bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 363: Impact of Health Questionnaires as a Behavioral Modifier in Obese Patients: A Prospective Analysis
Authors: Shehata Alexandre , Patel Ishan , Samreen Isha , Singh Swaiman , Waxman Sergio , Cohen Marc , patel sunil
Published: May 2020

Introduction:
The morbidity and mortality associated with obesity (BMI >30 kg/m2) has been known to medical science for more than 2000 years.
1
Obesity is increasing in prevalence in adults, adolescents, and children and is considered a global epidemic. The age-adjusted overall prevalence of obesity in the United States increased progressively from 22.9 to 30.5 to 39.6 percent from the year 2007 to 2016.
2

Purpose:
To Assess if filling out a survey on obesity has any impact on a patient’s behavior and self-awareness in an outpatient setting.

Methods:
In an urban outpatient setting, 350 individuals aged 18 and above, suffering from obesity (defined as BMI >30/m2) were asked to fill-out a survey. The survey included basic demographic information, weight, employment status, exercise frequency, eating habits, and questions about self-perception. Patients filled out an identical follow-up survey 2-3 months later. We measured the changes in responses between the pre- and the post- survey.

Results:
Of the 350 original respondents, 103 patients followed up with the post-survey. 68.9% were women, 73.2% were African-American, and 62.3% were unemployed. 46.4% of patients felt neutral, or content about their current weight. 37.7% of patients reported never exercising in the pre-survey vs. 16.8% in the post-survey (20.9% improvement), while 25.3% of patients reported exercising 2-3 times per week in the pre-survey vs. 36.4% in the post-survey (11.1% improvement). 61% of patients had lost weight (average weight loss of 6.75lbs), 19% of patients had gained weight (average weight gain 4.55 lbs.) and 20% had maintained the same weight. We recorded a net weight loss of 2.2 lbs.

Conclusion:
In our pilot study, we found that the act of filling out a survey on obesity may have a positive impact on the behavior and self-awareness of patients with BMI > 30kg/m2. Larger sample sizes would be beneficial in order to further establish the impact of such intervention.

1. Bray GA. The Battle of the Bulge: A History of Obesity Research, Dorrance, Pittsburgh 2007. 2. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016. JAMA. 2018;319(16):1723.
Abstract 365: Psychiatric Illness is Correlated With Lower Incidence of Obstructive Coronary Artery Disease But Not Mortality in U.S. Veterans
Authors: Soofi Muhammad , Garg Swapnil , Markert Ronald , Agarwal Ajay
Published: May 2020

Background:
The association between psychiatric illness, coronary artery disease (CAD) and mortality is poorly understood. It has been theorized that psychiatric diseases may result in increased mortality and poor cardiovascular outcomes, but prior studies have been limited by short follow-up time and non-angiographic methods to document CAD. In a long-term follow-up study we report the relationship between psychiatric disease, mortality, and angiographically proven CAD.

Methods:
We retrospectively reviewed 1532 consecutive patients presenting to the Dayton VA Medical Center between 2001-2005 for left heart catheterization. “Psychiatric illness” was defined as the prior diagnosis of a psychiatric disorder or the current prescription of antidepressant/antipsychotic medication. We evaluated the association between psychiatric illness, mortality and CAD with mean follow-up time of 9.3 ± 5.4 years.

Results:
Of 1532 patients, 503 (32.8%) had a psychiatric illness. Mortality did not differ in patients with and without psychiatric disease (psychiatric disease = 65.4% vs no psychiatric disease = 69.8%,
p
=0.084). Psychiatric illness had a Cox hazard ratio of 0.92 (CI 0.81-1.05,
p
=0.20) and 0.97 (CI 0.85-1.11,
p
=0.63) after controlling for reduced ejection fraction, obstructive coronary artery disease, chronic kidney disease, hypertension, hyperlipidemia, and diabetes mellitus. Patients with psychiatric illness had a lower prevalence of obstructive coronary artery disease compared to those without psychiatric illness (66.6% vs 75.1% respectively,
p
<0.001).

Conclusion:
In a high-risk US Veteran population followed for a mean of 9.3 years, psychiatric disease was associated with a lower incidence of obstructive coronary artery disease but was not associated with a significant difference in mortality. These finding challenge the existing assumption that all psychiatric illnesses are associated with CAD and mortality. The Veteran population (regardless of psychiatric disease) has a high baseline risk factor burden compared to the general population, which may obscure the negative effects of psychiatric disease. Our population had 32.8% mental disease (vs 18.9% in general population per NIMH/NIH), 72.3% obstructive CAD (vs 4.8% per AHA) and mean lifespan of 71.8 years (vs 78.6 years per CDC). Psychiatric illness was associated with lower rates of obstructive CAD and no significant difference in mortality in our population, suggesting that further research is required on individual psychiatric disorders and that Veterans require aggressive management of coronary risk factors.
Abstract 368: Contrast-Functional Flow Reserve vs. Instantaneous Wave-Free Ratio for Functional Assessment of Coronary Stenosis: A Systematic Review and Meta-analysis
Authors: Alreshq Rabah , Yager Neil M
Published: May 2020

Background:
Fractional flow reserve (FFR) remains underutilized due to practical concerns related to the need for hyperemic agents. Adenosine-free indexes including instantaneous wave-free ratio (iFR) and contrast-FFR (cFFR) are newly proposed modalities to circumvent the use of vasodilators. We performed this meta-analysis to assess the diagnostic performance of cFFR and iFR in evaluating coronary stenosis severity with FFR as the reference standard.

