bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serious Illness Conversations in advanced kidney disease: a mixed-methods implementation study
Authors: Thamcharoen Natanong , Nissaisorakarn Pitchaphon , Cohen Robert A , Schonberg Mara A 
Published: March 2021

ObjectiveAdvanced kidney disease is associated with a high risk of morbidity and mortality. Consequently, invasive treatments such as dialysis may not yield survival benefits. Advance care planning has been encouraged. However, whether such discussions are acceptable when done earlier, before end-stage kidney treatment decision-making occurs, is unclear. This pilot study aimed to explore whether use of the Serious Illness Conversation Guide to aid early advance care planning is acceptable, and to evaluate the information gained from these conversations.MethodsPatients with advanced kidney disease (stage 3B and above) and high mortality risk at 2 years were enrolled in this mixed-methods study from an academic nephrology clinic. Semi-structured interviews were conducted using the adapted Serious Illness Conversation Guide. Thematic analysis was used to assess patients’ perceptions of the conversation. Participants completed a questionnaire assessing conversation acceptability.ResultsTwenty-six patients participated, 50% were female. Participants felt that the conversation guide helped them reflect on their prognosis, goals of care and treatment preferences. Most did not feel that the conversation provoked anxiety (23/26, 88%) nor that it decreased hopefulness (24/26, 92%). Some challenges were elicited; patients expressed cognitive dissonance with the kidney disease severity due to lack of symptoms; had difficulty conceptualising their goals of care; and vocalised fear of personal failure without attempting dialysis.ConclusionsPatients in this pilot study found the adapted Serious Illness Conversation Guide acceptable. This guide may be used with patients early in the course of advanced kidney disease to gather information for future advanced care planning.
End-of-life care in natural disasters including epidemics and pandemics: a systematic review
Authors: Kelly Marguerite , Mitchell Imogen , Walker Iain , Mears Jane , Scholz Brett 
Published: March 2021

BackgroundNatural disasters are becoming more frequent and severe, and place additional strains on end-of-life care services and users. Although end-of-life and palliative care are considered essential components of disaster planning and response, there are gaps in understandings about their real-life application, and how natural disasters impact end-of-life care.ObjectiveTo synthesise existing evidence of the impacts of natural disasters (eg, bushfires, communicable pandemics, etc) on end-of-life care.MethodsA systematic review with a narrative synthesis was undertaken. The review was registered on PROSPERO (registration: CRD42020176319). PubMed, Scopus, PsycINFO, Science Direct and Web of Science were searched for studies published in English between 2003 and 2020, with findings explicitly mentioning end-of-life care impacts in relation to a natural disaster. Articles were appraised for quality using a JBI-QARI tool.ResultsThirty-six empirical studies met the inclusion criteria and quality assessment. Findings were synthesised into three key themes: impacts on service provision, impacts on service providers and impacts on service users. This review demonstrates that natural disasters impact profoundly on end-of-life care, representing a stark departure from a palliative care approach.ConclusionsClinical practitioners, policy makers and researchers must continue to collaborate for viable solutions to achieve universal access to compassionate and respectful end-of-life care, during natural disasters. Using models, policies and practices already developed in palliative care, involving those most impacted in disaster planning and anticipating barriers, such as resource shortages, enables development of end-of-life care policies and practices that can be rapidly implemented during natural disasters.
Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action
Authors: Belaid Loubna , Atim Pamela , Atim Eunice , Ochola Emmanuel , Ogwang Martin , Bayo Pontius , Oola Janet , Wonyima Okello Isaac , Sarmiento Ivan , Rojas-Rozo Laura , Zinszer Kate , Zarowsky Christina , Andersson Neil 
Published: March 2021

ObjectivesDescribe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.Study designMixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process.SettingThree parishes in Nwoya district in the Gulu region, Northern Uganda.ParticipantsPurposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5–8 participants in each of three parishes.ResultsStakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall.They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient–provider relationships as short-term gains of the codesign.ConclusionParticipatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.
CT coronary angiography and COVID-19: inpatient use in acute chest pain service
Authors: Cronin Michael , Wheen Peter , Armstrong Richard , Kumar Rajesh , McMahon Alannah , White Max , Sheehy Niall , McMahon Geraldine , Murphy Ross T , Daly Caroline 
Published: March 2021

