bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comment on ‘Pulse rate variability in cardiovascular health: a review on its applications and relationship with heart rate variability’
Authors: Hejjel László , Béres Szabolcs 
Published: February 2021

Abstract
Precise beat-to-beat fiducial point detection in the photoplethysmogram signal is essential for reliable pulse rate variability (PRV) analysis, which is considered an integral part of health monitoring devices in the evolving era of mobile health. Several studies have aimed to compare PRV to the well-investigated, gold standard heart rate variability (HRV) analysis, to see if they are interchangeable. The agreement between PRV and HRV is not unequivocal, as we learn from the commented metaanalysis. Technical factors like low sampling rate of photoplethysmography (PPG) or imprecise fiducial point detection are more important in this difference than physiological factors corresponding to pulse arrival time. Standardization of the PPG acquisition and reference point detection is necessary for comparable studies and correct measurement.
EMC3-EIRENE simulation of first wall recycling fluxes in W7-X with relation to H-alpha measurements
Authors: Winters V R , Reimold F , König R , Krychowiak M , Romba T , Biedermann C , Bozhenkov S , Drewelow P , Endler M , Feng Y , Frerichs H , Fuchert G , Geiger J , Gao Y , Harris J H , Jakubowski M , Kornejew P , Kremeyer T , Niemann H , Pasch E , Puig-Sitjes A , Schlisio G , Scott E R , Wurden G A 
Published: February 2021

Abstract
In the Wendelstein 7-X stellarator, the main locations of particle sources are expected to be the carbon divertors, baffles and graphite heat shield first wall. In this paper, the heat shield is implemented in EMC3-EIRENE to understand the expected areas and magnitudes of the recycling flux to this component. It is found that in the simulation the heat shield is not a significant source of recycling neutrals. The areas of simulated recycling flux are shown to correlate well with footprints of plasma-wetting seen in post-experimental campaign in-vessel inspection photos. EMC3-EIRENE reconstruction of line-integrated H-alpha measurements at the heat shield indicate that the majority of emission does not come from local recycling neutrals. Rather, the H-alpha signals at the heat shield are dominated by ionization of neutrals which have leaked from the divertor/baffle region into the midplane. The magnitude of the H-alpha line emission from the synthetic reconstruction is consistent with the experiment, indicating that a large overestimation of heat shield recycling would occur if these measurements were assumed to be from local recycling sources. In the future, it may be possible to obtain some information of local recycling from the heat shield since it was found that the majority of the recycling flux occurs on two well-localized areas.
Chiral switching and dynamic barrier reductions in artificial square ice
Authors: Leo Naëmi , Pancaldi Matteo , Koraltan Sabri , González Pedro Villalba , Abert Claas , Vogler Christoph , Slanovc Florian , Bruckner Florian , Heistracher Paul , Hofhuis Kevin , Menniti Matteo , Suess Dieter , Vavassori Paolo 
Published: February 2021

Abstract
Collective dynamics in lithographically-defined artificial spin ices offer profound insights into emergent correlations and phase transitions of geometrically-frustrated Ising spin systems. Their temporal and spatial evolution are often simulated using kinetic Monte Carlo (kMC) simulations, which rely on the precise knowledge of the switching barriers to obtain predictive results in agreement with experimental observations. In many cases, however, the barriers are derived from simplified assumptions only, and do not take into account the full physical picture of nanomagnetic switching. Here we describe how the immediate magnetic square- or kagome-ice environment of a nanomagnet reversing via quasi-coherent rotation can induce clockwise and counter-clockwise switching channels with different barrier energies. This energy splitting for chiral reversal channels can be sizeable and, as string-method micromagnetic simulations show, is relevant for artificial spin ice systems made of both exchange- as well as magnetostatically-dominated units. Due to the barrier splitting and further reductions due to non-uniform reversal, transition rates can be exponentially enhanced by several orders of magnitude compared to mean-field predictions, especially in the limit of rare switching events where thermal excitation is less likely. This leads to significantly faster relaxation time scales and modified spatial correlations. Our findings are thus of integral importance to achieve realistic kMC simulations of emergent correlations in artificial spin systems, magnonic crystals, or the evolution of nanomagnetic logic circuits.
The high-value pharmacy enterprise framework: Advancing pharmacy practice in health systems through a consensus-based, strategic approach
Authors: Rough Steve , Shane Rita , Armitstead John A , Belford Sylvia M , Brummond Philip W , Chen David , Collins Christine M , Dalton Heather , Dopp Anna Legreid , Estevez Michelle M , Hager David R , Halbach Brooke , Hays Ryan , Knoer Scott , Kotis Desi , Montgomery Derek , Plummer Brooks , Riester Melissa R , Schreier Diana J , Simonson Deborah , Siska Mark H , Waier Kelsey , Vermeulen Lee C 
Published: February 2021

