bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 16606: Diagnostic Performance of AI-QCT
ISCHEMIA
for Abnormal FFR Across Calcified Plaque Subgroups
Authors: van Rosendael Alexander , Nurmohamed Nick , Danad Ibrahim ,   CREDENCE study group,   PACIFIC study group, Knaapen Paul , Earls James
Published: December 2023

Introduction:
Coronary atherosclerosis and vascular morphology imaging by quantitative CT angiography (AI-QCT) provides detailed plaque and vessel measures of the coronary tree. These features combined in a tool (AI-QCT
ISCHEMIA
) accurately estimate vessel level ischemia. We investigated the diagnostic performance of AI-QCT
ISCHEMIA
for abnormal invasive fractional flow reserve (FFR) across subgroups of calcified plaque.

Methods:
Symptomatic patients within the CREDENCE (N=305) and PACIFIC (N=208) studies underwent CCTA, myocardial perfusion imaging (MPI; single photon emission computed tomography [SPECT] and/or positron emission tomography [PET]), fractional flow reserve by CT (FFR-CT ) and invasive coronary angiography in conjunction with unbiased 3-vessel invasive FFR measurements as reference standard. The diagnostic performance of the non-invasive tests was compared on vessel-level across the tertiles of calcified plaque volume, on an intention-to-diagnose basis.

Results:
Within the CREDENCE study, AI-QCT
ISCHEMIA
had an area under the receiver operating characteristics curve (AUC ROC) of 0.887, 0.850, 0.816 across tertile 1-3 of calcified plaque, respectively, which was significantly higher than FFR-CT and MPI. Within the PACIFIC study, the AUC ROC was 0.811, 0.860, 0.817 across the calcified plaque tertiles 1-3, which was significantly better than SPECT, and comparable to FFR-CT ad PET. The specificity of AI-QCT
ISCHEMIA
was lower with increased calcified plaque, being approximately 70% for the most calcified vessels amongst both cohorts.

Conclusion
AI-QCT
ISCHEMIA
, a tool to assess coronary ischemia based on quantitative coronary plaque and vascular morphology retained good diagnostic performance for invasive FFR across calcified plaque subgroups.
Abstract 16624: Patients’ Perspectives on the Impact and Management of Angina - Preliminary Results of the PACT-ANGINA International Survey
Authors: Rosano Giuseppe , George Maria , Kaski Juan-Carlos , abdelaziz magdy , Abdullakutty Jabir , Agarwala Rajeev , Christory Francois , crea Filippo , Farag Nabil M , Gowdak Luis Henrique W , Gulati Martha , Mendez Gustavo F , Percoma Dalton B , Sierra Lara Martinez Jorge Daniel ,   on behalf of the PACT-ANGINA Working Group and INOCA International
Published: December 2023

Introduction:
PACT-ANGINA is a quality improvement initiative aimed to improve the understanding of challenges in the management of angina and chronic coronary syndromes.

Hypothesis:
An international patient survey is conducted to assess how angina and its management affect patients’ lives and what patients want in terms of the management of their angina.

Methods:
A working group that included 9 cardiologists and 7 patient representatives developed an online, anonymous questionnaire. Patients with angina were invited to take part in the survey by patient organizations and treating physicians.

Results:
Between January and June 2023, the survey was completed by 891 patients in 21 countries. The proportion of female patients was 46%. Among participants, 57% had been diagnosed with angina for 2 years or less, and 54% had never undergone a percutaneous coronary intervention. The proportion of patients with no history of smoking was 65% and the most common self-reported concomitant diseases were hypertension (49%), diabetes (38%) and dyslipidemia (23%). Pain, tightness, pressure or discomfort in the chest (89%), shortness of breath (44%), and fatigue (39%) were the most frequently reported symptoms, and 34% of participants felt that their physical activities were very or extremely limited by angina symptoms. The proportion of respondents who felt that angina was having a great or extreme impact on their quality of life was 37%. When asked to rate the relative importance of 9 treatment objectives, respondents assigned the highest priority to 1) reducing angina attacks and symptoms, 2) avoiding hospitalizations, and 3) prolonging their life as much as possible. Among different aspects of care, those considered the most important by respondents to improve the management of their angina were 1) a better follow-up of their symptoms, 2) practical and easy-to-understand information, and 3) lifestyle changes counseling.

Conclusions:
This study demonstrates that patients with angina are often limited by their symptoms, which impact their quality of life. Patient-centered management of angina is necessary to improve clinical care of such a common cardiac condition.
Abstract 16628: Threshold for Ascending Aorta Diameter for Clinical Management: An Assessment of the UK Biobank Population Based on Z-Scores
Authors: Paliwal Nikhil , Henry Albert , Finan Chris , Davies Rhodri , Lumbers Tom , Hughes Alun , Williams Bryan , Hingorani Aaron
Published: December 2023

Introduction:
Ascending aortic diameter (AAoD) is commonly monitored to manage patients at risk of aortic dissection. Z-scores have also been proposed to identify at risk aortas, adjusting AAo for age, gender, and body surface area (BSA). Despite improved imaging and proven association of AAoD with age, sex and BSA, cutoff remains at 4.5 cm for monitoring and 5.5 cm for surgery in guidelines. However, studies like International Registry of Acute Aortic Dissection found that most aortic dissection had AAoD<5.5 cm.

Aim:
Identify AAoD in the UK Biobank population and compare current 4.5 cm cutoff with Z-scores to classify cases with dilated ascending aortas.

