bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate
Authors: de Oliveira Dietrich Cristiano , de Oliveira Hollanda Lucas , Cirenza Claudio , de Paola Angelo Amato Vincenzo 
Published: December 2021

Background
Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter ablation guided by late potentials (LPs) in patients with CCC.

Methods and Results
Seventeen consecutive patients with refractory VT and CCC were prospectively included in the study. Combined endo‐epicardial voltage and late activation mapping were obtained during baseline rhythm to define scarred and LP areas, respectively. The end point of the ablation procedure was the elimination of all identified LPs. Epicardial and endocardial dense scars (<0.5 mV) were detected in 17/17 and 15/17 patients, respectively. LPs were detected in the epicardial scars of 16/17 patients and in the endocardial scars of 14/15 patients. A total of 63 VTs were induced in 17 patients; 22/63 (33%) were stable and entrained, presenting LPs recorded in the isthmus sites. The end point of ablation was achieved in 15 of 17 patients. Ablation was not completed in 2 patients because of cardiac tamponade or vicinity of the phrenic nerve and circumflex artery. Three patients (2 with unsuccessful ablation) had VT recurrence during follow‐up (39 months).

Conclusions
Endo‐epicardial LP mapping allows us to identify the putative isthmuses of different VTs and effectively perform catheter ablation in patients with CCC and drug‐refractory VTs.
Machine Learning Approach to Classify Cardiovascular Disease in Patients With Nonalcoholic Fatty Liver Disease in the UK Biobank Cohort
Authors: Sharma Divya , Gotlieb Neta , Farkouh Michael E. , Patel Keyur , Xu Wei , Bhat Mamatha 
Published: December 2021

Background
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease worldwide. Cardiovascular disease (CVD) is the leading cause of mortality among patients with NAFLD. The aim of our study was to develop a machine learning algorithm integrating clinical, lifestyle, and genetic risk factors to identify CVD in patients with NAFLD.

Methods and Results
We created a cohort of patients with NAFLD from the UK Biobank, diagnosed according to proton density fat fraction from magnetic resonance imaging data sets. A total of 400 patients with NAFLD with subclinical atherosclerosis or clinical CVD, defined by disease codes, constituted cases and 446 NAFLD cases with no CVD constituted controls. We evaluated 7 different supervised machine learning approaches on clinical, lifestyle, and genetic variables for identifying CVD in patients with NAFLD. The most significant clinical and lifestyle variables observed by the predictive modeling were age (59 years [54.00–63.00 years]), hypertension (145 mm Hg [134.0–156.0 mm Hg] and 85 mm Hg [79.00–93.00 mm Hg]), waist circumference (98 cm [95.00–105.00 cm]), and sedentary lifestyle, defined as time spent watching TV >4 h/d. In the genetic data, single‐nucleotide polymorphisms in IL16 and ANKLE1 gene were most significant. Our proposed ensemble‐based integrative machine learning model achieved an area under the curve of 0.849 using the random forest modeling for CVD prediction.

Conclusions
We propose a machine learning algorithm that identifies CVD in patients with NAFLD through integration of significant clinical, lifestyle, and genetic risk factors. These patients with NAFLD at higher risk of CVD should be flagged for screening and aggressive treatment of their cardiometabolic risk factors to prevent cardiovascular morbidity and mortality.
Non‐Hispanic Black and Hispanic Patients Have Worse Outcomes Than White Patients Within Similar Stages of Peripheral Artery Disease
Authors: Kalbaugh Corey A. , Witrick Brian , Sivaraj Laksika Banu , McGinigle Katharine L. , Lesko Catherine R. , Cykert Samuel , Robinson William P. 
Published: December 2021

Background
Racial and ethnic disparities in outcomes following lower limb revascularization for peripheral artery disease have been ascribed to disease severity at presentation for surgery.

