bluuebunny/crossref_metadata_2025 huggingface dataset:
Protocol for a systematic review and meta-analysis of culturally adapted internet- and mobile-based health promotion interventions
Authors: Balci Sumeyye , Spanhel Kerstin , Sander Lasse , Baumeister Harald
Published: November 2020

Introduction

High rates of immigration pose challenges for the healthcare systems of many countries to offer high-quality care to diverse populations. Advancing health interventions with incorporating the cultural background of diverse populations can be helpful to overcome this challenge. First studies suggest that culturally diverse populations might benefit from culturally adapted internet-based and mobile-based interventions (IMI) to promote health behaviours. However, the effectiveness of culturally adapted IMIs for health promotion interventions has not been evaluated systematically. Therefore, the aim of this review is to assess the effectiveness of culturally adapted IMIs regarding health promotion. Additionally, the cultural adaptation features of these interventions will be outlined.

Methods and analysis

Randomised controlled trials (RCTs) investigating the effectiveness of culturally adapted IMIs to promote health behaviours in the field of healthy eating, smoking cessation, alcohol consumption, physical activity and sexual health behaviour will be identified via a systematic search of the databases MEDLINE, Embase, PsycINFO, CENTRAL. The preliminary search has been conducted on the 26 August 2019 and will be updated in the process. Data will be pooled meta-analytically in case of at least three included studies reporting on the same outcome. Moreover, a narrative synthesis of the included studies will be conducted. The risk of bias will be assessed using the Cochrane Collaboration’s tool for the Quality Assessment of RCTs V. 2.0. Publication bias will be assessed using funnel plots.

Ethics and dissemination

Ethical approval is not required for this study. The results of this study will be published in a peer-reviewed international journal.

PROSPERO registration number

PROSPERO; CRD42020152939
Social burden of people with the migraine diagnosis in Japan: evidence from a population-based cross-sectional survey
Authors: Igarashi Hisaka , Ueda Kaname , Jung Sungeun , Cai Zhihong , Chen Yirong , Nakamura Tomomi
Published: November 2020

Objectives

To quantify the social burden among Japanese migraine patients in the context of currently available migraine treatments, by comparison with non-migraine controls, and comparison of migraine patients currently taking prescription medication versus not taking prescription medication.

Design

Cross-sectional analysis.

Setting

Data from the population-based online self-administered Japan National Health and Wellness Survey (NHWS) 2017.

Participants

Respondents to the NHWS (n=30 001) were ≥18 years. Migraine patients were respondents with self-reported experience and physician diagnosis of migraine. Non-migraine controls reported no migraine experience. Migraine patients were subgrouped into currently taking prescription medication for migraine (Rx) and currently not taking prescription medication (non-Rx).

Methods

One-way analysis of variance tests were performed to compare health-related quality of life (HRQoL), work productivity and activity impairment and healthcare resource utilisation between migraine patients and matched non-migraine controls selected by 1:1 propensity score matching. Generalised linear models were used to compare outcomes and migraine related characteristics between Rx and non-Rx.

Results

Compared with matched controls, migraine patients (n=1265) had significantly lower HRQoL in terms of lower Physical Component Summary (48.36 vs 51.29, p<0.001), Mental Component Summary (44.65 vs 48.31, p<0.001), Role/Social Component Summary (41.78 vs 46.18, p<0.001) and mean EuroQol 5-Dimension index (0.77 vs 0.86, p<0.001) scores. Migraine patients experienced significantly higher absenteeism (6.95% vs 3.07%, p<0.001), presenteeism (32.73% vs 18.94%, p<0.001), work productivity loss (34.82% vs 20.03%, p<0.001) and daily activity impairment (35.70% vs 22.04%, p<0.001) and visited healthcare professionals more often (8.38 vs 4.57, p<0.001) than controls. No significant differences in these outcomes were found when comparing Rx (n=587) and non-Rx (n=678) patients.

Conclusions

There is an unmet need for improved HRQoL and work productivity in Japanese migraine patients despite the currently available prescription medications, which are important factors to consider for future development of migraine therapies.
Relationship between dietary magnesium intake and rheumatoid arthritis in US women: a cross-sectional study
Authors: Hu Congqi , Zhu Fangfang , Liu Lijuan , Zhang Mingying , Chen Guangxing
Published: November 2020

Objectives

Diet has been shown to be associated with rheumatoid arthritis (RA), and magnesium has been shown to inhibit inflammatory responses, but research on the relationship between dietary magnesium and RA is limited and controversial. In this study, we aimed to explore the non-linear relationship between dietary magnesium intake and RA in US women.

Design

Cross-sectional survey.

Setting

National Health and Nutrition Examination Survey (NHANES).

Primary and secondary outcome measures

Non-linear relationship between dietary magnesium intake and prevalence of RA.

Participants

A total of 13 324 women aged 18–80 years (RA n=12 306, non-RA n=1018) were included in this study.

Results

Overall, the absolute risk (AR) of RA was 7.24% in all participants. In the multivariable logistic regression analysis, we found a negative correlation between dietary magnesium intake and RA (OR=0.84, 95% CI 0.75 to 0.95, p=0.006). When we converted dietary magnesium intake into a categorical variable (tertiles), the ARs of the low group, the middle group and the high group were 9%, 7.1% and 4.9%, respectively. We noticed that the ORs between the three groups were not equidistant; then, we detected a U-shaped linking by smooth curve fitting and obtained inflection points at 181 and 446 mg/day. The prevalence of RA decreased when dietary magnesium intake was <181 mg/day (OR=0.7, 95% CI 0.5 to 0.8, p<0.001) and increased when it was >446 mg/day (OR=2.8, 95% CI 1.2 to 6.6, p=0.020), remaining at a minimum when it was between 181 and 446 mg/day (OR=1.0, 95% CI 0.7 to 1.2, p=0.700).