Methods:
Using cardiac magnetic resonance images of participants in the UK Biobank, we applied a pre-trained neural network to segment and quantify the AAoD. We also obtained demographics and clinical covariates for the participants with AAoD. Two common Z-scores were calculated using published equations including: (1) age, height, and sex (Z-HAS) and (2) age, BSA and sex (Z-BAS). We identified participants with AAoD>4.5 cm and compared them with Z>2 cutoff value that might require imaging follow-up for managing their dilated aortas.

Results:
AAoD diameter was calculated for 44,799 participants (22,983 females and 21,816 males). Common demographics in both groups are listed in the Table. Average AAoD was 3.15±0.32 cm in females and 3.44±0.35 cm in males. Diameter cutoff of 4.5 cm identified 15 females and 110 males with dilated aortas. On the other hand, Z-HAS classified 862 females and 674 males, while Z-BAS classified 583 females and 405 males (orange dots in the top and bottom panels of Figure, respectively) with higher aortic diameter that might require regular follow-up imaging.

Conclusion:
Z-Score might identify more people at dilated aortas as compared to the hard cutoff. Future work is needed to define whether Z scores are more sensitive means of identifying patients who might be at increased risk of aortic dissection.
Abstract 16631: Isolated Cardiac Sarcoidosis Presenting as Recurrent Transient Ischemic Attacks
Authors: Vasquez Moises A , Rosario Manuel , Luna Alvarez Amezquita Jose , Mijares Ivan A , Andrade-Bucknor Sharon
Published: December 2023

Background:
Cardiac sarcoidosis (CS) is a rare disease that can present with a variety of clinical scenarios including, heart failure and sudden death. We present a case of isolated CS presenting as recurrent transient ischemic attacks (TIA) in a previously asymptomatic patient.

Description of Case.
A 54-year-old female with a history of two previous TIAs presented 30 minutes after the onset of left-sided facial droop and incomprehensible speech. CT and MRI brain did not show acute infarction. ECG showed a right bundle branch block pattern. Transthoracic echocardiogram (TTE) showed an abnormal global longitudinal strain of 12.8%, a left ventricular ejection fraction of 40%, segmental wall motion abnormalities involving the apex and basal inferior walls, and swirling of contrast at the apex. She had no previous history of cardiomyopathy. CTA was unrevealing for coronary artery disease but a cardiac MRI showed areas of late gadolinium enhancement and a RV wall aneurysm. PET scan revealed multifocal patchy nodular areas of FDG uptake within the myocardium. A diagnosis of isolated CS was made. At a three-month follow-up, TTE showed a new apical thrombus measuring 0.8cm x 0.6 cm. The patient was started on anticoagulation with the eventual resolution of the thrombus. She had no further ischemic events.

Discussion.
TIAs and ischemic stroke are extremely rare complications of CS and are largely attributed to cardioembolic phenomena, in the absence of systemic disease. Cardiac structural changes that lead to arrhythmias, hypokinesis, and stasis with clot formation largely explain embolic events in these patients. In addition, evidence suggests that the inflammatory cytokines, such as IFN gamma and IL-12, released by the sarcoid granuloma may also have an independent role in clot formation. The combination of stagnant flow in akinetic areas and a strong inflammatory bed of cytokines led to recurrent TIAs in this patient and the apical thrombus that was later identified.
Abstract 16736: Comparison of Pulmonary Arterial Hypertension Risk Assessment Tools Using a Harmonized FDA Dataset
Authors: Fauvel Charles , Lin Shili , Correa-Jaque Priscilla , Everett Allen D , Perer Adam , Liu Yongqi , Kanwar Manreet , Vanderpool Rebecca , Kraisangka Jidapa , Benza raymond
Published: December 2023

Introduction:
One-year mortality risk for a pulmonary arterial hypertension (PAH) patient is the most substantial. Accordingly, the initial risk stratification should be the most accurate to ensure appropriate aggressiveness of the primary treatment choices. According to PAH guidelines, the European 3-strata system is recommended at baseline for risk assessment. However, the US REVEAL2.0 and REVEAL Lite risk scores also provide high performances. Yet, comparison of risk assessment performances at baseline in the same dataset of patients is still missing.

Hypothesis:
REVEAL 2.0 provide higher discrimination performances than the European 3-strata system at baseline. We aim to compare the discrimination power at baseline of the currently available tools.

Methods:
Treatment naïve PAH patients from 6 PAH trials were provided by the FDA and harmonized (AMBITION n=500, ARIES n=126, PATENT n=221, PHIRST n=77, GRIPHON n=231, and SERAPHIN n=270). Kaplan-Meier and log-rank tests were performed for each of the following tools: noninvasive FRENCH method (FR), European 3-strata system (E3), COMPERA2.0 4-strata (CO), REVEAL2.0 (RE), and REVEAL Lite (RL). Their C-indices were compared. A total of 100 bootstrap samples were obtained from the original data providing a robust method for comparing across the different tools.

Results:
Among the 1,425 patients, 78% were female, 54% NYHA 3-4 with a median age of 51(38, 64) yo, 6-min walking distance of 365(295, 418)m, mPAP of 49(38, 59) mmHg, PVR 9.3(6.2, 13.5) WU. At baseline, the C-index for FR, CO, E3, RL, and RE were 0.64, 0.67, 0.68, 0.69, 0.73, respectively. Out of the 100 bootstrap samples, 99% led to a better C-index for RE compared to E3, with a statistically significant paired t-test (p<e
-40
) as well as RL compared to E3 (p<
e-8
). Forrest plots of 95%CI for the C-index differences among the 100 bootstrap samples showed that RE was the best performer, followed by RL, while the E3 and FR models were comparable and worse than the others.