AbstractPurposeThe high-value pharmacy enterprise (HVPE) framework and constituent best practice consensus statements are presented, and the methods used to develop the framework’s 8 domains are described.SummaryA panel of pharmacy leaders used an evidence- and expert opinion–based approach to define core and aspirational elements of practice that should be established within contemporary health-system pharmacy enterprises by calendar year 2025. Eight domains of an HVPE were identified: Patient Care Services; Business Services; Ambulatory and Specialty Pharmacy Services; Inpatient Operations; Safety and Quality; Pharmacy Workforce; Information Technology, Data, and Information Management; and Leadership. Phase 1 of the project consisted of the development of draft practice statements, performance elements, and supporting evidence for each domain by panelists, followed by a phase 2 in-person meeting for review and development of consensus for statements and performance elements in each domain. During phase 3, the project cochairs and panelists finalized the domain drafts and incorporated them into a full technical report and this summary report.ConclusionThe HVPE framework is a strategic roadmap to advance pharmacy practice by ensuring safe, effective, and patient-centered medication management and business practices throughout the health-system pharmacy enterprise. Grounded in evidence and expert recommendations, the statements and associated performance elements can be used to identify strategic priorities to improve patient outcomes and add value within health systems.
The Escherichia coli CitT transporter can be used as a succinate exporter for succinate production
Authors: Takahashi Sousuke , Miyachi Mayu , Tamaki Hisanori , Suzuki Hideyuki 
Published: February 2021

ABSTRACT
Escherichia coli strain, whose gene is one of the subunits of succinate dehydrogenase (sdhA), and gene of the transcriptional repressor of isocitrate lyase (iclR) were disrupted, accumulated 6.6 times as much intracellular succinate as the wild-type MG1655 strain in aerobic growth, but succinate was not found in the culture medium. E. coli citT gene that encodes a citrate transporter was cloned under the control of the lacI promoter in pBR322-based plasmid and the above strain was transformed. This transformant, grown under aerobic condition in M9-tryptone medium with citrate, accumulated succinate in the medium while no succinate was found in the medium without citrate. CitT was active as a succinate transporter for 168 h by changing the culture medium or for 24 h in fed-batch culture. This study suggests that the CitT transporter functions as a succinate exporter in E. coli for succinate production in the presence of citrate.
Imaging meningeal inflammation in CNS autoimmunity identifies a therapeutic role for BTK inhibition
Authors: Bhargava Pavan , Kim Sol , Reyes Arthur A , Grenningloh Roland , Boschert Ursula , Absinta Martina , Pardo Carlos , Van Zijl Peter , Zhang Jiangyang , Calabresi Peter A 
Published: February 2021

Abstract
Leptomeningeal inflammation in multiple sclerosis is associated with worse clinical outcomes and greater cortical pathology. Despite progress in identifying this process in multiple sclerosis patients using post-contrast fluid-attenuated inversion recovery imaging, early trials attempting to target meningeal inflammation have been unsuccessful. There is a lack of appropriate model systems to screen potential therapeutic agents targeting meningeal inflammation. We utilized ultra-high field (11.7 T) MRI to perform post-contrast imaging in SJL/J mice with experimental autoimmune encephalomyelitis induced via immunization with proteolipid protein peptide (PLP139–151) and complete Freund’s adjuvant. Imaging was performed in both a cross-sectional and longitudinal fashion at time points ranging from 2 to 14 weeks post-immunization. Following imaging, we euthanized animals and collected tissue for pathological evaluation, which revealed dense cellular infiltrates corresponding to areas of contrast enhancement involving the leptomeninges. These areas of meningeal inflammation contained B cells (B220+), T cells (CD3+) and myeloid cells (Mac2+). We also noted features consistent with tertiary lymphoid tissue within these areas, namely the presence of peripheral node addressin-positive structures, C-X-C motif chemokine ligand-13 (CXCL13)-producing cells and FDC-M1+ follicular dendritic cells. In the cortex adjacent to areas of meningeal inflammation we identified astrocytosis, microgliosis, demyelination and evidence of axonal stress/damage. Since areas of meningeal contrast enhancement persisted over several weeks in longitudinal experiments, we utilized this model to test the effects of a therapeutic intervention on established meningeal inflammation. We randomized mice with evidence of meningeal contrast enhancement on MRI scans performed at 6 weeks post-immunization, to treatment with either vehicle or evobrutinib [a Bruton tyrosine kinase (BTK) inhibitor] for a period of 4 weeks. These mice underwent serial imaging; we examined the effect of treatment on the areas of meningeal contrast enhancement and noted a significant reduction in the evobrutinib group compared to vehicle (30% reduction versus 5% increase; P = 0.003). We used ultra-high field MRI to identify areas of meningeal inflammation and to track them over time in SJL/J mice with experimental autoimmune encephalomyelitis, and then used this model to identify BTK inhibition as a novel therapeutic approach to target meningeal inflammation. The results of this study provide support for future studies in multiple sclerosis patients with imaging evidence of meningeal inflammation.
Reducing Broad-Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study
Authors: Shah Aditya , Sampathkumar Priya , Stevens Ryan W , Bohman John K , Lahr Brian D , Dhungana Prabij , Vashistha Kirtivardhan , O’Horo John C 
Published: February 2021

