bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P200: Effects Of A 2-year Randomized Controlled Trial Physical Activity Intervention On Accelerometer-measured Sleep Characteristics Among Older Adults In Senior Center Communities
Authors: Full Kelsie M , Crist Katie , Jankowska Marta , Lutsey Pamela L , Natarajan Loki
Published: May 2021

Background:
Targeting daily increases in physical activity (PA) is a common lifestyle strategy for cardiovascular disease (CVD) risk reduction. While less targeted in lifestyle interventions, poor sleep is also consistently linked to CVD. Emerging evidence connects changes in daily PA to beneficial changes in sleep; however, little is known about the impact of community-based PA interventions on habitual sleep among older adults. We leveraged accelerometer data from the Peer Empowerment Program for Physical Activity in Low Income & Minority Seniors (PEP4PA) randomized controlled trial to examine the effect of a PA intervention on accelerometer-measured sleep characteristics among older adults in low income and diverse senior center communities.

Methods:
PEP4PA participants (N=476; mean age=71.0 ± 9 years, 75% female, 60% low income, 36% non-white) were recruited from senior centers and randomized to a healthy control condition(n=209) or a peer-lead walking intervention (N=267). The peer-led PA intervention included self-monitoring techniques, health coach counseling, group walks, and community advocacy to improve walking conditions. Participants wore Actigraph GT3X+ accelerometers on the wrist at baseline, 6, 12, and 24 months. Data were processed for sleep characteristics including weekly average sleep duration and sleep efficiency. Mixed effects regression models provided estimates of the intervention effect on sleep characteristics at each time point. Models were adjusted for age, sex, and race. Three way interaction terms (time*treatment*sleep duration status) were used to assess differential intervention effects by short (<7) and long (>8 hours) sleep duration status at baseline.

Results:
At baseline, the average sleep duration of participants was 7 hours (SD: 1.07 hours) and the average sleep efficiency was 87.0% (SD: 6.2%). Compared to participants in the control group, participants in the intervention group had shorter sleep durations (7.1 hours vs 7.0 hours; p value: 0.08) and poorer sleep efficiency 86.0% vs 88.2%; p<0.001) at baseline. At 12 or 24-months, there was no intervention effect on participants’ average sleep duration or efficiency. Although not significant, at 6 months, long sleepers in the intervention group experienced an average 6-minute reduction in sleep duration (-B: 6.25, p=0.45) compared to those in the control group.

Conclusions:
Over the 2-year period, the PA intervention did not appear to have an impact on participants’ average sleep duration or quality. More investigation is needed into the temporal and daily relations of PA and sleep among older adults in interventions to understand if increases in daily PA are associated with better sleep characteristics at night.
Abstract P207: Food Insecurity, Anxiety And Depression In An Underserved Heart Failure Population
Authors: Clarkson Erin B , Clarkson Stephen , Eagleson Reid , White-Williams Connie
Published: May 2021

Objective:
The HRTSA (HeaRt -Failure Transitional Services for Adults) Clinic at the University of Alabama at Birmingham Hospital serves underinsured individuals with heart failure (HF). We examined the differences in sociodemographic, clinical characteristics, and depression and anxiety among food secure and insecure patients who established care in clinic.

Methods:
Between May 2018 and December 2019, 291 patients established care in the HRTSA Clinic post-hospitalization. Patients were adults ≥18 years of age with heart failure. At the first clinic visit, baseline sociodemographic and medical history were obtained. Additionally, each patient was screened for depression using the Patient Health Questionaire-9 (PHQ-9) and anxiety using the General Anxiety Disorder-7 (GAD-7) questionnaire. Patients were also screened for food insecurity (FI) using the Hunger Vital Signs screener, a validated 2-item tool created for clinical settings to rapidly identify FI. Using descriptive statistics and t-tests, we compared demographic and clinical characteristics of FI and FS clinic patients.

Results:
Of the 291 newly referred patients seen in the HRTSA Clinic and screened for food insecurity, the mean age was 50 years, 58% were African American and 29% were female. A total of 80 patients (27%) screened positive for food insecurity. FI patients tended to be female (37% vs 27%, p=0.108) and African American (68% vs. 58%, p=0.142), although not statistically significant. FI patients had statistically significant higher depression scores and had anxiety scores that trended to higher values.

Conclusions:
Food insecurity, an important social determinant of health, is associated with more depression and anxiety. Depression and anxiety are important contributors to patient-centered outcomes for heart failure patients, specifically in underserved populations. This has implications for health care providers to implement screening interventions to improve mental health in underserved populations.
Abstract P208: The Differential Impact Of Residential Segregation On Gestational Hypertension Development Among Minority Women
Authors: Schiff Mary D , Fabio Anthony , Gary-Webb Tiffany , Mendez Dara
Published: May 2021

Introduction:
Higher levels of residential segregation have been associated with poorer cardiometabolic health profiles among women. Still, it remains unclear whether segregation may differentially impact the development of gestational hypertension (gHTN) among an ethnically-diverse cohort of pregnant women. We used birth record data from 2003-2009 and data from the 2000 US Census to determine whether racial and economic segregation are associated with gHTN among a diverse cohort of child-bearing women in the greater Philadelphia area.