Methods:
A comprehensive literature search of PUBMED, EMBASE, and Cochrane databases was conducted in September 2019 to include relevant studies with the diagnostic accuracy of iFR or cFFR referenced to FFR. Correlation data were extracted from individual studies and then pooled using a random effect model as Pearson's correlation, with 95% confidence intervals. We used Cochran's Q test and I
2
index to assess heterogeneity.

Results:
A total of 16 studies involving 6370 patients were included in the analysis. Overall, 4822 and 2021 coronary lesions were evaluated by iFR and cFFR, respectively. The Pearson's correlations were 0.80 (95%CI 0.78-0.81,
I
2
63%) and 0.92 (95%CI 0.90-0.94,
I
2
81%) for iFR and cFFR, respectively. The pooled sensitivity and specificity were 83% (95%CI 0.77-0.88) and specificity of 82% (95%CI 0.78-0.85) for iFR and 88% (95%CI 0.75-0.95) and 93% (95%CI 0.87-0.96) for cFFR, respectively.

Conclusions:
Our meta-analysis demonstrates that cFFR has higher correlation than iFR in functional assessment of coronary stenosis when FFR is used as the standard reference. Further studies are warranted to evaluate the accuracy of cFFR in detecting functional ischemia.
Abstract 374: Trans-radial Access Angiography Learning Curve
Authors: Chan Julian , Tavella Rosanna , Beltrame John F , Worthley Matthew , Pasupathy Sivabaskari , Zeitz Chris
Published: May 2020

Introduction:
Radial artery access has been adopted widely around the world as standard best practice for coronary angiography with or without percutaneous coronary intervention. Radial artery access offers benefits in regard to reduced major bleeding, reduced hospital stay, fewer vascular complications, similar procedural times, patient preference and a mortality benefit in acute coronary syndrome/STEMI management. Despite transradial access being best practice, there has been a slow uptake of this technique amongst some cardiologists/interventionalists, particularly in the USA. This may partially be attributed to uncertainties regarding the learning curve and concerns regarding delaying treatment in STEMI if radial access fails.

Methods:
Using the data from the Coronary Angiography Database Of South Australia registry (CADOSA), we sought to determine the radial access failure rates for acute cases during transition from routine femoral access to routine radial access from 2012 to 2016, a period when the greatest transition in practice occurred. Data regarding initial vascular access, success or failure, and subsequent vascular access was prospectively recorded for all cases. Operators with at least a 70% rate of initial radial access were deemed to be established radial operators and acted as controls for operators transitioning from femoral access (at least 70% of cases) to radial access during the study period. Cases were further classified as elective, urgent (eg inpatient ACS) or emergency (eg STEMI).

Results:
There were 23 operators with sufficient volumes, responsible for 20,073 cath lab visits during the 5 year period studied. The overall radial access rate increased from 57% in 2012 to 78% in 2016. For operators transitioning from a default femoral access (76% of case) to a default radial access (75% of cases), the radial access failure rate for urgent and emergency cases was 3.7%, compared to 3.5% for experienced radial operators over the same period.

Conclusion:
Despite strong evidence of benefit for radial access angiography and intervention, compared to femoral access, some operators remain reluctant to transition. Utilising the CADOSA database, we observed a safe transition from femoral to radial access without an increased risk of access site failure for acute cases. Transition from femoral to radial access can be made safely by a range of clinicians managing acute cases.
Abstract 375: Improving Door to Balloon Time for Primary Percutaneous Coronary Intervention
Authors: Ahmad Fida , Arabi Abdulrahman
Published: May 2020

Background:
In patients with ST-segment-elevation myocardial infarction (MI), timely treatment with primary percutaneous coronary intervention (PPCI) with door-to-balloon (D2B) time <90 minutes is recommended by the current guidelines. Recent study showed continuous association between shortening D2B time to < 60 minutes and reducing mortality risk.D2B time was maintained below the international target of <90 minutes for patients directly arriving to Heart Hospital emergency department (ED) for the last three years.

Aim:
Our aim is to reduce D2B time for PPCI to reach the new target of < 60 minutes by the end of August 2019.

Method:
We started our improvement project by understanding the current process and identifying theareas were delay occurred using Safety I concept. Several reasons of delays were identified: Delay in receiving and preparing the patient in ED Several handovers during patient transfer to Cath Lab. Delay in staff arrival to Heart Hospital during the busy traffic after 3:00 pm Back to back procedures during the busy working hours (7:00 am to 3:00 pm) IHI model for improvement was used to test the effectiveness of the suggested changes.Change Concepts: September 2018 - well trained intensive PPCI nurse was assigned daily during the evening and the night shift to manage the patient from ED arrival to the Cath Lab procedure room and from Cath lab following procedure to the destination unit. January 2019 - The role of PPCI nurse extended to all shifts (24 hours) January 2019 - In house Cath lab team (from 3:00 pm to 10 pm) to overcome travel delay during peak traffic hours. August 2019 - Cardiology fellow from the Cath Lab team receives the patient from arrival at ED door. This reduced the time patient spent in the ED. In May 2019 we tried to apply the concept of Safety II: Weekly data for the shortest D2B time compared to the average D2B was posted in the Cath lab and circulated to all staff with the names of the team members involved. This approach allowed us to learn from good experience and share that experience. It also empowered the team to do better in the future cases. Reasons for achieving weekly shortest D2B were collected and analyzed. It has been found that interventionist had made some corrective actions to avoid delay: Many interventionists accept the case based on the ambulance ECG and activate the Cath lab from the field before patient arrived at the ED.o To avoid delay due to difficulty in registration, some interventionists start the procedure without a full registration. Some on call interventionist stayed in the hospital.

