bluuebunny/crossref_metadata_2025 huggingface dataset:
A Robust Invariant Local Feature Matching Method for Changing Scenes
Authors: Wang Di , Zhang Hongying , Shao Yanhua
Published: December 2021

The precise evaluation of camera position and orientation is a momentous procedure of most machine vision tasks, especially visual localization. Aiming at the shortcomings of local features of dealing with changing scenes and the problem of realizing a robust end‐to‐end network that worked from feature detection to matching, an invariant local feature matching method for changing scene image pairs is proposed, which is a network that integrates feature detection, descriptor constitution, and feature matching. In the feature point detection and descriptor construction stage, joint training is carried out based on a neural network. In the feature point extraction and descriptor construction stage, joint training is carried out based on a neural network. To obtain local features with solid robustness to viewpoint and illumination changes, the Vector of Locally Aggregated Descriptors based on Neural Network (NetVLAD) module is introduced to compute the degree of correlation of description vectors from one image to another counterpart. Then, to enhance the relationship between relevant local features of image pairs, the attentional graph neural network (AGNN) is introduced, and the Sinkhorn algorithm is used to match them; finally, the local feature matching results between image pairs are output. The experimental results show that, compared with the existed algorithms, the proposed method enhances the robustness of local features of varying sights, performs better in terms of homography estimation, matching precision, and recall, and when meeting the requirements of the visual localization system to the environment, the end‐to‐end network tasks can be realized.
Immune Score Predicts Outcomes of Gastric Cancer Patients Treated with Adjuvant Chemoradiotherapy
Authors: Zou Wei , Zhou Meng-long , Zhang Ling-yi , Yang Jia-ning , Yang Wang , Wang Ya-qi , Yi Yu-xi , Li Gui-chao , Zhang Zhen
Published: December 2021

Background. Substantial evidence has demonstrated that tumor-infiltrating lymphocytes (TILs) are correlated with patient prognosis. The TIL-based immune score (IS) affects prognosis in various cancers, but its prognostic impact in gastric cancer (GC) patients treated with adjuvant chemoradiotherapy remains unclear. Methods. A total of 101 GC patients who received chemoradiotherapy after gastrectomy were retrospectively analyzed in this study. Immunohistochemistry staining for CD3+ and CD8+ T-cell counts in both tumor center (CT) and invasive margin (IM) regions was built into the IS. Patients were then divided into three groups based on their differential IS levels. The correlation between IS and clinical parameters was analyzed. The prognostic impact of IS and clinical parameters was evaluated using Kaplan–Meier analysis and Cox proportional hazard regression analysis. Receiver operating characteristic (ROC) curves were plotted to compare the area under the curve (AUC) of IS with other clinical parameters. Nomograms for disease-free survival (DFS) and overall survival (OS) prediction were constructed based on the identified parameters. Results. Finally, 20 (19.8%), 57 (56.4%), and 24 (23.8%) GC patients were identified with low, intermediate, and high IS levels, respectively. GC patients with higher IS levels exhibited better DFS (

p

 < 0.001) and OS (

p

 < 0.001). IS was an independent prognostic factor for both DFS (

p

 < 0.001) and OS (

p

 < 0.001) in multivariate analysis. IS presented a better predictive ability than the traditional pathological tumor-node-metastasis (pTNM) staging system (AUC: 0.801 vs. 0.677 and 0.800 vs. 0.660, respectively) with respect to both DFS and OS. The C-index of the nomograms for DFS and OS prediction was 0.737 and 0.774, respectively. Conclusions. IS is a strong predictive factor for both DFS and OS in GC patients treated with adjuvant chemoradiotherapy, which may complement the traditional pTNM staging system.
Toward Understanding of Suicidality in a Spanish Clinical Population: Validation of the European Spanish Version of the Interpersonal Needs Questionnaire
Authors: Canal-Rivero Manuel , Silva Caroline , Obiols-Llandrich Jordi E. , García-Bernal Cristina , García-Sanchez Cándido , Bustos-Cardona Tatiana , Joiner Thomas E. , Crespo-Facorro Benedicto , Ruiz-Veguilla Miguel
Published: December 2021

Introduction: Suicidal ideation (SI) represents one of the most prominent predictors of suicidal behavior (SB). The Interpersonal Needs Questionnaire (INQ) was developed from the Interpersonal Theory of Suicide (ITS) to assess the 2 core drivers of SI proposed by the theory. Despite the relevance of suicide-related ideations and ITS, there is a lack of psychometric measures validated in clinical Spanish population that adequately evaluate SI components of ITS. Thus, the main aim of the study was to validate INQ-10 in a Spanish clinical sample including the genuine cultural and linguistic characteristics of European Spanish. Methods: 315 participants were included in the analyses; 149 of them consulted mental health services for the presence of suicide-related behaviors. A series of exploratory and confirmatory factor analyses were carried out to identify the factor solution. Bivariate and multivariate analyses were used to analyze psychometric properties. Finally, sensitivity and specificity properties were explored through receiver-operating characteristic analyses which also provided the cut-off values of the questionnaire. Results: An 8-item version demonstrated a good fit to the 2-factor solution. Likewise, this 8-item version showed good psychometric properties. Sensitivity and specificity indices of the version validated as well as the calculated cut-off points were excellent. Conclusions: The current results demonstrate the utility of an 8-item INQ European Spanish version as a valid measure of the current SI in Spanish clinical population. In addition, the validated form reflects the theoretical framework on which it was built.
Take-Home Naloxone and the Prevention of Deaths from Heroin Overdose: Pursuing Strong Science, Fuller Understanding, Greater Impact
Authors: Strang John
Published: December 2021

