bluuebunny/crossref_metadata_2025 huggingface dataset:
49 ’Pic’ your patient: development of a multi-professional handover tool
Authors: Chapman Laura , Mills Mark , Robinson Claire
Published: May 2024

Background

In a 26 bedded hospice, handovers were excessive and inefficient. Our review revealed over 15 handovers per day between different professionals. The Multi-disciplinary team (MDT) felt frustrated, recognising handovers reduced time for direct patient contact without ensuring timely sharing of crucial information.

Staff wanted a single, efficient MDT handover to identify key patient issues.

Method

Current available tools were reviewed including SBAR1(Situation, Background, Assessment, and Recommendation) but were unsuitable for the hospice. The PIC acronym was created to facilitate nursing presentation of each patient. This prompted discussion of: Plan (Is the patient going anywhere today? Are we planning discharge to their preferred place of care?); Involvement (Are appropriate MDT members involved?); Concerns (Are there any patient or family concerns?). The PIC tool was used at the newly launched ‘Huddle’ – a handover led by a senior nurse and designated consultant, with a representative from each discipline of the MDT occurring each weekday morning.

Results

Informal feedback from staff suggested the Huddle and PIC tool enabled more efficient discharges. It was useful to view the complexity of the patients throughout the hospice and guide admissions. A formal survey of the MDT is being carried out, with results available by October 2017.

Conclusion

Huddle is reducing the number of handovers each day and increasing the productivity of the hospice. This has benefits for swift discharge and assessing the needs of patients with complex problems. An unintended benefit has been improved nursing confidence in their presenting skills.

Reference

. Haig K, Sutton S, Whittington J. SBAR: A shared mental model for improving communication between clinicians. The Joint Commission Journal on Quality and Patient Safety 2006;32(3):167–175
52 What is current practice when using sedative medication at the end of life in a london hospice and teaching hospital? a mixed methods investigation for i-can-care
Authors: Vivat Bella , Harrington Jane , Bemand-Qureshi Lucy , Davis Sarah , Stone Patrick
Published: May 2024

Introduction

The I-CAN-CARE research programme explores care and assessment of dying patients in two under-researched areas: use of sedative medication at the end of life and prognostication. We present findings from an exploration of current practice relating to sedative use.

Aims

To explore the understandings of palliative care physicians and nurses in London regarding use of sedatives, and simultaneously audit deceased patient records for documented sedative use.

Methods

Focus groups with experienced palliative care physicians and nurses working in a London hospice or hospital/community-based palliative care were audio-recorded, transcribed, and analysed thematically. Deceased patient notes at both sites were audited independently, working backwards from December 2015 to obtain 25 patients at each site who had received continuous sedation at the end of life.

Results

Focus group participants (ten consultants/SpRs; seventeen senior nurses) all said they used sedative medication for managing agitation or distress; aiming for patients to be “comfortable”, “calm”, or “relaxed”, and selecting drugs and dosages as appropriate for patients’ individual needs, aiming to start with the lowest doses possible. None used structured observational tools to assess the effects of sedatives; strongly preferring clinical observation and judgement. The audit found usually low dosages: 10 mg/day median continuous dose midazolam; range 0.35–69.5, with written comments often addressing patients’ perceived comfort.

Conclusions

Focus group participants considered the role of sedative medication as primarily symptom management, emphasising individualised care, and using lowest dosages possible to achieve patient comfort, assessed using clinical judgement. Data from patient records corroborated these qualitative findings.
A Logic for P: Are we Nearly There Yet?
Authors: Dawar Anuj , Pago Benedikt
Published: May 2024

Whether or not there is a logic for P is the classic problem of descriptive complexity theory. It has been an open problem for over four decades (since its first formulation by Chandra and Harel [1980]) now and much has been written about it, including surveys and textbook presentations (see, for instance [Ebbinghaus and Flum 1999, Chapter 11]. The problem remains a focus of active research and there have been significant recent developments related to it. These may not be well known outside a specialist group of researchers and one aim of the present article is to bring these to a wider audience. To place the new results in their context, we begin with a wider perspective on the question.
Salvaguardias al Acero Chino y Protección a la Industria Nacional
Authors: Saavedra P. Eduardo
Published: May 2024

Chile está inserto en la economía mundial y comprometido al libre juego del mercado en materia de comercio exterior, negociando con prácticamente todos los países del orbe, aunque concentrando más del 40% de este comercio con República Popular China. (seguir leyendo...)
Table S8 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

ITSS score and immunophenotyping values: Pearson r coefficient and p values are indicated for each variable.
Table S7 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Necrosis score in relation to other MRI features: Pearson r coefficient and p values are indicated for each variable. Correlation between necrosis score and ITSS.
Table S6 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Necrosis score and immunophenotyping values: Pearson r coefficient and p values are indicated for each variable. Linear correlation of necrosis score with tumor PDL-1 expression and PDL-1/FKBP51s PB-TAMs.
Table S1 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Patients’ details
TABLE 1 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Cox regression analysis for overall survival with multiple variables
Supplementary Methods from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Details on plasmids, SiRNAs, antibodies, flow cytometry analysis, qPCR primers
Supplementary Figure S6 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Analysis by qPCR of the mRNA levels of the stemness markers CD133, EPHA2, NANOG, OCT 3 and 4, SNAIL, SOX2, ZEB1 in GB138 and GB83 spheroids (grey), compared to correspondent cells grown in adhesion (black).
Supplementary Figure S4 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

