bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of multiple fragmented QRS on cardiac events in idiopathic dilated cardiomyopathy
Authors: Marume Kyohei , Noguchi Teruo , Kamakura Tsukasa , Tateishi Emi , Morita Yoshiaki , Miura Hiroyuki , Nakaoku Yuriko , Nishimura Kunihiro , Yamada Naoaki , Tsujita Kenichi , Izumi Chisato , Kusano Kengo , Ogawa Hisao , Yasuda Satoshi 
Published: July 2020

Abstract

Aims
To evaluate the prognostic impact of fragmented QRS (fQRS) on idiopathic dilated cardiomyopathy (DCM).

Methods and results
We conducted a prospective observational study of 290 consecutive patients with DCM (left ventricular ejection fraction ≤ 40%) and narrow QRS who underwent cardiac magnetic resonance. We defined fQRS as the presence of various RSR′ patterns in ≥2 contiguous leads representing the anterior (V1–V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Multiple fQRS was defined as the presence of fQRS in ≥2 myocardial segments. Patients were divided into three groups: no fQRS, single fQRS, or multiple fQRS. The primary endpoint was a composite of hard cardiac events consisting of heart failure death, sudden cardiac death (SCD), or aborted SCD. The secondary endpoints were all-cause death and arrhythmic event. During a median follow-up of 3.8 years (interquartile range, 1.8–6.2), 31 (11%) patients experienced hard cardiac events. Kaplan–Meier analysis showed that the rates of hard cardiac events and all-cause death were similar in the single-fQRS and no-fQRS groups and higher in the multiple-fQRS group (P = 0.004 and P = 0.017, respectively). Multivariable Cox regression identified that multiple fQRS is a significant predictor of hard cardiac events (hazard ratio, 2.23; 95% confidence interval, 1.07–4.62; P = 0.032). The multiple-fQRS group had the highest prevalence of a diffuse late gadolinium enhancement pattern (no fQRS, 21%; single fQRS, 22%; multiple fQRS, 39%; P &lt; 0.001).

Conclusion
Multiple fQRS, but not single fQRS, is associated with future hard cardiac events in patients with DCM.
Usefulness of post-procedural heart rate response to predict syncope recurrence or positive head up tilt table testing after cardioneuroablation
Authors: Aksu Tolga , Guler Tumer Erdem , Bozyel Serdar , Yalin Kivanc , Gopinathannair Rakesh 
Published: July 2020

Abstract

Aims
Previous reports have suggested that cardioneuroablation (CNA) can be effective in reducing syncopal recurrences in patients with vasovagal syncope (VVS). This study assessed the efficacy of CNA in preventing a positive response to head-up tilt testing (HUT).

Methods and results
This is a single-centre retrospective study reviewing prospectively collected data. Fifty-one consecutive patients with VVS were included in the study. After confirmation of &gt;3 s asystole on HUT, all patients underwent CNA. Head-up tilt testing was repeated 1 month after CNA. The main outcome measures were recurrence of syncope episode and positive response on HUT. During a median follow-up period of 11 months (interquartile range 3–27 months), all but 3 (5.8%) of 51 patients were free of syncope. Repeated HUTs were negative in 44 (86.2%) patients. When patients with recurrent syncope were excluded, vasodepressor response was seen in three cases and cardioinhibitory response in one case, respectively. Cardioneuroablation caused significant and durable shortening of RR interval in all cases. This effect was significantly higher in patients without positive HUT responses.

Conclusion
This pilot study shows that CNA can effectively prevent recurrent syncopal episodes in patients with refractory VVS. Head-up tilt testing seems as a valuable diagnostic tool not only to select suitable candidates and but also to evaluate success of CNA.
Emergent Viral Infections of the CNS
Authors: Wiley Clayton A 
Published: July 2020

