bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of Pulse Oximetry Oxygen Saturation (SpO2) with Incorporation of Positive End-Expiratory Pressure (SpO2
∗
10/FiO2
∗
PEEP) for Classification and Prognostication of Patients with Acute Respiratory Distress Syndrome
Authors: Todur Pratibha , Nileshwar Anitha , Chaudhuri Souvik , Gupta Nitin , Natarajan Srikant , Rao Shwethapriya
Published: September 2022

Background. Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2

∗

10/FiO2

∗

PEEP or P/FP

∗

10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2

∗

10/FiO2

∗

PEEP (S/FP

∗

10) to PaO2

∗

10/FiO2

∗

PEEP (P/FP

∗

10) and evaluate the utility of S/FP

∗

10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling. Aim. To evaluate if pulse oximetry is a reliable indicator of oxygenation in ARDS patients by calculating SpO2

∗

10/FiO2

∗

PEEP (S/FP

∗

10). The primary objective was to determine the correlation of S/FP

∗

10 to P/FP

∗

10 ratio in ARDS patients. The secondary objective was to determine the cut-off value of S/FP

∗

10 ratio to predict severe ARDS and survival. Methods. Patients aged 18–80 years on invasive mechanical ventilation (MV) diagnosed with ARDS as defined by the Berlin definition were included. The values of PaO2, FiO2, and SpO2 were collected at three different time points. They were at baseline, i.e., after intubation and initiation of MV (within one hour of intubation), day one (1–24 hours of MV), and day three (48–72 hours of MV). The primary outcome was survival at the end of intensive care unit (ICU) stay. Results. A total of 85 patients with ARDS on invasive MV were included. The data points were obtained at baseline, day one, and day three of MV. S/FP

∗

10 ratio has an excellent correlation to P/FP

∗

10 ratio at baseline and day three of invasive MV (r = 0.831 and 0.853, respectively;

p
<
0.001

) and has a strong correlation on day one of invasive MV (r = 0.733,

p
<
0.001

). S/FP

∗

10 ratio ≤116 at baseline has excellent discriminant function to be categorized as severe ARDS as per Berlin definition (AUC: 0.925,

p
<
0.001

, 90% sensitivity, 93% specificity, CI: [0.862–0.988]). The increase in S/FP

∗

10 ratio by ≥64.40 from baseline to day three of MV is a good predictor of survival (AUC: 0.877,

p
<
0.001

, 73.5% sensitivity, 97% specificity, CI: [0.803–0.952]). Conclusion. S/FP

∗

10 has a strong correlation to P/FP

∗

10 in ARDS patients. S/FP

∗

10 ≤116 has an excellent discriminant function to be categorized as severe ARDS. The S/FP

∗

10 ratio on day three of MV and the change in S/FP

∗

10 ratio from baseline and day one to day three of MV are good predictors of survival in ARDS patients. This trial is registered with CTRI/2020/04/024940.
Low-Rank Tensor Patching Based on Convolutional Sparse Coding for Communication Data Repair
Authors: Hu Yi , Yao Yuyi , Cheng Zhen
Published: September 2022

The study aimed to solve the common problem that hardware limitations and degradation make the data obtained in reality usually incomplete and improve the quality of communication transmission. In this paper, we propose a new low-rank tensor complementation model LRTC-CSC, which is based on tensor kernel parametrization (TNN), preserves the low-rank structure of information while restoring the detail features, and finally solves the problem using the efficient alternating direction multiplier method (ADMM). Based on the low-rank nature of the tensor, adding convolutional sparse coding (CSC) can well represent the characteristics of the high-frequency part of the information to handle the details while recovering the global information. The experimental results show that the training set of this paper saves much time compared with other models in several metrics by using only ten images of similar color for each data. At the same time, the data recovery effect is much higher than the novel TV canonical prior. In particular, the LRTC-CSC model is 5.18 dB higher than the LRTC-TV model in terms of PSNR value for image recovery at a 70% missing rate. The LRTC-CSC model proposed in this paper is more accurate and efficient for communication data restoration.
Path Planning of a Multifunctional Elderly Intelligent Wheelchair Based on the Sensor and Fuzzy Bayesian Network Algorithm
Authors: Kong Jian , Li Peng
Published: September 2022

