bluuebunny/crossref_metadata_2025 huggingface dataset:
A DLPNO‐CCSD(T) benchmarking study of intermolecular interactions of ionic liquids
Authors: Seeger Zoe L. , Izgorodina Ekaterina I.
Published: October 2021

The accuracy of correlation energy recovered by coupled cluster single‐, double‐, and perturbative triple‐excitations, CCSD(T), has led to the method being considered the gold standard of computational chemistry. The application of CCSD(T) has been limited to medium‐sized molecular systems due to its steep scaling with molecular size. The recent development of alternative domain‐based local pair natural orbital coupled‐cluster method, DLPNO‐CCSD(T), has significantly broadened the range of chemical systems to which CCSD(T) level calculations can be applied. Condensed systems such as ionic liquids (ILs) have a large contribution from London dispersion forces of up to 150 kJ mol−1 in large‐scale clusters. Ionic liquids show appreciable charge transfer effects that result in the increased valence orbital delocalization over the entire ionic network, raising the question whether the application of methods based on localized orbitals is reliable for these semi‐Coulombic materials. Here the performance of DLPNO‐CCSD(T) is validated for the prediction of correlation interaction energies of two data sets incorporating single‐ion pairs of protic and aprotic ILs. DLPNO‐CCSD(T) produced results within chemical accuracy with tight parameter settings and a non‐iterative treatment of triple excitations. To achieve spectroscopic accuracy of 1 kJ mol−1, especially for hydrogen‐bonded ILs and those containing halides, the DLPNO settings had to be increased by two orders of magnitude and include the iterative treatment of triple excitations, resulting in a 2.5‐fold increase in computational cost. Two new sets of parameters are put forward to produce the performance of DLPNO‐CCSD(T) within chemical and spectroscopic accuracy.
Effects of temperature mode and the substrate/inoculum ratio on anaerobic digestion of Tibetan food waste
Authors: Song Yingjin , Li Yihang , Chen Guanyi , Yan Beibei , Li Jinlei , Li Hongji , Li Ruiyi , Wang Yuxin , Zhang Yingxiu
Published: October 2021

BACKGROUND

The research and applications of anaerobic digestion (AD) in plateau areas are limited by the specific climatic conditions (e.g., low temperature, large temperature difference). To explore feasible and economical strategies of AD in these regions, the effects of different temperature modes (constant mode: 35, 25, 15 °C; stepwise changes mode that simulated daily environmental temperature changes: 35–25 °C, 25–15 °C) and substrate/inoculum (S/I) ratios (1: 1, 1: 2, 1: 4) on Tibetan food waste (FW) digestion performance and microbial community structure were analyzed. Besides this, the energy balance of AD under different conditions was estimated.

RESULTS

The methane yields (335–463 mL g−1 VS) of FW at temperature changes mode with less energy consumption could reach the same level or even slightly higher than the methane yields at 35 °C. Kinetic analysis revealed that, compared with 25 °C, methane production performance was not greatly affected by temperature fluctuations around 25 °C. The relative abundance of acetoclastic methanogens (e.g., Methanosaeta) were dominant over hydrogenotrophic methanogens (e.g., Methanobacterium, Methanospirillum) at 35 °C. The opposite was true at 15 °C.

CONCLUSION

The decrease in temperature caused the digestion pathway to shift from acetoclastic to the hydrogenotrophic pathway. The effect of temperature on the microbial community structure was more pronounced than the S/I ratio. Energy balance calculations showed that psychrophilic conditions and AD without temperature control were likely to be more economically competitive than mesophilic conditions for small‐scale AD in cold regions. © 2021 Society of Chemical Industry (SCI).
Ultrastructural comparison between the oral cavity floor of the juvenile and adult Epinephelus aeneus: New vision of aging development and its carnivorous adaptation
Authors: Alsafy Mohamed , Madkour Naglaa F. , El‐Bakary Raafat , Karkoura Ashraf , El‐Gendy Samir , Abumandour Mohamed M. A.
Published: October 2021

The current work is designed to give the first trial to characterize the ultrastructural lineaments of the oral cavity floor in juvenile and adult white grouper. The present work depends on 10 oral cavities floor from each age. The common features joined the oral cavities floor of the juvenile and adult fish summarized in; oral cavity floor had two teeth bands (lower incisive and lower molar), tongue with its two lateral spinated lines, lower velum, ridges, the lower lip divided into a single anterior part and two lateral part, and the absence of lower canine teeth. The oral surface of semilunar lower velum had round fungiform papillae that carried taste buds type I. The non‐protrusible elongated tongue had a clear apex, body, and root with the absence of any taste buds. The dorsal lingual surface of the body had two lateral spinated lines, a single ridge and microtubercles. The smooth dorsal lingual surface of the root did not carry any ridges. The notched lower velum at the middle of the free border was observed in juveniles and adults. Meanwhile, there are some variations between juvenile and adult as; absence of lower incisive ridge only in juvenile, pointed tongue with sublingual ridge observed in juvenile while round without sublingual ridge in adult fish, moreover the presence of velvar ridges observed only in adult fish. The obtained findings provided essential data to aquaculture of this fish species in Egypt by determining the food particle types that are favorite to this fish.

