bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 346: Targeted Temperature Management is Associated with Improved Neurological Outcomes in Witnessed Out-of-hospital Cardiac Arrest Patients Who Achieve Early Return of Spontaneous Circulation
Authors: Enzan Nobuyuki , Hiasa Ken-ichi , Ichimura Kenzo , Nishihara Masaaki , Iyonaga Takeshi , Shono Yuji , Kitazono Takanari , Tsutsui Hiroyuki
Published: November 2020

Background:
Previous randomized controlled trials demonstrated the efficacy of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA) patients with both shockable and non-shockable rhythm. Real-world evidence for TTM using large OHCA database are scarce, and no study has investigated the relationship between TTM and time-to-return of spontaneous circulation (ROSC).

Methods:
The Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients with witnessed non-traumatic OHCA who had been resuscitated and were in a coma were included. Eligible patients were divided into two groups according to the use of TTM. The primary outcome was defined as a Cerebral Performance Categories (CPC) Scale 1-2 at 30 days after OHCA. The propensity score matching analysis was used. The cubic spline analysis of the odds ratio of CPC 1-2 for TTM use by time-to-ROSC was performed.

Results:
Out of 34,754 patients with OHCA, 5,261 patients were included. The mean age was 70.3 years, and 3,417 (65.0%) were male. CPC 1-2 was more frequently observed in the TTM group in propensity score matching analysis (15.1% vs. 8.5%; odds ratio 1.92; 95% confidence interval 1.04-3.53; P=0.037). The cubic spline analysis showed that TTM was associated with CPC 1-2 in witnessed OHCA patients, which did not reach statistical significance in patients with time-to-ROSC longer than 50 min.

Conclusions:
TTM was associated with better neurological outcomes in witnessed OHCA patients, especially when patients were resuscitated within 50 min after collapse.
Abstract 347: The Effect of Targeted Temperature Management at 34 °C and 36 °C on Day-30 Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients
Authors: Iyonaga Takeshi , Hiasa Ken-ichi , Enzan Nobuyuki , Nishihara Masaaki A , Ichimura Kenzo , Shono Yuji , Kitazono Takanari , Tsutsui Hiroyuki
Published: November 2020

Introduction:
Targeted temperature management (TTM) has established evidence for improving neurological outcomes in cardiac arrest patients who sustained coma after return of spontaneous circulation (ROSC). The target temperature has been recommended to be between 32 and 36 °C. However optimal temperature remains unestablished. This study aimed to assess the relationship between target temperature and neurological outcome by using the Japanese nationwide registry.

Methods:
This retrospective observational cohort study was based on the Japanese association for acute medicine - out-of-hospital cardiac arrest (JAAM-OHCA) registry during 2014 to 2017. Our study included all initial rhythms and any cause of OHCA patients and excluded age < 18 and Glasgow Coma Scale score > 8. The primary outcome was 30 day favorable neurological outcome, defined as cerebral performance category (CPC) scale 1 and 2. First, to clarify the efficacy of TTM, the neurological outcome was compared whether patients received TTM or not. Next, to evaluate the relationship between neurological outcome and target temperature on TTM, the neurological outcome was compared hypothermia (34 °C) group with normothermia (36 °C) group . Single and multivariable logistic regression analysis was performed.

Results:
The study included 9930 patients. Of these, 1184 (11.9%) patients received TTM. Favorable neurological outcome was more present in TTM group than in no TTM group (39.7% vs. 4.3%, odds ratio [OR] 14.6, 95% confidence interval [CI] 12.5-17.1, p<0.001). Multivariable analysis showed TTM was associated with favorable neurological outcome (OR 1.6, 95%CI 1.1-2.3, p<0.001). Of TTM group, 801 (68.5%) patients received hypothermia management and 242 (20.7%) patients received normothermia management. Favorable neurological outcome was more present in the hypothermia group than in the normothermia group (42.6% vs. 34.3%, OR 1.42, 95% CI 1.1-1.9, p=0.022). However, the neurological outcome did not differ between these two groups (OR 0.84, 95%CI 0.46-1.5, p<0.57).

Conclusions:
TTM was significantly associated with favorable neurological outcome. However, neurological outcome was not associated with target temperature on TTM.
Abstract 354: Teaching Effective Cardiopulmonary Resuscitation to 4
Th
and
5
Th
Grade Elementary Students
Authors: Rogotzke Cyle , Bencik Sherrie , Billian Joseph , Ford Maureen , Elg Nathan , Bencik Cambrie , Mastenbrook Joshua
Published: November 2020

Background:
Cardiac arrests are a leading cause of mortality in the US. Many states have CPR training requirements for high school graduation. There is a paucity of research on CPR education and assessment in elementary students. We hypothesized that 4
th
and 5
th
graders could attain the knowledge of, and be physically equipped to provide, hands-only CPR.

Methods:
Forth and fifth grade students from one school district were taught basic resuscitation physiology and hands-only CPR using videos and inflatable CPR manikins. Knowledge gain was assessed by a 13-question pre-test and a 2-week follow-up post-test, at which time students also performed 1 minute of hands-only CPR on an adult high-fidelity manikin. CPR skills were assessed by an 11-step checklist. Manikin software analyzed the compression effectiveness. A secondary analysis evaluated for association between compression effectiveness and age, gender, and BMI.

