 1.6% (95% CI: 1.2, 2.1) greater CVD risk, respectively.

Conclusion:
In a large US population-based sample of adults, we found strong graded associations between lower income and lower educational attainment with greater CVD risk. Though SDOH are not inputs into calculators of ASCVD risk, they are strongly associated with ASCVD risk scores.
Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association
Authors: Lopez Keila N. , Baker‐Smith Carissa , Flores Glenn , Gurvitz Michelle , Karamlou Tara , Nunez Gallegos Flora , Pasquali Sara , Patel Angira , Peterson Jennifer K. , Salemi Jason L. , Yancy Clyde , Peyvandi Shabnam ,   the American Heart Association Congenital Cardiac Defects Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Epidemiology and Prevention; and Council on Lifestyle and Cardiometabolic Health
Published: April 2022

Despite the overall improvement in life expectancy of patients living with congenital heart disease (congenital HD), disparities in morbidity and mortality remain throughout the lifespan. Longstanding systemic inequities, disparities in the social determinants of health, and the inability to obtain quality lifelong care contribute to poorer outcomes. To work toward health equity in populations with congenital HD, we must recognize the existence and strategize the elimination of inequities in overall congenital HD morbidity and mortality, disparate health care access, and overall quality of health services in the context of varying social determinants of health, systemic inequities, and structural racism. This requires critically examining multilevel contributions that continue to facilitate health inequities in the natural history and consequences of congenital HD. In this scientific statement, we focus on population, systemic, institutional, and individual‐level contributions to health inequities from prenatal to adult congenital HD care. We review opportunities and strategies for improvement in lifelong congenital HD care based on current public health and scientific evidence, surgical data, experiences from other patient populations, and recognition of implicit bias and microaggressions. Furthermore, we review directions and goals for both quantitative and qualitative research approaches to understanding and mitigating health inequities in congenital HD care. Finally, we assess ways to improve the diversity of the congenital HD workforce as well as ethical guidance on addressing social determinants of health in the context of clinical care and research.
Tailored Sitting Tai Chi Program for Subacute Stroke Survivors: A Randomized Controlled Trial
Authors: Zhao Jie , Chau Janita Pak Chun , Chan Aileen Wai Kiu , Meng Qiang , Choi Kai Chow , Xiang Xiaoqi , Zhao Yali , He Rong , Li Qin
Published: April 2022

Background:

The initiation of exercise during rehabilitation at the subacute stage could provide stroke survivors with an approach to recovery that capitalizes on unique physiological conditions and promotes spontaneous recovery. We aimed to examine the effects of a tailored sitting Tai Chi program on recovery outcomes among subacute stroke survivors.

Methods:

We conducted a 12-week assessor-blind randomized controlled trial in China. Subacute stroke survivor-caregiver dyads were recruited and randomly assigned to either the sitting Tai Chi group (n=80) or attention control group (n=80). Outcomes including upper limb function (Fugl-Meyer Assessment Upper Extremity & Wolf Motor Function Test), balance control (Berg Balance Scale), sitting balance control (Trunk Impairment Scale), depressive symptoms (Geriatric Depression Scale Short Form), shoulder range of motion, shoulder pain (ShoulderQ), activities of daily living (Modified Barthel Index), and quality of life (Stroke Specific Quality of Life Scale) were measured at baseline, in-process, immediately post, and 4-week postintervention.

Results:

Immediately postintervention, the sitting Tai Chi group (n=69) showed significant upper limb function improvement in the primary outcomes including the performance time (regression coefficient of the group-by-time interaction, B=–21.415 [95% CI, –31.000 to –11.831]) and functional ability (B=10.146 [95% CI, 4.886–15.406]) domains of the Wolf Motor Function Test, balance control (B, 4.972 [95% CI, 1.356–8.588]), and sitting balance control (B=4.397 [95% CI, 2.699–6.096]). Compared with the control group (n=65), improvements were also observed in secondary outcomes including depressive symptoms (B=–1.626 [95% CI, –2.304 to –0.948]), shoulder extension (B=4.518 [95% CI, 0.893–8.144]), activities of daily living (B=5.510 [95% CI, 0.450–10.569]), and quality of life (B=15.680 [95% CI, 7.255–24.105]).

