bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score
Authors: Hasselbalch Rasmus Bo , Pries-Heje Mia Marie , Kjølhede Holle Sarah Louise , Engstrøm Thomas , Heitmann Merete , Pedersen Frants , Schou Morten , Mickley Hans , Elming Hanne , Steffensen Rolf , Koeber Lars , Iversen Kasper 
Published: October 2020

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.
ECONOMIC FLUCTUATIONS AND THE SHADOW ECONOMY: A GLOBAL STUDY
Authors: NGUYEN CANH P. , SCHINCKUS CHRISTOPHE , THANH DINH SU 
Published: October 2020

The recent economic crisis re-emphasizes the importance of the economic fluctuations. This study investigates the role of shadow economy in combination with economic factors on the economic instability for 133 economies between 1991 and 2015. Using the system-GMM estimations, this paper shows that a larger shadow economy increases the fluctuations of GDP growth rate in relation to the size and the volatility of shadow economy. Notably, the shadow economy presents an inverted-U relationship with economic instability and this relationship is strongest for low- and lower-middle income economies. Our results identify two categories of drivers for economic fluctuations: the stabilizing factors (the labor force and the TFP) and the enhancing factors (capital investment, consumption, government spending, trade, and FDI inflows). Interestingly, exports increase economic fluctuations while imports decrease them. Finally, we discuss the differences in the determinants of economic instability across low, middle and high incomes countries. This study documented that shadow economy influences the economic fluctuations — our results actually confirm our hypothesis and the impact of shadow economy on the effectiveness of macroeconomic policies. The contribution of this paper is to show the extent to which the impact can affect the economic activities and how institutions can smooth this effect.
Effectiveness of protected areas for jaguars: the case of the Taiamã Ecological Station in Brazil
Authors: Cardoso Henrique Matheus , Morato Ronaldo Gonçalves , Miyazaki Selma Samiko , Pereira Thadeu Deluque Costa , Araújo Gediendson Ribeiro de , Kantek Daniel Luis Zanella 
Published: October 2020

The largest feline in the Americas and the third largest in the world, the jaguar is an apex predator in the food chain and a key species in the ecosystems where it occurs, developing important ecological functions in maintaining ecosystem balance. In Brazil, the Pantanal is considered an important refuge for the species, and protected areas such as the Taiamã Ecological Station (TES) are relevant for conservation of pristine ecosystem where the species persist. Thus, considering that this area is located in one of the regions with the highest concentration of this large cat in the Pantanal, the objective of this study was to evaluate the effectiveness of the protection given by the TES for the jaguar population. The station is a flooded island in the middle of the Paraguay river and surrounded by extensive wetlands. We monitored ten jaguars using GPS collar at the TES and its surroundings. The samples were separated into high-water season (January to June) and low-water season (July to December), and the estimated home ranges were grouped as: 1) residents only and 2) all monitored individuals. The stabilization of the home ranges of eight jaguars, considered residents, was determined through variograms. When all jaguars were analysed together there was 55% overlap between the clustered areas of the two analysed seasons. In the analysis excluding non-resident individuals there was 72% overlap between the clustered areas. The type of land cover inside these areas was very similar between these periods. The range of this protected area is not sufficient to effectively protect these jaguar populations, since the grouped home ranges of the resident animals studied are 3.5(wet)/2.5(dry) times larger than the area of the TES. However, the surroundings of the TES have low human impact and no deforestation and, in this way, the landscape context of the station may have a significant effect on the persistence of a large carnivore like the jaguar. However, it is necessary to create more protected areas in order to prevent possible future environmental changes in the areas surrounding TES.
Distribution and identification of the White-collared Kite Leptodon forbesi and the juvenile plumages of the Gray-headed Kite Leptodon cayanensis
Authors: Lima Rafael Dantas , Menq Willian , Pallinger Frederick 
Published: October 2020