Results:
We achieved our target of reducing D2B time to < 60 minutes before the end of 2019.

Conclusion:
Door to balloon time for primary percutaneous coronary intervention was successfully reduced to the new <60 minutes target by Integrating of both safety I and Safety II concepts.
Abstract 377: Enhancing Adherence to Lipid-lowering Agents for Secondary Prevention After a Primary Cardiovascular Event: A Quality Improvement Initiative
Authors: Olarte Neal , Wells Nicole , Salter Jonathan , Jacobs Mark , Panakos Andrew , Leonor-Lopez George , Andreu Aileen , Labrada Mabel , Marzouka George , Figueroa-Valdes Jessica
Published: May 2020

Background:
Targeting lower serum low-density lipoprotein cholesterol (LDL-C) levels has been a cornerstone for primary and secondary prevention of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, coronary revascularization, and cardiovascular death. The most recent cholesterol guidelines advise a target serum LDL-C level of <70 mg/dL using statins and other lipid-lowering agents in an escalating stepwise manner. The purpose of this quality improvement (QI) project is to encourage both physicians and patients to adhere to these new guidelines.

Methods:
This is a single-center QI project to be conducted at the Miami Veterans Affairs Medical Center (VAMC). When providers initiate or renew a prescription for a statin, a clinical reminder order check (CROC) will display within the electronic medical record (EMR) advising them that lipid guidelines now recommend high-intensity statin and/or additional agents as needed to target serum LDL-C level <70 mg/dL. This CROC will only be activated in the charts of patients with a history of cardiac ischemic event with or without revascularization and/or do not have a recent LDL-C on file within the past year and/or the most recent LDL-C is >70 mg/dL. Preliminary data from 6 months before and after CROC implementation will be collected and analyzed. The primary outcome of interest is statin prescription fill rate. Secondary outcomes include the number of patients with a serum LDL-C >70 mg/dL and 30-day mortality and readmissions rate for patients admitted for acute myocardial infarction (AMI).

Results/Anticipated Results:
Study enrollment and data collection is ongoing. For fiscal year 2019 (FY19), the national prescription fill rate for statins within the VA health system was 90.29% in patients with history of previous cardiac ischemic event. Regionally, prescription fill rate was 92.80%. The Miami VAMC prescription fill rate was 89.77% for FY19, and 83.78% in quarter 4. National and regional prescription fill rate in quarter 4 FY19 were 90.21% and 90.20%, respectively. The average 30-day mortality rate through quarter 3 of FY19 for the Miami VAMC for patients with a diagnosis of AMI was 7.17% (50th percentile, nationally = 7.60%). The average 30-day readmission rate after AMI during the same timeframe was 15.92% (50th percentile, nationally = 15.74%).

Conclusion:
Statins and other lipid lowering agents, targeting a serum LDL-C <70 mg/dL, have demonstrated to prevent secondary MACE in patients with a history of cardiac ischemia. By initiating this QI project to increase adherence to statins at the Miami VAMC, we expect an improvement in patient care reflected in relevant hospital quality metrics.
Abstract 382: Four-tiered Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies Ischemic Stroke in the General Population
Authors: Wang Haoyu , Dou Kefei , He Jiang , Zhang Zugui , Sun Yingxian
Published: May 2020

Background:
Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of ischemic stroke in a new 4-group LVH classification based on LV concentricity (mass/end-diastolic volume
0.67
) and indexed LV end-diastolic volume (EDV) in the general Chinese population.

Methods:
The cross-sectional study consisted of 11,037 general Chinese population (mean age 54 years; 54% women) from Northeast China Rural Cardiovascular Health (NCRCH) study who underwent echocardiography measurement. A 4-tiered classification of LVH was proposed where eccentric LVH is subdivided into “indeterminate hypertrophy (n=484)” and “dilated hypertrophy (n=386)” and concentric LVH into “thick hypertrophy (n=246)” and “both thick and dilated hypertrophy (n=138)” based on the presence of increased LV end-diastolic volume.

Results:
Compared with normal LV geometry (2.6%), indeterminate (7.4%) and thick hypertrophy (10.2%) showed a higher prevalence of ischemic stroke (p<0.05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115–2.398) and thick (2.143 [1.329–3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803–1.950]) and both thick and dilated hypertrophy (0.926 [0.435–1.971]) compared with normal geometry in multivariable analysis. Additionally, the continuous parameters of LV concentricity
0.67
(OR, 1.067; 95% CI, 1.024–1.113 per 1 SD increment) was independently associated with the presence of ischemic stroke in multivariable analysis adjusted for age, sex, race, physical activity, current smoking and drinking status, BMI, TC, hypertension and diabetes, while LVEDV/BSA was not (OR, 0.957; 95% CI, 0.859–1.065 per 1 SD increment).

Conclusions:
In a large-scale Asian population, we identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy.
Abstract 383: Effect of Race on Risk of Recurrent Myocardial Infarction After Index Myocardial Infarction
Authors: Nair Raunak , Johnson Michael , Kravitz Kathleen A , Anabila Moses , Rajeswaran Jeevanantham , Blackstone Eugene H , Menon Venu , Lincoff A Michael , Kapadia Samir R , Khot Umesh
Published: May 2020

Background:
Though the prevalence of coronary artery disease is known to be highest in African Americans, it is unclear if there are any racial factors predisposing patients for a recurrent Myocardial Infarction (MI) after index MI.

