bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laminin‐221 Enhances Therapeutic Effects of Human‐Induced Pluripotent Stem Cell–Derived 3‐Dimensional Engineered Cardiac Tissue Transplantation in a Rat Ischemic Cardiomyopathy Model
Authors: Samura Takaaki , Miyagawa Shigeru , Kawamura Takuji , Fukushima Satsuki , Yokoyama Jun‐ya , Takeda Maki , Harada Akima , Ohashi Fumiya , Sato‐Nishiuchi Ryoko , Toyofuku Toshihiko , Toda Koichi , Sekiguchi Kiyotoshi , Sawa Yoshiki 
Published: August 2020

Background
Extracellular matrix, especially laminin‐221, may play crucial roles in viability and survival of human‐induced pluripotent stem cell‐derived cardiomyocytes (hiPS‐CMs) after in vivo transplant. Then, we hypothesized laminin‐221 may have an adjuvant effect on therapeutic efficacy by enhancing cell viability and survival after transplantation of 3‐dimensional engineered cardiac tissue (ECT) to a rat model of myocardial infarction.

Methods and Results
In vitro study indicates the impacts of laminin‐221 on hiPS‐CMs were analyzed on the basis of mechanical function, mitochondrial function, and tolerance to hypoxia. We constructed 3‐dimensional ECT containing hiPS‐CMs and fibrin gel conjugated with laminin‐221. Heart function and in vivo behavior were assessed after engraftment of 3‐dimensional ECT (laminin‐conjugated ECT, n=10; ECT, n=10; control, n=10) in a rat model of myocardial infarction. In vitro assessment indicated that laminin‐221 improves systolic velocity, diastolic velocity, and maximum capacity of oxidative metabolism of hiPS‐CMs. Cell viability and lactate dehydrogenase production revealed that laminin‐221 improved tolerance to hypoxia. Furthermore, analysis of mRNA expression revealed that antiapoptotic genes were upregulated in the laminin group under hypoxic conditions. Left ventricular ejection fraction of the laminin‐conjugated ECT group was significantly better than that of other groups 4 weeks after transplantation. Laminin‐conjugated ECT transplantation was associated with significant improvements in expression levels of rat vascular endothelial growth factor. In early assessments, cell survival was also improved in laminin‐conjugated ECTs compared with ECT transplantation without laminin‐221.

Conclusions
In vitro laminin‐221 enhanced mechanical and metabolic function of hiPS‐CMs and improved the therapeutic impact of 3‐dimensional ECT in a rat ischemic cardiomyopathy model. These findings suggest that adjuvant laminin‐221 may provide a clinical benefit to hiPS‐CM constructs.
Machine Learning Prediction of Stroke Mechanism in Embolic Strokes of Undetermined Source
Authors: Kamel Hooman , Navi Babak B. , Parikh Neal S. , Merkler Alexander E. , Okin Peter M. , Devereux Richard B. , Weinsaft Jonathan W. , Kim Jiwon , Cheung Jim W. , Kim Luke K. , Casadei Barbara , Iadecola Costantino , Sabuncu Mert R. , Gupta Ajay , Díaz Iván 
Published: August 2020

Background and Purpose:
One-fifth of ischemic strokes are embolic strokes of undetermined source (ESUS). Their theoretical causes can be classified as cardioembolic versus noncardioembolic. This distinction has important implications, but the categories’ proportions are unknown.

Methods:
Using data from the Cornell Acute Stroke Academic Registry, we trained a machine-learning algorithm to distinguish cardioembolic versus non-cardioembolic strokes, then applied the algorithm to ESUS cases to determine the predicted proportion with an occult cardioembolic source. A panel of neurologists adjudicated stroke etiologies using standard criteria. We trained a machine learning classifier using data on demographics, comorbidities, vitals, laboratory results, and echocardiograms. An ensemble predictive method including L1 regularization, gradient-boosted decision tree ensemble (XGBoost), random forests, and multivariate adaptive splines was used. Random search and cross-validation were used to tune hyperparameters. Model performance was assessed using cross-validation among cases of known etiology. We applied the final algorithm to an independent set of ESUS cases to determine the predicted mechanism (cardioembolic or not). To assess our classifier’s validity, we correlated the predicted probability of a cardioembolic source with the eventual post-ESUS diagnosis of atrial fibrillation.

