bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 270: Temporal Trends in Heart Failure Mortality in an Integrated Healthcare Delivery System, California and the US, 2001-2017
Authors: Mefford Matthew , Zhuang Zimin , Liang Zhi , Chen Wansu , Watson Heather , Koyama Sandra , Lee Mingsum , Sidney Stephen , Reynolds Kristi
Published: May 2020

Background:
In recent years declines in the rate of mortality attributable to cardiovascular diseases have slowed and mortality attributable to heart failure (HF) has increased.

Objective:
To examine secular trends in mortality with HF as the underlying cause in Kaiser Permanente Southern California (KPSC), California, and the US among adults 45 years of age and older from 2001 and 2017.

Methods:
KPSC mortality rates with HF as an underlying cause from 2001 to 2017 were derived through linkage with California State death files and were compared with rates in California and the US. Rates were age-standardized to the 2000 US Census population. Trends were examined overall and among men and women, separately, using best-fit Joinpoint regression models. Average annual percent change (AAPC) and 95% confidence intervals (CI) were calculated for the overall study period, and within earlier (2001-2011) and later (2011-2017) time periods.

Results:
Between 2001-2017, age-adjusted mortality rates with HF as the underlying cause were lower comparing KPSC to California and the US. In KPSC, rates increased from 23.9 to 44.7 per 100,000 person-years (PY) in KPSC, representing an AAPC of 1.3% (95% CI 0.0%, 2.6%). (Table) During the same time period, HF mortality rates in California also increased from 33.9 to 46.5 per 100,000 PY (AAPC 1.5%, 95% CI 0.3%, 2.7%), while remaining unchanged in the US at 57.9 per 100,000 PY in 2001 and 2017 (AAPC 0.0%, 95% CI -0.5%, 0.5%). AAPCs were not statistically different comparing KPSC to both California and the US (all p > 0.05). Between 2001-2011, rates of HF mortality increased in KPSC (AAPC 1.3%, 95% CI 0.0, 2.6), non-significantly increased in California (AAPC 0.2%, 95% CI -0.8%, 1.2%) and decreased in the US (AAPC -2.1%, 95% CI -2.7%, -1.5%). Between 2011-2017, rates of HF mortality increased in KPSC (AAPC 1.3%, 95% CI 0.0%, 2.6%), California (AAPC 3.7%, 95% CI 1.0%, 6.5%), and the US (AAPC 3.6%, 95% CI 2.4%, 4.8%) except among KPSC women (AAPC 0.3% [95% CI -1.6%, 2.2%]).

Conclusion:
Despite increases in HF mortality after 2011, rates of HF mortality were lower among KPSC compared to California and the US. Given the mortality burden of HF at older age, there is a need to improve HF prevention, treatment and management efforts earlier in life.
Abstract 301: Differential Outcomes for Geriatric Patients in Cardiac Intensive Care Unit Compared to Medical Intensive Care Unit
Authors: Ong Caroline , Lui Albert , Dodson John A , Strom Jordan B , Alviar Carlos
Published: May 2020

Background:
The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU.

Methods:
All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality.

Results:
We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure).

Conclusion:
Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.
Abstract 304: Characteristics of Acute Coronary Syndrome Patients Referred to the Bridge Transitional Care Clinic By Time to Readmission
Authors: Cholack George , Garfein Joshua , Krallman Rachel H , Feldeisen Delaney , Montgomery Daniel G , Eagle Kim , Rubenfire Melvyn , Kline-Rogers Eva M , Bumpus Sherry
Published: May 2020

Introduction:
Prompt follow-up post-discharge is recommended by many readmission reduction initiatives. Identifying predictors of early readmission may inform discharge planning. We compared characteristics of acute coronary syndrome (ACS) patients (pts) based on time to readmission to determine factors associated with early readmission.

Methods:
Pts referred to the BRIDGE transitional care clinic following index admission for ACS from 2008-2017 were eligible. Demographics and inpatient clinical characteristics were compared between pts readmitted early (0-7 days post-discharge) versus late (8-30 days post-discharge). Multivariable logistic regression models were created to identify independent predictors of early readmission.

Results:
Of 1220 ACS pts, 198 were readmitted within 30 days; 70 (35.4%) were readmitted early, and 10.0% of these were readmitted for ACS. Early readmissions were more likely to be female, have an ED visit prior to readmission, and have an index ICU admission. Female sex [OR: 2.26, 95% CI: 1.23, 4.16] and ICU admission [OR: 2.20, 95% CI: 1.14, 4.24] were both independent predictors of early readmission.

Conclusion:
Female sex and ICU admission during index were associated with roughly twice the odds of early readmission. Non-white pts were also more often readmitted early (p=0.05), suggesting potential care disparities in this population. Future studies to identify pts at increased risk of early readmission and efforts to reduce disparities are warranted.
Abstract 311: Cost-effectiveness Analysis of California Hospitals That Perform Coronary Artery Bypass Graft Surgery
Authors: Tupas Desiree , Hoegh Holly , Morris Phil , Krawczyk Christopher
Published: May 2020

Objectives:
California collects clinical data on coronary artery bypass graft (CABG) surgeries and has published a hospital level risk-adjusted performance report for every data year since 2003. Recent efforts have for the first-time combined hospital level utilization and financial data to components of the clinical CABG data. With the goal of understanding how performance might vary by hospital financial aspects, a cost-effectiveness analysis (CEA) of the 125 California hospitals that performed CABG surgery in 2016 was completed.