Conclusion

There was a U-shaped relationship between dietary magnesium and RA in women, and our study highlights the importance of moderate dietary magnesium intake in possibly exerting a protective role in women with RA.
Hypertension, cardiovascular disease and cause of death in Danish living kidney donors: matched cohort study
Authors: Chaudry Mavish , Gislason Gunnar Hilmar , Fosbøl Emil Loldrup , Køber Lars , Gerds Thomas Alexander , Torp-Pedersen Christian
Published: November 2020

Objectives

We aimed to investigate the long-term absolute risk of hypertension and cardiovascular disease after kidney donation in living kidney donors.

Design

Living kidney donors were matched to 10 controls from the general population.

Setting

Multiple Danish national registries were used to identify living kidney donors from 1 January 1996 to 31 December 2017 nationwide.

Participants

1262 living kidney donors and 12 620 controls.

Main outcome measures

Hypertension, cardiovascular disease and diabetes.

Results

The median age of living kidney donors was 52 (men 43%). Hypertension developed in 50 (4%) and 231 (1.8%) with a median follow-up of 7 years (IQR 3.3–12.1 years with a maximum follow-up of 22 years) and 6.9 years (IQR 3.2–11.7 years and maximum follow-up of 22 years) for donors and controls, respectively. The absolute risk of hypertension was 2.3% (95% CI 1.4% to 3.2%) and 1.2% (95% CI 1.0% to 1.4%), 4.2% (95% CI 2.8% to 5.7%) and 2.4% (95% CI 2.1% to 2.8%), 8.6% (95% CI 6.0% to 11.3%) and 3.3% (95% CI 2.8% to 3.8%) within 5, 10, 15 years for donors and controls, respectively. The ratio of the 10-year absolute risks for hypertension was 1.64 (95% CI 1.44 to 1.88) for donors compared with the controls. Two donors and four controls developed renal replacement therapy requiring end-stage renal disease during follow-up. The absolute risk of cardiovascular disease and diabetes was 7.3% (95% CI 5.7% to 9.5%) and 8.3% (95% CI 7.7% to 9.0%), 1.7% (95% CI 0.7% to 2.8%) and 3.2% (95% CI 2.7% to 3.6%) at 10 years for donors and controls, respectively.

Conclusions

Living kidney donors have an increased long-term absolute risk of hypertension compared with controls from the general population.
Type-I thermal leptogenesis in $$Z_3$$-symmetric three Higgs doublet model
Authors: Chakraborty Indrani , Roy Himadri
Published: November 2020

Our present work explores the possibility of neutrino mass generation through Type-I see-saw mechanism and provides an explanation of the baryon asymmetry of the Universe via thermal leptogenesis in the framework of a $$Z_3$$

Z
3

-symmetric three Higgs doublet model (3HDM) augmented with three right-handed neutrinos. Here the thermal leptogenesis is initiated by the out-of-equilibrium decay of the lightest heavy neutrino $$N_1$$

N
1

. The constraints arising out of the scalar sector put strong bound on the model parameter $$\tan \beta $$

tan
β

, which in turn takes part in the computation of the lepton asymmetry $$\epsilon $$
ϵ
. Lepton asymmetry being converted partially into the baryon asymmetry by electroweak sphelaron processes, will account for the required baryon asymmetry satisfying the current data. We therefore analyse the parameter space consistent with the constraints arising from neutrino oscillation, lepton asymmetry and baryon asymmetry together, last one turning out to be the most stringent one.
Distributed Approximation Algorithms for Steiner Tree in the CONGESTED CLIQUE
Authors: Saikia Parikshit , Karmakar Sushanta
Published: November 2020

The Steiner tree problem is one of the fundamental and classical problems in combinatorial optimization. In this paper we study this problem in the CONGESTED CLIQUE model (CCM) [29] of distributed computing. For the Steiner tree problem in the CCM, we consider that each vertex of the input graph is uniquely mapped to a processor and edges are naturally mapped to the links between the corresponding processors. Regarding output, each processor should know whether the vertex assigned to it is in the solution or not and which of its incident edges are in the solution. We present two deterministic distributed approximation algorithms for the Steiner tree problem in the CCM. The first algorithm computes a Steiner tree using [Formula: see text] rounds and [Formula: see text] messages for a given connected undirected weighted graph of [Formula: see text] nodes. Note here that [Formula: see text] notation hides polylogarithmic factors in [Formula: see text]. The second one computes a Steiner tree using [Formula: see text] rounds and [Formula: see text] messages, where [Formula: see text] and [Formula: see text] are the shortest path diameter and number of edges respectively in the given input graph. Both the algorithms achieve an approximation ratio of [Formula: see text], where [Formula: see text] is the number of leaf nodes in the optimal Steiner tree. For graphs with [Formula: see text], the first algorithm exhibits better performance than the second one in terms of the round complexity. On the other hand, for graphs with [Formula: see text], the second algorithm outperforms the first one in terms of the round complexity. In fact when [Formula: see text] then the second algorithm achieves a round complexity of [Formula: see text] and message complexity of [Formula: see text]. To the best of our knowledge, this is the first work to study the Steiner tree problem in the CCM.
Owner–Intruder contests with correlated resource values
Authors: Bukina Polina A. , Khara Mehtab S. , Nadhem Haider H. , Woolley Patrick L. , Rychtář Jan , Taylor Dewey
Published: November 2020

We study a conflict of two individuals over a valuable resource. We construct a sequential game where the first individual, the Owner, decides whether to defend the resource and the other individual, the Intruder, decides whether to attack and try to steal the resource. Individuals know the value of the resource to themselves. This provides the individuals an estimate of the value of the resource to the opponent. We build a mathematical model that allows us to quantify and vary the accuracy of this estimate. We study how the outcomes of the game depend on the accuracy. We show that, in our setting, the accuracy does not matter to the Intruder but it does to the Owner. For resources of a large value, the Owner benefits from a smaller accuracy. However, for resources of a small value, the Owner benefits from a bigger accuracy.
Do Bond Investors Price Tail Risk Exposures of Financial Institutions?
Authors: Chava Sudheer , Ganduri Rohan , Yerramilli Vijay
Published: November 2020