ObjectivesCT coronary angiography (CTCA) is a well-validated clinical tool in the evaluation of chest pain. In our institution, CTCA availability was increased in January 2020, and subsequently, expanded further to replace all exercise testing during the COVID-19 pandemic. Our objective was to assess the impact of increased utilisation of CTCA on length of stay in patients presenting with chest pain in the prepandemic era and during the COVID-19 pandemic.MethodsStudy design was retrospective. Patients referred for cardiology review between October 2019 and May 2020 with chest pain and/or dyspnoea were broken into three cohorts: a baseline cohort, a cohort with increased CTCA availability and a cohort with increased CTCA availability, but after the national lockdown due to COVID-19. Coronary angiography and revascularisation, length of stay and 30-day adverse outcomes were assessed.Results513 patients (35.3% female) presented over cohorts 1 (n=179), 2 (n=182), and 3 (n=153). CTCA use increased from 7.8% overall in cohort 1% to 20.4% in cohort 3. Overall length of stay for the patients undergoing CTCA decreased from a median of 4.2 days in cohort 1 to 2.5 days in cohort 3, with no increase in 30 days adverse outcomes. Invasive coronary angiogram rates were 45.8%, 39% and 34.2% across the cohorts. 29.6% underwent revascularisation in cohort 1, 15.9% in cohort 2 and to 16.4% in cohort 3.ConclusionsIncreased CTCA availability was associated with a significantly reduced length of stay both pre-COVID-19 and post-COVID-19 lockdown, without any increase in 30-day adverse outcomes.
Spatial and temporal variability in the diet of Pacific marten (Martes caurina) on Haida Gwaii: an apex predator in a highly modified ecosystem
Authors: Breault David N. , Johnson Chris J. , Todd Melissa , Verenitch Sergei S. , Gillingham Michael P. 
Published: March 2021

Knowledge of the diet ecology of apex predators in insular island ecosystems has direct applications to the conservation of endemic species at risk of extinction. We used stable isotopes of carbon and nitrogen to infer resource-use strategies of an indigenous predator, the Pacific marten (Martes caurina (Merriam, 1890)), in a highly modified ecosystem on Haida Gwaii, British Columbia, Canada. We used Bayesian isotopic mixing models to estimate the relative contributions of different food sources to marten diet across seasons and during overall lifetime, and to determine how diet varied with different levels of access to marine resources. Isotopes of carbon and nitrogen measured in hair and muscle tissue suggested that marten consumed salmon (3%–17%) and berries (25%–37%) seasonally; these diet groups were relatively minor components of the lifetime diet. Analysis of bone collagen suggested that terrestrial fauna — including birds, deer, small mammals, and invertebrates — contributed the most to diet (41%–55%), and marine invertebrates (38%–48%), not salmon (0%–3%), were the main allochthonous marine nutrient subsidy to lifetime diet. Plasticity in foraging ecology, combined with a broad dietary niche, introduced prey, notably the invasive Sitka black-tailed deer (Odocoileus hemionus sitkensis Merriam, 1898), as well as abundant marine resources, may allow marten to outcompete other indigenous and endemic carnivores on Haida Gwaii.
Null geodesics in five-dimensional Reissner–Nordström anti-de Sitter black holes
Authors: González P. A. , Olivares Marco , Vásquez Yerko , Villanueva J. R. 
Published: March 2021

