bluuebunny/crossref_metadata_2025_split huggingface dataset:
Winners and Losers: the Distributional Effects of the French Feebate on the Automobile Market
Authors: Durrmeyer Isis 
Published: October 2021

Abstract
I quantify the welfare and environmental gains and losses from a policy establishing an environmental tax/subsidy for new cars in France in 2008. I estimate a structural model of demand and supply that features heterogeneity in consumer preferences to go beyond the average policy effects and analyse distributional aspects. The policy reduces average carbon emissions by 1.6% at the cost of additional emissions of local pollutants. The regulation favours middle-income individuals but has redistributive effects when combined with a tax that is proportional to income. Moreover, local pollutant emissions increase least in poor and rural areas, suggesting another redistribution channel.
It’s the End of the (Offline) World as We Know It: From Human Rights to Digital Human Rights – A Proposed Typology
Authors: Dror-Shpoliansky Dafna , Shany Yuval 
Published: October 2021

Abstract
‘The same rights that people have offline must also be protected online’ is used in recent years as a dominant concept in international discourse about human rights in cyberspace. But does this notion of ‘normative equivalency’ between the ‘offline’ and the ‘online’ afford effective protection for human rights in the digital age? This is the question at the heart of this article. We first review the development of human rights in cyberspace as they were conceptualized and articulated in international fora and critically evaluate the normative equivalency paradigm adopted by international bodies for the online application of human rights. We then attempt to describe the contours of a new digital human rights framework, which goes beyond the normative equivalency paradigm. We offer in this connection a typology of three ‘generations’ or modalities in the evolution of digital human rights – the radical reinterpretation of existing rights, the development of new rights and the introduction of new right and duty holders. In particular, we focus on the emergence of new digital human rights, present two prototype rights (the right to Internet access and the right not to be subject to automated decision) and discuss the normative justifications invoked for recognizing these new digital human rights. We propose that such a multilayered framework corresponds better than the normative equivalency paradigm to the unique features and challenges of upholding human rights in cyberspace.
Is the Establishment of Air Defence Identification Zones Outside National Airspace in Accordance with International Law?
Authors: Su Jinyuan 
Published: October 2021

Abstract
Whereas the right of a state to establish an air defence identification zone (ADIZ) in national airspace falls squarely within its sovereignty, the question whether coastal states may claim such zones outside national airspace remains a matter of controversy. The latter category, referred to as ‘offshore ADIZs’, usually do not amount to sovereignty claims over the open airspace outside national airspace or involve threat or use of force. The right of coastal states to identify aircraft in the open airspace near coastal areas has arguably become part of customary international law. This customary right, however, only extends to ‘passive identification’ by radar detection, radio communication or close visual checks, which thus is only capable of justifying the establishment of offshore ADIZs for this purpose. The identification of aircraft in offshore ADIZs, through either voluntary or passive measures, is nevertheless within the parameters of the obligation of paying due regard to the freedom of overflight. This explains why ‘passive identification’ is ‘permissible’ under customary international law, while ‘voluntary identification’ is at least ‘tolerated’ albeit in the absence of a permissive customary rule.
Effects of COVID-19 pandemic on cardiac surgery and practice. Did we hit the mark: strategy or casuality?
Authors: Di Gaetano M , Minotti A S , Usai F , Morini E , Contristano M L 
Published: October 2021

Abstract

Background
COVID-19 pandemic is having a collateral health effect on delivery of surgical therapies and reports from management and maintaining surgical care are little.

Purpose
Investigate the impact of COVID-19 in our cardiac surgical ward and practice by scoping review of the last two years of activity, between 1st March 2019 and 28th February 2021.

Methods
Our Hospital is a private institution accredited with the National Health Service with a global volume load of 750 cardiac cases per year.
We analized the pre-pandemic and the ongoing pandemic period on volume activity, the capacity of satisfying the needs of cardiosurgical patient and the mortality rate.

Results
We observed a minimal cardiac surgery caseload decline of 14.8%, probably due to environmental factor, the absence of E.D. in our institute, the rapid re-organization pathways, the hospital surveillance, the supply of personal protective equipment, the informative measures to improve patient and personnel welfare.
In order to enhance the pshycological impact of this devastating event, we invited all the health workers to fill a questionnaire regarding concerns and worries about the risk of transmitting the infection to their families or to aquire it themselves.