Methods:
We quantified racial and economic segregation using sociodemographic data from the US Census and the local Getis-Ord (Gi*) spatial statistic. The Gi* produces a spatially-weighted z-score for each census tract reflecting the degree of clustering of racially-similar neighborhoods in an area relative to the surrounding Philadelphia region. We categorized each type of segregation as low (Gi*<0), moderate (Gi*0-1.96), or high (Gi*>1.96), and assigned these to each woman by her census tract of residence. Gestational hypertension was defined in the birth record data as the development of pregnancy-induced hypertension or preeclampsia. We used hierarchical generalized linear mixed effect models to obtain risk ratios and differences (per 1000 women) for the relationships between each form of residential segregation and gHTN. All models were stratified by maternal race/ethnicity, and sequentially adjusted for maternal sociodemographics, health behaviors, medical histories, and neighborhood-level characteristics.

Results:
Our sample consisted of 220,897 Non-Hispanic (NH) Black (26%), NH White (64%), and Hispanic (10%) women, of whom 4% developed gHTN. However, a much greater proportion of NH Black women both developed gHTN and lived in high segregation neighborhoods compared to NH Whites and Hispanics. After adjustment, NH Black women in moderate and high economic segregation areas had 16% higher risk (RR=1.16, 95% CI: 1.03-1.31) and 23% higher risk (RR=1.23, 95% CI: 1.08-1.39) of gHTN, respectively, compared to NH Black women living in low segregation areas. NH Black women in highly racially segregated neighborhoods saw an additional 9 cases of gHTN (per 1000 women) compared to NH Black women living in more racially integrated neighborhoods (RD=8.47, 95% CI: 3.14-13.80). Among NH White and Hispanic women, economic segregation was not associated with gHTN, and only marginally significant findings were observed for racial segregation.

Conclusions:
In our diverse sample of child-bearing women from the greater Philadelphia area, higher levels of racial and economic segregation were associated with greater risk of gHTN among NH Black women. Future work should seek to delineate the specific pathways by which neighborhoods differentially impact individual level cardiovascular health based upon race.
Abstract P213: Characterizing The Distribution Of Coronary Artery Calcification In The 75-and-older Population: The Atherosclerosis Risk In Communities Study
Authors: Wang Frances M , Cainzos-Achirica Miguel , Ballew Shoshana , Folsom Aaron R , Wagenknecht Lynne E , Howard-Claudio Candace M , Coresh Josef , Budoff Matthew J , Blaha Michael J , Matsushita Kunihiro
Published: May 2021

Introduction:
The coronary artery calcium (CAC) score is a strong predictor of atherosclerotic cardiovascular disease (ASCVD) events. Current clinical practice guidelines recommend using a CAC score of 100 or age-, sex-, and race-specific 75
th
percentile as thresholds of high risk for guiding preventive therapy for ASCVD. On the low end of the spectrum, zero CAC attracts attention as a potent negative predictor of ASCVD and may be used to “de-risk” individuals who may safely defer aggressive preventive therapy. However, due to sparse data on CAC in the age 75+ population, the value of these CAC thresholds in older adults is uncertain.

Objective:
To understand the distribution of CAC (75
th
percentile, CAC 100, and zero CAC) in adults aged 75+.

Methods:
We assessed 2,303 ARIC Visit 7 (2018-2019) participants age 75+ years without clinical coronary heart disease (CHD) who underwent CAC scanning (median age 80 years, 39% males). Demographic-specific percentiles of the CAC distribution across age were estimated nonparametrically with pooled residual ranking and locally weighted regressions.

Results:
Male-white and male-black participants had lower prevalence of zero CAC than female-white and female-black participants (4% and 10% versus 13% and 16%, respectively). CAC scores tended to increase with age across race and sex strata but appeared to peak at an old age threshold (between age~85-95) (
Figure
). Regardless of age, sex, and race, a majority of individuals in this age range had CAC >100 (
Figure
, green 50
th
percentile line exceeds red dashed CAC 100 line at most ages).

Conclusions:
In the largest US cohort of community-dwelling adults aged 75+ free of clinical CHD with CAC data, the prevalence of zero CAC was approximately 4-16%. We also confirmed a general age-dependent increase in CAC. Using CAC >100 as a threshold for high ASCVD risk would categorize the majority of older adults age 75+ as high risk. Alternatively, our demographic-specific CAC percentiles may be a valuable tool for interpreting CAC in the age 75+ population.
Abstract P214: Ideal Cardiovascular Health And Progression Of Extra-coronary Calcification In The Multi-ethnic Study Of Atherosclerosis
Authors: Ogunmoroti Oluseye , Osibogun Olatokunbo , Mathews Lena , Esuruoso Olumuyiwa A , Ndumele Chiadi E , Okunrintemi Victor , Burke Gregory L , Blumenthal Roger S , Budoff Matthew J , Michos Erin D
Published: May 2021

Background:
Ideal cardiovascular health (CVH) is associated with a lower incidence of cardiovascular disease (CVD). Extra-coronary calcification (ECC) – measured at the aortic valve (AVC), mitral annulus (MAC), ascending thoracic aorta (ATAC) and descending thoracic aortic (DTAC) – is an indicator of systemic atherosclerosis. However, the association between ideal CVH and ECC is unknown. This study examined whether favorable CVH was associated with a lower risk of ECC.