Methods:
We reviewed 6,626 cases of MI at a single quaternary care medical center from January 1
st
, 2010 to January 1
st
, 2017 (29% STEMI, 71% NSTEMI), and we identified all cases of recurrent MI within 90 days of discharge after index MI. The patients were categorized according to their corresponding races into White Americans, African Americans, and Others.

Result:
Out of the 6626 initial cases of MI, 72% were white patients, 25% were African Americans and 3% belonged to other races. A total of 2051 patients were readmitted within 90 days of index admission, of which 168 patients were readmitted with an MI. Only 2.1% of White patients developed a recurrent MI whereas 4% of African Americans were readmitted with a recurrent MI (P=0.003).

Conclusion:
We observed that African Americans were more likely to be readmitted with a recurrent MI than White Americans. Understanding the reasons for this increased risk in MI can translate into improved care for African Americans.
Abstract 387: Practice Patterns and Use of High Sensitivity Troponin Assays in the Outpatient Setting
Authors: Ferro Enrico G , Bhatt Ankeet S , Fiumara Karen , Wasfy Jason H , Sequist Thomas , Morrow David A , Scirica Benjamin M
Published: May 2020

Introduction:
High sensitivity troponin T (hs-TnT) are more sensitive than prior assays to evaluate patients for acute coronary syndrome. To date, hs-TnT utilization in the outpatient setting is not well described.

Methods:
We identified outpatient hs-TnT tests ordered at a large medical center in the first 9 months of implementation (April-December 2018). Charts were reviewed by physicians to identify patient characteristics, specialty of ordering provider, reason for ordering hs-TnT, and clinical action taken. Using unadjusted two-sample t-tests, we compared the proportion of patients referred to the ED between patients with hs-TnT levels ≥99
th
% sex-specific cutoffs (≥15 ng/dL men, ≥10 ng/dL women) versus those with either undetectable hs-TnT or detectable <99
th
% (control group).

Results:
About 100 hs-TnT outpatient tests were ordered. Patients had mean age of 66 years, 53% were male; 30% had coronary artery disease, and 12% had left ventricular ejection fraction ≤40%. Most orders were placed by cardiologists (n=58) followed by primary care physicians (n=30). The top chief complaints were dyspnea (n=38) and chest pain (n=33). Of all hs-TnT samples, 27% were undetectable, while mean detectable hs-TnT level was 38.8 ng/L, of which 57% were ≥99
th
%. About 25% of patients had chronic cardiovascular conditions (like heart failure) but were asymptomatic at the time of the test. Among symptomatic patients (n=75), 31% were sent home, 28% to stress test, and 16% to the ED. Patients with hs-TnT ≥99
th
% were 4.6 times more likely (95% CI 1.1-19.5, p=0.04) to be referred to the ED, compared to control.

Conclusions:
This is the first study describing outpatient utilization of the novel hs-TnT assay in the U.S. Despite the lack of consensus on diagnosing cardiac ischemia in outpatient clinics, providers are ordering hs-TnT in this setting - and hs-TnT values seem to influence their decision to triage patients to the ED. Our results highlight the need to standardize the implementation of hs-TnT for outpatient evaluation of cardiac ischemia. Providers are also collecting hs-TnT among asymptomatic patients with heart disease unrelated to ischemia. This suggests that novel uses of hs-TnT may emerge to monitor and prognosticate chronic cardiovascular conditions.

Figure.
Patient Triage based on Elevation in Outpatient hs-TnT Level
Abstract 391: Telemetry Talk: A Quality Improvement Initiative To Decrease Inappropriate Telemetry Use
Authors: Ferraro Bruce , Tzeng Michael , Zaidi Muhammad , Nguyen Thang , Topakas Annamaria , Gonzalez Alejandro , Rubin Rachel , Mehta Isha
Published: May 2020

Objectives:
The purpose of this study was to identify the percentage of inappropriate telemetry and reduce inappropriate use via a multidisciplinary interventional approach.

Background:
Nationally studies have demonstrated that up to 43% of telemetry orders are inappropriate and do not change patient outcomes or clinical decision making. Overuse may also lead to unnecessary diagnostic workup, hospital costs, clinical duties, and even hospital divert status.

Methods:
Using the AHA guidelines and the TUH official policy, we created an updated table of appropriate telemetry indications
(Table 1).
We used the Epic telemetry column to identify active orders. Then, each patient’s chart was reviewed to determine whether the order was appropriate."We reviewed all active telemetry orders on our medicine services over four days.

Results:
Teaching services had 72/140 (51%) inappropriate orders while direct-care services had 4/19 (21%) inappropriate orders
(Table 2).
"Subspecialty teaching services had 10/15 (67%) inappropriate orders.

Discussion:
Inappropriate telemetry use is a systems-based, multidisciplinary problem requiring interventions at multiple levels Our goal was to reduce overall inappropriate telemetry use from 49% to 35% At our center, interventions underway include: Posting the indications on workstations, Encouraging “Time out for Tele!” review on rounds, Educating hospital teams, Additional Epic modifications.