Conclusion
During this devastating pandemic the rapid response in re-organization pathways and hospital surveillance allowed us to preserve the cardiac surgery volume of life-saving and non deferrable cases.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic value of post-return of spontaneous circulation electrocardiogram for selection of candidates for primary percutaneous coronary intervention after out-of-hospital cardiac arrest
Authors: Severo A , Rivero B , Catanzaro G , Juarez V , Arbas E , Poveda D , Tebar D , Garcia-Arribas D , Caro J , Rosillo S , Armada E , Lopez De Sa E 
Published: October 2021

Abstract

Background
Once return of spontaneous circulation (ROSC) is achieved in cardiac arrest (CA) patients (pts), guidelines recommend immediate acquisition of a 12-lead electrocardiogram (ECG) in order to try to identify those with underlying ischemic heart disease that would benefit from an emergent coronary angiography. Nevertheless, post-ROSC ECG findings may be influenced by factors such as drugs used during CPR (e.g., adrenaline) or metabolic state of pts (e.g., lactic acidosis) and therefore its diagnostic value for identification acute coronary lesions has not yet been established.

Objectives
To describe the correlation between post-ROSC ECG findings and acute coronary angiography lesions in out-of-hospital CA (OHCA) pts.

Methods
Retrospective analysis from a prospective database of pts admitted consecutively to the acute cardiac care unit of a tertiary care hospital from September 2006 to April 2019. Post-ROSC ECG of OHCA pts who underwent emergent coronary angiography were blindly and separately classified by 2 cardiologists as follows 1) ST-s elevation, 2) ST-s depression, 3) LBBB, 4) T wave changes/unespecific and 5) normal ECG. If discordant diagnosis, a senior cardiologist made a third and separate analysis. Additionally, coronary lesions were considered to be acute in presence of thrombi or unstable plaque (with or without complete occlusion).

Results
From 412 pts, 211 had an available and interpretable post-ROSC ECG and underwent emergent coronary angiography. Mean age 60±13 years, male sex 183 (86.7%). Correlation between ECG findings and acute coronary lesions are shown in table 1. Pts with ST-s elevation had an underlying acute coronary lesion in 55.2%. Moreover ST-s elevation had a positive predictive value of 84% and sensitivity of 58.8% for identifying acute coronary lesions. Other post-ROSC ECG findings did not significantly associate acute coronary lesions, in fact LBBB had a high negative predictive value for acute lesions.

Conclusion
Among post-ROSC ECG findings, ST-s elevation is significantly associated with acute coronary lesions and when identified, an invasive strategy should be considered as established by current practice guidelines. On the contrary, LBBB rarely associates acute coronary lesions at least in OHCA scenario and when its “new onset” is not specified.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital La Paz (Madrid) ECG findings and acute coronary lesions
Therapeutic hypothermia after resuscitated cardiac arrest: benefits in survival and neurological outcome
Authors: Olivares Martinez B , Rivadeneira Ruiz M , Seoane Garcia T , Fernandez Valenzuela M I , Barea Gonzalez C , Garcia Rubira J C 
Published: October 2021

Abstract

Introduction
The benefits of therapeutic hypothermia in patients remaining in coma after resuscitated cardiac arrest are still controversial, specially for nonshockable rhythm. This study aims to assess the effects of this technique in survival and neurological outcome in comatous patients after resuscitated cardiac arrest.

Methods
Retrospective analysis of patients admitted to a Coronary Care Unit from 2006 to 2020 who remained in coma (Glasgow Coma Scale ≤10) after resuscitated cardiac arrest. We compared intrahospital mortality and neurological outcome at discharge between patients who were treated with therapeutic hypothermia and those who weren't. We used intravascular cooling catheter with a target core temperature of 33°C, which was maintained for 24 hours. We performed a subgroup analysis to compare shockable and nonshockable rhythm. Neurological outcome was evaluated with the Cerebral Performance Categories Scale (CPC), which considers survival without limiting disability (CPC 1–2) as favourable neurological outcome.