Methods:
We analyzed data from 6,504 men and women aged 45-84 years from MESA, a multi-ethnic cohort free of CVD at baseline. Extra-coronary calcification [AVC, MAC, ATAC and DTAC] was measured by non-contrast cardiac CT scan at baseline and after an average of 2.4 years. Prevalent and incident ECC were defined as an Agatston score >0. Each CVH metric (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) was scored 0-2 points, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. The maximum CVH score attainable ranged from 0-14 points (inadequate score: 0-8; average: 9-10; optimal: 11-14). We used Poisson regression and linear mixed-effect models to examine the association between CVH and ECC adjusted for age, sex, race/ethnicity, education, income, health insurance and study site.

Results:
The mean (SD) age of participants was 62 (10) years, 53% were women, 39% White, 12% Chinese American, 26% Black and 22% Hispanic. Optimal and average CVH scores were associated with a lower prevalence and incidence of ECC as well as lower ECC extent at baseline compared to inadequate scores
(Table).
In addition, optimal and average CVH scores were associated with less ECC progression at 2 years although the associations were only significant for MAC and DTAC.

Conclusion:
In this multi-ethnic cohort, favorable CVH was associated with a lower risk of developing extra-coronary atherosclerosis. These findings underscore the importance of primordial prevention as an intervention to reduce the burden of CVD.
Abstract P218: The Association Of Mid-life Cumulative Exposure To Systolic Blood Pressure, Myocardial Oxygen Demand, And Hypertension With Later-life Central Arterial Stiffness And Its 5-year Change: The Atherosclerosis Risk In Communities Study - Neurocognitive Study (ARIC-NCS)
Authors: Meyer Michelle L , Saraiya Veeral , Tanaka Hirofumi , Palta Priya , Hughes Timothy M , Kucharska-newton Anna , Wei Jingkai , Matsushita Kunihiro , Folsom Aaron R , Hoogeveen Ron C , Heiss Gerardo M
Published: May 2021

Background:
Greater central artery stiffness predicts cardiovascular disease and all-cause mortality, thus understanding arterial stiffness determinants has prevention implications. Reports of the temporal association of blood pressure with arterial stiffness are conflicting and the association with myocardial oxygen demand has not been evaluated.

Objective:
Characterize the association of mid- to later-life cumulative exposure to systolic blood pressure (SBP), myocardial oxygen demand, and hypertension (HTN) with arterial stiffness and its 5-year change in older adults.

Methods:
We included 1,975 adults (1151 women; 359 Black; visit 5 mean age 74 years) examined in visits 5 (2011-13) and 6 or 7 (2016-19) of the population-based ARIC-NCS with measures of arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)). Higher cfPWV indicates greater arterial stiffness. We calculated cumulative exposures as the sum of averages from four consecutive visits from 1987-89 to 1996-98 divided by total time. Myocardial oxygen demand was calculated as the rate pressure product (RPP): (SBP x heart rate)/1,000. We derived HTN duration as the time since first HTN detection. Associations of cumulative exposures with visit 5 cfPWV and the 5-year cfPWV change were evaluated by multivariable linear regression adjusted for demographics and cardiometabolic factors.

Results:
Over the mean 5.7 years between visits 5 and 6 or 7, cfPWV increased by 144.9 cm/s (SD: 276.0; range -680.0, 961.5 cm/s). HTN at any visit, duration, and the time-weighted cumulative measures were associated with higher visit 5 cfPWV (Table). Prevalent HTN was inversely associated with cfPWV change. No statistically significant associations were observed for the other exposures and cfPWV change.

Conclusion:
Cumulative exposure to SBP, RPP, and HTN are modifiable traits associated with higher cfPWV at later-life, but not with rate of cfPWV change in older adulthood. HTN at visit 5 was associated with lower cfPWV change, albeit the change is of small magnitude.
Abstract P219: Association Of Age At Menopause And Reproductive Years With Arterial Stiffness And Its 5-year Change: The Atherosclerosis Risk In Communities - Neurocognitive Study (ARIC-NCS)
Authors: Jayawickreme Shantal , Bonner Alison N , Malek Angela M , Vladutiu Catherine J , Oliver-Williams Clare , Cortes Yamnia I , Tanaka Hirofumi , Meyer Michelle L
Published: May 2021

Introduction:
Early age at menopause is posited to increase cardiovascular disease (CVD) risk. However, studies examining the association with arterial stiffness, a predictor of CVD, are inconsistent and cross-sectional.

Hypothesis:
Earlier age at menopause and shorter reproductive years in women are associated with higher arterial stiffness and greater 5-year change at later life.

Methods:
We included 1,084 women in ARIC-NCS (mean 74 years at visit 5) with measures of arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)) at visit 5 (2011-13) and visit 6 or 7 (2016-19). At visits 1-4, women self-reported age at first menses, age at menopause, and hysterectomy with and without bilateral oophorectomy. We defined menopause type as natural, surgical, and unknown, which included women with a hysterectomy, but unknown ovarian status. Multivariable linear regression was used to evaluate associations of age at menopause, early age at menopause (<45 years vs. ≥45 years), and reproductive years (age at menopause - age at first menses) with visit 5 cfPWV and cfPWV change between visit 5 and 6 or 7, adjusting for demographics and cardiometabolic risk factors.