An intelligent wheelchair is a kind of service robot. The most critical part of its research field is the safe navigation control of a wheelchair, and path planning is the core part of the navigation control system. The use of a reasonable obstacle avoidance algorithm can not only ensure the safe navigation of wheelchair but also protect the personal safety of users. This paper analyzes the actual needs of the wheelchair following system according to the application scenarios and determines the way to follow the target. The sensor scheme and the wheelchair mobile platform are selected through the analysis of the following methods and the characteristics of each sensor, and the overall architecture of the wheelchair hardware system is designed. Then, the key components such as processor, laser ranging radar, signal strength positioning module, and ultrasonic sensor in the hardware system are selected, and the corresponding peripheral circuit is designed according to the interface type and working voltage of the sensor. In order to solve the problems of the complex calculation process, one-way reasoning, and poor accuracy of the original fault tree method, this paper designs an expert knowledge inference machine based on the Bayesian network. After completing the definition of component vulnerability, the inference engine can be activated, the construction of the directed acyclic network is completed based on the knowledge model mapping of the fault tree, the conditional probability table definition of the directed edge is completed, and the bidirectional probability inference of the Bayesian network can be started. Diagnostic inference obtains the posterior probability to characterize the system impact degree of the bottom event failure. Based on a comprehensive analysis of the research status and research trend of intelligent wheelchair obstacle avoidance path planning methods, this paper mainly studies the intelligent wheelchair path planning method. The environment modeling and path planning of global path planning for static obstacles and dynamic obstacles are realized, and a simulation platform for wheelchair obstacle avoidance path planning based on MATLAB is designed, and simulation experiments are carried out on this basis. The effectiveness of the studied algorithms and strategies in the dynamic obstacle environment is verified by simulation experiments.
Climate Variability Impacts and Coping Strategies in Malipati Communal Area, Chiredzi District, Southeast Zimbabwe
Authors: Dhliwayo Itai , Mutanga Chiedza Ngonidzashe , Mashapa Clayton , Muboko Never , Gandiwa Edson
Published: September 2022

The spatial-temporal impacts and coping strategies to climate variability vary across human communities. Focusing on Malipati Communal Area in Chiredzi District, southeast Zimbabwe, the study analysed the impacts of climate variability and coping strategies adopted by local communities. Data were collected between May and June 2018 in five (5) villages in Ward 15 of Malipati Communal Area, where a total of 133 participants were involved through focus group discussions, questionnaires, and key informant interviews. The results showed an increase in livestock mortality and in contrast no significant changes in crop yields between 1990 and 2018. Further, the study established that local communities have negative perceptions towards the adaptive coping strategies to climate change, especially on the production of small grains. There is a need for other innovative strategies to enable communities to continuously buffer the impacts of climate variability inclusive of diversifying economic activities.
Application of Modern Multimedia and Sensing Technology in Fault Detection and Diagnosis of Hydraulic Agricultural Machinery
Authors: Jia Jia , Lin Jijing
Published: September 2022

In order to solve the problem of fault diagnosis of agricultural machinery hydraulic system, the authors propose an application of modern multimedia and sensing technology in fault detection and diagnosis of hydraulic agricultural machinery. By analyzing the component faults and system faults of the hydraulic system of agricultural machinery, an expert system for fault diagnosis is constructed, and a knowledge base and inference engine suitable for fault diagnosis of the hydraulic system of agricultural machinery are designed. In order to further improve the diagnostic accuracy of the fault diagnosis expert system, a fault diagnosis based on sparse coding is designed, and the sparse coding fault diagnosis results are integrated with the expert system to improve the diagnostic accuracy. The experimental results show that after sparse coding fusion, the fault diagnosis accuracy can be improved to more than 91%. In conclusion, the model meets the requirements of fault diagnosis and puts forward a new idea for the fault diagnosis of agricultural machinery hydraulic system. Make the agricultural machinery and equipment industry develop healthily.
MRI Images‐Based Evaluation of Efficacy of Neoadjuvant Chemotherapy for Breast Cancer and Its Effect on Depression and Immune Function of Patients
Authors: Nie Ying , He Yingjuan , Wang Jianzhi , Zhang Hongjun , Su Junpeng
Published: September 2022

The aim of this study was to investigate the therapeutic value of neoadjuvant chemotherapy for breast cancer (BC) based on magnetic resonance imaging (MRI) and to evaluate its effect on depressive mood and immune function in patients. 70 female patients with BC who received neoadjuvant chemotherapy were selected for the experiment to comprehensively evaluate the MRI image findings, immune cell levels before and after chemotherapy, as well as the depression score and influencing factors of the patients during chemotherapy. The results showed that 49 patients (70%) responded to treatment, and MRI showed that the breast mass after chemotherapy was significantly reduced. 55 patients experienced depressive mood during chemotherapy, and the incidence of depression was 78.5%. Adverse symptoms such as pain, worry, sadness, vertigo, and nausea are important factors in the development of depression in patients. However, there were no significant changes in the levels of CD4+, CD8+, CD4+/CD8+, and killer cells before and after chemotherapy, and only B cells showed a significant decrease (9.78 ± 3.65% and 7.63 ± 3.65%) (P < 0.05). In summary, neoadjuvant chemotherapy can effectively shrink the breast mass and provide favorable conditions for subsequent surgery, and its clinical efficacy can be more accurately assessed by MRI. Neoadjuvant chemotherapy has little effect on the immune function of patients, but it will promote patients to experience depression. It provides a reference for the clinical treatment and prognosis of BC patients.
Intelligent Control Techniques for the Detection of Biomedical Ear Infections
Authors: Abdulaal Mohammed J. , Mehedi Ibrahim M. , Aljohani Abdulah Jeza , Milyani Ahmad H. , Mahmoud Mohamed , Sahu Manish Kumar , Abusorrah Abdullah M. , Meem Rahtul Jannat
Published: September 2022

