bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Patient Survival and Clinician Variability in Treatment Rates for Aortic Valve Stenosis
Authors: Brennan J. Matthew , Lowenstern Angela , Sheridan Paige , Boero Isabel J. , Thourani Vinod H. , Vemulapalli Sreekanth , Wang Tracy Y. , Liska Otto , Gander Stuart , Jager Jason , Leon Martin B. , Peterson Eric D. 
Published: August 2021

Background
Patients with symptomatic severe aortic stenosis (ssAS) have a high mortality risk and compromised quality of life. Surgical/transcatheter aortic valve replacement (AVR) is a Class I recommendation, but it is unclear if this recommendation is uniformly applied. We determined the impact of managing cardiologists on the likelihood of ssAS treatment.

Methods and Results
Using natural language processing of Optum electronic health records, we identified 26 438 patients with newly diagnosed ssAS (2011–2016). Multilevel, multivariable Fine‐Gray competing risk models clustered by cardiologists were used to determine the impact of cardiologists on the likelihood of 1‐year AVR treatment. Within 1 year of diagnosis, 35.6% of patients with ssAS received an AVR; however, rates varied widely among managing cardiologists (0%, lowest quartile; 100%, highest quartile [median, 29.6%; 25th–75th percentiles, 13.3%–47.0%]). The odds of receiving AVR varied >2‐fold depending on the cardiologist (median odds ratio for AVR, 2.25; 95% CI, 2.14–2.36). Compared with patients with ssAS of cardiologists with the highest treatment rates, those treated by cardiologists with the lowest AVR rates experienced significantly higher 1‐year mortality (lowest quartile, adjusted hazard ratio, 1.22, 95% CI, 1.13–1.33).

Conclusions
Overall AVR rates for ssAS were low, highlighting a potential challenge for ssAS management in the United States. Cardiologist AVR use varied substantially; patients treated by cardiologists with lower AVR rates had higher mortality rates than those treated by cardiologists with higher AVR rates.
Pacemaker‐Based Cardiac Neuromodulation Therapy in Patients With Hypertension: A Pilot Study
Authors: Kalarus Zbigniew , Merkely Béla , Neužil Petr , Grabowski Marcin , Mitkowski Przemysław , Marinskis Germanas , Erglis Andrejs , Kaźmierczak Jarosław , Sturmberger Thomas , Sokal Adam , Pluta Slawomir , Gellér László , Osztheimer István , Malek Filip , Kolodzińska Agnieszka , Mika Yuval , Evans Steven J. , Hastings Harold M. , Burkhoff Daniel , Kuck Karl‐Heinz 
Published: August 2021

Background
In prior unblinded studies, cardiac neuromodulation therapy (CNT) employing a sequence of variably timed short and longer atrioventricular intervals yielded sustained reductions of systolic blood pressure (SBP) in patients with hypertension. The effects of CNT on SBP were investigated in this double‐blind randomized pilot study.

Methods and Results

Eligible patients had daytime ambulatory SBP (aSBP) ≥130 mm Hg and office SBP ≥140 mm Hg despite taking ≥1 antihypertensive medication, and an indication for a dual‐chamber pacemaker. Patients underwent Moderato device implantation, which was programmed as a standard pacemaker during a 1‐month run‐in phase. Patients whose daytime aSBP was ≥125 mm Hg at the end of this period were randomized (1:1, double blind) to treatment (CNT) or control (CNT inactive). The primary efficacy end point was the between‐group difference of the change in 24‐hour aSBP at 6 months. Of 68 patients initially enrolled and who underwent implantation with the Moderato system, 47 met criteria for study continuation and were randomized (26 treatment, 21 control). The mean age was 74.0±8.7 years, 64% were men, left ventricular ejection fraction was 59.2%±5.7%, and aSBP averaged 141.0±10.8 mm Hg despite the use of 3.3±1.5 antihypertensive medications; 81% had isolated systolic hypertension. Six months after randomization, aSBP was 11.1±10.5 mm Hg (95% CI, −15.2 to −8.1 mm Hg) lower than prerandomization in the treatment group compared with 3.1±9.5 mm Hg (−7.4 to 1.2 mm Hg) lower in controls, yielding a net treatment effect of 8.1±10.1 mm Hg (−14.2 to −1.9 mm Hg) (
P
=0.012). There were no Moderato device– or CNT‐related adverse events.

Conclusions
CNT significantly reduced 24‐hour aSBP in patients with hypertension with a clinical indication for a pacemaker. The majority of patients had isolated systolic hypertension, a particularly difficult group of patients to treat.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02837445.
Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis
Authors: Halasz Geza , Cattaneo Mattia , Piepoli Massimo , Biagi Andrea , Romano Silvio , Biasini Vincenzo , Villa Michele , Cassina Tiziano , Capelli Bruno 
Published: August 2021

Background
Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years.