The genus Leptodon encompasses two Neotropical raptor species. The more widely-distributed Gray-headed Kite (Leptodon cayanensis) occurs in a vast area of Neotropical region, while the White-collared Kite (Leptodon forbesi) is endemic of the Atlantic Forest of northeastern Brazil, but there are some questions about the extent of its geographic distribution and about its sympatry with its congener. Here we present a review of the geographic distribution and the diagnoses of L. forbesi, correcting recent records based on misidentifications. We also clarify the main features of juvenile and subadult plumage of Leptodon raptors and describe new phases of juvenile plumage.
Risk Factors for Early Recurrence Following Ablation for Accessory Pathways
Authors: Dionne Audrey , Gauvreau Kimberlee , O’Leary Edward , Mah Douglas Y. , Abrams Dominic J. , Alexander Mark E. , DeWitt Elizabeth S. , Bezzerides Vassilios J. , Triedman John K. , Walsh Edward P. 
Published: October 2020

Background:
Atrioventricular reentrant tachycardia is common in children. Catheter ablation is increasingly used as a first-line therapy with a high acute success rate, but recurrence during follow-up remains a concern. The aim of this study was to identify risk factors for recurrence after accessory pathway (AP) ablation.

Methods:
Retrospective cohort study including patients who underwent AP ablation between 2013 and 2018. Cox proportional hazards model was used to examine the association between patient and procedural characteristics and recurrence during follow-up.

Results:
From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 (interquartile range, 0.1–1.4) years, there were 42 (8%) patients with documented recurrence. On univariate analysis, early recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and posteroseptal versus left sided), cryoablation (versus radiofrequency), empirical ablation, the lack of full power radiofrequency lesions (<50 W), radiofrequency consolidation time <90 seconds and the use of fluoroscopy without a 3-dimensional electroanatomic mapping system. On multivariable analysis, only multiple AP (hazard ratio, 2.78 [95% CI, 1.063–4.74]) and radiofrequency consolidation time < 90 seconds (hazard ratio, 4.38 [95% CI, 1.92–9.51]) remained significantly associated with early recurrence; this association remained true when analyzed in subgroups by pathway location for right and left free wall AP.

Conclusions:
In our institutional experience, radiofrequency consolidation time <90 seconds after ablation of AP was associated with an increased risk of early recurrence.
Single-Cell Transcriptome Analysis Reveals Dynamic Cell Populations and Differential Gene Expression Patterns in Control and Aneurysmal Human Aortic Tissue
Authors: Li Yanming , Ren Pingping , Dawson Ashley , Vasquez Hernan G. , Ageedi Waleed , Zhang Chen , Luo Wei , Chen Rui , Li Yumei , Kim Sangbae , Lu Hong S. , Cassis Lisa A. , Coselli Joseph S. , Daugherty Alan , Shen Ying H. , LeMaire Scott A. 
Published: October 2020

Background:
Ascending thoracic aortic aneurysm (ATAA) is caused by the progressive weakening and dilatation of the aortic wall and can lead to aortic dissection, rupture, and other life-threatening complications. To improve our understanding of ATAA pathogenesis, we aimed to comprehensively characterize the cellular composition of the ascending aortic wall and to identify molecular alterations in each cell population of human ATAA tissues.

Methods:
We performed single-cell RNA sequencing analysis of ascending aortic tissues from 11 study participants, including 8 patients with ATAA (4 women and 4 men) and 3 control subjects (2 women and 1 man). Cells extracted from aortic tissue were analyzed and categorized with single-cell RNA sequencing data to perform cluster identification. ATAA-related changes were then examined by comparing the proportions of each cell type and the gene expression profiles between ATAA and control tissues. We also examined which genes may be critical for ATAA by performing the integrative analysis of our single-cell RNA sequencing data with publicly available data from genome-wide association studies.