IB of the expression levels of FKBP51s in 7 GB tumor cell lysates with the respective densitometric analysis of IB. Bands were quantitated by densitometry, using ImageJ 1.42q for Macintosh. Integrated ODs were normalized to two relative housekeeping genes (G3PDH and Tubulin).
Supplementary Figure S10 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

ADC values and Immunophenotype of TME and peripheral blood. Graphical representation (linear regression) of flow cytometry data of TME (graphs on the left) and peripheral blood (graphs on the right) from primary tumors and recurrences. Significant result is underlined in red.
FIGURE 3 from The FKBP51s Splice Isoform Predicts Unfavorable Prognosis in Patients with Glioblastoma
Authors: Giordano Carolina , Marrone Laura , Romano Simona , Della Pepa Giuseppe Maria , Donzelli Carlo Maria , Tufano Martina , Capasso Mario , Lasorsa Vito Alessandro , Quintavalle Cristina , Guerri Giulia , Martucci Matia , Auricchio Annamaria , Gessi Marco , Sala Evis , Olivi Alessandro , Romano Maria Fiammetta , Gaudino Simona
Published: May 2024

Effect of the tumor on macrophage polarization. Cocultures of M0 cells with GB138 (A) and GB83 (B), either adherent cell or spheroid. Expression of CD163 on macrophages was upregulated in cocultures with adherent cells (red column) more than spheroids (gray column). Part of CD163 macrophages expressed FKBP51s (N = 3). Cocultures of M0 cells with GB138 (C) and GB83 (D), either adherent cell or spheroid. Expression of HLA-DR (MFI) on macrophages was upregulated in cocultures with spheroids (gray column). HLA-DR's expression was also registered on tumor cells, particularly spheroids (N = 3). E, Immunoblot of pSTAT6 expression in PBMCs of 5 patients with GBM. Samples 2 and 3 show pSTAT6. Corresponding values of CD163/FKBP51s (top) and PD-L1/FKBP51s or CD206/FKBP51s (bottom) PB-TAMs are also shown. F, Graphic representation of pSTAT6 levels (MFI) in CD163 macrophages from cocultures (N = 5). Coexpression of FKBP51s in CD163 significantly increased pSTAT6 (see Supplementary Fig. S5F and S5G). G, Immunoblot of pSTAT-6 levels in cocultures. Tumor cell–macrophage interaction induced STAT6 activation (N = 3).
What Is It Like to Be in Alcohol Addiction Recovery? A Dialectical Phenomenological Analysis
Authors: Monteiro Victor , Bloc Lucas , Messas Guilherme
Published: May 2024

Introduction: Currently, there is no scientific consensus on the concept of alcohol addiction recovery beyond substance use control. This conceptual issue challenges the implementation of therapeutic strategies and mental health policies that are unrestricted to symptomatic remission. Aiming to contribute to its definition, this study aimed to examine the recovery experience of individuals with alcohol addiction using dialectical phenomenological psychopathology (DPP) as a theoretical and methodological framework. Methods: A dialectical phenomenological analysis was conducted through an examination of online interviews with eight Brazilian, São Paulo state citizens who were self-declared to be undergoing alcohol addiction recovery (or who declared that they had completely recovered). Results: Participants’ reports generated eight categories that were subdivided into two groups. The first group indicated experiential elements of recovery, such as changes in self-relation, changes in interpersonal relations, and changes in time relations, giving new meanings to suffering and alcohol use, and recovery as a continuous process. The second group referred to how the participants interpreted recovery according to their worldviews: as a spiritual experience, moral reformation, and mentality change. Conclusion: These categories can be understood through the lens of DPP as a process of change in the subjects’ being in the world, characterized by the continued management of their existential imbalances in the dimensions of spatiality, temporality, selfhood, and intersubjectivity. The results are preliminary when it comes to conceptualizing recovery but may help future studies to develop recovery-oriented therapeutic strategies.
Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial
Authors: Berger Ruben , Hurlemann Rene , Shamay-Tsoory Simone , Kanterman Alisa , Brauser Maura , Gorni Jessica , Luhmann Maike , Schramm Elisabeth , Schultz Johannes , Philipsen Alexandra , Lieberz Jana , Scheele Dirk
Published: May 2024

Introduction: Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55). Methods: Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D). Results: The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members. Conclusion: Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.
Evaluation Of Biomarker-Based GFR Estimating Equations in Glomerular Disease
Authors: Mondal Antara , Kobe Christina , Mariani Laura H. , Zee Jarcy
Published: May 2024

Introduction: Glomerular filtration rate (GFR) is typically estimated with equations that use biomarkers such as serum creatinine and/or cystatin-C. The impact of these different biomarkers on GFR estimates in glomerular disease patients is unclear. In this study, we compared the different GFR estimating equations in the Cure Glomerulonephropathy (CureGN) cohort of children and adults with glomerular disease.