Background and Context: Realization of the life-saving potential of “take-home naloxone” has been a personal journey, but it has also been a collective journey. It has been a story of individual exploration and growth, and also a story of changes at a societal level. “Take-home naloxone” has matured since its first conceptualization a quarter of a century ago. It required recognition of the enormous burden of deaths from drug overdose (particularly heroin and other opioids), and also realization of critical clusterings (such as post-release from prison). It also required realization that, since many overdose deaths are witnessed, we can potentially prevent many deaths by mobilizing drug users themselves, their families, and the wider caring community to act as intervention workforce to give life-saving interim emergency care. Summary of Scope: This article explores 5 areas (many illustrations UK-based where the author works): firstly, the need for strong science; secondly, our improved understanding of opioid overdose and deaths; thirdly, the search for greater impact from our policies and interventions; fourthly, developing better forms of naloxone; and fifthly, examining the challenges still to be addressed. Key Messages: “Take-home naloxone” is an exemplar of harm reduction with potential global impact – drug policy and practice for the public good. However, “having the potential” is not good enough – there needs to be actual implementation. This will be easier once the component parts of “take-home naloxone” are improved (better naloxone products, better training aids, revised legislation, and explicit funding support). Many improvements are already possible, but we hesitate about implementation. It is our responsibility to drive progress faster. With “take-home naloxone,” we can be proud of what we have achieved, but we must also be humble about how much more we still need to do.
Acute Lymphoblastic Leukemia Relapse Limited to the Anterior Chamber of the Eye and Treated with Novel CAR T-Cell Therapy
Authors: Gomel Nir , Levinger Eliya , Ram Ron , Limon Dror , Habot-Wilner Zohar
Published: December 2021

Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the blood stem cells, characterized by increased formation of immature lymphocytes. Ocular manifestations may vary with ocular, adnexal, and orbital involvement. In this case report, we describe the first case of extramedullary relapse of ALL limited to the anterior chamber of the eye treated with the novel chimeric antigen receptor T (CAR T)-cell therapy and provide a literature review of cases of ALL relapse in the anterior chamber. A 21-year-old male with a history of B-cell ALL presented with a unilateral blurry vision in his left eye. Ocular examination revealed the presence of cells +3 in the anterior chamber and a 1.5-mm hypopyon. Anterior chamber aspiration confirmed a B-ALL relapse. The patient was successfully treated with radiotherapy of his left eye and received CTL-019 transduced T cells (tisagenlecleucel; Novartis) with cytarabine as a bridging chemotherapy treatment. On the last examination, 18 months after the first presentation, the patient presented a complete ocular remission with no systemic or CNS involvement. ALL relapse may involve the anterior chamber of the eye, and an accurate diagnosis is crucial to enable a fast and appropriate treatment. Novel CAR T-cell immunotherapy, combined with ocular irradiation, may be considered in such cases.
MicroRNA-Expression Profiling in Myopia: A Meta-Analysis and Systematic Review
Authors: Hong Nan , Jiang Bo , Gu Lei , Chen Si-Yi , Tong Jian-Ping
Published: December 2021

Background: Myopia (nearsightedness) is currently the most common human eye disorder, worldwide. In the recent years, several studies have addressed the role of microRNAs (miRNAs) in the pathogenesis of myopia. Objectives: The aim of this study was to perform a meta-analysis on the miRNA-expression profiling studies in myopia to identify commonly dysregulated miRNAs in myopic tissues. Method: Seven independent studies were included in the meta-analysis. A vote-counting strategy was employed as the meta-analysis method. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and Gene Ontology (GO) functional enrichment analysis were performed to identify the pathways most strongly affected by the dysregulated mouse miRNAs. Results: According to the vote-counting method, eighteen miRNAs were reported in at least 2 studies with the consistent direction, of which 13 miRNAs were commonly upregulated in myopic samples compared with control samples, and five miRNAs were commonly downregulated. Subgroup analyses divided and compared the differentially expressed miRNAs according to species (human and animal) and ocular tissue types. The KEGG analysis showed that the dysregulated mouse miRNAs were most enriched in extracellular matrix-receptor interaction signal pathway. The most enriched GO process regulated by the dysregulated mouse miRNAs was cellular protein modification process. Conclusions: Our meta-analysis recommends several miRNAs may provide some clues of the potential biomarkers in myopia. Further mechanistic studies are warranted to elucidate the biological role of the dysregulated miRNAs in the development of myopia.
Thyroid Disorders and Development of Cognitive Impairment: A Review Study
Authors: Khaleghzadeh-Ahangar Hossein , Talebi Anis , Mohseni-Moghaddam Parvaneh
Published: December 2021

Dementia is a neurological disorder that is spreading with increasing human lifespan. In this neurological disorder, memory and cognition are declined and eventually impaired. Various factors can be considered as the background of this disorder, one of which is endocrine disorders. Thyroid hormones are involved in various physiological processes in the body; one of the most important of them is neuromodulation. Thyroid disorders, including hyperthyroidism or hypothyroidism, can affect the nervous system and play a role in the development of dementia. Despite decades of investigation, the nature of the association between thyroid disorders and cognition remains a mystery. Given the enhancing global burden of dementia, the principal purpose of this study was to elucidate the association between thyroid disturbances as a potentially modifiable risk factor of cognitive dysfunction. In this review study, we have tried to collect almost all of the reported mechanisms demonstrating the role of hypothyroidism and hyperthyroidism in the pathogenesis of dementia.
ОЦІНКА ДІЯЛЬНОСТІ ЗАМОВНИКА МЕДИЧНИХ ПОСЛУГ КЕРІВНИКАМИ ЗАКЛАДІВ ПЕРВИННОЇ МЕДИЧНОЇ ДОПОМОГИ
Authors: Лехан В. М. , Надутий К. О. , Гриценко Л. О.
Published: December 2021

Мета: оцінка керівниками закладів первинної медичної допомоги (ПМД) стосунків між замовником і постачальниками медичних послуг за умов запровадження в Україні програми медичних гарантій (ПМГ) та виявлення характеристик діяльності замовника, які потребують удосконалення з точки зору постачальників послуг ПМД.

