bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning–Based Quantification of Epicardial Adipose Tissue Volume and Attenuation Predicts Major Adverse Cardiovascular Events in Asymptomatic Subjects
Authors: Eisenberg Evann , McElhinney Priscilla A. , Commandeur Frederic , Chen Xi , Cadet Sebastien , Goeller Markus , Razipour Aryabod , Gransar Heidi , Cantu Stephanie , Miller Robert J.H. , Slomka Piotr J. , Wong Nathan D. , Rozanski Alan , Achenbach Stephan , Tamarappoo Balaji K. , Berman Daniel S. , Dey Damini 
Published: February 2020

Background:

Epicardial adipose tissue (EAT) volume (cm
3
) and attenuation (Hounsfield units) may predict major adverse cardiovascular events (MACE). We aimed to evaluate the prognostic value of fully automated deep learning-based EAT volume and attenuation measurements quantified from noncontrast cardiac computed tomography.

Methods:
Our study included 2068 asymptomatic subjects (56±9 years, 59% male) from the EISNER trial (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) with long-term follow-up after coronary artery calcium measurement. EAT volume and mean attenuation were quantified using automated deep learning software from noncontrast cardiac computed tomography. MACE was defined as myocardial infarction, late (>180 days) revascularization, and cardiac death. EAT measures were compared to coronary artery calcium score and atherosclerotic cardiovascular disease risk score for MACE prediction.

Results:

At 14±3 years, 223 subjects suffered MACE. Increased EAT volume and decreased EAT attenuation were both independently associated with MACE. Atherosclerotic cardiovascular disease risk score, coronary artery calcium, and EAT volume were associated with increased risk of MACE (hazard ratio [95%CI]: 1.03 [1.01–1.04]; 1.25 [1.19–1.30]; and 1.35 [1.07–1.68],
P
<0.01 for all) and EAT attenuation was inversely associated with MACE (hazard ratio, 0.83 [95% CI, 0.72–0.96];
P
=0.01), with corresponding Harrell C statistic of 0.76. MACE risk progressively increased with EAT volume ≥113 cm
3
and coronary artery calcium ≥100 AU and was highest in subjects with both (
P
<0.02 for all). In 1317 subjects, EAT volume was correlated with inflammatory biomarkers C-reactive protein, myeloperoxidase, and adiponectin reduction; EAT attenuation was inversely related to these biomarkers.

Conclusions:
Fully automated EAT volume and attenuation quantification by deep learning from noncontrast cardiac computed tomography can provide prognostic value for the asymptomatic patient, without additional imaging or physician interaction.
Efficient 1-Hour Technetium-99 m Pyrophosphate Imaging Protocol for the Diagnosis of Transthyretin Cardiac Amyloidosis
Authors: Masri Ahmad , Bukhari Syed , Ahmad Shahzad , Nieves Ricardo , Eisele Yvonne S. , Follansbee William , Brownell Amy , Wong Timothy C. , Schelbert Erik , Soman Prem 
Published: February 2020

Background:
Technetium-99 m pyrophosphate protocols for transthyretin cardiac amyloidosis diagnosis have variably used 1- and 3-hour imaging time points. We investigated whether imaging at 1 hour with superior efficiency had comparable diagnostic accuracy as 3-hour imaging.

Methods:
This is a registry analysis of patients with suspected transthyretin cardiac amyloidosis referred for technetium-99 m pyrophosphate at a single tertiary center from June 2015 through January 2019. Patients underwent planar and single-photon emission computed tomography (SPECT) imaging at 1 and 3 hours. A positive Tc-99m pyrophosphate study was defined by the presence of diffuse myocardial tracer uptake on SPECT. For planar imaging, visual semiquantitative (grades 0-3, ≥2 considered positive) and quantitative heart to contralateral ratios (≥1.5 considered positive) were used.

Results:
Two hundred thirty-three patients (69% men; median age, 77 [69–83] years) underwent the study protocol. There were 60 (25.8%) patients with diffuse myocardial uptake, 1 (0.4%) with regional uptake, and 172 (73.8%) with no myocardial uptake. Results of SPECT were identical at 1 and 3 hours. Planar imaging at 1 hour had 98% sensitivity and 96% specificity. Planar grade 0 uptake or heart to contralateral ratio ≤1.2 and planar grade 3 uptake or heart to contralateral ratio ≥2.0 were always associated with negative and positive SPECT, respectively. For planar grades 1 and 2 uptake and heart to contralateral ratio 1.3 to 1.9, SPECT was needed to make a diagnosis. No patient with light-chain cardiac amyloidosis had positive SPECT.

