bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discontinuation of β-blocker therapy in stabilised patients after acute myocardial infarction (SMART-DECISION): rationale and design of the randomised controlled trial
Authors: Choi Ki Hong , Kim Juwon , Kang Danbee , Doh Joon-Hyung , Kim Juhan , Park Yong Hwan , Ahn Sung Gyun , Kim Weon , Park Jong Pil , Kim Sang Min , Cho Byung-Ryul , Nam Chang-Wook , Cho Jang Hyun , Joo Seung-Jae , Suh Jon , Jeong Jin-Ok , Jang Woo , Yoon Chang-Hwan , Hwang Jin-Yong , Lim Seong-Hoon , Lee Sang-Rok , Shin Eun-Seok , Kim Byung Jin , Yu Cheol Woong , Her Sung-Ho , Kim Hyun Kuk , Park Kyu Tae , Kim Jihoon , Park Taek Kyu , Lee Joo-Myung , Cho Juhee , Yang Jeong Hoon , Song Young Bin , Choi Seung Hyuk , Gwon Hyeon-Cheol , Guallar Eliseo , Hahn Joo-Yong 
Published: December 2024

Introduction
There is a lack of evidence to support the effectiveness of prolonged β-blocker therapy after stabilisation of patients with acute myocardial infarction (AMI) without heart failure (HF) or left ventricular systolic dysfunction.

Methods and analysis
The SMart Angioplasty Research Team: DEcision on Medical Therapy in Patients with Coronary Artery DIsease or Structural Heart Disease Undergoing InterventiON (SMART-DECISION) trial is a multicentre, prospective, open-label, randomised, non-inferiority trial designed to determine whether discontinuing β-blocker therapy after ≥1 year of maintenance in stabilised patients after AMI is non-inferior to continuing it. Patients eligible for participation are those without HF or left ventricular systolic dysfunction (ejection fraction >40%) who have been continuing β-blocker therapy for ≥1 year after AMI. A total of 2540 patients will be randomised 1:1 to continuation of β-blocker therapy or not. Randomisation will be stratified according to the type of AMI (ie, ST-segment-elevation MI or non-ST-segment-elevation MI), type of β-blocker (carvedilol, bisoprolol, nebivolol or other) and participating centre. The primary study endpoint is a composite of all-cause death, MI and hospitalisation for HF over a median follow-up period of 3.5 years (minimum, 2.5 years; maximum, 4.5 years). Adverse effects related to β-blocker therapy, the occurrence of atrial fibrillation, medical costs and Patient-reported Outcomes Measurement Information system-29 questionnaire responses will also be collected as secondary endpoints.

Ethics and dissemination
Ethics approval for this study was granted by the Institutional Review Board of Samsung Medical Center (no. 2020-10-176). Informed consent is obtained from every participant before randomisation. The results of this study will be submitted for publication in international peer-reviewed journals and the key findings will be presented at international scientific conferences.

Trial registration number

ClinicalTrials.gov,
NCT04769362
.
Assessing the state of polypectomy practice: are we ready for the new colonoscopy training pathway?
Authors: Rankin Melissa , Hambleton Scott , Derbyshire Edmund , O'Toole Paul , Smith Grahame 
Published: December 2024