Methods and Results
We calculated 1‐year risk of major adverse limb events (MALEs), major amputation, and death for patients undergoing elective revascularization for claudication or chronic limb‐threatening ischemia in the Vascular Quality Initiative data (2011–2018). We report hazard ratios according to race and ethnicity using Cox (death) or Fine and Gray subdistribution hazards models (MALE and major amputation, treating death as a competing event), adjusted for patient, treatment, and anatomic factors associated with disease severity. Among 88 599 patients (age, 69 years; 37% women), 1‐year risk of MALE (major amputation and death) was 12.8% (95% CI, 12.5–13.0) in 67 651 White patients, 16.5% (95% CI, 5.8–7.8) in 15 442 Black patients, and 17.2% (95% CI, 5.6–6.9) in 5506 Hispanic patients. Compared with White patients, we observed an increased hazard of poor limb outcomes among Black (MALE: 1.17; 95% CI, 1.12–1.22; amputation: 1.52; 95% CI, 1.39–1.65) and Hispanic (MALE: 1.22; 95% CI, 1.14–1.31; amputation: 1.45; 95% CI, 1.28–1.64) patients. However, Black and Hispanic patients had a hazard of death of 0.85 (95% CI, 0.79–0.91) and 0.71 (95% CI, 0.63–0.79) times the hazard among White patients, respectively. Worse limb outcomes were observed among Black and Hispanic patients across subcohorts of claudication and chronic limb‐threatening ischemia.

Conclusions
Black and Hispanic patients undergoing infrainguinal revascularization for chronic limb‐threatening ischemia and claudication had worse limb outcomes compared with White patients, even with similar disease severity at presentation. Additional investigation aimed at eliminating disparate limb outcomes is needed.
On the Southern Hemisphere Stratospheric Response to ENSO and Its Impacts on Tropospheric Circulation
Authors: Stone Kane A. , Solomon Susan , Thompson David W. J. , Kinnison Douglas E. , Fyfe John C. 
Published: December 2021

Abstract
As the leading mode of Pacific variability, El Niño–Southern Oscillation (ENSO) causes vast and widespread climatic impacts, including in the stratosphere. Following discovery of a stratospheric pathway of ENSO to the Northern Hemisphere surface, here we aim to investigate if there is a substantial Southern Hemisphere (SH) stratospheric pathway in relation to austral winter ENSO events. Large stratospheric anomalies connected to ENSO occur on average at high SH latitudes as early as August, peaking at around 10 hPa. An overall colder austral spring Antarctic stratosphere is generally associated with the warm phase of the ENSO cycle, and vice versa. This behavior is robust among reanalysis and six separate model ensembles encompassing two different model frameworks. A stratospheric pathway is identified by separating ENSO events that exhibit a stratospheric anomaly from those that do not and comparing to stratospheric extremes that occur during neutral ENSO years. The tropospheric eddy-driven jet response to the stratospheric ENSO pathway is the most robust in the spring following a La Niña, but extends into summer, and is more zonally symmetric compared to the tropospheric ENSO teleconnection. The magnitude of the stratospheric pathway is weaker compared to the tropospheric pathway and therefore, when it is present, has a secondary role. For context, the magnitude is approximately half that of the eddy-driven jet modulation due to austral spring ozone depletion in the model simulations. This work establishes that the stratospheric circulation acts as an intermediary in coupling ENSO variability to variations in the austral spring and summer tropospheric circulation.
Parameterization of Submesoscale Mixed Layer Restratification under Sea Ice
Authors: Shrestha Kalyan , Manucharyan Georgy E. 
Published: December 2021