Methods:
Patient-level clinical data for the 125 California licensed hospitals that performed CABG surgery in 2016 were linked to patient discharge data and California death records. Selected patient-level characteristics from this data were then merged with hospital-level financial and utilization data. The 34 hospitals that report financial data at a network or corporate level were excluded, resulting in a cohort of 91 hospitals. A CEA was conducted to understand cost summaries and variations across hospitals that perform CABG surgery in California. Resources and information essential for cardiac surgery programs such as hospital personnel time, source charges and payments, patient complications and in-hospital mortality rates were evaluated.

Results:
Gross inpatient revenue in 2016 for the 91 CABG hospitals for total surgery and recovery services (which includes open heart surgeries) was $21.5 billion for an average of $236.5 million per hospital. Revenues ranged from $28.8 million to $1.3 billion. Total direct expenses for total surgery and recovery services (which includes open heart surgeries) were $1.8 billion and ranged from $2.6 million to $105.4 million with an average of $20.3 million per hospital. Additional analyses evaluated revenue and expenditure differences by hospital performance and patient characteristics.

Conclusions:
Revenue and expenses for CABG hospitals in California vary greatly. A CEA using a linked clinical and financial dataset allows California hospitals to identify which financial resources to use and allocate effectively, redefine missions and objectives, improve financial standing, and design smarter growth strategies for hospital expenditures.
Abstract 312: Association of Electronic Health Record Documented Contraindications and Adverse Events in Patients Undergoing Peripheral Catheter Directed Thrombolysis
Authors: Greco Gina , Shroff Adhir R , Dwyer Kaluzna Stephanie , Lipnik Andrew , Vuckovic Karen M
Published: May 2020

Background:
Standardized documentation of contraindications for catheter-directed thrombolysis (CDT) and its association with adverse events (AEs) is unknown. We reviewed the presence of contraindications for CDT and their documentation in the EHR as part of a QI initiative.

Methods:
We retrospectively reviewed 100 randomly selected patients who received CDT between 2015-2019. Data included demographics, comorbidities, and 10 established contraindications, and were classified as present, absent, or ambiguous (missing/unclear). AEs included bleeding, transfusion, urgent surgery, stroke, and in-hospital death.

Results:
Majority of patients were non-white males, mean age of 58.5 ± 13 years. There was ambiguous documentation of the contraindications in 95% (95 of 100) of the records (mean contraindications/record = 4, range 0-7). The most frequently documented contraindication was BP; the least frequently documented were CVA/TIA ≤ 2 months and brain aneurysm. Thirty-nine patients had an AE with 92% (36 of 39) experiencing a BARC 2-3c bleed. Of those with an adverse event, the documented contraindications included SBP ≥ 180 mmHg, brain aneurysm, and platelets < 50,000 μL. Additional contraindications to CDT documented in patients who did not have an AE included DBP ≥ 110 mmHg, major surgery within 10 days, and neurosurgery within 3 months.

Conclusion:
Contraindications for CDT lack clear documentation, and our rate of AEs is higher than expected. Also, some patients with contraindications still received CDT. This demonstrates the need for improvement in our screening process and has led to implementation of a standardized checklist prior to CDT initiation.
Abstract 336: Anticoagulation Prescribing Patterns and Rates of Bleeding for People With Cancer and Atrial Fibrillation
Authors: Barker Sarah , Cohen Adam L , Shah Rashmee , Catino Anna
Published: May 2020

Introduction:
Atrial fibrillation (AF) is a major cause of stroke and increased mortality among people with cancer. People with cancer have a higher risk of developing AF at time of cancer diagnosis, prior to treatment, and after therapy than patients without cancer. AF management includes anticoagulation (AC) for stroke prophylaxis. Risk stratification tools are used to assess patients’ stroke and bleeding risk. However, such tools have not been validated in people with cancer. Therapeutic AC poses challenges due to increased risk of bleeding, platelet dysfunction, and drug interaction. Given this, therapeutic AC is often deferred despite potentially higher thrombosis risk. We sought to better understand practice patterns of therapeutic AC among people with cancer and AF.

Hypothesis:
We predicted reduced AC prescribing rates for AF among people with cancer despite high CHA
2
DS
2
-VASc score.

Methods:
We conducted a retrospective cohort study of people with cancer and AF at a single institution from 2010 to 2018. Cancer type was ascertained from an institutional registry; AF and other characteristics were determined from the electronic medical record. Patients were classified as anticoagulated based on medication orders and lists. Bleeding event rates were assessed using ICD billing codes. The primary outcome was rate of anticoagulant use with a secondary outcome of frequency of bleeding events.

Results:
We identified 2914 people with cancer and AF. 48% (1406 of 2914) were anticoagulated, and those prescribed AC were older (71.6 ± 9.7 vs. 69.8 ± 11, p<0.01), had higher CHA
2
DS
2
-VASc scores (3.7 ± 1.8 vs. 3.5 ± 1.9, p<0.01), and were more likely to have AF before cancer (49.7% vs. 39.7%p<0.01). People with breast (61%) and skin (66%) cancers had higher rates of AC, while people with hematologic (44%), brain (39%), lung (38%), and gastrointestinal (39%) cancers were less likely to be anticoagulated. Treated patients were more likely to experience a bleeding event (32% vs. 20%, p<0.01).