Conclusions:

The results support the effectiveness of a tailored sitting Tai Chi program in improving recovery outcomes among subacute stroke survivors and provide additional knowledge to support the clinical implementation of such a program.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04138407.
UDapter: Typology-based Language Adapters for Multilingual Dependency Parsing and Sequence Labeling
Authors: Üstün Ahmet , Bisazza Arianna , Bouma Gosse , Noord Gertjan van
Published: April 2022

Recent advances in multilingual language modeling have brought the idea of a truly universal parser closer to reality. However, such models are still not immune to the “curse of multilinguality”: Cross-language interference and restrained model capacity remain major obstacles. To address this, we propose a novel language adaptation approach by introducing contextual language adapters to a multilingual parser. Contextual language adapters make it possible to learn adapters via language embeddings while sharing model parameters across languages based on contextual parameter generation. Moreover, our method allows for an easy but effective integration of existing linguistic typology features into the parsing model. Because not all typological features are available for every language, we further combine typological feature prediction with parsing in a multi-task model that achieves very competitive parsing performance without the need for an external prediction system for missing features.

The resulting parser, UDapter, can be used for dependency parsing as well as sequence labeling tasks such as POS tagging, morphological tagging, and NER. In dependency parsing, it outperforms strong monolingual and multilingual baselines on the majority of both high-resource and low-resource (zero-shot) languages, showing the success of the proposed adaptation approach. In sequence labeling tasks, our parser surpasses the baseline on high resource languages, and performs very competitively in a zero-shot setting. Our in-depth analyses show that adapter generation via typological features of languages is key to this success.1
Towards General Natural Language Understanding with Probabilistic
Worldbuilding
Authors: Saparov Abulhair , Mitchell Tom M.
Published: April 2022

We introduce the Probabilistic Worldbuilding Model (PWM), a new fully symbolic Bayesian model of semantic parsing and reasoning, as a first step in a research program toward more domain- and task-general NLU and AI. Humans create internal mental models of their observations that greatly aid in their ability to understand and reason about a large variety of problems. In PWM, the meanings of sentences, acquired facts about the world, and intermediate steps in reasoning are all expressed in a human-readable formal language, with the design goal of interpretability. PWM is Bayesian, designed specifically to be able to generalize to new domains and new tasks. We derive and implement an inference algorithm that reads sentences by parsing and abducing updates to its latent world model that capture the semantics of those sentences, and evaluate it on two out-of-domain question-answering datasets: (1) ProofWriter and (2) a new dataset we call FictionalGeoQA, designed to be more representative of real language but still simple enough to focus on evaluating reasoning ability, while being robust against heuristics. Our method outperforms baselines on both, thereby demonstrating its value as a proof-of-concept.
Data-driven Model Generalizability in Crosslinguistic Low-resource Morphological Segmentation
Authors: Liu Zoey , Prud’hommeaux Emily
Published: April 2022

Common designs of model evaluation typically focus on monolingual settings, where different models are compared according to their performance on a single data set that is assumed to be representative of all possible data for the task at hand. While this may be reasonable for a large data set, this assumption is difficult to maintain in low-resource scenarios, where artifacts of the data collection can yield data sets that are outliers, potentially making conclusions about model performance coincidental. To address these concerns, we investigate model generalizability in crosslinguistic low-resource scenarios. Using morphological segmentation as the test case, we compare three broad classes of models with different parameterizations, taking data from 11 languages across 6 language families. In each experimental setting, we evaluate all models on a first data set, then examine their performance consistency when introducing new randomly sampled data sets with the same size and when applying the trained models to unseen test sets of varying sizes. The results demonstrate that the extent of model generalization depends on the characteristics of the data set, and does not necessarily rely heavily on the data set size. Among the characteristics that we studied, the ratio of morpheme overlap and that of the average number of morphemes per word between the training and test sets are the two most prominent factors. Our findings suggest that future work should adopt random sampling to construct data sets with different sizes in order to make more responsible claims about model evaluation.
Sexual adaptation: is female–male mounting a supernormal courtship display in Japanese macaques?
Authors: Gunst Noëlle , Leca Jean-Baptiste , Vasey Paul L.
Published: April 2022

