bluuebunny/crossref_metadata_2025 huggingface dataset:
Connections for resilience: sharing land management knowledge between farmers and politicians
Authors: Hall Carolyn
Published: July 2021

Sharing knowledge is essential if Australian politicians are to effectively support farmers to be more resilient and adapt to climate change. Transformational change takes time; it can be fostered by on-ground examples of best practice in land management and innovative new approaches such as landscape rehydration. Farmers and politicians need to connect, to view and understand these methods and approaches and share their learnings. However, we need to go from connections for resilience to actions in the form of outcomes-based policy and financial support to achieve change.
Managing the unmanageable: reinstating the dingo for pastoral sustainability in Australian rangelands
Authors: Pollock David
Published: July 2021

The predominant grazing management system used in the arid rangelands regions of Australia, set stocking, is not conducive to sustainable land management. More appropriate grazing management systems based upon periodic rest periods for important pasture species have not been adopted by pastoralists because the unmanaged grazing pressure from animals such as goats and kangaroos has been too high. Dingoes are the only cost-effective and long-term management solution to the effect of unmanaged grazing by goats and kangaroos. Yet government funding targets dingo eradication in pastoral areas, and it does so by adopting misleading and scientifically inaccurate terms for describing dingoes.
Three-color single-molecule imaging reveals conformational dynamics of dynein undergoing motility
Authors: Niekamp Stefan , Stuurman Nico , Zhang Nan , Vale Ronald D.
Published: July 2021

Significance

Dynein, a dimeric motor protein, moves along microtubules through adenosine 5′-triphosphate- and thermal-driven motions of two large ring domains (AAA rings) and small microtubule-binding domains (MTBDs) separated by a long coiled-coil. Previous single-molecule studies have tracked the positions of the AAA rings during motility, but not the MTBDs. Here, we tracked the relative positions of both MTBDs and one AAA ring by three-color, nanometer-resolution imaging. The observation of both MTBDs provided a direct measurement of how dynein steps on the tubulin subunits, and the simultaneous observation of three fiducial markers revealed extraordinary flexibility and previously unknown conformational states of the motor during motility. The techniques presented here can be used to explore conformational dynamics of many other macromolecular complexes.
Soluble mannose receptor induces proinflammatory macrophage activation and metaflammation
Authors: Embgenbroich Maria , van der Zande Hendrik J. P. , Hussaarts Leonie , Schulte-Schrepping Jonas , Pelgrom Leonard R. , García-Tardón Noemí , Schlautmann Laura , Stoetzel Isabel , Händler Kristian , Lambooij Joost M. , Zawistowska-Deniziak Anna , Hoving Lisa , de Ruiter Karin , Wijngaarden Marjolein A. , Pijl Hanno , Willems van Dijk Ko , Everts Bart , van Harmelen Vanessa , Yazdanbakhsh Maria , Schultze Joachim L. , Guigas Bruno , Burgdorf Sven
Published: July 2021

Significance

Obesity-associated metaflammation is an emerging disease, in which proinflammatory macrophages play a decisive role. Here, we identified the soluble mannose receptor (sMR) as a regulator of metaflammation and demonstrated increased levels of sMR in obese mice and humans. Additionally, we identified that increased sMR directly binds to CD45 on macrophages, inhibiting its activity and inducing inflammatory macrophage activation via the Akt/NF-κB pathway. Consequently, increased sMR levels induced inflammatory activation of metabolic tissue macrophages and aggravation of whole-body metabolic homeostasis. These data identify the MR as a regulator of macrophage activation and offer perspectives for therapeutic approaches for the treatment of metaflammation.
Wild-type GBA1 increases the α-synuclein tetramer–monomer ratio, reduces lipid-rich aggregates, and attenuates motor and cognitive deficits in mice
Authors: Glajch Kelly E. , Moors Tim E. , Chen Yi , Bechade Pascal A. , Nam Alice Y. , Rajsombath Molly M. , McCaffery Thomas D. , Dettmer Ulf , Weihofen Andreas , Hirst Warren D. , Selkoe Dennis J. , Nuber Silke
Published: July 2021

Significance

The mechanisms responsible for brain α-synuclein (αS) dyshomeostasis, caused by Gaucher’s GBA1 mutations that increase Parkinson’s disease (PD) risk, are largely unknown. We previously showed that abrogating physiological αS tetramers by a familial PD-E46K–amplified 3K mutation produces PD-like syndrome in mice and that treatment with stearoyl-CoA desaturase inhibitors increased a portion of the αS tetramers, benefitting the motor phenotypes. Here, we show that—similar to previous findings in GBA1-mutant PD culture—GCase elevation prolonged the stabilization of wild-type and 3K mutant αS tetramers in wtGBA1–transduced mouse brains, improving lysosomal integrity and motor and cognitive phenotypes. These data help elucidating lipid modulators that impact the αS physiological state in vivo and the development of PD therapeutic approaches.
A comparative metabologenomic approach reveals mechanistic insights into
Streptomyces
antibiotic crypticity
Authors: Qi Yunci , Nepal Keshav K. , Blodgett Joshua A. V.
Published: July 2021