Results
A total of 272 patients were admitted at our Coronary Care Unit after resuscitated cardiac arrest. 182 patients remained in coma after cardiac arrest. The median age was 65.83±0.98 years and 29.1% were women. 70 patients (38.46%) were treated with therapeutic hypothermia – 44 (62.85%) of them had shockable rhythm at presentation and 26 (37.14%), nonshockable rhythm. When we analysed all patients with shockable rhythm, mortality was significantly lower in those treated with therapeutic hypothermia (25% vs 53.8%, p=0.004). In nonshockable rhythm, there was a tendency for lower mortality in the hypothermia group (73.1% vs. 85%, p=0.19). Regarding neurological outcomes, we observed that therapeutic hypothermia also improved neurological outcome at discharge in patients with initial shockable rhythm (CPC 1–2 in 68.2% vs. 26.9%, p&lt;0.001). On the other hand, more patients with nonshockable rhythm had a CPC 1–2 with this technique, although these results didn't reach statistical significance (19.2% vs. 10%, p=0.24).

Conclusions
According to our experience, therapeutic hypothermia in patients who remained in coma after resuscitated cardiac arrest showed favourable results in survival and neurological outcome both in shockable and nonshockable rhythm.

Funding Acknowledgement
Type of funding sources: None. Intrahospital MortalityGood neurological outcome at discharge
Hypoxia inducible factor (HIF1A) is associated with increased right ventricular fibrosis by T1 mapping cardiac magnetic resonance in patients with repaired tetralogy of Fallot
Authors: Vaikom House A , Chetan D , Grosse Wortmann L , Mital S 
Published: October 2021

Abstract

Background
Right ventricular fibrotic remodeling has been identified pre- and postoperatively in patients with tetralogy of Fallot (ToF) and linked to adverse outcomes. Polymorphisms of hypoxia inducible factor-1-alpha (HIF1α) have been associated with fibrotic burden by cardiac magnetic resonance (CMR) late gadolinium enhancement imaging. Their association with diffuse fibrotic myocardial remodeling is unknown.

Purpose
We sought to determine whether polymorphisms in hypoxia inducible factor (HIF1α) are related to CMR markers of diffuse myocardial fibrosis in pediatric patients with repaired ToF.

Methods
Patients with repaired ToF who had undergone CMR with T1 mapping as well as whole genome sequencing were included. Myocardial native T1 was quantified using a modified Look-Locker inversion recovery sequence and measured in the left ventricular free wall, the interventricular septum, and the right ventricular free wall. Patients who had at least one functioning allele of HIF1α were compared to those who did not using Mann Whitney U test for continuous variables and chi-square or Fischer test for discrete variables. Data are displayed in Table 1 as median (IQR) for continuous variables and frequency (percentage) for discrete variables.

Results
46 patients had both CMR and whole genome sequencing. Only one HIF1α variant was identified in the cohort and present in 13 patients. There were no significant differences in demographics, surgical variables, right or left ventricular volumes or function between the groups (Table 1). Despite a trend towards a lower age at the time of CMR (11.3 vs 13.7 years; p=0.07), patients with HIF1α had higher native T1 values (1094 vs. 1050; p=0.027; Table 1) in the right ventricular outflow tract myocardium, reflecting increased diffuse interstitial ventricular fibrosis in patients with the HIF1α variant.

Conclusion
Hypoxia-inducible factor is associated with imaging markers of increased diffuse right ventricular fibrosis late after repair of tetralogy of Fallot.

Funding Acknowledgement
Type of funding sources: None. Table 1
Lipoprotein(a) is associated with incidence but not progression of aortic valve calcium
Authors: Kaiser Y , Van Der Toorn J E , Zheng K H , Kavousi M , Vernooij M W , Sijbrands E J G , Boekholdt S M , Stroes E S G , De Rijke Y B , Bos D 
Published: October 2021

Abstract

Background
Lipoprotein(a) [Lp(a)] has been implicated in the etiology of aortic valve stenosis. Although Lp(a) is strongly associated with the presence of aortic valve calcium (AVC), there are no data evaluating the relationship of Lp(a) with AVC incidence and AVC progression.

Purpose
To assess whether high Lp(a) levels are associated with AVC incidence and progression.