We analyze whether bond investors price tail risk exposures of financial institutions using a comprehensive sample of bond issuances by U.S. financial institutions. Although primary bond yield spreads increase with an institution’s own tail risk (expected shortfall), systematic tail risk (marginal expected shortfall) of the institution doesn’t affect its yields. The relationship between yield spreads and tail risk is significantly weaker for depository institutions, large institutions, government-sponsored entities, politically-connected institutions, and in periods following large-scale bailouts of financial institutions. Overall, our results suggest that implicit bailout guarantees of financial institutions can exacerbate moral hazard in bond markets and weaken market discipline.
Levofloxacin-Induced Acute Hyperpigmentation Changes in a Chronic Kidney Disease Patient
Authors: Patil Shakuntala S. , Patil Sachin M. , Campbell Ryan , Singh Manisha , Plotkin Matthew
Published: November 2020

Medication-induced cutaneous hyperpigmentation has variable clinical presentations and is dependent on the specific drug involved. Most commonly, an attentive patient observes such changes early in the course; when missed by the patient, such changes are usually noted by an observant clinician. Clinical diagnosis can be challenging if the patient is on multiple medications because other causes must be excluded. This condition occurs via multiple mechanisms. Frequently, the pigmentary change is reversible with discontinuation of the drug. Causative medications include nonsteroidal; anti-inflammatory agents, antimalarials, antibiotics, psychotropics, amiodarone, and chemotherapeutic agents. The; antimicrobials responsible for hyperpigmentation are antimalarials, tetracyclines, tigecycline, dapsone, rifampicin, and antiretrovirals such as zidovudine. Sunlight exposure can worsen the pigmentation seen with some of the above antimicrobials (e.g., dapsone). Here, we describe an older adult white woman presenting with acute cutaneous; hyperpigmentation of the bilateral lower extremities while on levofloxacin therapy. Hyperpigmentation resolved after cessation of the agent. Our case highlights this unique acute presentation after only a few days of oral levofloxacin.
Investigation of the Potential Mechanism Governing the Effect of the Shen Zhu San on COVID‐19 by Network Pharmacology
Authors: Wang Yuxuan , Ru Yuhua , Zhuo Guowei , Sheng Maozheng , Wang Shuangqiu , Ma Jiarui , Zhou Chongyi , Sun Xiaohe , Zeng Yanqi , Zhang Ya , Li Hui , Lu Zhigang , Wu Depei , Wu Minghua
Published: November 2020

Background. Since December 2019, coronavirus disease 2019 (COVID‐19) due to SARS‐CoV‐2 infection has emerged in Wuhan and rapidly spread throughout China and even to other countries. Combined therapy with modern medicine and traditional Chinese medicine has been proposed, in which Shen Zhu San (SZS) was regarded as one of the basic prescriptions. Methods. Network pharmacological approaches along with candidate compound screening, target prediction, target tissue location, protein‐protein interaction network, gene ontology (GO), KEGG enrichment analyses, and gene microarray analyses were applied. Results. A total of 627 targets of the 116 active ingredients of SZS were identified. Targets in immune cells and tissues were much more abundant than those in other tissues. A total of 597 targets were enriched in the GO biological cellular process, while 153 signaling pathways were enriched according to the KEGG analysis. A total of 450 SARS‐related targets were integrated and intersected with the targets of SZS to identify 40 common targets that were significantly enriched in five immune function aspects of the immune system process during GO analysis. Several inflammation‐related pathways were found to be significantly enriched throughout the study. Conclusions. The therapeutic mechanisms of the effects of SZS on COVID‐19 potentially involve four effects: suppressing cytokine storms, protecting the pulmonary alveolar‐capillary barrier, regulating the immune response, and mediating cell death and survival.
Use of a Four-miRNA Panel as a Biomarker for the Diagnosis of Stomach Adenocarcinoma
Authors: Chen Xuan , Li Xinji , Peng Xiqi , Zhang Chunduo , Liu Kaihao , Huang Guocheng , Lai Yongqing
Published: November 2020

Background. MicroRNAs (miRNAs) have been applied to cancer diagnosis taking into account their role in tumorigenesis. The main purpose of our study was to confirm the possibility of using miRNAs as noninvasive biomarkers for stomach adenocarcinoma (STAD) diagnosis. Methods. A total of 246 participants (130 STAD patients and 116 healthy controls (HCs)) were enrolled in this 3-phase study. Five STAD pools and 3 HC pools (with 4 participants in each pool) were used for the screening of the 28 miRNAs using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The training phase (30 STAD patients vs. 24 HCs) and validation phase (80 STAD patients vs. 80 HCs) were used to further verify the identity of these miRNAs. Kaplan–Meier survival analysis and bioinformatics analysis were also used. Results. The expression levels of miR-125b-5p and miR-196a-5p were upregulated in STAD serum, compared with the HCs, while miR-1-3p and miR-149-5p showed the opposite result. A four-serum miRNA panel was constructed, and the area under the receiver operating characteristic curve (AUC) was found to be 0.892 (95% CI: 0.834 to 0.936,

sensitivity
=
86.25
%

,

specificity
=
78.75
%

). Only miR-125b-5p expression showed a significant difference between STAD patients and NCs in the survival analysis. The neurotrophin signaling pathway was associated with 4 miRNAs identified in STAD patients. Conclusion. The four-serum miRNA panel has great potential to be used as a noninvasive biomarker for STAD diagnosis.
Novel and Unusual Retinal Findings in Two Patients with Neurofibromatosis Type 1
Authors: Kilgore David A. , Sanders Riley , Uwaydat Sami
Published: November 2020