ObjectiveThe 2023 Joint Advisory Group on Gastrointestinal Endoscopy consensus statements on colonoscopy training and certification in the UK recommend that trainees should be competent in size, morphology, site, access (SMSA) level 2 polypectomy; familiar with classification systems for describing polyps and able to handle common intraprocedural complications. Anecdotal concerns expressed by established colonoscopists regarding their own competence in relation to these new requirements prompted an assessment of the competence and confidence of the existing colonoscopy workforce.MethodAn anonymous online survey was used to ascertain self-reported competence and confidence in polypectomy among colonoscopists from all professional groups: both medically qualified endoscopists (MEs) (from a medical or surgical background) and clinical endoscopists (CEs), who are nurses or allied health professionals trained to perform independent colonoscopy. Respondents were predominantly from Northwest England. The survey ran between May and August 2023. Attempts were made to identify barriers preventing more advanced practice.Results120 independent colonoscopists responded (55% medical, 45% clinical). 21% of respondents were confident tackling lesions at SMSA level 4. However, 20% do not remove non-pedunculated lesions >9 mm. The majority of these were CEs. Of those involved in training or supervision, 11% restricted their polypectomy practice to Level 1. Overall, 21% expressed only ‘slight’ or ‘no confidence’ in teaching the SMSA scoring system. CEs involved in training were at least as confident as MEs in teaching aspects of polyp assessment. Lack of support in the event of a complication was of significantly more concern to CEs than MEs (p<0.001).ConclusionThe new curriculum presents a technical challenge for only a small minority of established colonoscopists, but we have identified a lack of confidence in teaching about optical diagnosis and the SMSA scoring system. Endoscopy training academies may have a role in educating training supervisors in their region rather than focusing solely on trainees.
Retrospective study on the utility of optical genome mapping as a follow-up method in genetic diagnostics
Authors: Dremsek Paul , Schachner Anna , Reischer Theresa , Krampl-Bettelheim Elisabeth , Bettelheim Dieter , Vrabel Sybille , Delissen Zoja , Pfeifer Mateja , Weil Beatrix , Bajtela Robert , Hengstschläger Markus , Laccone Franco , Neesen Jürgen 
Published: December 2024

BackgroundCurrent standard-of-care (SOC) methods for genetic testing are capable of resolving deletions and sequence variants, but they mostly fail to provide information on the breakpoints of duplications and balanced structural variants (SV). However, this information may be necessary for their clinical assessment, especially if the carrier’s phenotype is difficult to assess and/or carrier analysis of relatives is not viable. A promising approach to solving such challenging cases arises with access to optical genome mapping (OGM) but has not been systematically explored as of yet.MethodsIn this retrospective study, we evaluated diagnostic cases from a 1-year period (2023) in which an SV discovery by SOC methods (microarray, karyotyping and whole-exome sequencing) was followed up by OGM, with the objective to unlock clinically relevant information about the SV.ResultsSeven cases were shown by SOC methods to bear potential pathogenic SVs and were consequently followed up by OGM. Of these, six were solved by the additional use of OGM alone. One case required sequencing after OGM analysis to further specify the SV’s breakpoints. In all seven cases, OGM was crucial for determining the clinical relevance of the detected SV.ConclusionThis study describes the use of OGM as a valuable method for characterising duplications and balanced SVs. Often, this additional information does not add to the quality of a clinical report. However, for a subset of patients, these data are critical, especially in the prenatal setting or when no familial analyses are possible.
Genomic sequencing in paediatric oncology: navigating conflicting roles and responsibilities
Authors: Goudie Catherine , Zawati Ma'n H , Knoppers Bartha Maria , Laberge Anne-Marie 
Published: December 2024

BackgroundThis study explores the ethical and moral challenges faced by paediatric oncologists when they are informed of patient genomic results, particularly during molecular tumour boards (MTBs), highlighting the interplay between their clinic, research and expert roles.MethodsThis was an explanatory sequential mixed-methods study using a survey distributed to paediatric oncologists in Quebec followed by optional semi-structured interviews. Oncologists’ attitudes and comfort levels with six hypothetical germline DNA results identified in a patient from a clinical vignette were assessed using Likert scales. Hypothetical genetic results represented ethical challenges of extended paediatric genomic sequencing. Interviews were conducted with a subgroup of participants to gain insight and context on key survey results.ResultsEighty per cent (n=28) of oncologists in Quebec completed the survey; five participated in the interviews. Comfort levels of oncologists were influenced by the type of genetic result (expected, secondary, incidental finding), whether or not the oncologist was the patient’s treating physician, and whether the information disclosed to the patient aligned with the information that they had received. Awareness of a genetic result was sufficient to trigger a feeling of responsibility and liability for that result.ConclusionOncologists who take part in genomic sequencing initiatives and who attend MTBs have privileged access to genomic results, above what may be accessible to patients. This imbalance in knowledge contributes to moral discomfort experienced by oncologists who feel responsible for genomic information they are aware of. We propose recommendations applicable to consent processes, policies and pipelines for sharing genomic results.
Assisted dying: participation barriers and facilitators – qualitative interview study of doctors’ perceptions
Authors: Ley Greaves Laura , Willmott Lindy , Feeney Rachel , White Ben P 
Published: December 2024