Results:

We identified 11 major cell types in human ascending aortic tissue; the high-resolution reclustering of these cells further divided them into 40 subtypes. Multiple subtypes were observed for smooth muscle cells, macrophages, and T lymphocytes, suggesting that these cells have multiple functional populations in the aortic wall. In general, ATAA tissues had fewer nonimmune cells and more immune cells, especially T lymphocytes, than control tissues did. Differential gene expression data suggested the presence of extensive mitochondrial dysfunction in ATAA tissues. In addition, integrative analysis of our single-cell RNA sequencing data with public genome-wide association study data and promoter capture Hi-C data suggested that the erythroblast transformation-specific related gene(
ERG
) exerts an important role in maintaining normal aortic wall function.

Conclusions:
Our study provides a comprehensive evaluation of the cellular composition of the ascending aortic wall and reveals how the gene expression landscape is altered in human ATAA tissue. The information from this study makes important contributions to our understanding of ATAA formation and progression.
Comprehensive Ex Vivo Comparison of 5 Clinically Used Conduit Configurations for Valve-Sparing Aortic Root Replacement Using a 3-Dimensional–Printed Heart Simulator
Authors: Paulsen Michael J. , Imbrie-Moore Annabel M. , Baiocchi Michael , Wang Hanjay , Hironaka Camille E. , Lucian Haley J. , Farry Justin M. , Thakore Akshara D. , Zhu Yuanjia , Ma Michael , MacArthur John W. , Woo Y. Joseph 
Published: October 2020

Background:
Many graft configurations are clinically used for valve-sparing aortic root replacement, some specifically focused on recapitulating neosinus geometry. However, the specific impact of such neosinuses on valvular and root biomechanics and the potential influence on long-term durability are unknown.

Methods:
Using a custom 3-dimenstional–printed heart simulator with porcine aortic roots (n=5), the anticommissural plication, Stanford modification, straight graft (SG), Uni-Graft, and Valsalva graft configurations were tested in series using an incomplete counterbalanced measures design, with the native root as a control, to mitigate ordering effects. Hemodynamic and videometric data were analyzed using linear models with conduit as the fixed effect of interest and valve as a fixed nuisance effect with post hoc pairwise testing using Tukey’s correction.

Results:

Hemodynamics were clinically similar between grafts and control aortic roots. Regurgitant fraction varied between grafts, with SG and Uni-Graft groups having the lowest regurgitant fractions and anticommissural plication having the highest. Root distensibility was significantly lower in SG versus both control roots and all other grafts aside from the Stanford modification (
P
≤0.01 for each). All grafts except SG had significantly higher cusp opening velocities versus native roots (
P
<0.01 for each). Relative cusp opening forces were similar between SG, Uni-Graft, and control groups, whereas anticommissural plication, Stanford modification, and Valsalva grafts had significantly higher opening forces versus controls (
P
<0.01). Cusp closing velocities were similar between native roots and the SG group, and were significantly lower than observed in the other conduits (
P
≤0.01 for each). Only SG and Uni-Graft groups experienced relative cusp closing forces approaching that of the native root, whereas relative forces were >5-fold higher in the anticommissural plication, Stanford modification, and Valsalva graft groups.

Conclusions:
In this ex vivo modeling system, clinically used valve-sparing aortic root replacement conduit configurations have comparable hemodynamics but differ in biomechanical performance, with the straight graft most closely recapitulating native aortic root biomechanics.
National Variation in Congenital Heart Surgery Outcomes
Authors: Pasquali Sara K. , Thibault Dylan , O’Brien Sean M. , Jacobs Jeffrey P. , Gaynor J. William , Romano Jennifer C. , Gaies Michael , Hill Kevin D. , Jacobs Marshall L. , Shahian David M. , Backer Carl L. , Mayer John E. 
Published: October 2020

Background:
Optimal strategies to improve national congenital heart surgery outcomes and reduce variability across hospitals remain unclear. Many policy and quality improvement efforts have focused primarily on higher-risk patients and mortality alone. Improving our understanding of both morbidity and mortality and current variation across the spectrum of complexity would better inform future efforts.