Highlights

The common features joined the oral cavities floor of the juvenile and adult fish summarized in; oral cavity floor had two teeth bands (lower incisive and lower molar), tongue with its two lateral spinated lines, lower velum, ridges, the lower lip divided into a single anterior part and two lateral part, and the absence of lower canine teeth. The oral surface of semilunar lower velum had round fungiform papillae that carried taste buds type I. The dorsal lingual surface of the body had two lateral spinated lines, a single ridge and microtubercles. The smooth dorsal lingual surface of the root did not carry any ridges. Meanwhile, there are some variations between juvenile and adult as; absence of lower incisive ridge only in juvenile, pointed tongue with sublingual ridge observed in juvenile while round without sublingual ridge in adult fish, moreover the presence of velvar ridges observed only in adult fish.
Rate constant ratios in the consecutive chlorination of liquid‐phase p‐xylene with Cl2 and an iron(III) chloride catalyst
Authors: Rigas Fotis P.
Published: October 2021

Given that p‐xylene is an important chemical feedstock for many final products in the market from pesticides, pharmaceuticals, peroxides to dyes, its chlorinated derivatives are of interest in the chemical industry. In this paper, the rate constant ratios of the consecutive chlorination of p‐xylene at 70°C in a gas–liquid semibatch reactor using molecular chlorine and iron(III) chloride as a catalyst was investigated up to the fourth successive reaction (tetrachloro‐p‐xylene production). The ratios were determined with both mathematical expressions and a graphical method proposed recently in the literature by use of the maxima of the successive products. The ratios found for monochloro‐p‐xylene (2‐chloro‐p‐xylene), dichloro‐p‐xylene (the sum of 2,3‐dichloro‐p‐xylene and 2,5‐dichloro‐p‐xylene), trichloro‐p‐xylene (2,3,5‐trichloro‐p‐xylene), and tetrachloro‐p‐xylene (2,3,5,6‐tetrachloro‐p‐xylene) are k2/k1 = 0.295, k3/k1 = 0.0826, and k4/k1 = 0.00383. The ratio of the dichlo‐isomers produced was also determined as 2.12 in favor of 2,5‐dichloro‐p‐xylene, which is reasonable since 2,3‐dichloro‐p‐xylene is highly hindered by the adjacent groups on the aromatic nucleus. The existing knowledge found in the literature on the rate constant ratios of consecutive reactions was also extended in this paper with a new mathematical expression for the determination of the third stage product peak concentration. The standard uncertainties of the rate constant ratios, the standard deviation of the means, as well as the expanded uncertainties of the means, were calculated. Finally, the propagation of uncertainties for the trichloro‐p‐xylene was estimated using the partial derivatives of this product for each of the rate constants.
Who's The Boss?
Authors: Wich Scott
Published: October 2021

It sounds like a simple question… “Who's the boss?” If you are the CEO or president of your company, you may summarily answer, “Ha! I'm the boss.” If you are a front‐line manager, your answer may be more reserved… “I have a boss, but I am also in charge of the shift… so I guess I am a boss too.” In truth, there are many “bosses” in a company because a boss is someone (or something) with the authority to direct others' actions.
Shape Analysis of Energy Polydisperse Polymers
Authors: Singh Thoudam Vilip , Shagolsem Lenin S.
Published: October 2021

The equilibrium properties of an energy polydisperse chain, in which the interaction strengths between the monomers are drawn from a log‐normal distribution, at small polydispersity value are investigated by means of computer simulations. We perform coarse‐grained molecular dynamics simulations in an implicit solvent condition, and a comparative study with that of the corresponding homopolymers is carried out. In this study, we focus our attention in understanding the behavior of average instantaneous conformations, characterized through various shape parameters for both energy polydisperse and homopolymer chains as a function of temperature (T). It is found that the energy polydisperse chain has relatively low value of θ‐temperature (Tθ), at which polymer assumes ideal conformation. In particular, we investigate the conformational changes across Tθ and found that for T at/above Tθ the behavior is independent of the chain type and length, whereas for T below Tθ, strong dependence on the chain length is observed. To understand the detailed statistics, we also compare the distributions of chain sizes as well as eigenvalues of the gyration tensor.
Determinants of early‐stage entrepreneurship in the Kingdom of Saudi Arabia: Evidence from the Global Entrepreneurship Monitor Database
Authors: Shabir Suheela , Ali Jabir
Published: October 2021

This study aims at identifying the determinants of early‐stage entrepreneurial activities (TEA) in the Kingdom of Saudi Arabia based on the Global Entrepreneurship Monitor (GEM) survey. Out of 4,048 adult populations surveyed in Saudi Arabia, about 11.4% have reported early‐stage entrepreneurial activity. Analysis indicates a significant association between demographic characteristics and early‐stage entrepreneurship. Further, the regression estimates indicate that all three components of the theory of planned behavior, i.e., attitude towards entrepreneurship (ATE), Perceived Subjective Norms (PSN), and Perceived Behavioral Control (PBC), have a positive and significant impact on the early‐stage entrepreneurial activities among the adult population. The analysis indicates the individuals choosing entrepreneurship as a career choice and perceive greater economic opportunities with social orientation are induced to start an enterprise at an early stage. Moreover, self‐efficacy is a strong factor inducing early‐stage entrepreneurs, while risk perception towards entrepreneurship hinders entrepreneurial growth. The study provides insights for developing schemes and policies towards strengthening the entrepreneurial ecosystem in Saudi Arabia and provides further research direction on entrepreneurial initiatives.
California landmark law to address treatment gaps in MH care
Authors: Canady Valerie A.
Published: October 2021