Abstract

Background
The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across 3 time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol.

Methods
In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and National Healthcare Safety Network–reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we reevaluated the same metrics.

Results
Our study population included 338 intensive care unit patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol, we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad-spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates.

Conclusions
Our final protocol significantly reduces broad-spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.
Summary: There are no guidelines for antimicrobial prophylaxis in patients on extracorporeal membrane oxygenation (ECMO). A rational approach employing concepts of antimicrobial stewardship can drive logical antimicrobial selection for prophylaxis in patients on ECMO without adversely impacting outcomes.
Baseline Neurocognitive Impairment (NCI) Is Associated With Incident Frailty but Baseline Frailty Does Not Predict Incident NCI in Older Persons With Human Immunodeficiency Virus (HIV)
Authors: Masters Mary Clare , Perez Jeremiah , Wu Kunling , Ellis Ronald J , Goodkin Karl , Koletar Susan L , Andrade Adriana , Yang Jingyan , Brown Todd T , Palella Frank J , Sacktor Ned , Tassiopoulos Katherine , Erlandson Kristine M 
Published: February 2021

Abstract

Background
Neurocognitive impairment (NCI) and frailty are more prevalent among persons with human immunodeficiency virus (HIV, PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well established.

Methods
AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI.

Results
In total, 929 participants were included with a median age of 51 years (interquartile range [IQR] 46–56). At study entry, 16% had NCI, and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR] = 2.06; 95% confidence interval [CI] = .94, 4.48; P = .07). Further adjustment for confounding strengthened this association (OR = 2.79; 95% CI = 1.21, 6.43; P = .02). Baseline frailty however was not associated with NCI development.

Conclusions
NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.
The impact of measuring methods and normal values for assessment of left atrial size and filling pressures- an echocardiographic study of volume, area and diameter
Authors: Svedin JS , Avertoft MA , Petrini JP 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Different normal values for left atrial size are used in different hospitals, most commonly American Society of Echocardiography (ASE) and Normal Reference Range for Echocardiography (NORRE) which is recommended by a national external quality assessor.

Purpose
The aim of the study was to compare left atrial volume indexed (LAVI) by Simpson and Area-length (A-L) using the normal values of ASE and NORRE respectively as well as left atrial area and the older anterio-posterior diameter to compare the number of dilated left atria. We also wanted to use the volumes, area and diameter in an algorithm (LAVI, E/e´ and sPAP) for estimation of left ventricular filling pressures.

Material and methods
100 men and 100 women examined at the same echo lab in January 2020 were included. Measurements of volume and area were extracted, and the anterio-posterior diameter was measured. The measurements were compared with ASE and NORRE normal values and used in the algorithm to estimate the filling pressure.

Results
There was an excellent correlation between Simpson and A-L (p &lt;0,001). For A-L there was 50 % increase in dilated left atria compared to NORRE, using Simpson the increase was 38 % (p &lt;0,001). The correlation between Simpson and A-L gave that in LAVI 34 ml/m² according to Simpson corresponded to A-L of 37 ml/m² and 37 ml/m² according to Simpson corresponded to 40 ml/m² according to A-L.
The number of patients with elevated filling pressure was 7% for NORRES normal values of LAVI (Simpson and A-L), for ASE normal values 10 % (Simpson, ns) and 11% (A-L, p &lt;0,05 compared to NORRE).
Using LAVI NORRE Simpson as a reference standard the sensitivity for ASE LAVI Simpson and A-L was 100 % and the specificity 75 % and 63 % respectively. The anterio-posterior diameter had the lowest sensitivity (54 %). NORRE LAVI A-L turned out with 99 % specificity and 86 % sensitivity.