Methods:
Hospitals participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2014–2017) were included. Case mix–adjusted operative mortality, major complications, and postoperative length of stay were evaluated using Bayesian models. Hospital variation was quantified by the interdecile ratio (IDR, upper versus lower 10%) and 95% credible intervals (CrIs). Stratified analyses were performed by risk group (Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery [STAT] category) and simulations evaluated the potential impact of reductions in variation.

Results:
A total of 102 hospitals (n=84 407) were included, representing ≈85% of US congenital heart programs. STAT category 1 to 3 (lower risk) operations comprised 74% of cases. All outcomes varied significantly across hospitals: adjusted mortality by 3-fold (upper versus lower decile 5.0% versus 1.6%, IDR 3.1 [95% CrI 2.5–3.7]), mean length of stay by 1.8-fold (19.2 versus 10.5 days, IDR 1.8 [95% CrI 1.8–1.9]), and major complications by >3-fold (23.5% versus 7.0%, IDR 3.4 [95% CrI 3.0–3.8]). The degree of variation was similar or greater for low- versus high-risk cases across outcomes, eg, ≈3-fold mortality variation across hospitals for STAT 1 to 3 (IDR 3.0 [95% CrI 2.1–4.2]) and STAT 4 or 5 (IDR 3.1 [95% CrI 2.4–3.9]) cases. High-volume hospitals had less variability across outcomes and risk categories. Simulations suggested potential reductions in deaths (n=282), major complications (n=1539), and length of stay (101 183 days) over the 4-year study period if all hospitals were to perform at the current median or better, with 37% to 60% of the improvement related to the STAT 1 to 3 (lower risk) group across outcomes.

Conclusions:
We demonstrate significant hospital variation in morbidity and mortality after congenital heart surgery. Contrary to traditional thinking, a substantial portion of potential improvements that could be realized on a national scale were related to variability among lower-risk cases. These findings suggest modifications to our current approaches to optimize care and outcomes in this population are needed.
Culture or Context?
Authors: Payette Alex , Chien Yi-Chun 
Published: October 2020

Abstract
Policy legacies are an important factor explaining how, regardless of the nontraditional discourse, previously implemented laws and policies have greatly influenced the state of eldercare arrangements in both China and Taiwan. On the one hand, Taiwan has been shifting eldercare responsibilities from the family to the public through a series of social policy reforms fueled by political demands from the civil society since its democratic transition, whereas the Chinese Party-State enacted a series of filial laws in addition to reform policies, which inflated the demand and supply for familial care while at the same time impacting the development of institutional eldercare. While the issue often framed as the prevalence of filial culture in Chinese societies, this article argues, through a path dependency-based perspective, that legal provisions, policies and the structure of the political competition are largely responsible for shaping current eldercare arrangements on both sides of the strait.
Privatizing the Temple Mount (Haram es-Sharif) and the Western Wall (Kotel)
Authors: Broyde Michael J. , Zeligman David 
Published: October 2020

Abstract
Proposals abound in Israel to address the question of pluralistic access to the Temple Mount and the Western Wall. Each of these proposals has been a source of great controversy. In this article, we propose a Swiftian solution of privatization. We propose that the government of Israel sell the Temple Mount, the Western Wall, and many other holy sites to specific faith groups that will then operate them as private property, with the ability to restrict various rights within them. This proposal is based on a model adopted and implemented in Salt Lake City, Utah, to address various questions regarding access to property purchased by the Church of Jesus Christ of Latter-day Saints.
Conversion of Abandoned Property to Green Space as a Strategy to Mitigate the Urban Heat Island Investigated with Numerical Simulations
Authors: Cady Timothy J. , Rahn David A. , Brunsell Nathaniel A. , Lyles Ward 
Published: October 2020