ObjectivesAs more countries legalise assisted dying, it is of increasing significance for policy-makers and the medical profession. Doctors are needed for patients to access this choice; however, there is currently limited participation. Few studies identify what factors, if any, facilitate participation in assisted dying and how the inter-relationship of multiple factors may also influence participation. This study investigates factors influencing potential participation of doctors who have no in-principle objection to assisted dying in Queensland, Australia.MethodsA qualitative interview study with 31 doctors who have no in-principle objection to assisted dying. Interviews were conducted between March 2022 and January 2023 during the implementation period, when the assisted dying law had passed but was not yet in effect.ResultsParticipants identified four categories of barriers to participation: personal burdens; professional ramifications; external constraints and the difference from the traditional role of a doctor. Facilitators to participation were: continuation of care; philosophical support for assisted dying; providing a good death and scope of provision. The interplay between barriers and facilitators influenced the degree of expected participation, if any. Three key decision points determining participation were also identified: providing for all patients or only their own patients; participation as the co-ordinating or consulting practitioner and whether to participate in practitioner administration.ConclusionsParticipation in assisted dying may be shaped by whether or not an individual doctor’s philosophical support for this choice is outweighed by barriers to participation. Removing barriers could positively affect the future sustainability of an assisted dying workforce.
The influence of density models on wormhole formation in Finsler–Barthel–Randers geometry
Authors: Yashwanth B. R. , Narasimhamurthy S. K. , Praveen J. , Malligawad Manjunath 
Published: December 2024

Abstract
This paper investigates the structure and stability of wormholes within the framework of Finsler–Barthel–Randers geometry, focusing on the influence of different density models. Finsler geometry, as a generalization of Riemannian geometry, allows for the incorporation of anisotropic characteristics, making it a valuable tool in exploring cosmological phenomena. By employing osculating Riemannian space approaches, we develop wormhole models under non-commutative geometry and power-law energy density distributions. We analyze the role of the Finsler parameter

$$\eta $$

η

while evaluating the energy conditions in each model. The specific models developed here with Finsler geometry offer insights into the physical viability of wormholes in this context, potentially resolving some of the longstanding issues in wormhole theory. These findings suggest that Finsler geometry, combined with osculating Barthel–Randers geometry, provides a promising avenue for the construction of stable and physically plausible wormhole structures, The results are validated through analytical solutions and 3-D visualizations, thus contributing to our broader understanding of gravitational physics and spacetime geometry.
Effective dimensionality of space-time in f(R)-general relativity with quantum boundary terms included
Authors: Bellini Mauricio 
Published: December 2024

Abstract
I study an extended theory of General Relativity that incorporates normalized relativistic velocities, where the boundary terms in the varied f(R)-action are considered as a part of the physical system to be studied. Within this context, I investigate how the classical perturbations can be originated by quantum geometric perturbations, that alters the dynamics of the physical system without perturbations. To do it we use a modified nonlinear quantum algebra recently introduced. The quantum field perturbations of space-time also alter the geodesic equations that describe the dynamics of the relativistic velocities, the metric tensor and the Ricci tensor. But perhaps the most intriguing of this phenomena is that these space-time alterations change the effective number of space-time dimensions of the system with perturbations included N(z), in a such manner that N(z) can take an irrational value

$$N(z=2)=8/(1+\sqrt{5})\simeq 2.4721$$

N

(
z
=
2
)

=
8
/

(
1
+

5

)

≃
2.4721

, when the nonlinear quantum perturbations of space-time are related to the relativistic velocities

$$\bar{U}^{\mu }$$

U

¯

μ

. To illustrate the theory, we calculate exactly the cosmological parameter in an early inflationary universe.
Short-hair black holes and the strong cosmic censorship conjecture
Authors: Tu Zhiqin , Tang Meirong , Xu Zhaoyi 
Published: December 2024