Landmark legislation to require health plans and insurers to provide patients with mental health and substance use disorders with timely care after an initial appointment was signed into law Oct. 10 by California Gov. Gavin Newsom. The law becomes effective July 1, 2022.
Methodological challenges in measuring meaningful change in individuals with spinal muscular atrophy
Authors: Oskoui Maryam , Potter Beth K.
Published: October 2021

See article on pages 552‐559 in November issue.
Early detection of increased marrow adiposity with age in rats using Z‐spectral MRI at ultra‐high field (7 T)
Authors: Cai Zimeng , Tao Quan , Scotti Alessandro , Yi Peiwei , Feng Yanqiu , Cai Kejia
Published: October 2021

Background

Nowadays, the drive towards high‐field MRI is fueled by the pursuit of higher signal‐to‐noise ratio, spatial resolution, and imaging speed. However, high field strength is associated with field inhomogeneity, acceleration of T2* decay, and increased chemical shift, which may pose challenges to conventional MRI for fat quantification in complex tissues such as bone marrow. With proton MRI spectroscopy (1H‐MRS), on the other hand, it is difficult to produce high resolution. As a novel alternative fat quantification method, high‐resolution Z‐spectral MRI (ZS‐MRI) can achieve fat quantification by acquiring direct saturated images of both fat and water under the same TE, which may be less affected by T2* decay and field inhomogeneity.

Purpose

To demonstrate ZS‐MRI for marrow adipose tissue (MAT) quantification in rat's lumbar spine and the early detection of MAT changes with age.

Methods

The accuracy of ZS‐MRI for fat quantification at ultra‐high‐field MRI (7 T) was verified with MRS and conventional Dixon MRI in water‐oil mixed phantoms with varying fat fraction (FF). Dixon MRI data were processed with iterative decomposition of water and fat with echo asymmetry and least‐squares estimation. ZS‐MRI was then used to longitudinally monitor the adiposity in the lumbar spine of young healthy rats at 13, 17, and 21 weeks to detect the early changes of FF with age in MAT. Hematoxylin‐eosin staining of lumbar spines from separated rat groups was performed for verification.

Results

In ex vivo phantom experiments, both Dixon MRI and ZS‐MRI were well correlated with 1H‐MRS for the quantification of FF at 7 T (R > 0.99). Compared with Dixon MRI, ZS‐MRI showed reduced image artifacts due to field inhomogeneity and presented better agreement with 1H‐MRS for the early detection of increased MAT due to age at 7 T (ZS‐MRI R = 0.78 versus Dixon MRI R = 0.34). The increased MAT FF due to age was confirmed by histology.

Conclusion

ZS‐MRI proves itself as an alternative fat quantification method for bone marrow in rats at 7 T.
Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study
Authors: Matsugu Yasuhiro , Ito Keiko , Oshita Akihiko , Nobuhara Hiroshi , Tanaka Junko , Akita Tomoyuki , Itamoto Toshiyuki
Published: October 2021

Background

Although postoperative early oral feeding in the enhanced recovery after surgery (ERAS) program for pancreaticoduodenectomy (PD) is deemed safe, the assessment of oral intakes has been insufficient. This study aimed to investigate postoperative oral intakes and the effectiveness of an ERAS program incorporating early enteral nutrition (EN).

Methods

In total, 203 patients with PD were enrolled retrospectively. The first group (group E1; n = 61) comprised 11 ERAS care elements, whereas the second group (group E2; n = 106) comprised 19 elements. The control group (group C; n = 36) was managed using traditional care before ERAS was implemented. Postoperative energy and protein requirements were estimated at 25–30 kcal per kilogram of ideal body weight and 1.2–1.5 g per kilogram of ideal body weight, respectively, and were investigated along with the length of hospital stay (LOS).

Results

The oral energy and protein intakes from the diets in the ERAS groups at postoperative day 7 significantly increased compared with those in group C. Intakes in groups E1 and E2 were not significantly different and provided <30% of the requirements. However, the total intakes, which were compensated by EN, were maintained at >80% of the requirements. LOS was significantly shorter in groups E1 (31 days) and E2 (19 days) than in group C (52 days).

Conclusions

Postoperative early oral energy and protein intakes of this modified ERAS program failed to meet the dietary requirements. However, early EN compensated for the shortages and contributed to the reduction of LOS.
Factors associated with media use for parenting information: A cross‐sectional study among parents of children aged 0–8 years
Authors: Fierloos Irene N. , Windhorst Dafna A. , Fang Yuan , Mao Yuping , Crone Matty R. , Hosman Clemens M.H. , Jansen Wilma , Raat Hein
Published: October 2021

Aim

Media use may strengthen parents’ capacities to deal with parenting issues. This study examined which factors are associated with media use for parenting information.

Design

Cross‐sectional data of 658 parents of children aged 0–8 years, gathered in the CIKEO cohort study in the Netherlands, were analysed.

Methods

Multivariable logistic regression models were used to examine which factors were associated with media use for parenting information.