Significance

Streptomyces
genomes harbor a trove of biosynthetic gene clusters (BGCs) that encode for drug-like molecules. However, only a fraction of these readily yield expected products. To investigate why this is, we used polycyclic tetramate macrolactam (PTM) antibiotic production as a model system. By comparing the genomes and PTM production profiles of several closely related
Streptomyces griseus
clade members, we uncovered two mechanisms that differentiate more robust producers from weaker ones. The first involves small insertion–deletion lesions in PTM BGC promoters that significantly modulate production. The second mechanism involves biosynthetic pathway interactions, in which robust PTM producers unexpectedly benefit from griseorhodin coproduction, and weaker producers lack the pathway. We highlight comparative metabologenomics as a powerful approach to understand antibiotic crypticity.
Nature of dynamic gradients, glass formation, and collective effects in ultrathin freestanding films
Authors: Ghanekarade Asieh , Phan Anh D. , Schweizer Kenneth S. , Simmons David S.
Published: July 2021

Significance

The origin of spatially heterogeneous alterations in the dynamics of nanoconfined liquids has been a major question in physics, chemistry, and materials science for over 30 y. We combine simulation and theory to establish a unified predictive microscopic understanding in freestanding films at low to medium molecular weight, spanning from thick to ultrathin films. The simulation-based phenomenology of altered dynamics is theoretically predicted and understood based on a combination of coupled near-interface gradients of local caging constraints and interfacial and finite size-induced changes in a collective elastic barrier to motion. No invocation of any realized or incipient critical-like phenomenon is necessary, which may have broad implications for other confined systems and the mechanism of the bulk glass transition.
Mechanoelectric coupling and arrhythmogenesis in cardiomyocytes contracting under mechanical afterload in a 3D viscoelastic hydrogel
Authors: Hegyi Bence , Shimkunas Rafael , Jian Zhong , Izu Leighton T. , Bers Donald M. , Chen-Izu Ye
Published: July 2021

Significance

The heart autoregulates its contractile strength to maintain cardiac output when pumping blood against the mechanical afterload from vascular resistance. Increased afterload in cardiovascular diseases is associated with cardiac arrhythmias. However, the underlying mechanisms remain elusive. Here, we studied the afterload effect on electrophysiology by embedding single cardiomyocytes in a three-dimensional viscoelastic hydrogel to apply afterload during cell contraction. We found that afterload is acutely transduced via nitric oxide synthase 1 (NOS1) signaling to modulate multiple ion channels to prolong action potential, increase Ca
2+
transient, and enhance contractility. However, higher afterload causes a discordant alternans that is arrhythmogenic. Hence, our findings reveal an afterload-induced mechano-chemo-electro-transduction pathway that closes feedback loops in cardiac excitation–contraction coupling to enable autoregulation of contractility.
Backward control, long distance agree, nominative case and TP/CP
transparency
Authors: Alexiadou Artemis , Anagnostopoulou Elena
Published: July 2021

In this paper, we revisit the evidence that what
has been analyzed as Backward Control in Greek is just another
instance of Long Distance Agree. Through the formation of such long
distance chains, Greek allows non-local assignment of nominative. We
further argue that long distance chains come in two versions,
obligatory ones and optional ones; the former involve
uninterpretable T in the embedded clause, while the latter involve
the formation of a chain between matrix T and embedded T with
interpretable features across a CP phase boundary, which can be
suspended. We finally attempt an explanation for the observation
that [+Perfective] Aspect may disallow long distance chain formation
in Greek.
Control and covert modality in Hungarian
Authors: Szécsényi Krisztina
Published: July 2021

We discuss two seemingly unrelated constructions
of Hungarian: a type of modal existential
wh-construction (MEC), and a structure that on the
surface seems to be a monoclausal focus construction. They are
argued to have a similar biclausal underlying structure involving
control and covert modality, the latter triggering the raising of
the embedded verb to the selecting predicate. To account for this
movement and other transparency phenomena attested in these
constructions, adjunction of the moved wh-words to a non-finite
TP-domain is proposed following Šimík (2011, 2013a). This analysis is closer to standard
cross-linguistic accounts of both control and restructuring: though
infinitival clauses can contain their own focus-related elements, it
seems justifiable to assume that they are smaller than CPs.
AIM2 regulates anti-tumor immunity and is a viable therapeutic target for melanoma
Authors: Fukuda Keitaro , Okamura Ken , Riding Rebecca L. , Fan Xueli , Afshari Khashayar , Haddadi Nazgol-Sadat , McCauley Sean M. , Guney Mehmet H. , Luban Jeremy , Funakoshi Takeru , Yaguchi Tomonori , Kawakami Yutaka , Khvorova Anastasia , Fitzgerald Katherine A. , Harris John E.
Published: July 2021

