bluuebunny/crossref_metadata_2025_split huggingface dataset:
Menopausal Vasomotor Symptoms and Subclinical Atherosclerotic Cardiovascular Disease: A Population‐Based Study
Authors: Nilsson Sigrid , Qvick Angelika , Henriksson Moa , Lawesson Sofia Sederholm , Holm Anna‐Clara Spetz , Leander Karin 
Published: August 2024

Background
Menopausal vasomotor symptoms (VMS) are increasingly emphasized as a potentially important cardiovascular risk factor, but their role is still unclear. We assessed the association between VMS and subclinical atherosclerotic cardiovascular disease in peri‐ and postmenopausal women.

Methods and Results
Using a cross‐sectional study design, questionnaire data were collected from a population‐based sample of women aged 50 to 64. The questionnaire asked whether menopause was/is associated with bothersome VMS. A 4‐point severity scale was used: (1) never, (2) mild, (3) moderate, and (4) severe. The VMS duration and time of onset were also assessed. Associations with subclinical atherosclerotic cardiovascular disease, detected via coronary computed tomography angiography, coronary artery calcium score, and carotid ultrasound were assessed using the outcome variables “any coronary atherosclerosis,” “segmental involvement score >3,” “coronary artery calcium score >100,” and “any carotid plaque,” using logistic regression. Covariate adjustments included socioeconomic, lifestyle, and clinical factors. Of 2995 women, 14.2% reported ever severe, 18.1% ever moderate, and 67.7% ever mild/never VMS. Using the latter as reference, ever severe VMS were significantly associated with coronary computed tomography angiography‐detected coronary atherosclerosis (multivariable adjusted odds ratio, 1.33 [95% CI, 1.02–1.72]). Corresponding results for ever severe VMS persisting >5 years or beginning before the final menstrual period were 1.50 (95% CI, 1.07–2.11) and 1.66 (95% CI, 1.10–2.50), respectively. No significant association was observed with segmental involvement score >3, coronary artery calcium score >100, or with any carotid plaque.

Conclusions
Ever occurring severe, but not moderate, VMS were significantly associated with subclinical coronary computed tomography angiography‐detected atherosclerosis, independent of a broad range of cardiovascular risk factors and especially in case of long durations or early onset.
Cost‐Effectiveness of Prehospital Ambulance Helicopter Transportation of Patients With Presumed Stroke in the Era of Mechanical Thrombectomy
Authors: Vogel Nicklas Ennab , Wester Per , Granberg Tobias Andersson , Levin Lars‐Åke 
Published: August 2024

Background
Mechanical thrombectomy has emerged as standard of care in treatment of patients with acute ischemic stroke attributable to large‐vessel occlusion. Efforts to reduce the time from symptom onset to treatment initiation remain critically important to improve functional outcomes in patients treated with either intravenous thrombolysis, mechanical thrombectomy, or both. The use of ambulance helicopters in prehospital acute stroke care could potentially reduce symptom onset to treatment time to mechanical thrombectomy. This study aims to optimize the use of ambulance helicopters in prehospital transportation of patients with presumed acute stroke attributable to large‐vessel occlusion given economic constraints in health care budget.

Methods
By means of an economic model within a decision‐analytical framework, this study evaluates the cost‐effectiveness of complementary ambulance helicopters compared with road ambulances only for prehospital acute transportation of patients with presumed stroke and potential eligibility for mechanical thrombectomy, in regard to the number and locations of ambulance helicopters in Sweden.

Results
A single, optimally located complementary ambulance helicopter was cost‐effective compared with road ambulances only. The most cost‐effective solution in the base‐case scenario with the current 8 thrombectomy centers comprised 13 optimally located helicopters. It reduced mean onset to treatment time with intravenous thrombolysis and onset to treatment time with mechanical thrombectomy by 7.9 and 32.1 minutes, respectively, and produced health gains equal to 91 quality‐adjusted life‐years per year. When the willingness to pay per quality‐adjusted life‐years gained was set at Euro (EUR) 80 000, the incremental net monetary benefit per patient reached EUR 2240. The solution with 13 optimally located helicopters prevailed as the most cost‐effective in the extended scenario analysis with 11 thrombectomy centers, reaching an estimated incremental net monetary benefit per patient at EUR 1754. Furthermore, mean incremental net monetary benefit per patient reached global maximum (EUR 6046) at the geodesic distance of 165.2 km between patient location and the nearest thrombectomy center in the base‐case scenario, and at 238.5 km in the extended scenario with an estimated incremental net monetary benefit per patient at EUR 7994.