Results:
The average age at menopause was 46.2 years, and 319 (29.4%) women had early age at menopause. No statistically significant associations were observed for age at menopause and reproductive years with either visit 5 cfPWV or cfPWV change. However, the associations with cfPWV change differed by menopause type (Table). Age at menopause and reproductive years were inversely associated with cfPWV change in women with natural menopause but were positively associated with cfPWV change in women with surgical menopause.

Conclusion:
At later life, age at menopause and reproductive years are not strongly associated with arterial stiffness, although the change in arterial stiffness differs by menopause type. Longitudinal arterial stiffness measures among women at mid-life is needed to understand the effect of natural versus surgical menopause on arterial stiffness.
Randomized Placebo-Controlled Trial of Ferric Carboxymaltose in Heart Failure With Iron Deficiency: Rationale and Design
Authors: Mentz Robert J. , Ambrosy Andrew P. , Ezekowitz Justin A. , Lewis Gregory D. , Butler Javed , Wong Yee Weng , De Pasquale Carmine G. , Troughton Richard W. , O’Meara Eileen , Rockhold Frank W. , Garg Jyostna , Samsky Marc D. , Leloudis Dianne , Dugan Michael , Mundy Linda M. , Hernandez Adrian F. ,   on behalf of the HEART-FID Trial Investigators
Published: May 2021

Background:

Iron deficiency (ID) has a prevalence of ≈40% to 50% among patients in heart failure (HF) with reduced ejection fraction and is associated with worse prognosis. Several trials demonstrated that intravenous ferric carboxymaltose leads to early and sustained improvement in patient-reported outcomes and functional capacity in patients with HF with reduced ejection fraction with ID, yet morbidity and mortality data are limited.

Methods:

The objective of the HEART-FID trial (Ferric Carboxymaltose in Heart Failure With Iron Deficiency) is to assess efficacy and safety of ferric carboxymaltose compared with placebo as treatment for symptomatic HF with reduced ejection fraction with ID. HEART-FID is a multicenter, randomized, double-blind, placebo-controlled trial enrolling ≈3014 patients at ≈300 international centers. Eligible patients are aged ≥18 years in stable chronic HF with New York Heart Association functional class II to IV symptoms, ejection fraction ≤40%, ID (ferritin <100 ng/mL or ferritin 100–300 ng/mL with a transferrin saturation <20%), and documented HF hospitalization or elevated N-terminal pro-brain natriuretic peptide. Consented patients are assigned to ferric carboxymaltose or placebo at baseline, with repeated visits/assessments every 6 months for additional study drug based on hemoglobin and iron indices for the trial duration. The primary end point is a hierarchical composite of death and HF hospitalization at 12 months and change from baseline to 6 months in the 6-minute walk test distance.

Conclusions:

The HEART-FID trial will inform clinical practice by clarifying the role of long-term treatment with intravenous ferric carboxymaltose, added to usual care, in ambulatory patients with symptomatic HF with reduced ejection fraction with ID.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03037931.
Detrimental Immediate- and Medium-Term Clinical Effects of Right Ventricular Pacing in Patients With Myocardial Fibrosis
Authors: Saunderson Christopher E.D. , Paton Maria F. , Brown Louise A.E. , Gierula John , Chew Pei G. , Das Arka , Sengupta Anshuman , Craven Thomas P. , Chowdhary Amrit , Koshy Aaron , White Hazel , Levelt Eylem , Dall’Armellina Erica , Garg Pankaj , Witte Klaus K. , Greenwood John P. , Plein Sven , Swoboda Peter P.
Published: May 2021

Background:

Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients. We aimed to establish whether patients with focal fibrosis detected on late gadolinium enhancement cardiovascular magnetic resonance (CMR) have deterioration in LV function after RV pacing.

Methods:

We recruited 84 patients with LV ejection fraction ≥40% into 2 observational CMR studies. Patients (n=34) with a dual-chamber device and preserved atrioventricular conduction underwent CMR in 2 asynchronous pacing modes (atrial asynchronous and dual-chamber asynchronous) to compare intrinsic atrioventricular conduction with forced RV pacing. Patients (n=50) with high-grade atrioventricular block underwent CMR before and 6 months after pacemaker implantation to investigate the medium-term effects of RV pacing.

Results:

The key findings were (1) initiation of RV pacing in patients with fibrosis, compared with those without, was associated with greater immediate changes in both LV end-systolic volume index (5.3±3.5 versus 2.1±2.4 mL/m
2
;
P
<0.01) and LV ejection fraction (−5.7±3.4% versus −3.2±2.6%;
P
=0.02); (2) medium-term RV pacing in patients with fibrosis, compared with those without, was associated with greater changes in LV end-systolic volume index (8.0±10.4 versus −0.6±7.3 mL/m
2
;
P
=0.008) and LV ejection fraction (−12.3±7.9% versus −6.7±6.2%;
P
=0.012); (3) patients with fibrosis did not experience an improvement in quality of life, biomarkers, or functional class after pacemaker implantation; (4) after 6 months of RV pacing, 10 of 50 (20%) patients developed LV ejection fraction <35% and were eligible for upgrade to cardiac resynchronization according to current guidelines. All 10 patients had fibrosis on their preimplant baseline scan and were identified by >1.1 g of fibrosis with 90% sensitivity and 70% specificity.

