bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immuno-Electrophysiological Mechanisms of Functional Electrical Connections Between Recipient and Donor Heart in Patients With Orthotopic Heart Transplantation Presenting With Atrial Arrhythmias
Authors: Herweg Bengt , Nellaiyappan Madhan , Welter-Frost Allan M. , Tran Thanh , Mabry George , Weston Kathryn , Tobón Catalina , Saiz Javier , Noujaim Sami , Weston Mark W. 
Published: March 2021

Background:
The formation of recipient-to donor atrio-atrial connections (AAC) in patients after orthotopic heart transplantation (OHT) is poorly understood. We sought to investigate the mechanisms of atrial tachyarrhythmias after OHT, the role of AACs, and their relationship to the immunologic match.

Methods:
In a large series of OHT patients, we performed a retrospective review of 42 patients who underwent catheter ablation for atrial arrhythmias. A realistic 3-dimensional computer model of human atria was used to study AAC conductivity.

Results:

Patient age was 55±15 years (71% male). Biatrial anastomosis was present in 24/42 patients (57%). An AAC was found in 9/42 patients (21%, right-sided in 5 patients with biatrial anastomosis, left-sided in 4 patients). The AAC became apparent at the time of the electrophysiology study 10.1±7.6 years after OHT (range, 0.3–22.2 years). Donor-specific antibodies were present in no patient with AAC but were present in 69% of patients without AAC,
P
=0.002. In all patients with AAC, a recipient atrial tachycardia propagated via AAC to the donor atrium (4 patients presented with atrial fibrillation). Simulations showed AAC conduction requires an isthmus of ≥2 mm and is cycle length and location dependent. Patients without AAC (n=13) frequently presented with donor atrial arrhythmias, in 77% cavo-tricuspid isthmus flutter was ablated. The procedural success was high, although, 12 patients (29%) required reablation.

Conclusions:
AACs are found in 21% of OHT patients with atrial tachyarrhythmias and can manifest very early after OHT. Immune privilege characterized by the absence of donor-specific antibodies may facilitate AAC formation. Propagation across an AAC is width, cycle length, and location dependent. Patients with AAC present with focal atrial tachycardias or atrial fibrillation originating from the recipient atria; patients without most frequently present with cavo-tricuspid isthmus dependent atrial flutter. While multiple arrhythmias frequently require reablation, ablative therapy is highly effective.

Graphic Abstract:

A
graphic abstract
is available for this article.
Temporal Trends in Stroke-Related Memory Change
Authors: Eng Chloe W. , Mayeda Elizabeth R. , Gilsanz Paola , Whitmer Rachel A. , Kim Anthony S. , Glymour M. Maria 
Published: March 2021

Background and Purpose:
Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains unclear. We investigated evidence for temporal trends in memory change related to incident stroke in a nationally representative cohort.

Methods:
Adults age 50+ in the HRS (Health and Retirement Study) were followed across three successive 6-year epochs (epoch 1: 1998–2004, n=16 781; epoch 2: 2004–2010, n=15 345; and epoch 3: 2010–2016; n=15 949). Participants were included in an epoch if they were stroke-free at the start of that epoch. Annual rates of change in a composite z-standardized memory score were compared using demographic-adjusted linear regression models for stroke-free participants, those who survived after stroke, and those who died after stroke, considering memory change before stroke, at the time of stroke, and for years following stroke.

Results:

Crude stroke incidence rates decreased from 8.5 per 1000 person-years in epoch 1 to 6.8 per 1000 person-years in epoch 3. Rates of memory change before and following stroke onset were similar across epochs. Memory decrement immediately after stroke onset attenuated from −0.37 points (95% CI, −0.44 to −0.29) in epoch 1 to −0.26 (95% CI, −0.33 to −0.18) points in epoch 2 and −0.25 (95% CI, −0.33 to −0.17) points in epoch 3 (
P
value for linear trend=0.02).

Conclusions:
Decreases in stroke-related dementia in recent years may be partially attributable to smaller memory decrements immediately after stroke onset. Findings suggest reductions in stroke incidence and improvements in stroke care may also reduce population burden of dementia. Further investigations into whether temporal trends are attributable to improvements in stroke care are needed.
China’s Efforts to Shape and Improve Its International Discursive Power: Diplomatic Practice
Authors: Sun Jisheng 
Published: March 2021