Conclusions:
Inappropriate telemetry use on medicine services at our institution is higher than national averages. We increased physician awareness of orders and performed education on appropriate use. We plan to re-assess telemetry use at interval periods to assess for improvement.
Abstract 392: Incidence Of Paroxysmal Supraventricular Tachycardia In The United States
Authors: Rehorn Michael , Sacks Naomi , Preib Madison , Cyr Philip , Emden Maia , Pokorney Sean
Published: May 2020

Background:
Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythm disorders that lead to abrupt increases in heart rate. Given its episodic nature, PSVT can be difficult to capture in a clinical setting. Therefore, estimating incidence of PSVT is challenging and thus limited data is available on the incidence of this disease.

Objective:
Estimate the incidence of PSVT within the United States in contemporary practice.

Methods:
Using claims, enrollment, and demographic data from the IBM Marketscan® Commercial Research Database (<65y) and the Medicare Limited Dataset (≥65y), individuals enrolled in health plans for at least 5 continuous years from 2008-2016 were identified. Patients having claims with a PSVT diagnosis (ICD-9: 427.0; ICD-10 I47.1) on 2+ outpatient visits, 1+ ED visit, or 1+ inpatient admission were included in the analysis. Only patients receiving an initial diagnosis of PSVT in year 5 of continuous enrollment were included in the incidence calculation in order to avoid including prevalent cases. Incidence was projected to the US population based on the 2018 US census data.

Results:
Among 18,057,297 patients, 86,614 met PSVT criteria. Incidence rates were higher in female and older patients. Within the 18-44y group, the incidence rate was 1.9-fold higher for females as compared to males. Overall incidence rate per 100,000 was 79.1 and 107.2 for males and females respectively (Table). Projected to the 2018 US Census, there were 305,548 incident PSVT cases in 2018.

Conclusion:
There were over 305,000 incident cases of PSVT in 2018 with higher rates in female and older patients. Further studies are needed to understand practice patterns in management of PSVT, given the high incidence of this disease.
Abstract 399: Addressing Weight Goals In Patients With Coronary Artery Disease: A Dilemma At Resident Physician Clinic
Authors: Ahmad Sana , Ma Rosaline , Mazurkiewicz Rebecca
Published: May 2020

Background:
Adults diagnosed as overweight (BMI 25-29.9 kg/m
2
) or obese (BMI ≥30 kg/m
2
) are at increased risk of ASCVD, heart failure, and atrial fibrillation compared with those of a normal weight. According to the 2011 ACC/AHA guidelines for secondary prevention of CAD, BMI should be assessed at every visit and clinicians should consistently encourage weight loss to their patients by promoting exercise, caloric intake and formal behavioral programs.

Objective:
To evaluate whether residents are following the 2011 ACC/AHA guidelines by identifying patients with CAD that are overweight/obese and counseling them regarding weight loss.

Methods:
We performed a retrospective chart review of patients with known diagnosis of CAD from January 2019-June 2019 at Lenox Hill Medical Associates. The inclusion criteria for this study was patients of all ages with a known diagnosis of CAD and BMI ≥ 25 who had at least 1 annual physical exam performed and had an assigned resident physician. We excluded patients who only visited the clinic for acute visits. We reviewed progress notes to see if patients’ weights were addressed and whether there was a plan discussed with the patient regarding weight loss. A survey was sent to PGY1-PGY3 residents to identify barriers to weight management.

Results:
Between January 2019-June 2019, a total of 87 patients with CAD and BMI ≥ 25 were evaluated in clinic. Out of these patients, only 23% (20 of 87) had their BMI addressed during the visit and most notes (12/20) did not document a weight loss plan for patients. For those patients who received weight loss counseling, 13 out of 20 of them had BMI above 35. Based on an anonymous survey sent to PGY1-PGY3 residents, only 19% (7 of 36) residents reported that they addressed patients' weight at an annual visit. More than 60% of our residents identified time as the biggest barrier to accomplishing weight goals in CAD patients.

Conclusion:
This retrospective chart review showed that less than a quarter of our patients with the diagnosis of CAD and BMI ≥25 had their weight addressed during their visits at our resident physician clinic. Overall, patients with a higher BMI were more likely to be identified as obese with a higher likelihood of getting counseled on weight loss. Based on our survey, the biggest barrier to counseling patients is time. Due to these missed opportunities of educating our patients on weight goals, we are increasing their risk of complications in the future. We are currently developing time efficient strategies to help residents improve the process of educating and documenting patient specific weight loss plans.
Low Insulin Is an Independent Predictor of All‐Cause and Cardiovascular Death in Acute Decompensated Heart Failure Patients Without Diabetes Mellitus
Authors: Nogi Maki , Kawakami Rika , Ishihara Satomi , Hirai Kaeko , Nakada Yasuki , Nakagawa Hitoshi , Ueda Tomoya , Nishida Taku , Onoue Kenji , Soeda Tsunenari , Okayama Satoshi , Watanabe Makoto , Saito Yoshihiko
Published: May 2020

Background

Insulin beneficially affects myocardial functions during myocardial ischemia. It increases glucose‐derived
ATP
production, decreases oxygen consumption, suppresses apoptosis of cardiomyocytes, and promotes the survival of cardiomyocytes. Patients with chronic heart failure generally have high insulin resistance, which is correlated with poor outcomes. The role of insulin in acute decompensated heart failure (
ADHF
) remains unclear. This study aimed to investigate the prognostic value of serum insulin level at the time of admission for long‐term outcomes in patients with
ADHF
.