Results:
Three hundred fifty-five students completed the high-fidelity portion of the study. On average, students answered 1.1 more questions correctly on the post-test than the pre-test (P<0.0001). The proportion of students self-reporting adequate CPR knowledge increased from 45% (155/345) to 98% (339/345) (p<0.0001) pre-test to post-test. The proportion of students willing to perform CPR increased from 92% (320/349) to 96% (335/349) (p=0.0018). At least 8/11 resuscitation steps were completed by 72% (256/355) (95% CI, 68-77%) of students. The most frequently missed step was “get the attention of an adult,” which was only demonstrated by 5.9% (21/355) of students. Seventy-six percent (271/355) (95% CI, 72-81%) were able to deliver at least half of their compressions effectively. Age, BMI, and gender were not significantly associated with compression effectiveness.

Conclusions:
The education intervention resulted in a significant increase in the number of questions answered correctly from the pre-test to the post-test. Most students were able to learn hands-only CPR, apply the knowledge in a simulated cardiac arrest, and deliver effective chest compressions. Following the intervention, the students felt more prepared and were more willing to do CPR. It would be reasonable for older elementary students to be taught hands-only CPR.
Abstract 355: Using Low-Fidelity Simulation with Hospital Specific Equipment to Improve Front Line Nursing Staff Knowledge, Skill, and Confidence in a Code Blue
Authors: McCullough-Leewright Shauna R
Published: November 2020

Introduction:
At this facility, staff response to unresponsive victims prior to arrival of Rapid Response Team is unreliable. The gaps in care reported by debrief forms include unable to find and use equipment on the crash cart, unable to appropriately document Code Blue in EHR, and not performing adequate CPR. Currently, the nursing staff is required to maintain Basic Life Support (BLS) and Advanced Life Support (ALS) (per their job description) via the Resuscitation Quality Improvement (RQI) program. RQI delivers quarterly training via computer scenarios and mannequin simulations. There is no consideration in RQI for hospital specific equipment or processes. The recommendation for improving staff response to code situations is to incorporate an annual Mock Code Event for all nursing staff to improve performance during code situations, in addition to RQI quarterly activities.

Hypothesis:
Participating in an instructor led Mock Code Event annually to review hospital specific equipment and processes, along with the quarterly RQI simulations, will improve staff response to code blue situations.

Methods:
The Mock Code Event included stations to review items in crash cart, use of defibrillator, documenting in EHR, and review of BLS. After completing the stations, the staff participated in a low-fidelity code blue simulation with a debrief. At end of activity, participants voluntarily completed a survey regarding Mock Code Event.

Results:
The participants scored 6 items on a Likert scale (from 1 disagree to 5 agree). 457 RNs and PCTs attended Mock Code Events in 2019. 189 completed survey after event.

Conclusion:
The survey findings demonstrate the Mock Code Event was an effective method to improve knowledge, skill, and confidence of front-line staff during Code Blue situations. The survey findings support that the educational techniques used were helpful and easy to understand.
Abstract 365: The Minnesota Mobile Extracorporeal Cardiopulmonary Resuscitation Consortium for Treatment of Out-of-hospital Refractory Ventricular Fibrillation: Program Description and Outcomes
Authors: Bartos Jason , Frascone Rj , Conterato Marc , Wesley Keith , Lick Charles , Sipprell Kevin , Vuljaj Nik , Simpson Nicholas S , Ham Kealy , Bruen Charles , Harkins Kim , Kosmopoulos Marinos , Aufderheide Tom P , Yannopoulos Demetris
Published: November 2020

Background:
Extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation has been shown to improve the survival rate for patients with refractory VF/VT cardiac arrest. However, survival decreases as CPR duration increases and metabolic derangement progresses. We describe here a first of its kind multi-healthcare system consortium to rapid deploy ECMO-facilitated resuscitation to patients across a metropolitan area.

Methods:
This retrospective cohort study analyzed 58 consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium’s ECMO-facilitated resuscitation program. Inclusion criteria included: 1) age 18 to 75 years, 2) VF/VT as presenting rhythm, 3) refractory cardiac arrest despite 3 shocks, 4) body habitus accommodating a LUCAS mechanical CPR device, 5) estimated transfer time of < 30 min from a cannulating center. The consortium included multiple healthcare systems, dispatch services, and emergency medical services. Essential components included EMS, selection of 3 ECMO cannulation sites in geographically favorable emergency departments, a centralized ECMO center for post-arrest care, and a 24/7 mobile ECMO cannulation team. The cannulation team provided ECMO cannulation and medical care until the patient reached the ECMO center.

Results:
From December 1, 2019 to April 1, 2020, 58 consecutive patients were treated by the mobile ECMO team. Mean age was 57 ± 1.8 years. Of these, 25/58 (43%) were discharged from the hospital with neurologically favorable survival. Patients were cannulated at all three cannulation sites with transport to the nearest site leading to mean professional CPR time of 52 min.

Conclusions:
This represents the first community-wide ECMO-facilitated resuscitation program in the United States. A consortium including multiple healthcare systems and emergency medical services coordinated efforts to rapidly deliver patients with refractory VF/VT cardiac arrest to a highly trained and equipped mobile ECMO cannulation team resulting in improved neurologically favorable survival.
Abstract 370: Electrical Features Of Pulseless Electrical Activity Associated With Cardiac Arrest Outcomes
Authors: Balian Steve , Alanis Garza David , Leturiondo Mikel , Lupton Joshua R , Russell James K , Daya Mohamud R , Abella Benjamin
Published: November 2020

Introduction:
The cardiac arrest rhythm of pulseless electrical activity (PEA) poses various diagnostic and therapeutic challenges. PEA may represent a spectrum of arrest conditions with variable responses to resuscitation care.