Матеріали і методи. Дослідження проведено у два етапи: фокус інтерв’ювання керівників закладів ПМД з високим рівнем компетентності для визначення набору характеристик діяльності замовника медичних послуг; опитування за нашою анкетою, складеною за результатами першого етапу дослідження, 100 керівників закладів ПМД. Статистичний аналіз, що включав методи описової та аналітичної статистики, здійснено за допомогою STATISTICA 6.1.

Результати. Виділено 11 параметрів, які характеризують діяльність замовника медичних послуг у системі ПМД разом із загальною оцінкою його функціонування. Із загального числа опитаних негативно або скоріше негативно оцінили: збалансованість стосунків із замовником – 70 %, порядок формування замовником вимог до постачальників – 70 %, реагування замовника на зміну потреб у послугах ПМД – 21 %, обґрунтованість тарифу для фінансування послуг ПМД – 96 %, фінансову забезпеченість введення нових вимог до надавачів – 91 %, цілеспрямованість політики щодо формування ПМГ – 67 %, ефективність ПМГ – 50 %, дієвість економічних стимулів ПМГ – 84 %, узгодженість намірів і дій, що потребують інвестицій, між замовником та надавачем послуг – 60 %, характеристику електронної системи охорони здоров’я – 52 %. У цілому діяльність замовника медичних послуг 72 % оцінили скоріше позитивно, ніж негативно, 28 % – скоріше негативно, ніж позитивно.

Висновки. Дослідження показало існування складнощів формування стосунків між замовником і поста­чальниками послуг ПМД при реалізації реформи фінансування системи охорони здоров’я. Встановлено, що серед характеристик діяльності замовника постачальників найбільше турбують недоліки економічної обґрун­тованості та прогалини політичної урегульованості цих взаємовідносин.
КОНЦЕПТУАЛЬНА ФУНКЦІОНАЛЬНО-ОРГАНІЗАЦІЙНА МОДЕЛЬ РЕГІОНАЛЬНОГО ЦЕНТРУ КАРДІОЛОГІЇ НА ПРИНЦИПАХ ДЕРЖАВНО-ПРИВАТНОГО ПАРТНЕРСТВА
Authors: Іванюк А. В.
Published: December 2021

Мета: обґрунтувати концептуальну функціонально-організаційну модель регіонального центру кардіології (РЦК) на принципах державно-приватного партнерства (ДПП).

Матеріали і методи. У дослідженні використовували загальнонаукові методи аналізу, синтезу, узагальнення, моделювання, інтерпретації наукових даних, а також системний і структурно-функціональний підходи.

Результати. Для вирішення проблеми фінансування та розвитку найбільш витратної третинної високо­спеціалізованої кардіологічної допомоги населенню регіону був реалізований проект обґрунтування концептуальної функціонально-організаційної моделі РЦК на принципах ДПП, тобто об’єднання сил і засобів держави і бізнесу.

Модель РЦК розроблена як самоврядний, господарсько і юридично самостійний суб’єкт медичної діяльності, що забезпечує оптимальне поєднання державного регулювання і ринкового саморегулювання. Економічна ефективність розробленої моделі РЦК забезпечується за рахунок юридичної та господарської самостійності моделі, багатоканального фінансування та прибутковості комерційної діяльності.

Медична допомога у моделі РЦК представлена двома напрямками – медико-соціальним (безоплатним) та економічно рентабельним (платним), кожний з яких орієнтований на свого споживача послуг і в цілому забезпечує підтримку кардіологічного здоров’я усіх верств населення регіону.

Організаційна структура моделі РЦК на принципах ДПП інтегрує три центри: центр високоспеціалізованої стаціонарної допомоги, центр консультативної амбулаторно-поліклінічної екстреної і планово-консультативної допо­моги, центр організаційно методичної, інформаційно-аналітичної, інтеграційної та статистичної роботи, а також два блоки – адміністративно-господарський та допоміжних підрозділів.

Пацієнторієнтованість моделі забезпечує доступність високоспеціалізованої медичної допомоги для різних категорій населення.

Висновки. Потенціал моделі РЦК на принципах ДПП орієнтований на бізнес-процеси та інтегрування медичних послуг, забезпечує її економічну, медичну і соціальну ефективність та оптимальне функціонування у ринкових умовах. Реалізація моделі РЦК на практиці дасть змогу виконати її цільову функцію – задовольнити потреби населення регіону в доступних і якісних високотехнологічних кардіологічних послугах.
ШЛЯХИ ПІДВИЩЕННЯ РЕАЛІЗАЦІЇ СОЦІАЛЬНИХ ПРОГРАМ У ГРОМАДСЬКОМУ ЗДОРОВ’Ї
Authors: Кравець Н. О.
Published: December 2021

Мета: дослідити чинники, які сприяють успішному впровадженню і виконанню програм у галузі громадського здоров’я та розширенню сфер їх застосування.