Conclusions:
REVEAL 2.0 and REVEAL Lite risk scores perform better than the European-3 strata, COMPERA-4 strata, and the noninvasive FRENCH models in predicting 1-year survival at baseline and should be considered as the initial stratification scheme in future guidelines.
Abstract 16851: Tricyclic Antidepressant Induced Wide Complex Tachycardia With Brugada Pattern
Authors: Chhetri Chandra , Haseeb Shahan , Ansari Umair A , Goyal Rajat
Published: December 2023

Case Description:
A 52-year-old male with bipolar disorder and depression was brought to the ED after he was found confused following an episode of syncope. He reported taking 5 pills of his new dose of Nortriptyline 75mg instead of 5 pills of his previous dose of Nortriptyline 25mg. ECG from the field showed a wide complex tachycardia (WCT) with a rightward axis and a Brugada pattern in V1 and V2 at a rate of 120-130s. Upon arrival in the ED, he continued to have WCT, and was treated with Amiodarone, Magnesium Sulfate, and Sodium Bicarbonate. Following treatment, his heart rate improved and the QRS duration shortened with a gradual loss of Brugada pattern (Figure 1). Six hours from initial presentation, his QRS completely normalized. Transthoracic echocardiogram (TTE) showed normal LV function. His presentation was consistent with tricyclic antidepressant (TCA) overdose.

Discussion:
The cardiotoxic effects of TCAs are mediated through their behavior as class IA antiarrhythmic drugs. This results in lengthening of both depolarization and repolarization of the cardiac action potential resulting in a widened QRS complex and QT prolongation. Sodium channel blockade can precipitate a Brugada phenotype which resolves after Sodium Bicarbonate administration. Similar to class IA agents, TCAs also exhibit use dependence and in our patient, the Brugada pattern began to resolve soon after presentation, possibly due to slowing of the tachycardia. Recognition of TCA toxicity is important to allow for timely administration of bicarbonate which facilitates prompt reversal.
Abstract 18100: Comparative Analysis of Right Ventricular (RV) Apical Pacing versus Physiologic Left Bundle Branch Area Pacing (LBBAP) in Hypertrophic Cardiomyopathy With Left Ventricular Outflow Tract Obstruction (LVOTO): A Case Study
Authors: Osei Kofi M , Wuni George , Mehta Nikhil , Gupta Sanjaya K
Published: December 2023

Introduction:
AV dyssynchrony is considered advantageous in HoCM patients requiring pacemaker therapy. The impact of physiologic pacing, particularly LBBAP, on LVOTO in HoCM remains unexplored. We present a patient highlighting the effect of LBBAP on LVOTO.

Case:
A 69-year-old female with HoCM (resting gradient ~130mmHg) and asymmetric septal hypertrophy (17mm), managed conservatively due to high surgical risk. She had persistent AF, accompanied by debilitating fatigue and palpitations. Due to unsuccessful treatment with sotalol, dofetilide, and 5 DCCV procedures, other treatment options were discussed. She opted for LBBA pacing and AV node ablation. Dual chamber device was implanted utilizing a Medtronic 3830 lead.

Within 48 hours of discharge, she came to the ER with exertional dyspnea and lightheadedness, indicating ambulatory cardiogenic shock (BP: 78/66 mmHg). A stat echo showed LVEF of 75%, severe SAM, LVOT gradient of 179 mmHg, and severe MR. No pericardial effusion. Phenylephrine was initiated, and VVIR rate was decreased from 90 bpm to 60 bpm, but no BP improvement.

Obstructive cardiogenic shock from worsened LVOTO was likely caused by physiologic LBBAP. To objectively demonstrate this, she underwent a brief study in the lab after informed consent. We inserted a temporary RV apical pacing lead and assessed LVOT gradients at rest and during exercise for both physiologic pacing and RV apical pacing. RV apical pacing had lower LVOT gradient at rest and exercise compared to LBBA pacing (Figure 1). LBBA lead was extracted and a CRT-P device implanted and programmed for optimal dyssynchrony.

Discussion:
Traditional RV apical pacing is superior to physiologic LBBAP in HoCM. Limited studies suggest biventricular pacing reduces LVOT gradient, but CRT is not superior to RV pacing. LBBA pacing may be contraindicated in LVOTO patients.

Conclusion:
In HCM patients with LVOTO, RV apical pacing appears superior to LBBAP, reducing LVOT gradient at rest and during exercise.
Abstract 18890: Outcomes for Patients With STEMI vs NTEMI in COVID-19: A Contemporary National Insight
Authors: Umrani Rohan , Matsumura Martin , Khalid Yaser , Dasu Neethi , Dasu Kirti
Published: December 2023

Introduction:
The COVID-19 pandemic posed significant challenges to cardiovascular care. Previous studies have shown that patients with NSTEMI type II have worse outcomes than those with NSTEMI type I or STEMI. In 2020, STEMI incidence was disproportionately high compared to NSTEMI. Since there are no ICD 10 codes to differentiate NSTEMI types I and II, we sought to compare patients with COVID-19 admitted for STEMI vs NSTEMI using the NIS database.

Hypothesis:
Given the initial pandemic response, we expect outcomes for STEMI to be worse than NSTEMI in COVID-19 patients.

Methods:
A retrospective analysis was completed utilizing the National Inpatient Sample (2020). Patients were identified based on ICD-10 codes corresponding to those with COVID-19 and STEMI vs. patients with COVID-19 and NSTEMI. Primary outcomes were mortality, length of stay (LOS) and total hospital charge (TOTHC). Secondary outcomes were analyzed using multivariate analysis.