AbstractImpervious surfaces and buildings in the urban environment alter the radiative balance and surface energy exchange and can lead to warmer temperatures known as the urban heat island (UHI), which can increase heat-related illness and mortality. Continued urbanization and anthropogenic warming will enhance city temperatures worldwide, raising the need for viable mitigation strategies. Increasing green space throughout a city is a viable option to lessen the impacts of the UHI but can be difficult to implement. The potential impact of converting existing vacant lots in Kansas City, Missouri, to green spaces is explored with numerical simulations for three heat-wave events. Using data on vacant property and identifying places with a high fraction of impervious surfaces, the most suitable areas for converting vacant lots to green spaces is determined. Land-use/land-cover datasets are modified to simulate varying degrees of feasible conversion of urban to green spaces in these areas, and the local cooling effect using each strategy is compared with the unmodified simulation. Under more aggressive greening strategies, a mean local cooling impact of 0.5°–1.0°C is present within the focus area itself during the nighttime hours. Some additional cooling via the “park cool island” is possible downwind of the converted green spaces under the more aggressive scenarios. Although moderate and conservative strategies of conversion could still lead to other benefits, those strategies have little impact on cooling. Only an aggressive approach yields significant cooling.
Systematic review on the benefit of graduated compression stockings in the prevention of venous thromboembolism in low-risk surgical patients
Authors: Machin M , Younan HC , Smith S , Salim Safa , Davies AH , Shalhoub J 
Published: October 2020

Objectives The aim of this systematic review is to assess the performance of graduated compression stockings (GCS) in comparison to no venous thromboembolism (VTE) prophylaxis in the prevention of hospital-acquired thrombosis in low-risk surgical patients undergoing short-stay procedures. Methods Aligning with PRISMA guidelines, online databases MEDLINE and EMBASE, Cochrane Library® and trial registries were searched. Eligible articles reported the VTE rate in low-risk surgical patients either receiving GCS or no VTE prophylaxis. Results Narrative synthesis was performed on a single eligible article. The included study arm consisted of participants undergoing knee arthroscopy with the use of GCS alone reporting a total of 29 VTE events (4.4%), 16 of which were asymptomatic DVTs (2.4%). Conclusion There is a complete lack of evidence to support the use of GCS in the prevention of HAT for low-risk surgical patients. An adequately powered trial is required to provide level-IA evidence to support this practice.
Effectiveness and Safety of Twice Daily Versus Thrice Daily Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis at a Tertiary Medical Center
Authors: Sorgi Meghan W. , Roach Erin , Bauer Seth R. , Bass Stephanie , Militello Michael , Welch Sarah , Lam Simon , Reddy Anita J. , Torbic Heather 
Published: October 2020

Background: The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied. Objective: This study evaluated the effectiveness and safety of BID compared to TID dosing of LDUH for prevention of VTE. Methods: Retrospective, single-center analysis of patients who received LDUH for VTE prophylaxis between July and September 2015. Outcomes were identified by ICD-9 codes. A matched cohort was created using propensity scores and multivariate analysis was conducted to identify independent risk factors for VTE. The primary outcome was incidence of symptomatic VTE. Results: In the full cohort, VTE occurred in 0.71% of patients who received LDUH BID compared to 0.77% of patients who received LDUH TID ( p = 0.85). There was no difference in major ( p = 0.85) and minor ( p = 0.52) bleeding between the BID and TID groups. For the matched cohort, VTE occurred in 1.4% of BID patients and 2.1% of TID patients ( p = 0.32). Major bleed occurred in 0.36% of BID patients and 0.52% of TID patients ( p = 0.7), while a minor bleed was seen in 3.4% of BID patients and 2.1% of TID patients ( p = 0.13). Personal history of VTE ( p = 0.002) and weight ( p = 0.035) were independently associated with increased risk of VTE. Conclusion: This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.