Abstract
The singularity problem has always been a key focus of physicists’ research. To address this issue, Penrose proposed the cosmic censorship conjecture, with the Strong Cosmic Censorship Conjecture (SCCC) being particularly crucial. However, verifying SCCC in different scenarios still faces many challenges. This paper, set against the background of short-hair black holes, explores whether they obey SCCC when subjected to scalar field perturbations. Using the WKB method, Prony method, Lyapunov exponent, and Weak Gravity Conjecture (WGC), the behavior of a short-hair black hole under different parameter conditions was systematically analyzed. Numerical results indicate that as the charge

$$ Q $$

Q

of the short-hair black hole approaches its extremal value, the SCCC is violated. However, as the order

$$ k $$

k

of the metric equation and the angular quantum number

$$ \ell $$

ℓ

increase, the violation of SCCC is delayed. These results suggest that the proximity of the black hole’s charge

$$ Q $$

Q

to its extremal value, along with the size of the angular quantum number

$$ \ell $$

ℓ

and the order

$$ k $$

k

, play key roles in exploring the physical properties of black holes and verifying SCCC. Finally, research using the WGC shows that when the charge-to-mass ratio in a scalar field meets certain conditions, short-hair black holes can still comply with the SCCC under extreme conditions. This study not only reveals the behavior of short-hair black holes in extreme situations but also offers a new perspective for further exploration of such black holes.
Reinforcement Learning for Intra- & Inter-Node Recommender Data Pipeline Optimization
Authors: Nagrecha Kabir , Liu Lingyi , Delgado Pablo 
Published: December 2024

Deep learning-based recommender models (DLRMs) have become an essential component of many modern recommender systems. Several companies are now building large compute clusters reserved for DLRM training, driving new interest in cost- & time- saving optimizations. The systems challenges faced in this setting are unique; while typical deep learning (DL) training jobs are dominated by model execution times, the most important factor in DLRM training performance is often
online data ingestion.

In this paper, we study real-world DLRM data processing pipelines taken from our compute cluster at Netflix to observe the performance impacts of online ingestion and identify shortfalls in existing data pipeline optimizers. Our studies lead us to design a new solution for data pipeline optimization,
InTuneX
.

InTuneX
is designed for production-scale multi-node recommender data pipelines. It unifies & tackles the challenges of both
intra-
and
inter-
node pipeline optimization. We achieve this with a multi-agent reinforcement learning (RL) design, simultaneously optimizing node assignments at the cluster level & CPU assignments within nodes.

Our experiments show that
InTuneX
can build optimized data pipeline configurations within minutes. We apply
InTuneX
to our cluster, and find that it increases single-node data ingestion throughput by as much as 2.29X versus state-of-the-art optimizers, while improving the cost-efficiency of multi-node pipelines by 15-25%.
Aerobic Capacity of Adults With Fontan Palliation: Disease-Specific Reference Values and Relationship to Outcomes
Authors: Egbe Alexander C. , Ali Ahmed E. , Miranda William R. , Connolly Heidi M. , Borlaug Barry A. 
Published: December 2024

BACKGROUND:
Patients with Fontan palliation have reduced aerobic capacity because of impaired cardiac, pulmonary, and skeletal muscle function. However, the assessment of aerobic capacity in this population still relies on comparisons with people without cardiovascular disease rather than comparison with the expected aerobic capacity of other Fontan patients. The purpose of this study was to determine the expected aerobic capacity of adults with Fontan palliation.

METHODS:

Adults with Fontan palliation who underwent a cardiopulmonary exercise test at Mayo Clinic (2003–2023) were stratified into quartiles based on the predicted peak oxygen consumption (VO
2
). We assessed the correlates of predicted peak VO
2
and the relationship between predicted peak VO
2
quartiles and cardiovascular outcomes (death/transplant).

RESULTS:

Of 323 patients (age, 29±9 years; 177 [55%] men), the median peak VO
2
was 19.1 (15.2–23.9) mL/kg per minute, and this corresponds to a predicted peak VO
2
of 51% (range, 19–88; interquartile range, 41–62). After multivariable adjustments, the correlates of predicted peak VO
2
were body mass index (β±SE, −2.61±0.95; 2.61% decrease in predicted peak VO
2
per 5 kg/m
2
increase in body mass index;
P
=0.009), systemic saturation (β±SE, 3.65±0.85; 3.65% increase in predicted peak VO
2
per 5% increase in oxygen saturation;
P
<0.001), and Fontan pressure (β±SE, −1.24±0.22; 1.24% decrease in predicted peak VO
2
per 1 mm Hg increase in Fontan pressures;
P
<0.001). There was a 47% increase in the risk for death/transplant from a higher predicted peak VO
2
quartile to the next lower quartile (adjusted hazard ratio, 1.47 [95% CI, 1.09–2.05];
P
=0.01).