Results:
1,685,745 patients had COVID-19, of which 39,246 had a STEMI, and 5,818 had a NSTEMI. Average age was 62.. When comparing COVID-19, patients with STEMI vs. NSTEMI, the mortality odds ratio (OR) was 2.5 (95% CI 2.28-3.75, p < 0.001) and LOS was -1.27 days. Primary and secondary outcomes are described in Table 1.

Conclusions:
STEMI was significantly associated with increased mortality in the setting of COVID-19. This may explain the lower LOS and lack of difference in TOTHC between the two groups. This may be related to the initial pandemic response of strict isolation protocols with closing of catheterization and surgical suites. Patients with STEMI and COVID-19 most likely were medically managed or diagnosed late leading to increased mortality. Intubation, cardiogenic shock and cardiac arrest were all significantly associated with increased mortality, LOS and TOTHC. Future studies may show reversal of these outcomes given a return to standard operations with respect to cardiac catheterization and surgical intervention.
Abstract 19107: Variation in Women's Representation Among Leadership Positions in Pediatric Cardiology Programs Across North America
Authors: Kipps Alaina , Marshall Audrey , Sachdeva Ritu , Bansal Neha , Bauser-Heaton Holly , CHOUEITER NADINE , Chowdhury Devyani , Dalal Aarti , Ehlrich Molly S , Freud Lindsay R , Jain Supriya , Jone Pei-Ni , laraja kristin , Owens Sonal , Lopez-Colon Dalia , Ronai Christina , Stiver Corey , Sutton Nicole J , Co-Vu Jennifer ,   On Behalf of the ACC Women in Cardiology-Adult Congenital Pediatric Cardiology Working Group
Published: December 2023

Introduction:
Despite several years of gender parity entering the field of pediatric cardiology, representation of women leaders trails that of their male colleagues. We sought to better understand the variation in women in leadership roles in our field.

Methods:
Pediatric cardiology programs that participate in the Society of Thoracic Surgeons database with > 5 cardiologists were included. Data regarding gender of physicians in 16 leadership positions was collected. We analyzed the association of women in leadership roles with center size (based on surgical volume), geographic region, presence of fellowship, and gender of division chief and department chair.

Results:
Of the 99 centers in this study, a median of 13 (IQR 10-15) roles/center were identified, with 4 (IQR 3-6), 33.3% held by women. The lowest representation was in pediatric cardiology chiefs: 13% (table). Programs led by women chiefs had more women in leadership roles (48% vs 35%, p=0.01). In the US, the Northeast has more %women leaders than the West, South, or Midwest: 43% vs 33, 32, 34% respectively, p=0.035. Fellowship program or a woman department chair were not associated with %women leaders. The %women varied among the different sections: lowest in invasive subspecialties, interventional (17%) and EP (20%), and highest in fetal directors (66%). Fewer cardiac MRI leads in medium or high-volume centers are women compared to low volume centers (16 vs 39%, p=0.02), otherwise no volume-based differences were seen.
Conclusions:
Women hold fewer leadership positions across most subsections of pediatric cardiology programs, with more equitable distribution at centers led by women division chiefs. Future studies will define barriers to leadership equity.
Abstract 288: The Tool to Empower (TEMPO) Surrogate Decision Makers of Comatose Survivors of Cardiac Arrest: A Pilot Trial of a Novel Decision Tool
Authors: Perman Sarah M , Shelton Shelby , Siry-Bove Bonnie , Martinez Amanda , Matlock Dan D , Daugherty Stacie L , Havranek Ed
Published: December 2023

Introduction:
OHCA is a sudden unexpected event that frequently renders patients incapable of decision-making. Surrogate decision makers are often thrust into the position of deciphering complex medical information while representing their loved one’s wishes with little support.

Hypothesis:
An evidence based, iteratively designed decision tool will be feasible to deploy, acceptable to surrogates, increase knowledge of post-cardiac arrest care and impart self-efficacy for decision making.

Goal:
To measure the efficacy of a novel decision aid for surrogates.

Methods:
We conducted a pilot trial of the
T
ool to
EMPO
wer (TEMPO) decision makers to examine feasibility, acceptability, knowledge, and self-efficacy. Surrogates were given a pre-intervention survey on the day of arrest, provided the tool and a post-intervention survey at least 24 hours later. The survey included an 8-question knowledge questionnaire. The post-interventions survey included the same knowledge questions, the Ottawa acceptability survey and a measure of self-efficacy for decision-making for the unconscious patient.

Results:
We enrolled 41 surrogates into the TEMPO Pilot Trial between 9/20 and 12/22. Subjects identified were predominantly women (75.6%, n=31), 53.7% were White, 22% Black and 24.4% Hispanic. Participants had varied relationships to the patient including spouse (44%), sibling (17%), adult child (17%) and parent (12%). Knowledge increased from 56.4% to 85.9%, an absolute improvement of 29.5%. Significant improvements were noted in self-efficacy in the following domains after exposure to TEMPO: 1) receipt of resuscitation; 2) care at the end-of-life; and 3) continued desire to fight the disease. Surrogates found the tool to be useful (84.6%) and that it made their choice easier (91.2%). One participant reported “I had never dealt with this and did not know what to expect so the information given was very helpful” and another stated “Now I know what type of questions to ask and what to look for.”