Aim:
We analyzed PEA rhythms to identify diagnostic patterns associated with survival in cardiac arrest.

Methods:
In this retrospective cohort study, we utilized the Portland Resuscitation Outcomes Consortium database of out-of-hospital cardiac arrests compiled by the Tualatin Valley Fire and Rescue from 2006-2016. Recordings from defibrillation pads included compression waveforms, electrocardiogram, and transthoracic impedance signals. For each patient, we analyzed the first two pauses in chest compressions, characterized by flat compression and impedance signals. Features extracted from raw ECG signals included contraction frequency and variability. Signal Fourier transformation and 0-100 Hz band pass filtering yielded signals’ distribution across a frequency spectrum from which signal power was extracted. Extraction of the three most prominent frequencies was performed from the Gaussian filtered frequency spectrum. Non-parametric tests (Mann-Whitney, Fisher) and logistic regression methods were used for analysis.

Results:
Fifty-nine ECG recordings were analyzed corresponding to 7 (11.9%) survivors and 52 (88.1%) non-survivors. Median age was 72 (IQR 20), and 28.8% (17/59) were female. No significant differences were noted in sex or median age between survivors and non-survivors. Analysis of the first ECG pause showed a higher first peak median frequency among survivors (2.15 vs 0.06 Hz, p=0.049). We did not find a significant association between the second peak median frequency of the first ECG segment (6.46 vs 1.49 Hz, p=0.882) or the signal power of the second ECG segment (108.04 vs 100.77 Hz, p=0.647) with survival. Regression analysis did not provide reliable outcome prediction models for survival in this preliminary cohort.

Conclusion:
Computerized analysis of PEA ECG waveforms offers alternate approaches to bedside signal interpretation that may correlate with survival. Our preliminary work offers a potential approach to PEA analysis that will require application to a larger PEA arrest cohort.
Abstract 372: Regional Cerebral Saturation in a Swine Model of Goal-directed Resuscitation of Prolonged Ventricular Fibrillation Cardiac Arrest
Authors: Genbrugge Cornelia , Salcido David D , Koller Allison C , Kern Caelie , Menegazzi James J
Published: November 2020

Introduction:
The characteristics and limitations of near-infrared spectroscopy (NIRS) measurement of regional cerebral saturation (rSO2) for reflecting key moment-to-moment physiological changes needed to guide cardiopulmonary resuscitation (CPR) have yet to be fully determined.

Objective:
Examine the impact of NIRS sensor placement and resuscitation process variation on rSO2 measurements during prolonged cardiac arrest.

Methods:
Thirty mixed-breed domestic pigs (mean weight: 25.0kg+/-2.0) were sedated (ketamine / xylazine), anesthetized (fentanyl), paralyzed (vecuronium) and mechanically ventilated. Micromanometer pressure transducers were placed in the aorta and right atrium via femoral cutdown to measure central pressures, including mean arterial pressure (MAP) and coronary perfusion pressure (CPP). Two NIRS sensors were placed on the cranium: one on the skin surface and one on the bare skull. Ventricular fibrillation was induced electrically and untreated for 8 minutes followed by CPR. Initial BLS phase: 4 minutes of CPR at 100 compressions per minute (CPM) and 2 inches depth with manual ventilations (30:2). Randomized ALS phase: CPR with a pressor-titrated (Group A) or a compression rate/depth-titrated (Group B) strategy targeting 25mmHg CPP. Group A animals received pressor doses q1min and fixed rate/depth CPR. Group B animals received increasing rates and depth of CPR with epinephrine q3min. Defibrillation was attempted at 6min CPR q2min. rSO2 was compared between skin and skull across phases of resuscitation with t-tests and generalized estimating equations (GEE).

Results:
Mean skin and skull rSO2 differed marginally overall (63.8 vs 62.0, p < 0.001), at baseline (69.9 vs 64.9, p < 0.001), during BLS CPR (56.9 vs 48.7, p < 0.001), during ALS CPR (59.5 vs 51.0, p < 0.001), and following ROSC (70.0 vs 60.5, p<0.001). rSO2 measured on either skull or skin both varied throughout phases of the experiment but not between CPR groups. In GEE models, rSO2 measured on skin or skull was not associated with MAP at baseline, but was directly associated during BLS (coef 0.13; p<0.001) & ALS CPR (coef 0.09; p<0.001), and after ROSC (coef 0.02; p=0.017).

Conclusion:
rSO2 measures differ between skin and skull though both correlate with MAP.
Durable Mechanical Circulatory Support in Patients With Amyloid Cardiomyopathy
Authors: Michelis Katherine C. , Zhong Lin , Tang W.H. Wilson , Young James B. , Peltz Matthias , Drazner Mark H. , Pandey Ambarish , Griffin Jan , Maurer Mathew S. , Grodin Justin L.
Published: November 2020

Background:

Many patients with amyloid cardiomyopathy (ACM) develop advanced heart failure, and durable mechanical circulatory support (MCS) may be a consideration. However, data describing clinical outcomes after MCS in this population are limited.

Methods:

Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support with dilated cardiomyopathy (DCM, n=19 921), nonamyloid restrictive cardiomyopathy (RCM, n=248), or ACM (n=46) between 2005 and 2017 were included. Patient and device characteristics were compared between cardiomyopathy groups. The primary end point was the cumulative incidence of death with heart transplantation as a competing risk.