Neurofibromatosis type 1 (NF1) is a phacomatosis known to be associated with several developmental abnormalities in multiple organ systems including the eyes. NF1 can present with varying ophthalmic manifestations, including Lisch nodules, retinal astrocytic hamartomas, capillary hemangiomas, plexiform neurofibromas, and choroidal nodules. We present 2 cases of NF1 with presentations that may represent underreported retinal abnormalities occurring in NF1. Case 1 presents a patient who developed spontaneous peripheral retinal dialysis with subsequent retinal detachment; case 2 discusses a patient with multiple pigmented choroidal lesions bilaterally.
Surviving Lambs with Myelomeningocele Repaired in utero with Placental Mesenchymal Stromal Cells for 6 Months: A Pilot Study
Authors: Yamashiro Kaeli , Galganski Laura A. , Peyton Jamie , Haynes Kalie , Vicuna Victoria , Kumar Priyadarsini , Keller Benjamin , Becker James , Pivetti Christopher , Stokes Sarah , Theodorou Christina , Jackson Jordan , Wang Aijun , Farmer Diana
Published: November 2020

Background: Fetal repair of myelomeningocele (MMC) with placental mesenchymal stromal cells (PMSCs) rescues ambulation in the ovine model up to 48 h postnatally. Outcomes past 48 h are unknown as MMC lambs have not been survived past this timepoint. Objective: We aimed to survive lambs for 6 months following the fetal repair of MMC with PMSCs. Methods: Fetal MMC lambs were repaired with PMSCs. Lambs received either no additional treatment or postnatal bracing and physical therapy (B/PT). Motor function was assessed with the sheep locomotor rating (SLR). Lambs with an SLR of 15 at birth were survived for 6 months or until a decline in SLR less than 15, whichever came first. All lambs underwent a perimortem MRI. Results: The lambs with no postnatal treatment (n = 2) had SLR declines to 7 and 13 at 29 and 65 days, respectively, and were euthanized. These lambs had a spinal angulation of 57° and 47°, respectively. The B/PT lamb (n = 1) survived for 6 months with a sustained SLR of 15 and a lumbar angulation of 42°. Conclusion: Postnatal physical therapy and bracing counteracted the inherent morbidity of the absent paraspinal muscles in the ovine MMC model allowing for survival and maintenance of rescued motor function of the prenatally treated lamb up to 6 months.
Technology-Based Psychosocial Interventions for People with Borderline Personality Disorder: A Scoping Review of the Literature
Authors: Frías Álvaro , Solves Laia , Navarro Sara , Palma Carol , Farriols Núria , Aliaga Ferrán , Hernández Mònica , Antón Meritxell , Riera Aloma
Published: November 2020

Evidence-based psychosocial interventions for borderline personality disorder (BPD) still face multiple challenges regarding treatment accessibility, adherence, duration, and economic costs. Over the last decade, technology has addressed these concerns from different disciplines. The current scoping review aimed to delineate novel and ongoing clinical research on technology-based psychosocial interventions for patients with BPD. Online databases (PubMed, Cochrane Library, EMBASE, Web of Science, PsycInfo, and Google Scholar) were searched up to June 2020. Technology-based psychosocial treatments included innovative communication (eHealth) and computational (e.g., artificial intelligence), computing (e.g., computer-based), or medical (e.g., functional magnetic resonance imaging [fMRI]) software. Clinical research encompassed any testing stage (e.g., feasibility, efficacy). Fifteen studies met the inclusion criteria. The main findings were the following: almost two-thirds of the studies (9/15) tested software explicitly conceived as adjunctive interventions to conventional therapy; nearly half of the studies (7/15) were referred to as dialectical behavior therapy-based software; most studies (13/15) were focused on the initial stage of the clinical research cycle (feasibility/acceptance/usability testing), reporting good results at this point; more than one-third of the studies (6/15) tested mobile apps; there is emerging evidence for Internet-based interventions and real-time fMRI biofeedback but only little evidence for mHealth interventions, virtual and augmented reality, and computer-based interventions; there was no computational technology-based clinical research; and there was no satisfaction/preference, security/safety, or efficiency testing for any software. Taken together, the results suggest that there is a growing but still incipient amount of technology-based psychosocial interventions for BPD supported by some kind of clinical evidence. The limitations and directions for future research are discussed.
Editorial
Authors: Pinto Julio Pimentel
Published: November 2020

Editorial RH 179
Abstract 118: Multicentric, Randomized Controlled Phase III Study of Centhaquine (Lyfaquin®) as an Effective First-in-class Resuscitative Agent in Hypovolemic Shock Patients
Authors: Gulati Anil , Choudhuri Rajat , Gupta Ajay , Singh Saurabh , Ali S. K. Noushad , Sidhu Gursaran Kaur , Haque Parvez David , Rahate Prashant , Bothra Aditya R. , Singh G.P. , Maheshwari Sanjeev , Jeswani Deepak , Haveri Sameer , Agarwal Apurva , Agrawal Nilesh Radheshyam
Published: November 2020

Background:
Centhaquine (CQ) is a novel, first-in-class resuscitative agent for the treatment of hypovolemic shock.

Methods:
Efficacy of CQ for the treatment of hypovolemic shock as an adjuvant to standard of care (SOC) was evaluated in a prospective, multi-center, randomized, double-blind, placebo-controlled Phase 3 study. Key inclusion criteria were; systolic blood pressure of <90 mm Hg, blood lactate levels of > 2 mmol/L and patients receiving SOC in a hospital or ICU setting. Patients were randomized in a 2:1 ratio either to the CQ group receiving CQ dose of 0.01 mg/kg by IV infusion along with SOC or to the control group receiving SOC plus saline. Primary endpoints of the study were change in systolic blood pressure (SBP) and diastolic blood pressure (DBP), change in blood lactate levels and change in base deficit. Mortality through day 28 was the key secondary endpoint.