Conclusion(s):
In a pilot trial of TEMPO, a novel decision tool for surrogate decision makers of comatose survivors of cardiac arrest, we found the intervention was feasible, acceptable, improved knowledge and increased feelings of self-efficacy in decision making.
Abstract 307: In-Situ Simulation-Based Booster ACLS Training to Increase the Confidence and Performance of Internal Medicine Residents as Code Blue Leaders - A Quality Improvement Project
Authors: Ibrahim Ali O , Alghizzawi Moh'd , Patel Nisha , Haji Mariam , Malik Afeerah , Mishra Abhay , Sultan Nadia ,   Clinical Education Specialists, Saint Luke’s Hosp, Banderas Julie , Chan Paul S , Wooldridge David
Published: December 2023

Background:
In the United States, nearly 290,000 adult patients develop in-hospital cardiac arrest (IHCA) every year. Delivery of guideline-based resuscitation has improved patient outcomes. During 2022, our hospital had 68 inpatient i.e., approximately 1 code/resident. Residents have reported desire for more exposure. The 2020 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommended: 1) booster training, 2) in-situ simulation-based resuscitation training, and 3) specific teamwork and leadership training for healthcare providers. We aimed to implement such training to achieve an improvement in resident confidence and performance as code blue leaders.

Methods:
Pre-intervention, residents completed a 5-item 0-100 continuous scale to assess confidence in major code leader skills (Fig 1-A). Interventions included: 1) Calling residents to patient rooms to run simulation-based codes, and 2) a didactic session that discussed common errors during codes. Time to key ACLS steps was recorded during the simulations. At the end of the project, residents completed the post-intervention survey of confidence and balancing measures.

Results:
13 residents led simulation-based codes, 20 attended the didactic session, and 25 completed the survey. Resident confidence in the defined skills increased by an average of 30%. (P<0.05) (Fig 1-A). Residents who led codes after the didactic session had shorter times to key ACLS steps (Fig 1-B). Balancing measures included resident-reported satisfaction and perceived disruption to clinical workflow (100% and 0% of responses, respectively).

Conclusions:
In-situ simulation-based booster ACLS training was associated with an increase in the confidence and performance of IM residents as code blue leaders. Incorporation of such training in IM residency curriculum should be considered as a practical application to sustain the gains of this QI initiative.
Abstract 384: The Association of End-Tidal Carbon Dioxide During Pediatric Cardiopulmonary Resuscitation With Survival Outcomes
Authors: Morgan Ryan W , Reeder Ron , Bender Dieter , Cooper Kellimarie , Friess Stuart , Graham Kathryn , Meert Kathleen , Mourani Peter , Murray Robert , Nadkarni Vinay M , Nataraj C. , Palmer Chella , Srivastava Neeraj , Tilford Bradley , Wolfe Heather A , Yates Andrew R , Berg Robert A , Sutton Robert M ,   The ICU-RESUS Investigators,   The Collaborative Pediatric Critical Care RschNetwork (CPCCRN) Investigators
Published: December 2023

Background:
Pediatric resuscitation guidelines recommend monitoring end-tidal carbon dioxide (ETCO
2
) as an indicator of CPR quality but note that “specific values to guide therapy have not been established in children.”

Aims & Hypotheses:
We aimed to determine the association of ETCO
2
during CPR with pediatric IHCA outcomes. We hypothesized that event-level average ETCO
2
≥20 mmHg would be associated with higher rates of survival to hospital discharge.

Methods:
NHLBI-funded ancillary prospective observational cohort study of pediatric IHCAs in 18 U.S. ICUs from the
ICU-RESUS
trial (NCT02837497). Children with invasive mechanical ventilation at the start of CPR were included. The primary exposure was event-level average ETCO
2
(≥20 mmHg vs. <20 mmHg). The primary outcome was survival to hospital discharge. Secondary outcomes were ROSC and intra-arrest CPR quality and physiology measurements. Average ETCO
2
<10 mmHg was a secondary exposure. The associations between ETCO2 and outcomes were evaluated with multivariable Poisson regression. Exploratory analyses used receiver operating characteristic (ROC) and spline curves to identify alternative ETCO
2
targets.

Results:
Among 234 patients, 133 (57%) had average ETCO
2
≥20 mmHg. After controlling for
a priori
covariates, average ETCO
2
≥20 mmHg was associated with higher rates of survival to hospital discharge (aRR 1.33, CI
95
1.04 - 1.69, p=0.023) and ROSC (aRR 1.22, CI
95
1.00 - 1.49, p=0.046) compared to lower values. Average ETCO
2
≥20 mmHg was associated with higher blood pressures during CPR (diastolic: 46.5 [37.9, 57.9] mmHg vs. 33.3 [26.8, 42.9] mmHg, p<0.01); systolic: 90.6 [75.1, 118.7] mmHg vs. 70.9 [55.5, 86.4] mmHg, p<0.01), higher chest compression fraction (0.98 [0.94, 1.00] vs. 0.97 [0.92, 0.99], p=0.034), and lower ventilation rates (26.2 [19.7, 30.9] min
-1
vs 29.5 [22.8, 41.4] min
-1
, p<0.01). Average ETCO
2
<10 mmHg was not associated with outcomes. Exploratory analyses did not detect an alternative ETCO
2
target (ROC cutpoint: 19.6 mmHg).