Methods: All available cystatin-C measurements from CureGN study participants were matched to same-day serum creatinine measurements to estimate GFR. To explore the strength of agreement between eGFR values obtained from the "Under 25” (U25) and Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) equations, we used intraclass correlation coefficients. Multivariable linear mixed effects models were used to determine which factors were independently associated with differences in eGFR values.

Results: A total of 928 cystatin-C measurements were matched to same-day serum creatinine measurements from N=332 CureGN study participants (58% male, 69% White/Caucasian, 20% Black/African American). Among 628 measurements collected while study participants were under 25 years old, there was moderate agreement (0.731) in serum creatinine vs. cystatin-C U25 equations. Models showed that higher eGFR values were associated with larger differences between the two equations (p <0.001). Among 253 measurements collected while study participants were at least 18 years old, there was excellent agreement (0.891-0.978) among CKD-Epi equations using serum creatinine alone, cystatin-C alone, or the combination of both. Younger age was associated with larger differences between CKD-Epi equations (p=0.06 to p=0.016).

Conclusion: Excellent agreement between CKD-Epi equations indicates continued use of serum creatinine only for GFR estimation could be appropriate for adults. In contrast, only moderate agreement between U25 equations indicates a need for more frequent measurement of cystatin-C among children and young adults, especially as eGFR increases.
Abstract 13: Associations Between Leisure-Time Physical Activity and Mortality by Sociodemographic Factors in a Nationally Representative Sample of 567,483 US Adults
Authors: Van Dyke Miriam E , Webber Bryant J , Hyde Eric T , Williamson John , Boyer William , Whitfield Geoffrey P
Published: May 2024

Introduction:
The 2018 Physical Activity Guidelines Advisory Committee Scientific Report called for investigating whether the established health benefits of meeting physical activity guidelines (PAG) differ by sociodemographic factors. Guidelines for adults recommend engaging in muscle-strengthening activities (MSAs; ≥2 days per week) and moderate-to-vigorous aerobic physical activity (MVPA; ≥150 minutes per week at moderate intensity, ≥75 minutes per week at vigorous intensity, or an equivalent combination).

Objective:
To examine associations between meeting MVPA and MSA guidelines (combined PAG) in leisure time and all-cause and heart disease mortality across sociodemographic factors.

Methods:
We used nationally representative data on 567,483 adults from the 1998-2018 US National Health Interview Survey (NHIS) and 2019 public-use linked mortality files from the National Death Index. Median follow-up was 9.5 years (range=1-21.8 years). We classified participants into categories (met combined PAG, met MVPA only, met MSA only, met neither) based on reported leisure-time physical activity. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between meeting the combined PAG vs. meeting neither guideline and all-cause and heart disease mortality, overall and stratified by sex (women, men), race and ethnicity (six groups), or education (four levels). Models were adjusted for sociodemographic and health factors. We conducted pairwise comparisons (adjusted for multiple comparisons) to determine if associations differed across sociodemographic factors.

Results:
Compared to meeting neither PAG, meeting the combined PAG was associated with a reduced mortality risk between 14-36% for all-cause mortality and 25-52% for heart disease mortality across sociodemographic groups. Reductions in mortality risk were larger for some groups compared with others. For example, reduction in all-cause mortality was larger for non-Hispanic White compared with Hispanic or Latino adults (HR=0.66 [95% CI: 0.64-0.69] vs. 0.86 [0.75-0.99]; pairwise
p
<0.001) and for people with more vs. less education (college or more=0.64 [0.60-0.69] vs. less than high school=0.75 [0.69-0.82];
p
<0.001). Reduction in heart disease mortality was larger for women compared with men (0.54 [0.48-0.62] vs. 0.66 [0.60-0.73];
p
<0.001).

Conclusions:
Meeting the guidelines for MVPA and MSA generally provides a substantial reduction in risk of all-cause and heart disease mortality. There may be differences in the magnitude of benefit physical activity provides for health across sociodemographic groups. The reasons for these differences are unclear. Identifying factors contributing to these differences would further address research gaps identified in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.
Abstract 14: Post-Traumatic Stress Disorder Symptoms and Physical Activity Behavior After Hospitalization for Suspected Acute Coronary Syndromes
Authors: Xu Chang , Schwartz Joseph , Sanchez Gabriel , Murdock Margaret , Cruz Gaspar , Jurado Ammie , Duran Andrea , Boudreaux Benjamin , Edmondson Donald , Diaz Keith
Published: May 2024

Background:
An acute coronary syndrome (ACS) related event can induce post-traumatic stress disorder (PTSD), and post-ACS PTSD is associated with a greater risk for secondary clinical outcomes among ACS survivors. While moderate-vigorous physical activity (MVPA) has been shown to reduce the risk of adverse outcomes after ACS, its impact on PTSD symptoms remains largely unknown. There is a notable absence of empirical evidence, especially from large-scale observational cohort studies with device-based measures of physical activity, on this topic.