Results:
A total of 197 patients were screened, of which 105 patients met the eligibility criteria and were included in the study. Out of 105 patients, 71 patients were randomized to CQ group and 34 patients to control group. Demographics and baseline characteristics of patients in both groups was comparable. Hemoglobin level was 9.38 ± 0.71 g/dL and 8.73 ± 0.55 g/dL in control and CQ groups, respectively at the time of inclusion in the study. At 24 hours of resuscitation, SBP of more than 110 mmHg was in 59.38% patients of control and 81.82% patients of CQ group (P=0.00842). Similarly, at 24 hours of resuscitation, DBP of more than 70 mmHg was in 50.00% patients in control group and 78.46% patients in CQ group (P=0.002175). The number of patients with blood lactate levels of 1.5 mmol/L or less were 46.88% in the group with standard treatment compared to 69.35% in CQ group (P=0.0168). The number of patients with base-deficit of less than minus 2 were 46.88% in standard treatment group compared to 68.25% in those receiving CQ (P=0.0217). CQ treatment significantly reduced the mortality rate. In the control group, the mortality rate was 11.76% compared to 2.94% in the CQ group (odds ratio: 4.4; 95% CI 0.9651 to 23.74 and P=0.037). No drug related adverse event was reported.

Conclusion:
Centhaquine (Lyfaquin®) is a highly efficacious resuscitative agent for the treatment of hypovolemic shock as an adjuvant to SOC.
Abstract 134: Survival After Out-of-hospital Cardiac Arrest: The Role of Urban-rural Residence and Demographic Factors
Authors: Abbott Ethan E , Buckler David G , Zebrowski Alexis M , Abella Benjamin S , Carr Brendan G
Published: November 2020

Introduction:
Survival to discharge after out-of-hospital cardiac arrest (OHCA) exhibits significant regional variability across communities in the US with differences in outcomes following arrest between rural, suburban, and urban communities. We examined the relationship between urban-rural residential county classification and survival following OHCA to determine if racial composition of a county and community health indicators contribute to improved outcomes following OHCA.

Methods:
Utilizing age-eligible Medicare fee-for-service claims data from January 2013 - December 2014, we identified OHCA patients by ICD-9-CM diagnosis code 427.5 and determined survival to discharge and at 30 days. Additional data sources included the 2013 National Center for Health Statistics (NCHS) urban-rural classification, US Census data, and County Health Rankings. Mixed effect logistic regression was used to determine the association of OHCA outcomes and NCHS classified residence, when accounting for individual age, sex, and race, county-level racial composition, poverty status, and community health measures.

Results:
256,107 cases of OHCA were identified with a mean age of age of 78.7 (SD 8.5) years, 22.8% nonwhite, 47.5% female. Overall survival to discharge was 21.8% and survival at 30 days was 15.1%. Patients living in the most rural counties had increased likelihood of initial survival (aOR1.1, CI 1.0-1.1), but were associated with lower survival at 30 days (aOR 0.9, CI 0.8-0.9). Nonwhite patient race and residing in a majority nonwhite county were associated with significant decreases in the likelihood of survival to discharge and at 30 days (7% and 11%, respectively).

Conclusions:
Among Medicare beneficiaries, survival to discharge after OHCA was higher if residing in a non-urban community but did not persist at 30 days. OHCA patients residing in majority non-white counties were significantly less likely to survive the initial hospitalization and to 30-days post discharge. More study is needed to elucidate these disparities and determine if modifiable county level health factors exist that could contribute to improvements in OHCA survival.
Abstract 136: Disparities in Out of Hospital Cardiac Arrest Care and Outcomes in Texas
Authors: Huebinger Ryan , Wang Henry , Jarvis Jeff , Decker Cameron , Dickson Robert , Osborn Lesley , Escott Mark , White Lynn , Villa Normandy , Panczyk Micah , Bobrow Bentley
Published: November 2020

Background:
Minorities and impoverished persons experience disparities in access to healthcare. Large inequalities in out-of-hospital cardiac arrest (OHCA) care have been described. We sought to characterize racial and socioeconomic disparities in OHCA care and outcomes in Texas.

Hypothesis:
There are census tract level disparities in OHCA care and outcomes in Texas.

Methods:
We analyzed Texas-Cardiac Arrest Registry to Enhance Survival (CARES) data from 13 EMS agencies providing care in 15 counties to roughly 30% of the state population. We included all adult (>=18 year) OHCA from 1/1/14 through 12/31/18 with complete data. Using census tract data, we stratified census tracts into racial/ethnic categories: >50% non-Hispanic/Latino white, >50% black, and >50% Hispanic/Latino. We also stratified census tracts into neighborhoods above and below the median for socioeconomic characteristics: household income, employment rate, and high school graduation. We defined outcomes as bystander CPR rates, public bystander AED use, and survival to hospital discharge. Using mixed models, we analyzed the associations between outcomes and neighborhood (1) racial/ethnic categories and (2) socioeconomic categories.

Results:
We included data on 18,487 OHCAs from 1,727 census tracts. Relative to white neighborhoods, black neighborhoods had a significantly lower rate of bystander AED use (OR 0.3, CI 0.1-0.9), and Latino neighborhoods had a lower rate of bystander CPR (OR 0.7, CI 0.6-0.8), bystander AED use (OR 0.4, CI 0.3-0.6) and survival to hospital discharge (OR 0.9, CI 0.8-0.98). Lower income was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.8), bystander AED use (OR 0.5, 0.4-0.8), and survival to hospital discharge (OR 0.6, CI 0.5-0.9). Lower high school graduation was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.9) and bystander AED use (OR 0.6, CI 0.4-0.9). High unemployment was associated with lower rates of bystander CPR (OR 0.9, CI 0.8-0.94) and bystander AED use (OR 0.7, CI 0.5-0.99).