Methods and Results

We enrolled 1074 consecutive patients who were admitted to our department for
ADHF
. Of these 1074 patients, we studied the impact of insulin on the prognosis of
ADHF
in 241 patients without diabetes mellitus. The patients were divided into groups according to low, intermediate, and high tertiles of serum insulin levels. Primary end points were all‐cause death and cardiovascular death. During a mean follow‐up of 21.8 months, 71 all‐cause deaths and 38 cardiovascular deaths occurred. Kaplan–Meier analysis showed that all‐cause and cardiovascular mortality was significantly higher in the low‐insulin group than those in the intermediate‐ and high‐insulin groups (log‐rank
P
=0.0046 and
P
=0.038, respectively). Moreover, according to the multivariable analysis, low serum insulin was an independent predictor of all‐cause and cardiovascular mortality (hazard ratio, 2.37 [95% CI, 1.24–4.65;
P
=0.009] and 2.94 [95%
CI,
1.12–8.19;
P
=0.028], respectively).

Conclusions

Low serum insulin levels were associated with increased risk of all‐cause and cardiovascular death in
ADHF
patients without diabetes mellitus.
High Salt Intake Augments Blood Pressure Responses During Submaximal Aerobic Exercise
Authors: Babcock Matthew C. , Robinson Austin T. , Migdal Kamila U. , Watso Joseph C. , Martens Christopher R. , Edwards David G. , Pescatello Linda S. , Farquhar William B.
Published: May 2020

Background

High sodium (Na
+
) intake is a widespread cardiovascular disease risk factor. High Na
+
intake impairs endothelial function and exaggerates sympathetic reflexes, which may augment exercising blood pressure (BP) responses. Therefore, this study examined the influence of high dietary Na
+
on BP responses during submaximal aerobic exercise.

Methods and Results

Twenty adults (8F/12M, age=24±4 years; body mass index 23.0±0.6 kg·m
−2
; VO
2
peak=39.7±9.8 mL·min
−1
·kg
−1
; systolic BP=111±10 mm Hg; diastolic BP=64±8 mm Hg) participated in this randomized, double‐blind, placebo‐controlled crossover study. Total Na
+
intake was manipulated via ingestion of capsules containing either a placebo (dextrose) or table salt (3900 mg Na
+
/day) for 10 days each, separated by ≥2 weeks. On day 10 of each intervention, endothelial function was assessed via flow‐mediated dilation followed by BP measurement at rest and during 50 minutes of cycling at 60% VO
2peak
. Throughout exercise, BP was assessed continuously via finger photoplethysmography and every 5 minutes via auscultation. Venous blood samples were collected at rest and during the final 10 minutes of exercise for assessment of norepinephrine. High Na
+
intake increased urinary Na
+
excretion (placebo=140±68 versus Na
+
=282±70 mmol·24H
−1
;
P
<0.001) and reduced flow‐mediated dilation (placebo=7.2±2.4 versus Na
+
=4.2±1.7%;
P
<0.001). Average exercising systolic BP was augmented following high Na
+
(placebo=Δ30.0±16.3 versus Na
+
=Δ38.3±16.2 mm Hg;
P
=0.03) and correlated to the reduction in flow‐mediated dilation (
R
=−0.71,
P
=0.002). Resting norepinephrine concentration was not different between conditions (
P
=0.82). Norepinephrine increased during exercise (
P
=0.002), but there was no Na
+
effect (
P
=0.26).

Conclusions

High dietary Na
+
augments BP responses during submaximal aerobic exercise, which may be mediated, in part, by impaired endothelial function.
Distinct Commensal Bacterial Signature in the Gut Is Associated With Acute and Long-Term Protection From Ischemic Stroke
Authors: Benakis Corinne , Poon Carrie , Lane Diane , Brea David , Sita Giulia , Moore Jamie , Murphy Michelle , Racchumi Gianfranco , Iadecola Costantino , Anrather Josef
Published: May 2020

Background and Purpose—

Commensal gut bacteria have a profound impact on stroke pathophysiology. Here, we investigated whether modification of the microbiota influences acute and long-term outcome in mice subjected to stroke.

Methods—

C57BL/6 male mice received a cocktail of antibiotics or single antibiotic. After 4 weeks, fecal bacterial density of the 16S rRNA gene was quantitated by qPCR, and phylogenetic classification was obtained by 16S rRNA gene sequencing. Infarct volume and hemispheric volume loss were measured 3 days and 5 weeks after middle cerebral artery occlusion, respectively. Neurological deficits were tested by the Tape Test and the open field test.

Results—

Mice treated with a cocktail of antibiotics displayed a significant reduction of the infarct volume in the acute phase of stroke. The neuroprotective effect was abolished in mice recolonized with a wild-type microbiota. Single antibiotic treatment with either ampicillin or vancomycin, but not neomycin, was sufficient to reduce the infarct volume and improved motorsensory function 3 days after stroke. This neuroprotective effect was correlated with a specific microbial population rather than the total bacterial density. In particular, random forest analysis trained for the severity of the brain damage revealed that Bacteroidetes S24.7 and the enzymatic pathway for aromatic metabolism discriminate between large versus small infarct size. Additionally, the microbiota signature in the ampicillin-treated mice was associated with a reduced gut inflammation, long-term favorable outcome shown by an amelioration of the stereotypic behavior, and a reduction of brain tissue loss in comparison to control and was predictive of a regulation of short-chain fatty acids and tryptophan pathways.

Conclusions—

The findings highlight the importance of the intestinal microbiota in short- and long-term outcomes of ischemic stroke and raises the possibility that targeted modification of the microbiome associated with specific microbial enzymatic pathways may provide a preventive strategy in patients at high risk for stroke.