Results:

Patients with ACM (n=46) were older (61 years [interquartile range, 55–69 years] versus 58 years [interquartile range, 49–66 years] for DCM and 55 years [interquartile range, 46–62 years] for nonamyloid RCM,
P
<0.001) and were more commonly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30.4% versus 17.9% for DCM and 21.0% for nonamyloid RCM,
P
=0.04) at device implantation. Use of biventricular support (biventricular assist device or total artificial heart) was the highest for patients with ACM (41.3% versus 6.7% and 19.4% for patients with DCM and nonamyloid RCM, respectively,
P
=0.014). The cumulative incidence of death was highest for patients with ACM relative to those with DCM or nonamyloid RCM (
P
<0.001) but did not differ significantly between groups for those who required biventricular MCS.

Conclusions:

Compared with patients with DCM or nonamyloid RCM who received durable MCS, those with ACM experienced the highest use of biventricular support and the worst survival. These data highlight concerns with the use of durable MCS for patients with ACM.
Examining the Nocebo Effect of Statins Through Statin Adverse Events Reported in the Food and Drug Administration Adverse Event Reporting System
Authors: Moon Jungyeon , Cohen Sedgh Robert , Jackevicius Cynthia A.
Published: November 2020

Background:

This study aimed to evaluate whether the high frequency of reported statin adverse effects (AEs) may be associated with the nocebo effect. We compared nocebo-related subjective AEs with objective AEs and investigated factors potentially associated with the nocebo effect.

Methods:

A retrospective cohort study was conducted using the Food and Drug Administration Adverse Event Reporting System between January 2010 and December 2019 for statins, including, atorvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Subjective AEs included fatigue, subjective muscular, and nervous system AEs. Objective AEs were defined as hepatic and objective muscular AEs. We compared the number of subjective and objective AEs using the Mann-Whitney
U
test and examined trends in the frequency of subjective versus objective reports over time using linear regression with interaction terms. We evaluated the association between AEs and gender and country using linear regression. Quantitative detection of signals was estimated using proportional reporting ratio and reporting odds ratio for simvastatin.

Results:

Of 2 994 487 overall AE reports, more subjective than objective AEs were reported per quarter (mean±SD: 4777±1375.45 versus 999±276.95;
P
<0.0001), and over time during the study period (
P
<0.001). Women reported more subjective AEs than men per quarter (fatigue: 86.98 more per quarter,
P
=0.035; subjective muscular AE: 417.95,
P
<0.0001; nervous system AE: 273.60,
P
<0.0001), but fewer objective muscular AEs (−125.23 per quarter,
P
<0.0001). More subjective AEs and fewer objective AEs were reported per quarter in the United States relative to other countries. Simvastatin-associated reports showed signals for higher objective muscular AEs relative to all other statins (reporting odds ratio, 1.53 [95% CI, 1.49–1.58]).

Conclusions:

This study found that significantly more subjective than objective AEs are reported for statins. Subjective statin AEs, potentially related to the nocebo effect are reported more often by women than by men, and in the United States than in other countries.
Association of Medicaid Expansion With Rates of Utilization of Cardiovascular Therapies Among Medicaid Beneficiaries Between 2011 and 2018
Authors: Sumarsono Andrew , Lalani Hussain , Segar Matthew W. , Rao Shreya , Vaduganathan Muthiah , Wadhera Rishi K. , Das Sandeep R. , Navar Ann Marie , Fonarow Gregg C. , Pandey Ambarish
Published: November 2020

Background:

The Affordable Care Act expanded Medicaid eligibility allowing low-income individuals greater access to health care. However, the uptake of state Medicaid expansion has been variable. It remains unclear how the Medicaid expansion was associated with the temporal trends in use of evidence-based cardiovascular drugs.

Methods:

We used the publicly available Medicaid Drug Utilization and Current Population Survey to extract filled prescription rates per 1000 Medicaid beneficiaries of statins, antihypertensives, P2Y12 inhibitors, and direct oral anticoagulants. We defined expander states as those who expanded Medicaid on or before January 1, 2014, and nonexpander states as those who had not expanded by December 31, 2018. Difference-in-differences (DID) analyses were performed to compare the association of the Medicaid expansion with per-capita cardiovascular drug prescription rates in expander versus nonexpander states.

Results:

Between 2011 and 2018, the total number of prescriptions among all Medicaid beneficiaries increased, with gains of 89.7% in statins (11.0 to 20.8 million), 76% in antihypertensives (35.3 to 62.2 million), and 37% in P2Y12 inhibitors (1.7 to 2.3 million). Medicaid expansion was associated with significantly greater increases in quarterly prescriptions (per 1000 Medicaid beneficiaries) of statins (DID estimate [95% CI]: 22.5 [16.5–28.6],
P
<0.001), antihypertensives (DID estimate [95% CI]: 63.2 [47.3–79.1],
P
<0.001), and P2Y12 inhibitors (DID estimate [95% CI]: 1.7 [1.2–2.2],
P
<0.001). Between 2013 and 2018, >75% of the expander states had increases in prescription rates of both statins and antihypertensives. In contrast, 44% of nonexpander states saw declines in statins and antihypertensives. The Medicaid expansion was not associated with higher direct oral anticoagulants prescription rates (DID estimate [95% CI] 0.9 [−0.3 to 2.1],
P
=0.142).