Conclusion:
Minority and poor neighborhoods in Texas experience large and unacceptable disparities in OHCA bystander response and outcomes. These data present an important opportunity for targeted resuscitation training and quality improvement.
Abstract 138: Socioeconomically Equitable Public Defibrillator Placement Using Mathematical Optimization
Authors: Leung K.H. Benjamin , Brooks Steven , Chan Timothy , Clegg Gareth
Published: November 2020

Introduction:
Mathematical optimization can be used to place automated external defibrillators (AEDs) in locations that maximize coverage of out-of-hospital cardiac arrests (OHCAs). However, the extent to which optimization strategies affect socioeconomically equitable distribution of AEDs is unknown.

Methods:
All suspected OHCAs and registered AEDs in Scotland between Jan. 2011 - Sept. 2017 with a recorded location were included and mapped across the quintiles of the Scottish Index of Multiple Deprivation (SIMD), a national measure of socioeconomic status. First, we maintained AEDs at current locations and modeled placing an equal number of additional AEDs to maximize “coverage” (i.e., AED located within 100 m) of suspected OHCAs. A second analysis determined optimal sites for relocating all existing AEDs to optimize coverage without additional AEDs. We computed the proportion of OHCAs covered in each SIMD quintile under each AED placement strategy. A Wilcoxon signed-rank test was used to test difference in coverage levels across all regions of Scotland.

Results:
We identified 49,692 suspected OHCAs and 1,532 AEDs. Existing AEDs covered 1,384 OHCAs (2.8%), with OHCA coverage peaking in quintile 3 (moderate deprivation), indicating a mismatch with the distribution of suspected OHCA. Adding an equal number of new AEDs in optimal locations covered 10,465 OHCAs (21.1%; P<0.001). Optimal relocation of existing AEDs with no additional units covered 9,464 OHCAs (19.0%; P<0.001). OHCA coverage under either optimization strategy peaked in quintile 1 (highest deprivation), aligning to the OHCA incidence distribution.

Conclusion:
Optimizing AED placement significantly increases OHCA coverage and better aligns coverage with OHCA incidence across SIMD quintiles, improving socioeconomic equity of OHCA coverage. Relocating existing AEDs could achieve similar coverage to doubling the number of devices.
Abstract 203: Thoracic Impedance Reflects Differences Between Endotracheal and Laryngeal Advanced Airway During Mechanical Chest Compressions
Authors: Jaureguibeitia Xabier , Aramendi Elisabete , Irusta Unai , Idris Ahamed H , Wang Henry E
Published: November 2020

Background:
Ventilations during out-of-hospital cardiac arrest (OHCA) produce thoracic impedance(TI) waveforms due to air volume changes in the lungs. Different airway management techniques, i.e. laryngeal tube (LT) and endotracheal intubation (ETI), may produce distinct TI waveforms as a result of different air flows and dead space volumes.

Methods:
Adult OHCA cases from the Pragmatic Airway Resuscitation Trial were analyzed. Cases recorded with Philips MRx monitor-defibrillators and treated with LUCAS mechanical CPR devices were considered, ensuring homogeneous TI acquisition and compression therapy. Impedance and capnogram signal intervals were extracted after successful airway insertion and during ongoing chest compressions. Ventilations were confirmed in the capnogram, and the associated TI waveforms were analyzed. Adaptive filtering was applied to remove compression artifacts, and the amplitudes (A
i
, A
e
) and durations (D
i
, D
e
) of the insufflation and exhalation phases were computed (see Figure). Each case was characterized by its observed median values. Differences between airway groups were assessed with a Wilcoxon rank sum test.

Results:
Data from 100 OHCA cases (57 LT and 43 ETI) were analyzed, totaling 10348 ventilations, with median (IQR) of 87 (51 - 146) ventilations per case. Median TI amplitudes for ETI and LT groups showed significant differences (p<0.05), with 1.1 (0.7 - 1.8) Ω and 0.7 (0.3 - 1.3) Ω for A
i
, and 1.0 (0.7 - 1.6) Ω and 0.6 (0.3 - 1.2) Ω for A
e
. No significant differences were observed for phase durations, 1.6 (1.3 - 2.0) s and 1.6 (1.2 - 1.8) s for D
i
, and 2.3 (1.8 - 3.3) s and 2.6 (2.0 - 3.3) s for D
e
.

Conclusions:
Significant differences on ventilation impedance waveform amplitudes were observed between patients treated with ETI and LT. This might be related to higher insufflated air volumes for ETI or larger dead space volumes for LT.
Abstract 205: Effect of Prehospital Noninvasive Positive Pressure Ventilation for Rescue of Acute Respiratory Distress
Authors: Walter Daniel , Chan Hei Kit , Wang Henry E
Published: November 2020

Background:
Emergency medical services (EMS) patients in respiratory distress require prompt rescue treatment. Only limited data describe the outcomes of prehospital rescue treatment with non-invasive positive pressure ventilation (NIPPV), including continuous positive airway pressure (CPAP) or bilevel positive air pressure (BiPAP). We sought to characterize the outcomes of prehospital CPAP/BiPAP in a national EMS cohort.

Methods:
We analyzed 2018 cross-sectional data on 1289 EMS agencies from ESO Solutions, Inc. (Austin, Texas). We included adult (age ≥18 years) patients with respiratory distress (respiratory rate (RR) ≥30 breaths/min. We divided the patients between those receiving NIPPV and standard care (SC). The primary outcome was change in RR during EMS care. We censored the analysis at 40 minutes of treatment. We compared baseline characteristics between NIPPV and SC. Using mixed linear, fractional polynomial and multiple spline models, we determined the associations of prehospital NIPPV with changes in RR.