Conclusion
This study demonstrates the cost‐effectiveness of ambulance helicopters as a complementary mode of transportation to road ambulances. The most cost‐effective solution of complementary ambulance helicopters comprises 13 optimally located heliports across Sweden.
Mechanochemical chemically assisted ablation of varicose veins for venous insufficiency: American vein and lymphatic society position statement
Authors: Blebea John , Fukaya Eri , Moore Keith S , Lurie Fedor 
Published: August 2024

Background: Mechanical occlusion chemically assisted ablation (MOCA) of incompetent saphenous veins has been utilized since its FDA approval in 2008. However, only recently have longer-term three and 5 year clinical follow up data become available. This updated information necessitates a societal update to guide treatment and ensure optimal patient outcomes. Method: The American Vein and Lymphatic Society convened an expert panel to write a Position Statement with explanations and recommendations for the appropriate use of MOCA for patients with venous insufficiency. Result: This Position Statement was produced by the expert panel with recommendations for appropriate use, treatment technique, outcomes review, and potential adverse events. These recommendations were reviewed, edited, and approved by the Guidelines Committee of the Society. Conclusions: MOCA is effective in alleviating symptoms and a safe treatment option for venous insufficiency. It obviates the need for tumescent anesthesia, has less procedural discomfort and lower risk of thermal nerve or skin injury. It may be used in both the below knee distal GSV as well as the SSV. However, it is associated with significantly lower rates of vessel closure and higher recanalization rates compared to both RFA and EVLA and is less cost effective than thermal techniques. It is an available option for those in whom thermal ablation is not suitable.
Open label experience of repeated OnabotulinumtoxinA injections towards the sphenopalatine ganglion in patients with chronic cluster headache and chronic migraine
Authors: Simmonds Lucy , Jamtøy Kent Are , Aschehoug Irina , Hara Sozaburo , Meisingset Tore W. , Matharu Manjit S. , Tronvik Erling , Bratbak Daniel Fossum 
Published: August 2024

Background A novel technique for injection of OnabotulinumtoxinA (BTA) towards the sphenopalatine ganglion (SPG) has shown promise in refractory chronic migraine (CM) and chronic cluster headache (CCH). Open label safety and efficacy data are presented here. Methods Patients with refractory CM or CCH who had received at least one injection and completed headache diaries were included. Efficacy was defined as ≥50% reduction in moderate-to-severe headache days for CM, or ≥50% reduction in attack frequency for CCH, at weeks five to eight. Results Over 261 injections, there were 123 adverse events (AE), of which one was serious. Most (93%) AEs were mild and all were transient. The 50% response to one injection was 81% for CM and 69% for CCH. The response gradually reduced over subsequent months for CM but stayed between 55% and 67% for CCH. Repeated injections were beneficial. Conclusions Injections resulted in improvement for both groups and was maintained with repeated injections. Repeat injection after three months may be beneficial in CM. Adverse events were not uncommon, but universally transient, presumably as a result of the mechanism of action of BTA. Repeated BTA injection towards the SPG could be an effective treatment for refractory CM and CCH. Larger, randomised, placebo-controlled trials are required.
Applying optical coherence tomography to inline quality monitoring of unidirectional glass-fiber-reinforced thermoplastic tapes
Authors: Wenninger Michael , Kloiber Karin , Marschik Christian , Hochleitner Gernot , Berger-Weber Gerald , Steinbichler Georg 
Published: August 2024