AbstractThe study of the motion of photons around massive bodies is one of the most useful tools to find the geodesic structure associated with said gravitational source. In the present work, different possible paths projected in an invariant hyperplane are investigated, considering a five-dimensional Reissner–Nordström anti-de Sitter black hole. Also, we study some observational tests, such as the bending of light and the Shapiro time delay effect. Mainly, we found that the motion of photons follows the hippopede of a Proclus geodesic, which is a new type of trajectory of the second kind, the Limaçon of Pascal being their analog geodesic in four-dimensional Reissner–Nordström anti-de Sitter black hole.
Chromatin Accessibility Identifies Regulatory Elements Predictive of Gene Expression and Disease Outcome in Multiple Myeloma
Authors: Barwick Benjamin G. , Gupta Vikas A. , Matulis Shannon M. , Patton Jonathan C. , Powell Doris R. , Gu Yanyan , Jaye David L. , Conneely Karen N. , Lin Yin C. , Hofmeister Craig C. , Nooka Ajay K. , Keats Jonathan J. , Lonial Sagar , Vertino Paula M. , Boise Lawrence H. 
Published: March 2021

Abstract

Purpose:
Multiple myeloma is a malignancy of plasma cells. Extensive genetic and transcriptional characterization of myeloma has identified subtypes with prognostic and therapeutic implications. In contrast, relatively little is known about the myeloma epigenome.

Experimental Design:
CD138+CD38+ myeloma cells were isolated from fresh bone marrow aspirate or the same aspirate after freezing for 1–6 months. Gene expression and chromatin accessibility were compared between fresh and frozen samples by RNA sequencing (RNA-seq) and assay for transpose accessible chromatin sequencing (ATAC-seq). Chromatin accessible regions were used to identify regulatory RNA expression in more than 700 samples from newly diagnosed patients in the Multiple Myeloma Research Foundation CoMMpass trial (NCT01454297).

Results:
Gene expression and chromatin accessibility of cryopreserved myeloma recapitulated that of freshly isolated samples. ATAC-seq performed on a series of biobanked specimens identified thousands of chromatin accessible regions with hundreds being highly coordinated with gene expression. More than 4,700 of these chromatin accessible regions were transcribed in newly diagnosed myelomas from the CoMMpass trial. Regulatory element activity alone recapitulated myeloma gene expression subtypes, and in particular myeloma subtypes with immunoglobulin heavy chain translocations were defined by transcription of distal regulatory elements. Moreover, enhancer activity predicted oncogene expression implicating gene regulatory mechanisms in aggressive myeloma.

Conclusions:
These data demonstrate the feasibility of using biobanked specimens for retrospective studies of the myeloma epigenome and illustrate the unique enhancer landscapes of myeloma subtypes that are coupled to gene expression and disease progression.
Kinetic Characterization of ASXL1/2-Mediated Allosteric Regulation of the BAP1 Deubiquitinase
Authors: Peng Hongzhuang , Cassel Joel , McCracken Daniel S. , Prokop Jeremy W. , Sementino Eleonora , Cheung Mitchell , Collop Paul R. , Polo Alexander , Joshi Surbhi , Mandell Jacob P. , Ayyanathan Kasirajan , Hinds David , Malkowicz S. Bruce , Harbour J. William , Bowcock Anne M. , Salvino Joseph , Kennedy Eileen J. , Testa Joseph R. , Rauscher Frank J. 
Published: March 2021

Abstract

BAP1 is an ubiquitin hydrolase whose deubiquitinase activity is mediated by polycomb group-like protein ASXL2. Cancer-related BAP1 mutations/deletions lead to loss-of-function by targeting the catalytic ubiquitin C-terminal hydrolase (UCH) or UCH37-like domain (ULD) domains of BAP1, and the latter disrupts binding to ASXL2, an obligate partner for BAP1 enzymatic activity. However, the biochemical and biophysical properties of domains involved in forming the enzymatically active complex are unknown. Here, we report the molecular dynamics, kinetics, and stoichiometry of these interactions. We demonstrate that interactions between BAP1 and ASXL2 are direct, specific, and stable to biochemical and biophysical manipulations as detected by isothermal titration calorimetry (ITC), GST association, and optical biosensor assays. Association of the ASXL2-AB box greatly stimulates BAP1 activity. A stable ternary complex is formed, comprised of the BAP1-UCH, BAP1-ULD, and ASXL2-AB domains. Stoichiometric analysis revealed that one molecule of the ULD domain directly interacts with one molecule of the AB box. Real-time kinetic analysis of the ULD/AB protein complex to the BAP1-UCH domain, based on surface plasmon resonance, indicated that formation of the ULD/AB complex with the UCH domain is a single-step event with fast association and slow dissociation rates. In vitro experiments validated in cells that the ASXL-AB box directly regulates BAP1 activity.