Abstract
Biological evolution of the microbiome continually drives the emergence of human viral pathogens, a subset of which attack the nervous system. The sheer number of pathogens that have appeared, along with their abundance in the environment, demand our attention. For the most part, our innate and adaptive immune systems have successfully protected us from infection; however, in the past 5 decades, through pathogen mutation and ecosystem disruption, a dozen viruses emerged to cause significant neurologic disease. Most of these pathogens have come from sylvatic reservoirs having made the energetically difficult, and fortuitously rare, jump into humans. But the human microbiome is also replete with agents already adapted to the host that need only minor mutations to create neurotropic/toxic agents. While each host/virus symbiosis is unique, this review examines virologic and immunologic principles that govern the pathogenesis of different viral CNS infections that were described in the past 50 years (Influenza, West Nile Virus, Zika, Rift Valley Fever Virus, Hendra/Nipah, Enterovirus-A71/-D68, Human parechovirus, HIV, and SARS-CoV). Knowledge of these pathogens provides us the opportunity to respond and mitigate infection while at the same time prepare for inevitable arrival of unknown agents.
Late-time decaying dark matter: constraints and implications for the H0-tension
Authors: Haridasu Balakrishna S , Viel Matteo 
Published: July 2020

ABSTRACT
We constrain and update the bounds on the lifetime of a decaying dark matter model with a warm massive daughter particle using the most recent low-redshift probes. We use Supernovae Type-Ia, Baryon Acoustic Oscillations and the time delay measurements of gravitationally lensed quasars. These data sets are complemented by the early universe priors taken from the Cosmic Microwave background. For the maximum allowed fraction of the relativistic daughter particle, the updated bounds on the lifetime are found to be $\tau \gt 9\, \rm {Gyr}$ and $\tau \gt 11\, \rm {Gyr}$ at $95{{\ \rm per\ cent}}$ C.L., for the two-body and many-body decay scenarios, respectively. We also comment on the recent proposal that the current two-body decaying dark matter model can provide resolution for the H0-tension, by contrasting against the standard ΛCDM model. We infer that the current dark matter decaying scenario is unlikely to alleviate the H0-tension. We find that the decaying dark matter is able to reduce the trend of the decreasing H0 values with increasing lens redshifts observed in the strong lensing data set.
The nature of kink MHD waves in the solar corona: magnetic twist and phase mixing
Authors: Bahari K , Ebrahimi Z 
Published: July 2020

ABSTRACT
To study the nature of magnetohydrodynamic (MHD) kink waves, the temporal behaviour of an initial kink perturbation of a typical coronal flux tube has been investigated in this paper. The flux tube has a transitional layer that separates the core region of the tube from the surrounding environment. In the transitional layer, the background density and magnetic field varies continuously from the internal to the external values. The magnetic field is straight and aligned with the tube axis in the internal and external regions of the flux tube, but is assumed to be twisted in the transitional layer. Hence, in the transitional layer the background Alfvén speed is inhomogeneous and perturbations become out of phase due to the process of phase mixing. Our result shows that as the energy of the wave transfers to the local Alfvén waves in the inhomogeneous region, the magnetic tension force becomes the dominant restoring force of the wave. The numerical results show that the nature of the small-scale oscillations in the transitional layer is determined by the ratio of the azimuthal components of the restoring forces.
The dual origin of the Galactic thick disc and halo from the gas-rich Gaia–Enceladus Sausage merger
Authors: Grand Robert J J , Kawata Daisuke , Belokurov Vasily , Deason Alis J , Fattahi Azadeh , Fragkoudi Francesca , Gómez Facundo A , Marinacci Federico , Pakmor Rüdiger 
Published: July 2020

ABSTRACT
We analyse a set of cosmological magnetohydrodynamic simulations of the formation of Milky Way-mass galaxies identified to have a prominent radially anisotropic stellar halo component similar to the so-called ‘Gaia Sausage’ found in the Gaia data. We examine the effects of the progenitor of the Sausage (the Gaia–Enceladus Sausage, GES) on the formation of major galactic components analogous to the Galactic thick disc and inner stellar halo. We find that the GES merger is likely to have been gas-rich and contribute 10–50 ${{\ \rm per\ cent}}$ of gas to a merger-induced centrally concentrated starburst that results in the rapid formation of a compact, rotationally supported thick disc that occupies the typical chemical thick disc region of chemical abundance space. We find evidence that gas-rich mergers heated the proto-disc of the Galaxy, scattering stars on to less-circular orbits such that their rotation velocity and metallicity positively correlate, thus contributing an additional component that connects the Galactic thick disc to the inner stellar halo. We demonstrate that the level of kinematic heating of the proto-galaxy correlates with the kinematic state of the population before the merger, the progenitor mass, and orbital eccentricity of the merger. Furthermore, we show that the mass and time of the merger can be accurately inferred from local stars on counter-rotating orbits.
Dynamic zoom simulations: A fast, adaptive algorithm for simulating light-cones
Authors: Garaldi Enrico , Nori Matteo , Baldi Marco 
Published: July 2020

