bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advance care planning: the future
Authors: Rietjens Judith , Korfage Ida , Taubert Mark 
Published: May 2020

ObjectivesThere is increased global focus on advance care planning (ACP) with attention from policymakers, more education programmes, laws and public awareness campaigns.MethodsWe provide a summary of the evidence about what ACP is, and how it should be conducted. We also address its barriers and facilitators and discuss current and future models of ACP, including a wider look at how to best integrate those who have diminished decisional capacity.ResultsDifferent models are analysed, including new work in Wales (future care planning which includes best interest decision-making for those without decisional capacity), Asia and in people with dementia.ConclusionsACP practices are evolving. While ACP is a joint responsibility of patients, relatives and healthcare professionals, more clarity on how to apply best ACP practices to include people with diminished capacity will further improve patient-centred care.
Characterization of organ dysfunction and mortality in pediatric patients with trauma with acute traumatic coagulopathy
Authors: Nair Alison , Flori Heidi , Cohen Mitchell Jay 
Published: May 2020

BackgroundTraumatic injuries are a leading cause of mortality and morbidity in pediatric patients and abnormalities in hemostasis play an important role in these poor outcomes. One such abnormality, acute traumatic coagulopathy (ATC), is a near immediate endogenous response to injury and has recently been described in the pediatric population. This study aims to evaluate the epidemiology of pediatric ATC, specifically its association with organ dysfunction.MethodsAll patients with trauma presenting to the University of California, Benioff Children’s Hospital Oakland between 2006 and 2015 with coagulation testing drawn at presentation were included. Patients were excluded if they (1) were >18 years of age, (2) were admitted with a non-mechanical mechanism of injury, (3) were on anticoagulation medications, or (4) had coagulation testing >4 hours after injury. ATC was defined as an international normalized ratio (INR) ≥1.3. The primary outcome was new or progressive multiple organ dysfunction syndrome (MODS) and secondary outcomes included in-hospital mortality and other morbidities.ResultsOf the 7382 patients that presented in the 10-year study period, 545 patients met criteria for analysis and 88 patients (16%) presented with ATC. Patients with ATC were more likely to develop MODS than those without ATC (68.4% vs 7.7%, p<0.001) and had higher in-hospital mortality (26.1% vs 0.4%, p<0.001) than those without ATC. Along with arterial hypotension and an Injury Severity Score ≥30, ATC was independent predictor of MODS and in-hospital mortality. An isolated elevated INR was associated with MODS and in-hospital mortality while an isolated elevated partial thromboplastin time was not.ConclusionsPediatric ATC was associated with organ dysfunction, mortality, and other morbidities. ATC along with arterial hypotension and high injury severity were independent predictors of organ dysfunction and mortality. Pediatric ATC may be biologically distinct from adult ATC and further studies are needed.Level of evidenceIV, epidemiologic.
Comparison between smartphone electrocardiography and standard three‐lead base apex electrocardiography in healthy horses
Authors: Welch‐Huston Brittany , Durward‐Akhurst Sian , Norton Elaine , Ellingson Lacey , Rendahl Aaron , McCue Molly 
Published: May 2020

BackgroundCardiac arrhythmias are commonly auscultated during routine physical examinations in horses and determining the underlying electrical abnormality using an ECG is important. The most commonly used device is a three‐lead base apex system (Televet), however few practitioners carry this for routine visits. With recognition of the utility of smartphone‐based ECGs in humans, dogs and ruminants, the AliveCor single‐lead bipolar smartphone‐based ECG has gained popularity. The objective of this study was to determine if AliveCor and Televet ECG measurements were comparable in healthy horses using multiple observers.MethodsECGs were performed on 15 healthy horses simultaneously using the AliveCor and Televet.ResultsThere was very good to perfect interdevice and interobserver agreement for heart rate and RR interval measurement, and moderate‐to‐good interdevice and interobserver agreement for detection of non‐pathological arrhythmias. Interdevice agreement for measurement of P‐wave and QRS duration, QT, PR and T‐peak to T‐end interval was poor to fair. Interestingly, interobserver agreement for P‐wave and QRS duration, QT, PR, and T‐peak to T‐end interval measurements was fair to good.ConclusionOverall, the AliveCor is comparable to the Televet for heart rate and RR measurement, and for the detection of non‐pathogenic arrhythmias with acceptable agreement between observers.
Probing quantum field theory particle mixing and dark-matter-like effects with Rydberg atoms
Authors: Capolupo A. , Giampaolo S. M. , Lambiase G. , Quaranta A. 
Published: May 2020