Methods and Results

Eight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (
P
=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (
P
<0.001) had lower rest and recovery heart rates (
P
<0.001), increased precordial and limb R‐wave voltages (
P
<0.001), increased R/S Sokolow index (
P
<0.001), and longer PR interval (
P
=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively.

Conclusions
ERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern.
Postnatal Right Ventricular Developmental Track Changed by Volume Overload
Authors: Sun Sijuan , Hu Yuqing , Xiao Yingying , Wang Shoubao , Jiang Chuan , Liu Jinfen , Zhang Hao , Hong Haifa , Li Fen , Ye Lincai 
Published: August 2021

Background
Current right ventricular (RV) volume overload (VO) is established in adult mice. There are no neonatal mouse VO models and how VO affects postnatal RV development is largely unknown.

Methods and Results
Neonatal VO was induced by the fistula between abdominal aorta and inferior vena cava on postnatal day 7 and confirmed by abdominal ultrasound, echocardiography, and hematoxylin and eosin staining. The RNA‐sequencing results showed that the top 5 most enriched gene ontology terms in normal RV development were energy derivation by oxidation of organic compounds, generation of precursor metabolites and energy, cellular respiration, striated muscle tissue development, and muscle organ development. Under the influence of VO, the top 5 most enriched gene ontology terms were angiogenesis, regulation of cytoskeleton organization, regulation of vasculature development, regulation of mitotic cell cycle, and regulation of the actin filament‐based process. The top 3 enriched signaling pathways for the normal RV development were PPAR signaling pathway, citrate cycle (Tricarboxylic acid cycle), and fatty acid degradation. VO changed the signaling pathways to focal adhesion, the PI3K‐Akt signaling pathway, and pathways in cancer. The RNA sequencing results were confirmed by the examination of the markers of metabolic and cardiac muscle maturation and the markers of cell cycle and angiogenesis.

Conclusions
A neonatal mouse VO model was successfully established, and the main processes of postnatal RV development were metabolic and cardiac muscle maturation, and VO changed that to angiogenesis and cell cycle regulation.
Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision‐Analytic Model
Authors: Khurshid Shaan , Chen Wanyi , Bode Weeranun D. , Wasfy Jason H. , Chhatwal Jagpreet , Lubitz Steven A. 
Published: August 2021

Background
Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain.

Methods and Results
We developed an individual‐level simulation comprising 2 000 000 average‐risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)‐guided implantable cardioverter‐defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality‐adjusted life years (QALYs), with cardiac deaths (arrest or procedural‐related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost‐effectiveness at $100 000/QALY. Compared with observation, EPS‐guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS‐guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD‐based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20–39.4 years and arrest rates >1.37%/year; EPS‐guided ICD was the most effective strategy at ages 39.5–51.3 years and arrest rates 0.47%–1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS‐guided subcutaneous ICD was cost‐effective ($80 508/QALY).

Conclusions
Device‐based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.
LFG Generation from Acyclic F-Structures is NP-Hard
Authors: Wedekind Jürgen , Kaplan Ronald M. 
Published: August 2021

Abstract
The universal generation problem for LFG grammars is the problem of determining whether a given grammar derives any terminal string with a given f-structure. It is known that this problem is decidable for acyclic f-structures. In this brief note, we show that for those f-structures the problem is nonetheless intractable. This holds even for grammars that are off-line parsable.
For 19-Month-Olds, What Happens On-Screen Stays On-Screen
Authors: Revencu Barbu , Csibra Gergely 
Published: August 2021

Abstract
Humans rely extensively on external representations such as drawings, maps, and animations. While animations are widely used in infancy research, little is known about how infants interpret them. In this study, we asked whether 19-month-olds take what they see on a screen to be happening here and now, or whether they think that on-screen events are decoupled from the immediate environment. In Experiments 1–3, we found that infants did not expect a falling animated ball to end up in boxes below the screen, even though they could track the ball (i) when the ball was real or (ii) when the boxes were also part of the animation. In Experiment 4, we tested whether infants think of screens as spatially bounded physical containers that do not allow objects to pass through. When two location cues were pitted against each other, infants individuated the protagonist of an animation by its virtual location (the animation to which it belonged), not by its physical location (the screen on which the animation was presented). Thus, 19-month-olds reject animation-reality crossovers but accept the depiction of the same animated environment on multiple screens. These results are consistent with the possibility that 19-month-olds interpret animations as external representations.
Multisensory Information Facilitates the Categorization of Untrained Stimuli
Authors: Wu Jie , Li Qitian , Fu Qiufang , Rose Michael , Jing Liping 
Published: August 2021