Aim:
To investigate the relationship between physical activity behaviors over the first month post-discharge with PTSD symptoms at one month among patients with suspected ACS.

Methods:
Patients (n = 434, 48.6% female, 62.6±12.4yrs) evaluated for ACS in the emergency department were fitted with a GENEActiv wrist accelerometer in-hospital and wore the device on their non-dominant wrist for 30 days post-discharge to measure MVPA. Presence and severity of PTSD symptoms were assessed at 1-month follow-up using the PCL-5. Multilevel structural equation modeling was used to simultaneously 1) fit a linear growth curve (GC) model to patients’ 30-day trajectories of MVPA and 2) predict total PTSD symptoms from a) mean daily MVPA, b) average daily change in MVPA (GC slope), and c) covariates (age, biological sex, education, and Charlson Comorbidity Index).

Results:
Patients engaged in an average of 20.8 (95% CI: 18.4, 23.3, p < 0.001) minutes of MVPA per day. MVPA levels increased at an average rate of 0.11 mins/day (95% CI: 0.05, 0.16, p < 0.001) over the 30 days post-discharge. There was substantial between-patient variability in both average MVPA minutes (SD = 26.0) and daily rate of change in MVPA minutes (SD = 0.38). The daily rate of change in MVPA was significantly associated with 1-month PTSD symptoms (β per 0.5 mins/day difference in daily rate of change in MVPA minutes = -4.5 points on the PCL-5; 95% CI: -6.5, -2.5, p < 0.001), controlling for the above-mentioned covariates. The association between average MVPA minutes and PCL-5 score was small and not statistically significant (β = 0.02; 95% CI: -0.04, 0.07, p = 0.60).

Conclusion:
PTSD symptoms appear to be mitigated in patients whose MVPA minutes increased over the 30 days post-discharge, whereas no evident association was observed between PTSD symptoms and average daily MVPA minutes. These findings suggest that progressively increasing MVPA by as little as .5 mins/day (i.e., ~1 SD above the mean rate of increase) within the immediate first month post-discharge, as opposed to maintaining a consistent daily average of MVPA, may impede the development of PTSD symptoms in ACS survivors.
Abstract 23: Multidimensional Association of Sleep With Health Behaviors and Cardiometabolic Risk in Adolescents
Authors: Fernandez-Mendoza Julio , Nyhuis Casandra C , Morales-Ghinaglia Natasha , Rahawi Anthony , Ballester-Navarro Pura , Calhoun Susan , Liao Jason , Vgontzas Alexandros , Liao Duanping , Bixler Edward O
Published: May 2024

Introduction:
Insufficient sleep has been recognized by AHA as part of Life’s Essential 8 in the prevention of cardiovascular disease (CVD). While sleep is a multidimensional phenomenon comprised of duration, efficiency, quality, timing, and regularity, prior epidemiological research in youth has predominantly focused on sleep duration. It is important to disentangle which sleep dimensions most associate with other health behaviors and biomarkers for CVD risk in adolescents.

Hypothesis:
We hypothesize that specific dimensions of insufficient, disturbed, and misaligned sleep will be differentially associated with nutrition, physical activity, and inflammation.

Methods:
We analyzed data from 421 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 5-night at-home actigraphy (ACT), 1-night in-lab 9-h polysomnography (PSG), self-reported insomnia symptoms, daytimes sleepiness, sleep schedule, circadian preference, and dietary assessment, as well as fasting blood draw assayed for C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα). Linear regression models tested the independent association of each sleep dimension with caloric intake, ACT-derived sedentary behavior, and blood-based inflammatory biomarkers, while accounting for sex, age, race/ethnicity, and body mass index.

Results:
Higher ACT-measured night-to-night variability in sleep duration was most strongly associated with increased caloric intake, particularly carbohydrates (B=0.203, p<0.001), while shorter PSG-measured sleep duration was also associated with carbohydrates but to a lesser extent (B=-0.150, p=0.002). Later bedtime on weekdays was most strongly associated with higher bouts of sedentary behavior (B=0.216, p<0.001), while shorter ACT-measured sleep duration was most strongly associated with time spent sedentary (B=-0.226, p<0.001). PSG-measured sleep apnea was most strongly associated with higher CRP (B=0.287, p<0.001) and IL-6 levels (B=0.260, p<0.001), while later bedtime on weekdays (B=0.136, p=0.025) and evening circadian preference (B=-0.124, p=0.017) were also associated with inflammation but to a lesser extent.