Conclusions:

Fibrosis detected on CMR is associated with immediate- and medium-term deterioration in LV function following RV pacing and could be used to identify those at risk of heart failure before pacemaker implantation.
Aspirin Versus Clopidogrel as Single Antithrombotic Therapy After Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry
Authors: Kobari Yusuke , Inohara Taku , Saito Tetsuya , Yoshijima Nobuhiro , Tanaka Makoto , Tsuruta Hikaru , Yashima Fumiaki , Shimizu Hideyuki , Fukuda Keiichi , Naganuma Toru , Mizutani Kazuki , Yamawaki Masahiro , Tada Norio , Yamanaka Futoshi , Shirai Shinichi , Tabata Minoru , Ueno Hiroshi , Takagi Kensuke , Watanabe Yusuke , Yamamoto Masanori , Hayashida Kentaro
Published: May 2021

Background:

Current guidelines recommend dual antiplatelet therapy for the first 1 to 6 months after transcatheter aortic valve replacement (TAVR); however, recent studies have reported better outcomes with single antiplatelet therapy than with dual antiplatelet therapy in the occurrence of bleeding events, while not increasing thrombotic events. However, no data exist about optimal single antiplatelet therapy following TAVR.

Methods:

Patients who underwent TAVR between October 2013 and May 2017 were enrolled from the OCEAN-TAVI Japanese multicenter registry (Optimized Transcatheter Valvular Intervention). After excluding 1759 patients, 829 who received aspirin (100 mg/d) or clopidogrel (75 mg/d) after TAVR were identified and stratified according to the presence or absence of anticoagulation. Propensity score matching was performed to adjust the baseline characteristics between the aspirin and clopidogrel groups. Outcomes of interest were all-cause and cardiovascular deaths, stroke, and life-threatening or major bleeding within 2 years following TAVR.

Results:

After propensity score matching, 98 and 157 pairs of patients without and with anticoagulation, respectively, were identified. Falsification end points of pneumonia, urinary tract infection, and hip fracture were evaluated, and their rates were not different between groups. All-cause deaths were not statistically different between the groups in patients with (aspirin, 17.5%; clopidogrel, 11.1%; log-rank
P
=0.07) and without (aspirin, 29.6%; clopidogrel, 20.1%; log-rank
P
=0.15) anticoagulation at 2 years post-TAVR, whereas clopidogrel was associated with a lower cardiovascular mortality at 2 years in patients with (aspirin, 8.5%; clopidogrel, 2.7%; log-rank
P
=0.03) and without (aspirin, 18.0%; clopidogrel, 5.2%; log-rank
P
=0.02) anticoagulation.

Conclusions:

We demonstrated that clopidogrel monotherapy was associated with a lower incidence of cardiovascular death compared with aspirin monotherapy during the 2-year follow-up after TAVR regardless of anticoagulation use.

Registration:

URL:
https://upload.umin.ac.jp
; Unique identifier: UMIN000020423.
Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: A Health Economic Analysis
Authors: Zhou Jennifer , Liew Danny , Duffy Stephen J. , Shaw James , Walton Antony , Chan William , Gerber Robert , Stub Dion
Published: May 2021

Background:

There is increasing evidence that use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography guidance alone. However, concern regarding the cost-effectiveness of IVUS has limited use of this technology worldwide. In this study, we aimed to evaluate the cost-effectiveness of IVUS-guided PCI compared with angiography-guided PCI in patients undergoing drug-eluting stent implantation.

Methods:

A decision-analytic Markov model was constructed to compare the cost-effectiveness of IVUS to angiography guidance from the Australian healthcare system perspective. Procedure-related morbidity and mortality were estimated from the literature. Costs were obtained from Australian sources. The population of interest was all-comers undergoing PCI with drug-eluting stent. Outcomes of interest included costs, life-expectancy, and quality-adjusted life years (QALYs) for both treatment groups.

Results:

In the base case, IVUS guidance was cost-effective compared with angiography guidance alone. With 5% annual discounting, IVUS was associated with increased lifetime costs of Australian dollars (AUD) $823 (USD $597) per person and benefits of 0.04 life years and 0.05 QALYs compared with angiography, yielding an incremental cost-effectiveness ratio of AUD $17 539 (USD $12 730) per QALY gained. Results were robust to sensitivity analyses, with IVUS being cost-effective in 99% of 10 000 Monte Carlo iterations assuming a willingness-to-pay threshold of AUD $50 000 per QALY gained. In a worst-case scenario analysis, IVUS remained the cost-effective option, with an ICER of AUD $36 651 (USD $26 601) per QALY gained. Exploratory subgroup analysis revealed that cost-effectiveness may be greatest among patients with left main and complex coronary lesions.