Conclusions:
An efficient 1-hour technetium-99 m pyrophosphate protocol had comparable diagnostic performance to a 3-hour protocol.
SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation
Authors: Kapoor Alok , Amroze Azraa , Vakil Fatima , Crawford Sybil , Der Jacqueline , Mathew Jomol , Alper Eric , Yogaratnam Dinesh , Javed Saud , Elhag Rasha , Lin Abraham , Narayanan Siddhartha , Bartlett Donna , Nagy Ahmed , Shagoury Bevin Kathleen , Fischer Michael A. , Mazor Kathleen M. , Saczynski Jane S. , Ashburner Jeffrey M. , Lopes Renato , McManus David D. 
Published: February 2020

Background:
Previous provider-directed electronic messaging interventions have not by themselves improved anticoagulation use in patients with atrial fibrillation. Direct engagement with providers using academic detailing coupled with electronic messaging may overcome the limitations of the prior interventions.

Methods and Results:

We randomized outpatient providers affiliated with our health system in a 2.5:1 ratio to our electronic profiling/messaging combined with academic detailing intervention. In the intervention, we emailed providers monthly reports of their anticoagulation percentage relative to peers for atrial fibrillation patients with elevated stroke risk (CHA
2
DS
2
-VASc ≥2). We also sent electronic medical record-based messages shortly before an appointment with an anticoagulation-eligible but untreated atrial fibrillation patient. Providers had the option to send responses with explanations for prescribing decisions. We also offered to meet with intervention providers using an academic detailing approach developed based on knowledge gaps discussed in provider focus groups. To assess feasibility, we tracked provider review of our messages. To assess effectiveness, we measured the change in anticoagulation for patients of intervention providers relative to controls. We identified 85 intervention and 34 control providers taking care of 3591 and 1908 patients, respectively; 33 intervention providers participated in academic detailing. More than 80% of intervention providers read our emails, and 98% of the time a provider reviewed our in-basket messages. Replies to messages identified patient refusal as the most common reason for patients not being on anticoagulation (11.2%). For the group of patients not on anticoagulation at baseline assigned to an intervention versus control provider, the adjusted percent increase in the use of anticoagulation over 6 months was 5.2% versus 7.4%, respectively (
P
=0.21).

Conclusions:
Our electronic messaging and academic detailing intervention was feasible but did not increase anticoagulation use. Patient-directed interventions or provider interventions targeting patients declining anticoagulation may be necessary to raise the rate of anticoagulation.

Clinical Trial Registration

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT03583008.
Sex Differences in Symptom Phenotypes Among Patients With Acute Myocardial Infarction
Authors: Brush John E. , Krumholz Harlan M. , Greene Erich J. , Dreyer Rachel P. 
Published: February 2020

Background:
The diagnosis of acute myocardial infarction (AMI) is missed more frequently in young women than men, which may be related to the cognitive psychology of the diagnostic process. Physicians start the diagnostic process by intuitively recognizing familiar symptom phenotypes, but little is known about how symptoms combine in individuals as unique symptom phenotypes. We examined how symptoms of AMI combine as unique symptom phenotypes in individual patients to compare the distribution of symptom phenotypes in women versus men.

Methods and Results:

The VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) was a multicenter, observational cohort study of 3501 young adults hospitalized with AMI. Data were collected on presenting symptoms with standardized interviews and from medical record abstraction. The number and distribution of unique symptom phenotypes were compared between women and men. Because of the 2:1 female-to-male enrollment ratio, women and men were compared with permutation testing and repeated subsampling. There were 426 interview-symptom phenotypes in women and 280 in men. The observed difference between women and men of 146 phenotypes was significant, even allowing for the greater enrollment of women (permutation
P
=0.004, median difference 110 under the null hypothesis of no association between sex and phenotype). The repeated subsample analysis also showed significantly more interview-symptom phenotypes in women than men (206.8±7.3 versus 188.6±6.0,
P
<0.001). Women were more broadly distributed among symptom phenotype subgroups than men (
P
<0.001). Similar findings were observed in the analysis of symptoms abstracted from the medical record.