Abstract
Although it has been demonstrated that multisensory information can facilitate object recognition and object memory, it remains unclear whether such facilitation effect exists in category learning. To address this issue, comparable car images and sounds were first selected by a discrimination task in Experiment 1. Then, those selected images and sounds were utilized in a prototype category learning task in Experiments 2 and 3, in which participants were trained with auditory, visual, and audiovisual stimuli, and were tested with trained or untrained stimuli within the same categories presented alone or accompanied with a congruent or incongruent stimulus in the other modality. In Experiment 2, when low-distortion stimuli (more similar to the prototypes) were trained, there was higher accuracy for audiovisual trials than visual trials, but no significant difference between audiovisual and auditory trials. During testing, accuracy was significantly higher for congruent trials than unisensory or incongruent trials, and the congruency effect was larger for untrained high-distortion stimuli than trained low-distortion stimuli. In Experiment 3, when high-distortion stimuli (less similar to the prototypes) were trained, there was higher accuracy for audiovisual trials than visual or auditory trials, and the congruency effect was larger for trained high-distortion stimuli than untrained low-distortion stimuli during testing. These findings demonstrated that higher degree of stimuli distortion resulted in more robust multisensory effect, and the categorization of not only trained but also untrained stimuli in one modality could be influenced by an accompanying stimulus in the other modality.
A Synoptic View of the Onset of the Mid-Latitude QBO Signal
Authors: Silverman Vered , Lubis Sandro W. , Harnik Nili , Matthes Katja 
Published: August 2021

AbstractThe extratropical effect of the quasi-biennial oscillation (QBO), known as the Holton-Tan effect, is manifest as aweaker, warmer winter Arctic polar vortex during the east QBO phase. While previous studies have shown that the extratropical QBO signal is caused by the modified propagation of planetary waves in the stratosphere, the mechanism dominating the onset and seasonal development of the Holton-Tan effects remains unclear. Here, the governing wave-mean flow dynamics of the early winter extratropical QBO signal onset and its reversibility is investigated on a synoptic timescale with a finite-amplitude diagnostic using reanalysis and a chemistry-climate model. The extratropical QBO signal onset in October is found to primarily result from modulated stratospheric life-cycles of wave pulses entering the stratosphere from the troposphere, rather than from a modulation of their tropospheric wave source. A comprehensive analysis of the wave activity budget during fall, when the stratospheric winter polar vortex starts forming and waves start propagating up into the stratosphere, shows significant differences. During the east QBO phase, the deceleration of the mid-high latitude stratospheric zonal mean jet by the upward propagating wave pulses is less reversible, due to stronger dissipation processes, while during the west phase, a more reversible deceleration of the main polar vortex is found owing to the waves being dissipated at lower latitudes, accompanied by a weak but different response of the tropospheric subtropical jet. From this synoptic wave-event viewpoint, the early season onset of the Holton-Tan effect results from the cumulative effect of the QBO dependent wave-induced deceleration during the life cycle of individual upward wave pulses.
Tracing the Origin of the South Asian Summer Monsoon Precipitation and Its Variability Using a Novel Lagrangian Framework
Authors: Dey Dipanjan , Döös Kristofer 
Published: August 2021

AbstractThe water sources and their variability responsible for the South Asian summer monsoon precipitation were analyzed using Lagrangian atmospheric water-mass trajectories. The results indicated that evaporated waters from the central and south Indian Ocean are the major contributors to the South Asian summer monsoon rainfall, followed by the contribution from the local recycling (precipitated water that evapotranspirated from the South Asian landmass), the Arabian Sea, remote sources, and the Bay of Bengal. It was also found that although the direct contribution originating from the Bay of Bengal is small, it still provides a pathway for the atmospheric water that comes from other regions. This pathway is hence only crossing over the Bay of Bengal. The outcomes further revealed that the evaporated waters originating from the central and south Indian Ocean are responsible for the net precipitation over the coastal regions of the Ganges–Brahmaputra–Meghna Delta, northeast India, Myanmar, the foothills of the Himalayas, and central-east India. Evaporated waters from the Arabian Sea are mainly contributing to the rainfall over the western coast and west-central India. Summer monsoon precipitation due to the local recycling is primarily restricted to the Indo-Gangetic plain. No recycled precipitation was observed over the mountain chain along the west coast of India (Western Ghats). The month-to-month precipitation variation over South Asia was analyzed to be linked with the Somali low-level jet variability. The interannual variability of the South Asian summer monsoon precipitation was found to be mainly controlled by the atmospheric waters that were sourced and traveled from the central and south Indian Ocean.
Contemporary Management and Outcomes of Injuries to the Inferior Vena Cava: A Prospective Multicenter Trial From PROspective Observational Vascular Injury Treatment
Authors: Stonko David P , Azar Faris K. , Betzold Richard D. , Morrison Jonathan J. , Fransman Ryan B. , Holcomb John , Bee Tiffany , Fabian Timothy C. , Skarupa David J. , Stein Deborah M. , Kozar Rosemary A. , O’Connor James V. , Scalea Thomas M. , DuBose Joseph J. , Feliciano David V. 
Published: August 2021