Conclusions:

The 2014 Medicaid expansion was associated with a significant increase in per-capita utilization of cardiovascular prescription drugs among Medicaid beneficiaries. These gains in utilization may contribute to long-term cardiovascular benefits to lower-income and previously underinsured populations.
Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children
Authors: Alsaied Tarek , Tremoulet Adriana H. , Burns Jane C. , Saidi Arwa , Dionne Audrey , Lang Sean M. , Newburger Jane W. , de Ferranti Sarah , Friedman Kevin G.
Published: November 2020

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with substantial cardiovascular implications. Although infection with SARS-CoV-2 is usually mild in children, some children later develop a severe inflammatory disease that can have manifestations similar to toxic shock syndrome or Kawasaki disease. This syndrome has been defined by the US Centers for Disease Control and Prevention as multisystem inflammatory syndrome in children. Although the prevalence is unknown, >600 cases have been reported in the literature. Multisystem inflammatory syndrome in children appears to be more common in Black and Hispanic children in the United States. Multisystem inflammatory syndrome in children typically occurs a few weeks after acute infection and the putative etiology is a dysregulated inflammatory response to SARS-CoV-2 infection. Persistent fever and gastrointestinal symptoms are the most common symptoms. Cardiac manifestations are common, including ventricular dysfunction, coronary artery dilation and aneurysms, arrhythmia, and conduction abnormalities. Severe cases can present as vasodilatory or cardiogenic shock requiring fluid resuscitation, inotropic support, and in the most severe cases, mechanical ventilation and extracorporeal membrane oxygenation. Empirical treatments have aimed at reversing the inflammatory response using immunomodulatory medications. Intravenous immunoglobulin, steroids, and other immunomodulatory agents have been used frequently. Most patients recover within days to a couple of weeks and mortality is rare, although the medium- and long-term sequelae, particularly cardiovascular complications, are not yet known. This review describes the published data on multisystem inflammatory syndrome in children, focusing on cardiac complications, and provides clinical considerations for cardiac evaluation and follow-up.
Association of Baseline and Longitudinal Changes in Body Composition Measures With Risk of Heart Failure and Myocardial Infarction in Type 2 Diabetes
Authors: Patel Kershaw V. , Bahnson Judy L. , Gaussoin Sarah A. , Johnson Karen C. , Pi-Sunyer Xavier , White Ursula , Olson KayLoni L. , Bertoni Alain G. , Kitzman Dalane W. , Berry Jarett D. , Pandey Ambarish ,   On behalf of the Look AHEAD Research Group
Published: November 2020

Background:

Intentional weight loss is associated with lower risk of heart failure (HF) and atherosclerotic cardiovascular disease among patients with type 2 diabetes. However, the contribution of baseline measures and longitudinal changes in fat mass (FM), lean mass (LM), and waist circumference (WC) to the risk of HF and myocardial infarction (MI) in type 2 diabetes is not well established.

Methods:

Adults from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. FM and LM were predicted using validated equations and compared with dual-energy x-ray absorptiometry measurements in a subgroup. Adjusted Cox models were used to evaluate the associations of baseline and longitudinal changes in FM, LM, and WC over 1- and 4-year follow-up with risk of overall HF, HF with preserved ejection fraction (EF; EF ≥50%), HF with reduced EF (EF <50%), and MI.

Results:

Among 5103 participants, there were 257 incident HF events over 12.4 years of follow-up. Predicted and measured FM/LM were highly correlated (
R
2
=0.87–0.90; n=1369). FM and LM decreased over 4-year follow-up with greater declines in the intensive lifestyle intervention arm. In adjusted analysis, baseline body composition measures were not significantly associated with HF risk. Decline in FM and WC, but not LM, over 1 year were each significantly associated with lower risk of overall HF (adjusted hazard ratio per 10% decrease in FM, 0.80 [95% CI, 0.68–0.95]; adjusted hazard ratio per 10% decrease in WC, 0.77 [95% CI, 0.62–0.95]). Decline in FM was significantly associated with lower risk of both HF subtypes. In contrast, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF. Similar patterns of association were observed for 4-year changes in body composition and HF risk. Longitudinal changes in body composition were not significantly associated with risk of MI.

Conclusions:

In adults with type 2 diabetes, a lifestyle intervention is associated with significant loss of FM and LM. Declines in FM and WC, but not LM, were each significantly associated with lower risk of HF but not MI. Furthermore, decline in WC was significantly associated with lower risk of HF with preserved EF but not HF with reduced EF.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00017953.
Flow-Mediated Susceptibility and Molecular Response of Cerebral Endothelia to SARS-CoV-2 Infection
Authors: Kaneko Naoki , Satta Sandro , Komuro Yutaro , Muthukrishnan Sree Deepthi , Kakarla Visesha , Guo Lea , An Jennifer , Elahi Fanny , Kornblum Harley I. , Liebeskind David S. , Hsiai Tzung , Hinman Jason D.
Published: November 2020

Background and Purpose:

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with an increased rate of cerebrovascular events including ischemic stroke and intracerebral hemorrhage. The mechanisms underlying cerebral endothelial susceptibility and response to SARS-CoV-2 are unknown yet critical to understanding the association of SARS-CoV-2 infection with cerebrovascular events.