Results

The mean age of the participants was 33.8 years (SD = 5.0); 94.7% were mothers; 77.4% used media for parenting information. Parents with more questions or concerns (OR: 1.40, 95% CI: 1.23, 1.59), and parents who received parenting information from their social contacts (OR: 5.57, 95% CI: 3.22, 9.61), had higher odds of media use for parenting information. Older parents (OR: 0.95, 95% CI: 0.91, 1.00), and parents of older children (OR: 0.84, 95% CI: 0.74, 0.95), had lower odds of media use for parenting information.
Five tips for supporting and empowering international students in the United States
Authors: Sanford Amy Aldridge , Raj Rishi
Published: October 2021

A little more than 1,000,000 students with international student or scholar visas are currently enrolled in institutions of higher education in the United States,  making up nearly 6% of all postsecondary enrollment within the country. NAFSA, the world's largest professional association dedicated to international education, reported that in 2019–20 alone international students contributed $38.7 billion to the U.S. economy (read more at https://bit.ly/3AfNCla).
The perpetuation of bribery–prone relationships: A study from Vietnamese public officials
Authors: Nguyen Thang V. , Doan Minh H. , Tran Nhung H.
Published: October 2021

Studies of bribery have not adequately considered individual psychological processes in the development of bribery–prone relationships. We propose an integration of moral disengagement and the norm of reciprocity as a theoretical lens to explain the evolvement of bribery–prone relationships. Based on qualitative data from a sample of government officials in Vietnam, we found that public officials normally go through a “calculative judgment”, experience a certain level of emotional discomfort and then use rationalization strategies to decide whether to engage in a bribery–prone exchange or relationship. Furthermore, these psychological processes are distinctive in the initiation and perpetuation stages of a bribery–prone relationship. The study suggests that interactions of the norm of reciprocity and wider ethical norms in governing bribery should be further addressed by both researchers and practitioners.
NICE on the management of acute coronary syndromes
Authors: Chaplin Steve
Published: October 2021

NICE has recently published a guideline on the early management and longer‐term rehabilitation of acute coronary syndromes (NG185), including myocardial infarction and unstable angina. This article provides a brief overview of the guidance and its impact.
Simultaneous three‐translational‐axis vibration test that considers non‐Gaussianity
Authors: Hosoyama Akira , Tsuda Kazuki , Horiguchi Shogo
Published: October 2021

Packaging vibration tests are used to evaluate the vibration durability of packaged products by simulating transport vibration. Currently, the vertical Gaussian random vibration test is commonly used. However, in actual transport vibration environments, non‐Gaussian random vibration occurs along various axes simultaneously. To simulate actual transport vibration environments accurately and realistically, this study developed a simultaneous three‐translational‐axis vibration test that considers the three‐axis simultaneity of shock events, which is unique to non‐Gaussian vibration. In addition, to verify the effectiveness of the test, an experiment on the collapse of packaged products was performed by using three sets of vibration data (actual transport vibration data and vibration data with and without the three‐axis simultaneity of shock events), and the collapse time for each dataset was measured. The collapse time obtained using the vibration data with the three‐axis simultaneity of shock events was closer to the collapse time obtained using the actual transport vibration data than the collapse time obtained using the vibration data without the three‐axis simultaneity of shock events. Therefore, the simultaneous three‐translational‐axis vibration test that does not consider the three‐axis simultaneity of shock events may give different results from those obtained under actual transport vibration conditions. Therefore, to simulate actual transport vibration environments accurately and realistically, a simultaneous three‐translational‐axis vibration test that considers the three‐axis simultaneity of shock events should be performed.
Study examines college transition for students with ADHD
Authors: Sutton Halley
Published: October 2021

College students with attention deficit hyperactivity disorder received, on average, grades that were half a grade below their peers, and this deficit persisted for all four years of their enrollment. That finding comes from the largest and most comprehensive study of the experience of college students with ADHD, recently published in the Journal of Clinical Child & Adolescent Psychology.
Critical approaches in leadership education: Making the case for racial equity via institutional type
Authors: Collins Jasmine D. , Whitney Rich
Published: October 2021

In this introductory article, we offer a theoretical overview of racial equity and provide the rationale for pursuing an issue related to racial equity in leadership education. We also make the case for examining marginalized institutional contexts as a step toward advancing racial equity in postsecondary leadership education.
Trust in Government Agencies in the Time of COVID-19
Authors: Robinson Scott E. , Gupta Kuhika , Ripberger Joseph , Ross Jennifer A. , Fox Andrew , Jenkins-Smith Hank , Silva Carol
Published: October 2021

As the US faced its lowest levels of reported trust in government, the COVID-19 crisis revealed the essential service that various federal agencies provide as sources of information. This Element explores variations in trust across various levels of government and government agencies based on a nationally-representative survey conducted in March of 2020. First, it examines trust in agencies including the Department of Health and Human Services, state health departments, and local health care providers. This includes variation across key characteristics including party identification, age, and race. Second, the Element explores the evolution of trust in health-related organizations throughout 2020 as the pandemic continued. The Element concludes with a discussion of the implications for agency-specific assessments of trust and their importance as we address historically low levels of trust in government. This title is also available as Open Access on Cambridge Core.
Taking off the gown: Impact of discontinuing contact precautions for extended-spectrum β-lactamase (ESBL)–producing organisms
Authors: Gottlieb Lindsey B. , Walits Emily , Patel Gopi , Schaefer Sarah
Published: October 2021