ABSTRACT
The advent of a new generation of large-scale galaxy surveys is pushing cosmological numerical simulations in an uncharted territory. The simultaneous requirements of high resolution and very large volume pose serious technical challenges, due to their computational and data storage demand. In this paper, we present a novel approach dubbed dynamic zoom simulations – or dzs – developed to tackle these issues. Our method is tailored to the production of light-cone outputs from N-body numerical simulations, which allow for a more efficient storage and post-processing compared to standard comoving snapshots, and more directly mimic the format of survey data. In dzs, the resolution of the simulation is dynamically decreased outside the light-cone surface, reducing the computational work load, while simultaneously preserving the accuracy inside the light-cone and the large-scale gravitational field. We show that our approach can achieve virtually identical results to traditional simulations at half of the computational cost for our largest box. We also forecast this speedup to increase up to a factor of 5 for larger and/or higher resolution simulations. We assess the accuracy of the numerical integration by comparing pairs of identical simulations run with and without dzs. Deviations in the light-cone halo mass function, in the sky-projected light-cone, and in the 3D matter light-cone always remain below 0.1 per cent. In summary, our results indicate that the dzs technique may provide a highly valuable tool to address the technical challenges that will characterize the next generation of large-scale cosmological simulations.
Escape Room: Innovative Teaching Strategy to Stimulate Critical Thinking/Judgment in Nursing Students
Authors: Smith Veronica Rakaczky , Paul Patricia Ann 
Published: July 2020

Abstract
The Escape Room, an innovative teaching strategy, can be customized to various nursing scenarios. Student teams complete puzzles and tasks to reach designated goals and objectives within a limited time frame. Escape Rooms were designed as a clinical make-up day for 10 first-year, second-semester associate degree nursing students. Using activity theory to create a constructivist learning environment, scenarios were designed to focus on diabetic ketoacidosis and safety/environmental factors associated with aspiration pneumonia and wound dehiscence. This student sample evaluated the Escape Room experiences as an effective method for content retention and clinical thinking/judgment.
Resuscitating the Socratic Method: Student and Faculty Perspectives on Posing Probing Questions During Clinical Teaching
Authors: Abou-Hanna Jacob J. , Owens Sonal T. , Kinnucan Jami A. , Mian Shahzad I. , Kolars Joseph C. 
Published: July 2020

Purpose
Teaching by way of asking questions is a time-honored practice that has taken on the negative connotation of “pimping” among medical students and has made some faculty hesitant to ask students questions during clerkship rotations. Yet, quantitative studies exploring student perspectives on this practice are limited. This study aimed to solicit student and faculty views and investigate faculty perceptions of students’ preferences.

Method
Students who completed their internal medicine clerkship during the 2017–2018 academic year (n = 165) and were from the 2020 graduating class and their supervising faculty (n = 144) at the University of Michigan Medical School were asked to complete a Likert response survey in April 2019. The survey solicited perspectives on questions probing medical knowledge posed to students by faculty. Surveys were constructed using an iterative process, and data were analyzed using t tests and linear regressions.

Results
A total of 140 (85%) students and 112 (78%) faculty participated. Of those, 125 (89%) students and 109 (97%) faculty agreed that probing questions are valuable for student education, but only 73 (65%) faculty perceived that students agreed with this statement (P < .001). In addition, 115 (82%) students preferred to be asked too many questions than none at all. Fifty-five (39%) students agreed that they feel humiliated when they answer a question incorrectly. However, only 7 (5%) students agreed that faculty ask questions to humiliate them, and only 20 (14%) preferred that faculty stop asking questions if they answer a question incorrectly.

