bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physician performance scores used to predict emergency department admission numbers and excessive admissions burden
Authors: Eyre Andy , Stein Gideon Y , Chen Jacob , Alon Danny 
Published: September 2024

BackgroundOvercrowding in hospitals is associated with a panoply of adverse events. Inappropriate decisions in the emergency department (ED) contribute to overcrowding. The performance of individual physicians as part of the admitting team is a critical factor in determining the overall rate of admissions. While previous attempts to model admission numbers have been based on a range of variables, none have included measures of individual staff performance. We construct reliable objective measures of staff performance and use these, among other factors, to predict the number of daily admissions. Such modelling will enable enhanced workforce planning and timely intervention to reduce inappropriate admissions and overcrowding.MethodsA database was created of 232 245 ED attendances at Meir Medical Center in central Israel, spanning the years 2016–2021. We use several measures of physician performance together with historic caseload data and other variables to derive statistical models for the prediction of ED arrival and admission numbers.ResultsOur models predict arrival numbers with a mean absolute percentage error (MAPE) of 6.85%, and admission numbers with a MAPE of 10.6%, and provide a same-day alert for heavy admissions burden with 75% sensitivity for a false-positive rate of 20%. The inclusion of physician performance measures provides an essential boost to model performance.ConclusionsArrival number and admission numbers can be predicted with sufficient fidelity to enable interventions to reduce excess admissions and smooth patient flow. Individual staff performance has a strong effect on admission rates and is a critical variable for the effective modelling of admission numbers.
Association between stroke subtypes and outcomes of endovascular therapy: a post-hoc analysis of the ANGEL-ASPECT Trial
Authors: Lu Da , ­ Raynald , Sun Dapeng , Zheng Na , Zhang Bohao , Luo Leilei , Wang Sifei , Pan Sihu , Dou Yuchao , Wang Mengxing , Pan Yuesong , Huo Xiaochuan , Miao Zhongrong , Wei Ming 
Published: September 2024

ObjectivesOur study aims to examine the value of endovascular therapy (EVT) and its comparison to medical management (MM) in ischaemic stroke patients accompanied by large artery atherosclerosis (LAA) and non-LAAMethodsmodified Rankin scale score (mRS) was evaluated at 90 days post the stroke attack and was considered as the primary outcome. Other outcomes measured in this study included score changes of 0–2 and 0–3 on the mRS. The occurrence of symptomatic intracranial haemorrhage at 24 hours after EVT was also measured as a safety endpoint. Logistic regression analysis was used to determine the associations.ResultsIn the LAA group, no significant difference in mRS at 90-day (median IQR 3 (2–5) vs 4 (3–4), 95% CI 0.53 to 2.00, p=0.924), mRS 0–2 and mRS 0–3 was observed between EVT and MM groups. However, in the non-LAA group, patients who underwent EVT had lower 90-day mRS scores (4 (2–5) vs 4 (3–5), generalised OR 1.47, 95% CI 1.14 to 1.88, p<0.001). No interaction effect on the primary outcomes between treatment options and aetiology. More intracranial haemorrhage events within 48 hours were identified in the EVT group for both LAA and non-LAA cohorts (LAA: 40.98% vs 9.62%, relative risk (RR) 4.26, 95% CI 1.76 to 10.34, p<0.001; non-LAA, 52.07% vs 19.65%, RR 2.65, 95% CI 1.90 to 3.70, respectively).ConclusionsFor large infarcts, EVT may be more effective than MM for patients with non-LAA aetiology, but not for those with LAA stroke. As no interaction effect was found, the benefit of EVT compared with MM did not vary by stroke subtypes.
Equity in Heart Failure Care: A Get With the Guidelines Analysis of Between- and Within-Hospital Differences in Care by Sex, Race, Ethnicity, and Insurance
Authors: Sandhu Alexander T. , Grau-Sepulveda Maria V. , Witting Celeste , Tisdale Rebecca L. , Zheng Jimmy , Rodriguez Fatima , Edward Justin A. , Ambrosy Andrew P. , Greene Stephen J. , Alhanti Brooke , Fonarow Gregg C. , Joynt Maddox Karen E. , Heidenreich Paul A. 
Published: September 2024

BACKGROUND:
Disparities in guideline-based quality measures likely contribute to differences in heart failure (HF) outcomes. We evaluated between- and within-hospital differences in the quality of care across sex, race, ethnicity, and insurance for patients hospitalized for HF.