Results:

Among 1083 strokes with known etiologies, our classifier distinguished cardioembolic versus noncardioembolic cases with excellent accuracy (area under the curve, 0.85). Applied to 580 ESUS cases, the classifier predicted that 44% (95% credibility interval, 39%–49%) resulted from cardiac embolism. Individual ESUS patients’ predicted likelihood of cardiac embolism was associated with eventual atrial fibrillation detection (OR per 10% increase, 1.27 [95% CI, 1.03–1.57];
c-statistic, 0.68
[95% CI, 0.58–0.78]). ESUS patients with high predicted probability of cardiac embolism were older and had more coronary and peripheral vascular disease, lower ejection fractions, larger left atria, lower blood pressures, and higher creatinine levels.

Conclusions:
A machine learning estimator that distinguished known cardioembolic versus noncardioembolic strokes indirectly estimated that 44% of ESUS cases were cardioembolic.
Labor Market Trajectories for Community College Graduates: How Returns to Certificates and Associate's Degrees Evolve Over Time
Authors: Minaya Veronica , Scott-Clayton Judith 
Published: August 2020

Abstract
We estimate labor market returns to terminal associate's degrees and certificates, with a particular focus on how returns for different credential types evolve over a longer period of time (eleven years post entry) than most of the prior literature. We also explore how returns vary depending on labor market conditions and on which labor market outcome metric is used. Using administrative data from Ohio and an individual fixed-effects approach, we find that the value of an associate's degree grows substantially after graduation, and this finding is robust to choice of specification and outcome. The returns to a long-term certificate are flat over time in our main specification, but more sensitive to assumptions about individual-specific earnings trends. Returns to associate's degrees are notably higher in recession years versus prerecession years. Finally, we find that associate's degrees lead to improved outcomes relative to non-completion across a range of metrics, including higher paying jobs, more stability in employment over time, and a greater likelihood of earning a living wage, whereas certificates generally pay off via the employment margin and a reduced likelihood of claiming unemployment insurance.
Isolating the Evolving Contributions of Anthropogenic Aerosols and Greenhouse Gases: A New CESM1 Large Ensemble Community Resource
Authors: Deser Clara , Phillips Adam S. , Simpson Isla R. , Rosenbloom Nan , Coleman Dani , Lehner Flavio , Pendergrass Angeline G. , DiNezio Pedro , Stevenson Samantha 
Published: August 2020

AbstractThe evolving roles of anthropogenic aerosols (AER) and greenhouse gases (GHG) in driving large-scale patterns of precipitation and SST trends during 1920–2080 are studied using a new set of “all-but-one-forcing” initial-condition large ensembles (LEs) with the Community Earth System Model version 1 (CESM1), which complement the original “all-forcing” CESM1 LE (ALL). The large number of ensemble members (15–20) in each of the new LEs enables regional impacts of AER and GHG to be isolated from the noise of the model’s internal variability. Our analysis approach, based on running 50-yr trends, accommodates geographical and temporal changes in patterns of forcing and response. AER are shown to be the primary driver of large-scale patterns of externally forced trends in ALL before the late 1970s, and GHG to dominate thereafter. The AER and GHG forced trends are spatially distinct except during the 1970s transition phase when aerosol changes are mainly confined to lower latitudes. The transition phase is also characterized by a relative minimum in the amplitude of forced trend patterns in ALL, due to a combination of reduced AER and partially offsetting effects of AER and GHG. Internal variability greatly limits the detectability of AER- and GHG-forced trend patterns in individual realizations based on pattern correlation metrics, especially during the historical period, highlighting the need for LEs. We estimate that <20% of the spatial variances of observed precipitation and SST trends are attributable to AER and GHG forcing, although model biases in patterns of forced response and signal-to-noise may affect this estimate.
Floods due to Atmospheric Rivers along the U.S. West Coast: The Role of Antecedent Soil Moisture in a Warming Climate
Authors: Cao Qian , Gershunov Alexander , Shulgina Tamara , Ralph F. Martin , Sun Ning , Lettenmaier Dennis P. 
Published: August 2020