We analysed heterosexual consortships in a free-ranging group of Japanese macaques in which adult females routinely perform female-to-male mounting (FMM). We tested whether FMM is more efficient (i.e., a ‘supernormal courtship’ behavioural pattern) than species-typical female-to-male sexual solicitations (FMSS) at prompting subsequent male-to-female mounts (MFM). In a context of high female-female competition for male mates, we found that (1) FMM functioned to focus the male consort partner’s attention as efficiently as FMSS and prevented him from moving away, and (2) FMM was more efficient than species-typical FMSS at expediting MFM (i.e., the most fitness-enhancing sexual behaviour of a mating sequence). We concluded that FMM could be considered a supernormal courtship behavioural pattern in adult female Japanese macaques. This population-specific sexual adaptation may result from a combination of favourable socio-demographic conditions. This study has implications for the evolutionary history of non-conceptive mounting patterns in Japanese macaques and non-conceptive sexuality in humans.
Common and Uncommon Jewish Purity Concerns in City and Village in Early Roman Palestine and the Flourishing of the Stone Vessel Industry: A Summary and Discussion
Authors: Gibson Shimon
Published: April 2022

A stone vessel industry existed in early Roman Palestine (first century CE), and many of these utensils were either hand-carved or made on a lathe. The stone vessels were part of the tableware within Jewish households from different socio-economic levels of society in cities and villages. This research indicates that stone vessels were not as “common” in Jewish settlements of that time as has previously been thought. The article’s purpose is to sum up the new archaeological data on the subject. It deals with manufacturing processes, morphological aspects. This article also offers a refined chronological scheme for stone vessels (late first century BCE–mid-second century CE) in Judea, and it incorporates hitherto unpublished data from the excavation of a quarry-cave manufacturing site at Tel el-Ful, as well as providing detailed information on the typological frequency of stone vessels from sites at Jerusalem, notably at Mount Zion.
Did the published Theodosian Code include obsolete constitutions?
Authors: Sirks Boudewijn
Published: April 2022

It is a point of contention whether the Theodosian Code contains also obsolete constitutions as foreseen for the projected interim code of CTh 1,1,5, or only valid constitutions (with the exception of Book 16). The text of CTh 1,1,6 is unclear in this point and seems to be a mere continuation of the plan of CTh 1,1,5. However, it appears that the first view does not take into account other statements of Theodosius, and that research into particular subjects shows the compilers have rendered a logically consistent review of the law, without superfluous texts. In view of this evidence it is better to assume that also elsewhere in the Books 1 to 15 as a rule only valid laws were included.
Toxic Military Masculinities and the Politics of Conscript After-Death Remembrance in Singapore
Authors: Lowe John
Published: April 2022