Summary
Discursive power is the reflection of a country’s national strength and international influence. The increase of economic power does not necessarily mean the increase of discursive power. The improvement of discursive power has to be strategically designed and multidimensionally improved. Due to China’s historical experiences regarding discursive power, China is weak in many fields. Since the 18th National Congress of the Communist Party of China, China began to pay more attention to improve its international discursive power such as expanding its discursive presence and strengthening effectiveness of its voice, changing language style, enhancing institutional power and innovating diplomatic practice. In the future, more substantive efforts will be needed such as strengthening the overall strategic layout, enhancing institutional discursive power in various fields, improving the discursive system and promoting integration of China’s major diplomatic ideas and discourse with global ones.
Developing and Validating Heat Exposure Products Using the U.S. Climate Reference Network
Authors: Rennie J. Jared , Palecki Michael A. , Heuser Sean P. , Diamond Howard J. 
Published: March 2021

AbstractExtreme heat is one of the most pressing climate risks in the United States and is exacerbated by a warming climate and aging population. Much work in heat health has focused only on temperature-based metrics, which do not fully measure the physiological impact of heat stress on the human body. The U.S. Climate Reference Network (USCRN) consists of 139 sites across the United States and includes meteorological parameters that fully encompass human tolerance to heat, including relative humidity, wind, and solar radiation. Hourly and 5-min observations from USCRN are used to develop heat exposure products, including heat index (HI), apparent temperature (AT), and wet-bulb globe temperature (WBGT). Validation of this product is conducted with nearby airport and mesonet stations, with reanalysis data used to fill in data gaps. Using these derived heat products, two separate analyses are conducted. The first is based on standardized anomalies, which place current heat state in the context of a long-term climate record. In the second study, heat events are classified by time spent at various levels of severity of conditions. There is no consensus as to what defines a heat event, so a comparison of absolute thresholds (i.e., ≥30.0°, 35.0°, and 40.0°C) and relative thresholds (≥90th, 95th, and 98th percentile) will be examined. The efficacy of the product set will be studied using an extreme heat case study in the southeastern United States. While no heat exposure metric is deemed superior, each has their own advantages and caveats, especially in the context of public communication.
Survey participation effects in conflict research
Authors: De Juan Alexander , Koos Carlo 
Published: March 2021

Do survey participants in conflict zones respond differently if they have been interviewed before? Academic and policy interest in postwar political opinion has increased tremendously. One unexpected consequence of this surge of survey research is a growing probability that individuals will be interviewed multiple times. However, if participating in one survey causes respondents to change their attitudes or behavior, their subsequent survey responses may be biased in comparison to the rest of the sample population. Our article aims to investigate such ‘survey participation effects’ in conflict contexts. We draw on original survey data collected in the eastern Democratic Republic of Congo (DRC). In our representative sample, 18% of respondents report that they have been interviewed before. Multivariate analyses demonstrate that their stated attitudes on social relations, political institutions, gender norms, and wartime victimization differ substantively from the responses of first-time interviewees. Moreover, our analyses indicate that experienced respondents have specific response styles – in particular, a tendency to support extreme response options. While substantive bias in multivariate analyses seems to be rather rare, our findings indicate that researchers should be aware of the footprints of data collection efforts in areas frequently targeted by household and opinion surveys.
A review of research on dynamic thermal comfort
Authors: Cao Shuanghua , Li Xin , Yang Bing , Li Fan 
Published: March 2021

Nowadays, people’s requirements for comfort are getting higher and higher, and traditional steady-state thermal comfort environment sometimes cannot meet people’s requirements. Dynamic thermal comfort is considered to meet people's requirements for comfort better than traditional thermal comfort, and it is also conducive to the health of occupants and building energy conservation. Therefore, this article reviews the literature on dynamic thermal comfort. First, this article briefly describes the transition from a steady-state thermal environment to a dynamic thermal environment. Next, this article reviews the research related to dynamic thermal comfort, such as the frequency of airflow fluctuations, simulation of natural wind, thermal prediction models, the use of intelligent detection equipment, and personal environmental control. This article summarizes the related research and development of dynamic thermal comfort from the aspects of dynamic airflow parameters, indoor thermal environment regulation, thermal experience, etc. This article aims to illustrate the necessity of the development of dynamic thermal comfort and its current results. The results show that under the trend of the artificial intelligence era, dynamic thermal comfort still has broad development potential. This article It can provide some research ideas for subsequent thermal comfort research. Practical application: This paper summarizes the research and development of dynamic thermal comfort from dynamic airflow, indoor thermal environment control, thermal experience, etc., and makes appropriate extensions and prospects accordingly. At the same time, the necessity of combining thermal comfort with AI trends is emphasized. This paper can provide references and ideas for thermal research on thermal comfort.
Comparison of Endoscopic Cartilage Myringoplasty in Dry and Wet Ears With Chronic Suppurative Otitis Media
Authors: Yang Juanmei , Lyu Jihan , Wang Yanmei , Chen Binjun , Xu Jianghong , Ren Dongdong 
Published: March 2021