Conclusions:
In this multicenter study, ETCO
2
≥20 mmHg was associated with higher quality CPR and superior outcomes. ETCO
2
<10 mmHg was not associated with worse outcomes, suggesting resuscitation should not be terminated based on low ETCO
2
alone.
Rule Mining Trends from 1987 to 2022: A Bibliometric Analysis and Visualization
Authors: Zhou Shiqi , Bi Sheng , Qi Guilin
Published: December 2023

Rule mining has emerged as a crucial technique in data mining and knowledge discovery, enabling the extraction of valuable insights and patterns from vast datasets. This has garnered significant attention from both academic and industrial communities. However, there is a lack of bibliometric and visualization research on rule mining, leading to an unclear delineation of research topics and trends in the field. To fill this gap, this paper provides a comprehensive and up-to-date bibliometric analysis of rule mining, covering 4524 publications published between 1987 and 2022. Using various metrics and visualization techniques, we examine the patterns, trends, and evolution of rule mining. The results show a sustained growth in rule mining research, with a significant increase in publication output in recent years, and its rapid expansion into new areas such as explainable artificial intelligence and privacy protection. While the majority of publications come from Asia, the National Natural Science Foundation of China emerges as the top funding agency in the field. We also identify highly productive authors and significant members of co-authorship networks, as well as the most influential publications and citation bursts. The need for international collaboration and the integration of diverse research perspectives is highlighted. Despite the progress in rule mining, several challenges still require further research, including scalability and efficiency, explainability, network security and privacy protection, and personalized and user-centered design. Overall, this paper provides a valuable roadmap for researchers, policymakers, and practitioners interested in rule-mining research.
Cross-Modal Contributions to Episodic Memory for Voices
Authors: Tatz Joshua R. , Peynircioğlu Zehra F.
Published: December 2023

Multisensory context often facilitates perception and memory. In fact, encoding items within a multisensory context can improve memory even on strictly unisensory tests (i.e., when the multisensory context is absent). Prior studies that have consistently found these multisensory facilitation effects have largely employed multisensory contexts in which the stimuli were meaningfully related to the items targeting for remembering (e.g., pairing canonical sounds and images). Other studies have used unrelated stimuli as multisensory context. A third possible type of multisensory context is one that is environmentally related simply because the stimuli are often encountered together in the real world. We predicted that encountering such a multisensory context would also enhance memory through cross-modal associations, or representations relating to one’s prior multisensory experience with that sort of stimuli in general. In two memory experiments, we used faces and voices of unfamiliar people as everyday stimuli individuals have substantial experience integrating the perceptual features of. We assigned participants to face- or voice-recognition groups and ensured that, during the study phase, half of the face or voice targets were encountered also with information in the other modality. Voices initially encoded along with faces were consistently remembered better, providing evidence that cross-modal associations could explain the observed multisensory facilitation.
Trompe-l’oeil Mirrors of the Soul in Jan David, S.J.’s Duodecim specula (Twelve Mirrors) of 1610
Authors: Melion Walter S.
Published: December 2023

Jan David, S.J.’s Duodecim specula (Antwerp: Jan Moretus, 1610), an innovative emblematic treatise in twelve chapters, focuses on various kinds and degrees of specular image generated by the human soul. Each chapter responds to an opening imago, designed and engraved by Theodoor Galle, that illustrates the operations of the mirror in question. Three of the imagines, v. The Mirror of Others’ Eyes, viii. The Mirror of Created Things, and x. The Mirror of Example, rather than displaying persons, actions, or things that fall under the purview of the respective mirror, instead depict the mirrored image that such a speculum is seen to reflect. Accordingly, as printed imagines that prove upon closer inspection to contain specular imagines or, better, that function as pictorial representations of particular kinds of image, these imagines imaginum (images of images) can be said to produce a trompe-l’oeil effect. They ask the reader-viewer to consider why s/he thinks s/he sees a present image when what is actually seen by the eye is a pictured image, a pictured picture, doubly mediated by the process of representation. My essay examines how and why this deceptive effect was marshaled by David as a figure of thought: by articulating the manner and meaning of these three specula in particular, he offers the reader-viewer a therapeutic antidote wherewith to combat the human propensity for idolatry and self-deception.
“Per aspera ad astra”: Starry Heavens and Sidereal Metamorphosis in Jesuit Emblematics
Authors: Zierholz Steffen
Published: December 2023

This article sheds new light on a series of Jesuit emblems, from both spiritual and cosmological perspectives, in which stars and starlit night skies figure prominently. The starting point is Ignatius of Loyola’s preferred devotional exercise, as Pedro Ribadeneyra recounts: the contemplation of stars. Given Ignatius’s importance in this exercise, they are recurring motifs in Jesuit emblematics. Considering this exercise in the context of the classical definition of human beings as contemplators of heaven, I will provide an interpretive framework based on anthropology, epistemology, and ethics. I argue that stellar imagery draws on three closely intertwined key elements: firstly, the idea that God reveals himself through nature. Secondly, that knowledge of God is mediated by sight but achieved by reason, and finally, that the divine nature of stars and heavenly bodies made them worthy models to ponder and imitate. Stars mediate access to the knowledge of God and, as a poetic metaphor for deification, provide a model for cultivating one’s soul and conforming it to the divine. This article is part of the special issue of the Journal of Jesuit Studies on Jesuit emblems and emblematic edited by Walter S. Melion.
Affectionate Research
Authors: Yılmaz Tebessüm
Published: December 2023

This paper delves into the dynamic relationship between research and the researcher within Kurdish Studies, focusing on emotions, responsibility, and solidarity. Drawing from personal experiences and employing decolonial intersectional feminist methodologies, the author presents their research on state violence and resistance in Kurdish cinema. Through this exploration, the paper underscores the pressing need for intersectional queer-feminist research within Kurdish Studies and elucidates the connection between theoretical and methodological choices and the author’s personal experiences in academia and activism. Additionally, the paper discusses applying feminist intersectional approaches as a methodological lens and emphasises their benefits in understanding positionality and shifting subject positions. By highlighting the imperative for critical reflexivity and diversification of onto-epistemological methods in the field of Kurdish Studies, this paper advocates for a transformative and inclusive approach to knowledge production.
Tackling the Divide in the Kurdish Language
Authors: Yüksel Metin
Published: December 2023