Conclusions:
The association of inadequate sleep with health behaviors and cardiometabolic risk in adolescents is in itself multidimensional. These data support that AHA guidelines should be updated to include insufficient, disturbed, and misaligned sleep as contributors to CVD risk.
Abstract 25: Association Between Household Sleep Environment and Sleep Health Characteristics: The Coronary Artery Risk Development in Young Adults (CARDIA)—Sleep Study
Authors: Chapagai Swaty , Vu Thanh-Huyen T , Alexandria Shaina J , Reid Kathryn , Abbott Sabra , Harrington Katharine , Thomas S. , Lewis Cora E , Schreiner Pamela , Carnethon Mercedes R , Knutson Kristen
Published: May 2024

Introduction:
Household environmental factors and sleep behaviors may contribute to poor sleep health. We identified associations between household sleep environment (HHSE) and sleep health characteristics.

Hypothesis:
Individuals with adverse HHSE will have poorer sleep health.

Methods:
We used cross-sectional data from the CARDIA sleep ancillary study at Year 35. HHSE (i.e., sleep disruptors and sleep behaviors) scores were derived from responses to questions in the questionnaire (see Table footnote), where a higher score indicated higher sleep disruptors or more detrimental sleep behaviors. Sleep outcomes were: 1) sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness assessed with the Epworth Sleepiness Scale (ESS) (N=699) and 2) sleep duration (minutes) and efficiency (%) measured by 7-day wrist actigraphy (N=574). Robust regression estimated differences in sleep outcomes corresponding to each 1-score increment in HHSE. We adjusted for age, sex, race, education, smoking status, body mass index, depressive symptoms, and comorbidities. Racial differences in associations of interest were examined by testing for interaction.

Results:
Participants mean age was 61.5 years, 63.1% were female and 35.9% were Black. Means (SD) of PSQI, ESS scores, sleep duration, and sleep efficiency were 6.2 (3.7), 5.5 (3.7), 414.6 minutes (SD=60.4), and 84.4% (SD= 6.7), respectively. After multivariable adjustment, both higher sleep disruptors and more detrimental sleep behaviors were associated with poorer sleep quality and greater daytime sleepiness. HHSE showed no association with sleep duration and efficiency (Table 1). Sleep disruptors were only significantly associated with daytime sleepiness among Black participants (p-interaction= 0.01).

Conclusions:
Adverse household sleep environment was related to poorer subjective sleep quality and daytime sleepiness. Future studies should investigate reasons why Black adults appear more susceptible to household sleep disruptors.
Abstract 47: Five-Year Change in Biological Aging: Insights From the Age Gene-Environment Susceptibility-Reykjavik Study
Authors: Asefa Nigus , Li Zhiguang , Guðmundsdóttir Valborg , Gudnason Vilmundur , Launer Lenore
Published: May 2024

Introduction:
Epigenetic clocks help to establish a pace of biological aging. Many studies employ biologic aging scores but typically assume consistent aging pace as individuals age. We examined demographic differences in biologic aging over time in an older population.

Methods:
DNA methylation data are from the Age Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) cohort (n=2,081 participants; 57.6% female; baseline mean [SD] age 75.5 [4.8]). The participants were examined in 2002-2006 (AGES-1) and after approximately 5-year follow-up (AGES-2). We calculated the AGES-1 and AGES-2 Epigenetic Age Acceleration (EAA) separately using the DunedinPACE clock. EAA >1 implies fast biological aging, EAA <1 implies slow aging, and EAA~1 suggests similar biological and chronological aging pace. Individuals were categorized as having slow (<1 SD of the mean), stable (within one SD), or fast (>1 SD) EAA. We investigated age (<76 vs. ≥76yrs) and sex differences in biological aging, as well as changes in biological aging pace.

Results:
Mean EAA (SD) at AGES-1 was 1.10 (0.11) and 1.13 (0.12) at AGES-2, with a strong correlation (r=0.83). While mean (SD) chronological age was comparable between women (75.4, [4.9]) and men (75.7 [4.7]) in AGES-1, women had lower EAA (1.07 [0.11]) than men (1.12 [0.10]; p < 2.2e-16). At AGES-1, people <76yrs had EAA 1.09 (0.11), while those aged ≥76yrs had 1.11 (0.11), p = 0.007. At AGES-1, 68.7% were stable, 15.1% slow, and 16.1% fast agers. At AGES-2, 74.6% maintained their pace, with 25.4% (n=528) changing categories. Of the 528, almost one-quarter (23.7%) went from fast to slow biological aging. Stratifying by sex, among the 314 (26.2%) women who switched categories, most (76.4%) transitioned from slow to fast, while 23.6% changed from fast to slow. Among males, 214 (24.2%) experienced EAA shifts, with 23.8% from fast to slow. When considering age groups, 297 individuals (24.3%) aged < 76yrs had shifts compared to 231 (26.8%) aged ≥76yrs. Notably, the shift from slow to fast was 75.8% among those < 76yrs compared to 77.1% in those ≥76yrs.