The STING and absent in melanoma 2 (AIM2) pathways are activated by the presence of cytosolic DNA, and STING agonists enhance immunotherapeutic responses. Here, we show that dendritic cell (DC) expression of AIM2 within human melanoma correlates with poor prognosis and, in contrast to STING, AIM2 exerts an immunosuppressive effect within the melanoma microenvironment. Vaccination with AIM2-deficient DCs improves the efficacy of both adoptive T cell therapy and anti–PD-1 immunotherapy for “cold tumors,” which exhibit poor therapeutic responses. This effect did not depend on prolonged survival of vaccinated DCs, but on tumor-derived DNA that activates STING-dependent type I IFN secretion and subsequent production of CXCL10 to recruit CD8+ T cells. Additionally, loss of AIM2-dependent IL-1β and IL-18 processing enhanced the treatment response further by limiting the recruitment of regulatory T cells. Finally, AIM2 siRNA-treated mouse DCs in vivo and human DCs in vitro enhanced similar anti-tumor immune responses. Thus, targeting AIM2 in tumor-infiltrating DCs is a promising new treatment strategy for melanoma.
Attoclock with bicircular laser fields as a probe of velocity-dependent tunnel-exit positions
Authors: Brennecke Simon , Eckart Sebastian , Lein Manfred
Published: July 2021

Strong-field ionization of atoms can be investigated on the attosecond time scale by using the attoclock method, i.e. by observing the peak of the photoelectron momentum distribution (PMD) after applying a laser pulse with a two-dimensional polarization form. Examples for such laser fields are close-to-circular or bicircular fields. Here, we report numerical solutions of the time-dependent Schrödinger equation for bicircular fields and a comparison with a compact classical model to demonstrate that the tunnel-exit position, i.e. the position where the electron emerges after tunnel ionization, is encoded in the PMD. We find that the tunnel-exit position depends on the transverse velocity of the tunneling electron. This gives rise to a momentum-dependent attoclock shift, meaning that the momentum shift due to the Coulomb force on the outgoing electron depends on which slice of the momentum distribution is analysed. Our finding is supported by a momentum-space-based implementation of the classical backpropagation method.
Following O and OH in He/O2 and He/H2O gas mixtures—from the gas phase through the liquid phase to modifications on a biological sample
Authors: Stapelmann Katharina , Myers Brayden , Quesada Maria Herrera , Lenker Eleanor , Ranieri Pietro J
Published: July 2021

Applied cold atmospheric plasma allows for the controlled delivery of reactive oxygen and nitrogen species tailored for specific applications. Through the manipulation of the plasma parameters, feed gases, and careful consideration of the environment surrounding the treatment target, selective chemistries that preferentially influence the target can be produced and delivered. To demonstrate this, the COST reference microscale atmospheric pressure plasma jet is used to study the generation and transport of O and

⋅

OH from the gas phase through the liquid to the biological model target cysteine. Relative and absolute species densities of

⋅

OH and O are measured in the gas phase through laser induced fluorescence (LIF) and two-photon absorption LIF respectively. The transport of these species is followed into the liquid phase by hydrogen peroxide quantification and visualized by a fluorescence assay. Modifications to the model biological sample cysteine exposed to

⋅

OH and H2O2 dominated chemistry (He/H2O (0.25%)) and O dominated chemistry (He/O2 (0.6%)) is measured by FTIR spectroscopy. The origin of these species that modify cysteine is considered through the use of heavy water (H

2

18

O) and mass spectrometry. It is found that the reaction pathways differ significantly for He/O2 and He/H2O. Hydrogen peroxide is formed mainly in the liquid phase in the presence of a substrate for He/O2 whereas for He/H2O it forms in the gas phase. The liquid chemistry resulting from the He/O2 admixture mainly targets the sulfur moiety of cysteine for oxidation up to irreversible oxidation states, while He/H2O treatment leads preferentially to reversible oxidation products. The more O or OH/H2O2 dominated chemistry produced by the two gas admixtures studied offers the possibility to select species for target modification.
Heat transfer of graphene foams and carbon nanotube forests under forced convection
Authors: Cohen Yaniv , Reddy Siva K , Ya’akobovitz Assaf
Published: July 2021

The effective dissipation of heat from electronic devices is essential to enable their long-term operation and their further miniaturization. Graphene foams (GF) and carbon nanotube (CNT) forests are promising materials for thermal applications, including heat dissipation, due to their excellent thermal conduction and low thermal interface resistance. Here, we study the heat transfer characteristics of these two materials under forced convection. We applied controlled airflow to heated samples of GF and CNT forests while recording their temperature using infrared micro-thermography. Then, we analyzed the samples using finite-element simulations in conjunction with a genetic optimization algorithm, and we extracted their heat fluxes in both the horizontal and vertical directions. We found that boundary layers have a profound impact on the heat transfer characteristics of our samples, as they reduce the heat transfer in the horizontal direction. The heat transfer in the vertical direction, on the other hand, is dominated by the material conduction and is much higher than the horizontal heat transfer. Accordingly, we uncover the fundamental thermal behavior of GF and CNT forests, paving the way toward their successful integration into thermal applications, including cooling devices.
Deep reinforcement learning for predicting kinetic pathways to surface reconstruction in a ternary alloy
Authors: Yoon Junwoong , Cao Zhonglin , Raju Rajesh K , Wang Yuyang , Burnley Robert , Gellman Andrew J , Barati Farimani Amir , Ulissi Zachary W
Published: July 2021

