bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of Jets and Vortex Generators to Improve Air-Cooling and Temperature Uniformity in a Simple Battery Pack
Authors: Shahid Seham , Agelin-Chaab Martin 
Published: September 2018

Abstract
In this paper, the problem of air cooling and temperature nonuniformity at the cell and pack level is addressed. Passive techniques are developed by integrating jet inlets and vortex generators (VGs) in a simple battery pack with the goal to achieve an effective cooling, and the desired temperature uniformity at the cell and pack level to less than 5 °C, without an increase in the required mass flow and power requirements. Moreover, various configurations of the developed techniques are assessed and compared. In order to achieve the objectives, computational fluid dynamics (CFD) is used to conduct numerical studies on the battery packs. The results concluded that by adding both the delta winglet (DW) vortex generator arrays and jet inlet arrays in the same configuration, improvements in temperature reduction and uniformity can be achieved. The results showed that the maximum temperature of the battery pack was reduced by ∼6% and the temperature uniformity at the pack level was increased by 24%. Additionally, a ∼37% improvement in the temperature uniformity at cell level was achieved.
Evidence of a distinct group of Black African patients with systemic lupus erythematosus
Authors: Sibanda Elopy N , Chase-Topping Margo , Pfavayi Lorraine T , Woolhouse Mark E J , Mutapi Francisca 
Published: September 2018

BackgroundThe autoimmune disease systemic lupus erythematosus (SLE) occurs more frequently in patients of African descent with high morbidity and mortality. Current SLE diagnostic criteria including antinuclear antibody (ANA) reactivity are derived largely from non-African populations. This study characterises ANA reactivity patterns and relates them to SLE clinical presentation in Black African patients.MethodsSera from Black participants (61 patients with SLE and 100 controls) aged 1–81 years were analysed for reactivity against the antigens: uridine 1-ribonuclear protein, Smith uridine-1-5 ribonuclear protein antigen, soluble substance-A, recombinant Ro-52, soluble substance-B, Scl-70, cytoplasmic histidyl-tRNA synthetase antigen, proliferating cell nuclear antigen (PCNA), nucleosomes, ribonuclear P-protein, antimitochondrial antibody M2 (AMA-M2), histones, double-stranded DNA (dsDNA), centromere protein B and polymyositis–sclerosis overlap antigen.FindingsA significantly higher proportion (97%) of the 61 patients with SLE had detectable autoantibody reactivity compared with 15% of the 100 controls (p<0.001). The highest frequencies of autoantibody reactivity in patients with SLE were against the dsDNA antigen (41%) and PCNA (54%). Anti-PCNA and anti-dsDNA reactivity were mutually exclusive (p<0.001) giving rise to two distinct groups of Black African patients with SLE. The first group (n=25) had reactivity profiles consistent with international standard SLE definitions, including anti-dsDNA reactivity, and was 13 times more likely to present with joint symptoms. The larger, second group (n=34), characterised by anti-PCNA and anti-AMA-M2 reactivity, was nine times more likely to present with only cutaneous symptoms.InterpretationOur study demonstrates a need to extend autoantibody panels to include anti-PCNA in the diagnostic process of Black African patients and further refine the predictive values of the reactivity to different antigens to differentiate SLE syndromes in African populations.
Impact of residence altitude on readmission in patients with heart failure
Authors: Saito Makoto , Yamaoka Manami , Ohzawa Mayuri , Tominaga Emi , Takahashi Kayo , Morofuji Toru , Sumimoto Takumi , Inaba Shinji 
Published: September 2018