Results:
Of the 6,156,846 adult 911 cases, we included 87,219 with respiratory distress, including 11,271 (12.9%) NIPPV (11,206 CPAP and 65 BiPAP) and 75,948 (87.1%) SC. Median treatment duration were: NIPPV 20.0 minutes (IQR 13.5-29.2 minutes), SC 18.5 minutes (IQR 11.1-27.6 minutes). Common concurrent treatments for NIPPV and SC included: Albuterol (48.6%, 20.9%), Ipratropium (27.9%, 11.2%) and Methylprednisolone (23.7%, 7.8%). At 20 minutes, mean RR change was greater for SC than NIPPV; SC -7.8 breaths/min vs. NIPPV -6.0 breaths/min, difference 2.3 (95% CI 1.9-2.6), p<0.001. At 40 minutes, mean RR change was greater for SC than NIPPV; SC -9.5 breaths/min vs. NIPPV -8.2 breaths/min, difference 1.6 (95% CI 0.8 - 2.5), p<0.001. On linear mixed modeling adjusted for age, sex, incident location, race, ethnicity, agency type, initial RR, and medication use, SC was associated with a larger decrease in respiratory rate across time than NIPPV; [NIPPV X time] interaction p<0.001.

Conclusions:
In this multicenter series of prehospital respiratory distress, SC was associated with greater reductions in RR than NIPPV.
Abstract 206: Effect of Airway Strategy Upon Chest Compression Quality in the Pragmatic Airway Resuscitation Trial
Authors: Wang Henry E , Jaureguibeitia Xabier , Idris Ahamed H , Iruste Unai , Gonzalez Erik , Aufderheide Tom P , Hansen Matthew L , Huebinger Ryan , Schmicker Robert , Carlson Jestin N , Colella Riccardo , Jarvis Jeffrey , Gordon Richard , Suchting Robert , Aramendi Elisabete
Published: November 2020

Background:
Chest compression (CC) quality is associated with improved out-of-hospital (OHCA) outcomes. Airway management efforts may adversely influence CC quality. We sought to compare the effects of initial laryngeal tube (LT) and initial endotracheal intubation (ETI) airway management strategies upon chest compression fraction (CCF), rate and interruptions in the Pragmatic Airway Resuscitation Trial (PART).

Methods:
We analyzed CPR process files collected from adult OHCA enrolled in PART. We used automated signal processing techniques (MATLAB) to identify and calculate CC quality measures. We defined a CC interruption as ≥3 second pause in chest compressions. We determined CC fraction, rate and interruptions (number and total duration) in 1-minute epochs for the entire resuscitation. We compared differences in CC quality between LT and ETI using t-tests. We repeated the analysis stratified by time before/after airway insertion as well as by successive 3-minute time segments. We also compared CC quality between single vs. multiple airway insertion attempts, as well as between BVM-only vs. ETI or LT.

Results:
Of 3,004 patients enrolled in PART, CPR process data were available for 1,996 (1,001 LT, 995 ETI). Mean resuscitation duration was: LT 22.6±10.8 min, ETI 25.3±11.3 min. Mean CC fraction (88% vs. 87%, p=0.045) and rate (114 vs. 114 bpm, p=0.59) were similar between LT and ETI. Median number of CC interruptions was similar between LT and ETI (11 vs. 12). Total CC interruption duration was lower for LT than ETI (160 vs. 181 sec, p=0.002); this difference was largest before airway insertion (56 vs. 78 sec, p=0.001). There were no differences in CC quality when stratified by 3-min time epochs. Total CC interruption duration was shorter for single than multiple airway insertion attempts (127 vs. 153 sec, p=0.005). Total CC interruption duration was shorter for BVM-only than LT or ETI (104 vs. 135 sec, p<0.001).

Conclusion:
In PART, compared with ETI, LT was associated with shorter total CC interruption duration but not other CC quality measures. Single-attempt airway insertion and BVM-only were associated with shorter total CC interruption duration. OHCA airway management may influence CC quality.
Abstract 216: Tat Delivery of a Pten Peptide Inhibitor Has Direct Cardioprotective Effects and Improves Outcomes in Rodent Models of Cardiac Arrest
Authors: Zhu Xiangdong , Li Jing , Wang Huashan , Gasior Filip , Lee Chunpei , Lin Shaoxia , Zhu Zhiyi , O'donnell J. Michael , Vanden Hoek Terry L
Published: November 2020

Introduction:
We have recently shown that pharmacologic inhibition of PTEN significantly increases cardiac arrest survival in a mouse model, however, this protection required pretreatment 30 min prior to the arrest. To improve the onset of PTEN inhibition during cardiac arrest treatment, we have designed a TAT fused cell-permeable peptide (TAT-PTEN9c) for rapid tissue delivery and protection.

Hypothesis:
We hypothesized that TAT-PTEN9c interferes with the endogenous PTEN binding to its regulatory proteins, resulting in reduced PTEN activity, improved mouse survival and cardiac functional recovery. The improved survival is in part due to enhanced glycolysis and reduced shunting to polyol pathway and osmotic injury in heart and brain.

Methods:
TAT-PTEN9c (7.5 mg/kg) was given intravenously after CA in mouse to determine protective effects of the treatment on survival and heart function. Western blot was used to determine the efficacy of TAT-PTEN9c for enhancing Akt and PDH E1α activity. The effect of TAT-PTEN9c on sorbitol accumulation in tissues was measured by spectrophotometer using NAD as substrate. Direct effect of TAT-PTEN9c treatment on cardiac function were also measured in Langendorff model of isolated rat heart.