This article discusses the relationality between death and masculinity in economically prosperous Singapore. In positioning the Singaporean male conscript, spatially disciplined by the state in both life and death, this article discusses how the reproduction of militarized masculinities through National Service (NS) in Singapore is co-constitutive of geopolitical tensions that contour how the space of the male body is reproduced. In the aftermath of four training-related deaths, this article examines the extent to which the authoritarian state is selective in exercising necropower by denying slain military bodies their existence as bodies-as-space. Granted that bodies-as-space are generative of emotions and affects, the final section of this article discusses how the Singaporean state exercises necropower to enhance life-giving conditions. It does so by deciding which military cadavers are most worthy of communicating affects and emotions for the purposes of preventing future deaths from training and ensuring support for conscription.
The Rhyacophila fasciata Group in Europe: Rhyacophila macedonica Karaouzas, Valladolid & Ibrahimi (n. sp.) from Greece, Kosovo, Republic of North Macedonia and Serbia (Trichoptera: Rhyacophilidae)
Authors: VALLADOLID MARIA , KARAOUZAS IOANNIS , IBRAHIMI HALIL , ARAUZO MERCEDES , STAMENKOVIĆ VALENTINA SLAVEVSKA , DORDA BEATRIZ A. , HINIĆ JELENA , BILALLI ASTRIT , MUSLIU MILAIM , REY ISABEL
Published: April 2022

The morphology of all postembryonic stages (larva, pupa, male, and female) of Rhyacophila macedonica Karaouzas, Valladolid, & Ibrahimi n. sp. from Greece, Republic of North Macedonia, Kosovo and Serbia was examined. Morphological data were supplemented by a molecular analysis of the mitochondrial cytochrome C oxidase subunit I (COI) and compared with samples of the nominate species Rhyacophila fasciata Hagen 1859, as well as with other species and subspecies in this group: Rhyacophila septentrionis McLachlan 1865, Rhyacophila denticulata McLachlan 1879, Rhyacophila sociata Navás 1916, Rhyacophila kykladica Malicky & Sipahiler 1993, Rhyacophila fasciata delici Kucinic & Valladolid 2020, and Rhyacophila fasciata viteceki Valladolid & Kucinic 2020. Our results revealed morphological differences between the nominate species and R. macedonica, as well as genetic differences among the taxa in the Rhyacophila fasciata Group, so we propose R. macedonica as a new species of the Group. Based on the new molecular data, we also elevate R. f. delici to the status of a distinct species, R. delici (status promotus).
On the Interaction between Moist Convection and Large-Scale Ascent in the Tropics
Authors: Singh Martin S. , Neogi Sramana
Published: April 2022

A simple steady-state model is constructed for the interaction between moist convection and large-scale ascent in the tropics. The model is based on a bulk-plume representation of convection, and it is coupled to the large-scale circulation using methods developed for limited-area numerical models that are consistent with the weak temperature gradient approximation. Given the midtropospheric temperature anomaly in the ascent region, the model solves for the profiles of temperature, relative humidity, and large-scale vertical velocity in this region, as well as the tropical-mean profiles of temperature and relative humidity, as a function of two parameters representing the importance of entrainment and condensate re-evaporation in moist convection. According to the simple model, the ascent region is characterized by an anomalously moist and stable free troposphere with a top-heavy vertical velocity profile that peaks in the upper troposphere. These results are shown to be consistent with simulations using a cloud system–resolving model in which the large-scale circulation is parameterized. Furthermore, it is shown that, due to the effect of entrainment on the tropospheric lapse rate, the predicted vertical velocity profile is more top-heavy than the first-baroclinic mode profile used in previous reduced-complexity models of tropical dynamics. The simple model therefore provides a framework to link mixing and microphysical processes in moist convection to the large-scale structure of the tropical overturning circulation.
Harmonic Analysis of Non-Phase-Locked Tides with Red Noise Using the red_tide Package
Authors: Kachelein Luke , Cornuelle Bruce D. , Gille Sarah T. , Mazloff Matthew R.
Published: April 2022