Conclusions:
There is a large group of people with cancer and high CHA
2
DS
2
-VASc scores who are not anticoagulated. Further research is needed to determine if this lack of AC is due to bleeding risk, lack of prescribing, or invalid use of CHA
2
DS
2
-VASc stratification in this population. Apparent bleeding rates are higher than previously published.
Abstract 342: A Description of Cardiac Outcomes in Patients With Sickle Cell Trait and Chronic Kidney Disease: Evaluated in a National Inpatient Data Sample
Authors: Ogbuchi Samuel I , Abe Temidayo , Bhatia Kapil , McIver Leondus S , Lee Michelle , Sachdeva Rajesh
Published: May 2020

Introduction:
Sickle cell trait (SCT) is an independent risk factor for chronic kidney disease (CKD). CKD is a well-established risk factor for progressive cardiovascular dysfunction. Sickle Cell trait has been noted to promote a persistent systemic pro-inflammatory state. This pro-inflammatory state could potentially increase the risk of systemic endothelial dysfunction when accompanied with other cardiotoxic conditions. We aim to investigate cardiovascular outcomes in patients with SCT and CKD, compared to SCT alone.

Methods:
Patients with CKD were identified in the National Inpatient Sample (NIS) database 2016 using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), and subsequently were divided into two groups, those with and without SCT. Both population sets were paired using 1:1 propensity score matching based on Age, Sex and co-morbidities to address potential confounding factors. Outcomes of interest were overall mortality, rates of stroke, sudden cardiac arrest (SCA) and cardiomyopathy.

Results:
Mean age of patients with CKD alone was 72.98 ± 13.2 years, while for CKD and SCT 56.68 ± 17.3 years. There was no significant difference between the two group in the rates of stroke (1.3% vs 1.0%; P= 0.125), and SCA (1.0% vs 1.1%; P= 0.841). Overall mortality (5.7% vs 2.2%; P<0.0001) and rates of cardiomyopathy (10.1% vs 2.9%; P<0.0001) were significantly lower in patients with CKD and SCT, compared to CKD alone. Multivariate logistic regression followed a similar trend, compared to those with CKD alone, the adjusted odds ratio (aOR) for overall mortality aOR; 0.625 (0.372-1.049) and cardiomyopathy aOR; 0.451 (0.293-0.696) were significantly lower in patients with CKD and SCT.

Conclusion:
Compared to patients with CKD alone, those with CKD and SCT have a lower risk for overall mortality and cardiomyopathy. Further studies are needed to replicate this finding and look at the possible protective role of SCT in patients with CKD.
Abstract 349: Outcomes Among Women With Bicuspid Aortic Valve and/or Bicuspid Aortopathy During Pregnancy
Authors: Meikle Sarina , Wu Jenny , Bach David , Hofmann Bowman Marion , Norris Mark , Cotts Timothy , Braverman Alan C , Langen Elizabeth , Davis Melinda
Published: May 2020

Background:
Bicuspid aortic valve (BAV) is associated with an increased risk of aortic dissection, but little is known about pregnancy-associated outcomes.

Methods:
ICD codes and a text recognition program (EMERSE) were used to identify women with BAV and pregnancy (2000-2018) at a single center. Charts were manually reviewed to confirm the diagnoses, echocardiographic data, co-morbidities, and outcomes. Inclusion criteria were congenital BAV pathology and pregnancy. Primary endpoints included expansion of aortic aneurysm and aortic dissection during pregnancy and up to 6 weeks post-partum.

Results:
We identified 622 women with diagnoses of BAV and pregnancy. After detailed review, 72 women (87 pregnancies) met inclusion criteria. Mean gestational age at delivery was 36.9 weeks. Ten (11.5%) patients had hypertensive disorders of pregnancy, 7 (8.0%) had gestational diabetes, and 25 (28.7%) were treated with beta-blockers. Two (2.3%) pregnancies had intra-uterine growth restriction. Vaginal deliveries occurred in 56.5% and cesarean section in 36.3%. No Type A or B aortic dissections occurred. During pregnancy, there were no significant changes in the aortic dimensions. Prior to pregnancy, 6 women had aortic measurements > 40mm (mean pre-pregnancy 40.8 ± 3.2 mm; mean post-pregnancy 42.5 ± 3.9 mm). In this higher-risk group, mean gestational age was 38.7 weeks, 4 (66.7%) had vaginal delivery, 1 (16.7%) had preeclampsia, 4 (66.7%) were treated with beta-blockers, and all breastfed. There were no delivery complications, no aortic dissections, and no maternal or fetal deaths.

Conclusions:
Women with BAV appear to be at relatively low risk for acute aortic dissection during pregnancy.
Abstract 360: Neighborhood-level Poverty and Incident Atrial Fibrillation: Analysis of Electronic Health Records From 2005-2018
Authors: Essien Utibe R , McCabe Megan , Khan Sadiya S
Published: May 2020

Introduction:
Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality. Disparities in AF outcomes have been related to individual-level social determinants of health, including race/ethnicity and socioeconomic status. While neighborhood-level factors, such as poverty, have been related to prevalence of key risk factors (e.g. obesity, hypertension), the association between neighborhood poverty and incident AF has not been previously examined.