Methods:

Endothelial cells were isolated from human brain and analyzed by RNA sequencing. Human umbilical vein and human brain microvascular cells were used in both monolayer culture and endothelialized within a 3-dimensional printed vascular model of the middle cerebral artery. Gene expression levels were measured by quantitative polymerase chain reaction and direct RNA hybridization. Recombinant SARS-CoV-2 S protein and S protein–containing liposomes were used to measure endothelial binding by immunocytochemistry.

Results:

ACE2
(angiotensin-converting enzyme-2) mRNA levels were low in human brain and monolayer endothelial cell culture. Within the 3-dimensional printed vascular model,
ACE2
gene expression and protein levels were progressively increased by vessel size and flow rates. SARS-CoV-2 S protein–containing liposomes were detected in human umbilical vein endothelial cells and human brain microvascular endothelial cells in 3-dimensional middle cerebral artery models but not in monolayer culture consistent with flow dependency of ACE2 expression. Binding of SARS-CoV-2 S protein triggered 83 unique genes in human brain endothelial cells including upregulation of complement component C3.

Conclusions:

Brain endothelial cells are susceptible to direct SARS-CoV-2 infection through flow-dependent expression of ACE2. Viral S protein binding triggers a unique gene expression profile in brain endothelia that may explain the association of SARS-CoV-2 infection with cerebrovascular events.
How Did Japan Cope with COVID-19? Big Data and Purchasing Behavior*
Authors: Konishi Yoko , Saito Takashi , Ishikawa Toshiki , Kanai Hajime , Igei Naoya
Published: November 2020

Japan has been recognized as having successfully controlled the spread of COVID-19. This study aims to gather insights to combat the spread of infection in our daily lives by observing our purchasing behavior. We use point of sales (POS) data from supermarkets, convenience stores, home centers, drug stores, and electronics retail stores for a nationwide analysis. Our analysis revealed the following. First, the Japanese actively prevented the spread of infection by voluntarily wearing masks, using alcohol-based disinfectants, and gargling. Second, they willingly stayed home during the semi-lockdown. Third, they continued to purchase infection prevention essentials during periods of both low and high levels of infection. We conclude that continuing to wear masks, wash and sanitize hands, and gargle, along with spending more time at home to maintain safe distancing, will be effective in reducing the spread of the virus and combatting the pandemic. Finally, infections and deaths were primarily concentrated in the Tokyo metropolitan area and the Kansai region, where the nature of the spread of the infection was different from that in small and middle-sized prefectures.
How China Managed the COVID-19 Pandemic*
Authors: Tian Wei
Published: November 2020

The COVID-19 pandemic has swept across China and the world, causing more than 30 million infections and incalculable damage. China was seriously damaged and threatened by the disease in the first quarter of 2020, but finally succeeded in halting its spread in a short period. This was achieved through quick and strong measures in self-protection, mobility control, resource allocation, professional health care, and disinfection, under the organization of the government and the cooperation of all the Chinese people. The measures that were taken to prevent the spread of COVID-19 proved to be efficient in fighting the outbreak in Beijing in June 2020. This paper reviews China's experience with COVID-19, the Chinese economy's performance during the pandemic, and the government's policies to protect lives, maintain markets, and promote the economy. The data show that strong monetary and fiscal policies accelerated the country's economic recovery. These policies, including tax reductions and credit support, targeting small- and medium-size enterprises (SMEs) and industries and regions that were severely damaged, have helped to create jobs and encourage production and investment.
Beyond Difference in Reaction Time: Understanding Neuronal Activity during the Preparatory Period of the Decision Process
Authors: Paluch Katarzyna , Jurewicz Katarzyna , Wróbel Andrzej
Published: November 2020

Even the simplest perceptual tasks are executed with significant interindividual differences in accuracy and RT. In this work, we used the diffusion decision model and multi-electrode EEG signals to study the impact of neuronal activity during the preparatory period on the following decision process in an attention task. Two groups were defined by fast and slow responses during the performance of control trials. A third, control group performed the same experiment but with instructions defining signal for response execution. We observed that the fast-responding group had a shorter duration of nondecision processes (describing both stimulus encoding and response preparation) preceded by lower power of the frontal upper alpha (10–15 Hz) and central beta (21–26 Hz) activities during the preparatory period. To determine whether these differences were followed by a shortening of the early perceptual or late motor process, we analyzed lateralized readiness potential (LRP). The time from LRP onset until response execution (LRP-RT interval) was similar in all three groups, enabling us to interpret shortening of nondecision time as reflecting faster stimulus encoding.
Freshwater fishes from Paraná State, Brazil: an annotated list, with comments on biogeographic patterns, threats, and future perspectives
Authors: DOS REIS RENAN BORGES , FROTA AUGUSTO , DE CARVALHO DEPRÁ GABRIEL , OTA RENATA RÚBIA , DA GRAÇA WEFERSON JÚNIO
Published: November 2020