Originally developed for biomedical applications and diagnosis, optical coherence tomography (OCT) has recently been demonstrated to be a powerful non-destructive and non-invasive measurement method for detecting defects in glass-fiber reinforced polymer composites. While previous studies have focused mainly on the use of OCT in the analysis of thermoset composites, we were able to show in offline experiments that OCT can be used to quickly detect typical defects (e.g., dry fiber regions, gaps and fiber breakage) in thermoplastic unidirectional (UD) tapes at high resolution. To investigate the applicability of OCT to inline monitoring, we advanced our previously published approach in two major steps: First, we incorporated the OCT system into an industrial-scale UD-tape production line, and derived optimal settings for inline detection of dry region defects from a comprehensive design of experiments (DoE) to find an optimal balance between accuracy and data size for a stationary tape sample by varying A-scan sampling rate, A-scan averaging and OCT transverse travel velocity. Second, using these optimal settings, we went on to investigate moving tapes over a range of industrially relevant take-off speeds. Microscopy was used for validation in both cases. We developed a fast and robust statistical analysis of B-scans that visualizes the quality of full cross-sections in an interpretable manner for potential use in a real-time setting. Within an industrially relevant production speed range of up to 15 m/min, we are thus now able to investigate 120 mm wide (and potentially wider) UD tapes inline at a transverse resolution of 22 µm, producing only 21 MB of data per measurement.
Prevalence and Factors Associated With Healthy Aging in a Large Representative Community Sample of Older Ethiopians
Authors: Belachew Amare , Cherbuin Nicolas , Bagheri Nasser , Burns Richard 
Published: August 2024

Objectives: To examine the prevalence and predictors of healthy aging among community-dwelling older adults living in Bahir Dar, Ethiopia. Methods: A community-based cross-sectional study included older adults aged 60 and above ( n = 845; Mage = 71 years; 56.4% females). Poisson regression estimated the Relative Risk (RR) of factors associated with healthy aging status. Results: 36.7% of respondents were classified as healthy agers. Factors associated with an increased likelihood of healthy aging included reporting not being lonely, adequate nutrition, no multimorbidity, good self-rated health, financial independence, and engaging in at least 1 hour of moderate physical activity per week. Discussion: The proportion of healthy agers in this study was substantially lower compared to developed countries but comparable to the prevalence reported in similar developing nations. Enhancing physical activity, ensuring proper nutrition, interventions to foster social participation engagement, and networking, and managing chronic diseases were identified as promising strategies to promote healthy aging.
Joint Trajectories of Performance-Based and Self-Reported Physical Functioning in Older Adults: A 20-Year Longitudinal Study in the Netherlands
Authors: Deeg Dorly J. H. , Hoogendijk Emiel O. , van Schoor Natasja M. , Schaap Laura A. , Lima Passos Valéria 
Published: August 2024

Background The well-known disablement process has been conceptualized as a series of transitions between progressive states of functional decline. We studied joint patterns of change within disablement states defined as walking speed, grip strength, and self-reported disability. Methods 1702 participants aged 65 and over were included from the Longitudinal Aging Study Amsterdam, spanning seven waves over 20 years (1996–2016). Group-based multi-trajectory modeling yielded trajectory clusters (TCs) of different patterns of change, further characterized by baseline sociodemographic characteristics, physical and cognitive health, and survival rate. Results Five TCs were identified, distinguished by increasing baseline age. Walking speed and disability showed generally concomitant trajectories. Women had poorer trajectories in grip strength than men, but not in walking speed and disability. Poor physical health distinguished especially the poorest, and cognitive impairment distinguished especially the one-before-poorest from the better TCs. Discussion The findings suggest that the disablement states are not generally distinct or sequential.
Mortality of cytomegalovirus infection among people living with HIV: A retrospective study from a tertiary hospital in Indonesia
Authors: Yunihastuti Evy , Kurniati Nia , Yusuf Muhammad , Yasmon Andi , Sjatha Fithriyah , Edwar Lukman , Nusyirwan Saskia Aziza , Imran Darma , Kurniawan Juferdy , Lubis Anna Mira , Yulianti Mira , Pitoyo Ceva Wicaksono , Nugroho Pringgodigdo , Rusdi Lusiani , Susilo Adityo , Sinto Robert , Muktiarti Dina , Maharani Kartika , Adhari Amalia Irsha , Nora Rina La Distia , Achmad Yustika Novianti , Purap Markus Molan , Karjadi Teguh Harjono , Widhani Alvina 
Published: August 2024