ObjectiveMountain districts normally have tougher geographic conditions than plain districts, which might worsen heart failure (HF) conditions in patients. Also, those places frequently are associated with social problems of ageing, underpopulation and fewer medical services, which might cause delay in detection of disease progression and require more admissions. We investigated the association of residence altitude with readmission in patients with HF.MethodsWe followed 452 patients with HF to determine all-cause readmissions over a median of 1.1 years. The altitude of patient residences, population, proportion of the elderly and number of hospitals or clinics in a minor administrative district (Cho-Aza district) located at the residences were examined using data from the 2010 census and Google Maps.ResultsAll-cause readmissions were observed in 269 (60%) patients. The altitude of ≥200  m was significantly associated with readmissions (HR, 1.49; 95 % CI 1.12 to 1.96; p=0.006) after adjustment for physical and haemodynamic parameters, left ventricular ejection fraction, brain natriuretic peptide and components of the established score for predicting readmission for HF. Altitude was significantly associated with ageing, underpopulation, fewer hospitals or clinics and lower temperature (all p<0.01), with an increased tendency for readmission during the winter season; however, it was not associated with patient clinical parameters.ConclusionsHigh altitude residence may be an important predictor for readmission in patients with HF. This relationship may be confounded by unfavourable sociogeographic conditions at higher altitudes.
High Enhancement Settings for White Light Observation Improves Colorectal Polyp Visibility in Color Difference Value and an Endoscopist’s Visibility
Authors: Yoshida Naohisa , Inoue ken , Yasuda Ritsu , Hirose Ryohei , Dohi Osamu , Naito Yuji , Murakami Takaaki , Inada Yutaka , Ogiso Kiyoshi , Morinaga Yukiko , Kishimoto Mitsuo , Konishi Eiichi , Itoh Yoshito 
Published: September 2018

Background/Aims: Settings of structure and color enhancement (CE) change view of white light imaging and a preset low enhancement setting is used regularly. The aim of this study was to investigate whether higher enhancement settings increased colorectal lesions’ visibility with endoscopists’ visibility scoring and objective color difference (CD) value. Methods: From April 2015 to September 2015, we analyzed 27 pictures and 100 videos of colorectal lesions. Combinations of structure enhancement (B3, A3, A5) and CE (CE 0, 1, 3) were evaluated and CD values of 2 corresponding modes (high enhancement: A5 + CE3, preset low enhancement: A3 + CE0) were calculated using marketed software. In the video, these 2 modes were evaluated. All pictures and movies were graded by 4 endoscopists using visibility scores: score 4 (excellent) to score 1 (poor). Results: The scores of A3 + CE0 (2.74 ± 1.09) were significantly lower than those of all other higher enhancement settings such as B3 + CE1 (3.11 ± 1.08), A3 + CE1 (3.33 ± 0.91), and A5 + CE3 (3.56 ± 0.74; p < 0.001). The CD value of A5 + CE3 was significantly higher than A3 + CE0 (20.2 ± 6.9 vs. 12.9 ± 5.6, p < 0.001). In the video, the scores for A5 + CE3 were significantly higher than A3 + CE0 (3.27 ± 0.83 vs. 2.53 ± 1.05, p < 0.001). Conclusions: Higher enhancement settings increased visibility of colorectal lesions.
Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment–Elevation Myocardial Infarction
Authors: Nepper-Christensen Lars , Lønborg Jacob , Høfsten Dan E. , Ahtarovski Kiril A. , Bang Lia E. , Helqvist Steffen , Kyhl Kasper , Køber Lars , Kelbæk Henning , Vejlstrup Niels , Holmvang Lene , Engstrøm Thomas 
Published: September 2018

Background:
Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment–elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.

Methods and Results:

We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%;
P
=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9–24] versus 11% [interquartile range, 4–19];
P
=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39–0.71] versus 0.65 [interquartile range, 0.49–0.84];
P
=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53–0.63];
P
<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI (
R
2
values <0.05).

Conclusions:
STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT01435408 and NCT01960933.
Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care
Authors: Ali Syed F. , Fonarow Gregg , Liang Li , Xian Ying , Smith Eric E. , Bhatt Deepak L. , Schwamm Lee 
Published: September 2018

Background
While many patients are transferred to specialized stroke centers for advanced acute ischemic stroke (AIS) care, few studies have characterized these patients. We sought to determine variation in the rates and differences in the baseline characteristics and clinical outcomes between AIS cases presenting directly to stroke centers’ front door versus Transfer-Ins from another hospital.