An annotated checklist for the freshwater fishes from Paraná State, Brazil is provided. A total of 440 freshwater fish species are recorded for the state, distributed across five ecoregions: Upper Parana, Lower Parana, and Iguassu, all within the rio Paraná basin, and corresponding to the state’s Inland Slope, and Southeastern Mata Atlantica and Ribeira de Iguape, corresponding to the Atlantic Slope, encompassing minor coastal drainages emptying in the Baía de Paranaguá or in the Baía de Guaratuba, and the rio Ribeira de Iguape basin, respectively. The Upper Parana ecoregion ocuppies the larger in area in the state, and is divided into the following sub-ecoregions: Floodplain, Paranapanema, Piquiri, and Ivaí. Species richness for each ecoregion is as follows: 273 species for the Upper Parana (Paranapanema sub-ecoregion, 217 species; Floodplain sub-ecoregion, 193 species; Piquiri sub-ecoregion, 154 species; Ivaí sub-ecoregion, 132 species), 154 species in the Lower Parana, 127 species in the Iguassu, 68 species in the Southeastern Mata Atlantica, and 50 species in the Ribeira de Iguape. We recorded 42 putatively undescribed species and 117 endemic species from specific ecoregions (except Upper Parana) or sub-ecoregions in the state. Ninety-eight species recorded are non-native from at least one of the state’s ecoregions. Thirty-three species are considered threatened. The ecoregions in the Atlantic Slope share many more species with each other than with ecoregions in the Inland Slope. The Iguassu ecoregion is the only one located in Inland Slope that shares more species with the Atlantic Slope than with the remaining ecoregions from the Inland Slope. The Ivaí sub-ecoregion lacks several species that are common to all other sub-ecoregions of the Upper Parana ecoregion. Comments on the historical development of taxonomic knowledge, biogeography, threats, and conservation strategies for the fish fauna from the Paraná State are provided.
Variability in Wind Energy Generation across the Contiguous United States
Authors: Pryor S. C. , Letson F.W. , Barthelmie R. J.
Published: November 2020

ERA5 provides high-resolution, high-quality hourly wind speeds at 100 m and is a unique resource for quantifying temporal variability in likely wind-derived power production across the United States. Gross capacity factors (CF) in seven independent system operators (ISOs) are estimated using the location and rated power of each wind turbine, a simplified power curve, and ERA5 output from 1979 to 2018. Excluding the California ISO, the marginal probability of a calm (zero power production) is less than 0.1 in any ERA5 grid cell. When a calm occurs, the mean co-occurrence across wind-turbine-containing grid cells ranges from 0.38 to 0.39 for ISOs in the Midwest and central plains [Midcontinent (or Midwest) ISO (MISO), Southwest Power Pool (SPP), and the Electric Reliability Council of Texas (ERCOT) region], increasing to 0.54–0.58 for ISOs in the eastern United States [Pennsylvania–New Jersey–Maryland interconnection (PJM), New York ISO (NYISO), and New England ISO (NEISO)]. Periods with low gross CF have a median duration of ≤6 h, except in California, and are most likely during summer. Gross CF exhibit highest variance at periods of 1 day in ERCOT and SPP; on synoptic scales in MISO, NEISO, and NYISO; and on interannual time scales in PJM. This implies differences in optimal strategies for ensuring resilience of supply. Theoretical scenarios show adding wind energy capacity near existing wind farms is advantageous even in areas with high existing installed capacity (IC), while expanding into areas with lower IC is more beneficial to reducing ramps and the probability of gross CF falling below 20%. These results emphasize the benefits of large balancing areas and aggregation in reducing wind power variability and the likelihood of wind droughts.
Mechanisms of Decadal North Atlantic Climate Variability and Implications for the Recent Cold Anomaly
Authors: Årthun Marius , Wills Robert C. J. , Johnson Helen L. , Chafik Léon , Langehaug Helene R.
Published: November 2020

Decadal sea surface temperature (SST) fluctuations in the North Atlantic Ocean influence climate over adjacent land areas and are a major source of skill in climate predictions. However, the mechanisms underlying decadal SST variability remain to be fully understood. This study isolates the mechanisms driving North Atlantic SST variability on decadal time scales using low-frequency component analysis, which identifies the spatial and temporal structure of low-frequency variability. Based on observations, large ensemble historical simulations, and preindustrial control simulations, we identify a decadal mode of atmosphere–ocean variability in the North Atlantic with a dominant time scale of 13–18 years. Large-scale atmospheric circulation anomalies drive SST anomalies both through contemporaneous air–sea heat fluxes and through delayed ocean circulation changes, the latter involving both the meridional overturning circulation and the horizontal gyre circulation. The decadal SST anomalies alter the atmospheric meridional temperature gradient, leading to a reversal of the initial atmospheric circulation anomaly. The time scale of variability is consistent with westward propagation of baroclinic Rossby waves across the subtropical North Atlantic. The temporal development and spatial pattern of observed decadal SST variability are consistent with the recent observed cooling in the subpolar North Atlantic. This suggests that the recent cold anomaly in the subpolar North Atlantic is, in part, a result of decadal SST variability.
Dryness over the U.S. Southwest, a Springboard for Cold Season Pacific SST to Influence Warm Season Drought over the U.S. Great Plains
Authors: Zhuang Yizhou , Erfanian Amir , Fu Rong
Published: November 2020

Although the influence of sea surface temperature (SST) forcing and large-scale teleconnection on summer droughts over the U.S. Great Plains has been suggested for decades, the underlying mechanisms are still not fully understood. Here we show a significant correlation between low-level moisture condition over the U.S. Southwest in spring and rainfall variability over the Great Plains in summer. Such a connection is due to the strong influence of the Southwest dryness on the zonal moisture advection to the Great Plains from spring to summer. This advection is an important contributor for the moisture deficit during spring to early summer, and so can initiate warm season drought over the Great Plains. In other words, the well-documented influence of cold season Pacific SST on the Southwest rainfall in spring, and the influence of the latter on the zonal moisture advection to the Great Plains from spring to summer, allows the Pacific climate variability in winter and spring to explain over 35% of the variance of the summer precipitation over the Great Plains, more than that can be explained by the previous documented west Pacific–North America (WPNA) teleconnection forced by tropical Pacific SST in early summer. Thus, this remote land surface feedback due to the Southwest dryness can potentially improve the predictability of summer precipitation and drought onsets over the Great Plains.
Submesoscale Currents in the Subtropical Upper Ocean Observed by Long-Term High-Resolution Mooring Arrays
Authors: Zhang Zhiwei , Zhang Xincheng , Qiu Bo , Zhao Wei , Zhou Chun , Huang Xiaodong , Tian Jiwei
Published: November 2020