The majority of computational catalyst design focuses on the screening of material components and alloy composition to optimize selectivity and activity for a given reaction. However, predicting the metastability of the alloy catalyst surface at realistic operating conditions requires an extensive sampling of possible surface reconstructions and their associated kinetic pathways. We present CatGym, a deep reinforcement learning (DRL) environment for predicting the thermal surface reconstruction pathways and their associated kinetic barriers in crystalline solids under reaction conditions. The DRL agent iteratively changes the positions of atoms in the near-surface region to generate kinetic pathways to accessible local minima involving changes in the surface compositions. We showcase our agent by predicting the surface reconstruction pathways of a ternary Ni3Pd3Au2(111) alloy catalyst. Our results show that the DRL agent can not only explore more diverse surface compositions than the conventional minima hopping method, but also generate the kinetic surface reconstruction pathways. We further demonstrate that the kinetic pathway to a global minimum energy surface composition and its associated transition state predicted by our agent is in good agreement with the minimum energy path predicted by nudged elastic band calculations.
Robinson–Schensted–Knuth correspondence in the representation theory of the general linear group over a non-archimedean local field
Authors: Gurevich Maxim , Lapid Erez
Published: July 2021

We construct new “standard modules” for the representations of general linear groups over a local non-archimedean field. The construction uses a modified Robinson–Schensted–Knuth correspondence for Zelevinsky’s multisegments.

Typically, the new class categorifies the basis of Doubilet, Rota, and Stein (DRS) for matrix polynomial rings, indexed by bitableaux. Hence, our main result provides a link between the dual canonical basis (coming from quantum groups) and the DRS basis.
Effects of the Great Recession on Educational Disparities in Cardiometabolic Health
Authors: Jiang Yanping , Boylan Jennifer Morozink , Zilioli Samuele
Published: July 2021

Background

Macroeconomic crises can exaggerate existing educational disparities in health. Few studies, however, have examined whether macroeconomic crises get under the skin to affect educational disparities in health-related biological processes.

Purpose

This study aimed to examine the effect of the economic recession of 2008 (i.e., Great Recession) on educational disparities in cardiometabolic risk and self-reported psychological distress.

Methods

Data were drawn from two subsamples of the Midlife in the United States (MIDUS) study: the second wave of the MIDUS sample (pre-recession cohort, N = 985) and the refresher sample (post-recession cohort, N = 863). Educational attainment was categorized into high school education or less, some college, and bachelor’s degree or higher. Outcomes included metabolic syndrome, C-reactive protein, and interleukin-6, as well as self-reported perceived stress, depressive symptoms, and financial distress.

Results

Results showed that having a bachelor’s degree or higher (compared to having a high school education or less) was more strongly associated with decreased metabolic syndrome symptoms in the post-recession cohort than the pre-recession cohort, above and beyond demographic, health, and behavioral covariates. These findings did not extend to systemic inflammation or psychological distress.

Conclusions

Our findings suggest that chronic macroeconomic stressors may widen the educational gap in physical health, particularly cardiometabolic health, by modifying biological and anthropometric risk factors implicated in metabolic syndrome.
Comparison of the Wrist-Worn Fitbit Charge 2 and the Waist-Worn Actigraph GTX3 for Measuring Steps Taken in Occupational Settings
Authors: Garza Jennifer L , Wu Zhao H , Singh Manjot , Cherniack Martin G
Published: July 2021

Objectives

If consumer-based monitors such as Fitbit can measure activity accurately, it could provide opportunities for improved assessment of physical activity in general and at work for research purposes. The accuracy of the Fitbit has hardly been investigated in an occupational setting.

Methods

We compared measurements of steps taken at work, out-of-work, and in total of a wrist-worn Fitbit to a waist-worn Actigraph. Seventeen participants wore the Fitbit and Actigraph for 1 full workday.

Results

Compared with the Actigraph, the Fitbit consistently recorded more steps [mean steps at work Fitbit = 7850 (6974), Actigraph = 4396 (1991); out-of-work Fitbit = 6414 (5691), Actigraph = 4116 (3502); total Fitbit = 13 478 (10 666), Actigraph = 8009 (5167)].

Conclusions

Compared with the Actigraph, the Fitbit consistently recorded more steps at work, out-of-work, and in total. The Fitbit and Actigraph recordings were more consistent for measuring steps taken out-of-work compared with at work. Steps counts recorded by the Fitbit, especially in occupational settings, may be inaccurate.
Mediation analysis for survival data with high-dimensional mediators
Authors: Zhang Haixiang , Zheng Yinan , Hou Lifang , Zheng Cheng , Liu Lei
Published: July 2021

Motivation

Mediation analysis has become a prevalent method to identify causal pathway(s) between an independent variable and a dependent variable through intermediate variable(s). However, little work has been done when the intermediate variables (mediators) are high-dimensional and the outcome is a survival endpoint. In this paper, we introduce a novel method to identify potential mediators in a causal framework of high-dimensional Cox regression.

Results

We first reduce the data dimension through a mediation-based sure independence screening method. A de-biased Lasso inference procedure is used for Cox’s regression parameters. We adopt a multiple-testing procedure to accurately control the false discovery rate when testing high-dimensional mediation hypotheses. Simulation studies are conducted to demonstrate the performance of our method. We apply this approach to explore the mediation mechanisms of 379 330 DNA methylation markers between smoking and overall survival among lung cancer patients in The Cancer Genome Atlas lung cancer cohort. Two methylation sites (cg08108679 and cg26478297) are identified as potential mediating epigenetic markers.