Background There are still many patients newly diagnosed with HIV at an advanced stage in Indonesia. We aimed to identify factors associated with 1-year mortality among cytomegalovirus (CMV)-infected people living with HIV (PLHIV). Methods This retrospective cohort study was carried out at a tertiary-care hospital in Jakarta, Indonesia (January 2017 to December 2022). We included PLHIV with CMV end-organ disease (EOD) and CMV syndrome. The presence of CMV infection was confirmed by fulfilling one of the following criteria: (1) positive PCR from plasma, urine, cerebrospinal fluid, or other body fluids, or associated tissue for CMV EOD; (2) positive immunoglobulin M (IgM); or (3) consistent symptoms and signs of CMV retinitis. Results Out of 1737 PLHIV, 147 (8.5%, 95% CI: 7.2 to 9.9%) were diagnosed with CMV infection. Forty (27.2%, 95% CI: 20.6 to 35.1%) patients died within 1 year of being diagnosed. Only anti-retroviral therapy (ART) defaulting (aHR 3.31, 95% CI: 1.12 to 9.73) was found to be significantly associated with 1-year mortality in multivariate analysis. Conclusion Defaulted ART status is significantly associated with reduced 1-year survival after CMV infection diagnosis. Patients with low CD4 counts, especially those with <50 cells/μL, should be assessed for CMV infection, monitored, and treated accordingly.
A semi-active adaptive pneumatic vibration isolator based on frequency response analysis and nonlinear control
Authors: Xu Shaofeng , Sun Zhibo , Wang Yixuan , Wu Jifan , Shi Yan 
Published: August 2024

In this work, an adaptive nonlinear error feedback controller based on fuzzy state observer is proposed to a novel rubber pneumatic vibration isolator (PVI) system. First, a novel rubber PVI system is designed and developed. Harmonic balance method is applied to establish the dynamic model of the PVI system, so as to analyze the frequency response characteristics of the system. Second, to improve the PVI performance in low-frequency vibration, a nonlinear state error feedback control system based on fuzzy state observer is designed for the active PVI system. Furthermore, the experiment system is established. Finally, through the experimental comparison under 5 Hz, 7 Hz, 20 Hz, and 40 Hz, an adaptive PVI strategy is proposed. The experimental results demonstrate that the adaptive PVI shows better performance in vibration isolation.
A critical hit: Dungeons and Dragons as a buff for autistic people
Authors: Atherton Gray , Hathaway Rhys , Visuri Ingela , Cross Liam 
Published: August 2024

Tabletop role-playing games (TTRPGs) are increasingly used in therapeutic and educational settings to improve the well-being of autistic people. This study investigated the potential of TTRPGs to provide a safe space where autistic adults could develop relationships with others while also engaging in character and world-building. Eight autistic adults were split into two groups and taken through a 6-week online Dungeons and Dragons campaign run by one of the researchers. Semi-structured interviews were then conducted to discuss how participants felt interacting in and out of the TTRPG. Several key themes were identified as important aspects of why autistic people could benefit from role-playing environments. The analysis showed that the participants felt a strong level of enjoyment from engaging in tabletop role-playing and, in many ways, experienced better social interactions during the TTRPG. The results suggested that TTRPGs can provide a safe space for autistic adults to engage in meaningful social interactions with like-minded individuals. Role-playing may also allow autistic participants to rewrite their own life stories through their characters’ adventures, leading to improved self-esteem. Lay abstract Tabletop role-playing games (TTRPGs) are popular hobbies that may offer specific social benefits for autistic people. This study investigated the ability of TTRPGs to provide a safe space where autistic adults could develop relationships with other autistic adults while engaging in character and world-building. A group of eight autistic adults were split into two groups and taken through a short-form online Dungeons and Dragons campaign over 6 weeks run by one of the researchers. The researcher then led a series of individual semi-structured interviews discussing how participants felt interacting in and out of the TTRPG. Several key themes were identified as important aspects of why autistic people could benefit from such an environment. Analysis showed that while real-life interactions could be challenging, in TTRPG play, they felt they experienced significantly fewer struggles. Results suggested that TTRPGs can provide a safe space environment where autistic adults can engage in productive social interactions with like-minded individuals. It also may allow autistic participants to experience ‘bleed’ or the ability to take on a new character that changes the way they feel about themselves outside of the game. Future directions for this work are discussed.
Physician Modified Endograft for Ruptured Dissecting Aortic Arch Aneurysm
Authors: Solano Antonio , Keller Melissa R. , Porras Colon Jesus , Patel Rhusheet , Timaran Carlos H. , Kirkwood Melissa L. , Baig M. Shadman 
Published: August 2024