The capacity to carry out one’s regular tasks is affected to varying degrees by hearing difficulties. Poorer understanding, slower learning, and an overall reduction in efficiency in academic endeavours are just a few of the negative impacts of hearing impairments on children’s performance, which may range from mild to severe. A significant factor in determining whether or not there will be a decrease in performance is the kind and source of impairment. Research has shown that the Artificial Neural Network technique is capable of modelling both linear and nonlinear solution surfaces in a trustworthy way, as demonstrated in previous studies. To improve the precision with which hearing impairment challenges are diagnosed, a neural network backpropagation approach has been developed with the purpose of fine-tuning the diagnostic process. In particular, it highlights the vital role performed by medical informatics in supporting doctors in the identification of diseases as well as the formulation of suitable choices via the use of data management and knowledge discovery. As part of the intelligent control method, it is proposed in this research to construct a Histogram Equalization (HE)-based Adaptive Center-Weighted Median (ACWM) filter, which is then used to segment/detect the OM in tympanic membrane images using different segmentation methods in order to minimise noise and improve the image quality. A tympanic membrane dataset, which is freely accessible, was used in all experiments.
[Retracted] Comparative Analysis of Chinese Culture and Hong Kong, Macao, and Taiwan Culture in the Field of Public Health Based on the CNN Model
Authors: Xiong Hui
Published: September 2022

In view of the defect of a large amount of information on cultural resources and poor recommendation effect on a standalone platform, a cultural recommendation system based on the Hadoop platform was proposed, combined with the convolutional neural network (CNN). It aims to improve the adaptability of Chinese culture and Hong Kong, Macao, and Taiwan culture. Firstly, the CNN is used to encode the collected information deeply and map it to the deep feature space. Secondly, the attention mechanism is used to focus the coded features in the deep feature space to improve the classification ability of features. Then, the model in this article is deployed using the distributed file system of the Hadoop platform, and the MapReduce programming model is used to implement the cultural resource recommendation algorithm in parallel. Finally, the recommendation simulation experiment of cultural resources is carried out, and the results show that the proposed model has good recommendation performance, and it is applied to open‐source data in the real public health field to test, and the results also perform well.
Inhibition of EGFR Overcomes Acquired Lenvatinib Resistance Driven by STAT3–ABCB1 Signaling in Hepatocellular Carcinoma
Authors: Hu Beiyuan , Zou Tiantian , Qin Wei , Shen Xiaotian , Su Yinghan , Li Jianhua , Chen Yang , Zhang Ze , Sun Haoting , Zheng Yan , Wang Chao-Qun , Wang Zhengxin , Li Tian-En , Wang Shun , Zhu Le , Wang Xufeng , Fu Yan , Ren Xudong , Dong Qiongzhu , Qin Lun-Xiu
Published: September 2022

Lenvatinib is an inhibitor of multiple receptor tyrosine kinases that was recently authorized for first-line treatment of hepatocellular carcinoma (HCC). However, the clinical benefits derived from lenvatinib are limited, highlighting the urgent need to understand mechanisms of resistance. We report here that HCC cells develop resistance to lenvatinib by activating EGFR and stimulating the EGFR–STAT3–ABCB1 axis. Lenvatinib resistance was accompanied by aberrant cholesterol metabolism and lipid raft activation. ABCB1 was activated by EGFR in a lipid raft–dependent manner, which significantly enhanced the exocytosis of lenvatinib to mediate resistance. Furthermore, clinical specimens of HCC showed a correlation between the activation of the EGFR–STAT3–ABCB1 pathway and lenvatinib response. Erlotinib, an EGFR inhibitor that has also been shown to inhibit ABCB1, suppressed lenvatinib exocytosis, and combined treatment with lenvatinib and erlotinib demonstrated a significant synergistic effect on HCC both in vitro and in vivo. Taken together, these findings characterize a mechanism of resistance to a first-line treatment for HCC and offer a practical means to circumvent resistance and treat the disease.

Significance:

HCC cells acquire resistance to lenvatinib by activating the EGFR–STAT3–ABCB1 pathway, identifying combined treatment with erlotinib as a strategy to overcome acquired resistance and improve the clinical benefit of lenvatinib.
MET-Induced CD73 Restrains STING-Mediated Immunogenicity of EGFR-Mutant Lung Cancer
Authors: Yoshida Ryohei , Saigi Maria , Tani Tetsuo , Springer Benjamin F. , Shibata Hirofumi , Kitajima Shunsuke , Mahadevan Navin R. , Campisi Marco , Kim William , Kobayashi Yoshihisa , Thai Tran C. , Haratani Koji , Yamamoto Yurie , Sundararaman Shriram K. , Knelson Erik H. , Vajdi Amir , Canadas Israel , Uppaluri Ravindra , Paweletz Cloud P. , Miret Juan J. , Lizotte Patrick H. , Gokhale Prafulla C. , Jänne Pasi A. , Barbie David A.
Published: September 2022