Although observational efforts have been made to detect submesoscale currents (submesoscales) in regions with deep mixed layers and/or strong mesoscale kinetic energy (KE), there have been no long-term submesoscale observations in subtropical gyres, which are characterized by moderate values of both mixed layer depths and mesoscale KE. To explore submesoscale dynamics in this oceanic regime, two nested mesoscale- and submesoscale-resolving mooring arrays were deployed in the northwestern Pacific subtropical countercurrent region during 2017–19. Based on the 2 years of data, submesoscales featuring order one Rossby numbers, large vertical velocities (with magnitude of 10–50 m day−1) and vertical heat flux, and strong ageostrophic KE are revealed in the upper 150 m. Although most of the submesoscales are surface intensified, they are found to penetrate far beneath the mixed layer. They are most energetic during strong mesoscale strain periods in the winter–spring season but are generally weak in the summer–autumn season. Energetics analysis suggests that the submesoscales receive KE from potential energy release but lose a portion of it through inverse cascade. Because this KE sink is smaller than the source term, a forward cascade must occur to balance the submesoscale KE budget, for which symmetric instability may be a candidate mechanism. By synthesizing observations and theories, we argue that the submesoscales are generated through a combination of baroclinic instability in the upper mixed and transitional layers and mesoscale strain-induced frontogenesis, among which the former should play a more dominant role in their final generation stage.
XMET—An Unattended Meteorological Sensing System for Austere Environments
Authors: Rogowski Peter , Otero Mark , Hazard Joel , Muschamp Thomas , Katz Scott , Terrill Eric
Published: November 2020

Accurate surface meteorological (MET) observations reported reliably and in near–real time remain a critical component of on-scene environmental observation systems. Presented is a system developed by Scripps Institution of Oceanography that allows for rapid, global deployment of ground-based weather observations to support both timely decision-making and collection of high-quality weather time series for science or military applications in austere environments. Named the Expeditionary Meteorological (XMET), these weather stations have been deployed in extreme conditions devoid of infrastructure ranging from tropical, polar, maritime, and desert environments where near continuous observations were reported. To date, over 1 million weather observations have been collected during 225 deployments around the world with a data report success rate of 99.5%. XMET had its genesis during Operation Iraqi Freedom (OIF), when the U.S. Marine Corps 3rd Marine Aircraft Wing identified an immediate capability gap in environmental monitoring of their operation area due to high spatiotemporal variability of dust storms in the region. To address the sensing gap, XMET was developed to be a portable, expendable, ruggedized, self-contained, bidirectional, weather observation station that can be quickly deployed anywhere in the world to autonomously sample and report aviation weather observations. This paper provides an overview of the XMETs design, reliability in different environments, and examples of unique meteorological events that highlight both the unit’s reliability and ability to provide quality time series. The overview shows expeditionary MET sensing systems, such as the XMET, are able to provide long-term continuous observational records in remote and austere locations essential for regional spatiotemporal MET characterization.
Toward Unifying Short-Term and Next-Day Convection-Allowing Ensemble Forecast Systems with a Continuously Cycling 3-km Ensemble Kalman Filter over the Entire Conterminous United States
Authors: Schwartz Craig S. , Romine Glen S. , Dowell David C.
Published: November 2020

Using the Weather Research and Forecasting Model, 80-member ensemble Kalman filter (EnKF) analyses with 3-km horizontal grid spacing were produced over the entire conterminous United States (CONUS) for 4 weeks using 1-h continuous cycling. For comparison, similarly configured EnKF analyses with 15-km horizontal grid spacing were also produced. At 0000 UTC, 15- and 3-km EnKF analyses initialized 36-h, 3-km, 10-member ensemble forecasts that were verified with a focus on precipitation. Additionally, forecasts were initialized from operational Global Ensemble Forecast System (GEFS) initial conditions (ICs) and experimental “blended” ICs produced by combining large scales from GEFS ICs with small scales from EnKF analyses using a low-pass filter. The EnKFs had stable climates with generally small biases, and precipitation forecasts initialized from 3-km EnKF analyses were more skillful and reliable than those initialized from downscaled GEFS and 15-km EnKF ICs through 12–18 and 6–12 h, respectively. Conversely, after 18 h, GEFS-initialized precipitation forecasts were better than EnKF-initialized precipitation forecasts. Blended 3-km ICs reflected the respective strengths of both GEFS and high-resolution EnKF ICs and yielded the best performance considering all times: blended 3-km ICs led to short-term forecasts with similar or better skill and reliability than those initialized from unblended 3-km EnKF analyses and ~18–36-h forecasts possessing comparable quality as GEFS-initialized forecasts. This work likely represents the first time a convection-allowing EnKF has been continuously cycled over a region as large as the entire CONUS, and results suggest blending high-resolution EnKF analyses with low-resolution global fields can potentially unify short-term and next-day convection-allowing ensemble forecast systems under a common framework.