Conclusions
Students valued probing questions more than faculty perceived, which argues against a withdrawal from the Socratic teaching method in the clinical arena. The students’ experience of humiliation when answering incorrectly requires further study and perhaps can be tempered by more explicit framing of the role of the questioning process.
Recent advances of miRNAs in the development and clinical application of gastric cancer
Authors: Wu Si-Ran , Wu Qiong , Shi Yong-Quan 
Published: July 2020

Abstract
Gastric cancer (GC) is one of the most common malignant tumors. The mechanism of how GC develops is vague, and therapies are inefficient. The function of microRNAs (miRNAs) in tumorigenesis has attracted the attention from many scientists. During the development of GC, miRNAs function in the regulation of different phenotypes, such as proliferation, apoptosis, invasion and metastasis, drug sensitivity and resistance, and stem-cell-like properties. MiRNAs were evaluated for use in diagnostic and prognostic predictions and exhibited considerable accuracy. Although many problems exist for the application of therapy, current studies showed the antitumor effects of miRNAs. This paper reviews recent advances in miRNA mechanisms in the development of GC and the potential use of miRNAs in the diagnosis and treatment of GC.
Social Determinants of Health and the Role of Routine Pediatric Care in a Medically Complex Toddler
Authors: Cuttin Karen , Neri Caitlin , Tang Margot , Kuhn Jocelyn , Pearl Kerry , Augustyn Marilyn 
Published: July 2020

CASE:
Late on a Friday afternoon, a new family presents to your practice for urgent care. They come with their youngest child Mai, a 2-year-old girl, who, although born in the United States at 36 weeks gestation, has resided in Laos with her grandparents for the past 16 months. Your triage nurse tells you that she has a fever and was found to have profound anemia while at the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) office earlier today.
On walking into the room, you describe Mai as “listless” and “sickly.” Her vitals were notable for fever (102°F), tachycardia (140 beats per minute), and tachypnea (35 breaths per minute). On physical examination, she was grunting with a systolic ejection murmur and without hepatosplenomegaly. Laboratory test results revealed hemoglobin of 2.2 g/dL, hematocrit of 12%, mean corpuscular volume of 50 fL, red cell distribution width of 27%, reticulocyte count of 3%, ferritin of <2 ng/mL, iron of 15 μg/dL, total iron binding count of 420 μg/dL, white blood cell count of 13.5 K/μL, and platelets of 605 K/μL. Her evaluation was consistent with severe iron deficiency anemia (IDA), which was further supported by reported restrictive diet and excessive cow milk intake of 35 ounces daily. She was admitted to the Pediatric Intensive Care Unit in high-output cardiac failure and was slowly transfused with 15 mL/kg of packed red blood cells over 2 days with careful monitoring. Once stabilized, she was transferred to the inpatient floor for further nutritional evaluation and supplementation. Additional workup, including hemoglobin electrophoresis, fecal occult blood test, celiac studies, and stool parasite testing were normal. The clinical picture was consistent with a viral infection in the setting of profound IDA and malnutrition.
Although her clinical status had improved, she remained inpatient for nutritional optimization. Her height was at the 54th percentile (z-score: 0.11), weight was at the first percentile (z-score: −2.25), and body mass index was below the first percentile (z-score: −3.18), diagnostic of severe protein-calorie malnutrition.1 She was evaluated by an interdisciplinary growth and nutrition team, received multivitamin and mineral supplements, and was monitored for refeeding syndrome. She was noted to be “difficult to engage,” “resistant to new faces,” and made little progress on expanding her dietary choices. Concerns about a possible diagnosis of autism spectrum disorder were raised by her treating team. What would you do next?

REFERENCE
1. Bouma S. Diagnosing pediatric malnutrition: paradigm shifts of etiology-related definitions and appraisal of the indicators. Nutr Clin Pract. 2017;32:52–67.
Patient insights on features of an effective pharmacogenomics patient portal
Authors: Truong Tien M. , Lipschultz Elizabeth , Schierer Emily , Danahey Keith , Ratain Mark J. , O’Donnell Peter H. 
Published: July 2020

Objectives
We built a novel mock pharmacogenomics web portal to deliver pharmacogenomic information and results to patients. Utilizing a patient focus group, we then sought to understand patient insights on desired features of an effective pharmacogenomics patient portal.