Immunotherapy has shown limited efficacy in patients with EGFR-mutated lung cancer. Efforts to enhance the immunogenicity of EGFR-mutated lung cancer have been unsuccessful to date. Here, we discover that MET amplification, the most common mechanism of resistance to third-generation EGFR tyrosine kinase inhibitors (TKI), activates tumor cell STING, an emerging determinant of cancer immunogenicity (1). However, STING activation was restrained by ectonucleosidase CD73, which is induced in MET-amplified, EGFR-TKI–resistant cells. Systematic genomic analyses and cell line studies confirmed upregulation of CD73 in MET-amplified and MET-activated lung cancer contexts, which depends on coinduction of FOSL1. Pemetrexed (PEM), which is commonly used following EGFR-TKI treatment failure, was identified as an effective potentiator of STING-dependent TBK1-IRF3-STAT1 signaling in MET-amplified, EGFR-TKI–resistant cells. However, PEM treatment also induced adenosine production, which inhibited T-cell responsiveness. In an allogenic humanized mouse model, CD73 deletion enhanced immunogenicity of MET-amplified, EGFR-TKI–resistant cells, and PEM treatment promoted robust responses regardless of CD73 status. Using a physiologic antigen recognition model, inactivation of CD73 significantly increased antigen-specific CD8+ T-cell immunogenicity following PEM treatment. These data reveal that combined PEM and CD73 inhibition can co-opt tumor cell STING induction in TKI-resistant EGFR-mutated lung cancers and promote immunogenicity.

Significance:

MET amplification upregulates CD73 to suppress tumor cell STING induction and T-cell responsiveness in TKI-resistant, EGFR-mutated lung cancer, identifying a strategy to enhance immunogenicity and improve treatment.
Rediscovering Allergic Rhinitis: The Use of a Novel mHealth Solution to Describe and Monitor Health-Related Quality of Life in Elderly Patients
Authors: Giuliano Antonio Francesco Maria , Buquicchio Rosalba , Patella Vincenzo , Bedbrook Anna , Bousquet Jean , Senna Gianenrico , Ventura Maria Teresa
Published: September 2022

Introduction: Allergic rhinitis (AR) is a disease characterized by IgE-mediated hypersensitivity responses akin to allergic asthma. Although common in children and young adults, AR can be particularly vexing in the elderly: several studies have underlined its impact on the patient’s self-perceived health-related quality of life (HR-QoL). Available literature data on AR-affected elderly patients remain sparse and often focused on specific characteristics. mHealth solutions such as MASK-air® can be used in assessing salient clinical characteristics and unique shifts in self-perceived HR-QoL in old age people. With this pilot study, we aim to assess these variables in two cohorts of AR-affected elderly patients – one actively involved in the daily use of mHealth applications and the other having never used such a solution – by applying a widespread, validated, and standardized tool. Methods: AR-affected patients aged ≥65 years accessing the outpatient clinic of the Bari Geriatric Immuno-allergology Unit between March and July 2021 were enrolled and assigned to “mHealth” (MASK-air®) and “non-mHealth” cohorts accordingly. Each participant was given a 19-item questionnaire delivered via a custom software solution, with the EuroQoL EQ-5D-5L used to assess HR-QoL. Results: 93 patients (51 mHealth users, 43 non-mHealth users) were enrolled. AR was often either standalone or associated with asthma and conjunctivitis, and 57.4% of the participants reported a negative influence of AR on daily activities. Analysis of HR-QoL showed significantly worse scores in mobility and anxiety/depression dimensions for female patients regardless of app usage, while male non-mHealth users had worse self-care scores. Female mHealth users had worse scores for the self-care and activity dimensions, whereas female non-mHealth users showed worse scores on the pain scale. In general, mHealth users showed a greater degree of anxiety/depression when compared to non-mHealth users, relating to a greater awareness of their health status. Conclusion: The use of an mHealth solution, along with a concise, clinically-validated, comprehensive HR-QoL assessment toolset such as the EQ-5D, can prove beneficial in defining the unique characteristics of AR in the elderly. It can enable a detailed exploration of the impact on specific aspects of quality of life in old age. Raising patient awareness towards a health condition can improve compliance to treatment as well as follow-up. A lack of uniformity in approach, along with missing data pertaining to the general population are critical issues that require further studies. A more thorough diffusion of mHealth usage is also necessary among the geriatric population.
Connexin37 Regulates Cell Cycle in the Vasculature
Authors: Fang Jennifer S. , Burt Janis M.
Published: September 2022

Control of vascular cell growth responses is critical for development and maintenance of a healthy vasculature. Connexins – the proteins comprising gap junction channels – are key regulators of cell growth in diseases such as cancer, but their involvement in controlling cell growth in the vasculature is less well appreciated. Connexin37 (Cx37) is one of four connexin isotypes expressed in the vessel wall. Its primary role in blood vessels relies on its unique ability to transduce flow-sensitive signals into changes in cell cycle status of endothelial (and perhaps, mural) cells. Here, we review available evidence for Cx37’s role in the regulation of vascular growth, vessel organization, and vascular tone in healthy and diseased vasculature. We propose a novel mechanism whereby Cx37 accomplishes this with a phosphorylation-dependent transition between closed (growth-suppressive) and multiple open (growth-permissive) channel conformations that result from interactions of the C-terminus with cell-cycle regulators to limit or support cell cycle progression. Lastly, we discuss Cx37 and its downstream signaling as a novel potential target in the treatment of cardiovascular disease, and we address outstanding research questions that still challenge the development of such therapies.
Fecal Calprotectin in Children with Cow’s Milk Protein Allergy: A Systematic Review and Meta-Analysis
Authors: Zhang Zhi-hong , Wang Wei , Zhang Xian-hui , Pan Jie , Chen Xin
Published: September 2022