Conclusion:
In this older population cohort (>67 years), approximately a quarter (25.4%) displayed shifts in biological aging due to methylation signals. More women had EAA shifts, but men often showed a greater biological aging. Older individuals (≥76yrs) also shifted from slow to fast aging. These findings highlight the dynamic nature of biological aging and its susceptibility to environmental influences. Further research is needed to investigate what factors are associated with these changes over time and whether the changes have clinical significance.
Abstract 51: Association Between Cumulative “Life’s Essential 8” Scores Through Young Adulthood and Cardiovascular Disease Risk: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Walker James , Won Daniel , Guo James W , Rana Jamal S , Allen Norrina B , Ning Hongyan , Lloyd-Jones Donald M
Published: May 2024

Background:
Associations of cardiovascular health (CVH) with incident cardiovascular disease (CVD) largely come from studies with single measures of CVH in mid-life. We used the American Heart Association’s “Life’s Essential 8” (LE8) score to examine the association of
cumulative
CVH through young adulthood, and time course of CVH exposure, with risk of incident CVD in mid-life.

Methods:
We estimated subject-specific LE8 score trajectories of 3932 CARDIA young adults aged 18-45 years (56.2% female, 48.1% Black) using a spline-based mixed effect model. Using multivariable Cox proportional models, we assessed associations of 1) cumulative LE8 score (cumLE8) from 18-45 by quartile, 2) cumLE8 continuous score from 18-45 and LE8 score at age 45, and 3) cumLE8 continuous score and slope of LE8 score from ages 18-45, with incident fatal or non-fatal CVD after age 45, adjusting for age, sex, race, and maximal education. Area under the LE8 curve from ages 18-45 was used to calculate cumLE8 for each subject.

Results:
There were 3932 CARDIA participants (56.2% female, 48.1% Black). The mean cumLE8 exposure from 18-45 was 2075.2 points*years, and mean LE8 score at age 45 was 69.9 points (out of 100; higher is better). After adjustment, the lowest 2 quartiles (Q1 and Q2) of cumLE8 score (poorest CVH) from 18-45 had significantly higher hazards for CVD after age 45 compared to the highest (best CVH, Q4) (
Figure 1, Model 1
). When cumLE8 score from 18-45 and LE8 score at age 45 were in the model together (
Model 2
), both were significantly associated with lower risk for CVD. Likewise, both cumLE8 score and positive slope of (improving) LE8 score from ages 18-45 were significantly associated with lower hazards for incident CVD after age 45 (
Model 3
).

Conclusion:
Greater cumulative CVH and improvement in CVH during young adulthood, as well as better CVH in middle age, were all independently associated with lower risk for incident CVD in mid-life. These results emphasize the importance of maintaining and improving CVH throughout young adulthood.
Abstract 55: Associations Between Cardiovascular Disease, Cognition, Kidney Function and Polyepigenetic Scores of Atherosclerosis in the Health and Retirement Study
Authors: Ammous Farah , Mitchell Colter , Faul Jessica
Published: May 2024

Introduction:
Atherosclerosis, characterized by the accumulation of arterial fatty and fibrous materials, underlies various morbidities, particularly cardiovascular disease (CVD). Epigenetic processes, like DNA methylation (DNAm), may function as mediators or biomarkers of atherosclerosis. In this study, we estimated polyepigenetic scores, which are risk-profile scores calculated from the results of an external epigenome-wide association study, for coronary artery calcification (DNAm-CAC) and carotid plaque (DNAm-cPlaque). We assessed the hypothesis that these scores are associated CVD, cognitive function, and renal function.

Methods:
We utilized data from the Health and Retirement Study, a longitudinal survey of U.S. adults over age 50. DNAm was measured on a representative sample of respondents aged 56 years and older who consented to blood draws in 2016 (N=3,875). We defined CVD based on self-reported physician diagnoses, cognitive function/dementia status using the Langa-Weir classification, and kidney function using serum cystatin C. We used weighted linear regression for modeling associations with cognitive and kidney function, logistic regression for prevalent CVD, and Cox proportional hazards models for incident CVD and dementia over a four-year follow-up period.

Results:
In 2016, the sample had a mean age of 67.4 years (SD=8.5). Most participants were females (57%), with Whites/Caucasians comprising 75% and Blacks/African Americans 17% of the sample. Both DNAm-CAC and DNAm-cPlaque were higher in smokers, individuals with a history of stroke, and those of Black/African American ancestry, while participants with higher education and greater wealth had lower scores (p<0.05). In unadjusted models, DNAm-CAC was linked to higher CVD (Odds ratio: 1.16, 95% CI: 1.07-1.26, p = 3.7х10
-4
), worse cognitive function (Beta: -0.50, 95%CI: -0.68 - -0.32, p=8.0х10
-9
for DNAm-CAC and -0.38, 95% CI: -0.56 - -0.20, p=1.1х10
-5
for DNAm-cPlaque), and declining kidney function (1.02 fold-increase, 95% CI: 1.01-1.03, p=0.004). Adjusting for comorbidities/lifestyle factors attenuated CVD and kidney function associations but not cognition (Beta = -0.30, 95% CI: -0.14 - -0.30 for DNAm-CAC; -0.23, 95% CI:-0.05- -0.23 for DNAm-cPlaque). DNAm-cPlaque was associated with dementia/cognitive impairment incidence (hazard ratio: 1.16, 95% CI: 1.01-1.32, p=0.03) after adjusting for comorbidities/lifestyle factors including
APOE
-E4 genotype. For both cognitive function and dementia/cognitive impairment incidence, adjusting for race/ethnicity, education, and wealth fully attenuated the associations.