Methods and Results
We analyzed 970 390 AIS cases in the Get With The Guidelines–Stroke registry from January 2010 to March 2014 to compare hospitals with high Transfer-In rates (≥15%) versus those with low Transfer-In rates (<5%) and to compare the front-door versus Transfer-In patients admitted to those hospitals with high Transfer-In rates (high Transfer-In hospitals). Of 970 390 patients discharged from 1646 hospitals, 87% initially presented via the emergency department versus 13% were a Transfer-In from another hospital. High Transfer-In hospitals had a median 31% Transfer-In rate among all stroke discharges, were larger, had higher annual AIS volume and intravenous tPA (tissue-type plasminogen activator) rates, and were more often Midwest teaching hospitals and stroke centers. Compared with front-door, Transfer-In patients were younger, more often white, had higher median National Institutes of Health Stroke Scale scores, less often hypertension and previous stroke/transient ischemic attack, and higher in-hospital mortality (7.9% versus 4.9%; standardized difference, 12.4%). After multivariable adjustment, Transfer-In patients had higher in-hospital mortality and discharge modified Rankin scale.

Conclusions
There is significant regional variability in the transfer of patients with AIS. Because Transfer-In patients seem to have worse short-term outcomes, these patients have the potential to negatively influence institutional mortality rates and should be accounted for explicitly in hospital risk-profiling measures.
Impact of Patient Distance From Percutaneous Coronary Intervention Centers on Longitudinal Outcomes
Authors: Valle Javier A. , Glorioso Thomas J. , Maddox Thomas M. , Armstrong Ehrin J. , Waldo Stephen W. , Bradley Steven M. , Ho P. Michael 
Published: September 2018

Background
In regional healthcare referral networks, specialty care is provided at a few sites within the network, with patients referred there for management. This model may increase access to specialized care but also increases the distance that patients travel to receive such care, with unknown effects on longitudinal outcomes. The Veterans Administration uses such regional models for percutaneous coronary intervention (PCI). The impact of patient distance from specialty centers on longitudinal outcomes after receipt of specialized care is understudied and may carry implications for care delivery models.

Methods and Results
We identified 31 483 patients undergoing PCI at 64 Veterans Administration sites between 2008 to 2012, and assessed the relationship between quintile (Qn) of patient distance from PCI center and all-cause death or myocardial infarction within a year of PCI. Secondary analyses investigated interactions between patient distance and PCI presentation, urgency, and Medicare eligibility on the primary outcome. Median distance to PCI site was 48 miles (interquartile range, 17–110). After adjustment, increasing distance from PCI center was not associated with higher risk of 1-year death or myocardial infarction (with Qn1 as reference, Qn2: odds ratio, 1.02 [95% simultaneous CI, 0.84–1.25]; Qn3: 1.06 [95% simultaneous CI, 0.87–1.30]; Qn4: 0.92 [95% simultaneous CI, 0.75–1.14]; Qn5: 0.97 [95% simultaneous CI, 0.78–1.20]). Stratifying the cohort by acute coronary syndrome presentation, urgency of PCI, and by eligibility for Medicare did not find an association between distance and outcome.

Conclusions
In this cohort of US veterans, 50% traveled 48 miles or longer to undergo PCI, and 25% traveled >110 miles. Despite this wide range of distances traveled, there was no association between patient distance to PCI center and subsequent outcomes of death or myocardial infarction at 1 year. These findings suggest that regional referral networks may represent viable models for PCI care delivery.
Is Anticoagulation Beneficial in Pulmonary Arterial Hypertension?
Authors: Khan Muhammad Shahzeb , Usman Muhammad Shariq , Siddiqi Tariq Jamal , Khan Safi U. , Murad M. Hassan , Mookadam Farouk , Figueredo Vincent M. , Krasuski Richard A. , Benza Raymond L. , Rich Jonathan D. 
Published: September 2018

Background
Data about anticoagulation in pulmonary arterial hypertension (PAH) patients are inconsistent. The objective of this study was to examine the impact of adjunctive oral anticoagulants in patients with PAH through meta-analysis, and to further assess whether response differs by PAH subtype.