Матеріали і методи. У процесі дослідження використано загальнонаукові та спеціальні методи: теоретичного узагальнення, метод порівняльного аналізу, класифікації і групування, статистичного порівняння та узагальнення.

Результати. Фахівці, які працюють у галузі громадського здоров’я, допомагають у покращенні здоров’я окремим категоріям людей та громадам. Найбільшою силою громадського здоров’я є його особлива спрямованість на максимальне покращення здоров’я, щоб суспільство могло досягти найзаповітніших цінностей: щоб діти народжувалися і росли здоровими, студенти були здоровими та могли вчитися, працівники були здоровими та продуктивними, а люди похилого віку старіли гідно. Переконливі дані та докази дій, широкі коаліції та ефективна комунікація породжують та підтримують політичні зобов’язання, необхідні для успішних дій в галузі громадського здоров’я. Для поліпшення програм охорони здоров’я часто важливо виділити тягарі хвороб та їх наслідки для здоров’я. Також корисно наводити реальні приклади людей, яким завдано шкоди через бездіяльність або які отримали користь від конкретних програм. Ефективні об’єднання з ключовою підтримкою і керівництвом окремих осіб та позаурядових груп часто мають важливе значення для прогресу.

Висновки. Ефективне та скоординоване об’єднання політичного, технічного і управлінського керівництва може збільшити ймовірність реалізації програм, що захищають та покращують здоров’я населення.

Для подальшого успішного розвитку регіональних/місцевих соціальних програм є необхідним запровадження інноваційних підходів до профілактично-оздоровчих заходів; впровадження методології оцінки медико-екологічних ризиків; запровадження стандартизованих уніфікованих скринінгових методів щодо виявлення контингентів ризику.

На державному рівні необхідно створити систему регулювання регіональних/місцевих соціальних програм та впровадити комплексні заходи щодо звітності, стандартизації, моніторингу.
ДО ПИТАННЯ ЗАРОБІТНОЇ ПЛАТИ КЕРІВНИКІВ СИСТЕМИ ОХОРОНИ ЗДОРОВ’Я
Authors: Литвинова О. Н. , Ліштаба Л. В.
Published: December 2021

Мета: обґрунтувати концептуальні напрями формування заробітної плати керівників системи охорони здоров’я.

Матеріали і методи. Для досягнення поставленої мети у роботі застосовували загальнонаукові методи аналізу, синтезу, узагальнення, інтерпретації наукових даних, а також системний і структурно-функціональний підходи.

Результати. Концептуальні напрями формування заробітної плати керівників системи охорони здоров’я обґрунтовано з урахуванням системного підходу, Конституції України, законів та інших нормативно-правових актів України, загальновизнаних принципів і норм міжнародного права у галузі охорони здоровʼя, вітчизняного і зарубіжного досвіду. Концептуальні напрями утворюють нову систему формування заробітної плати на принципах державно-приватного партнерства, забезпечують стійкий економічний стан і можливість розвитку бази медичного закладу.

Висновки. Розробка концептуальних напрямів формування заробітної плати керівників системи охорони здоров’я дозволить оптимізувати роботу медичного закладу та забезпечить неухильний розвиток закладу шляхом надання високоякісних медичних послуг, використовуючи при цьому мінімальні витрати ресурсів та запроваджуючи інновації науково-технічного прогресу.
СОЦІАЛЬНІ ПРОБЛЕМИ ЗА УМОВ ПРОВЕДЕННЯ АНТИТЕРОРИСТИЧНОЇ ОПЕРАЦІЇ – ОПЕРАЦІЇ ОБʼЄДНАНИХ СИЛ НА ТЕРИТОРІЇ, ПІДКОНТРОЛЬНІЙ УРЯДУ УКРАЇНИ (ЛУГАНСЬКА ОБЛАСТЬ)
Authors: Стешенко Н. М. , Литвинова О. Н.
Published: December 2021

У статті висвітлено соціальні та гуманітарні проблеми, які стали наслідком військового вторгнення Російської Федерації на територію України. Показано катастрофічний стан внутрішньо переміщених осіб та структуру жертв серед цивільного населення.
Abstract 100: Clinical impact of United States Preventive Services Task Force screening recommendations for abdominal aortic aneurysm: Analysis of Nationwide Inpatient Sample data
Authors: Aggarwal Sourabh , Malik Devin , Schauer Mark
Published: December 2021

Introduction:
An abdominal aortic aneurysm (AAA) is defined when infra-renal aortic diameter is at least 3.0 cm. The United States Preventive Services Task Force recommended in 2005 that all men between the ages of 65 to 75 years who have ever smoked should be screened once for AAA by abdominal ultrasonography. However, the clinical impact of these recommendations are unknown.

Methods:
We queried Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) data for AAA and AAA rupture using ICD9 codes 441.4 and 441.3 respectively. The NIS represents 20% of all hospitals data in the US. All the data was extracted for years 2000-2010. Total hospitalizations and in-hospital mortality for pre-screening years (2000-2004) was compared with post-screening years (2006-2010) for both AAA and AAA rupture.

Results:
A total of 527,801 hospitalizations secondary to AAA and AAA rupture were analyzed for the study period.

Hospitalizations from AAA decreased from 61.72 to 58.77 per 10,000 total hospitalizations with in-hospital mortality decreasing from 3.5% to 2.12% (p value <0.001). On sub-analysis, the decrease in hospitalizations was significant in 65-84 age group (77.19 to 74.54 per 100 AAA admissions, p <0.001), with significant increase in 84+ age group (6.37 to 8.6 per 100 AAA admissions, p<0.001) and non-significant increase in 45-64 age group (16.16 to 16.51 per 100 AAA admissions, p value >0.05). Decrease in mortality was uniform in all age and gender sub-groups.