Background Endovascular repair of thoracic aortic aneurysms (TAA) in elective settings has demonstrated successful clinical outcomes. However, life-threatening conditions such as rupture are more often managed with open surgical repair due to the high complexity of arch endovascular repair, lack of available off-the-shelf devices, and limited long-term data. Case Summary A 49-year-old female with a recent history of prior ascending aortic repair for Type A10 aortic dissection presented with chest pain and dyspnea. Chest computed tomography angiogram (CTA) revealed acute bilateral pulmonary emboli and a 6.2 cm post dissection aneurysm of the posterior aortic arch with the dissection extending to the right iliac artery. She was treated with thrombolysis and subsequently became hemodynamically unstable. Repeat CTA revealed a massive left hemithorax with concern for aortic arch rupture. Given significant cardiorespiratory compromise and recent open repair, she was considered unfit for redo open repair. Thoracic endovascular aortic repair (TEVAR) with a physician-modified endograft (PMEG) was planned. An Alpha Zenith endograft was modified adding an internal branch for the innominate artery and a fenestration for the left common carotid artery. The left subclavian artery was occluded with a microvascular plug and coil embolization up to the level of the vertebral artery. TEVAR PMEG extension to the celiac artery was performed followed by deployment of a Zenith dissection stent to the aortic bifurcation. Completion angiogram demonstrated successful aneurysm exclusion and patency of target vessels. Conclusion Endovascular treatment of ruptured TAA with PMEGs is feasible. This approach may be an alternative for unfit patients for open repair in emergent settings.
Aspiration tubing diameter is a key determinant of vacuum pressure and is associated with procedural outcome in mechanical thrombectomy for large vessel occlusion: An experimental and cohort study
Authors: Verhey Leonard H , Lyons Leah , Sewell Andrea , Grandfield Ryan M , Khan Muhib , Mazaris Paul , Singer Justin A 
Published: August 2024

Background We (1) evaluated the effect of aspiration tubing diameter on intraluminal pressure and (2) compared thrombectomy outcomes in patients treated using small diameter tubing versus those treated using large diameter vacuum tubing. Methods Intraluminal negative pressure was measured in a validated benchtop set up where consistency of negative pressure (inHg) was measured between static and dynamic aspiration. Static aspiration refers to activation of vacuum once the catheter is engaged with the clot. Dynamic aspiration refers to activation of vacuum when the catheter is slightly proximal to the clot. Four different sizes of vacuum tubing were trialed. We performed a retrospective analysis of consecutive patients who underwent mechanical thrombectomy. Procedural and functional outcomes were compared. Results The large diameter aspiration tubing held a consistent high negative pressure in static and dynamic aspiration (p = 0.152). Tubing types I to III were associated with a significant fall off in negative pressure between static and dynamic technique (p < 0.05). Two-hundred and five patients were included in the retrospective analysis; 124 (60%) underwent thrombectomy using small diameter vacuum tubing, and 81 (40%) using the large tubing. Mean thrombectomy time was shorter with the larger tubing [25.9 (17.9) minutes] versus the small tubing [37.5 (28.5) minutes, p = 0.002]. A greater proportion of patients had a thrombolysis in cerebral infarction score ≥2b in the group treated using the large tubing (78, 99%) than those with the small tubing (96, 78%, p < 0.001). Conclusion Vacuum tubing diameter is linearly associated with intraluminal aspiration pressure. These findings have clinical significance as shown by increased recanalization rates and decreased thrombectomy times when large-diameter aspiration tubing is used. Shifting the paradigm toward a flow-based technique using large-bore vacuum tubing ought to be considered.