Methods
In 922 individuals from the population-based Rotterdam Study (mean age 66.0±4.2 years, 47.7% men) for whom Lp(a) measurements were available, non-enhanced cardiac CT imaging was performed at baseline and after a median follow-up of 14.0 [13.9–14.2] years. AVC incidence was defined as an AVC score &gt;0 on the second scan, in absence of AVC on the first scan. We performed logistic regression analyses to evaluate the relationship of Lp(a) with AVC incidence and linear regression analyses to assess the relationship between Lp(a) and AVC progression. All analyses were corrected for age, sex, body mass index, smoking, non-high-density lipoprotein cholesterol, use of lipid-lowering medication, and hypertension. Additionally, we analyzed the progression conditional on the baseline AVC-score.

Results
Of the 702 (76.1%) individuals without AVC at baseline, 415 (59.1%) showed incident AVC at follow-up. The 220 (23.9%) individuals with AVC on baseline had a median AVC score of 52 [15–131], with a median yearly progression of 13 [5–38]. Lp(a) concentration was independently associated with AVC incidence (OR 1.32 for each 105 nmol/L Lp(a) increase; 95% CI: 1.03–1.68), but not with AVC progression (β −4.3 AU/year for each 105 nmol/L Lp(a) increase; 95% CI: −12.3–3.7).

Conclusions
Lp(a) is associated with AVC incidence but not AVC progression, suggesting that Lp(a)-lowering interventions may be futile after AVC has been established. Future studies should focus on whether Lp(a) lowering interventions can prevent the development of AVC in high-risk individuals.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Rotterdam Study is supported by Erasmus MC and Erasmus University Rotterdam and the Netherlands Organization for Scientific Research
Prognostic value of serum biomarkers in patients with severe tricuspid regurgitation
Authors: Hinojar Baydes R , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J M , Sanroman M A , Rajjoub Al-Mahdi E A , Sanchez-Recalde A , Fernandez-Golfin C , Zamorano J L 
Published: October 2021

Abstract

Background
Significant tricuspid regurgitation (TR) is related to significant morbimortality. Given the lack of strong evidence, optimal timing for intervention remains controversial. Surgery is often performed late mainly because symptoms might go unnoticed until advance stages of the disease. The clinical impact of serum biomarkers evaluation in the serial evaluation of patients with significant TR is unknown.

Purpose
This study was aimed to evaluate the prognostic value of brain natriuretic peptide (BNP) and serum hepatic enzymes assessment in stable patients with significant tricuspid regurgitation

Methods
Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. Patients with previous episodes of heart failure were excluded. BNP levels and liver function enzymes were measured in all patients in their first visit. A combined endpoint of hospital admission due to right heart failure and cardiovascular (CV) mortality was defined.

Results
A total of 163 patients were included (mean age was 75±17 years, 69% females, 93% in NYHA I/II). According to etiology, 14% were primary TR and 86% were functional (49% due to corrected left valve disease and 37% due to tricuspid annulus dilatation). During a median follow up of 28 months (IQR: 15–49 months), n=59 patients (36%) reached the combined endpoint (n=12 patients died). Differences in BNP and liver function enzymes values in patients with or without events are shown in figure 1. BNP values and both cholestasis enzymes (alkaline phosphatase and gamma-glutamyl transferase) were independent predictors of the combined endpoints (Figure 2). In a multivariable Cox analysis (forward selection) in a model including BNP, alkaline phosphatase and gamma-glutamyl transferase, alkaline phosphatase remained as the sole independent predictor of outcome (HR: 1.01, [1.004–1.014], p&lt;0.001).

Conclusion
Serum biomarkers held prognostic value in patients with significant TR. BNP values and colestasis enzymes are predictive of heart failure and CV death in stable patients with TR. Given the low clinical expression of the disease, these serum biomarkers should be considered in the serial evaluation of these patients.

Funding Acknowledgement
Type of funding sources: None. Comparison of serum biomarkersCox regression analysis
Effect of thrombocytopenia in patients with infective endocarditis: an insight from the National Inpatient Sample database
Authors: Patel N , Amgai B , Chakraborty S , Hajra A , Ashish K , Patel Z , Aryal B , Aronow W , Singh A 
Published: October 2021

Abstract

Introduction
Infective endocarditis (IE) is one of the feared diseases in septic patients, and incidences are rising due to the intravenous drug abuse epidemic. Sepsis causes an escalation of the platelet destructions leading to thrombocytopenia (1). Few independent hospital-based studies have proposed increase mortality with thrombocytopenia in patients with IE (2–5). We aim to evaluate the significance of thrombocytopenia in IE subjects from the national inpatient sample (NIS) database.