Methods:
Using the Northwestern Medicine Enterprise Data Warehouse, we identified adults free of cardiovascular disease, with at least 5 years of follow-up from January 1, 2005 - December 31, 2013. Residential addresses were geocoded and matched to census tract level poverty estimates from the American Community Survey. Neighborhood poverty was defined as the proportion of residents in the census tract living below the US-defined poverty threshold. We categorized neighborhood poverty levels into tertiles. Generalized linear mixed effects models were used to examine the association between tertiles of neighborhood poverty and incident AF, adjusting for demographic (age, sex, race/ethnicity, insurance type) and AF risk factors (hypertension, diabetes, obesity and smoking status).

Results:
The cohort comprised 29,069 adults with a mean (SD) age of 51.4 (11.3) years, which included 58% women and 10% non-Hispanic Blacks. Higher rates of obesity, diabetes, hypertension, and smoking were observed in higher poverty groups. Approximately, 3.4% of patients developed incident AF over a follow-up of 5 years. The adjusted odds of incident AF were higher for the medium poverty compared to the low poverty group (adjusted odds ratio, aOR 1.30 (95% CI 1.05-1.56). The aOR of incident AF was similarly higher in the high poverty compared to low poverty group though not statistically significant (Table).

Conclusions:
In a cohort of adults free of cardiovascular disease at baseline, we found that residence in a more deprived neighborhood was associated with higher rates of incident AF, even after adjustment for traditional risk factors. Understanding how neighborhood and individual-level clinical factors interact to increase the incidence of AF is critical to developing equitable prevention strategies in this increasingly common condition.
Abstract 370: Trends, Incidence and In-hospital Outcomes of Frailty Among Patients Hospitalized for Transcatheter Aortic Valve Replacement in The United State
Authors: Olagoke Olakanmi O , Akuna Emmanuel , Asemota Iriagbonse , Quelal Karol C
Published: May 2020

Background:
Transcatheter aortic valve replacement (TAVR) is a relatively safe procedure and is fast becoming the preferred approach for aortic valve replacement in low risk patients. Although frail patients who pose high surgical risk may benefit from TAVR, little is known about the trends and outcomes of TAVR in frail patients admitted for TAVR. We sought to describe the trend, incidence and in-hospital outcomes of frailty in patients hospitalized for TAVR.

Methods:
We utilized the National Inpatient Sample database to identify patients admitted for TAVR between January 1, 2010 to December 31, 2014. We identified frail patients using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. We used the appropriate ICD-9-CM codes to identify the diagnoses. Proportions and frequencies were generated for categorical variables and differences were reported using the chi square test. We used student’s t-test to analyze differences in means for continuous variable. Predictors of frailty and mortality were assessed using logistic regression.

Results:
Of the 42243 TAVR admissions, 3.8% were identified as frail based on the John Hopkins' ACG frailty defining indicators. There is an increasing trend of TAVR use in frail patients from 2.1% in 2011 to 3.8% in 2014 of all the TAVR admissions (P
trend
=0.000). Predictors of frailty include older age group(aOR 1.65 95% CI 1.12-2.44 for age more than 80years compared to 18-64years), female sex(aOR 1.20 95% CI 1.07-1.35), depression (aOR 1.50 95% CI 1.23-1.82), complicated diabetes(aOR 1.47 95% CI 1.16-1.86) and significant weight loss (aOR 16.37 95% CI 14.41-18.60). Compared to non-frail patients, frail patients had a higher likelihood of in-hospital mortality (8.8% compared to 4.0% p=0.000), longer hospital stay (13.65±11.65 compared to 7.85±6.99 days in non-frail patients).

Conclusion:
Frailty is associated with poorer outcomes in patients hospitalized for TAVR in the United States. Identification of predisposing factors to frailty and optimization of these factors when possible may help reduce adverse outcomes in this patient population. More studies are needed to clearly elucidate the effect of frailty on TAVR outcomes.
Abstract 371: Stroke Healthcare Quality and Outcomes in Different Level of Stroke Centers
Authors: Xin Yang
Published: May 2020

Background:
Evidences support the stroke centers, including primary stroke center (PSC) and comprehensive stroke center (CSC) to improve stroke patient healthcare and outcomes.

Objects:
We aimed to compare stroke healthcare quality and in-hospital outcomes between CSCs and PSCs in China.

Methods:
Data were collected from acute stroke patients who were admitted to CSCs or PSCs that participated in the China Stroke Center Alliance (CSCA) program. Stroke care quality performances include: intravenous rtPA or endovascular thrombolysis (EVT) therapy in acute ischemic stroke (IS) patients, neurosurgical procedures of intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) patients, secondary prevention measures (such as medicines, dysphagia screening, rehabilitation assessment) in stroke patients. Performances of above were assessed by all-or-none measure and composite measure. The former was defined as the proportion of patients who received all the performance measures for which the patient was eligible. The latter was defined as the total number of eligible performance measures performed divided by the total number of performance measures for which a given patient was eligible. The composite measure was calculated for each patient and then averaged. Outcome was mainly estimated by in-hospital mortality. Multivariable logistic regression models were used to analyze the performances of stroke care quality and in-hospital outcomes between CSC and PSC.