The hospitalizations from AAA rupture decreased from 9.51 to 7.03 per 10,000 total hospitalizations (p<0.001) with mortality decreasing from 49.9% to 44.6% (p value <0.001). On sub-analysis decrease in hospitalizations was reciprocated in 65-84 age group (70.08 to 64.94 per 100 AAA rupture admissions, p value <0.001) and males (73.23 to 71.7 per 100 AAA rupture admissions, p value <0.001). However, hospitalizations from AAA rupture increased in age group 45-64 (14.41 to 15.43 per 100 AAA rupture admissions, p value <0.001), age 84+ (15.21 to 19.2 per 100 AAA rupture admissions, p value < 0.001) and females (26.28 to 28.28 per 100 AAA rupture admissions, p value <0.001). In-hospital mortality from AAA rupture decreased in all age and gender sub-groups independently.

Conclusion:
Our study reveals that post screening recommendations, hospitalizations for AAA decreased significantly in the age group 65-84 years. Also, hospitalizations from AAA rupture decreased in males and age group 65-84, with increase in other age sub groups (45-64 and 84+) and females. Thus, screening recommendations have resulted in decreased hospitalizations in specified age-gender subgroup likely from early recognition and better control of risk factors as outpatient. Our study also makes case to consider extension of recommendations to include other susceptible groups though prospective studies might be needed to support the data.
Abstract 107: Cardiovascular Events, Early Discontinuation of Trastuzumab, and Their Impact on Survival
Authors: Chen Jersey , Wang Shi-Yi , Long Jessica , Hurria Arti , Owusu Cynthia , Steingart Richard , Gross Cary
Published: December 2021

Background:
Trastuzumab increases risk of cardiovascular (CV) events such as heart failure (HF) in clinical trials. However, it is unknown how often trastuzumab therapy is ended early (i.e. early discontinuation), which CV events are associated with early discontinuation, and how CV events and early discontinuation affect overall survival among older women with breast cancer.

Methods:
Using the Surveillance, Epidemiology, and End Results-Medicare dataset, we identified women age 67-94 with stage I-III breast cancer diagnosed 2005-2009 who received trastuzumab adjuvant chemotherapy and followed them through 2011. Completed trastuzumab treatment was defined as ≥11 months of continuous trastuzumab treatments with no delay between trastuzumab treatments >45 days. We identified therapy-associated CV events as those occurring within 45 days before or after the last trastuzumab treatment. We compared CV events between the completed and early discontinuation groups using chi-squared statistics. We used Cox proportional hazard models to examine the association of overall survival with early discontinuation of trastuzumab treatment and CV events.

Results:
Our cohort consisted of 585 women (mean age: 71.6 years), with a median follow-up of 4.2 years. Approximately 41% (239) of women did not complete trastuzumab therapy. Patients with early discontinuation of trastuzumab treatment were more likely to have HF/cardiomyopathy (18.8% vs. 4.0%; p<.001), atrial fibrillation (5.4% vs. <3.2%, p=.006), and other cardiovascular events (7.9% vs. 3.5%; p=.017) within 45 days before or after the last trastuzumab treatment. These cardiovascular events were strongly associated with worse survival (adjusted hazard ratio [AHR] 3.54; 95% CI 1.87 to 6.68). Women with early discontinuation of trastuzumab treatment were also more likely to have worse overall survival, but the results were not statistically significant (AHR: 1.74; 95% CI 0.94 to 3.23).

Conclusion:
Early discontinuation of trastuzumab treatment is common among older women with breast cancer, and associated with higher rates of CV events. Reducing CV complications from trastuzumab therapy will likely improve overall survival in patients with breast cancer
Abstract 121: Testing Frequency Of Guideline-recommended Diabetes Performance Measures In A Cohort Of Post-acute Myocardial Infarction (AMI) Diabetics.
Authors: Kisra Sood , Spertus John , Kureshi Faraz , Jones Philip G , Kosiborod Mikhail , Arnold Suzanne V
Published: December 2021

Background:
Diabetes mellitus (DM) is common among patients hospitalized with acute myocardial infarction (AMI). Although guideline-supported performance measures exist to improve care for each condition, prior work assessing the quality of care for diabetic patients after AMI has focused only on adherence to CAD performance measures. The quality of diabetic care these patients’ receive is unknown.

Methods:
Using data from a prospective AMI registry (TRIUMPH), we identified patients with known DM and examined whether DM-focused performance measures had been applied over the 12 months after discharge. We focused upon 3 DM guideline-supported performance measures: a dilated eye exam, detailed foot exam, and HgbA1C testing. For this analysis, we conducted univariate statistics to describe the frequencies with which diabetics reported receiving these DM performance measures and 4 CAD performance measures at their 12-month interview.

Results:
Among 1,343 patients with a known diagnosis of diabetes presenting with an AMI, a total of 791 (58.9%) completed the 12-month follow up interview. The mean age (SD) of the analytic cohort was 6111 years, with 60% being males and 63% Caucasian. The frequencies of reported receipt among the examined DM and CAD performance measures ranged from 57.3%- 82.2%, with ASA being the most common and a dilated eye exam being the least (Figure). Only 47% of patients reported receiving all three DM performance measures over the past 12 months, while 41.1% reported receiving either one or two, and 12% reported receiving none.