Objective: There is still an unmet need for a reliable and straightforward biomarker to diagnose and monitor cow’s milk protein allergy (CMPA). Fecal calprotectin (FC) has been reported as a biomarker for CMPA. Therefore, the meta-analysis aimed to evaluate the value of FC in the diagnosis and monitoring of CMPA. Methods: PubMed, EMBASE, and the Cochrane Library up to April 2022 were searched for relevant studies. Pooled standardized mean difference (SMD) and 95% confidence intervals (CIs) were determined using the forest plot. Heterogeneity was used to determine the fixed or random-effect model. Results: Twelve studies including 310 patients and 217 controls were available for the meta-analysis. The FC levels in children with CMPA were significantly higher than in healthy control (SMD = 1.15; 95% CI: 0.38–1.91). After elimination diet treatment, FC levels were reduced considerably with the pooled SMD of 0.87 (95% CI: 0.48–1.26). Conclusion: The results indicated that FC could be a simple and reliable biomarker for diagnosing CMPA, especially in non-IgE-mediated CMPA infants. Besides, calprotectin was also potential for predicting therapy response of CMPA.
Drug Exposure and Risk of Microscopic Colitis: A Systematic Review and Meta-Analysis
Authors: Zhang Shao-Wen , Xu Ru-hu , Chen Dan
Published: September 2022

Background and Objectives: Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhoea and a normal radiological and endoscopic appearance. Concern regarding a potential association between drug exposure and MC has recently emerged. We sought to systematically review and summarize the evidence for the potential association. Methods: A systematic review and meta-analysis were performed to evaluate the incidence of MC associated with exposure to drug. The PubMed and Embase databases were searched to identify potential studies for inclusion. Results: Twelve case-control studies were included in the meta-analysis. The results showed exposure to NSAID (OR, 1.64; 95% CI: 1.14–2.37; p < 0.001), PPI (OR, 2.36; 95% CI: 1.59–3.52; p < 0.001), SSRI (OR, 2.16; 95% CI: 1.5–3.13; p < 0.001), or aspirin (OR, 2.84; 95% CI: 1.4–5.76; p < 0.001) was related to the incidence of MC; however, such relationships in PPI and SSRI may be modulated by the selection of controls. Furthermore, we did not found a positive association with other drug exposure and MC. Conclusion: This meta-analysis indicated that NSAID, PPI, SSRI, or aspirin consumption may increase the risk for MC. Further studies exploring drug-induced microscopic colitis should include control groups with diarrhoea and not only healthy controls.
Association Between Care Fragmentation and Total Spending After Durable Left Ventricular Device Implant: A Mediation Analysis of Health Care–Associated Infections Within a National Medicare-Society of Thoracic Surgeons Intermacs Linked Dataset
Authors: Kim K. Dennie , Funk Russell J. , Hou Hechuan , Airhart Austin , Nassar Khalil , Pagani Francis D. , Zhang Min , Chandanabhumma P. Paul , Aaronson Keith D. , Chenoweth Carol E. , Hider Ahmad , Cabrera Lourdes , Likosky Donald S. ,   on behalf of the Michigan Congestive Heart Failure Investigators
Published: September 2022

Background:

Care fragmentation is associated with higher rates of infection after durable left ventricular assist device (LVAD) implant. Less is known about the relationship between care fragmentation and total spending, and whether this relationship is mediated by infections.

Methods:

Total payments were captured from admission to 180 days post-discharge. Drawing on network theory, a measure of care fragmentation was developed based on the number of shared patients among providers (ie, anesthesiologists, cardiac surgeons, cardiologists, critical care specialists, nurse practitioners, physician assistants) caring for 4,987 Medicare beneficiaries undergoing LVAD implantation between July 2009 - April 2017. Care fragmentation was measured using average path length, which describes how efficiently information flows among network members; longer path length indicates greater fragmentation. Terciles based on the level of care fragmentation and multivariable regression were used to analyze the relationship between care fragmentation and LVAD payments and mediation analysis was used to evaluate the role of post-implant infections.

Results:

The patient cohort was 81% male, 73% white, 11% Intermacs Profile 1 with mean (SD) age of 63.1 years (11.1). The mean (SD) level of care fragmentation in provider networks was 1.7 (0.2) and mean (SD) payment from admission to 180 days post-discharge was $246,905 ($109,872). Mean (SD) total payments at the lower, middle, and upper terciles of care fragmentation were $250,135 ($111,924), $243,288 ($109,376), and $247,290 ($108,241), respectively. In mediation analysis, the indirect effect of care fragmentation on total payments, through infections, was positive and statistically significant (β=16032.5, p=0.008).

Conclusions:

Greater care fragmentation in the delivery of care surrounding durable LVAD implantation is associated with a higher incidence of infections, and consequently, higher payments for Medicare beneficiaries. Interventions to reduce care fragmentation may reduce the incidence of infections and in turn enhance the value of care for patients undergoing durable LVAD implantation.
Associations of Demographic, Socioeconomic, and Cognitive Characteristics With Mobile Health Access: MESA (Multi‐Ethnic Study of Atherosclerosis)
Authors: Patel Reshmi J. S. , Ding Jie , Marvel Francoise A. , Shan Rongzi , Plante Timothy B. , Blaha Michael J. , Post Wendy S. , Martin Seth S.
Published: September 2022

Background

Mobile health (mHealth) has an emerging role in the prevention of cardiovascular disease. This study evaluated possible inequities in mHealth access in older adults.