METHODS:
This retrospective analysis included patients hospitalized for HF across 596 hospitals in the Get With the Guidelines-HF registry between 2016 and 2021. We evaluated performance across 7 measures stratified by patient sex, race, ethnicity, and insurance. We evaluated differences in performance with and without adjustment for the treating hospital. We also measured variation in hospital-specific disparities.

RESULTS:
Among 685 227 patients, the median patient age was 72 (interquartile range, 61–82) and 47.2% were women. Measure performance was significantly lower (worse) for women compared with men for all 7 measures before adjustment. For 4 of 7 measures, there were no significant sex-related differences after patient-level adjustment. For 20 of 25 other comparisons, racial and ethnic minorities and Medicaid/uninsured patients had similar or higher (better) adjusted measure performance compared with White and Medicare/privately insured patients, respectively. Angiotensin receptor neprilysin inhibitor measure performance was significantly lower for Asian, Hispanic, and Medicaid/uninsured patients, and cardiac resynchronization therapy implant/prescription was lower among women and Black patients after hospital adjustment, indicating within-hospital differences. There was hospital-level variation in these differences. For cardiac resynchronization therapy implantation/prescription, 278 hospitals (46.6%) had ≥2% lower implant/prescription for Black versus White patients compared with 109 hospitals (18.3%) with the same or higher cardiac resynchronization therapy implantation/prescription for Black patients.

CONCLUSIONS:
HF quality measure performance was equitable for most measures. There were within-hospital differences in angiotensin receptor neprilysin inhibitor and cardiac resynchronization therapy implant/prescription for historically marginalized groups. The magnitude of hospital-specific disparities varied across hospitals.
Preventing Site-Specific Calpain Proteolysis of Junctophilin-2 Protects Against Stress-Induced Excitation-Contraction Uncoupling and Heart Failure Development
Authors: Wang Jinxi , Chen Biyi , Shi Qian , Ciampa Grace , Zhao Weiyang , Zhang Guangqin , Weiss Robert M. , Peng Tianqing , Hall Duane D. , Song Long-Sheng 
Published: September 2024

BACKGROUND:

Excitation-contraction (E-C) coupling processes become disrupted in heart failure (HF), resulting in abnormal Ca
2+
homeostasis, maladaptive structural and transcriptional remodeling, and cardiac dysfunction. Junctophilin-2 (JP2) is an essential component of the E-C coupling apparatus but becomes site-specifically cleaved by calpain, leading to disruption of E-C coupling, plasmalemmal transverse tubule degeneration, abnormal Ca
2+
homeostasis, and HF. However, it is not clear whether preventing site-specific calpain cleavage of JP2 is sufficient to protect the heart against stress-induced pathological cardiac remodeling in vivo.

METHODS:

Calpain-resistant JP2 knock-in mice (JP2
CR
) were generated by deleting the primary JP2 calpain cleavage site. Stress-dependent JP2 cleavage was assessed through in vitro cleavage assays and in isolated cardiomyocytes treated with 1 μmol/L isoproterenol by immunofluorescence. Cardiac outcomes were assessed in wild-type and JP2
CR
mice 5 weeks after transverse aortic constriction compared with sham surgery using echocardiography, histology, and RNA-sequencing methods. E-C coupling efficiency was measured by in situ confocal microscopy. E-C coupling proteins were evaluated by calpain assays and Western blotting. The effectiveness of adeno-associated virus gene therapy with JP2
CR
, JP2, or green fluorescent protein to slow HF progression was evaluated in mice with established cardiac dysfunction.

RESULTS:

JP2 proteolysis by calpain and in response to transverse aortic constriction and isoproterenol was blocked in JP2
CR
cardiomyocytes. JP2
CR
hearts are more resistant to pressure-overload stress, having significantly improved Ca
2+
homeostasis and transverse tubule organization with significantly attenuated cardiac dysfunction, hypertrophy, lung edema, fibrosis, and gene expression changes relative to wild-type mice. JP2
CR
preserves the integrity of calpain-sensitive E-C coupling–related proteins, including ryanodine receptor 2, Ca
V
1.2, and sarcoplasmic reticulum calcium ATPase 2a, by attenuating transverse aortic constriction–induced increases in calpain activity. Furthermore, JP2
CR
gene therapy after the onset of cardiac dysfunction was found to be effective at slowing the progression of HF and superior to wild-type JP2.