Objectives: This study compared the rate of graft success, as well as hearing improvement and dry ear time between dry ears and wet ears with otomycosis or without otomycosis in patients with chronic suppurative otitis media (CSOM) after endoscopic cartilage myringoplasty. Methods: This retrospective study was conducted in a tertiary hospital in Shanghai. In total, 83 patients with CSOM (43 with dry ears and 40 with wet ears) were included. Among the 40 patients with CSOM and wet ears, 25 exhibited otomycosis. All patients underwent endoscopic myringoplasty, and perforations were repaired using tragal cartilage with a single-sided perichondrium. Patients were followed up for at least 6 months. Pure-tone hearing was examined preoperatively and at 3 months postoperatively. The graft uptake rate, hearing improvement, and dry ear time were compared between the groups. Results: The graft success rate did not differ significantly between the dry-ear and wet-ear groups (95.35% and 90.00%, respectively). Furthermore, the graft success rate also did not differ significantly between patients with wet ears and otomycosis and those with wet ears without otomycosis (92.00% and 86.67%, respectively). Hearing gain did not differ significantly between the dry-ear and wet-ear groups. No significant difference in hearing gain was also found in patients with wet ears with or without otomycosis. However, the time to dry ear was significantly longer in the wet-ear group than in the dry-ear group. Conclusion: Patients with CSOM and wet ears required more time to achieve a completely healthy status. However, the graft success rate and hearing improvement were not affected by a wet middle ear and otomycosis. Thus, endoscopic myringoplasty using tragus cartilage is an effective treatment for refractory CSOM in patients with wet ears and otomycosis.
Economic Ripple Effect: The Effect of Public Transfer Payment Policy in Malaysia
Authors: Amirullah Muhammad Adli , Estrada Mario Arturo Ruiz , Aslam Mohamed 
Published: March 2021

This article models the interconnection between the public transfer payment policy in Malaysia and the overall Malaysian economy using an inter-linkage coordinate space. This space is represented graphically, with the public transfer payment distribution in the centre and the number of periods plotted along rays (axes) that are drawn from the centre, each of which can have as many windows as required at the predetermined perimeter levels. Using this model, this article evaluates whether and how the implementation of public transfer payment policy in Malaysia can simultaneously affect the overall Malaysian economy through selected macroeconomic indicators. Finally, this article proposes the use of computer graphical animation when sufficient data are available to provide a more accurate measurement and visual representation of the economic ripple effect in the same graphical space. JEL: C00, E60, H53
Testing the psychometric properties of the Chinese version of the Neurological Fatigue Index-Stroke
Authors: Ho Lily YW , Lai Claudia KY , Ng Shamay SM 
Published: March 2021

Objective: To test the psychometric properties of a Chinese version of the Neurological Fatigue Index-Stroke (C-NFI-Stroke) in stroke survivors. Design: This was a validation study. Cross-cultural adaptation of the scale was conducted according to standard guidelines. Reliability, validity, responsiveness, and interpretability were measured. Setting: Self-help groups and a community center. Subjects: One hundred and twelve Chinese stroke survivors and 65 healthy Chinese older people living in the community. Interventions: Not applicable. Main measures: The C-NFI-Stroke, Fatigue Severity Scale, Mental Fatigue Scale, General Self-Efficacy Scale, and Geriatric Depression Scale were used. Results: Cronbach’s α coefficients were 0.69–0.88; the item-level agreement was 70.4%–88.9%; the weighted Kappa value was 0.47–0.79; and the intra-class correlation coefficients were 0.88–0.93. The C-NFI-Stroke had no ceiling and floor effects. It had good content validity and had two factors, “lack of energy” and “tiredness/weakness.” The confirmatory factor analysis showed a good fit to the model. The C-NFI-Stroke significantly correlated with existing fatigue scales ( rs = 0.55–0.63), self-efficacy ( rs = −0.31 to −0.37), and depressive symptoms ( rs = 0.53–0.60). The C-NFI-Stroke could discern differences between stroke survivors and healthy older people. Conclusions: The C-NFI-Stroke is a reliable and valid tool for clinical and research use on people who have been diagnosed with stroke for a year or more, although its factor structure differs from that of the original English version.
A systematic review of quality improvement initiatives for continuous sedation until death
Authors: Robijn Lenzo , Deliens Luc , Scherrens Anne-Lore , Pauwels Nele S , Pype Peter , Rietjens Judith , Chambaere Kenneth 
Published: March 2021