Results:
In the mouse model of cardiac arrest, survival was significantly increased in the TAT-PTEN9c treated group compared to saline controls at 4 h after CPR. The treated mice had increased Akt phosphorylation and pyruvate dehydrogenase dephosphorylation at R30 min in heart tissues with significantly decreased sorbitol content and reduced release of taurine and glutamate into blood, suggesting improved metabolic recovery and glucose utilization. For the isolated heart model, RPP was reduced by 25% for non-treatment groups following arrest. With TAT-PTEN9c treatment, cardiac contractile function was completely recovered. TAT-PTEN9c significantly increased lactate production at 20 min of reperfusion, indicating increased glycolysis.

Conclusion:
TAT-PTEN9c enhances Akt and pyruvate dehydrogenase activity and decrease glucose shunting to the polyol pathway in critical organs, preventing osmotic injury and early cardiovascular collapse and death.
Abstract 219: Characterizing Covid-19 Pandemic Related Anxiety and Its Impact on Cardioprotective Health Behaviors Among Racially and Ethnically Diverse Cardiac Arrest Survivors
Authors: Agarwal Sachin , Shen Edmund , Birk Jeffrey L. , Shechter Ari , Diaz Keith , Roh David , Park Soojin , Claassen Jan , Elkind Mitchell S , Edmondson Donald
Published: November 2020

Introduction:
Cardiac arrest (CA) patients’ fear of contracting Coronavirus disease 2019 (COVID-19) may limit their ability or willingness to perform cardio-protective health behaviors. We assessed the association of COVID-19 anxiety with physical activity (PA), sleep, and the likelihood of seeking medical care.

Methods:
Between May 15-28, 2020, a month after the NYC COVID-19 pandemic peak, CA survivors from a prospective cohort were invited to participate in a telephone-based assessment of the pandemic’s impact on psychological and behavioral dimensions. COVID-19 anxiety was assessed using the 7-item Perceived Coronavirus Threat Questionnaire (PCTQ; range 1-42). PA in 7 days both pre- and during COVID-19 was categorized into International Physical Activity Questionnaire-based low, moderate, or high activity levels. Self-reported poor sleep quality and hours of sleep per night in the previous month were assessed via the Pittsburgh Sleep Quality Index. Self-reported likelihood of delay in seeking care for non-COVID related conditions was assessed.

Results:
Of 100 approached, 75 CA survivors participated (53% male; age 61±15 years; 44% White, 20% Black, and 31% Latinx). The majority (84%) were COVID-19 tests and/or symptoms negative. The median COVID-19 anxiety score was 28 (interquartile range [IQR]: 21-37)- indicating substantial fear. Black and Latinx participants reported greater COVID-19 anxiety than White (33±6 vs 32±8 vs 23±10 respectively, p=0.03). Compared to pre-COVID, CA survivors had reduced their days per week engagement in any PA by an average of 2±3.6 days. COVID-19 anxiety was highest in those who were previously high PA and now were low PA (high-high:25±9, low-low:28±9, and high-low:32±4, ANOVA p=0.06). For every 1 SD increase in COVID-19 anxiety, participants reported 45 min less sleep per night (B= -0.05, p =.06) and poorer sleep quality (OR = 1.07, 95% CI [1.0, 1.1], p=0.017). Participants (48%) who said they were “moderately” to “extremely” likely to delay seeking care for non-COVID related conditions had greater levels of COVID-19 anxiety (32±9 vs 26±10, p=0.02) compared to other responses.

Conclusions:
COVID-19 anxiety is more frequent in Black and Latinx participants and is associated with poorer health behaviors.
Abstract 221: Exosomal MicroRNAs Drive Tromboembolism in Covid-19
Authors: Gambardella Jessica , Sardu Celestino , Morelli Marco Bruno , Messina Vincenzo , Marfella Raffaele , Maggi Paolo , Paolisso Giuseppe , Wang Xujun , Santulli Gaetano
Published: November 2020

Introduction:
Thromboembolic complications play a crucial role in the clinical outcome of COVID-19. Emerging evidence has shown that exosomal microRNAs (miRNAs) are functionally involved in several pathologic processes.

Methods:
To test the hypothesis that exosomal miRNAs are a key determinant of thrombosis in COVID-19, we enrolled 26 COVID-19 patients. The study was approved by the local Ethical Committees. Circulating exosomes were isolated as we previously described and validated by our group and levels of exosomal miRNAs, from a custom panel of miRNAs, were quantified by RT-qPCR and normalized to the expression of U18.

Results:
We divided our population in two groups based on serum D-dimer level on admission, using a previously published cut-off of 3 μg/ml. No significant differences in the main clinical characteristics were noted comparing patients with low (n=11)
vs
high (n=15) D-Dimer. Strikingly, we found that exosomal miR-424 was significantly upregulated whereas exosomal miR-103a, miR-145, and miR-885 were significantly downregulated in patients in the high D-dimer group compared to patients in the low D-Dimer group (
p<0.0001
). Regression analysis confirmed these findings. Mechanistically, Tissue Factor (TF) was identified as a direct target of miR-145, while miR-885 targets the von Willebrand Factor (vWF). Equally important, miR-424 has been associated with hyper-coagulability whereas low levels of miR-103a have been observed in deep vein thrombosis, although precise mechanisms have not been defined for these miRNAs. Using a stepwise multiple regression analysis, exosomal miR-424 was an independent predictor of thromboembolic events (
i.e.
pulmonary embolism
and
acute myocardial infarction
) in COVID-19 patients (Wald: 4.180;
P<0.05
), whereas miR-103a independently regulated D-dimer levels (
P<0.001
).

Conclusions:
To our knowledge, this is the first study showing a significant contribution of exosomal non-coding RNAs in COVID19. Limitations of our study include the relatively small population and the fact that we did not determine the exact source of exosomes; nevertheless, we speculate that a main source could be represented by platelets and/or endothelial cells, which express these miRNAs in normal conditions.