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Decoding of Envelope vs. Fundamental Frequency During Complex Auditory Stream Segregation
Authors: Greenlaw Keelin M. , Puschmann Sebastian , Coffey Emily B. J.
Published: May 2020

Hearing-in-noise perception is a challenging task that is critical to human function, but how the brain accomplishes it is not well understood. A candidate mechanism proposes that the neural representation of an attended auditory stream is enhanced relative to background sound via a combination of bottom-up and top-down mechanisms. To date, few studies have compared neural representation and its task-related enhancement across frequency bands that carry different auditory information, such as a sound’s amplitude envelope (i.e., syllabic rate or rhythm; 1–9 Hz), and the fundamental frequency of periodic stimuli (i.e., pitch; >40 Hz). Furthermore, hearing-in-noise in the real world is frequently both messier and richer than the majority of tasks used in its study. In the present study, we use continuous sound excerpts that simultaneously offer predictive, visual, and spatial cues to help listeners separate the target from four acoustically similar simultaneously presented sound streams. We show that while both lower and higher frequency information about the entire sound stream is represented in the brain’s response, the to-be-attended sound stream is strongly enhanced only in the slower, lower frequency sound representations. These results are consistent with the hypothesis that attended sound representations are strengthened progressively at higher level, later processing stages, and that the interaction of multiple brain systems can aid in this process. Our findings contribute to our understanding of auditory stream separation in difficult, naturalistic listening conditions and demonstrate that pitch and envelope information can be decoded from single-channel EEG data.
The Nature of Haptic Working Memory Capacity and Its Relation to Visual Working Memory
Authors: Morimoto Taku
Published: May 2020

I conducted three experiments to investigate haptic working memory capacity using a haptic change detection task with 2D stimuli. I adopted a single-task paradigm comprising haptic single-feature (orientation or texture) and haptic multifeature (orientation and texture) conditions in Experiment 1 and a dual-task paradigm with a primary haptic orientation or texture change detection task and a concurrent secondary visual shape or colour change detection task in Experiments 2–3. I observed that in the single-task paradigm, haptic change detection capacity was higher for single features than it was for multiple features. In haptic working memory, unlike in visual working memory, features of two different dimensions within an object cannot be integrated. In the dual-task paradigm, interference was observed when the concurrent visual shape change detection task was combined with the haptic orientation change detection task although interference was not observed when the concurrent visual colour change detection task was combined with it. In addition, the concurrent visual shape or colour change detection task did not interfere with the capacity for haptic texture memory, which was higher than that for haptic orientation memory. These findings demonstrate that geometric properties perhaps retained a common storage system shared between haptic working memory and visual working memory; however, haptic texture might be retained in an independent stable storage system that is haptic-specific.
A new species of Haliclona (Flagellia) Van Soest, 2017 (Porifera, Demospongiae, Heteroscleromorpha) from the Gulf of St. Lawrence, Canada
Authors: DINN CURTIS
Published: May 2020

Haliclona (Flagellia) Van Soest, 2017 is a recently erected subgenus characterized by the presence of flagellosigma microscleres which are often distinctive between species (Van Soest 2017). Members of the taxon also have normal sigmas within a confused skeleton formed by oxea megascleres. The subgenus has a global distribution and contains 10 species (Van Soest et al. 2019). A large and abundant new species collected throughout the southern Gulf of St. Lawrence is characterized by thick and abnormally shaped flagellosigmas, two sizes of oxea, and abundant normal sigmas. Lambe (1896) previously reported Haliclona (Flagellia) porosa (Fristedt, 1887) from the Gulf of St. Lawrence, and the species is known to occur in nearby Arctic waters (Fristedt 1887; Lundbeck 1902; Hentschel 1916; Koltun 1959, 1966; Van Soest 2017; Dinn & Leys 2018). However, H. (F.) porosa is characterized by the presence of very few normal sigmas and no thick flagellosigmas. Type specimens were preserved in 95% ethanol and were deposited in the Atlantic Reference Centre (ARC) in St. Andrews, New Brunswick, Canada. The taxonomic identification was performed through spicule analysis using light and scanning electron microscopy, following methods described by Dinn et al. (2020).
First report of the Old World leafhopper genus Olidiana McKamey (Hemiptera: Cicadellidae: Coelidiinae) from Pakistan with description of a new species
Authors: NAVEED HASSAN , WANG XIU-DAN , CAO CHENGQUAN , ZHANG YALIN
Published: May 2020

The genus Olidiana McKamey, 2006 is reported for the first time from Pakistan based on the new species Olidiana pakistanica sp. nov. Photographic illustrations and a description are provided for the habitus and male genitalia of this new species. A partial mitochondrial cytochrome oxidase I gene (COI) sequence is also provided.
Five new species of the spider genus Savarna Huber, 2005 (Araneae: Pholcidae) from Thailand
Authors: LAN TIANQI , YAO ZHIYUAN , ZHENG GUO , WONGPROM PRASIT , LI SHUQIANG
Published: May 2020

The genus Savarna Huber, 2005 comprises only five species, from southern Thailand, Peninsular Malaysia and Sumatra. In this study, five new species are described from Thailand: Savarna bannang sp. nov. (Yala), S. chiangmai sp. nov. (Chiangmai), S. huahin sp. nov. (Prachuap Kiri Khan), S. satun sp. nov. (Satun), S. thungsong sp. nov. (Nakhon Srithammarat). All new species are described from males and females. The distribution of S. chiangmai sp. nov. represent the northernmost record of the genus.
Two new species and a new distribution record of the genus Malthodes Kiesenwetter (Coleoptera: Cantharidae) from Japan, with notes on the male and female abdominal morphology
Authors: TAKAHASHI NAOKI , IMASAKA SHÔICHI
Published: May 2020