AbstractWe analyze the oscillations of Rydberg atoms in the framework of quantum field theory and analyze the analogy with flavor mixing and oscillations. We reveal a non trivial vacuum energy which has the equation of state analogous to that of cold dark matter. This energy is formally similar to that expected for mixed neutrinos and affects the thermal capacity of the gas. Therefore, deflection of the thermal capacity of Rydberg atoms could prove the condensate structure of vacuum for mixing fermions and open new scenarios in the study of the dark components of the universe. We also derive new Rabi oscillation formulae which are, in principle, testable experimentally.
Spin-dependent Pomeron and Odderon in elastic proton–proton scattering
Authors: Hagiwara Yoshikazu , Hatta Yoshitaka , Pasechnik Roman , Zhou Jian 
Published: May 2020

AbstractWe introduce a new model of near-forward elastic proton–(anti)proton scattering at high energy based on the modern formulation of Pomeron and Odderon in terms of Wilson lines and generalized transverse momentum dependent distributions. We compute the helicity-dependent elastic amplitudes $$\phi _{1,2,3,4,5}$$ϕ1,2,3,4,5 in this model and study their energy dependence from the nonlinear small-x evolution equations. While both Pomeron and Odderon contribute to helicity-flip processes in general, in the forward limit $$t=0$$t=0 only the double helicity-flip amplitude $$\phi _2$$ϕ2, dominated by the spin-dependent Odderon, survives. This may affect the extraction of the $$\rho $$ρ parameter as well as the total cross section in the LHC energy domain and beyond.
Investigation of tungsten/MA956 steel diffusion bonding with an Nb/Ni composite interlayer
Authors: Chen Boyan , Li Xianfen , Cui Hanlin , Hua Peng , Chen Yuanting , Wang Cheng , Wu Yucheng , Zhou Wei 
Published: May 2020

Diffusion bonding is an effective method for joining dissimilar materials. In this study, dissimilar metals of MA956 steel and tungsten (W) were diffusion bonded with Ni/Nb composite interlayer. The experiments were carried out at [Formula: see text], 20 MPa for 20 min in vacuum by spark plasma sintering (SPS) technique. The microstructure and mechanical properties of the bonded joints were evaluated. SEM images and the results of elementary composition indicate that no intermetallics formed at Ni/MA956 steel and Nb/W interfaces, but [Formula: see text] and [Formula: see text] formed at the Nb/Ni interface. Compared with the directly bonded joint between W and MA956 steel, the average shear strength of the joint with Nb/Ni composite interlayer significantly increased to 270 MPa. Although the result of joint residual stresses simulation shows that the maximum residual stress was near the W substrate, the joints with composite interlayer in shear experiments fractured at Nb/Ni interface. The hardness changes along joint interfaces indicate the formation of intermetallic compounds and solid solution phases in the diffusion layers.
Antitumor Activity of Amivantamab (JNJ-61186372), an EGFR–MET Bispecific Antibody, in Diverse Models of EGFR Exon 20 Insertion–Driven NSCLC
Authors: Yun Jiyeon , Lee Soo-Hwan , Kim Seok-Young , Jeong Seo-Yoon , Kim Jae-Hwan , Pyo Kyoung-Ho , Park Chae-Won , Heo Seong Gu , Yun Mi Ran , Lim Sangbin , Lim Sun Min , Hong Min Hee , Kim Hye Ryun , Thayu Meena , Curtin Joshua C. , Knoblauch Roland E. , Lorenzi Matthew V. , Roshak Amy , Cho Byoung Chul 
Published: May 2020