CONCLUSIONS:
The results of the current study would help calibrate the interpretation of exercise test data in adults with Fontan palliation and improve risk stratification in this population. It also underscores the need to maintain normal Fontan hemodynamics and body weight, which are important determinants of aerobic capacity.
Moyamoya Angiopathy and Antiphospholipid Antibodies: A Coincidental Association?
Authors: Grosset Lina , Stepanian Alain , Labeyrie Marc-Antoine , Civelli Vittorio , Chabriat Hugues , Siguret Virginie , Hervé Dominique 
Published: December 2024

BACKGROUND:
The presence of antiphospholipid antibodies (aPL) has been suggested as a potential cause of moyamoya angiopathy (MMA), but this remains uncertain. In this case-control study, we aimed to compare the prevalence of circulating aPL in patients with MMA and in non-MMA cerebrovascular controls.

METHODS:
For comparison, we included 95 patients with MMA from the French National Referral Centre for this condition and 182 age- and sex-matched non-MMA controls with a different cerebrovascular disease, all younger than 55 years. Anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, and lupus anticoagulant were assessed using the guidelines of the International Society on Thrombosis and Haemostasis.

RESULTS:

aPL prevalence was 22% in patients with MMA and 25% in controls (
P
=0.74) with no differences in aPL subtypes between the 2 groups. The prevalence of transient ischemic attacks, ischemic stroke, and hemorrhagic stroke did not differ between patients with aPL-positive and aPL-negative MMA.

CONCLUSIONS:
The prevalence of aPL in patients with MMA is comparable to that in non-MMA controls. The present results do not support any causal relationship between aPL and MMA.
Angiotensin Inhibition Reduces the Risk of Subarachnoid Hemorrhage in Patients With Hypertension
Authors: Abbasi Mohammad Hossein , Brensinger Colleen M. , Acton Emily K. , Favilla Christopher G. , Burkhardt Jan‐Karl , Kasner Scott E. 
Published: December 2024

Background
Local angiotensin activity is thought to play a critical role in arterial wall homeostasis and remodeling, and impaired arterial wall integrity contributes to the pathogenesis of subarachnoid hemorrhage (SAH). Here we aimed to assess the association between pharmacologic inhibition of angiotensin‐converting enzyme and subsequent nontraumatic SAH.

Methods
In a retrospective cohort study based on Optum's Clinformatics Datamart deidentified database records (2000–2021), we included all subjects with a history of hypertension. We collected medication history, and the exposure of interest was the use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB). The primary outcome was the subsequent development of nontraumatic SAH. Cox proportional hazard regression models were used to compare the time to SAH by type of antihypertensive treatment.

Results

A total of 7.5 million patients with hypertension were assessed. Patients on ACEI/ARBs with or without other antihypertensives (n = 4.8 million, follow‐up: 6.3 years) had lower rates of SAH compared with those on alternative antihypertensive regimens (n = 1.3 million, follow‐up: 5.7 years) (hazard ratio [HR]:0.94 [0.91–0.97];
P
<0.0001), as well as compared with those on no antihypertensive medications (n = 1.4 million, follow‐up: 5.3 years) (HR:0.94 [0.91–0.97];
P
= 0.0002). However, antihypertensive medications other than ACEI/ARBs were not associated with SAH risk compared with treatment by no antihypertensives (HR:1.00 [0.97–1.04];
P
= 0.83). Among 8034 patients with known unruptured intracerebral aneurysms, no difference in SAH with ACEI/ARBs was observed compared to alternative antihypertensive regimens (HR:1.04 [0.95–1.13]) or no antihypertensive therapy (HR:1.06 [0.97–1.16]). Uninterrupted ACEI/ARBs use for ≥3 years reduced the risk of SAH by 23%, compared with treatment by only other hypertensives (HR:0.71 [0.68–0.74];
P
<0.001).

Conclusion
Treatment of hypertension with ACEI/ARBs was associated with a lower risk of SAH than other types of antihypertensive agents, particularly with longer courses of therapy.