Two new species, Malthodes morimotoi sp. nov. and M. okushimai sp. nov., are described and illustrated from the western part of Japan. Additionally, M. parvus Kazantsev, originally described from the Russian Far East, is recorded from Japan for the first time. The male and female morphology of M. morimotoi sp. nov. was examined and noted in detail with specimens observed in copula.
Mechanisms for the Dipolar Patterns of Rainfall Variability over Large Islands in the Maritime Continent Associated with the Madden–Julian Oscillation
Authors: Qian Jian-Hua
Published: May 2020

Before the eastward-propagating rainy envelope of a Madden–Julian oscillation (MJO) arrives at the Maritime Continent (MC), some islands in the MC experience dipolar patterns of rainfall variability with opposite signs of rainfall anomalies in two neighboring regions within an island. Similar incoherent rainfall anomalies are also observed after the MJO passed the MC. The mechanisms for these dipolar patterns of rainfall anomalies are investigated by using observed and reanalysis data. It is found that the response of rainfall in the MC depends on the direction of wind anomalies and the availability of atmospheric moisture in different phases of the MJO. The low-level wind anomalies over the MC are easterlies in MJO phases 1–3, which cause above-normal rainfall over the mountainous areas in Java, and in western Borneo, western Sumatra, and western Malay Peninsula, respectively. In phases 5–6, the low-level wind anomalies are westerlies and the positive rainfall anomalies are over the eastern part of the islands. Two physical mechanisms are responsible for this phenomenon of the dipolar patterns of rainfall anomalies: 1) the monsoonal damping effect on rainfall over elongated narrow islands—an inverse relationship between the intensity of the diurnal cycle of sea breezes and valley breezes and the large-scale monsoonal wind speed, and 2) the wake effect on rainfall over large and wide islands—above-normal rainfall on the downwind wake side of an island or mountain range with respect to large-scale wind anomalies.
Uncertainties Caused by Resistances in Evapotranspiration Estimation Using High-Density Eddy Covariance Measurements
Authors: Zhao Wen Li , Qiu Guo Yu , Xiong Yu Jiu , Paw U Kyaw Tha , Gentine Pierre , Chen Bao Yu
Published: May 2020

Quantifying the uncertainties caused by resistance parameterizations is fundamental for understanding, improving, and developing terrestrial evapotranspiration (ET) models. Using high-density eddy covariance (EC) tower observations in a heterogeneous oasis in northwest China, this study evaluates the impacts of resistances on the estimation of latent heat flux (LE), the energy equivalent of ET, by comparing resistance parameterizations with different complexities under one- and two-source Penman–Monteith (PM) equations. The results showed that the mean absolute percent error (MAPE) for the LE estimates from the one- and two-source PM equations varied from 32% to 53%, and the uncertainties were caused mainly by the resistance parameterizations. Calibrating the parameters required in the resistance estimations could improve the performance of the PM equations; specifically, the MAPEs for the one-source PM equations were approximately 16%, whereas they were 38% for the two-source PM equations, emphasizing that multiple resistances result in increased uncertainties. The following conclusions were reached: 1) the empirical and biophysical parameters required in resistance estimations were responsible for the uncertainty; 2) increasingly complex resistance parameterizations resulted in greater uncertainties in LE estimates; and 3) models without resistance parameterizations exhibited reduced uncertainties in LE estimates.
The Canadian Seasonal to Interannual Prediction System Version 2 (CanSIPSv2)
Authors: Lin Hai , Merryfield William J. , Muncaster Ryan , Smith Gregory C. , Markovic Marko , Dupont Frédéric , Roy François , Lemieux Jean-François , Dirkson Arlan , Kharin Viatcheslav V. , Lee Woo-Sung , Charron Martin , Erfani Amin
Published: May 2020

The second version of the Canadian Seasonal to Interannual Prediction System (CanSIPSv2) was implemented operationally at Environment and Climate Change Canada (ECCC) in July 2019. Like its predecessors, CanSIPSv2 applies a multimodel ensemble approach with two coupled atmosphere–ocean models, CanCM4i and GEM-NEMO. While CanCM4i is a climate model, which is upgraded from CanCM4 of the previous CanSIPSv1 with improved sea ice initialization, GEM-NEMO is a newly developed numerical weather prediction (NWP)-based global atmosphere–ocean coupled model. In this paper, CanSIPSv2 is introduced, and its performance is assessed based on the reforecast of 30 years from 1981 to 2010, with 10 ensemble members of 12-month integrations for each model. Ensemble seasonal forecast skill of 2-m air temperature, 500-hPa geopotential height, precipitation rate, sea surface temperature, and sea ice concentration is assessed. Verification is also performed for the Niño-3.4, the Pacific–North American pattern (PNA), the North Atlantic Oscillation (NAO), and the Madden–Julian oscillation (MJO) indices. It is found that CanSIPSv2 outperforms the previous CanSIPSv1 system in many aspects. Atmospheric teleconnections associated with the El Niño–Southern Oscillation (ENSO) are reasonably well captured by the two CanSIPSv2 models, and a large part of the seasonal forecast skill in boreal winter can be attributed to the ENSO impact. The two models are also able to simulate the Northern Hemisphere teleconnection associated with the tropical MJO, which likely provides another source of skill on the subseasonal to seasonal time scale.