Conclusions:
Women exhibited substantially more variation in unique symptom phenotypes than men, regardless of whether the symptoms were derived from structured interviews or abstracted from the medical record. These findings may provide an explanation for the higher missed diagnosis rate in young women with AMI and may have important implications for teaching and improving clinicians’ ability to recognize the diagnosis of AMI in women.
Genomic Characterization of Endothelial Enhancers Reveals a Multifunctional Role for NR2F2 in Regulation of Arteriovenous Gene Expression
Authors: Sissaoui Samir , Yu Jun , Yan Aimin , Li Rui , Yukselen Onur , Kucukural Alper , Zhu Lihua Julie , Lawson Nathan D. 
Published: February 2020

Rationale:
Significant progress has revealed transcriptional inputs that underlie regulation of artery and vein endothelial cell fates. However, little is known concerning genome-wide regulation of this process. Therefore, such studies are warranted to address this gap.

Objective:
To identify and characterize artery- and vein-specific endothelial enhancers in the human genome, thereby gaining insights into mechanisms by which blood vessel identity is regulated.

Methods and Results:

Using chromatin immunoprecipitation and deep sequencing for markers of active chromatin in human arterial and venous endothelial cells, we identified several thousand artery- and vein-specific regulatory elements. Computational analysis revealed that NR2F2 (nuclear receptor subfamily 2, group F, member 2) sites were overrepresented in vein-specific enhancers, suggesting a direct role in promoting vein identity. Subsequent integration of chromatin immunoprecipitation and deep sequencing data sets with RNA sequencing revealed that NR2F2 regulated 3 distinct aspects related to arteriovenous identity. First, consistent with previous genetic observations, NR2F2 directly activated enhancer elements flanking cell cycle genes to drive their expression. Second, NR2F2 was essential to directly activate vein-specific enhancers and their associated genes. Our genomic approach further revealed that NR2F2 acts with ERG (ETS-related gene) at many of these sites to drive vein-specific gene expression. Finally, NR2F2 directly repressed only a small number of artery enhancers in venous cells to prevent their activation, including a distal element upstream of the artery-specific transcription factor,
HEY2
(hes related family bHLH transcription factor with YRPW motif 2). In arterial endothelial cells, this enhancer was normally bound by ERG, which was also required for arterial
HEY2
expression. By contrast, in venous endothelial cells, NR2F2 was bound to this site, together with ERG, and prevented its activation.

Conclusions:

By leveraging a genome-wide approach, we revealed mechanistic insights into how NR2F2 functions in multiple roles to maintain venous identity. Importantly, characterization of its role at a crucial artery enhancer upstream of
HEY2
established a novel mechanism by which artery-specific expression can be achieved.
Cardiovascular Health Among Pregnant Women, Aged 20 to 44 Years, in the United States
Authors: Perak Amanda M. , Ning Hongyan , Khan Sadiya S. , Van Horn Linda V. , Grobman William A. , Lloyd‐Jones Donald M. 
Published: February 2020

Background
Pregnancy is a cardiometabolic stressor and thus a critical period to address women's lifetime cardiovascular health (CVH). However, CVH among US pregnant women has not been characterized.

Methods and Results

We analyzed cross‐sectional data from National Health and Nutrition Examination Surveys 1999 to 2014 for 1117 pregnant and 8200 nonpregnant women, aged 20 to 44 years. We assessed 7 CVH metrics using American Heart Association definitions modified for pregnancy; categorized metrics as ideal, intermediate, or poor; assigned these categories 2, 1, or 0 points, respectively; and summed across the 7 metrics for a total score of 0 to 14 points. Total scores 12 to 14 indicated high CVH; 8 to 11, moderate CVH; and 0 to 7, low CVH. We applied survey weights to generate US population‐level estimates of CVH levels and compared pregnant and nonpregnant women using demographic‐adjusted polytomous logistic and linear regression. Among pregnant women, the prevalences (95% CIs) of ideal levels of CVH metrics were 0.1% (0%–0.3%) for diet, 27.3% (22.2%–32.3%) for physical activity, 38.9% (33.7%–44.0%) for total cholesterol, 51.1% (46.0%–56.2%) for body mass index, 77.7% (73.3%–82.2%) for smoking, 90.4% (87.5%–93.3%) for blood pressure, and 91.6% (88.3%–94.9%) for fasting glucose. The mean total CVH score was 8.3 (95% CI, 8.0–8.7) of 14, with high CVH in 4.6% (95% CI, 0.5%–8.8%), moderate CVH in 60.6% (95% CI, 52.3%–68.9%), and low CVH in 34.8% (95% CI, 26.4%–43.2%). CVH levels were significantly lower among pregnant versus nonpregnant women; for example, 13.0% (95% CI, 11.0%–15.0%) of nonpregnant women had high CVH (adjusted, comparison
P
=0.01).