Conclusions:

Use of IVUS guidance during PCI is likely to be cost-effective compared with angiography guidance alone among patients undergoing drug-eluting stent implantation.
The Expected Number of Viable Autocatalytic Sets in Chemical Reaction Systems
Authors: Kauffman Stuart , Steel Mike
Published: May 2021

The emergence of self-sustaining autocatalytic networks in chemical reaction systems has been studied as a possible mechanism for modeling how living systems first arose. It has been known for several decades that such networks will form within systems of polymers (under cleavage and ligation reactions) under a simple process of random catalysis, and this process has since been mathematically analyzed. In this paper, we provide an exact expression for the expected number of self-sustaining autocatalytic networks that will form in a general chemical reaction system, and the expected number of these networks that will also be uninhibited (by some molecule produced by the system). Using these equations, we are able to describe the patterns of catalysis and inhibition that maximize or minimize the expected number of such networks. We apply our results to derive a general theorem concerning the trade-off between catalysis and inhibition, and to provide some insight into the extent to which the expected number of self-sustaining autocatalytic networks coincides with the probability that at least one such system is present.
The Epidemic of Mental Disorders in Business—How Depression, Anxiety, and Stress Spread across Organizations through Employee Mobility*
Authors: Kensbock Julia M. , Alkærsig Lars , Lomberg Carina
Published: May 2021

Combining management research with infectious disease epidemiology, we propose a new perspective on mental disorders in a business context. We suggest that—similar to infectious diseases—clinical diagnoses of depression, anxiety, and stress-related disorders can spread epidemically across the boundaries of organizations via social contagion. We propose a framework for assessing the patterns of disease transmission, with employee mobility as the driver of contagion across organizations. We empirically test the proposed mental disorder transmission patterns by observing more than 250,000 employees and more than 17,000 Danish firms over a period of 12 years. Our findings reveal that when organizations hire employees from other, unhealthy organizations (those with a high prevalence of mental disorders), they “implant” depression, anxiety, and stress-related disorders into their workforces. Employees leaving unhealthy organizations act as “carriers” of these disorders regardless of whether they themselves have received a formal diagnosis of a mental disorder. The effect is especially pronounced if the newcomer holds a managerial position.
Nature Contact in the Carceral Workplace: Greenspace and Staff Sickness Absence in Prisons in England and Wales
Authors: Moran Dominique , Jones Phil I. , Jordaan Jacob A. , Porter Amy E.
Published: May 2021

This paper demonstrates for the first time that prisons with a higher proportion of natural vegetation within their perimeter have lower levels of staff sickness absence. It makes three significant contributions. First, it extends studies of workplace nature contact into the un-researched carceral context. Second, whereas previous workplace nature contact studies have largely utilized single-site surveys, it presents national-level, statistically robust analysis. Third, it brings a novel new perspective to studies of sickness absence within correctional workforces, by considering the effect of the physical environment. Econometric estimations presented in the paper confirm lower levels of staff sick-leave in prisons with more greenspace. This relationship persists when we control for prison size, security level, age, level of crowding, levels of self-harm and violence among prisoners, and assaults against staff. The findings are significant in demonstrating the benefits of nature contact in workplaces in general, and carceral environments in particular. Importantly, this has the potential to influence future prison design.
Biological requirements or social expectations? Entanglements of sex and gender in nutrition policies in Ontario secondary schools
Authors: Gray Sarah
Published: May 2021

Objectives:

An increasing number of nutrition policies have been implemented in Ontario schools as part of a concerted effort to address students’ well-being. This article explores understandings of biological differences in nutrition requirements between young men and women and the extent to which these differences are (re)produced in social eating behaviours and food pedagogies.

Setting:

A suburban school (grades 9–12) located in the Greater Toronto-Hamilton Area in Ontario, Canada.

Method:

Critical policy analysis combined with 13 focus groups of students (13–18 years old) in one Ontario school. A biopedagogical lens was used to analyse how young people develop and deploy their own reasoning and question the messages they receive about expected behaviour.

Results:

Focus group discussions suggest that dominant discourses and constructions about sex/gender are reproduced within the school environment, which has implications for the effectiveness of nutrition policies in schools. Furthermore, differences between young men and women’s eating behaviours were found to be contradictory to biopedagogical instructions from educational institutions and governmental agencies. For some young people, the pedagogical messages received are limited in their effectiveness because young people have not been convinced that it is worth risking their social status or because their content is contrary to messages received from media or their peers.

Conclusion:

Incorporating student voice in the creation of educational policy will assist health educators and school officials to understand sex/gender influences on the behaviour of students in terms of financial considerations, peer influence and social image. Optimising student voice to understand how they themselves may contribute to the implementation of policies will in turn increase the policies’ effectiveness.
Framing national security secrecy: A conceptual review
Authors: Heide Marlen , Villeneuve Jean-Patrick
Published: May 2021

This essay investigates justifications for the “necessity” of official secrecy, by tracing and structuring the rationales underlying it. Justifications will be investigated through the case of “national security secrecy,” a prominent example of official secrecy. While the literature generally treats “national security secrecy” as unidimensional, this analysis demarcates several distinct rationales. Specifically, three justifications for national security secrecy are identified: the logic of crisis demanding the suspension of normal democratic processes (threat frame); the need for enabling and enhancing governance (effectiveness frame); and the delegation to and protection of decision makers (elite governance frame). The paper illustrates possible frictions, overlaps, and synergies between different rationales for national security secrecy, thus broadening the existing conceptualization away from transparency and secrecy as direct opposites. It further contributes to ongoing research on national security secrecy from a frame analysis perspective, thus linking theories, justifications, and practices of secrecy.
The geopolitics of Pakistan’s 2018 greylisting by the Financial Action Task Force
Authors: Shah Abdur Rehman
Published: May 2021