This article is an autoethnographic account that traces the widening divide between Kurdish dialects in the age of nation-states. It aspires to problematize and go beyond the widespread gap characterizing the Kurdish language along two dialects and alphabets. From its emergence as a non-state language in the 1920s onward, Kurdish actors sought to revive Kurmanji Kurdish in Damascus, Beirut and Yerevan; and Sorani Kurdish in Sulaimaniya and Baghdad. While the Kurmanji side of the story and its actors have been studied to a certain degree, how Kurdish developed in Sulaimaniya and Baghdad has received little scholarly attention. Through its author’s autoethnographic account of acquiring literacy in both dialects which recently came to fruition at the Zheen Center for Documentation and Research in Sulaimaniya, this article provides some reflections on the story of the Kurdish language in the age of nation-states.
The Other Side of LGBTI+ Activism in Turkey
Authors: Atçeken Rukan
Published: December 2023

Under the current AKP regime, an ideology of Turkish-Islamic supremacy has increasingly been gaining hold in Turkey. This has entailed profound changes across all social segments in the country, with those who conform to the ideology being rewarded and those who do not facing harsh punishment. The LGBTI+ movement, too, has been affected by these changes. The movement has been weakened not only by heavy political oppression, but also by neglecting ideological and practical relations with other—including Kurdish—segments of the social opposition. As a result, Kurdish LGBTI+ people have found themselves distanced from the movement. In this commentary I will describe and analyse this process of distance and removal as a Kurdish LGBTI+ person.
Contextualizing Kurdish Gender Studies
Authors: Açık Necla , Kutlay-Sarıkaya Berivan , Ghaderi Farangis , Kılıçaslan Gülay
Published: December 2023

Established in 2020, the Kurdish Gender Studies Network (KGSN) is an online epistemic community that brings together activists and scholars dedicated to advancing knowledge in Kurdish gender and sexuality studies. This paper aims to introduce the network to a larger public while situating the formation of the KGSN in relation to the growth of Kurdish gender studies (KGS), and the increasing influence of women and queer scholars in Kurdish studies (KS) since 2010. It highlights that both KGSN and KS have been greatly influenced by the conditions shaped by the colonial legacy surrounding Kurdistan and the Kurdish issue while discussing the ways in which Kurdish women’s and gender studies were often marginalized in KS. As Kurdish women scholars and members of the network’s steering committee, we position the trajectory of the network and the evolution of KGS within the broader framework of knowledge production in colonial contexts and address the ongoing struggle to decolonize feminist knowledge production, which, historically, has been dominated by Western-centric epistemologies and methodologies.
10. Epistle to Robert Earl of Oxford and Earl Mortimer; To Mr Addison; Epitaph on James Craggs, Esq
Authors: Hutchings William
Published: December 2023

Chapter 10 brings together further examples from two genres, the verse epistle and the elegy. The Epistle to Robert Earl of Oxford and Earl Mortimer, To Mr Addison and the Epitaph on James Craggs, Esq as a trio show how Pope’s poetry can negotiate the tensions of personal relationships within a commitment to friendship.
21. The Second Epistle of the Second Book of Horace Imitated
Authors: Hutchings William
Published: December 2023

Chapter 21 begins by proposing that epistles and satires may be considered as overlapping genres: for Pope, the personal is the political and vice versa. Two extracts from The Second Epistle of the Second Book of Horace Imitated are then read in detail to show how Pope self-depreciatingly reviews his addiction to writing ‘verses’ in the light of the passing of time. He ought now to put away such childish things and take a sober and philosophical look at his own mind and soul. But, at the same time, Pope is advancing a counter-argument. By writing highly crafted ‘verse’, he demonstrates a fundamental principle underlying the poetic art. Truly philosophical poetry – as opposed to poetry which looks self-important by writing about philosophy – embodies truth within form.
25. Epilogue to the Satires
Authors: Hutchings William
Published: December 2023

Chapter 25 reads the Epilogue to the Satires: Dialogues I and II as an envoi to Pope’s poems of the 1730s. The first dialogue argues wittily but firmly for satire’s value in condemning corruption in the body politic. The longer second dialogue, which accordingly occupies the longer part of the chapter, argues for the naming of satire’s victims against the friend’s more cautionary approach. It then sets the need for satire against dignified praise for individual participants in public life who have maintained the finest traditions of social engagement and ethical standards. The dialogue concludes with a resounding assertion of the need for poetry to provide a voice for those standards.
26. The Dunciad
Authors: Hutchings William
Published: December 2023