Results:
From 1st Aug, 2015 to 31st July, 2019, 750594 stroke patients from 1474 stroke centers (252 CSCs and 1222 PSCs) were analyzed. The mean age of patients was 65.8 (SD 12.2) years old, and 62.5% (469308) were male. By multivariable logistic regression analysis, patient characteristics (age, gender, NIHSS or GCS score, smoking and all the medical histories) and hospital characteristics (hospital level and location) were adjusted, patients in CSCs had higher all-or-none measure (adjusted OR, 1.22 [95%CI, 1.11 to 1.35]). Compared to PSCs, IS patients at CSCs were more likely to receive IV rtPA or EVT therapy (adjusted OR, 1.31 [95%CI, 1.27 to 1.35]; adjusted OR, 1.43 [95%CI, 1.31 to 1.57]), more ICH and SAH patients received neurosurgery (adjusted OR, 1.70 [95%CI, 1.58 to 1.83]; adjusted OR, 1.29 [95%CI, 1.14 to 1.46]). While, CSCs had higher in-hospital mortality than PSCs (adjusted OR, 1.33 [95%CI, 1.23 to 1.43]), especially in ICH patients (adjusted OR, 1.77 [95%CI, 1.54 to 2.03]).

Conclusions:
CSCs achieved higher care quality for stroke patients but lower risk-adjusted in-hospital mortality. The results might be instructive in improving the care quality in different types of stroke.
Abstract 378: Accuracy of EHR-based Computable Phenotypes to Identify Cardiovascular Clinical Events and Patient Comorbidities
Authors: Wosik Jedrek , Peterson Eric D , Rousseau Justin R , Flaker Greg , Pignone Michael , Alderson Tyler , Minor Noah , Smyth Taylor , McNiel Katharine , Navar Ann
Published: May 2020

Introduction:
The accuracy of electronic health record (EHR) data to identify prevalent disease status and/or clinical events is a major concern for the use of ‘real world’ data for research. We assessed the accuracy of EHR data for specific CV conditions based on EHR data compared with manual chart review.

Methods:
Using a cloud-based infrastructure, Cerner’s
HealtheIntent
EHR data from two health systems were de-identified and aggregated. We created EHR-based computable phenotypes for patients with ASCVD, (based on prior diagnosis and procedure codes, to identify comorbidities and hospitalizations with acute limb ischemia (ALI), bleeding, acute coronary syndrome (ACS), and cerebrovascular events (stroke/transient ischemic attack/intracranial hemorrhage). Chart reviews were performed (n=1,869) to validate the hospitalization final diagnosis and prevalent comorbidities, with the first 100 charts undergoing review by two concurrent chart reviewers. When reviewers noted an absence of a comorbidity, but EHR data indicated it may be present, an automated cue was presented to the reviewer of “Are you Sure?”. Cohen’s kappas (κ) were calculated to indicate agreement inter-review of event types and comorbidities. The PPV of EHR data for hospitalization diagnosis and comorbidities compared with cue-augmented chart review as gold standard were assessed.

Results:
The inter-rater agreement for the hospitalization diagnosis was very good overall and highest for ACS (0.83), followed by ALI (0.75), , and cerebrovascular events (0.69). The PPV of EHR-based diagnoses for single chart reviewers was 0.93 for cerebrovascular events, 0.81 for bleeding, 0.78 for ACS, and 0.51 for ALI. Similarly, the predictive accuracy of the EHR-based computable phenotypes for comorbidities and events was variable: as high as 0.93 for hypertension, 0.87 for atrial fibrillation, and 0.86 for peripheral arterial disease, to as low as 0.13 for type 1 diabetes, 0.38 for prior transient ischemic attack, and 0.56 for heart failure with reduced ejection fraction. Providing the chart reviewer with automated cue for comorbidities improved PPV.

Conclusions:
Many, but not all, clinical outcomes and comorbidities can be identified using EHR-based algorithms, with variable performance depending on the condition. Human chart reviews, long considered a gold standard, may be improved using EHR data.
Abstract 393: Addressing The Gap In Outpatient Guideline Directed Medical Therapy Dosing In Heart Failure With Reduced Ejection Fraction: Preliminary Findings
Authors: Seedat Zed , Neupane Prashank , Waldburg David , Satyavolu Shannu , Haire Henry , Zahra Touqir
Published: May 2020

Background:
The benefit of guideline directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF) is well established in the medical literature and clinical practice guidelines. The low prevalence of optimal dosing of these medications remains an obstacle in providing quality care for this patient population.

Methods:
An electronic medical record (EMR) triggered alert was attached to all patient charts with ICD-10 codes associated with HFrEF at a single internal medicine residency-associated outpatient primary care office. This alert urged use of a GDMT initiation and titration reference sheet based on the
2017 ACC Expert Consensus Decision Pathway
for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart
Failure With Reduced Ejection Fraction
. A retrospective review of patients with corresponding ICD-10 codes and documented ejection fractions less than or equal to 40% was conducted and the intensity of GDMT dosing in these patients was recorded. A group of patients treated 3 years prior to the intervention were then compared to those treated after the intervention