Method
We analyzed the NIS database from Jan-2016 to Dec-2018 using Stata 16.0. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays per year. We identified patients with IE with or without thrombocytopenia using ICD-10 codes. The primary outcome of interest was in-hospital mortality comparison. We adjusted potential confounders (age, sex, diabetes, hypertension, etc.) with multivariate logistic regression analysis. Further analysis was done after balancing the population co-morbidity using a Greedy propensity match for accuracy.

Results
A total of 174,495 subjects were included in this study with a diagnosis of IE. Among these individuals, 33,285 patients had a concurrent diagnosis of thrombocytopenia. The mean ages were 53±19.5 years for the thrombocytopenia group and 55±19.8 years for others. Females were equally represented in both cohorts. There were 4,945 (14.86%) vs 2,835 (2.01%) mortalities reported in with and without thrombocytopenia group respectively. After propensity matching, there was a pronounced increase in mortality [Odds ratio (OR): 1.93 (1.72 – 2.15), p-value: &lt;0.001] in the group with thrombocytopenia comparing to others. Complications such as Major bleeding requiring blood transfusion [OR: 1.45 (1.35–1.57)], acute myocardial infarction [OR: 1.56 (1.35–1.70)], complete heart block [OR: 1.44 (1.16–1.53)], cardiac arrest [OR: 1.44 (1.25–1.72)], acute respiratory failure [OR: 1.51 (1.39–1.73)] and pressor support requirement [(OR: 1.73 (1.57–2.01)] were notably higher in the cohort of thrombocytopenia with statistically significant p-value (&lt;0.001). The difference in length of stay between both cohorts after propensity match wasn't statistically significant.

Conclusion
In conclusion, IE patients with thrombocytopenia have higher incidences of in-patient mortality and poor outcomes than cohort without thrombocytopenia. Some of the adverse consequences could be temporally explained by complications related to underlying thrombocytopenia. Further investigations are needed to delineate the outcome in this group of subjects.

Funding Acknowledgement
Type of funding sources: None.
Acute coronary syndrome with non-obstructive coronary arteries (ACS-NOCA in patients with hypertrophic cardiomyopathy
Authors: Trongtorsak A , Wanlapakorn C , Songsirisuk N , Ariyachaipanich A , Boonyaratavej S , Puwanant S 
Published: October 2021

Abstract

Background
Previous case reports have described myocardial ischemia and/or infarction in hypertrophic cardiomyopathy (HCM); however, prevalence and prognosis are little known. Thus, our study aimed to determine the prevalence and prognosis of acute coronary syndrome with non-obstructive coronary artery (ACS-NOCA) in patients with hypertrophic cardiomyopathy (HCM).

Methods
We prospectively enrolled 200 consecutive HCM patients (mean age 66±16 years, 42% males) from 2002 to 2013 attending a tertiary referral center, King Chulalongkorn Memorial Hospital, Thailand. The median follow-up time was 13 years. ACS-NOCA was diagnosed by a clinical syndrome of acute myocardial ischemia or MI with &lt;50% angiographically luminal stenosis in the major epicardial coronary branch by coronary angiogram.

Results
Of 200 HCM patients, 28 patients (14% of overall patients, 51% of patients with ACS) had ACS-NOCA, and 18 patients (9% of overall patients, 86% of patients with acute MI) had myocardial infarction with nonobstructive coronary artery (MINOCA) as initial clinical presentations. Of the 28 patients, 4 (14%) were STEMI, 14 (50%) were NSTEMI and 10 (36%) were UA. ACS-NOCA group had more frequent ventricular tachycardia and lower resting left ventricular (LV) outflow tract gradients than no ACS-NOCA group (p&lt;0.05). The ACS-NOCA group tended to have a lower rate of HCM-related death compared with the no ACS-NOCA group and the significant coronary artery disease (CAD) group (p-log-rank = 0.0018). As shown in Figure 1.

Conclusions
ACS-NOCA is not an uncommon initial presentation (prevalence rate 9–14%) in patients with HCM. More than half of HCM patients presenting with ACS were found to have NOCA. ACS-NOCA was not associated with an increased mortality, but had a more favorable prognosis.

Funding Acknowledgement
Type of funding sources: None. Figure 1