CONCLUSIONS:
The data presented here demonstrate that preserving JP2-dependent E-C coupling by prohibiting the site-specific calpain cleavage of JP2 offers multifaceted beneficial effects, conferring cardiac protection against stress-induced proteolysis, hypertrophy, and HF. Our data also indicate that specifically targeting the primary calpain cleavage site of JP2 by gene therapy approaches holds great therapeutic potential as a novel precision medicine for treating HF.
In‐Hospital Mortality and Treatment in Patients With Acute Coronary Syndrome With and Without Standard Modifiable Cardiovascular Risk Factors: Findings From the CCC‐ACS Project
Authors: Gong Wei , Yan Yan , Liu Jing , Wang Xiao , Zheng Wen , Que Bin , Ai Hui , Smith Sidney C. , Fonarow Gregg C. , Morgan Louise , Zhao Dong , Ma Changsheng , Han Yaling , Nie Shaoping ,   the CCC‐ACS Investigators
Published: September 2024

Background
Patients with acute coronary syndrome without standard modifiable cardiovascular risk factors (SMuRFs; hypertension, smoking, dyslipidemia, diabetes) have not been well studied, with little known about their characteristics, quality of care, or outcomes. We sought to systematically analyze patients with ACS without SMuRFs, especially to evaluate the effectiveness of guideline‐directed medical therapy for these patients.

Methods and Results
In the CCC‐ACS (Improving Care for Cardiovascular Disease in China‐Acute Coronary Syndrome) project (2014–2019), we examined the presence and absence of SMuRFs and features among 89 462 patients with initial acute coronary syndrome. The main outcome was in‐hospital all‐cause mortality. Among eligible patients, 11.0% had none of the SMuRFs (SMuRF‐less). SMuRF‐less patients had higher in‐hospital mortality (unadjusted hazard ratio [HR], 1.49 [95% CI, 1.19–1.87]). After adjustment for clinical characteristics and treatments, the associations between SMuRF status and in‐hospital mortality persisted (adjusted HR, 1.35 [95% CI, 1.07–1.70]). Guideline‐directed optimal medical therapy (receiving angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, β‐blockers, and statins) was not associated with lower mortality (adjusted HR, 0.98 [95% CI, 0.58–1.67]) in SMuRF‐less patients, unlike the association in patients with SMuRFs (adjusted HR, 0.80 [95% CI, 0.66–0.98]). Sensitivity analyses were consistent with these results.

Conclusions
SMuRF‐less patients were associated with an increased risk of in‐hospital mortality. Guideline‐directed medical therapy was less effective in SMuRF‐less patients than in patients with SMuRFs. Dedicated studies are needed to confirm the optimal therapy for SMuRF‐less patients.

REGISTRATION

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02306616.
Effects of Long‐Term Exposure to Ambient Formaldehyde on Hypertension and Angina Pectoris Symptoms: Evidence From the WHO SAGE Cohort Study
Authors: Xu Jiahong , Shi Yan , He Guanhao , Guo Yanfei , Ruan Ye , Hu Jianxiong , Zhu Qijiong , Chen Zhiqing , Liang Shuru , Zheng Yuan , Huang Zhongguo , Yu Siwen , Zhu Ruotong , Dong Xiaomei , Wu Fan , Ma Wenjun , Liu Tao 
Published: September 2024

Background
We aimed to investigate the associations of long‐term exposure to ambient formaldehyde with hypertension and angina pectoris symptoms in Chinese adults.

Methods and Results

Participants' information was obtained from the WHO SAGE (World Health Organization Study on Global Aging and Adult Health) study. The Cox proportional hazards regression model was applied to estimate the associations of formaldehyde with hypertension and angina pectoris symptoms. Mediating effect analysis was used to investigate the mediating effect of hypertension between formaldehyde exposure and angina pectoris symptoms. Long‐term exposure to formaldehyde was positively associated with the risk of angina pectoris symptoms (hazard ratio [HR], 1.66 [95% CI, 1.29–2.13], per interquartile range [IQR], 3.33, 10
15
molecules/cm
2
) and hypertension (HR, 1.17 [95% CI, 1.02–1.34], per IQR, 3.34, 10
15
molecules/cm
2
). The associations between formaldehyde and angina pectoris symptoms were greater in participants aged ≥65 years (HR, 1.90 [95% CI, 1.29–2.80]) and in rural areas (HR, 2.71 [95% CI, 1.54–4.77]), whereas the associations of formaldehyde with hypertension were stronger in men (HR, 1.27 [95% CI, 1.02–1.58]), rural areas (HR, 1.22 [95% CI, 0.94–1.59]), and in ever smokers (HR, 1.33 [95% CI, 1.02–1.72]). The mediation effect analysis indicated that 18.44% (95% CI, 2.17–37.65) of the association between formaldehyde exposure and angina pectoris symptoms was mediated by hypertension.