Chapter 26 is the longest in the book. The Dunciad was written in two separate phases of Pope’s career, the late 1720s and the early 1740s. The first version, in three books and with Lewis Theobald (‘Tibbald’) as anti-hero, was published in 1728 and re-issued in 1729 in a fuller form, increasing its burlesque of literary and critical pedantry. The poem celebrates the home of the goddess Dulness in Rag-fair, a market-place near the Tower of London where rags and ragged writings of all kinds are sold, and the triumph of its ‘values’ over the world of the court and the town. Parodies of Virgil’s Aeneid provide models of the perversion of ‘heroic’ language and forms into their opposites. Pope returned to the poem to add a fourth book in 1742, and the full four-book version, with Colley Cibber replacing ‘Tibbald’ as King of the Dunces and with Grub Street and ‘Bedlam’ (a foundation for the reception and cure of the mentally ill) as Dulness’s new home, appeared in 1743. Through extensive analyses of key extracts from both versions and all four books, the chapter illustrates and examines the dark but riotous world of Dulness and its denizens. Book four is particularly well represented, as the apogee of the work. The argument, implicit throughout, is rendered fully explicit in the conclusion of the chapter. The narrative, which tells of the extinction of language, learning and light, is conveyed with a spirit which exemplifies what Pope’s own poetry represents: the survival and celebration of his consistent commitment to all that is genuinely creative. His last poem, the fourth book of The Dunciad, is a final enactment of ‘wit’s wild dancing light’.
A List in Three Versions
Authors: Tarras Peter
Published: December 2023

Tarras examines the transmission process in the study of lists through a definition list in the Arabic philosophical tradition, a well-known text commonly attributed to the “philosopher of the Arabs” al-Kindī (d. after 252/866). The study of this list, thought to stand at the beginning of the career of this literary format in that tradition, promises to offer insights into the way in which Arabic philosophy emerged in the early ʿAbbāsid caliphate. However, the manuscripts that transmit it witness three divergent versions. Further, each version testifies not to a well-ordered text, but to a more or less loose assemblage of technical terms harvested from philosophy and related fields. This raises a number of questions as to the structure, function, and use of this text. This study attempts to show that these questions can be addressed fruitfully once we attend to the stratified compositional process from which the three versions of this text must have emerged. Its manuscript witnesses represent the latest stage in this process. After a brief survey of previous scholarship, the study begins with a review of the manuscript evidence in order to make observations as to the text’s codicological settings and paratextual features. It proceeds with an analysis of its different structural levels. The conclusion that can be drawn from this inquiry is that this definition list has not reached us as one unified literary entity, but in the form of three distinct historical artifacts, which owe themselves to the sum of the intentions of their users/producers.
Regularity and Variation in Islamic Chains of Transmission
Authors: Bednarkiewicz Maroussia
Published: December 2023

The isnād is a list of narrators’ names which precedes an account about Islam’s prophet or his companions, and indicates its origin. The content and the form of this list have been studied in different fields. Islamicists have scrutinised the names contained in the isnād in order to assess the authenticity of the following account and uncover potential fraudsters. Computer scientists, in turn, have focused on form: they attempted to exploit the regular succession of names and transmission terms to develop algorithms capable of distinguishing isnād from non-isnād texts. The present chapter opens a novel horizon by analyzing the structural variations of the isnād within the old and universal context of list-making. A twofold methodology, combining traditional and computational text analysis, highlights the actual contours of the isnād in a large corpus of texts and propose a hierarchy of functions linked to the different variations observed.
Relating Tropical Cyclone Intensification Rate to Precipitation and Convective Features in the Inner Core
Authors: Wang Xinxi , Jiang Haiyan , Guzman Oscar
Published: December 2023

Using Tropical Rainfall Measuring Mission Microwave Imager observations of global tropical cyclones (TCs) from 1998 to 2013, relationships between TC intensification rate and inner-core convective and precipitation parameters are examined by decoupling the dependency of these parameters on TC intensity and that on TC intensification rate. A total of 16 TC intensity change–intensity categories are categorized based on the initial intensity and 24-h future intensity change. The results show that the TC inner-core mean rain rate, convective intensity, and stratiform rain occurrence, and axisymmetric index of convective intensity increase significantly with TC intensification rate for each TC intensity category. The symmetry of rain rate and stratiform rainfall occurrence also increase significantly with TC intensification rate for each intensity category, except from slowly intensifying (SI) to rapidly intensifying (RI) group when the initial intensity is major hurricane. The RI major hurricanes have significantly more asymmetric rainfall distribution and distribution of stratiform rainfall occurrence than those of SI major hurricanes. For TCs with initial intensity in tropical depression, tropical storm, and major hurricane categories, the RI group has a significantly more asymmetric pattern of shallow precipitation/convection occurrence in the inner core than the SI group, while it has a significantly more symmetric pattern of deep convection occurrence than the SI group. The inner-core size, as quantified by the radius of maximum azimuthal mean rainfall decreases with both TC intensification rate and TC intensity.
Bleach Cleaning of Commercially Available Gold Nanopillar Arrays for Surface-Enhanced Raman Spectroscopy (SERS)
Authors: Morder Courtney J. , Schorr Hannah C. , Balss Karin M. , Schultz Zachary D.
Published: December 2023

Surface-enhanced Raman spectroscopy (SERS) is a highly sensitive technique that can assist in trace analysis for biomedical, diagnostic, and environmental applications. However, a major limitation of SERS is surface contamination of the substrates used, which can complicate the spectral reproducibility, limits of detection, and detection of unknown analytes. This is especially prevalent with commercially available substrates as shipping under a controlled and clean environment is difficult. Here we report a method using dilute bleach solutions to remove surface contamination from commercially available substrates consisting of gold-coated nanopillar arrays that maintains functionality. The results show that this method can be used to remove background signals associated with typical surface contamination in commercially available substrates as well as remove thiolated self-assembled monolayers (SAMs). Results indicate the bleach oxidizes the surface contaminants, which can then be easily washed away. Although the metallic surface also becomes oxidized in this process, the surface can be reduced without loss of SERS activity. The SERS intensity of SAMs improved following bleach treatment across all concentrations studied.