Implications:
Collectively, these data elucidate molecular interactions between specific protein domains regulating BAP1 deubiquitinase activity, thus establishing a foundation for small-molecule approaches to reactivate latent wild-type BAP1 catalytic activity in BAP1-mutant cancers.
Mid-Term Outcomes Following Percutaneous Pulmonary Valve Implantation Using the “Folded Melody Valve” Technique
Authors: Jalal Zakaria , Valdeolmillos Estíbaliz , Malekzadeh-Milani Sophie , Eicken Andreas , Georgiev Stanimir , Hofbeck Michael , Sieverding Ludger , Gewillig Marc , Ovaert Caroline , Bouvaist Helene , Pillois Xavier , Thambo Jean-Benoit , Boudjemline Younes 
Published: March 2021

Background:
The folded valve is a manual shortening of the Melody device, which has been validated as a valuable therapeutic option for the management of dysfunctional right ventricular outflow tracts needing a short valved stent. In this article, we aimed to evaluate, in a multicenter cohort, the mid-term outcomes of patients in whom a percutaneous pulmonary valve implantation was performed using the folded valve technique.

Methods:
A 2012 to 2018 retrospective multicenter study was performed in 7 European institutions. All patients who benefit from percutaneous pulmonary valve implantation with a folded Melody valve were included.

Results:

A total of 49 patients (median age, 19 years [range 4–56], 63% male) were included. The primary percutaneous pulmonary valve implantation indication was right ventricular outflow tract stenosis (n=19; 39%), patched native right ventricular outflow tracts were the most common substrate (n=15; 31%). The folded technique was mostly used in short right ventricular outflow tracts (n=28; 57%). Procedural success was 100%. After a median follow-up of 28 months (range, 4–80), folded Melody valve function was comparable to the immediate postimplantation period (mean transvalvular peak velocity=2.6±0.6 versus 2.4±0.6 m/s,
P
>0.1; only 2 patients had mild pulmonary regurgitation). Incidence rate of valve-related reinterventions was 2.1% per person per year (95% CI, 0.1%–3.9%). The probability of survival without valve-related reinterventions at 36 months was 90% (95% CI, 76%–100%).

Conclusions:
The folded Melody valve is a safe technique with favorable mid-term outcomes up to 6.5 years after implantation, comparable with the usual Melody valve implantation procedure. Complications and reinterventions rates were low, making this technique relevant in selected patients.
Levels of Prebeta‐1 High‐Density Lipoprotein Are a Strong Independent Positive Risk Factor for Coronary Heart Disease and Myocardial Infarction: A Meta‐Analysis
Authors: Pullinger Clive R. , O’Connor Patricia M. , Naya‐Vigne Josefina M. , Kunitake Steven T. , Movsesyan Irina , Frost Philip H. , Malloy Mary J. , Kane John P. 
Published: March 2021

Background
We previously showed that levels of prebeta‐1 high‐density lipoprotein (HDL), the principal acceptor of cholesterol effluxed from cells, including artery wall macrophages, are positively associated with coronary heart disease (CHD) and myocardial infarction (MI) risk.

Methods and Results

In a multiethnic follow‐up cohort of 1249 individuals from University of California–San Francisco clinics, we determined the degree to which prebeta‐1 HDL levels, both absolute and percentage of apolipoprotein AI, are associated with CHD and history of MI. Independent, strong, positive associations were found. Meta‐analysis revealed for the absolute prebeta‐1 HDL for the top tertile versus the lowest, unadjusted odds ratios of 1.90 (95% CI, 1.40–2.58) for CHD and 1.79 (95% CI, 1.35–2.36) for MI. For CHD, adjusting for established risk factors, the top versus bottom tertiles, quintiles, and deciles yielded sizable odds ratios of 2.37 (95% CI, 1.74–3.25,
P
<0.001), 3.20 (95% CI, 2.07–4.94,
P
<0.001), and 4.00 (95% CI, 2.11–7.58,
P
<0.001), respectively. Men and women were analyzed separately in a combined data set of 2507 individuals. The odds ratios for CHD and MI risk were similar. Higher levels of prebeta‐1 HDL were associated with all 5 metabolic syndrome features. Addition of prebeta‐1 HDL to these 5 features resulted in significant improvements in risk‐prediction models.