Conclusion:
In a large, multi-center cohort of diabetic AMI survivors we found that patient-reported receipt of 3 DM and 4 CAD performance measures is sub-optimal and there is significant room for improvement. Novel strategies and approaches for assessing the quality of care delivered to post-AMI diabetics in a multidimensional fashion remains vital for improving care and outcomes in this high-risk group of patients.

Characters:
1,683 + figure 500. Limit 2,500
Abstract 124: The Caregiver Experience of Caring for a Patient with a Left Ventricular Assist Device Patient: A Qualitative Meta-Synthesis
Authors: Matlock Daniel , Magid Molly , Jones Jacqueline , Allen Larry , McIlvennan Colleen , Sterling Jocelyn
Published: December 2021

Background:
The use of a left ventricular assist device (LVAD) is becoming increasingly common in patients with end-stage heart failure. Many LVAD programs require patients to have a caregiver before receiving a device.

Objectives:
The aim of this study was to formally synthesize the qualitative literature specifically focusing on caregivers’ perceptions.

Methods:
We searched Medline to find English-language articles on the topic of caregivers’ perceptions. A meta-synthesis, as an interpretive study of qualitative interpretive studies, was conducted to answer what caregivers perceive to be important in caring for an adult LVAD patient. Three levels of qualitative theme analysis and reciprocal translation were applied to the textual data.

Results:
Eight articles met criteria for inclusion. The meta-synthesis across the articles resulted in several themes categorized under three domains. We noted that many of the articles suggested a longitudinal process of caregiving where perceptions are largely dependent on where caregivers are in the LVAD course. The first domain of caregiving is the “Early” stage covering the timeframe from life before the LVAD through surgical implantation. This phase is characterized by the pre-LVAD “
emotional rollercoaster
,” the decision seen as “
no option
,” and the thought of “
leave it at the hospital
.” The second domain is the “Middle” stage covering the timeframe from discharge home and going forward. This phase is characterized by fragility of the patient, recognition of a need to adapt, and a transformed life. The final domain is “Contextual” and describes how the LVAD indication (bridge to transplant or destination therapy) brings in to focus what is important to caregivers.

Conclusions:
Existing literature indicates that the LVAD caregiver experience is intense, burdensome, and requires resiliency. Given the burdens they experience, clinicians and future research should explore strategies to support these important individuals.
Abstract 105: Obesity Paradox in Patients with Non-Hemorrhagic Stroke: Increased Short-Term Survival with Decreased Longevity
Authors: Ashamalla Michael , Yager Neil , Pieper Justin , Sedhom Daniel , Ghate Ketan , Shkolnik Boris , Torosoff Mikhail
Published: December 2021

Background:
Obesity is associated with improved outcomes in patients with congestive heart failure and/or coronary artery disease; the obesity paradox. Effects of obesity on mortality in non-hemorrhagic stroke patients have not been well investigated.

Material and Methods:
Retrospective chart review was performed in 146 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided in to 4 groups according to their BMI: Group I with BMI (0-18.5 kg/m
2
)-4 patients (3%) Group II BMI (18.6-25 kg/m
2
)-51 patients (35%), Group III BMI (26-30 kg/m
2
)-46 patients (32%), and Group IV BMI (31+)-45 patients (31%). Long-term outcomes were ascertained through the National Death Index. This study was approved by the institutional IRB.

Results:
Prevalence of CAD, female gender, hypertension, atrial fibrillation, hyperlipidemia, PVD and chronic kidney disease were similar between BMI groups.

Overweight patients with non-hemorrhagic stroke were younger, with an increased incidence of diabetes (4% in Group II, 25% in Group III, and 37% in Group IV, p<0.0016). There was a trend of increased prevalence of hypertension in overweight patients with non-hemorrhagic stroke (51% in Group II, 55% in Group III, and 70% in Group IV, p=0.3146).

Lower BMI was associated with increased short-term mortality (52% in Group II, 33% in Group III and 12% in Group IV, p <0.004). Despite improved short term mortality, the overall longevity in obese stroke patients were significantly reduced, as compared to patients with normal weight. Average age at time of death was 86+/- 9.6 years old in Group II patients, 76 +/- 15 years old in Group III, and 76 +/- 9.8 years old in Group IV patients, p<0.003 for Group III vs. II and p<0.001 in Group IV vs. II)

Conclusions:
Obese patients present with non-hemorrhagic stroke at a younger age. Despite short term improved outcomes, obesity is not associated with improved overall longevity.
Abstract 114: Mechanical Circulatory Support in Percutaneous Coronary Intervention: A Propensity-matched Analysis
Authors: Khera Rohan , Cram Peter , Vaughan-Sarrazin Mary , Horwitz Phillip A , Girotra Saket
Published: December 2021

Introduction:
Percutaneous ventricular assist devices (PVAD) and intra-aortic balloon pump (IABP) are used to provide mechanical circulatory support for high-risk percutaneous coronary intervention (PCI). Due to limited evidence from randomized controlled trials, we compared clinical outcomes between PVAD and IABP in PCI patients using a propensity-matched analysis.

Methods:
Adult patients who underwent PCI during 2004-2012 and also received either a PVAD or an IABP on the same day as PCI were identified in the National Inpatient Sample using ICD9 procedure codes. We compared in-hospital mortality for PVAD vs. IABP using a 1:2 propensity-matched analysis - both overall and in subgroups with cardiogenic shock, AMI without cardiogenic shock and no cardiogenic shock or AMI.