Abstract
Commonly used parameterization of mixed layer instabilities in general circulation models was developed for temperate oceans and does not take into account the presence of sea ice in any way. However, the ice–ocean drag provides a strong mechanical coupling between the sea ice and the surface ocean currents and hence may affect mixed layer restratification processes. Here we use idealized simulations of mixed layer instabilities to demonstrate that the sea ice dramatically suppresses the eddy-driven overturning in the mixed layer by dissipating the eddy kinetic energy generated during instabilities. Considering the commonly used viscous-plastic sea ice rheology, we developed an improvement to the existing mixed layer overturning parameterization, making it explicitly dependent on sea ice concentration. Below the critical sea ice concentration of about 0.68, the internal sea ice stresses are very weak and the conventional parameterization holds. At higher concentrations, the sea ice cover starts acting as a nearly immobile surface lid, inducing strong dissipation of submesoscale eddies and reducing the intensity of the restratification streamfunction up to a factor of 4 for a fully ice-covered ocean. Our findings suggest that climate projection models might be exaggerating the restratification processes under sea ice, which could contribute to biases in mixed layer depth, salinity, ice–ocean heat fluxes, and sea ice cover.
Environmental Justice: Segregation, Noise Pollution and Health Disparities near the Hartsfield-Jackson Airport Area in Atlanta
Authors: Ray Mona 
Published: December 2021

The inquiry in this paper has two parts: (1) an examination of potential disparities in exposure to airport noise pollution between Blacks (non-Hispanic) and Whites (non-Hispanic) around the Atlanta Hartsfield-Jackson airport (AHJA) area, and (2) a binary logistic regression analysis studying factors contributing to these disparities. The proposed model is that the difference in noise exposure measured by Net Exposure Difference score is a function of the degree of Black-White residential segregation; differences in poverty rates between Blacks and Whites; some socio-economic-demographic variables and four health indicators - noise annoyance (NA); sleep disturbance (SD); hearing impairment (HI); and cardiovascular disorder (CVD). A stratified random sampling method and telephonic survey using a 43-questions questionnaire among the adult households around the AHJA area produced 237 observations on Black and White households over a period of 2 years. Parameter estimates reveals disparities in exposure to aircraft noise exposure between the Black and White households within the 10-mile radius of the airport area indicating environmental injustice. The odds-ratios from the binary logistic regression suggests residential segregation, difference in poverty rates, race, education, as well as health conditions like hearing impairment and sleep disturbances have a statistically significant association with this disparity in noise exposure.
Evaluation of Combined Cancer Markers With Lactate Dehydrogenase and Application of Machine Learning Algorithms for Differentiating Benign Disease From Malignant Ovarian Cancer
Authors: Jeong Seri , Son Dae-Soon , Cho Minseob , Lee Nuri , Song Wonkeun , Shin Saeam , Park Sung-Ho , Lee Dong Jin , Park Min-Jeong 
Published: December 2021

Background The differential diagnosis of ovarian cancer is important, and there has been ongoing research to identify biomarkers with higher performance. This study aimed to evaluate the diagnostic utility of combinations of cancer markers classified by machine learning algorithms in patients with early stage ovarian cancer, which has rarely been reported. Methods In total, 730 serum samples were assayed for lactate dehydrogenase (LD), neutrophil-to-lymphocyte ratio (NLR), human epididymis protein 4 (HE4), cancer antigen 125 (CA125), and risk of ovarian malignancy algorithm (ROMA). Among them, 53 were diagnosed with early stage ovarian cancer, and the remaining 677 were diagnosed with benign disease. Results The areas under the receiver operating characteristic curves (ROC-AUCs) of the ROMA, HE4, CA125, LD, and NLR for discriminating ovarian cancer from non-cancerous disease were .707, .680, .643, .657, and .624, respectively. ROC-AUC of the combination of ROMA and LD (.709) was similar to that of single ROMA in the total population. In the postmenopausal group, ROC-AUCs of HE4 and CA125 combined with LD presented the highest value (.718). When machine learning algorithms were applied to ROMA combined with LD, the ROC-AUC of random forest was higher than that of other applied algorithms in the total population (.757), showing acceptable performance. Conclusion Our data suggest that the combinations of ovarian cancer-specific markers with LD classified by random forest may be a useful tool for predicting ovarian cancer, particularly in clinical settings, due to easy accessibility and cost-effectiveness. Application of an optimal combination of cancer markers and algorithms would facilitate appropriate management of ovarian cancer patients.
Telephone based smoking cessation intervention for adults with serious mental illness during the COVID-19 pandemic
Authors: Leutwyler Heather , Hubbard Erin 
Published: December 2021