Methods
The mock YourPGx Portal delivered four sample pharmacogenomic results (omeprazole, simvastatin, clopidogrel, and codeine). Patients from our existing institutional, prospective pharmacogenomics implementation study were recruited to pilot the mock portal and then asked to participate in a focus group discussion led by two facilitators. All patients had been previously genotyped, but none had been directly provided access to their own genotyping results and none had previously used the YourPGx portal. The focus group discussion explored nine domains: (1) factors influencing drug response, (2) concerns about drug effects, (3) understanding of genomics and pharmacogenomics, (4) reasons to undergo pharmacogenomic testing, (5) sources of pharmacogenomic information for patient education, (6) attributes of pharmacogenomic sources of information, (7) considerations about privacy and personal pharmacogenomic information, (8) sharing of pharmacogenomic information, and (9) features of an effective patient portal.

Results
The median age of patients (n = 10) was 65.5 years old (range 38–72), 70% female, 50% Caucasian/30% Black, and 60% held a bachelor/advanced degree. When asked about resources for seeking pharmacogenomic information, patients preferred consulting their providers first, followed by self-education, then using information provided by university research organizations. A theme emerged regarding attributes of these sources, namely a desire for understandability and trust. Patients said that the effectiveness of a pharmacogenomics patient portal is improved with use of symbolisms/graphics and clear and concise content. Effective use of colors, quantifying information, consistency, and use of layperson’s language were additional important facets. Patients communicated the appeal of secured phone/app-enabled access and said that they would desire linking to their electronic medical records to allow sharing of information with different members of their healthcare team.

Conclusions
Patients named providers as their primary source of pharmacogenomic information, but a pharmacogenomics patient portal that is carefully constructed to incorporate desired features may be a favorable tool to effectively deliver pharmacogenomic information and results to patients.
Assessment and management of coronary artery disease in patients undergoing transcatheter aortic valve replacement
Authors: Prabhakar Manu , Liu Shuangbo , Bagai Akshay , Yanagawa Bobby , Verma Subodh , Cheema Asim N. 
Published: July 2020

Purpose of review
Coronary artery disease (CAD) is commonly observed in patients undergoing transcatheter aortic valve replacement (TAVR). Significant variability exists across institutions for strategies used for CAD diagnosis and its management. The heart team often relies upon traditional practice patterns and the decision for revascularization by percutaneous coronary intervention (PCI) is influenced by patient, angiographic, operator, and system-related factors.

Recent findings
Contemporary coronary tomography angiography (CTA) shows significant promise for detection of clinically important CAD and preliminary data support CTA use for TAVR patients. The prognostic implications of CAD in a TAVR population remain unclear with studies showing conflicting data for the benefits of PCI. Recent trials show that medical management is an effective initial treatment strategy for stable CAD, a finding likely also applicable for asymptomatic and stable TAVR patients. In addition, PCI performed pre-TAVR, concomitant with TAVR or after TAVR has been shown to produce similar outcomes. Dual antiplatelet therapy (DAPT) is mandated after PCI but associated with increased risk of bleeding in TAVR population with accumulating evidence for single antiplatelet therapy (SAPT) post-TAVR unless DAPT or anticoagulation is indicated for another reason.

Summary
Although coronary angiography remains the predominant modality for CAD assessment, CTA is increasingly being used in TAVR patients. There is limited evidence to guide CAD management in TAVR patients with significant variability in practice patterns. Medical therapy is recommended for asymptomatic and stable CAD patients with applicability for TAVR population. Despite prior concerns, recent studies suggest successful coronary access post-TAVR and similar outcomes for PCI offered pre-TAVR, concomitant with TAVR and post-TAVR settings. Safety of DAPT should be an important consideration for PCI in TAVR patients. Ongoing studies will determine the preferred testing for CAD diagnosis, benefit of revascularization, timing of PCI, and optimum antithrombotic therapy for TAVR populations.