Conclusions:
Our findings highlight the significance of polyepigenetic scores of atherosclerosis as potential biomarkers for associated morbidities in a representative U.S. sample and underscore the role of social factors as a pathway influencing these associations.
Abstract MP05: Proportion of All-Cause and Cardiovascular Disease Mortality Attributable to Social, Behavioral, and Metabolic Risk Factors in US Adults
Authors: Allouch Farah , Geng Siyi , Tian Ling , Marshall Allison , Bundy Joshua D , Chen Jing , Mills Katherine T , He Jiang
Published: May 2024

Introduction:
Recent studies have shown that social determinants of health (SDoH) are related to all-cause and cardiovascular (CVD) mortality. However, the attribution of SDoH to all-cause and CVD mortality beyond behavioral and metabolic risk factors has not been quantified in the US general population.

Methods:
National Health and Nutrition Examination Survey (NHANES) 2005-2018 included a nationally representative sample of 25,165 individuals aged 20-74. Data on social, behavioral, and metabolic risk factors were collected using standard methods. Deaths were ascertained from linkage to the National Death Index with follow-up through 2019. Multivariable-adjusted Cox regression models using backwards elimination were used to select risk factors associated with all-cause and CVD mortality. Average population attributable fractions (PAF) for risk factors significantly associated with mortality were calculated.

Results:
Over an average of 7.6 years of follow-up, 765 CVD deaths and 2,540 all-cause deaths were confirmed. Hazard ratios and PAFs from multivariable-adjusted regression models are presented in the table. Overall, social, behavioral, and metabolic risk factors accounted for 71.1% (95% CI: 63.0, 79.3) of all-cause deaths and 70.6% (62.4, 78.7) of CVD deaths in the US population. The top five leading risk factors for all-cause mortality are hypertension (15.7%), physical inactivity (11.9%), lower family income (11.6%), not married or living with a partner (9.7%), and diabetes (7.0%); and for CVD mortality are hypertension (15.5%), lower family income (13.0%), physical inactivity (12.6%), not married or living with a partner (10.5%), and diabetes (7.1%).

Conclusion:
These data indicate that social, behavioral, and metabolic factors account for most all-cause and CVD deaths in the US. Furthermore, in addition to interventions targeting hypertension, diabetes, and physical activity, novel public health policies focusing on SDoH are warranted to reduce premature deaths in the US.
Abstract MP12: Educational Attainment and the Effect of Intensive Blood Pressure Reduction: A Post-Hoc Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)
Authors: Garfein Joshua , Sekikawa Akira , Mrkva Andrew , Magnani Jared W
Published: May 2024

Introduction:
Hypertension is a major risk factor for cardiovascular disease (CVD). The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that systolic blood pressure (SBP) <120 mm Hg reduced CVD risk and all-cause mortality among those with elevated SBP and high CVD risk. Educational attainment (EA) is associated with CV health, but whether EA modifies the effect of intensive SBP reduction remains unclear.

Hypothesis:
We predicted that SPRINT participants with lower EA would have greater CVD risk reduction with intensive SBP lowering than those with higher EA.

Methods:
We included 9,361 individuals recruited as part of the SPRINT study and categorized them by EA (college degree). We examined the effect of intensive SBP lowering across EA strata in relation to the composite endpoint defined by SPRINT (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or CV death) in multivariable proportional hazards models.

Results:
The cohort was age 67.9±9.4 years, 35.6% female, and 57.8% White race. Those with high EA were more likely to be older, male, and White race. Higher EA was associated in a dose-response manner with a larger reduction in the risk of developing the composite endpoint after intensive SBP lowering [highest to lowest EA: adjusted HR 0.48 (95% CI: 0.34, 0.70); 0.81 (0.63, 1.03); 0.90 (0.70, 1.15);
P
, interaction=0.01] (
Table
). The interaction between intensive SBP lowering and EA was limited to non-Black individuals; among Black participants, the association of SBP lowering with the endpoint did not differ significantly by EA.

Conclusion:
In the SPRINT cohort, higher EA was associated with a larger improvement in CV outcomes after intensive SBP reduction, with differences by race or ethnicity. This post-hoc SPRINT analysis suggests that the benefit of intensive SBP lowering varies by EA, and highlights a need for tailored approaches to optimize hypertension management for individuals with different social backgrounds.
Abstract MP13: Association Between Visceral Adiposity Index and Non-Alcoholic Liver Fibrosis Among United States Adults With Prediabetes
Authors: Abdel-Meguid Sarah , Pelton Matthew , Visaria Aayush
Published: May 2024

Background:
Although type 2 diabetes is a well-established risk factor for non-alcoholic fatty liver disease (NAFLD) and downstream liver fibrosis, little is known about the risk factors associated with NAFLD fibrosis in adults with prediabetes. We aimed to understand whether visceral adiposity was associated with liver fibrosis, independent of insulin resistance, among participants with prediabetes.