Conclusions
Long‐term exposure to ambient formaldehyde was positively associated with hypertension and angina pectoris symptoms. The effects of formaldehyde may be modified by age, sex, urbanicity, and smoking status. Hypertension might play a mediating effect in formaldehyde‐induced angina pectoris symptoms.
Clinical Characteristics and Outcomes in Patients With Apical and Nonapical Hypertrophic Cardiomyopathy
Authors: Chen Qin‐Fen , Zou Jiahao , Katsouras Christos S. , You Shenban , Zhou Jian , Ge Hang‐Bin , Liu Chenyang , Zhou Xi , Ni Chao , Peng Yangdi , Hong Chenlv , Lin Wei‐Hong , Zhou Xiao‐Dong 
Published: September 2024

Background
Apical hypertrophic cardiomyopathy (ApHCM) is a variant of hypertrophic cardiomyopathy, with distinct clinical characteristics and outcomes. We aimed to clarify the natural history of patients with ApHCM and identify the risk of end‐stage heart failure incidence.

Methods and Results

This retrospective study was conducted on patients with hypertrophic cardiomyopathy in China between January 2009 and February 2024. Patients were stratified into ApHCM and non‐ApHCM groups. The primary outcome was a composite of major adverse cardiovascular events, including all‐cause deaths, heart failure hospitalization, sudden cardiac death, and ventricular tachycardia. The secondary outcome was the incidence of end‐stage heart failure, defined as left ventricular ejection fraction <50%. Kaplan‐Meier and univariable and multivariable Cox proportional analyses were applied. Adjustment variables were included for important baseline characteristics, comorbidities, and medication use. Of 5653 patients enrolled with hypertrophic cardiomyopathy, 584 (10.3%) had ApHCM and 5069 (89.7%) had non‐ApHCM. During the median follow‐up period of 4.6 years (1.6–8.0 years), major adverse cardiovascular events occurred in 32.2% (n=1808), with a lower incidence in patients with ApHCM than non‐ApHCM (20.4% versus 33.3%,
P
<0.001). Non‐ApHCM was an independent predictor of major adverse cardiovascular events (hazard ratio [HR], 1.65 [95% CI, 1.36–1.99];
P
<0.001). In the serial cohort, patients with ApHCM exhibited a lower incidence of end‐stage heart failure than those with non‐ApHCM (12.4% versus 2.7%,
P
<0.001). Non‐ApHCM was associated with a higher risk of end‐stage heart failure development (HR, 2.31 [95% CI, 1.28–4.15];
P
<0.001). In subgroup and sensitivity analysis, the results were consistent for our main and secondary outcomes.

Conclusions
ApHCM is relatively common in hypertrophic cardiomyopathy and shows lower rates of all‐cause mortality and heart failure hospitalizations than non‐ApHCM.
Hemorrhagic Moyamoya Angiopathy in European Patients
Authors: Brokbals Mosche , Pilgram-Pastor Sara , Focke Jan K. , Strunk Daniel , Veltkamp Roland , Kraemer Markus 
Published: September 2024

BACKGROUND:
Moyamoya angiopathy (MMA) is an important cause of juvenile stroke but an overall rare disease among European populations compared with East Asian cohorts. Consecutively, hemorrhagic MMA is described well in East Asian cohorts, but knowledge in non-Asian patients is limited. Literature suggests that disease presentation may vary between those cohorts, also including hemorrhage frequencies. Hence, this article aims to analyze hemorrhagic MMA in European patients.

METHODS:
We screened for patients of European origin with MMA from a single-center consecutive database of a German hospital specialized on MMA. Those who had a record of intracranial hemorrhage were analyzed individually regarding the type of hemorrhage and use of antiplatelet therapy before and after bleeding onset. To identify associated factors of intracranial hemorrhage, an age- and sex-matched control group was identified from the pool of patients without a history of hemorrhage. Both groups had a comparable follow-up time and were compared in terms of disease presentation, therapeutic interventions, and imaging characteristics, using both univariate tests and multivariate logistic regression analysis.