Results:
We identified 5031 patients who received a PVAD and 122,333 who received an IABP on the same day as PCI. Patients who received PVAD were older (69 vs 65 years), more likely to be men (74% vs 69%), admitted electively (30% vs 11%) but less likely to have AMI (52% vs 90%), cardiogenic shock (23% vs 50%), cardiac arrest (12% vs 25%) or need mechanical ventilation (16% vs 29%) compared to IABP patients (P<0.001 for all). In contrast, prevalence of heart failure (68% vs 41%), valvular heart disease (22% vs 13%), chronic kidney disease (27% vs 11%), hypertension (71% vs 56%) and diabetes (46% vs 32%) was higher in PVAD recipients (P<0.001 for all). Unadjusted in-hospital mortality in PVAD recipients was lower compared to IABP patients - both overall (12.8% vs 20.9%, P<0.001) and in the cardiogenic shock subgroup (31% vs 38%, P=0.04) but was similar in patients without cardiogenic shock. After propensity-matching and successful balancing of covariates (figure) we found no difference in mortality in PVAD and IABP recipients (odds ratio [OR] 0.88, 95% CI 0.70-1.09). Our findings were also consistent among patients with cardiogenic shock (OR 1.37, 95% CI 0.99-1.90), AMI without cardiogenic shock (OR 0.72, 95% CI 0.46-1.14) and no cardiogenic shock or AMI (OR 0.54, 95% CI 0.27-1.06).

Conclusion:
The lower unadjusted mortality in patients undergoing PCI with PVAD support compared to IABP support may be due to selective use of PVADs in a lower risk population. Randomized trials are necessary to establish the clinical effectiveness of PVADs to support high-risk PCI.
Abstract 116: Temporal Trends and Hospital-level Variation in the Incidence and 30-day Mortality of In-Hospital Cardiac Arrest within the Veterans Health Administration
Authors: Bradley Steven M , Kepreos Kyle M , Chan Paul S , Iwashyna Theodore J , Nallamothu Brahmajee K
Published: December 2021

Background:
Improving the quality of in-hospital cardiac arrest (IHCA) care within the Veterans Health Administration (VHA) has received significant attention. Yet there are no national VHA data on the incidence and mortality outcomes of IHCA to guide or evaluate these efforts. We sought to determine overall trends and hospital-level variation in the incidence and 30-day mortality of IHCA within the VHA.

Methods:
Among 2,731,295 patients hospitalized at 115 VHA hospitals between 2008 and 2012, we defined IHCA using specific ICD-9 procedure codes for cardiac arrest and cardiopulmonary resuscitation. Among patients suffering IHCA, we used the VA Vital Status file to identify 30-day mortality from hospital admission. A severity of illness score was used to account for case-mix and determined from a logistic multivariate adaptive regression spline (MARS) model fit to our mortality outcome with covariates for age, race, gender, admission diagnosis category, 29 comorbid conditions, and 11 lab values drawn within 24 hours of admission. Hospital-level IHCA incidence and 30-day mortality rates were compared using empirical Bayes random effects estimates from multi-level regression models after risk- and reliability-adjustment.

Results:
8,565 (0.3%) patients suffered IHCA between 2008 and 2012 and there was no significant trend in the rate of IHCA over this time period. The hospital-level incidence of IHCA varied and was statistically significantly higher than the median rate at 38 (34%) hospitals and significantly lower at 24 (21%) hospitals (Figure A, p<0.05 without adjustment for multiple comparisons). Among patients suffering IHCA, the overall 30-day mortality rate was 68.6% and the risk-adjusted 30-day mortality rate decreased from 71.2% in 2008 to 66.1% in 2012 (p for trend <0.01). Hospital-level 30-day mortality was significantly higher than the median rate at 5 (4%) hospitals and significantly lower at 7 (6%) hospitals (Figure B).

Conclusions:
Within the VHA, the incidence of IHCA has remained stable while 30-day mortality has improved. However, hospital-level variation in IHCA incidence and mortality rates suggest variation in care processes related to IHCA and a target for future investigation to improve patient outcomes.
Urban Literacy Leadership: Examining One Principal’s Vision and Practice
Authors: Francois Chantal
Published: December 2021

School leadership research offers prescriptions for strong instructional and culturally relevant leadership for diverse and urban adolescent populations, yet little evidence describes how school principals impact adolescents’ in-school reading experiences. This qualitative inquiry sought to understand how one urban secondary principal perceived and enacted his role in a school’s effort to teach reading. It also investigated how staff and students perceived his actions. Framed by sociocultural perspectives of reading and a distributed leadership perspective, data analysis revealed that the principal made time and nurtured relationships to grow teacher capacity, support and participate in independent reading, and attend to individual readers and teachers. This study affirms the importance of context in shaping urban adolescents’ reading experiences and raises implications for the urban school principal’s role in their literacy instruction.
Taking Financial Literacy Downtown: Leveraging Community Partnerships to Increase Communication of Essential Financial Information in an Urban Area
Authors: Neuberger Lindsay , Carroll Deborah A. , Bastante Silvana , Rogers Maeven , Boutemen Laura
Published: December 2021

Financial illiteracy is a systemic issue across the country, especially among lower-income individuals in urban communities. This low level of financial literacy often leads to higher levels of debt, lower credit scores, less wealth accumulation, and poor retirement planning. Increasing financial literacy in these priority populations can be effective in combatting some of these negative financial outcomes. This study emerged from a partnership between community organizations in a large urban metropolitan area and scholars from diverse disciplinary backgrounds. Guided by formative research principles, this manuscript reports on research findings derived from several focus groups with community members. These focus groups helped to identify existing perceived financial knowledge levels, categorize barriers to enhancing financial literacy, and illuminate potentially pathways to effective financial literacy program development.
Listening to plants: Conversations between critical plant studies and vegetal geography
Authors: Lawrence Anna M
Published: December 2021