Conclusions
Analysis of 2507 subjects showed conclusively that levels of prebeta‐1 HDL are strongly associated with a history of CHD or MI, independently of traditional risk factors. Addition of prebeta‐1 HDL can significantly improve clinical assessment of risk of CHD and MI.
Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review
Authors: Alexis Sophia L. , Malik Aaqib H. , El‐Eshmawi Ahmed , George Isaac , Sengupta Aditya , Kodali Susheel K. , Hahn Rebecca T. , Khalique Omar K. , Zaid Syed , Guerrero Mayra , Bapat Vinayak N. , Leon Martin B. , Adams David H. , Tang Gilbert H. L. 
Published: March 2021

Abstract
Mitral annular calcification with mitral valve disease is a challenging problem that could necessitate surgical mitral valve replacement (SMVR). Transcatheter mitral valve replacement (TMVR) is emerging as a feasible alternative in high‐risk patients with appropriate anatomy. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to December 25, 2019 for studies discussing SMVR or TMVR in patients with mitral annular calcification; 27 of 1539 articles were selected for final review. TMVR was used in 15 studies. Relevant data were available on 82 patients who underwent hybrid transatrial TMVR, and 354 patients who underwent transapical or transseptal TMVR. Outcomes on SMVR were generally reported as small case series (447 patients from 11 studies); however, 1 large study recently reported outcomes in 9551 patients. Patients who underwent TMVR had a shorter median follow‐up of 9 to 12 months (range, in‐hospital‒19 months) compared with patients with SMVR (54 months; range, in‐hospital‒120 months). Overall, those undergoing TMVR were older and had higher Society of Thoracic Surgeons risk scores. SMVR showed a wide range of early (0%–27%; median 6.3%) and long‐term mortality (0%–65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years, 62.4%). The median in‐hospital, 30‐day, and 1‐year mortality rates were 16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and 9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular calcification is a complex disease and TMVR, with a versatile option of transatrial approach in patients with challenging anatomy, offers a promising alternative to SMVR in high‐risk patients. However, further studies are needed to improve technology, patient selection, operative expertise, and long‐term outcomes.
Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis
Authors: Sitticharoenchai Patita , Takkavatakarn Kullaya , Boonyaratavej Smonporn , Praditpornsilpa Kearkiat , Eiam‐Ong Somchai , Susantitaphong Paweena 
Published: March 2021

Background
Non‐vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non‐valvular atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin particularly renal outcomes remain inconclusive.

Methods and Results

Electronic searches were conducted through Medline, Scopus, Cochrane Library databases, and ClinicalTrial.gov. Randomized controlled trials and observational cohort studies reporting incidence rates and hazard ratio (HR) of renal outcomes (including acute kidney injury, worsening renal function, doubling serum creatinine, and end‐stage renal disease) were selected. The random‐effects model was used to calculate pooled incidence and HR with 95% CI. Eighteen studies were included. A total of 285 201 patients were enrolled, 118 863 patients with warfarin and 166 338 patients with NOACs. The NOACs group yielded lower incidence rates of all renal outcomes when compared with the warfarin group. Patients treated with NOACs showed significantly lower HR of risk of acute kidney injury (HR, 0.70, 95% CI, 0.64–0.76;
P
<0.001), worsening renal function (HR, 0.83; 95% CI, 0.73–0.95;
P
=0.006), doubling serum creatinine (HR, 0.58; 95% CI, 0.41–0.82;
P
=0.002), and end‐stage renal disease (HR, 0.82; 95% CI, 0.78–0.86;
P
<0.001).

Conclusions
In non‐valvular atrial fibrillation, patients treated with NOACs have a lower risk of both acute kidney injury and end‐stage renal disease when compared with warfarin.