Conclusions
From 1999 to 2014, <1 in 10 US pregnant women, aged 20 to 44 years, had high CVH.
Variability of Arctic Sea Ice Based on Quantile Regression and the Teleconnection with Large-Scale Climate Patterns
Authors: Zhang Shuyu , Gan Thian Yew , Bush Andrew B. G. 
Published: February 2020

AbstractUnder global warming, Arctic sea ice has declined significantly in recent decades, with years of extremely low sea ice occurring more frequently. Recent studies suggest that teleconnections with large-scale climate patterns could induce the observed extreme sea ice loss. In this study, a probabilistic analysis of Arctic sea ice was conducted using quantile regression analysis with covariates, including time and climate indices. From temporal trends at quantile levels from 0.01 to 0.99, Arctic sea ice shows statistically significant decreases over all quantile levels, although of different magnitudes at different quantiles. At the representative extreme quantile levels of the 5th and 95th percentiles, the Arctic Oscillation (AO), the North Atlantic Oscillation (NAO), and the Pacific–North American pattern (PNA) have more significant influence on Arctic sea ice than El Niño–Southern Oscillation (ENSO), the Pacific decadal oscillation (PDO), and the Atlantic multidecadal oscillation (AMO). Positive AO as well as positive NAO contribute to low winter sea ice, and a positive PNA contributes to low summer Arctic sea ice. If, in addition to these conditions, there is concurrently positive AMO and PDO, the sea ice decrease is amplified. Teleconnections between Arctic sea ice and the climate patterns were demonstrated through a composite analysis of the climate variables. The anomalously strong anticyclonic circulation during the years of positive AO, NAO, and PNA promotes more sea ice export through Fram Strait, resulting in excessive sea ice loss. The probabilistic analyses of the teleconnections between the Arctic sea ice and climate patterns confirm the crucial role that the climate patterns and their combinations play in overall sea ice reduction, but particularly for the low and high quantiles of sea ice concentration.
Spatial Radiative Feedbacks from Internal Variability Using Multiple Regression
Authors: Bloch-Johnson Jonah , Rugenstein Maria , Abbot Dorian S. 
Published: February 2020

AbstractThe sensitivity of the climate to CO2 forcing depends on spatially varying radiative feedbacks that act both locally and nonlocally. We assess whether a method employing multiple regression can be used to estimate local and nonlocal radiative feedbacks from internal variability. We test this method on millennial-length simulations performed with six coupled atmosphere–ocean general circulation models (AOGCMs). Given the spatial pattern of warming, the method does quite well at recreating the top-of-atmosphere flux response for most regions of Earth, except over the Southern Ocean where it consistently overestimates the change, leading to an overestimate of the sensitivity. For five of the six models, the method finds that local feedbacks are positive due to cloud processes, balanced by negative nonlocal shortwave cloud feedbacks associated with regions of tropical convection. For four of these models, the magnitudes of both are comparable to the Planck feedback, so that changes in the ratio between them could lead to large changes in climate sensitivity. The positive local feedback explains why observational studies that estimate spatial feedbacks using only local regressions predict an unstable climate. The method implies that sensitivity in these AOGCMs increases over time due to a reduction in the share of warming occurring in tropical convecting regions and the resulting weakening of associated shortwave cloud and longwave clear-sky feedbacks. Our results provide a step toward an observational estimate of time-varying climate sensitivity by demonstrating that many aspects of spatial feedbacks appear to be the same between internal variability and the forced response.
Processes Responsible for the Southern Hemisphere Ocean Heat Uptake and Redistribution under Anthropogenic Warming
Authors: Lyu Kewei , Zhang Xuebin , Church John A. , Wu Quran 
Published: February 2020