Methods and Results

mHealth access was assessed from 2019 to 2020 in MESA (Multi‐Ethnic Study of Atherosclerosis) telephone surveys of 2796 participants aged 62 to 102 years. A multivariable logistic regression model adjusted for general health status assessed associations of mHealth access measures with relevant demographic, socioeconomic, and cognitive characteristics. There were lower odds of all access measures with older age (odds ratios [ORs], 0.37–0.59 per 10 years) and annual income <$50 000 (versus ≥$50 000 ORs, 0.55–0.62), and higher odds with higher Cognitive Abilities Screening Instrument Score (ORs, 1.22–1.29 per 5 points). Men (versus women) had higher odds of internet access (OR, 1.32 [95% CI,1.05–1.66]) and computing device ownership (OR, 1.31 [95% CI, 1.05–1.63]) but lower fitness tracker ownership odds (OR, 0.70 [95% CI, 0.49–0.89]). For internet access and computing device ownership, we saw lower odds for Hispanic participants (versus White participants OR, 0.61 [95% CI, 0.44–0.85]; OR, 0.69 [95% CI, 0.50–0.95]) and less than a high school education (versus bachelor's degree or higher OR, 0.27 [95% CI, 0.18–0.40]; OR, 0.32 [95% CI, 0.28–0.62]). For internet access, lower odds were seen for Black participants (versus White participants OR, 0.64 [95% CI, 0.47–0.86]) and other health insurance (versus health maintenance organization/private OR, 0.59 [95% CI, 0.47–0.74]). Chinese participants (versus White participants) had lower internet access odds (OR, 0.63 [95% CI, 0.44–0.91]) but higher computing device ownership odds (OR, 1.87 [95% CI, 1.28–2.77]).

Conclusions

Among older‐age adults, mHealth access varied by major demographic, socioeconomic, and cognitive characteristics, suggesting a digital divide. Novel mHealth interventions should consider individual access barriers.

Registration

URL:
https://www.clinicaltrials.gov/
; Unique identifier: NCT00005487.
Guideline‐Recommended Time Less Than 90 Minutes From ECG to Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction Is Associated with Major Survival Benefits, Especially in Octogenarians: A Contemporary Report in 11 226 Patients from NORIC
Authors: Larsen Alf Inge , Løland Kjetil Halvorsen , Hovland Siren , Bleie Øyvind , Eek Christian , Fossum Eigil , Trovik Thor , Juliebø Vibeke , Hegbom Knut , Moer Rasmus , Larsen Tomas , Uchto Michael , Rotevatn Svein
Published: September 2022

Background

Using contemporary data from NORIC (Norwegian Registry of Invasive Cardiology) we investigated the predictive value of patient age and time from ECG diagnosis to sheath insertion (ECG‐2‐sheath) in primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction (STEMI).

Methods and Results

Data from 11 226 patients collected from all centers offering 24/7/365 primary percutaneous coronary intervention service were explored. For patients aged <80 years the mortality rates were 5.6% and 7.6% at 30 days and 1 year, respectively. For octogenarians the corresponding rates were 15.0% and 24.2%. The Cox hazard ratio was 2.02 (1.93–2.11,
P
value <0.0001) per 10 years of patient age. Time from ECG‐2‐sheath was significantly associated with mortality with a 3.6% increase per 30 minutes of time. Using achievement of time goal <90 minutes in patients aged >80 years and mortality at 30 days, mortality was 10.5% and 17.7% for <90 or ≥90 minutes, respectively. The number needed to prevent 1 death was 39 in the whole population and 14 in the elderly.

Restricted mean survival gains during median 938 days of follow‐up in patients with ECG‐2‐sheath time <90 minutes were 24 and 76 days for patients aged <80 and ≥80 years, respectively.

Conclusions

Time from ECG‐diagnosis to sheath insertion is strongly correlated with mortality. This applies especially to octogenarians who derive the most in terms of absolute mortality reduction.

Registration

URL:
https://helsedata.no/en/forvaltere/norwegian‐institute‐of‐public‐health/norwegian‐registry‐of‐invasive‐cardiology/
.
Incidence and Predictors of Adverse Events Among Initially Stable ST‐Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention
Authors: Amon Jaihoon , Wong Graham C. , Lee Terry , Singer Joel , Cairns John , Shavadia Jay S. , Granger Christopher , Gin Kenneth , Wang Tracy Y. , van Diepen Sean , Fordyce Christopher B.
Published: September 2022

Background

Cardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac intensive care units after a primary percutaneous coronary intervention (pPCI), independent of clinical risk or the provision of critical care therapies. The aim of this study was to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI.

Methods and Results

Between April 2012 and November 2019, 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority were evaluated. Patients were stratified into those with and without subsequent adverse events, which were defined as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events. After excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure, the final analysis cohort comprised 1770 stable patients with STEMI who had received pPCI. A total of 94 (5.3%) patients developed at least one adverse event: cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%). Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation. There was no significant difference in reperfusion times between those with and without adverse events. Following multivariable adjustment, moderate to severe chronic kidney disease (creatinine clearance <44 mL/min; 13% of cohort) was associated with adverse events (odds ratio 2.24 [95% CI, 1.12–4.48]) independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting.