Abstract

EGFR exon 20 insertion driver mutations (Exon20ins) in non–small cell lung cancer (NSCLC) are insensitive to EGFR tyrosine kinase inhibitors (TKI). Amivantamab (JNJ-61186372), a bispecific antibody targeting EGFR–MET, has shown preclinical activity in TKI-sensitive EGFR-mutated NSCLC models and in an ongoing first-in-human study in patients with advanced NSCLC. However, the activity of amivantamab in Exon20ins-driven tumors has not yet been described. Ba/F3 cells and patient-derived cells/organoids/xenograft models harboring diverse Exon20ins were used to characterize the antitumor mechanism of amivantamab. Amivantamab inhibited proliferation by effectively downmodulating EGFR–MET levels and inducing immune-directed antitumor activity with increased IFNγ secretion in various models. Importantly, in vivo efficacy of amivantamab was superior to cetuximab or poziotinib, an experimental Exon20ins-targeted TKI. Amivantamab produced robust tumor responses in two Exon20ins patients, highlighting the important translational nature of this preclinical work. These findings provide mechanistic insight into the activity of amivantamab and support its continued clinical development in Exon20ins patients, an area of high unmet medical need.

Significance:
Currently, there are no approved targeted therapies for EGFR Exon20ins–driven NSCLC. Preclinical data shown here, together with promising clinical activity in an ongoing phase I study, strongly support further clinical investigation of amivantamab in EGFR Exon20ins–driven NSCLC.
This article is highlighted in the In This Issue feature, p. 1079
Association Between Sleep Disordered Breathing and Left Ventricular Function
Authors: Ogilvie Rachel P. , Genuardi Michael V. , Magnani Jared W. , Redline Susan , Daviglus Martha L. , Shah Neomi , Kansal Mayank , Cai Jianwen , Ramos Alberto R. , Hurwitz Barry E. , Ponce Sonia , Patel Sanjay R. , Rodriguez Carlos J. 
Published: May 2020

Background:
Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure.

Methods:
We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011–2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements.

Results:

Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1–0.3) lower E′, 0.3 (0.1–0.5) greater E/E′ ratio, and 1.07-fold (1.03–1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3–2.4) g/m
2
greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function.

Conclusions:
Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.
Outcomes of Cardiac Catheterization in Patients With Atrial Fibrillation on Anticoagulation in Contemporary in Practice
Authors: Sherwood Matthew W. , Piccini Jonathan P. , Holmes DaJuanicia N. , Pieper Karen S. , Steinberg Benjamin A. , Fonarow Gregg C. , Allen Larry A. , Naccarelli Gerald V. , Kowey Peter R. , Gersh Bernard J. , Mahaffey Kenneth W. , Singer Daniel E. , Ansell Jack E. , Freeman James V. , Chan Paul S. , Reiffel James A. , Blanco Rosalia , Peterson Eric D. , Rao Sunil V. 
Published: May 2020

Background:
Patients with atrial fibrillation on oral anticoagulation (OAC) undergoing cardiac catheterization face risks for embolic and bleeding events, yet information on strategies to mitigate these risks in contemporary practice is lacking.

Methods:
We aimed to describe the clinical/procedural characteristics of a contemporary cohort of patients with atrial fibrillation on OAC who underwent cardiac catheterization. Use of bleeding avoidance strategies and bridging therapy were described and outcomes including death, stroke, and major bleeding at 30 days and 1 year were compared by OAC type.

Results:
Of 13 404 patients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II Registry from 2013 to 2016, 741 underwent cardiac catheterization (139 with percutaneous coronary intervention) in the setting of OAC. The patients’ median age was 71, 61.8% were male, white (87.2%), had hypertension (83.7%), hyperlipidemia (72.1%), diabetes mellitus (31.6%), and chronic kidney disease (28.2%); 20.2% received warfarin while 79.8% received direct acting oral anticoagulant. One third of patients underwent radial artery access, and bivalirudin was used in 4.6%. Bridging therapy was used more often in patients on warfarin versus direct acting oral anticoagulant (16.7% versus10.0%). OAC was interrupted in 93.8% of patients. Patients on warfarin versus direct acting oral anticoagulant were equally likely to restart OAC (58.0% versus 60.7%), had similar use of antiplatelet therapy (44.0% versus 41.3%) after catheterization, and had similar rates of myocardial infarction and death at 1 year, but higher rates of major bleeding (43.3 versus 12.9 events/100 patient years) and stroke (4.9 versus 1.9 events/100 patient years).