This article argues that, in addition to the valid reasons for Pakistan’s greylisting by the Financial Action Task Force (FATF) in 2018, geopolitical dynamics also played a crucial role behind this development. While the United States (US) under the Trump administration pushed Pakistan to seek an end to “the longest war” in Afghanistan, India, hoping to curb cross-border terrorism, capitalized on this momentum to pressure Pakistan. In order to hastily greylist Pakistan, institutional procedures of the FATF were thus disregarded. The case study demonstrates how economic coercion was used to push Pakistan to accept US and FATF demands. This article argues that Pakistan’s greylisting has created a win-for-all scenario for now. But these gains should not be overrated. Pakistan’s implementation of FATF requirements faces significant structural limitations. Still, the consensus between major actors underscores the potential of the FATF to counter money laundering and financing of terrorism globally.
Mental Fatigue From Smartphone Use Reduces Volume-Load in Resistance Training: A Randomized, Single-Blinded Cross-Over Study
Authors: Gantois Petrus , Lima-Júnior Dalton de , Fortes Leonardo de Sousa , Batista Gilmário Ricarte , Nakamura Fábio Yuzo , Fonseca Fabiano de Souza
Published: May 2021

We investigated the acute effects of mental fatigue induced by 30-minute use of smartphone social network apps on volume load in resistance training among recreationally trained adults. Sixteen (n = 16) adults of both sexes performed three sets of a half back-squat exercise to failure with 80% of 15RM, interspersed with 3-minutes of passive recovery between sets, before and after two different cognitive tasks: (a) use of smartphone social network apps; and (b) watching a documentary. We assessed mechanical variables and ratings of perceived exertion during the strength exercise. Relative to the documentary-viewing control condition, a 30-minute exposure to smartphone social network apps led participants toward increased perception of mental fatigue ( p = 0.004) and lower volume-load during the strength exercise ( p = 0.006). There were no significant differences in perceived exertion between conditions ( p = 0.54), participants’ motivation ( p = 0.277), intra-set mechanical variables ( p > 0.05), or blood lactate concentrations ( p = 0.36). Our findings of an isolated possible higher-than normal RPE without changes in physiological variables, accompanying the lower volume-load in the mentally-fatigued participants support psychological, rather than physiological, bases for mental fatigue effects.
The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: The EACG study
Authors: Chen Yu , Feng Fang , Chang Xue-ni , Liu Dong , Yuan Yuan , Li Min , Mu Chenghua
Published: May 2021

To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province. This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Univariate and multivariate logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. (2) Logistic regression analysis showed that sex, age, AKI stage, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time, and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury ( p < 0.05). Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high.

Trial registration: the Chinese Clinical Trial Registry number is ChiCTR1800016945. Date of registration: 4 July 2018.
Conventional, diffusion, and dynamic contrast-enhanced MRI findings for differentiating metaplastic Warthin’s tumor of the parotid gland
Authors: Jia Chuan-Hai , Wang Sheng-Yu , Li Qin , Qiu Jia-Ming , Kuai Xin-Ping
Published: May 2021

The purpose of this study was to explore conventional, diffusion, and dynamic contrast-enhanced MRI (DCE-MRI) characteristics for differentiating metaplastic Warthin’s tumor (MWT) from other tumor types of the parotid gland, including non-metaplastic Warthin’s tumor (non-MWT), pleomorphic adenoma (PA), and malignant tumor (MT). A total of 178 patients with histologically proven tumors of the parotid gland, including 21 MWTs, 49 non-MWTs, 66 PAs, and 42 MTs, were enrolled in the study. Conventional MRI was performed in all patients. One hundred and fifty patients had preoperative diffusion-weighted MR imaging (DWI), and 62 patients had preoperative DCE-MRI. The differences in the conventional, DCE-MRI, and DWI records between MWTs and the other three tumor types were statistically evaluated. Compared with non-MWTs and PAs, there was a statistically significant difference in circumscription ( p < 0.01). The ill-defined circumscription was more common in MWTs than non-MWTs and PAs. Compared with PAs, there was a statistically significant difference in morphology ( p < 0.05). The lobulated morphology was more common in PAs than MWTs. Compared with PAs and MTs, there was a statistically significant difference in the T2 signal of the solid component ( p < 0.01). The T2 moderate intensity of solid components was more common in MWTs than PAs and MTs. The solid components of PAs mostly showed hyperintense on T2-weighted imaging. Cyst/necrosis was more common in MWTs than PAs and MTs. Hyperintense of cyst/necrosis was more common in MWTs and non-MWTs. With respect to contrast enhancement, 52.4% MWTs exhibited moderate or marked enhancement, and most non-MWTs (81.6%) exhibited mild enhancement. Most PAs (84.8%) exhibited marked enhancement. The mean ADC value of MWTs (0.94 × 10−3 ± 0.11 mm2/s) was signiﬁcantly lower than that of the PAs (1.60 × 10−3 ± 0.17 mm2/s) ( p < 0.001). On DCE-MRI, six of eight MWTs demonstrated TIC of type B. Although MWT is rare, conventional MRI characteristics, DWI and DCE-MRI can provide useful information for differentiating MWT from other parotid mass.
Investigation of e-textile dipole antenna performance based on embroidery parameters
Authors: Agu Daniel , Eike Rachel J , Cliett Allyson , Michaelson Dawn , Cloud Rinn , Li Yang
Published: May 2021