Conclusions

Only 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Moderate to severe chronic kidney disease independently predicted the risk of future adverse events. These results indicate that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion.
Government Regulation and Percutaneous Coronary Intervention Volume, Access and Outcomes: Insights From the Washington State Cardiac Care Outcomes Assessment Program
Authors: Kataruka Akash , Maynard Charles C. , Hira Ravi S. , Dean Larry , Dardas Todd , Gurm Hitinder , Brown Josiah , Ring Michael E. , Doll Jacob A.
Published: September 2022

Background

It is unclear how to geographically distribute percutaneous coronary intervention (PCI) programs to optimize patient outcomes. The Washington State Certificate of Need program seeks to balance hospital volume and patient access through regulation of elective PCI.

Methods and Results

We performed a retrospective cohort study of all non‐Veterans Affairs hospitals with PCI programs in Washington State from 2009 to 2018. Hospitals were classified as having (1) full PCI services and surgical backup (
legacy
hospitals, n=17); (2) full services without surgical backup (
new certificate of need [CON]
hospitals, n=9); or (3) only nonelective PCI without surgical backup (
myocardial infarction [MI] access
hospitals, n=9). Annual median hospital‐level volumes were highest at
legacy
hospitals (605, interquartile range, 466–780), followed by
new CON
, (243, interquartile range, 146–287) and
MI access
, (61, interquartile range, 23–145). Compared with
MI access
hospitals, risk‐adjusted mortality for nonelective patients was lower for
legacy
(odds ratio [OR], 0.59 [95% CI, 0.48–0.72]) and
new‐CON
hospitals (OR, 0.55 [95% CI, 0.45–0.65]).
Legacy
hospitals provided access within 60 minutes for 90% of the population; addition of
new CON
and
MI access
hospitals resulted in only an additional 1.5% of the population having access within 60 minutes.

Conclusions

Many PCI programs in Washington State do not meet minimum volume standards despite regulation designed to consolidate elective PCI procedures. This CON strategy has resulted in a tiered system that includes low‐volume centers treating high‐risk patients with poor outcomes, without significant increase in geographic access. CON policies should re‐evaluate the number and distribution of PCI programs.
EmPHasis‐10 Health‐Related Quality of Life and Exercise Capacity in Chronic Thromboembolic Pulmonary Hypertension After Balloon Angioplasty
Authors: Sakamoto Hayato , Goda Ayumi , Tobita Kazuki , Takeuchi Kaori , Kikuchi Hanako , Inami Takumi , Tamura Yuichi , Kohno Takashi , Yamada Shin , Soejima Kyoko , Satoh Toru
Published: September 2022

Background

Whether pulmonary hemodynamic parameters and functional capacity are associated with quality of life in patients with chronic thromboembolic pulmonary hypertension remains unknown. This study aimed to evaluate disease‐specific quality of life using the emPHasis‐10 questionnaire and assess its determinants in patients with chronic thromboembolic pulmonary hypertension with normalized pulmonary hemodynamics.

Methods and Results

This cross‐sectional study included 187 health status assessments of 143 patients with chronic thromboembolic pulmonary hypertension (median age, 68 [58–75] years; men/women, 51/136; use of home oxygen therapy, 51 patients [27%]) after balloon pulmonary angioplasty with normalized mean pulmonary artery pressure <25 mm Hg at rest. Right heart catheterization was performed, followed by assessment of 6‐minute walk distance and the emPHasis‐10 questionnaire. The median pulmonary artery pressure and pulmonary vascular resistance were 18 (15–21) mm Hg and 2.2 (1.7–2.9) wood units, respectively. The median emPHasis‐10 score was 14 (8–24), whereas the median 6‐minute walk distance was 447 (385–517) m. Univariate linear regression analysis showed that the emPHasis‐10 score was associated with 6‐minute walk distance (β=−0.476 [95% CI −0.604, −0.348],
P
<0.001) and home oxygen therapy (β=0.214 [95% CI, 0.072, 0.356],
P
=0.003) but not with hemodynamic parameters. Multiple regression analysis revealed that a higher emPHasis‐10 score was associated with lower 6‐minute walk distance (β=−0.475 [95% CI, −0.631 to −0.319],
P
<0.001).

Conclusions

Health‐related quality of life was associated with exercise capacity and the use of home oxygen therapy, but not with hemodynamic parameters, in patients with chronic thromboembolic pulmonary hypertension and normalized hemodynamics after balloon pulmonary angioplasty. Improvements in exercise capacity may lead to further improvements in quality of life.
Structural re-design of the Animex Wildlife Bridge for the Hazel Dormouse (Muscardinus avellanarius): lessons learnt from two connectivity mitigation case studies in the UK
Authors: Moffat Darrelle , White Ian , Béga Steve , Aburrow Katherine
Published: September 2022