Conclusion
The choice of reference values and measuring method significantly affects the number of dilated left atria but also the assessment of left filling pressures to some degree.
Abstract Figure.
Clinical and echocardiographic characteristics of patients with pathology proven left-sided non-valvular papillary fibroelastoma
Authors: El-Am E , Ahmad A , Kurmann R , Sorour A , Bois M , Maleszewski J , Klarich K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Papillary fibroelastoma (PFE) is now regarded as the most common primary tumor of the heart. Although benign, they are clinically significant for their high risk of embolization. They are most commonly found on cardiac valves but can also be present on non-valvular endocardial surfaces.
The aim of this study was to better characterize patients with left-sided non-valvular PFE and its clinical sequelae.

Methods
We retrospectively identified patients with pathology-proven PFEs at a single center between January 1995 and December 2018 (n = 279). Patients with left-sided non-valvular PFE were analyzed. Medical records were retrospectively reviewed for clinical characteristics and outcomes. In addition, intra-operative transesophageal echocardiograms were manually reviewed to estimate overall size and location.

Results
During the study period, we identified 37 patients with left-sided non-valvular PFE (mean age 61 ± 14 years; 62% females) (Table). PFEs were located on the left ventricle in 41%, left atrium in 35%, and left ventricular outflow tract in 24% of patients. Around a quarter of patients (27%) had a diagnosis of hypertrophic cardiomyopathy, 19% had prior cardiac surgery, and 27% had cancer diagnosed prior to PFE diagnosis.
Transient ischemic attack or stroke was the presenting symptom in 22% of patients, myocardial infarction in 6% and peripheral embolization in 6%.
Median maximal length for PFE on the left ventricle was 11.1 mm [3;18], on the left atrium 9 mm [2;25], and left ventricular outflow tract 8 mm [6;13].
A minority of patients (9/37 [24%]) had associated valvular PFE on the mitral valve and/or aortic valve (1 patient had both mitral valve and aortic valve PFE, 7 had aortic valve PFE and 1 had Mitral valve PFE).
Only 13 patients had follow up transthoracic/transesophageal echocardiogram 1 year after PFE removal; 4/13 (31%) had documented PFE recurrence (3 PFE recurred in the same location as the original; 1 in a different location).

Conclusion
Left-sided non-valvular PFE is associated with thromboembolic events and at least in those that had follow-up echocardiograms, had a high recurrence rate. More studies are needed to evaluate the management of patients with asymptomatic PFE.
Abstract Figure. Baseline Characteristics
Pulmonary arterial wave reflection as a novel estimate of pulmonary vascular resistance
Authors: Hayama H , Uejima T , Okazaki T , Hara H , Hiroi Y 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): International Medical Research and Development Fund

Background
Measuring pulmonary vascular resistance (PVR) is essential for diagnosing pulmonary hypertension. PVR can be estimated from a simple ratio of tricuspid regurgitation velocity (TRV) to time-velocity integral of flow through right ventricular outflow tract (RVOT) (Abbas equation), but this relationship has been shown to be unreliable in patients with high PVR. Once PVR is elevated, there is an increased pressure wave reflected from the peripheral of pulmonary artery (PA). We tested the hypothesis that assessing PA wave reflection could be an alternative method for estimating PVR.

Methods
This study recruited 83 patients (69 ± 14 years old, 44 men), including 41 patients with left-sided heart disease, 23 patients with pulmonary arterial hypertension and 19 patients with chronic thromboembolic pulmonary hypertension. PA wave reflection was assessed by separating PA pressure waveform derived from a Doppler tracing of TRV into forward and backward pressure (Pf and Pb), using a velocity profile at RVOT. This separation was based on the concept of wave intensity. PVR was estimated using Abbas equation. Pb and PVR by Abbas equation were compared for the correlations with direct measurement of PVR by right heart catheterisation within 48 hours after echocardiography.

Results
Figure A illustrates Pb and Pf waveforms obtained from a patient with chronic thromboembolic pulmonary hypertension. Pb increased from mid systole and formed a late peak of PA pressure waveform. Pb correlated strongly with PVR by catheter (figure B), whereas PVR by Abbas equation underestimated PVR especially when PVR was high, resulting in a moderate correlation (figure C). Receiver-operator characteristic curves showed a higher accuracy of Pb for identifying PVR &gt; 3WU as well as 6WU, compared with PVR by Abbas equation (figure D and E).

Conclusions
This novel echocardiographic method for assessing PA wave reflection helps diagnose the severity of pulmonary hypertension.
Abstract Figure.