Contact precautions are used to prevent the spread of extended-spectrum β-lactamase (ESBL)–producing organisms in acute-care hospitals, but supporting data are lacking. We discontinued such precautions for ESBL Escherichia coli and Klebsiella spp and found no increased prevalence of these organisms with our change in practice.
Minimally critical regular endomorphisms of
Authors: INGRAM PATRICK
Published: October 2021

We study the dynamics of the map
$f:\mathbb {A}^N\to \mathbb {A}^N$
defined by
$$ \begin{align*} f(\mathbf{X})=A\mathbf{X}^d+\mathbf{b}, \end{align*} $$

for
$A\in \operatorname {SL}_N$
,
$\mathbf {b}\in \mathbb {A}^N$
, and
$d\geq 2$
, a class which specializes to the unicritical polynomials when
$N=1$
. In the case
$k=\mathbb {C}$
we obtain lower bounds on the sum of Lyapunov exponents of f, and a statement which generalizes the compactness of the Mandelbrot set. Over
$\overline {\mathbb {Q}}$
we obtain estimates on the critical height of f, and over algebraically closed fields we obtain some rigidity results for post-critically finite morphisms of this form.
Why was early therapeutic research on psychedelic drugs abandoned?
Authors: Hall Wayne
Published: October 2021

Background

Advocates of the therapeutic use of psychedelic drugs have argued that a promising approach to treatment was prematurely abandoned in the 1960s primarily because of Richard Nixon's ‘War on Drugs’.

This paper (1) briefly describes research in the 1950s and 1960s in North America on the use of LSD to treat alcohol dependence, anxiety in terminal illness, and anxiety and depression; and (2) discusses the factors that led to its abandonment.

Method

An analysis of historical scholarship on psychedelic research in the 1950s, 1960s and 1970s in North America.

Results

Research on psychedelic drugs in psychiatry was abandoned for a number of reasons that acted in concert. A major factor was that clinical research on psychedelic drugs was caught up in the tighter regulation of pharmaceutical research after the Thalidomide disaster in 1963. Psychedelic drugs also presented special challenges for randomised, placebo-controlled clinical trials in the 1970s that were not as positive as the claims made by their advocates in the 1950s and 1960s. Clinical research became more difficult after 1965 when Sandoz ceased providing psychedelic drugs for research and their nonmedical use was prohibited in 1970.

Conclusions

The demise of psychedelic drug research was not solely due to the ‘War on Drugs’. It was hastened by tighter regulation of pharmaceutical research, the failure of controlled clinical trials to live up to the claims of psychedelic advocates, and the pharmaceutical industry's lack of interest in funding clinical trials.
Scaphoid Dislocation Reconstruction with Scapholunotriquetral Ligament Tenodesis
Authors: Mailey Brian , Brown Amanda L. , Winters James
Published: October 2021

Traumatic injuries leading to complex scaphoid dislocations are uncommon. We present a successful reconstructive case after a complex intercarpal instability injury using scapholunotriquetral tenodesis without the need for Kirschner wire fixation and early controlled range of motion therapy. At 3 months, the patient had a pain-free wrist with a 100-degree arc of motion and returned to work with full functionality. A literature review was performed to describe the previously published surgical treatments of this injury pattern and compare functional outcomes.
Validating a Series of Photonumeric Rating Scales for Use in Facial Aesthetics Using Statistical Analysis of Intra- and Inter-rater Reliability
Authors: Lorenc Z Paul , Jones Derek , Kim Jeongyun , Gwak Hee Min , Batham Samixa , Vachon Ginny
Published: October 2021

Background

Growing demand for minimally invasive aesthetic procedures to correct age-related facial changes and optimize facial proportions has been met with innovation but has created an unmet need for objective assessment tools to evaluate results empirically.

Objectives

The purpose of this study is to establish the intra- and inter-rater reliability of ordinal, photonumeric, 4-, or 5-point rating scales for clinical use to assess facial aesthetics.

Methods

Board-certified plastic surgeons and dermatologists (3 raters) performed live validation of jawline contour, temple volume, chin retrusion, nasolabial folds, vertical perioral lip lines, midface volume loss, lip fullness, and crow’s feet dynamic- and at rest-rating scales over 2 rounds, 2 weeks apart. Subjects selected for live validation represented the range of scores and included 54 to 83 subjects for each scale. Test-retest reliability was quantitated through intra- and inter-rater reliability, determined from the mean weighted kappa and round 2 intraclass correlation coefficients, respectively. The clinical significance of a 1-grade difference was assessed through rater comparison of 31 pairs of side-by-side photographs of subjects with the same grade or a different grade on the developed scales.

Results

The study demonstrated substantial to near-perfect intra- and inter-rater reliability of all scales when utilized by trained raters to assess a diverse group of live subjects. Furthermore, the clinical significance of a 1-point difference on all the developed scales was established.