Results:
38 patients with a documented diagnosis of HFrEF that were evaluated between January 9, 2017 and January 9, 2020 were identified. 32 (84.2%) of these patients were on GDMT beta blockers and only 1 (3.1%) of these patients were receiving the target dose. Of the 31 (81.5%) of patients receiving ACE/ARB/ARNi therapy, 9 (41.9%) patients received target dosing. Mineralocorticoid receptor antagonist therapy (MRA) was prescribed to 11 (28.9%) patients; all of these patients received the target dose. Uptitration of medication was observed in the management of 9 (23.7%) of patients. Following the intervention, 8 patients with a documented diagnosis of HFrEF were evaluated between January 9, 2020 and March 5, 2020.GDMT beta blockers were prescribed to 7 (87.5%) of these patients; 1 (12.5%) patient received a target dose. ACE/ARB/ARNi therapy was given to all 8 patients and half of the patients were prescribed a target dose. MRA treatment was given to 2 (25%) of the8 patients; both patients were given the target dose. Uptitration of GDMT was observed in 1 (12.5%) patient following the intervention. There was no statistically significant difference between pre-intervention and post-intervention groups (P= 0.7187) regarding initiation and uptitration of GDMT.

Conclusion:
An EMR triggered effort to improve GDMT dosing in HFrEF patients did not show significant improvement in a small patient population over a short time period.
Caffeinated Beverage Intake, Dyspnea With Ticagrelor, and Cardiovascular Outcomes: Insights From the PEGASUS‐TIMI 54 Trial
Authors: Furtado Remo H. M. , Venkateswaran Ramkumar V. , Nicolau Jose C. , Gurmu Yared , Bhatt Deepak L. , Storey Robert F. , Steg P. Gabriel , Magnani Giuglia , Goto Shinya , Dellborg Mikael , Kamensky Gabriel , Isaza Daniel , Aylward Philip , Johanson Per , Bonaca Marc P.
Published: May 2020

Background

A proposed cause of dyspnea induced by ticagrelor is an increase in adenosine blood levels. Because caffeine is an adenosine antagonist, it can potentially improve drug tolerability with regard to dyspnea. Furthermore, association between caffeine and cardiovascular events is of clinical interest.

Methods and Results

This prespecified analysis used data from the
PEGASUS TIMI
54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54) trial, which randomized 21 162 patients with prior myocardial infarction to ticagrelor 60 mg or 90 mg or matching placebo (twice daily). Baseline caffeine intake in cups per week was prospectively collected for 9694 patients. Outcomes of interest included dyspnea, major adverse cardiovascular events (ie, the composite of cardiovascular death, myocardial infarction, or stroke), and arrhythmias. Dyspnea analyses considered the pooled ticagrelor group, whereas cardiovascular outcome analyses included patients from the 3 randomized arms. After adjustment, caffeine intake, compared with no intake, was not associated with lower rates of dyspnea in patients taking ticagrelor (adjusted hazard ratio (HR), 0.91; 95%
CI
, 0.76–1.10;
P
=0.34). There was no excess risk with caffeine for major adverse cardiovascular events (adjusted HR, 0.78; 95% CI, 0.63–0.98;
P
=0.031), sudden cardiac death (adjusted HR, 0.98; 95% CI, 0.57–1.70;
P
=0.95), or atrial fibrillation (adjusted odds ratio, 1.07; 95% CI, 0.56–2.04;
P
=0.84).

Conclusions

In patients taking ticagrelor for secondary prevention after myocardial infarction, caffeine intake at baseline was not associated with lower rates of dyspnea compared with no intake. Otherwise, caffeine appeared to be safe in this population, with no apparent increase in atherothrombotic events or clinically significant arrhythmias.

Registration

URL
:
https://www.clini​caltr​ials.gov
; Unique identifier:
NCT
01225562.
Protective Effect of ApoA1 (Apolipoprotein A1)-Milano in a Rat Model of Large Vessel Occlusion Stroke
Authors: Ducroux Célina , Desilles Jean-Philippe , Mawhin Marie-Anne , Delbosc Sandrine , Ho-Tin-Noé Benoit , Ollivier Véronique , Di Meglio Lucas , Lapergue Bertrand , Michel Jean-Baptiste , Amarenco Pierre
Published: May 2020

Background and Purpose—

Previous experimental studies found that the infusion of human purified nascent HDL (high-density lipoprotein) significantly reduced infarct volume and hemorrhagic transformation rate by decreasing neutrophil recruitment. ApoA1-M (apolipoprotein A1-Milano) is a natural variant of human ApoA1 that confers protection against atherosclerosis. Recombinant ApoA1-M has been formulated as a complex with phospholipids to mimic the properties of nascent HDL. The aim of this study was to assess the impact of intravenous ApoA1-M in a transient middle cerebral artery occlusion stroke model in rats.

Methods—

In a first experiment, rats were subjected to 120-minute transient middle cerebral artery occlusion and intravenous ApoA1-M was infused immediately or 4 hours after occlusion. In a second experiment, rats were subjected to 240-minute transient middle cerebral artery occlusion and intravenous ApoA1-M was infused with or without recombinant tPA (tissue-type plasminogen activator) immediately after recanalization. Primary outcome criteria were the infarct volume and hemorrhagic transformation rate measured at 24 hours. Platelets, coagulation, and neutrophil activation biomarkers were measured in brain homogenates and plasma. Additional in vitro experiments studied the effects of ApoA1-M on platelet aggregation and platelet-neutrophil interactions.