Background The high rates of smoking in adults with serious mental illness (SMI) increases risk for COVID-19 infection. The purpose of this paper is to present the results of a smoking cessation intervention that was adapted to be offered by phone during a Shelter in Place (SIP) period in San Francisco, California, at the beginning of the COVID-19 pandemic. Methods During the SIP, we offered counseling sessions by phone to five participants. At the end of each session, we assessed readiness to quit, tobacco cessation or reduction, and inquired about the impact of the shelter in place on smoking habits and mental health. Grounded theory guided data collection and analysis. Results The categories that emerged around barriers and facilitators for smoking cessation were COVID-19–related stressors, having purpose, structure and feelings of connections, and the importance of quitting aides for smoking cessation. Conclusion Offering telephone based smoking cessation counseling to adults with SMI while they shelter in place may improve their readiness to quit.
COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users
Authors: Krebs Nicolle M , D’Souza Gail , Bordner Candace , Allen Sophia I , Hobkirk Andrea L , Foulds Jonathan , Yingst Jessica M 
Published: December 2021

Novel mRNA vaccines have been developed and were first distributed to high-risk individuals (including smokers) in the United States starting in December 2020 to combat the coronavirus (COVID-19) pandemic. Over one-half of the U.S. adult population has received at least 1 dose of a COVID-19 vaccine, but many others have reported hesitation about becoming vaccinated. We examined COVID-19 vaccine uptake and hesitancy from a convenience sample of Pennsylvanian adult smokers in April 2021, approximately 3 months after tobacco users were eligible to receive vaccination in the state. Participants (n = 231) were 23.4% male, 90.5% white, and had a mean age of 48.1 (SD = 11.9) years. All participants were current tobacco users, with the majority reporting current cigarette smoking (90.9%) with an average of 16 (SD = 8.1) cigarettes smoked per day. Nearly 60% (n = 137) reported receiving at least 1 dose of the vaccine and of those who did not (n = 94), 84% (n = 79) said they were somewhat or very unlikely to get a vaccine. Those who were unvaccinated were more likely to not consume news about COVID-19 (chi-square P-value < .01) and less likely to believe government news sources as reliable information for COVID-19 (chi-square P-value < .01). Qualitative responses among those who were vaccine hesitant expressed concerns about the lack of research on the vaccine, distrust of the safety of the vaccine, and fears about side effects. Understanding vaccine hesitancy among tobacco users can help develop targeted communication strategies and directly address concerns to promote vaccination among this population who may be at an increased risk of severe complications from COVID-19.
Quality Assessment of Online Complementary and Alternative Medicine Information Resources Relevant to Cancer
Authors: Sansevere Megan E. , White Jeffrey D. 
Published: December 2021

Background: Complementary and alternative medicine (CAM) is often used by cancer patients and survivors in the US. Many people turn to the internet as their first source of information. Health information seeking through the internet can be useful for patients to gain a better understanding of specific CAM treatments to discuss with their healthcare team, but only if the information is comprehensive, high quality, and reliable. The aim of this article is to examine the content, writing/vetting processes, and visibility of cancer CAM online informational resources. Methods: Online CAM resources were identified by Google and PubMed searches, literature reviews, and through sources listed on various websites. The websites were analyzed through a modified online health information evaluation tool, DISCERN (score range = 1-5). The website’s features relevant to the quality assessment were described. Results: Eleven CAM websites were chosen for analysis. The DISCERN analysis showed a range of quality scores from 3.6 to 4.9. Lower DISCERN scores were generally due to deficiencies in describing the writing, editing, and updating processes. A lack of transparency with authorship and references was commonly present. Conclusion: Cancer patients interested in CAM need unbiased, evidence-based, reliable, high-quality, easily accessible educational materials. Individuals should use the guidelines followed in this analysis (including DISCERN and Medline Plus) to find reliable sources. Website developers can use CAM Cancer (NAFKAM), Beyond Conventional Cancer Therapies, Memorial Sloan Kettering Cancer Center, breastcancer.org , Office of Dietary Supplements, National Center for Complementary and Integrative Health, and Cancer.gov as models for trustworthy content.
State-Anxiety in Geriatric Patients Undergoing Surgical Treatment for Femoral Neck or Intertrochanteric Fractures
Authors: Jung Kwang-Hwan , Park Jang-Ho , Song Joon-Yeon , Han Jung-Won , Park Ki-Bong 
Published: December 2021