A novel tidal analysis package (red_tide) has been developed to characterize low-amplitude non-phase-locked tidal energy and dominant tidal peaks in noisy, irregularly sampled, or gap-prone time series. We recover tidal information by expanding conventional harmonic analysis to include prior information and assumptions about the statistics of a process, such as the assumption of a spectrally colored background, treated as nontidal noise. This is implemented using Bayesian maximum posterior estimation and assuming Gaussian prior distributions. We utilize a hierarchy of test cases, including synthetic data and observations, to evaluate this method and its relevance to analysis of data with a tidal component and an energetic nontidal background. Analysis of synthetic test cases shows that the methodology provides robust tidal estimates. When the background energy spectrum is nearly spectrally white, red_tide results replicate results from ordinary least squares (OLS) commonly used in other tidal packages. When background spectra are red (a spectral slope of −2 or steeper), red_tide’s estimates represent a measurable improvement over OLS. The approach highlights the presence of tidal variability and low-amplitude constituents in observations by allowing arbitrarily configurable fitted frequencies and prior statistics that constrain solutions. These techniques have been implemented in MATLAB in order to analyze tidal data with non-phase-locked components and an energetic background that pose challenges to the commonly used OLS approach.
Error Characterization of Significant Wave Heights in Multidecadal Satellite Altimeter Product, Model Hindcast, and In Situ Measurements Using the Triple Collocation Technique
Authors: Dodet Guillaume , Abdalla Saleh , Alday Matias , Accensi Mickaël , Bidlot Jean , Ardhuin Fabrice
Published: April 2022

Ocean wave measurements are of major importance for a number of applications including climate studies, ship routing, marine engineering, safety at sea, and coastal risk management. Depending on the scales and regions of interest, a variety of data sources may be considered (e.g., in situ data, Voluntary Observing Ship observations, altimeter records, numerical wave models), each one with its own characteristics in terms of sampling frequency, spatial coverage, accuracy, and cost. To combine multiple source of wave information (e.g., for data assimilation scheme in numerical weather prediction models), the error characteristics of each measurement system need to be defined. In this study, we use the triple collocation technique to estimate the random error variance of significant wave heights from a comprehensive collection of collocated in situ, altimeter, and model data. The in situ dataset is a selection of 122 platforms provided by the Copernicus Marine Service In Situ Thematic Center. The altimeter dataset is the ESA Sea State CCI version1 L2P product. The model dataset is the WW3-LOPS hindcast forced with bias-corrected ERA5 winds and an adjusted T475 parameterization of wave generation and dissipation. Compared to previous similar analyses, the extensive (∼250 000 entries) triple collocation dataset generated for this study provides some new insights on the error variability associated to differences in in situ platforms, satellite missions, sea state conditions, and seasonal variability.
A Climatology of Snow Squalls in Southern New England 1994–2018
Authors: Colby Frank P. , Coe David , Barlow Mathew , Brown Ryan , Krajewski Elizabeth
Published: April 2022

Snow squalls are sudden snow events that last less than 1 h, are characterized by low visibility and gusty winds, and can result in notable societal impacts. This analysis develops a climatology of non-lake-effect snow squall events in southern New England for 1994–2018 and investigates the synoptic environment and mesoscale factors conducive to their formation. National Weather Service surface observations were used to identify events; sea level pressure maps, composite radar charts, and a cell-tracking algorithm were used to determine their organization and movement; and ERA5 hourly reanalysis data were used to analyze the associated synoptic and infer mesoscale features, as well as convective and symmetric instability. A total of 100 events were identified and categorized into four distinct types on the basis of the direction of movement of the associated radar echoes, which is closely linked to characteristic synoptic structures and mesoscale factors. The four types are Classic (squall movement from the northwest; 72 events), Atlantic (from the southwest; 15 events), Northern (from the north; 9 events), and Special (varying; 4 events). All types have a 500-hPa trough over the Northeast but differ in the structure of the trough and its relation to lower-level flow, which accounts for the differences in movement of the squalls. The snow events occur in shallow, convective squall lines, and the ingredients for convection were present in all cases. Both upright and symmetric instability are typically present, all cases had at least one lower-tropospheric layer with cyclonic differential vorticity advection, and many cases were also associated with frontogenesis.