Conclusions:
In a real-world registry of patients with atrial fibrillation undergoing cardiac catheterization, most cases are elective, performed by femoral access, with interruption of OAC. Bleeding avoidance strategies such as radial artery access and bivalirudin were used infrequently and use of bridging therapy was uncommon. Nearly 40% of patients did not restart OAC postprocedure, exposing patients to risk for stroke. Further research is necessary to optimize the management of patients with atrial fibrillation undergoing cardiac catheterization.
Evaluation of Risk-Adjusted Home Time After Acute Myocardial Infarction as a Novel Hospital-Level Performance Metric for Medicare Beneficiaries
Authors: Pandey Ambarish , Keshvani Neil , Vaughan-Sarrazin Mary S. , Gao Yubo , Girotra Saket 
Published: May 2020

Background:
The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital performance metric has been a matter of debate. Home time is a patient-centered outcome measure that accounts for rehospitalization, mortality, and postdischarge care. We aim to characterize risk-adjusted 30-day home time in patients with acute myocardial infarction (AMI) as a hospital-level performance metric and to evaluate associations with 30-day RSRR, 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR.

Methods:
The study included 984 612 patients with AMI hospitalization across 2379 hospitals between 2009 and 2015 derived from 100% Medicare claims data. Home time was defined as the number of days alive and spent outside of a hospital, skilled nursing facility, or intermediate-/long-term acute care facility 30 days after discharge. Correlations between hospital-level risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated with the Pearson correlation. Reclassification in hospital performance using 30-day home time versus 30-day RSRR and 30-day RSMR was also evaluated.

Results:

Median hospital-level risk-adjusted 30-day home time was 24.0 days (range, 15.3–29.0 days). Hospitals with higher home time were more commonly academic centers, had available cardiac surgery and rehabilitation services, and had higher AMI volume and percutaneous coronary intervention use during the AMI hospitalization. Of the mean 30-day home time days lost, 58% were to intermediate-/long-term care or skilled nursing facility stays (4.7 days), 30% to death (2.5 days), and 12% to readmission (1.0 days). Hospital-level risk-adjusted 30-day home time was inversely correlated with 30-day RSMR (
r
=−0.22,
P
<0.0001) and 30-day RSRR
(r
=−0.25,
P
<0.0001). Patients admitted to hospitals with higher risk-adjusted 30-day home time had lower 30-day readmission (quartile 1 versus 4, 21% versus 17%), 30-day mortality rate (5% versus 3%), and 1-year mortality rate (18% versus 12%). Furthermore, 30-day home time reclassified hospital performance status in ≈30% of hospitals versus 30-day RSRR and 30-day RSMR.

Conclusions:
Thirty-day home time for patients with AMI can be assessed as a hospital-level performance metric with the use of Medicare claims data. It varies across hospitals, is associated with postdischarge readmission and mortality outcomes, and meaningfully reclassifies hospital performance compared with the 30-day RSRR and 30-day RSMR metrics.
Incidence, Microbiology, and Outcomes in Patients Hospitalized With Infective Endocarditis
Authors: Shah Anoop S.V. , McAllister David A. , Gallacher Peter , Astengo Federica , Rodríguez Pérez Jesús Alberto , Hall Jennifer , Ken Lee Kuan , Bing Rong , Anand Atul , Nathwani Dilip , Mills Nicholas L. , Newby David E. , Marwick Charis , Cruden Nicholas L. 
Published: May 2020

Background:
Despite improvements in management, infective endocarditis remains associated with high mortality and morbidity. We describe temporal changes in the incidence, microbiology, and outcomes of infective endocarditis and the effect of changes in national antibiotic prophylaxis guidelines on incident infective endocarditis.

Methods:
Using a Scotland-wide, individual-level linkage approach, all patients hospitalized with infective endocarditis from 1990 to 2014 were identified and linked to national microbiology, prescribing, and morbidity and mortality datasets. Linked data were used to evaluate trends in the crude and age- and sex-adjusted incidence and outcomes of infective endocarditis hospitalizations. From 2008, microbiology data and associated outcomes adjusted for patient demographics and comorbidity were also analyzed. An interrupted time series analysis was performed to evaluate incidence before and after changes to national antibiotic prophylaxis guidelines.