AbstractPrecipitation extremes are projected to become more frequent along the U.S. West Coast due to increased atmospheric river (AR) activity, but the frequency of less intense precipitation events may decrease. Antecedent soil moisture (ASM) conditions can have a large impact on flood responses, especially if prestorm precipitation decreases. Taken together with increased antecedent evaporative demand due to warming, this would result in reduced soil moisture at the onset of extreme precipitation events. We examine the impact of ASM on AR-related floods in a warming climate in three basins that form a transect along the U.S. Pacific Coast: the Chehalis River basin in Washington, the Russian River basin in Northern California, and the Santa Margarita River basin in Southern California. We ran the Distributed Hydrology Soil Vegetation Model (DHSVM) over the three river basins using forcings downscaled from 10 global climate models (GCMs). We examined the dynamic role of ASM by comparing the changes in the largest 50, 100, and 150 extreme events in two periods, 1951–2000 and 2050–99. In the Chehalis basin, the projected fraction of AR-related extreme discharge events slightly decreases. In the Russian basin, this fraction increases, however, and more substantially so in the Santa Margarita basin. This is due to increases in AR-related extreme precipitation events, as well as the fact that the relationship of extreme precipitation to extreme discharge is strengthened by projected increases in year-to-year volatility of annual precipitation in California, which increases the likelihood of concurrent occurrence of large storms and wet ASM conditions.
Automatic Classification of Biological Targets in a Tidal Channel Using a Multibeam Sonar
Authors: Cotter Emma , Polagye Brian 
Published: August 2020

AbstractMultibeam sonars are widely used for environmental monitoring of fauna at marine renewable energy sites. However, they can rapidly accrue vast volumes of data, which poses a challenge for data processing. Here, using data from a deployment in a tidal channel with peak currents of 1–2 m s−1, we demonstrate the data-reduction benefits of real-time automatic classification of targets detected and tracked in multibeam sonar data. First, we evaluate classification capabilities for three machine learning algorithms: random forests, support vector machines, and k-nearest neighbors. For each algorithm, a hill-climbing search optimizes a set of hand-engineered attributes that describe tracked targets. The random forest algorithm is found to be most effective—in postprocessing, discriminating between biological and nonbiological targets with a recall rate of 0.97 and a precision of 0.60. In addition, 89% of biological targets are correctly classified as either seals, diving birds, fish schools, or small targets. Model dependence on the volume of training data is evaluated. Second, a real-time implementation of the model is shown to distinguish between biological targets and nonbiological targets with nearly the same performance as in postprocessing. From this, we make general recommendations for implementing real-time classification of biological targets in multibeam sonar data and the transferability of trained models.
Biometric Analysis of Surgeons’ Physiologic Responses During Surgery
Authors: Ciraulo Luciano A. , Robaczewski Marshall L. , Ciraulo Nicolas A. , Ciraulo Rocco S. , Robaczewski Grant D. , Falank Carolyne R. , Ontengco Julianne B. , Ciraulo David L. 
Published: August 2020

Background Much has been written from the social science perspective surrounding surgeons’ stress and burn out. The literature is sparse in reference to scientific investigations of the hemodynamic effect of that stress. This prospective clinical study quantifies the physiologic impact of performing surgery upon the acute care surgeon. Methods Over 2.5 years, monitoring devices were affixed to surgeons prior to entering the operating room, and physiologic variables were documented every 30 minutes. Qualifying cases were projected as being greater than 2 hours with a baseline preoperative measurement obtained. Variables recorded included blood pressure (BP), heart rate (HR), rate pressure product (RPP), oxygen saturation (O2 sat), and end-tidal carbon dioxide (ET CO2). Results Statistically significant differences ( P < .05) were found between baseline data to the maximum recording during the surgical operation for: BP (min 101 ± 6.6 (mmHg)-max 117 ± 5.1 (mmHg)), HR (min 70.5 ± 6.2 (bpm)-max 83.7 ± 9.0 (bpm)), O2 sat (min 97 ± 2.0 (%)-max 100 ± 0.22(%)), and ET CO2 (min 34.1 ± 1.15 mmHg-max 38 ± 1.7 mmHg) ( P < .0001). The RPP ranged from 10.49 mmHg/min to 15.88 mmHg/min with a mean of 14.00 mmHg/min. Discussion The practice of surgery is considered demanding in training and lifestyle in comparison to other medical specialties. This data is among the first to demonstrate the negative physiological impact of surgery upon the metabolic demand of the surgeon. The longitudinal implications of increased physiologic demand over time may have cardiovascular and cerebrovascular consequences.
Improving educator’s knowledge and confidence to teach infection prevention and antimicrobial resistance
Authors: Hayes Catherine , Eley Charlotte , Brown Carla , Syeda Rowshonara , Verlander Neville Q , Hann Magda , McNulty Cliodna 
Published: August 2020