Availability and implementation

Our proposed method is available with the R package HIMA at https://cran.r-project.org/web/packages/HIMA/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Avoiding rather than resisting herbivore attacks is often the first line of plant defence
Authors: Lev-Yadun Simcha
Published: July 2021

A common idea is that resisting or blocking herbivore attacks by structural, chemical and molecular means after they have commenced is the first line of plant defence. However, these are all secondary defences, operating only when all the various methods of avoiding attack have failed. The real first line of plant defence from herbivory and herbivore-transmitted pathogens is avoiding such attacks altogether. Several visual, chemical and ‘statistical’ methods (and commonly their combined effects) have been proposed to allow avoidance of herbivore attacks. The visual types are camouflage, masquerade, aposematic coloration of toxic or physically defended plants (including Müllerian/Batesian mimicry), undermining herbivorous insect camouflage, delayed greening, dazzle and trickery coloration, heterophylly that undermines host identification, leaf movements, and signalling that colourful autumn leaves are soon to be shed. The mimicry types include: herbivore damage, insects and other animals, fungal infestation, dead/dry leaves or branches, animal droppings, and stones and soil. Olfactory-based tactics include odour aposematism by poisonous plants, various repelling volatiles, mimicry of faeces and carrion odours, and mimicry of aphid alarm pheromones. The ‘statistical’ methods are mast fruiting, flowering only once in many years and being rare. In addition to the theoretical aspects, understanding these mechanisms may have considerable potential for agricultural or forestry applications.
ST-segment elevation myocardial infarction due to septic coronary embolism: a case report
Authors: Mazzoni Carlotta , Scheggi Valentina , Marchionni Niccolò , Stefano Pierluigi
Published: July 2021

Background 

Coronary artery embolism is an infrequent cause of type 2 myocardial infarction which can be due to arterial thromboembolism or septic embolism. While systemic embolization is one of the most acknowledged and threatened complications of infective endocarditis, coronary localization of the emboli causing acute myocardial infarction is exceedingly rare occurring in <1% of cases.

Case summary 

A 52-year-old man with a history of Bentall procedure and redo aortic valve replacement due to prosthetic degeneration (11 years prior to the current presentation) presented to the emergency department with high-grade fever and myalgias. Shortly after his arrival, he experienced typical chest pain and an electrocardiogram demonstrated signs of inferior ST-elevation myocardial infarction: coronary angiography showed a lesion of presumed embolic origin at the level of the mid-distal circumflex coronary artery which was treated with embolectomy. Transthoracic and transoesophageal echocardiography highlighted the presence of a periaortic abscess. The final diagnosis of infective endocarditis as the cause of septic coronary artery embolization was confirmed with a Positron Emission Tomography-Computed Tomography (PET-CT) exam and by the growth of Staphylococcus lugdunensis on repeated blood cultures. The patient underwent successful redo Bentall surgery the good outcome was confirmed at 1-month follow-up.

Discussion 

Type 2 myocardial infarction caused by coronary embolism is a rare presentation of infective endocarditis and requires a high level of suspicion for its diagnosis. Prosthetic heart valves are a predisposing factor for infective endocarditis: aortic root abscess requires surgery as it rarely regresses with antibiotic therapy.
Student engagement with digital video production
Authors: Henry Alastair
Published: July 2021

In many contexts of contemporary ELT, the L2 can be widely encountered beyond the classroom. In these settings, teachers need to maximize opportunities for meaningful participation. Digital video production (DVP) provides one such opportunity. Little, however, is known about the types of DVP common in particular contexts of ELT, the extent to which DVP functions as a motivational resource, or how engagement is generated. This mixed-methods study in a Swedish context addresses these questions. Results show that DVP takes place in genre-specific forms and has significant motivational potential. Analyses suggest that DVP can generate embodied forms of engagement. By creating appealing characters and storylines, and through the use of mobile devices and easy-to-use video-editing software, students can engage in authentic self-expression in meaningful and satisfying ways. Insights into the ways in which engagement is generated can provide teachers with valuable knowledge when designing learning activities that incorporate DVP.
Knowledge about specific reversal agent of Greek AF patients on direct oral anticoagulants
Authors: Ioannidis A , Pechlevanis A , Pechlevanis A , Paraskelidou M , Paraskelidou M , Fragkiskou A , Fragkiskou A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Clinical guidelines recommend taking into account the patient’s preference when deciding on the options of direct oral anticoagulation (DOAC) therapy. Therefore, education is a prerequisite for informed, involved patients and patient-centred care.

Purpose

The aim of this study was to assess the patient’s awareness about the existence of the dabigatran specific reversal agent (Idarucizumab) and whether the patient was involved in the decision of the specific DOAC regimen.

Methods

Non-valvular atrial fibrillation (AF) patients on DOAC who visited the outpatient clinics of a city hospital in northern Greece were invited to participate. This project was part of the validation study of the Greek version of the Jessa Atrial fibrillation Knowledge Questionnaire. Analyses were performed by IBM SPSS Statistics.