Attention to plant life is currently flourishing across the social sciences and humanities. This paper introduces recent work in the informal sub-discipline of ‘vegetal geography’, placing it into conversation with the transdisciplinary field of ‘critical plant studies’ [CPS], a broad framework for re-evaluating plants and human-plant interactions informed by principles of agency, ethics, cognition and language. I explore three key themes of interest to multispecies scholars looking to attend more closely to vegetal life, namely: (1) plant otherness; (2) plant ethics; (3) plant-human attunements, in the hope of encouraging greater cross-pollination between more-than-human geography and critical plant studies.
Public servants working from home: Exploring managers’ changing allowance decisions in a COVID-19 context
Authors: Williamson Sue , Colley Linda , Foley Meraiah
Published: December 2021

Before the COVID-19 pandemic forced large sections of the workforce to work from home, the uptake of working from home in the public sector had been limited and subject to the discretion or ‘allowance decisions’ of individual managers. Allowance decisions are influenced by factors at the organisational, group and individual levels. This research examines managers’ allowance decisions on working from home at each of these levels. It compares two qualitative datasets: one exploring managerial attitudes to working from home in 2018 and another dataset collected in mid-2020, as Australia transitioned out of the initial pandemic lockdown. The findings suggest a change in the factors influencing managers’ allowance decisions. We have identified a new factor at the organisational level, in the form of local organisational criteria. At the group level, previous concerns about employee productivity largely vanished, and managers experienced an epiphany that working from home could be productive. At the individual level, a new form of managerial discretion emerged as managers attempted to reassert authority over employees working remotely. These levels intersect, and we conclude that allowance decisions are fluid and not made solely by managers but are the result of the interactions between the organisational, group and individual levels.
A Researcher–Practitioner Collaboration to Enable Replication of an Evidence-Based Financial Education and Coaching Program That Improves Health in Low-Income Single Mothers
Authors: Galvin Danielle , Kalkowski Julie
Published: December 2021

Financial strain is a social determinant of health (SDOH). Although public financial education helps individuals improve financial well-being, specifics are lacking on how and why effective programs work, potentially limiting their successful replication in other practice settings. In this study, researchers and practitioners cocreated the core components and theory of change of a novel financial education and coaching program, which a randomized controlled trial found was effective in significantly improving participants’ financial and health-related behaviors. A Cocreating Knowledge Translation Framework within a case study design was used at a university-affiliated nonprofit in Omaha, Nebraska, from August to December 2020. Twelve practitioner and alumni participants were purposefully sampled. An administrative records review, semi-structured interviews ( n =3), survey ( n = 10), and facilitated backward mapping session ( n = 5) were conducted. Transcripts were coded to identify themes. Thirty-one core components were identified within program principles, design, tools, activities, and expectations of participants and coaches. Ten theory of change outcomes described participants’ pathway to change. Interventions occurred at individual, relationship, and community levels from initial engagement, through behavioral changes, to improved health-related quality of life. Activities and indicators were mapped to each outcome. The program’s intersecting and reinforcing design was key to enabling participants’ outcomes. Its theory of change described how and why the model improved financial and health behaviors. Findings suggest that other SDOH-focused organizations may benefit from researcher–practitioner collaboration to investigate their interventions’ core components and theories of change. This may enable replication, promoting downstream health benefits in new community settings.
Anti-inflammatory and protective effects of combined treatment with sitagliptin and melatonin in cardiac ischemia reperfusion injury in obese rats: Involvement of TLR-4/NF-κB pathway
Authors: Sun Hailei , Zhou Zhengchun , Xuan Haiyang , Yan Zhongya
Published: December 2021

Background: Obesity is associated with an augmented risk of myocardial ischemia/reperfusion (I/R) injury. Reduction of I/R injury by effective cardioprotective strategies needs to be investigated in obese subjects. This study aimed to evaluate the combined effects of sitagliptin and melatonin on inflammatory response and TLR4/IκBα/NF-κB signaling following cardiac I/R damage in obese rats. Methods: Sixty-six male Wistar rats (180–200 g) were fed a low fat diet (10% Kcal from lipids) or high fat (45% Kcal from lipids) diets for 12 weeks. High fat-fed (obese) rats experienced 30 min left anterior descending occlusion followed by 24 h reperfusion. Obese rats received sitagliptin (20 mg/kg/day) for 1 month before I/R surgery. Melatonin (10 mg/kg) was injected at early reperfusion. Myocardial infarct size (IS), cTn-I release, pro-inflammatory cytokines, myeloperoxidase (MPO), COX-2 and iNOS, and the protein expressions of TLR4, p-NF-κB/p65, and p-IκBα were evaluated. Results: Monotherapies with sitagliptin-preconditioning or melatonin-postconditioning had no cardioprotective effects in obese rats. However, combined therapy with sitagliptin and melatonin significantly reduced IS, and the release of cTn-I, in comparison to untreated obese rats ( p < .01) Moreover, this combination decreased the production of pro-inflammatory cytokines, MPO, COX-2 and iNOS, and the expression of TLR4 and p-NF-κB/p65, while reduced the expression of p-IκBα, in comparison with untreated or monotherapies-received obese rats ( p < .01 for all). Conclusion: Combination therapy with sitagliptin and melatonin was a good cardioprotective strategy to modulate the inflammatory responses and TLR4/NF-κB signaling pathway in obese patients with cardiac I/R injury.