Objective: e-Bug is a teaching resource that addresses the UK 5-year National Action Plan on antimicrobial resistance (AMR) that pledges to work with educators and local authorities to ensure young people understand infection prevention and control (IPC) and AMR. This study aimed to evaluate the effectiveness and acceptability of the e-Bug face-to-face train-the-trainer intervention with school and community educators. Design: Service evaluation of an educational intervention via surveys. Setting: Workshops were organised by Public Health England (PHE) and collaborators in seven regions of the UK during 2018–2019. Method: Pre- and post-intervention surveys measured satisfaction with training, knowledge of IPC and AMR, and confidence to teach others. Statistical analyses included multilevel and ordinal logistic regression models to measure change in educator knowledge and confidence. Results: In all, 262 educators participated: primary (46%), secondary (17%), college (2%), healthcare (29%) and community (7%). Educators had high pre-intervention knowledge of topics, with significant improvement ( p < .05) in confidence to teach all topics and some significant IPC knowledge improvement, post-intervention. There was strong evidence for a difference in confidence change between educator types, with primary educators improving the most. Ninety-five percent of educators rated the train-the-trainer workshop positively, valued the interactive workshops and felt confident to use the resources. Conclusion: Confident and knowledgeable educators, achieved via e-Bug train-the-trainer workshops, will enhance education of IPC and AMR topics in schools and communities, and therefore support the UK 5-year AMR action plan. The intervention will be monitored with long-term follow-up surveys to explore how training has been disseminated and to evaluate long-term benefits.
Trends in Childhood Influenza Vaccination Coverage, United States, 2012-2019
Authors: Santibanez Tammy A. , Srivastav Anup , Zhai Yusheng , Singleton James A. 
Published: August 2020

Objective The objective was to compare estimates of childhood influenza vaccination across 7 consecutive influenza seasons based on 2 survey systems. Methods We analyzed data from the National Health Interview Survey (NHIS) and the National Immunization Survey–Flu (NIS-Flu) using Kaplan-Meier survival analysis to estimate receipt, based on parental report, of at least 1 dose of influenza vaccine among children aged 6 months to 17 years. Results We found no significant increasing trend in influenza vaccination coverage among children overall from 2012 to 2018 based on the NHIS or from 2012 to 2019 based on the NIS-Flu. We found 4 seasons with a significant increase in influenza vaccination coverage compared with the previous season (2012-2013 [NHIS, NIS-Flu], 2013-2014 [NIS-Flu], 2017-2018 [NHIS], and 2018-2019 [NIS-Flu]). As of the 2018-2019 season, based on NIS-Flu, influenza vaccination coverage was only 62.6%. Children with health conditions that put them at increased risk for complications from influenza had higher influenza vaccination coverage than children without these health conditions for all the seasons studied except 2014-2015. For all seasons studied, influenza vaccination coverage estimates for children were higher based on NIS-Flu data compared with NHIS data. Trends across seasons and differences in vaccination coverage between age groups were similar between the 2 surveys. Conclusions Influenza vaccination coverage among children appears to have plateaued. Only about half of the children in the United States were vaccinated against influenza. Improvements in measurement of influenza vaccination and development and review of strategies to increase childhood influenza vaccination coverage are needed.
Effect of antithrombin in fresh frozen plasma on hemostasis after cardiopulmonary bypass surgery
Authors: Shirozu Kazuhiro , Karashima Yuji , Yamaura Ken 
Published: August 2020