AbstractThe Southern Hemisphere oceans absorb most of the excess heat stored in the climate system due to anthropogenic warming. By analyzing future climate projections from a large ensemble of the CMIP5 models under a high emission scenario (RCP8.5), we investigate how the atmospheric forcing and ocean circulation determine heat uptake and redistribution in the Southern Hemisphere oceans. About two-thirds of the net surface heat gain in the high-latitude Southern Ocean is redistributed northward, leading to enhanced and deep-reaching warming at middle latitudes near the boundary between the subtropical gyres and the Antarctic Circumpolar Current. The projected magnitudes of the ocean warming are closely related to the magnitudes of the wind and gyre boundary poleward shifts across the models. For those models with the simulated gyre boundary biased equatorward, the latitude where the projected ocean warming peaks is also located farther equatorward and a larger poleward shift of the gyre boundary is projected. In a theoretical framework, the subsurface ocean changes are explored using three distinctive processes on the temperature–salinity diagram: pure heave, pure warming, and pure freshening. The enhanced middle-latitude warming and the deepening of isopycnals are attributed to the pure heave and pure warming processes, likely related to the wind-driven heat convergence and the accumulation of extra surface heat uptake by the background ocean circulation, respectively. The equatorward and downward subductions of the surface heat and freshwater input at high latitudes (i.e., pure warming and pure freshening processes) result in cooling and freshening spiciness changes on density surfaces within the Subantarctic Mode Water and Antarctic Intermediate Water.
Development of a Method to Detect High Ice Water Content Environments Using Machine Learning
Authors: Haggerty Julie A. , Rugg Allyson , Potts Rodney , Protat Alain , Strapp J. Walter , Ratvasky Thomas , Bedka Kristopher , Grandin Alice 
Published: February 2020

AbstractThis paper describes development of a method for discriminating high ice water content (HIWC) conditions that can disrupt jet-engine performance in commuter and large transport aircraft. Using input data from satellites, numerical weather prediction models, and ground-based radar, this effort employs machine learning to determine optimal combinations of available information using fuzzy logic. Airborne in situ measurements of ice water content (IWC) from a series of field experiments that sampled HIWC conditions serve as training data in the machine-learning process. The resulting method, known as the Algorithm for Prediction of HIWC Areas (ALPHA), estimates the likelihood of HIWC conditions over a three-dimensional domain. Performance statistics calculated from an independent subset of data reserved for verification indicate that the ALPHA has skill for detecting HIWC conditions, albeit with significant false alarm rates. Probability of detection (POD), probability of false detection (POFD), and false alarm ratio (FAR) are 86%, 29% (60% when IWC below 0.1 g m−3 are omitted), and 51%, respectively, for one set of detection thresholds using in situ measurements. Corresponding receiver operating characteristic (ROC) curves give an area under the curve of 0.85 when considering all data and 0.69 for only points with IWC of at least 0.1 g m−3. Monte Carlo simulations suggest that aircraft sampling biases resulted in a positive POD bias and the actual probability of detection is between 78.5% and 83.1% (95% confidence interval). Analysis of individual case studies shows that the ALPHA output product generally tracks variation in the measured IWC.
The weight of service delivery: administrative and rules burdens in street-level bureaucracy
Authors: Stanica Cristina M. , Balica Dan , Henderson Alexander C. , Ţiclău Tudor C. 
Published: February 2020

This article explores the factors that shape perceptions of administrative and rules burdens among street-level bureaucrats in Romania. Recent research examining the concept of administrative burden has focused on burdens experienced by a citizen or client. We argue here that national context shapes the features of public service delivery, and that burdens must also be understood from the perspective of bureaucrats in transitioning post-communist countries. Street-level bureaucrats represent an important category of public servants given their main characteristics in implementing policy. Findings of two analyses—one examining broader concepts of administrative burden and one looking at the narrower concept of rules burdens—indicate that rule complexity, autonomy, conformity, job satisfaction, educational attainment, and perceived corruption impact perceptions of administrative burden, while perceptions of rules burdens are impacted by rule-abiding tendencies, discretionary latitude, job satisfaction, organizational commitment, and supervisory status. Points for practitioners A major practical implication of this study derives from our findings on the factors that impact attitudes and perceptions of street-level bureaucrats in Romania. Managers that aim to improve public service delivery in this context will be able to disseminate the fact that reduced rule complexity and increased autonomy, among other organizational variables, positively impact perceptions on administrative and rules burdens. In this sense, our study provides evidence for new and current structures to improve organizational performance and service delivery.