Results

In total, there were 312 participants (168 females, 53.8%) with mean age: 64 ± 5.3 years old. The vast majority of patients (256, 82.1%) were not aware of the existence of any specific reversal agent regardless the socio-economic status (annual income, years of schooling) or the duration and type of AF. Patients that were switched from a vitamin-K antagonist (acenocoumarol) to a DOAC were more likely to be informed about specific reversal agents (31 out of 63 patients switched to DOAC, 49.2% vs. 10.0%, p < 0.05). Similarly, patients taking more than 5 pills per day were more likely to know about the reversal agent (41 of the 193 patients, 21.2% vs. 12.6%). Moreover, the majority of patients that reported any bleeding event that lead to seeking medical advice (minor or major bleeding) were informed about the specific reversal agent (35 out of 52 patients reporting bleeding event, 67.3% vs. 8.1%, p < 0.05). Inappropriately, only seven of the 38 patients (18.4%) that were also taking antiplatelet agents (mainly acetylsalicylic acid or clopidogrel) were aware of specific DOAC reversal agents. Patients with history of stoke or transient ischaemic attack were also better informed (38 out of 53 patients, 71.7% vs. 6.9%). Only about one of five patients on dabigatran (27 out of 129, 20.9%) knew about the dabigatran specific reversal agent, mainly from sources other than their doctor (e.g. journal in office waiting room). All patients agreed that they would prefer to have been informed about the current specific reversal agents when deciding on DOAC therapy. No data could be collected why patients who were informed about specific reversal agent were not prescribed dabigatran.

Conclusions

The sample of Greek non-valvular AF patients showed a noticeably low awareness of the existence of the specific DOAC reversal agent. It seems that DOAC prescription was a rather limited shared decision. Further research is warranted to confirm the aforementioned results.
The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a two-year time period
Authors: Purkayastha P , Ibrahim A , Haslen D , Gamma R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background & Purpose

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality and utilisation of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study we aim to evaluate the safety and efficacy of a specialised nurse-led DCCV cardioversion service. 

Methods

This was a retrospective cohort study analysing the outcome of patients presenting with atrial fibrillation or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019. 

Results

Analysis included a total of 341 patients (mean age = 68.37; STDV = 10.96) who presented with either atrial fibrillation (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were female (N = 101); and 70% were male (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%), whilst 42 patients remained in AF (12.32%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). 38 patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3 month period (7.04%). Of these admissions, 11 were due to persistent AF (45.83%), and 13 were due to other non-related reasons (54.17%). Importantly, no patients were admitted as a direct complication of the DCCV procedure. 

Using a Chi-squared analysis, we found a significant difference in cardioversion success rates between patients presenting with atrial flutter (97% success rate) versus those in atrial fibrillation (85% success rate) (χ2 = 8.089; p = 0.004; α<0.05). We did not find a significant difference in cardioversion success rates between males and females (χ2 = 1.651; p = 0.199; α<0.05); nor did we witness a significant impact from the presence of ischaemic heart disease (χ2 = 1.545; p = 0.214; α<0.05) or hypertension (χ2 = 2.075; p = 0.150; α<0.05). Similarly, we found negligible impact of LV ejection fraction (χ2 = 1.494; p = 0.684; α<0.05) or LA size (χ2 = 1.310; p = 0.727; α<0.05) upon cardioversion success rates.  We witnessed a dramatic improvement in DC cardioversion success rates in patients taking antiarrhythmic medication in preference to a rate control strategy alone (χ2 = 11.825; p = 0.008; α<0.05). 

Conclusion

Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF related issues after successful DCCV.
Trends in the medical therapy of patients who discharge from hospital after decompensated heart failure
Authors: Mantis C , Vasiliadis I , Anadiotis A , Ioannidis E , Patsilinakos S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Acute heart failure is one of the most common causes of cardiovascular hospitalization. An important factor in the prevention of re-admissions is the optimal medical therapy of heart failure patients.

Purpose

To evaluate medication in patients after hospitalization for acute decompensated heart failure.

Methods

We studied consecutive patients who admitted and discharged from two tertiary hospitals due to decompensated heart failure from June 2019 to December 2020. Their medication was recorded at the time of discharge and one month later.

Results

Overall, 730 patients (61% men), with mean age of 77 ± 12 years, were studied. At discharge, the vast majority of the patients (94%) received diuretic, while 45% of them received either angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) or sacubitril/valsartan (20%, 12% and 13%, respectively). 74% of the patients received b-blockers, half of the patients (51%) received aldosterone antagonists, 12% Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) , 6% cardiac glycosides, and only 3% ibavradine. In one month of reassessment, the corresponding percentages were: 90% diuretics, 25% ACEI, 16% ARB, 18% sacubitril/valsartan, 78% b-blockers, 53% aldosterone antagonists, 14% SGLT2i, 4% cardiac glycosides and 3% ibavradine. Despite the low dosing regimens at discharge, after one month, the majority of the patients already receiving ACEI, ARB,  sacubitril/valsartan and beta-blockers were up-titrated, while a dose reduction was noticed on diuretics in almost all patients.

Conclusion

There are still considerable margins to improve management of the optimal medical treatment of patients who discharge from hospital after acute heart failure.
Glycoprotein IIb/IIIa inhibitors in combination with thrombus aspiration with, or without, stent implantation in patients presenting with S-T elevation myocardial infarction and high thrombus burden
Authors: Mantis C , Kintis K , Papadakis E , Anadiotis A , Patsilinakos S
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary intervention (PCI) for S-T elevation myocardial infarction (STEMI).