Methods:
In this nationally representative, cross-sectional study, we selected non-pregnant adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 with prediabetes, defined as HbA1c of 5.7-6.4%, fasting blood glucose of 100-125 mg/dl, or a self-reported diagnosis of prediabetes. We excluded those with acute transaminitis (aspartate or alanine aminotransferase >500 IU/L), excessive alcohol consumption (>1 drinks/day for females, > 2 drinks/day for males), iron overload (transferrin saturation >50%), and positive hepatitis serology. Visceral adiposity was estimated using the validated Visceral Adiposity Index (VAI) and categorized into tertiles (<1.17, 1.17-2.19, >2.19). Our primary outcome was clinically significant liver fibrosis, defined dichotomously as median Fibroscan vibration controlled transient elastography liver stiffness measurements of 7.9 kPa or greater (≥F2). We used survey design-adjusted logistic regression, adjusting for covariates determined a priori (age, sex, race/ethnicity, income, education, smoking status, physical inactivity, hypertension, hemoglobin A1c (HbA1c), total caloric intake, and Homeostatic Model Assessment for Insulin Resistance [HOMA]) to estimate odds of fibrosis.

Results:
Among 1,290 prediabetic adults (mean age 62y [SD, 10], 44% female, 62% non-Hispanic White, representing 37,401,474 adults across the U.S.), 121 (10%) had NAFLD fibrosis. Participants in the highest tertile of VAI were more likely to be female, older, have higher waist circumference, and have comorbid cardiac conditions. The highest tertile of VAI was associated with three times higher odds of fibrosis (highest vs. lowest tertile; OR [95% CI], 3.81 [1.65, 8.79], middle vs. lowest tertile: 4.93 [1.74, 13.34]). There was no significant multiplicative interaction between VAI and HOMA (p=0.44). The highest tertile was also associated with 170% higher odds of F1 (mild) liver fibrosis (2.70 [1.10, 6.63], middle vs. lowest tertile: 2.69 [1.26, 5.77]).

Conclusion:
Nearly 1 in 10 adults with prediabetes have clinically significant liver fibrosis. High visceral adiposity was associated with more than 3 times the likelihood of fibrosis, independent of insulin resistance and traditional risk factors.
Abstract MP15: Developing and Validating VO
2
Prediction From 6-Minute Walk Test (6MWT) and Association With Cardiovascular Health and Risk Scores: Coronary Artery Risk Development in Young Adults (CARDIA)
Authors: Hornikel Bjoern , Dooley Erin , Bowling Barrett , Chen Baojiang , Martinez-Amezcua Pablo , Jacobs David R , Carnethon Mercedes R , Sternfeld Barbara , Lewis Cora E , Sidney Stephen , Palta Priya , Pettee Gabriel Kelley
Published: May 2024

Introduction:
Cardiorespiratory fitness (CRF) is a valuable diagnostic and prognostic measure. Yet, assessing VO
2
max (indicator of CRF) in population-based studies can be challenging due to requiring sophisticated equipment and trained personnel. Thus, we built and validated a model to estimate VO
2
max from a 6MWT, which is less burdensome for participants (submaximal effort). We tested the hypothesis that our model provides valid estimates of VO
2
max that are associated with cardiovascular health - AHA’s Life’s Simple 7 (LS7) and ASCVD scores.

Methods:
Data are from 576 CARDIA participants [60% female; 40% Black; mean ± SD age = 61.5 ± 3.6; BMI = 28.6 ± 5.7 kg/m
2
] who attended the Year 35 follow-up exam (2020-22) and completed VO
2
max and 6MWT tests. The study sample was split randomly into a training (2/3) or test (1/3) set. The prediction equation was developed using stepwise multiple linear regression models in the training set. We evaluated accuracy of the model using student's t-test and Pearson correlation coefficients (r) by examining the difference between the observed and predicted VO
2
max in the test dataset. Linear regression models adjusted for age, and sex were used to examine associations of VO
2
max estimates with cardiovascular health and risk indices.

Results:
The prediction equation included 6MWT distance, sex, age, BMI, physical activity status, and smoking status (R
2
adj
= 0.55, RMSE = 4.84). No significant difference was observed between predicted and measured VO
2
max (26.2 ± 5.4 vs 26.0 ± 7.5 mL/kg/min;
p
=0.76) and the measures were strongly correlated (r=0.80,
p
<.001) with Bland-Altman plot is presented (Figure). Predicted VO
2
max explained more variance in LS7 score (R
2
adj
= 0.55) compared to measured (R
2
adj
= 0.37), while explaining similar variance in ASCVD risk (R
2
adj
= 0.40 vs 0.38).

Conclusions:
This prediction equation provides a convenient and useful estimate of CRF estimate of CRF from 6MWT and may provide utility in clinical practice to screen and monitor CRF when direct measurement is not feasible.