bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department Referral of Patients With Chest Pain for Noninvasive Cardiac Testing and 2-Year Clinical Outcomes
Authors: Mark Dustin G. , Huang Jie , Ballard Dustin W. , Vinson David R. , Rana Jamal S. , Sax Dana R. , Rauchwerger Adina S. , Reed Mary E. ,   for the Kaiser Permanente CREST Network Investigators
Published: May 2024

BACKGROUND:
Noninvasive cardiac testing (NICT) has been associated with decreased long-term risks of major adverse cardiac events (MACEs) among emergency department patients at high coronary risk. It is unclear whether this association extends to patients without evidence of myocardial injury on initial ECG and cardiac troponin testing.

METHODS:
A retrospective cohort study was conducted of patients presenting with chest pain between 2013 and 2019 to 21 emergency departments within an integrated health care system in Northern California, excluding patients with ST-segment–elevation myocardial infarction or myocardial injury by serum troponin testing. To account for confounding by indication, we grouped patient encounters by the NICT referral rate of the initially assigned emergency physician relative to local peers within discrete time periods. The primary outcome was MACE within 2 years. Secondary outcomes were coronary revascularization and MACE, inclusive of all-cause mortality. Associations between the NICT referral group (low, intermediate, or high) and outcomes were assessed using risk-adjusted proportional hazards methods with censoring for competing events.

RESULTS:
Among 144 577 eligible patient encounters, the median age was 58 years (interquartile range, 48–68) and 57% were female. Thirty-day NICT referral was 13.0%, 19.9%, and 27.8% in low, intermediate, and high NICT referral groups, respectively, with a good balance of baseline covariates between groups. Compared with the low NICT referral group, there was no significant decrease in the adjusted hazard ratio of MACE within the intermediate (adjusted hazard ratio, 1.08 [95% CI, 1.02–1.14]) or high (adjusted hazard ratio, 1.05 [95% CI, 0.99–1.11]) NICT referral groups. Results were similar for MACE, inclusive of all-cause mortality, and coronary revascularization, as well as subgroup analyses stratified by estimated risk (history, electrocardiogram, age, risk factors, troponin [HEART] score: percent classified as low risk, 48.2%; moderate risk, 49.2%; and high risk, 2.7%).

CONCLUSIONS:
Increases in NICT referrals were not associated with changes in the hazard of MACE within 2 years following emergency department visits for chest pain without evidence of acute myocardial injury. These findings further highlight the need for evidence-based guidance regarding the appropriate use of NICT in this population.
Bidirectional Association Between Atrial Fibrillation and Myocardial Infarction, and Relation to Mortality in the Framingham Heart Study
Authors: Frederiksen Tanja Charlotte , Benjamin Emelia J. , Trinquart Ludovic , Lin Honghuang , Dahm Christina C. , Christiansen Morten Krogh , Jensen Henrik Kjærulf , Preis Sarah R. , Kornej Jelena 
Published: May 2024

Background
Individuals with both atrial fibrillation (AF) and myocardial infarction (MI) have higher mortality compared with individuals with only 1 condition. Whether mortality differs according to the temporal order of AF and MI is unclear.

Methods and Results
We included participants from the FHS (Framingham Heart Study) from 1960 and onwards. We assessed the hazard ratio (HR) of new‐onset AF and MI, and mortality according to MI and AF status (prevalent and interim) using multivariable‐adjusted Cox proportional hazards models. Interim diseases were modeled as time‐varying variables. For the analysis of new‐onset AF, 10 923 participants (55% women; mean±SD age, 54±8 years) were included. For new‐onset MI, 10 804 participants (55% women; mean±SD age, 54±8 years) were included. Compared with no MI, the hazard of new‐onset AF was higher in participants with prevalent (HR, 1.60 [95% CI, 1.32–1.94]) and interim MI (HR, 3.96 [95% CI, 3.18–4.91]). Both ST‐segment–elevation MI and non–ST‐segment–elevation MI were associated with new‐onset AF. Interim AF, not prevalent AF, was associated with higher hazard rate of new‐onset MI (HR, 2.21 [95% CI, 1.67–2.92]). Interim AF was associated with both ST‐segment–elevation MI and non–ST‐segment–elevation MI. Mortality was significantly greater among participants with AF and MI compared with participants with 1 of the 2, regardless of temporal order.