Purpose

To investigate whether a strategy of thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors without stent implantation is associated with a reduced incidence of slow- or no-reflow, and other thrombotic complications compared with stenting in patients with high thrombus burden.

Methods

A total of 210 patients with STEMI and high thrombus burden (thrombolysis in myocardial infarction thrombus grade ≥3) treated with thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation. Patients were divided into 2 groups: non-stent PCI group (deferred stenting, n = 105) and stent PCI group (immediate stenting, n = 105). A new catheterisation and deferred stent implantation was performed 48 - 72 hours after primary PCI. The end points were a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively) and the postprocedural frequencies of a TIMI flow grade of 3, complete resolution of ST-segment elevation immediately after primary PCI, target vessel revascularization, reinfarction, death and the combination of major adverse cardiac events by 30 days after randomisation.

Results

A myocardial blush grade of 0 or 1 occurred in 26.3% of the patients in the stent PCI group and in 17.1% of those in the non-stent PCI group (p < 0.05). Complete resolution of ST-segment elevation occurred in 86.6% and 78.2% of patients, respectively (p = 0.35). At 30 days, the rate of death in the stent PCI group and non-stent PCI group was 1.7% and 1.0%, respectively (p = 0.33) and the rate of adverse events was 12.1% and 2.2%, respectively (p < 0.01).

Conclusions

Thrombus aspiration, in combination with glycoprotein IIb/IIIa inhibitors without immediate stenting, is an applicable and effective method in a large majority of patients with myocardial infarction with ST-segment elevation and a high thrombus burden.
Triple drug therapy to manage uncontrolled BP in hypertensive patients during Covid-19 lockdown: perspectives from India
Authors: Abhyankar MAHESH , Kumar SHARAD , Kumar BK , Swain SK , Walavalkar AMAR , Silki SILKI
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Reportedly, hypertension (HTN) independently increases the risk of Covid-19 severity and doubles the risk of Covid-19 mortality. Also, individuals with untreated HTN remain at high risk of covid-19 complications in comparison to those managed with antihypertensive treatment.

Objective

The survey was carried out to seek the opinion of healthcare practitioners (HCPs) on the impact of Covid-19 lockdown on the blood pressure (BP) control, and the role of triple drug therapy in management of uncontrolled BP.

Method

This PAN India study was carried out through a structured web-based objective questionnaire survey involving 479 HCPs. The survey comprised questions related to the prevalence and causes of uncontrolled BP during the Covid-19 lockdown, and the use of triple drug therapy in the management of uncontrolled BP.

Results

The respondent pool of 479 HCPs consisted of consulting physicians (51.5%), family physicians (19%), diabetologists (15%), cardiologists (14%) and nephrologists (0.5%). In this study a majority (40%) of HCPs agreed that stress was the most common reason behind uncontrolled BP during Covid-19 lockdown followed by non-compliance of treatment and sedentary lifestyle, each opined by 30% of HCPs. Almost 54% and 40% of the HCPs respectively, mentioned that 10-40% and 40-80% of their patients with hypertension have reported uncontrolled BP levels following the Covid-19 lockdown. 4% of the HCPs reported that all of their patients lost BP control, while 2% of HCPs mentioned that none of their patients reported uncontrolled BP after the Covid-19 lockdown. Of all the HCPs, 12% opined that they will choose a triple drug combination (TDC) for patients uncontrolled with high dose monotherapy, ∼75% opined that they will chose TDC for patients uncontrolled with dual therapy while 13% mentioned that they will chose TDC for patients at high risk. Regarding the TDC of choice, more than half (51%) of the HCPs opted for Telmisartan + Amlodipine + Hydrochlorothiazide as the preferred combination. Among other TDCs, Telmisartan + Amlodipine + Chlorthalidone, Telmisartan + Cilnidipine + Chlorthalidone, and Olmesartan + Amlodipine + Hydrochlorothiazide were ranked as the next three choices opted by 28%, 17.5% and 2.5% of HCPs for the management of uncontrolled BP. A majority of HCPs (58%) also agreed that they would adopt TDC early in the treatment, during the ongoing Covid-19 pandemic.

Conclusion

This study underlined the negative impact of Covid-19 lockdown on the blood pressure control in patients with hypertension. It also highlighted the HCPs perspectives on the early use of TDC, and that Telmisartan + Amlodipine + Hydrochlorothiazide is the most commonly preferred TDC in patients with uncontrolled BP levels in Indian settings.
Higher levels of physical activity is associated with lower arterial stiffness in patients with resistant hypertension
Authors: Lopes S , Mesquita-Bastos J , Garcia C , Leitao C , Bertoquini S , Ribau V , Carvalho P , Oliveira J , Viana J , Figueiredo D , Guimaraes GV , Polonia J , Alves AJ , Ribeiro F
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Portuguese Foundation for Science and Technology (FCT) European Regional Development Fund – Operational Competitiveness Factors Program (COMPETE)

Background

 Physical activity has been associated with reduced arterial stiffness in patients with hypertension. However, in resistant hypertension, a specific population with an increased risk for target organ damage, cardiovascular morbidity, and mortality, the evidence is sparse. 