The Hazel Dormouse (Muscardinus avellanarius) is an arboreal mammal present in Europe and Asia minor. The population is declining in the United Kingdom (UK), partially due to habitat fragmentation caused by the development of linear infrastructure such as roads, railways and pipelines. In 2016, we designed and tested an arboreal bridge in Britain that was proven to be effective for Hazel Dormice. Subsequently, the bridge materials were upgraded to meet the technical standards of UK road agencies, so that it could be approved and implemented as mitigation on projects throughout the UK. In the UK, each bridge must be certified for technical approval by the relevant road authority and as the bridge is a unique structure, this can pose challenges on projects. The national safety standards of UK roads would not allow common methods used for arboreal bridges across the world to be applied, so we needed specialised engineering and design adaptations to be implemented. Two overarching installation designs were created: the standalone bridge and the retrofit bridge. Several bridges have now been installed across roads in the UK and we will be discussing the development and implementation process from two case studies: i) a 40-metre retrofit bridge to an underpass in St Athan, Wales and, ii) two 76+ metre bridges retrofit to an overbridge and underpass on the M1 motorway in Gayhurst, Buckinghamshire. The St Athan project was quickly approved and easily installed while the M1 project required several alterations to the design and installation methods to meet specific project requirements. This paper discusses what we have learned from these projects, how these projects have influenced the future designs of the Animex wildlife bridge and how this could be applied to future arboreal wildlife connectivity bridges across the world.
Something in the Sway: Effects of the Shepard–Risset Glissando on Postural Activity and Vection
Authors: Mursic Rebecca A. , Palmisano Stephen
Published: September 2022

This study investigated claims of disrupted equilibrium when listening to the Shepard–Risset glissando (which creates an auditory illusion of perpetually ascending/descending pitch). During each trial, 23 participants stood quietly on a force plate for 90 s with their eyes either open or closed (30 s pre-sound, 30 s of sound and 30 s post-sound). Their centre of foot pressure (CoP) was continuously recorded during the trial and a verbal measure of illusory self-motion (i.e., vection) was obtained directly afterwards. As expected, vection was stronger during Shepard–Risset glissandi than during white noise or phase-scrambled auditory control stimuli. Individual differences in auditorily evoked postural sway (observed during sound) were also found to predict the strength of this vection. Importantly, the patterns of sway induced by Shepard–Risset glissandi differed significantly from those during our auditory control stimuli — but only in terms of their temporal dynamics. Since significant sound type differences were not seen in terms of sway magnitude, this stresses the importance of investigating the temporal dynamics of sound–posture interactions.
Giving Back to the Community
Authors: Reifsnider Matthew
Published: September 2022

The question has been asked, what evidence of compassion does one see in the adaptations Asian-Arab Muslims make as minorities in the West? Within certain parameters, Islamic Jurisprudence (fiqh) has flexibility built into the processes of determining religious and social practices. This can be understood particularly in the concept ofmaslaha, defined as public/community interest, welfare, or well-being. The paper examines how Asian/Arab-American Muslims in Jacksonville, Florida, responded to issues of integration. Traditionally, Muslims definedummahas a world-wide, community of Muslims where their socio-religious, (and fiscal) needs would be met. However, “community” is not a constant, and Muslims living as a minority in the United States have begun to change those models. A contributing factor to that change is the diversity that Muslims experience within both the Islamic networks and in the society surrounding them, after they immigrate to the West. The multiplicity of peoples has created a desire to seek mutual respect and understanding through interfaith initiatives. In order to become a part of the larger society, several mentioned the importance of giving back to the society, being beneficial to those around them. Several projects have been undertaken to be a contributing member of society. A medical center, feeding the homeless, and building homes for the poor are some examples.
Working toward a National Coordinated Soil Moisture Monitoring Network: Vision, Progress, and Future Directions
Authors: Baker C. Bruce , Cosh Michael , Bolten John , Brusberg Mark , Caldwell Todd , Connolly Stephanie , Dobreva Iliyana , Edwards Nathan , Goble Peter E. , Ochsner Tyson E. , Quiring Steven M. , Robotham Michael , Skumanich Marina , Svoboda Mark , White W. Alex , Woloszyn Molly
Published: September 2022

Soil moisture is a critical land surface variable, impacting the water, energy, and carbon cycles. While in situ soil moisture monitoring networks are still developing, there is no cohesive strategy or framework to coordinate, integrate, or disseminate these diverse data sources in a synergistic way that can improve our ability to understand climate variability at the national, state, and local levels. Thus, a national strategy is needed to guide network deployment, sustainable network operation, data integration and dissemination, and user-focused product development. The National Coordinated Soil Moisture Monitoring Network (NCSMMN) is a federally led, multi-institution effort that aims to address these needs by capitalizing on existing wide-ranging soil moisture monitoring activities, increasing the utility of observational data, and supporting their strategic application to the full range of decision-making needs. The goals of the NCSMMN are to 1) establish a national “network of networks” that effectively demonstrates data integration and operational coordination of diverse in situ networks; 2) build a community of practice around soil moisture measurement, interpretation, and application—a “network of people” that links data providers, researchers, and the public; and 3) support research and development (R&D) on techniques to merge in situ soil moisture data with remotely sensed and modeled hydrologic data to create user-friendly soil moisture maps and associated tools. The overarching mission of the NCSMMN is to provide coordinated high-quality, nationwide soil moisture information for the public good by supporting applications like drought and flood monitoring, water resource management, agricultural and forestry planning, and fire danger ratings.