E-textile antennas have the potential to be the premier on-body wearable sensor. Embroidery techniques, which can be applied to produce e-textile antennas, assist in large production volumes and fast production speeds. This paper focuses on the effects of three commonly used embroidery parameters, namely stitch type, conductive thread location, and stabilizer, on the performance of embroidered dipole antennas in order to determine the ideal embroidery combination for optimal antenna performance. Fifty-four dipole antenna samples were fabricated and measured at the industrial, scientific, and medical (ISM) frequency band of 2.45 GHz. The results of this study show that machine-embroidered antenna designs with satin stitches resonate at a lower frequency and exhibit a lower transmission gain compared with those made with contour stiches, and the conductive thread location in the bobbin location plus the use of a water-soluble stabilizer can help improve impedance matching.
Sankofa: A Testimony of the Restorative Power of Black Activism in the Self-Care Practices of Black Activists
Authors: Hickson Joniesha M. , Paul Roddia J. , Perkins Aneesha C. , Anderson Chiquanna R. , Pittman Delishia M.
Published: May 2021

The current study investigates the relationship between Black activism and self-care among five Black womxn scholar-activists. Through collaborative autoethnography, we demonstrate that one byproduct of our Black activism is a cultural-relevant form of self-care that works to buffer the psychological impacts of racism and other forms of oppression. Findings suggest that our pathway to Black activism involves an “awakening,” which furthers identity development, and facilitates connectedness and self-love, underscores the salience of representation, and creates opportunity for broad social and structural change. This is to suggest that despite the potential deleterious psychophysiological consequences that accompany the engagement in activism, we have identified five unintended self-care benefits that play a central role in bolstering activists’ psychological well-being.
The implications of migration policies on migrant worker mixed families: The case of Filipinos in Israel
Authors: Babis Deby
Published: May 2021

The ever-growing worldwide phenomenon of transnational labor migration has resulted in the increase of families formed by migrant workers in destination countries. While scholarly attention has mainly focused on the transnational families of migrant workers, the formation of mixed families involving migrants in host countries has rarely been studied. Based on a qualitative and quantitative study of the Filipino migrant worker community in Israel, this paper explores the dynamics of mixed families within this community. The family formation of Filipino migrants in Israel reveals two main categories of mixed families: one consisting of a migrant worker and a local citizen, and the other consisting of two migrant workers of different origins. I proposed the terminologies “suspect mixed families” and “fragile mixed families” to emphasize the crucial impact of migration policies on the dynamics of these families.
Acculturation and Subsequent Oral Health Problems Among Foreign-Born Older Chinese Americans: Does Neighborhood Disorder Matter?
Authors: Mao Weiyu , Wu Bei , Chi Iris , Yang Wei , Dong XinQi
Published: May 2021

Objectives:

To investigate the relationship between acculturation and subsequent oral health problems in older Chinese Americans and to further test the moderating role of neighborhood disorder in such a relationship.

Methods:

The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at baseline between 2011 and 2013 and the 2-year follow-up between 2013 and 2015. Stepwise Poisson regressions with lagged dependent variable were conducted.

Results:

Behavioral acculturation was protective against subsequent oral health problems, and the protective role was stronger among individuals reporting lower levels of neighborhood disorder. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems.

Discussion:

To reduce oral health symptoms and related burdens, it is important to consider, in practice and policy, the role of acculturation and the neighborhood on subsequent oral health outcomes.
Orientalism is not my opinion: Decolonial teaching and the problem of credibility in IR courses with a MENA focus
Authors: Díaz Sanz Marina , Ferreiro Prado Lucía
Published: May 2021

Teaching about the Middle East and North Africa (MENA) region in politics or international studies courses in ‘the West’ is challenging due to the many stereotypes that inform students’ imagination. A common pedagogical purpose is to help students recognise their biases and work through them. This often renders the classroom a controversial place and the teacher suspect of lack of objectivity. The specialised literature points at ‘cognitive dissonance’ as an intervening factor. On occasions, cognitive dissonance leads to harm on teachers’ credibility. This article evaluates the question of credibility in two activities developed in International Relations (IR) undergraduate courses with a MENA focus, where students had to identify the impact of ‘Orientalism’ in the film Argo and in analyses of the ‘Arab Spring’. The article argues that to fully grasp episodes of cognitive dissonance and attending problems of teacher credibility, the disciplinary context in which learners are socialised into needs to be considered – in this case, IR. The article advocates the articulation of a student-centred decolonial teaching pedagogy that renders subjectivity an object of learning and, at the same time, prepares students to understand the potentialities and weaknesses of different IR paradigms.