Results:

There were 7638 hospitalizations (65±17 years, 51% females) with infective endocarditis. The estimated crude hospitalization rate increased from 5.3/100 000 (95% CI, 4.8-5.9) to 8.6/100 000 (95% CI, 8.1–9.1) between 1990 and 1995 but remained stable thereafter. There was no change in crude incidence following the 2008 change in antibiotic prophylaxis guidelines (relative risk of change 1.06 [95% CI, 0.94–1.20]). The incidence rate in patients >80 years of age doubled from 1990 to 2014 (17.7/100 000 [95% CI, 13.4–23.3] to 37.9/100 000 [95% CI, 31.5–45.5]). The predicted 1-year age- and comorbidity-adjusted case fatality rate for a 65-year-old patient decreased in women (27.3% [95% CI, 24.6–30.2] to 23.7% [95% CI, 21.1–26.6]) and men (30.7% [95% CI, 27.7–33.8] to 26.8% [95% CI, 24.0–29.7]) from 1990 to 2014. Blood culture data were available from 2008 (n=2267/7638, 30%), with positive blood cultures recorded in 42% (950/2267). Staphylococcus (403/950, 42.4%) and streptococcus (337/950, 35.5%) species were most common.
Staphylococcus aureus
and enterococcus had the highest 1-year mortality (adjusted odds ratio 4.34 [95% CI, 3.12–6.05] and 3.41 [95% CI, 2.04–5.70], respectively).

Conclusions:

Despite changes in antibiotic prophylaxis guidelines, the crude incidence of infective endocarditis has remained stable. However, the incidence rate has doubled in the elderly. Positive blood cultures were observed in less than half of patients, with
Staphylococcus aureus
and enterococcus bacteremia associated with worse outcomes.
Familial Recurrent Myocarditis Triggered by Exercise in Patients With a Truncating Variant of the Desmoplakin Gene
Authors: Poller Wolfgang , Haas Jan , Klingel Karin , Kühnisch Jirko , Gast Martina , Kaya Ziya , Escher Felicitas , Kayvanpour Elham , Degener Franziska , Opgen‐Rhein Bernd , Berger Felix , Mochmann Hans‐Christian , Skurk Carsten , Heidecker Bettina , Schultheiss Heinz‐Peter , Monserrat Lorenzo , Meder Benjamin , Landmesser Ulf , Klaassen Sabine 
Published: May 2020

Background
Variants of the desmosomal protein desmoplakin are associated with arrhythmogenic cardiomyopathy, an important cause of ventricular arrhythmias in children and young adults. Disease penetrance of desmoplakin variants is incomplete and variant carriers may display noncardiac, dermatologic phenotypes. We describe a novel cardiac phenotype associated with a truncating desmoplakin variant, likely causing mechanical instability of myocardial desmosomes.

Methods and Results

In 2 young brothers with recurrent myocarditis triggered by physical exercise, screening of 218 cardiomyopathy‐related genes identified the heterozygous truncating variant p.Arg1458Ter in desmoplakin. Screening for infections yielded no evidence of viral or nonviral infections. Myosin and troponin I autoantibodies were detected at high titers. Immunohistology failed to detect any residual
DSP
protein in endomyocardial biopsies, and none of the histologic criteria of arrhythmogenic cardiomyopathy were fulfilled. Cardiac magnetic resonance imaging revealed no features associated with right ventricular arrhythmogenic cardiomyopathy, but multifocal subepicardial late gadolinium enhancement was present in the left ventricles of both brothers. Screening of adult cardiomyopathy cohorts for truncating variants identified the rare genetic variants p.Gln307Ter, p.Tyr1391Ter, and p.Tyr1512Ter, suggesting that over subsequent decades critical genetic/exogenous modifiers drive pathogenesis from desmoplakin truncations toward different end points.

Conclusions
The described novel phenotype of familial recurrent myocarditis associated with a desmoplakin truncation in adolescents likely represents a serendipitously revealed subtype of arrhythmogenic cardiomyopathy. It may be caused by a distinctive adverse effect of the variant desmoplakin upon the mechanical stability of myocardial desmosomes. Variant screening is advisable to allow early detection of patients with similar phenotypes.