Conclusions

The high test-retest reliability and intuitive layout of these scales provide an objective approach with standardized ratings for clinical assessment of various facial features.
Stent deformation in a sutureless aortic valve bioprosthesis: a pilot observational analysis using imaging and three-dimensional modelling
Authors: Aljalloud Ali , Spetsotaki Konstantina , Tewarie Lachmandath , Rossato Leonardo , Steinseifer Ulrich , Autschbach Ruediger , Menne Matthias
Published: October 2021

OBJECTIVES

The goal of this analysis of the Perceval aortic bioprosthesis was to investigate the ovalization/deformation of the Perceval prosthesis stent after implantation and its propensity for cusp dysfunction, fluttering, fibrosis and blockage.

METHODS

Between August 2014 and May 2019, a total of 134 patients (52% female) underwent aortic valve replacement with the Perceval bioprosthesis. We reconstructed three-dimensional models of the Perceval stent using thorax computed tomography scans for 16 patients employing the software Mimics (Materialise NV, Leuven, Belgium) and analysed the ovality of the stents. Radial force (RF) measurements were performed to compare the stiffness of the Perceval bioprosthesis to that of other valves.

RESULTS

The three-dimensional reconstructions showed that all Perceval stents exhibited some degree of deformation and ovalization. Ovality in the annulus and commissure section of the Perceval stents ranged from 6.8% to 45% with mean values of 13.6% and 21.9%, respectively. The RF of the Perceval prosthesis was noticeably lower than that of the Edwards Intuity and several transcatheter aortic valve implantation devices. The stent adopted the preoperative shape of the aorta in the 2 patients for whom pre- and postoperative computed tomography data existed.

CONCLUSIONS

The Perceval bioprostheses were deformed to different degrees in all analysed cases. The comparably low RFs might be an explanation for the propensity towards this deformation, which can lead to fluttering, a reduction of the cusps’ mobility. This condition could potentially result in fibrosis as well as increased transvalvular pressure gradients and might be the cause for the increase in lactate dehydrogenase and the decrease in platelet count.
Referral decisions based on a pre-hospital HEART score in suspected non-ST-elevation acute coronary syndrome: final results of the Famous Triage study
Authors: Tolsma R T , Fokkert M J , Van Dongen D N , Slingerland R J , Badings E , Van Der Sluis A , Ottervanger J P , Van 'T Hof A W J
Published: October 2021

Background

Recent studies show that pre-hospital risk stratification of patients with suspected non-ST-elevation Acute Coronary Syndrome (NSTE-ACS) by ambulance paramedics is feasible. However, it is not investigated whether making referral decisions based on this risk stratification is safe and not associated with an increased risk of Major Adverse Cardiac Events (MACE). The hypothesis of the Famous Triage study is that implementation of referral decisions by ambulance paramedics based on a pre-hospital HEART score (History, ECG, Age, Risk factors and Troponin), is non-inferior to routine management on the occurrence of MACE within 45 days.

Methods

Famous Triage phase III is the first study where referral decisions by paramedics are based on a pre-hospital acquired HEART score. In the second phase (before implementation) a pre-hospital HEART score was assessed without consequences for referral decisions. In the third phase low-risk patients (HEART score ≤3) were not transferred to the hospital. Primary endpoint was the comparison of MACE (acute coronary syndrome, revascularization or death by all causes) within 45 days between phase II and III.

Results

A total of 1,236 patients were included, mean age was 63 years, 43% was female, 700 patients were included in the second phase (all referred to the hospital) and 536 in the third phase in which 149 low-risk patients (28%, HEART score ≤3) were not transferred to the hospital. Occurrence of 45 days MACE was 16.6% in phase II and 15.7% in phase III (p=0.67). Percentage MACE in low-risk patients was 2.9% in phase II and 1.3% in phase III. After adjustments for differences in baseline variables, the odds ratio of 45 days MACE in phase III was 0.88 (95% CI 0.63 – 1.25) as compared to phase II.

Conclusion

Pre-hospital risk stratification of patients with suspected NSTE-ACS, avoiding hospitalization of a substantial number of low-risk patients, is feasible and non-inferior to transferring all patients to the hospital. This pre-hospital triage strategy might improve value based healthcare (equal outcomes at less costs).

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Roche Diagnostics, The Netherlands
Myocardial efficiency in severe asymptomatic primary mitral regurgitation: relation to quantitative measures of regurgitation
Authors: Sorensen J , Bergsten J , Baron T , Orndahl L H , Kero T , Bjerner T , Hedin E , Harms H J , Flacshkampf F A
Published: October 2021

Objectives

To study the association of myocardial external efficiency (MEE) in mitral regurgitation (MR) towards routinely used quantitative indicators of disease severity and progression.

Background

Quantitative assessment of LV function and regurgitation in asymptomatic severe primary MR is crucial for management. MEE is a load-independent indicator of mechano-energetic coupling and can be measured non-invasively using 11C-acetate positron emission tomography (PET). The role of MEE in this setting has not been studied.

Methods

48 asymptomatic patients with severe primary mitral regurgitation underwent PET, echo, and CMR on the same day. MEE was automatically derived from PET as the ratio of cardiac work (cardiac output * mean arterial pressure) and total left ventricular (LV) oxygen consumption (mean MVO2 * LV mass). LV function and mitral regurgitant volumes (RegVol) were measured by echo and CMR. MEE in MR was compared to healthy volunteers (n=9). MEE and parameters of regurgitation severity and of LV volumes and function were studied as predictors of outcome (valve surgery or death).