Results—

The infusion of ApoA1-M immediately or 4 hours after 120-minute transient middle cerebral artery occlusion significantly reduced the infarct volume compared with saline (
P
=0.034 and
P
=0.036, respectively). Compared with tPA alone, co-administration of ApoA1-M and tPA showed similar rates of hemorrhagic transformation. ApoA1-M had no significant inhibition effect on neutrophil activation biomarkers. Platelet activation was slightly decreased in rats treated with ApoA1-M compared with saline. In vitro, the incubation of human and rat platelet-rich plasma with ApoA1-M significantly reduced ADP-induced platelet aggregation (
P
=0.001 and
P
=0.02, respectively).

Conclusions—

ApoA1-Milano significantly decreased the infarct volume through an inhibition of platelet aggregation but did not reduce hemorrhagic transformation and neutrophils activation as expected after previous experimental studies with nascent HDL.

Visual Overview—

An online
visual overview
is available for this article.
Female Entrepreneurs and Access to Financial Capital
Authors: Lueg Klarissa , Ni Amanda
Published: May 2020

This study identifies what similar aspects determine access to financial capital for female entrepreneurs both in Denmark and Indonesia. Departing from a structuralist constructivist perspective (including the concepts of symbolic violence, social similarity, female otherness), we identify the impact of gender-discrimination, nationality, and further variables. The sample comprises 124 female respondents and, for reasons of comparison, 86 male respondents from Denmark and Indonesia. Binary logistic regressions and t-tests show that financial discrepancies between male and female entrepreneurs (FE s) were larger in Indonesia than in Denmark. However, findings also suggest that gender discrimination prevails in both countries, as men have easier access to funds from family, banks, and angel investors. This study provides evidence of gender bias prevailing in both a maturing and a matured economy with a strong discourse on gender equality. We propose explaining the similarities in gender discrimination with veiled, structural discrimination being able to linger in both post-feminist, legally equality-granting, as well as in legally less egalitarian societies.
Construction of Gender Roles in 17th-Century Ottoman Dancing Boys (Köçeks)
Authors: Sankır Hasan
Published: May 2020

This study explores how the sexual identity and practices of the köçeks, who were positioned in the entertainment field in 17th Century Ottoman Istanbul, were socially constructed and how these practices had been well understood in the social sphere of the era. For this purpose, gender roles and practices of Köçeks’ in this period are discussed in instrumentalised body concept and dance field. The field and habitus approach of Bourdieu has been used to understand the relationship between the gender roles of the köçeks and the appreciation of this style by different social positions/classes/groups. As a result, their body and sexual identities had been accepted, and their dances had enabled köçeks to have an important position in the entertainment field by being among the tastes and preferences of the different social groups in the social space. In this sense, gender roles of köçeks had multi-component structure and cannot be easily understood over the male and female duality.
Socio-Cognitive and Cultural Influences on Children’s Concepts of God
Authors: Saide Anondah R. , Richert Rebekah A.
Published: May 2020

The current study examined (a) the impact of religious socialization practices and parents’ concepts on the development of an abstract religious concept (i.e., God) in young children, and (b) whether or not children’s socio-cognitive ability moderates the relationship between their religious concept and sources of information about the concept. 215 parent-child dyads from diverse religious backgrounds (Protestant Christian, Roman Catholic, Muslim, non-affiliated) participated. Children were between the ages of 3.52 and 6.98 years of age (M = 4.770, SD = .767). Four main findings emerged from this study. First, children conceptualized God as more humanlike than their parents did. Second, younger children were more likely to have a humanlike conception of God than older children. Third, parents’ concept of God and children’s concept of God had a stronger relationship when the child’s mental-state reasoning was more accurate. Fourth, the frequency of children’s engagement in religious practices was unrelated to children’s concept of God after controlling for child’s age. Taken together, these findings lend support for the view that social cognition is an important factor in young children’s acquisition of cultural information about abstract entities.
Animals, Superman, Fairy and God: Children’s Attributions of Nonhuman Agent Beliefs in Madrid and London
Authors: Lam Virginia L. , Guerrero Silvia
Published: May 2020

There have been major developments in the understanding of children’s nonhuman concepts, particularly God concepts, within the past two decades, with a body of cross-cultural studies accumulating. Relatively less research has studied those of non-Christian faiths or children’s concepts of popular occult characters. This paper describes two studies, one in Spain and one in England, examining 5- to 10-year-olds’ human and nonhuman agent beliefs. Both settings were secular, but the latter comprised a Muslim majority. Children were given a false-belief (unexpected contents) task in which they were asked to infer about three humans (mother, classmate, teacher), three animals (dog, bear, bird) and three supernatural beings (Superman, fairy, God). Similar false beliefs about humans, with subtle differences in inferences about animals and supernatural beings, were found between the two locations. In London different patterns for God between participants with a family religion, in particular Muslims, and non-affiliates, were identified as well as an association between religious beliefs and practice and inferences about God. Findings are discussed in the light of theory and research on the role of sociocultural inputs in children’s theory of mind development and understanding of agency.
Betrayal: A Philosophy
Authors: Marder Michael
Published: May 2020