Introduction Geriatric patients with hip fractures often experience unexpected falls and they may have unfamiliar and unpleasant experiences within a brief period. This study aimed to investigate the prevalence and levels of preoperative anxiety in patients undergoing surgical treatment for hip fractures, and to determine the anxiety-related characteristics experienced by patients during the period before and after surgery. Materials and methods We recruited a total of 75 geriatric patients who underwent surgical treatment for hip fractures and returned complete questionnaires. We used the State-Trait Anxiety Inventory (STAI)-X type to measure state-anxiety and defined a total score of 52 or higher as clinically meaningful state-anxiety. And, we investigated main cause of anxiety, moment of the highest level of anxiety, and the most helpful factor in overcoming anxiety before surgery and in reducing anxiety after surgery. Results The mean STAI score was 47.2 points and one-third of the patients experienced various levels of clinically meaningful state-anxiety. The most common cause of preoperative anxiety was the surgery itself and patients experienced the greatest level of anxiety from the night preceding the surgery to the day of the surgery. Further, patients’ trust in the medical staff prior to surgery and the surgeon’s explanation after the surgery were the most key factors in overcoming anxiety. Conclusion This study investigates the state-anxiety of geriatric patients undergoing surgery for hip fractures and presents important findings which can help in developing evidence-based interventions to improve the experience of patients undergoing hip surgeries.
Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up
Authors: Micheloni Gian Mario , Tarallo Luigi , Negri Alberto , Giorgini Andrea , Merolla Giovanni , Porcellini Giuseppe 
Published: December 2021

Abstract
Background
Elbow arthroscopy is becoming increasingly important for the treatment of a wide range of acute and chronic elbow pathologies. Even if elbow arthroscopy is technically demanding, in the pediatric population this minimally invasive technique is preferred by many surgeons for the treatment of pathologies such as osteochondritis dissecans (OCD), posttraumatic stiffness (PTS), or elbow posterior impingement (PI). The aim of this study is to evaluate outcomes and safety of elbow arthroscopy in the pediatric and adolescent population after long-term follow-up.

Materials and methods
In this retrospective study, 26 patients younger than 18 years old undergoing elbow arthroscopy were evaluated. All surgeries were performed by a single senior surgeon. Patients were divided into three subgroups based on preoperative diagnosis: OCD, PTS, and PI. After at least 60 months follow-up, several outcome measures, including range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) were evaluated in relation to preoperative values. The level of patient satisfaction on a five-level Likert scale, any limitation or change in sport activity, and the onset of any possible complications were also evaluated.

Results
In the study population, we found an improvement in ROM (flexion of 14.4 ± 13.6°, extension of 19.5 ± 13.9°, pronation of 5.8 ± 5.7°, and supination of 8.5 ± 11.6°) and in validated outcome measures (MEPS of 21.0 ± 13.5 points and VAS of 3.8 ± 2.2 points). The satisfaction rate was 4.5, with no dissatisfaction. Eighty-seven percent of patients fully recovered their performance levels, 9% changed sport, and 4% were unable to return to sport. We identified one major and one minor complication, with an overall complication rate of 7.7%. No neurovascular injuries were detected.

Conclusions
Elbow arthroscopy in a pediatric population can be considered an effective and safe procedure for selected pathologies when performed by an experienced surgeon. At long-term follow-up, we reported excellent clinical outcomes (both objective and subjective), with a relatively low complication rate without permanent injuries.

Level of evidence
Level IV—case series.