Results

MEE was reduced in MR (21.5±4.2%) vs healthy volunteers (32.0±5.6%, p<0.001) and showed weak but significant correlations (r2<0.25) with regurgitation severity and LV volumes. There were 23 cardiac events (valve surgery: 22; cardiovascular death: 1) during follow-up (median 2.7 years, IQR 1.9–3.2). Univariate Cox models showed that MEE, echocardiographic left atrial volume as well as RegVol and LV ventricular volumes from both echo and CMR were significant outcome predictors (all p<0.05), while LVEF and NT-pro-BNP were not (p>0.05). Prediction by MEE was not affected by age, sex or BMI. When categorically divided by the median MEE was a strong predictor in Kaplan-Meier analysis (log-rank p=0.0004, figure 1) and remained independently significant, compared to all other univariate predictors in bivariate Cox models.

Conclusions

This study suggests an important role of energetic insufficiency in progression of asymptomatic severe primary MR. Reduced MEE was linked to outcome independently of standard functional measures of regurgitation severity or left ventricular size and function. Strategies for improvement of myocardial energetics in MR are warranted.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Heart-Lung Foundation Figure 1
The prognostic value of cardiac magnetic resonance in assessment of right ventricular function after percutaneous balloon mitral valvuloplasty
Authors: Sayed M , I H Awad P , Abouelnour A , Taha Kishk Y
Published: October 2021

Background

Mitral stenosis (MS) results in right ventricular (RV) dysfunction secondary to chronic pulmonary hypertension. Poor outcomes have been reported in patients with persistent chronic RV dysfunction. Persistence RV dysfunction can affect the clinical improvement after percutaneous balloon mitral valvuloplasty (PBMV). Cardiac Magnetic Resonance (CMR) is emerged as a highly sensitive technique for assessment of RV function (RVF).

Purpose

To investigate RV function 3 months after PBMV using a variety of robust parameters associated with prognosis.

Methods

A prospective observational study was conducted in a tertiary University hospital included 31 patients with symptomatic uncomplicated MS with favorable morphology and having sinus rhythm who underwent PBMV. All patients were subjected to TTE and CMR examination 24 hours directly before and 3 months after PBMV for assessment of RV size and function.

Results

CMR showed reduced RV myocardial mass (36.1±6.1 vs 28.0±5.4g, P<0.001), RV end-diastolic volume (RV EDV) (123.5±31.3 vs 109.5±22.7 ml, P=0.03) and TR regurgitant fraction (19.6±8.6 vs 14.7±4.9%, P<0.001) On the other hand, there were increase in each of RV ejection fraction (60.0±10.4 vs 63.13±7.8%, P<0.001), RV stroke volume (SV) (50.2±15.1 vs 33.2±12.2 ml, P<0.001) and RV stroke index (44.2±7.7 vs 50.3±8.6 ml/beat/m2 <0.001). TTE showed improved systolic RV function parameters measured by fractional area change (42.1±7.8 vs 51.7±5.4%, P<0.00), Tei Index (0.6±0.1 vs 0.5±0.1, P<0.001) and TAPSE (22.2±3.3 vs 25.7±5.1 mm, P=0.04). Among RV diastolic parameters, there were an increase in TV-TDI E' (12.0±3.0 vs 14.0±2.0 cm/s, P<0.001), TV-TDI A' (13.0±3.0 vs 11.0±2.0 cm/s, P<0.001) and TV-TDI E'/A' (1.0±0.5 vs 1.3±0.3, P<0.001) with significantly decreased RV wall thickness (5.7±0.7 vs 4.3±0.8 mm P<0.001) 3 months after PBMV. Among patients who showing improved RV parameters by TTE, ten patients (32,3%) showed non improved RV end systolic volume, EDV, SV and stroke index by CMR.

Conclusion

Follow-up of RV function by TTE after PBMV yielded nearly similar results compared to CMR. However, CMR identified a subgroup of patient with persistent RV dysfunction 3 months after PBMV. That contributes to define the role of cardiac MRI in the evaluation of the prognosis in patients with MS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Assiut University hospital and Al Orman Institute
Abnormal fractional flow reserve and non-hyperaemic pressure ratios in patients with severe aortic stenosis and non-obstructive coronary artery disease
Authors: Chan J , Comella A , Liu R , Michail M , Sultana N , Thakur U , Cameron J C , Brown A J
Published: October 2021

Background

Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) are well-validated tools that assess the physiological significance of coronary artery disease (CAD). Low coronary lumen to myocardial mass (V/M) ratio on CT is associated with lower FFR/NHPRs and predisposes towards ischaemia in CAD. Whilst CAD and aortic stenosis (AS) frequently co-exist, patients report angina despite obstructive disease.

Purpose

We therefore sought to study the interrelationship between V/M and invasive pressure indices in patients with severe AS.

Methods

35 patients with severe AS were prospectively recruited as part of CAST-FFR study. Patients underwent CT coronary angiography and invasive pressure-wire assessment. All pressure-indices were assessed in the left anterior descending artery (LAD). Data was extracted to calculate FFR, iFR, diastolic pressure ratios (DPR and dPR) and Diastolic Hyperaemia-free Ratio (DFR). Patient-specific V/M were extracted off-site by independent core lab.