Purpose

 The present study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension.

Methods

 Fifty-seven patients with resistant hypertension were recruited. Physical activity was objectively assessed during 7 consecutive days with accelerometers. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV) . 

Results

 Participants (50.9% men), aged 58.8 ± 9.4 years, were mainly overweight and were taking in average 4.5 antihypertensive medications. The cf-PWV showed an inverse correlation with light-intensity physical activity (r = -0.290, p = 0.029) and total daily physical activity (r = -0.287, p = 0.030). Additionally, cf-PWV tended to be inversely associated with the number of steps per day (r = -0.242, p = 0.069). Patients with higher risk of cardiovascular events (cf-PWV ≥ 10 m/s) tended to spend less time in light-intensity physical activity (324.0 ± 129.4 vs. 380.5 ± 103.1 min/day, p = 0.090) and to perform less total daily physical activity (351.5 ± 141.7 vs. 411.7 ± 109.1 min/day, p = 0.091) than participants with cf-PWV below the risk threshold value.

Conclusions

 Higher levels of total physical activity and daily levels of light-intensity were associated to lower arterial stiffness. These results emphasize the importance of physical activity as a nonpharmacological tool for patients with resistant hypertension.
Impact on the quality of life after mitral clip implantation
Authors: Valverde Bernal J , Ruiz Gabalda J , Delgado Sanchez FJ , Berga Congost G , Marquez Lopez A
Published: July 2021

Background and objectives

Mitral regurgitation is a very limiting disease for the patient. The objetctive is to analitze the effectiveness of the mitral clip implantation on the quality of life and the degree of dependence in patients with mitral regurgitation

Methods

Almost experiment study of time series. The quality of life was evaluated with the Minnesota Living With Heart Failure (MLWHFQ) and Short-Form 36 (SF-36) questionnaire, 6 months before the intervention, 1 day before, 1 month after and 6 months later. The degree of dependence was evaluated with the Katz Index. The intervention was considered effective when the MLWHDQ decreased in 10 points and/or the Katz Index 1 point. Other variables were socio-demographic and clinical factors

Results

Twenty patients were introduced with a mean age of 78,6 ± mostly men (75%) and with very prevalent cardiovascular risk factors.

The total MLWHFQ score decreased significantly after the intervention by 26.63 points (p = 0.004) and in the physical dimension by 12.13 points (p = 0.004) and 5.75 points (p = 0.007). In contrast, the modification of the score in the Katz Index was 0.14 points (p = 0.257)

There was a significant decrease in pre and post intervention symptoms: dyspnea (p = 0.063), fatigue (p = 0.000) and maleolar oedema (p = 0.063)

In the SF-36 health transition question, 75% of patients reported feeling better or much better after 6 months of the intervention.

Conclusions

These results suggest that mitral clip implantation improves short-term quality of life in patients with mitral insufficiency, although it doesn"t change the degree of dependence for short-term daily life activities.

In addition, mitral clip implantation improves the limiting symptoms of these patients and the health perception at 6 months.
Appetite is an important factor for dietary intake in patients with heart failure - a comparison study
Authors: Andreae C , Witthoft C , Stromberg A , Arestedt K
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden, the Swedish Heart and Lung Foundation.

Background

Loss of appetite and suboptimal dietary intake is common in heart failure, which can result in malnutrition. Malnutrition is associated with poor prognosis and needs to be identified and treated. Despite this, few studies have investigated whether appetite and dietary intake may be intertwined.

Purpose

To compare dietary intake between heart failure patents with poor and good appetite.

Methods

A cross-sectional observational study design was used, and patients were recruited from three outpatient heart failure clinics in Sweden. The sample included 186 patients with confirmed heart failure with NYHA class II-IV (Mdn = NYHA class II). The mean age was 70 (SD = 11) years and 119 were male 69%. Dietary intake was assessed by a 3-day self-recorded food diary, including two weekdays and one week-end-day. Components including energy intake, macronutrients, fiber, minerals, vitamins, and water were collected, entered, and calculated by a dietician using the software Dietist XP. Appetite was self-reported using the Council on Nutritional Appetite Questionnaire (CNAQ). The total score ranges between 8-40, low scores indicate poor appetite. Mann-Whitney U test was used to investigate differences in dietary intake between patients with poor appetite (CNAQ ≤ 28) and good appetite (CNAQ > 28). The eta2 (Z2/N-1) was used to estimate the effect size.

Results

Patients with poor appetite (n = 71, 38%) reported significantly lower intake (p < 0.05) of calories, protein, fat, fiber, vitamin B6 and B12, thiamin, riboflavin, niacin, folate, phosphor, potassium, sodium, magnesium, iron, zinc, selenium and water compared to those with good appetite (n = 115, 62%). The effect size was small (eta2 = 0.02-0.09).

Conclusions

This study shows that poor appetite contributes to a significant lower intake of essential nutrients compared to patients with good appetite. Health care professionals should assess appetite routinely during heart failure follow-up since poor appetite may contribute to inadequate dietary intake with risk for malnutrition. Future longitudinal studies are required to increase the knowledge whether assessment of appetite can be used to determine malnutrition in heart failure.