Background: Extensive debate surrounds the practice of continuous sedation until death within end-of-life care. Aim: To provide insight into existing initiatives to support the practice of continuous sedation until death and assess their feasibility and effectiveness. Design: Systematic review and narrative synthesis, registered on PROSPERO (CRD42020149630). Data sources: Records were searched through MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science from inception to April 16 2020. Peer-reviewed studies reporting original data on initiatives to support the practice of continuous sedation were included for review. Results: Twenty-one studies met the criteria and were included. Initiatives were focused on assessment tools of consciousness and discomfort (9), the use of guidelines and protocols (8), and expert consultation (3). All initiatives were reported as useful, acceptable, and feasible. Studies on the use of monitoring devices showed that a small proportion of patients were found to be awake, despite the patient being unresponsive according to the observer-based sedation scales. However, the wide range of values of these monitoring devices for comfortable and adequately sedated patients seems to hamper its overall implementation in daily clinical practice. Physicians reported changes in practice conform to guideline recommendations but the shift was modest at best. Expert consultation was regarded as supportive when sufficient expertise is lacking and helpful in avoiding possibly unnecessary sedations. Conclusions: The reviewed initiatives may contribute to improvement of continuous sedation until death, though their evidence base is rather limited. More insight is needed into their feasibility, preconditions for effective implementation and impact in actual practice.
Adipose Stem Cell–Derived Exosomes Recover Impaired Matrix Metabolism of Torn Human Rotator Cuff Tendons by Maintaining Tissue Homeostasis
Authors: Zhang Xuancheng , Cai Zhuochang , Wu Minghu , Huangfu Xiaoqiao , Li Juehong , Liu Xudong 
Published: March 2021

Background: Adipose stem cell–derived exosomes (ASC-Exos) are reported to effectively prevent muscle atrophy and degeneration of torn rat rotator cuff, but their influence on human samples and their potential mechanism are still unclear. Purpose: We aimed to investigate the effects of ASC-Exos on the metabolic activities of torn human rotator cuff tendons and explore the potential mechanism behind it. Study Design: Controlled laboratory study. Methods: Diseased supraspinatus tendons were harvested from 15 patients with a mean ± SD age of 65.8 ± 3.2 years who underwent reverse shoulder arthroplasty for chronic rotator cuff tears associated with glenohumeral pathological changes. Each tendon was dissected into 3 × 4 × 4–mm explants: the ones derived from the same tendon were placed into 12-well plates and cultured in complete culture media (control) or in complete culture media supplemented with ASC-Exos for 72 hours. Afterward, the concentrations of cytokines secreted into the culture media—including interleukin 1β (IL-1β), IL-6, IL-8, and matrix metalloproteinase 9 (MMP-9)—were measured using enzyme-linked immunosorbent assay (ELISA). Tendons were stained with hematoxylin and eosin and immunohistochemistry (type I and III collagens) for histological analyses. Moreover, the expression of anabolic genes ( TIMP-1 and TIMP-3; type I and III collagen encoding) and catabolic genes ( MMP-9 and MMP-13) in tendons were measured using real-time quantitative polymerase chain reaction. Phosphorylated AMPKα and Wnt/β-catenin pathways were assayed by western blotting to explore the potential mechanism of action of ASC-Exos. Results: Secretion of proinflammatory cytokines, including IL-1β, IL-6, and MMP-9, was significantly reduced in the ASC-Exos group as compared with the control group. Supraspinatus tendons in the ASC-Exos group exhibited superior histological properties, as demonstrated by higher tendon maturing scores and more type I collagen content, but there was no significant difference in type III collagen content between groups. Expression of MMP-9 and MMP-13 genes was decreased in the ASC-Exos group versus the control group. Increased expression of type I and III collagens and an elevated type I/III ratio were found in the ASC-Exos group when compared with the control group. There was no significant difference in the secretion of IL-8 and expression of TIMP-1 and TIMP-3 genes between the ASC-Exos and control groups. Western blotting revealed that ASC-Exos enhanced phosphorylated AMPKα and decreased β-catenin levels to prevent tendon degeneration. Conclusion: ASC-Exos maintained metabolic homeostasis of torn human rotator cuff tendons to improve their histological properties, which might be achieved by enhancing AMPK signaling to suppress Wnt/β-catenin activity. Clinical Relevance: ASC-Exos could be used as an effective biological tool to promote healing in torn human rotator cuff tendons.
Segmenting or Summing the Parts? A Scoping Review of Male Suicide Research in Canada
Authors: Oliffe John L. , Kelly Mary T. , Montaner Gabriela Gonzalez , Links Paul S. , Kealy David , Ogrodniczuk John S. 
Published: March 2021

Objective: Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts?. Method: A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive. Results: Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities ( n = 29); (2) age-specific ( n = 30); and (3) occupation ( n = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men’s suboptimal connections to existing mental health care services were also highlighted. Conclusion: While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men’s mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.