RESULTS:

From a pool of 332 patients with MMA we identified 288 of European ancestry. From those, 36 had a record of intracranial hemorrhage (12.5%). Thirty-three patients presenting with 37 events were included for further analysis and case-control-comparison. Most events were intracerebral hemorrhage (n=20; 54%) and subarachnoid hemorrhage (n=11; 30%). 78% developed hemorrhage although no antiplatelet therapy was in use (n=29). Seven patients developed intracranial hemorrhage ipsilateral to prior bypass surgery (21%), while 29 of the control patients had a bypass surgery (88%;
P
=0.0001). There was no significant difference in terms of unilateral or bilateral disease type, history of hypertension, as well as imaging characteristics (high Suzuki stage and the presence of collateral pathways in conventional angiography, as well as ischemic defects and the presence of microbleeds on cerebral magnetic resonance imaging;
P
>0.05 in multivariate analysis, respectively).

CONCLUSIONS:
Bypass surgery was negatively associated with the development of intracranial hemorrhage in MMA in European patients. There was no difference in terms of a history of hypertension between groups, indicating that blood pressure is not the major contributor for rupture of fragile collateral vessels. The investigated imaging characteristics were not associated to hemorrhage onset and, therefore, are not suitable as a tool of screening for patients at risk.
Superpixel-ComBat modeling: A joint approach for harmonization and characterization of inter-scanner variability in T1-weighted images
Authors: Chen Chang-Le , Torbati Mahbaneh Eshaghzadeh , Minhas Davneet S. , Laymon Charles M. , Hwang Seong Jae , Bilgel Murat , Crainiceanu Adina , Jin Hecheng , Luo Weiquan , Maillard Pauline , Fletcher Evan , Crainiceanu Ciprian M. , DeCarli Charles S. , Aizenstein Howard J. , Tudorascu Dana L. 
Published: September 2024

Abstract
T1-weighted imaging holds wide applications in clinical and research settings; however, the challenge of inter-scanner variability arises when combining data across scanners, which impedes multi-site research. To address this, post-acquisition harmonization methods such as statistical or deep learning approaches have been proposed to unify cross-scanner images. Nevertheless, how inter-scanner variability manifests in images and derived measures, and how to harmonize it in an interpretable manner, remains underexplored. To broaden our knowledge of inter-scanner variability and leverage it to develop a new harmonization strategy, we devised a pipeline to assess the interpretable inter-scanner variability in matched T1-weighted images across four 3T MRI scanners. The pipeline incorporates ComBat modeling with 3D superpixel parcellation algorithm (namely SP-ComBat), which estimates location and scale effects to quantify the shift and spread in relative signal distributions, respectively, concerning brain tissues in the image domain. The estimated parametric maps revealed significant contrast deviations compared to the joint signal distribution across scanners (p &lt; 0.001), and the identified deviations in signal intensities may relate to differences in the inversion time acquisition parameter. To reduce the inter-scanner variability, we implemented a harmonization strategy involving proper image preprocessing and site effect removal by ComBat-derived parameters, achieving substantial improvement in image quality and significant reduction in variation of volumetric measures of brain tissues (p &lt; 0.001). We also applied SP-ComBat to evaluate and characterize the performance of various image harmonization techniques, demonstrating a new way to assess image harmonization. In addition, we reported various metrics of T1-weighted images to quantify the impact of inter-scanner variation, including signal-to-noise ratio, contrast-to-noise ratio, signal inhomogeneity index, and structural similarity index. This study demonstrates a pipeline that extends the implementation of statistical ComBat method to the image domain in a practical manner for characterizing and harmonizing the inter-scanner variability in T1-weighted images, providing further insight for the studies focusing on the development of image harmonization methodologies and their applications.
Gender differences in the patterns and consequences of changing research directions in scientific careers
Authors: Zhang Lin , Qi Fan , Sivertsen Gunnar , Liang Liming , Campbell David 
Published: September 2024

Abstract
Changes of research direction in scientific careers are related to the so-called “essential tension” between the exploration of new knowledge and the exploitation of established knowledge in research and innovation. Changes of research direction are thereby assumed to influence the evolution of science in general. Research has shown that such changes may also affect the success of individual scientists in their careers. However, the gender dimension of this aspect of career development is so far understudied. There is also a need for more dynamic indicators to record and interpret career developments in macro data. This study combines the gender perspective with the introduction of new indicators. We selected more than 29,000 scientists in Physics & Astronomy and studied them over six decades using a bibliographic data set from Scopus. We find that women are less likely to change research direction than their men counterparts, and that the research performance of women is less negatively affected by changing research direction. We discuss the policy implications of these findings as well as the methodological advancement related to the new indicators of career development.