Methods and Results

Cochrane CENTRAL, Medline, and Scopus databases were searched for randomized or nonrandomized studies that assessed the association between anticoagulation and outcomes in patients with PAH. Hazard ratios (HRs) for mortality were pooled using the random effects model. Subgroup analyses were performed for type of PAH and study design. Twelve nonrandomized studies, at moderate risk of bias, were included. These consisted of 2512 patients (1342 receiving anticoagulation and 1170 controls). Anticoagulation significantly reduced mortality in the overall PAH cohort (HR, 0.73 [0.57, 0.93];
P
=0.001;
I
2
=64%). On subgroup analysis, a significant mortality reduction was seen in idiopathic PAH patients (HR, 0.73 [0.56, 0.95];
P
=0.02;
I
2
=46%), whereas no significant difference was observed in connective tissue disease–related PAH (HR, 1.16 [0.58, 2.32];
P
=0.67;
I
2
=71%). Sensitivity analysis specific to scleroderma-associated PAH demonstrated a significant increase in mortality with anticoagulant use (HR, 1.58 [1.08, 2.31];
P
=0.02;
I
2
=9%).

Conclusions
This meta-analysis shows that use of anticoagulation may improve survival in idiopathic PAH patients, while increasing mortality when used in scleroderma-associated-PAH patients. Currently, no randomized clinical trials have been published, and until randomized data are available, anticoagulant use in PAH should be tailored to PAH subtype.
Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy
Authors: Walters Tomos E. , Wick Kate , Tan Gabriel , Mearns Megan , Joseph Stephen A. , Morton Joseph B. , Sanders Prashanthan , Bryant Christina , Kistler Peter M. , Kalman Jonathan M. 
Published: September 2018

Background

An association between atrial fibrillation (
AF
), anxiety, and depression is recognized, but the spectrum of psychological distress remains unclear. We aimed to characterize the severity and predictors of distress associated with
AF
in a tertiary population and its response to
AF
management.

Methods and Results

Seventy‐eight patients with symptomatic
AF
underwent evaluation, including of
AF
symptom severity, health‐related quality of life, psychological distress, suicidal ideation, and specific personality traits. Twenty participants underwent
AF
ablation and 58 were managed medically, with repeat assessments at 4, 8, and 12 months. Severe distress (Hospital Anxiety and Depression Scale score, ≥15/42) was identified in 27 of 78 (35%). Independent predictors were a personality marked by vulnerability to stress (Perceived Stress Scale:
R
2
, 0.54; β=0.7±0.1; t=7.8;
P
<0.001) and 1 marked by negativity/social inhibition (Type D Personality Scale:
R
2
, 0.47; β=0.7±0.1; t=6.7;
P
<0.001). Suicidal ideation was reported by 16 of 78 (20%) and was predicted by personality traits (Perceived Stress Scale score:
R
2
, 0.35; odds ratio, 1.22±0.06;
P
<0.001; Type D Personality Scale score:
R
2
, 0.48; odds ratio, 1.43±0.14;
P
<0.001). Effective
AF
ablation (median
AF
burden 1% [0–1%] over 12 months) was associated with significant reductions in distress (Hospital Anxiety and Depression Scale score, 13.9±1.8 to 4.3±1.8;
P
<0.05) and prevalence of suicidal ideation (30–5%;
P
=0.02).

Conclusions

There was a high prevalence of severe psychological distress (35%) and of suicidal ideation (20%) in a tertiary
AF
population, with personality traits predicting both. Effective
AF
ablation was associated with significant improvements, suggesting
AF
itself may be a treatable causative factor of distress.
Cognitive Impairment and Risk of All‐Cause and Cardiovascular Disease Mortality Over 20‐Year Follow‐up: Results From the BLSA
Authors: An Ji , Li Haibin , Tang Zhe , Zheng Deqiang , Guo Jin , Liu Yue , Feng Wei , Li Xia , Wang Anxin , Liu Xiangtong , Tao Lixin , Hou Chengbei , Zhang Feng , Yang Xinghua , Gao Qi , Wang Wei , Guo Xiuhua , Luo Yanxia 
Published: September 2018

Background

Cognitive impairment may increase the risk of all‐cause and cardiovascular disease (
CVD
) mortality. This study examined the association between cognitive function and risk of all‐cause and
CVD
mortality among the elderly in Beijing, China.