Results

Mean age was 75±7.5 years, median V/M ratio was 20.7 and mean aortic gradient and DI were 44.3±11.6mmHg and 0.23±0.4 respectively. 79% of patients had CADRADs score of <2. There were moderate positive correlations between FFR/NHPRs and V/M, including FFR (r=0.60), PdPa (r=0.48), iFR (r=0.59), DPR (r=0.59), dPR (r=0.63), DFR (r=0.67), (all p<0.005). In patients with positive pressure assessments, 69% (FFR), 71% (iFR), 70% (DPR) and 65% (DFR) had CADRADs score <2. In severe AS, lower V/M was associated with lower pressure-indices (FFR 0.75 vs 0.86, iFR 0.79 vs 0.92, DFR 0.80 vs 0.91, all p<0.005), leading to high rates of positive physiologic assessment (FFR 88%, PdPa 72%, iFR 67%, DPR 78%, DFR 74%).

Conclusion

Patients with severe AS exhibit high rates of abnormal FFR and NHPR values, despite having no obstructive CAD. Their propensity for having abnormal physiological results is, in part, influenced by coronary volume to mass ratio. These results are important for clinicians considering using invasive physiological tools to guide revascularisation decisions in patients with severe AS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Monash University, Cardiac Society of Australia and New Zealand Correlation between NHPR/FFR and VMInvasive pressure indices and VM
Inclusion of echocardiographic measure of right ventricular function in the non-invasive French pulmonary arterial hypertension risk stratification method
Authors: Fauvel C , Raitiere O , Boucly A , Artaud-Macari E , Viacroze C , Schleifer D , Dominique S , Pichon J , Jais X , Montani D , Sitbon O , Savale L , Doguet F , Humbert M , Bauer F
Published: October 2021

Background

Although preserved right ventricular (RV) function is consistently associated with better survival in pulmonary arterial hypertension (PAH), the French risk assessment method has not yet considered echocardiographic criteria of RV function.

Purpose

In the present study, we tested the value of tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography for non-invasive PAH risk assessment.

Methods

We retrospectively studied a cohort of 306 incident PAH patients treated in two French expert centers who underwent follow-up TAPSE measurement from echocardiographic apical 4-chamber view in addition to previously validated invasive and non-invasive risk stratification variables. The primary composite outcome was 3-year lung transplantation free survival after follow-up assessment.

Results

At re-evaluation, 66% of patients were in NYHA functional class I-II and mean pulmonary arterial pressure, cardiac index, N-Terminal pro brain natriuretic peptide (NTproBNP), and 6-minute walk distance (6MWD) were 40±16 mmHg, 3.5±1.1 L/min/m2, 270 [interquartile range (IQR) 896] ng/L and 401 (IQR 213) meters, respectively. The primary outcome occurred in 58 (19%) patients. In multivariable Cox regression analysis, NYHA functional class I-II (p=0.02), NTproBNP <300 ng/L or BNP <50 ng/L (p=0.02), 6MWD >440m (p=0.049) and TAPSE≥17 mm (p=0.02) were associated with lung transplantation free survival. TAPSE provided similar information over 6MWD when both were used alternatively to stratify PAH patients at low risk (log-rank<0.001); Harrell's c-index 0.73.

Conclusion

Three dichotomized low-risk criteria (TAPSE, 6MWD and NTproBNP or BNP plasma levels) allow non-invasive risk assessment in PAH.

Funding Acknowledgement

Type of funding sources: None. 3-years transplant-free survival
Assessment of ECG variables in patients with CRO revascularization: comparison of patients with evidence of ischemia versus patients with angina only
Authors: Uyanik M , Gedikli O , Cinar A , Soylu K , Kara K
Published: October 2021

Objective

Recent studies have shown that CTO intervention improves ECG depolarization. however, its effect on mortality and left ventricular function is uncertain. Therefore, decision to revascularisation in CTO patients remains challenging. In this study, we aimed to evaluate the electrical changes in CTO patients according to the ischemia status detected by myocardial perfusion scintigraphy (MPS).

Method

The study population consisted of two groups. CTO patients with angina were included in the first group and CTO patients with ischemia detected by MPS were included in the second group. Only symptomatic patients were included. CTO patients without angina were excluded from the study. After successful percutaneous CTO recanalization, ECG variables were measured before the procedure and 12–18 months after the procedure.

Results

After pre-assessment, 94 patients met study criteria. 49 patients without MPS. 45 patients were included in the MPS group. Three studies showed a significant decrease in mean QT dispersion of 17.46 ms [95% CI 10.62–24.30] after successful CTO PCI. In both groups, post-PCI QT dispersion did not differ between groups. All groups were similar in terms of ventricular arrhythmia. There was no sudden cardiac death in either group. However, more symptomatic improvement was observed in the group with ischemia with MPS.

Conclusion

According to our findings, CTO intervention has reduced proarrhythmic ECG findings. But similar electrical changes were observed between symptomatic (with angina) patients and patients with evidence of ischemia. In this context, CTO PCI should be considered in terms of electrical stability and improvement in symptoms in all patients presenting with anginal symptoms, with or without evidence of ischemia.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Ondokuz Mayis University Scientific Research Office