Introduction Injuries to the inferior vena cava (IVC), while uncommon, have a high mortality despite modern advances. The goal of this study is to describe the diagnosis and management in the largest available prospective data set of vascular injuries across anatomic levels of IVC injury. Methods The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from November 2013 to January 2019. Demographics, diagnostic modalities, injury patterns, and management strategies were recorded and analyzed. Comparisons between anatomic levels were made using non-parametric Wilcoxon rank-sum statistics. Results 140 patients from 19 institutions were identified; median age was 30 years old (IQR 23-41), 75% were male, and 62% had penetrating mechanism. The suprarenal IVC group was associated with blunt mechanism (53% vs 32%, P = .02), had lower admission systolic blood pressure, pH, Glasgow Coma Scale (GCS), and higher ISS and thorax and abdomen AIS than the infrarenal injury group. Injuries were managed with open repair (70%) and ligation (30% overall; infrarenal 37% vs suprarenal 13%, P = .01). Endovascular therapy was used in 2% of cases. Overall mortality was 42% (infrarenal 33% vs suprarenal 66%, P<.001). Among survivors, there was no difference in first 24-hour PRBC transfusion requirement, or hospital or ICU length of stay. Conclusions Current PROOVIT registry data demonstrate continued use of ligation extending to the suprarenal IVC, limited adoption of endovascular management, and no dramatic increase in overall survival compared to previously published studies. Survival is likely related to IVC injury location and total injury burden.
Attribution Errors by People and Intelligent Machines
Authors: Hancock P. A. , Lee John D. , Senders John W. 
Published: August 2021

Objective To explore the ramifications of attribution errors (AEs), initially in the context of vehicle collisions and then to extend this understanding into the broader and diverse realms of all forms of human–machine interaction. Background This work focuses upon a particular topic that John Senders was examining at the time of his death. He was using the lens of attribution, and its associated errors, to seek to further understand and explore dyadic forms of driver collision. Method We evaluated the utility of the set of Senders’ final observations on conjoint AE in two-vehicle collisions. We extended this evaluation to errors of attribution generally, as applicable to all human–human, human–technology, and prospectively technology–technology interactions. Results As with Senders and his many other contributions, we find evident value in this perspective on how humans react to each other and how they react to emerging forms of technology, such as autonomous systems. We illustrate this value through contemporary examples and prospective analyses. Applications The comprehension and mitigation of AEs can help improve all interactions between people, between intelligent machines and between humans and the machines they work with.
Is change over time in psychotic symptoms related to social functioning?
Authors: Kwakernaak Sascha ,   GROUP Investigators, Cahn Wiepke , Janssen Richard 
Published: August 2021

Objective: In psychosis, treatment often focuses on symptom reduction whereas social functioning is also essential. In this study, we investigate positive psychotic symptoms and medication use in relation to social functioning over a 3-year time-period in 531 patients diagnosed with psychosis. Furthermore, relations of positive symptoms with needs for care and quality of life were also investigated. Method: Using repeated measures analysis, changes were measured over time. Hereafter, mixed model analyses were performed to determine the associations of social functioning, needs for care, and quality of life with psychotic symptoms and patient characteristics. Finally, we assessed differences in symptoms and medication dose between those with an increase and those with a decrease in social functioning. Results: Patients significantly improved in social functioning, while psychotic symptoms increased. Improvement in social functioning was associated with younger age, higher IQ, and lower social functioning at T1, but not with positive symptoms. Also, improvement in social functioning was found to be related to a decrease in the dose of clozapine. Improvement in social functioning occurs despite worsening of positive symptoms. Conclusions: The findings suggest the need to further explore the relation between symptomatology, social functioning, and medication use. In the treatment of psychotic disorders, one should reconsider the strong focus on reducing psychotic symptoms. The current focus needs to shift much more toward improving functional outcome, especially when the patient expresses a desire for change in this respect.