Introduction: Supplementation of fresh frozen plasma immediately after cardiopulmonary bypass is an effective method to enhance clotting ability as coagulation factors are consumed in the extracorporeal circuit during cardiopulmonary bypass. On the other hand, the anticoagulation factors in fresh frozen plasma can also deter the clotting ability. This study investigated the effect of fresh frozen plasma administration on the comprehensive clotting ability following cardiopulmonary bypass. Methods: This prospective observational study included 22 patients scheduled for cardiac surgery. Clotting times and maximum clot firmness were evaluated using the types of rotational thromboelastometry, intrinsic rotational thromboelastometry, and heparinase thromboelastography preoperatively, immediately after cardiopulmonary bypass, and 1 hour after cardiopulmonary bypass. Activated clotting time, antithrombin activity, and heparin concentration were also measured at these time-points. Results: Antithrombin activity (62.9 ± 7.2% vs. 51.1 ± 7.4%, p < 0.0001) and activated clotting time (132.6 ± 9.6% vs. 120.0 ± 9.0%, p < 0.001) were significantly higher 1 hour after cardiopulmonary bypass compared to measurements taken immediately after cardiopulmonary bypass. Heparin concentration 1 hour after cardiopulmonary bypass was significantly decreased compared to that immediately after cardiopulmonary bypass. On the other hand, maximum clot firmness determined via intrinsic rotational thromboelastometry was significantly greater 1 hour after cardiopulmonary bypass (53.8 ± 4.8 mm) than that immediately after cardiopulmonary bypass (49.5 ± 4.8 mm). Clotting time determined via intrinsic rotational thromboelastometry and heparinase thromboelastography was also significantly shorter 1 hour after cardiopulmonary bypass than that immediately after cardiopulmonary bypass. Conclusion: Fresh frozen plasma administration increased antithrombin activity and caused activated clotting time prolongation, but then increased clotting ability. Thus, testing by rotational thromboelastometry after cardiopulmonary bypass could be valuable in the detection of comprehensive clotting ability.
Associations between hemodynamic parameters at rest and exercise capacity in patients with implantable left ventricular assist devices
Authors: Kondo Toru , Okumura Takahiro , Oishi Hideo , Arao Yoshihito , Kato Hiroo , Yamaguchi Shogo , Kuwayama Tasuku , Haga Tomoaki , Yokoi Tsuyoshi , Hiraiwa Hiroaki , Fukaya Kenji , Sawamura Akinori , Morimoto Ryota , Mutsuga Masato , Fujimoto Kazuro , Usui Akihiko , Murohara Toyoaki 
Published: August 2020

Background: Hemodynamic parameters at rest are known to correlate poorly with peak oxygen uptake (VO2) in heart failure. However, we hypothesized that hemodynamic parameters at rest could predict exercise capacity in patients with left ventricular assist device (LVAD), because LVAD pump rotational speed does not respond during exercise. Therefore, we investigated the relationships between hemodynamic parameters at rest (measured with right heart catheterization) and exercise capacity (measured with cardiopulmonary exercise testing) in patients with implantable LVAD. Methods: We performed a retrospective medical record review of patients who received implantable LVAD at our institution from November 2013 to December 2017. Results: A total of 20 patients were enrolled in this study (15 males; mean age, 45.8 years; median duration of LVAD support, 356 days). The mean peak VO2 and cardiac index (CI) were 13.5 mL/kg/min and 2.6 L/min/m2, respectively. CI and hemoglobin level were significantly associated with peak VO2 (CI: r = 0.632, p = 0.003; hemoglobin: r = 0.520, p = 0.019). In addition, pulmonary capillary wedge pressure, right atrial pressure, and right ventricular stroke work index were also significantly associated with peak VO2. In multiple linear regression analysis, CI and hemoglobin level remained independent predictors of peak VO2 (CI: β = 0.559, p = 0.006; hemoglobin: β = 0.414, p = 0.049). Conclusions: CI at rest and hemoglobin level are associated with poor exercise capacity in patients with LVAD.
Hypophosphatemia and Outcomes in ICU: A Systematic Review and Meta-Analysis
Authors: Sin Jeremy Cheuk Kin , King Lillian , Ballard Emma , Llewellyn Stacey , Laupland Kevin B. , Tabah Alexis 
Published: August 2020

Purpose: Hypophosphatemia is reported in up to 5% of hospitalized patients and ranges from 20% to 80% in critically ill patients. The consequences of hypophosphatemia for critically ill patients remain controversial. We evaluated the effect of hypophosphatemia on mortality and length of stay in intensive care unit (ICU) patients. Methods: MEDLINE, EMBASE, Cochrane Library (Reviews and Trials), and PubMed were searched for articles in English. The primary outcome was mortality and secondary outcome was length of stay. The quality of evidence was graded using a modified Newcastle-Ottawa Scale. Results: Our search yielded 828 articles and ultimately included 12 studies with 7626 participants in the analysis. Hypophosphatemia was associated with increased hospital length of stay (2.19 days [95% CI, 1.74-2.64]) and ICU length of stay (2.22 days [95% CI, 1.00-3.44]) but not mortality (risk ratio: 1.13 [95% CI, 0.98-1.31]; P = .09). Conclusions: Hypophosphatemia in ICU was associated with increased hospital and ICU length of stay but not all-cause mortality. Hypophosphatemia appears to be a marker of disease severity. Limited number of available studies and varied study designs did not allow for the ascertainment of the effect of severe hypophosphatemia on patient mortality.