Methods and Results

A total of 1996 participants aged ≥55 years at baseline were enrolled from the BLSA (Beijing Longitudinal Study of Aging). Cognitive function was assessed using the Mini‐Mental State Examination (
MMSE
), and participants were categorized as: <18, 18 to 23, 24 to 27, and 28 to 30. Cox proportional hazard models were used to estimate the association. Hazard ratio (
HR
) and 95% confidence interval (
CI
) were reported. During a 20‐year follow‐up, 1122 (56.21%) participants died, 478 (42.60%) of whom died of
CVD
. Compared with
MMSE
scores of 28 to 30, participants with
MMSE
scores of <18 were independently associated with all‐cause mortality (
hazard ratio,
2.14; 95%
confidence interval,
1.59–2.87;
P
<0.001) and CVD mortality (hazard ratio
,
4.52; 95% confidence interval
,
2.80–7.30,
P
<0.001). Each 5‐point decrease in
MMSE
score was associated with a 34% increased risk of all‐cause mortality and a 56% increased risk of
CVD
mortality. This relationship remained statistically significant after using the competing risk model to consider non‐
CVD
death as a competing risk event.

Conclusion

Cognitive impairment measured by
MMSE
score was associated with elevated risk of all‐cause and
CVD
mortality among the elderly in Beijing, China.
Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis
Authors: Kwok Chun Shing , Kontopantelis Evangelos , Kuligowski George , Gray Matthew , Muhyaldeen Alan , Gale Christopher P. , Peat George M. , Cleator Jacqueline , Chew‐Graham Carolyn , Loke Yoon Kong , Mamas Mamas Andreas 
Published: September 2018

Background
There is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality.

Methods and Results

We conducted a systematic review, meta‐analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched
MEDLINE
and
EMBASE
for these studies and extracted data from identified studies. We utilized linear and nonlinear dose‐response meta‐analysis models and used DerSimonian–Laird random‐effects meta‐analysis models of risk ratios, with inverse variance weighting, and the I
2
statistic to quantify heterogeneity. Seventy‐four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose‐response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self‐reported duration of sleep >8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio
,
1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio
,
1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes.

Conclusions
Divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.
Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability
Authors: Livia Christopher , Sugrue Alan , Witt Tyra , Polkinghorne Murray D. , Maor Elad , Kapa Suraj , Lehmann Helge I. , DeSimone Christopher V. , Behfar Atta , Asirvatham Samuel J. , McLeod Christopher J. 
Published: September 2018

Background

The Purkinje network appears to play a pivotal role in the triggering as well as maintenance of ventricular fibrillation. Irreversible electroporation (
IRE
) using direct current has shown promise as a nonthermal ablation modality in the heart, but its ability to target and ablate the Purkinje tissue is undefined. Our aim was to investigate the potential for selective ablation of Purkinje/fascicular fibers using
IRE
.

Methods and Results

In an ex vivo Langendorff model of canine heart (n=8), direct current was delivered in a unipolar manner at various dosages from 750 to 2500 V, in 10 pulses with a 90‐μs duration at a frequency of 1 Hz. The window of ventricular fibrillation vulnerability was assessed before and after delivery of electroporation energy using a shock on T‐wave method.
IRE
consistently eradicated all Purkinje potentials at voltages between 750 and 2500 V (minimum field strength of 250–833 V/cm). The ventricular electrogram amplitude was only minimally reduced by ablation: 0.6±2.3 mV (
P
=0.03). In 4 hearts after
IRE
delivery, ventricular fibrillation could not be reinduced. At baseline, the lower limit of vulnerability to ventricular fibrillation was 1.8±0.4 J, and the upper limit of vulnerability was 19.5±3.0 J. The window of vulnerability was 17.8±2.9 J. Delivery of electroporation energy significantly reduced the window of vulnerability to 5.7±2.9 J (
P
=0.0003), with a postablation lower limit of vulnerability=7.3±2.63 J, and the upper limit of vulnerability=18.8±5.2 J.

Conclusions

Our study highlights that Purkinje tissue can be ablated with
IRE
without any evidence of underlying myocardial damage.