This essay imagines the shape a phenomenology of betrayal would assume at the limits of phenomenology. With Caravaggio’s 1602 painting Cattura di Cristo for an aesthetic backdrop, I consider the paradoxical structure of betrayal with its interwoven strands of a surplus disclosure and a breach of trust. I go on to elaborate the relation of this complex term, at once positive and negative, to time, conceptuality, and truth. Ultimately, I am interested in how betrayal as a limit of phenomenology, where the coherence of intentionality and its correlations or of intuition and its fulfillments break down, underwrites the very possibility of phenomenological endeavor.
The Politics of Women Empowerment
Authors: Abdulkadir Rahma , Müller Henriette
Published: May 2020

In recent decades, the governments of Gulf Cooperation Council (GCC) states, especially the United Arab Emirates (UAE), have substantially increased their promotion of women in public life, with more women obtaining senior positions in an array of social domains. Despite these efforts, women’s leadership in the public sphere of GCC states still lags behind what has been achieved in other parts of the world. Focusing on the UAE, this article provides an overview of the current state and complex nature of women’s leadership in the Emirates. It examines who the UAE’s female leaders are, their socio-economic backgrounds, and the specific social arenas they most often obtain leadership positions in. The article utilizes a newly compiled data set on the socio-economic backgrounds of women who obtained leadership positions in the realms of politics, the economy, and society more broadly in the UAE between 1970 and 2017.
Unwelcomed Guests
Authors: Lie (李惠贞) Sunny , Sandel (申大德) Todd
Published: May 2020

This study explicates discourse on Indonesian social media pertaining to Chinese Indonesians by analyzing comments posted on Facebook. Using Cultural Discourse Analysis (CuDA), we show how Chinese are depicted as the “other” in Indonesian discourse. We also unpack persuasive efforts to convince readers of Chinese Indonesians’ other-ness through such rhetorical terms as cina (racial slur against Chinese Indonesians) and pribumi (native, indigenous, non-Chinese). The functional accomplishment of such discourse works to (1) exert the power to determine indigeneity and inclusivity; and (2) solidify Chinese Indonesians’ position as non-native, and a scapegoat for problems in Indonesia. Findings from this study further our understanding of ways to analyze and unpack discursive construction in online communication. They also demonstrate how social media may amplify and/or construct social and political discourses.
Learning from Women: Mothers, Slaves, and Regime Change in Tacitus’ Dialogue on Orators
Authors: Fertik Harriet
Published: May 2020

This essay offers a new assessment of the role of women in Tacitus’ Dialogue on Orators and of their significance for Tacitus’ analysis of regime change. The women of the Dialogue have received only cursory scholarly attention: they appear briefly in Messalla’s diatribe on the decline of Roman education (Dial. 28.4-29.2), when he contrasts the virtuous mothers of the Republic with the enslaved nurses who rear children in his own period, when an emperor rules in Rome. Yet Messalla’s exemplary mothers undermine his own interpretation of Roman history, and his description of the household ruled by slaves foreshadows Maternus’ account of Republican politics at the conclusion of the text. Women in Messalla’s speech challenge ideas of decline in the Dialogue and represent the possibility of practicing politics even in restrictive circumstances.
Justice and the Supposed Fallacy of Irrelevance in Plato’s Republic
Authors: Skedzielewski Sean
Published: May 2020

Previous commentators on Plato’s Republic have relied on mistaken assumptions about the requirements for Plato’s theory of justice: that Plato establishes a bi-conditional between proper psychic rule and the performance of conventionally just acts. They believe that if Plato does not establish this bi-conditional, then his theory of justice as a virtue will succumb to the fallacy of irrelevance. I claim Plato need not meet that requirement. A novel interpretation of the arguments of Book IV concerning justice in the soul suffices to dispense with one aspect of the bi-conditional – that conventional justice must imply justice as psychic harmony. Then, situating the theory of justice as psychic harmony in the context of the divided line, and in the dialectical ascent in the education of the philosopher-rulers, I show that the other conditional requirement – that justice in the soul must imply the performance of conventionally just actions – is also mistaken.
Animal Economies and Islamic Conversion in Eastern Ethiopia: Zooarchaeological Analyses from Harlaa, Harar and Ganda Harla
Authors: Gaastra Jane S. , Insoll Timothy
Published: May 2020

Excavations at three urban sites, Harlaa, Harar, and Ganda Harla, in eastern Ethiopia have recovered substantial assemblages of faunal remains. These, the first to be analysed from Islamic contexts in the country, were studied to reconstruct animal economies, and to assess if it was possible to identify Islamic conversion or the presence of Muslims in archaeological contexts through examining butchery practices and diet via the species present. Differences in animal economies between the sites in, for example, management strategies, use of animals for traction, and presence of imported marine fish, infers the development of different traditions. However, conversion to Islam was evident, and although issues of non-observance, mixed communities, and dietary eclecticism have to be acknowledged, the appearance of a similar range of butchery techniques suggests these were linked with the appearance of Muslim traders, and subsequent spread of Islam.
Science and Scientific Production in the Middle East
Authors: Shabana Ayman
Published: May 2020

Discussions concerning science and scientific production in the Middle East often trigger a comparison between a glorious past and a gloomy present. The past witnessed a thriving scientific culture within the Islamic civilization. In the present, however, science is usually entangled in a series of debates, ranging from the normative dimensions of modern science to the larger social and political circumstances shaping current realities, particularly in light of an incessant juxtaposition, competition, or rivalry with an imagined West.