Conclusions
We report a bidirectional association between AF and MI, which was observed for both non–ST‐segment–elevation MI and ST‐segment–elevation MI. Participants with both AF and MI had considerably higher mortality compared with participants with only 1 of the 2 conditions, regardless of order.
App‐Based Mental Training to Reduce Atrial Fibrillation–Related Symptoms After Pulmonary Vein Isolation:
MENTAL AF Trial
Authors: Lurz Julia , Hengelhaupt Laura , Unterhuber Matthias , Stenzel Lukas , Hilbert Sebastian , Schöber Anne Rebecca , Dinov Borislav , Darma Angeliki , Dagres Nikolaos , Hindricks Gerhard , Lurz Philipp , Bollmann Andreas 
Published: May 2024

Background
Even after atrial fibrillation (AF) catheter ablation, many patients still experience relevant symptom burden. The objective of the MENTAL AF trial was to determine whether app‐based mental training (MT) during the 3 months following pulmonary vein isolation reduces AF‐related symptoms.

Methods and Results

Patients scheduled for pulmonary vein isolation were enrolled and randomized 1:1 to either app‐based MT or usual care. Of 174 patients, 76 in the MT and 75 in the usual care group were included in the final analysis. The intervention was delivered by a daily 10‐minute app‐based MT. The primary outcome was the intergroup difference of the mean AF6 sum score, an AF‐specific questionnaire, during the 3‐month study period. Secondary outcomes included quality‐of‐life measures such as the AFEQT (Atrial Fibrillation Effect on Quality of Life). Mean age (SD) was 61 (8.7) years and 61 (41%) were women. The mean AF6 sum score over the study period was 8.9 (6.9) points in the MT group and 12.5 (10.1) in the usual care group (
P
=0.011). This referred to a reduction in the AF6 sum score compared with baseline of 75% in MT and 52% for usual care (
P
<0.001). The change in the AFEQT Global Score was 22.6 (16.3) and 15.7 (22.1), respectively;
P
=0.026.

Conclusions
MENTAL AF showed that app‐based MT as an adjunctive treatment tool following pulmonary vein isolation was feasible. App‐based MT was found to be superior to standard care in reducing AF‐related symptom burden and improving health‐related quality of life.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04067427.
Diastolic Filling in Patients After Heart Transplantation Is Impaired Due to an Altered Geometrical Relationship Between the Left Atrium and Ventricle
Authors: Steding‐Ehrenborg Katarina , Nelsson Anders , Hedström Erik , Engblom Henrik , Ingvarsson Annika , Nilsson Johan , Braun Oscar , Arheden Håkan 
Published: May 2024

Background
The geometrical relationship between atrial and ventricular short‐axis cross‐sectional area determines the hydraulic forces acting on intracardiac blood. This is important for diastolic filling. In patients undergoing heart transplantation (HTx), the left atrium is often enlarged as a result of the standard surgical technique. We hypothesized that diastolic filling in HTx patients is affected by the surgery altering the geometrical relationship between atrium and ventricle.

Methods and Results

This retrospective, cross‐sectional study included 25 HTx patients (median age, 52 [range, 25–70] years), 15 patients with heart failure with reduced ejection fraction (median age, 63 [range, 52–75] years), 15 patients with heart failure with preserved ejection fraction (median age, 74 [range, 56–82] years), and 15 healthy controls (median age, 64 [range, 58–67] years) who underwent cardiac magnetic resonance imaging. Left ventricular, atrial, and total heart volumes (THV) were obtained. Atrioventricular area difference at end diastole and end systole was calculated as the largest ventricular short‐axis area minus the largest atrial short‐axis area. Left atrial minimum volume normalized for THV (LA
min
/THV) was larger in HTx patients (median, 0.13 [range, 0.07–0.19]) compared with controls (median, 0.05 [range, 0.03–0.08],
P
<0.001), whereas left ventricular volume normalized for THV (left ventricular end‐diastolic volume/THV) was similar between HTx and controls (median, 0.19 [range, 0.12–0.24] and median, 0.22 [range, 0.20–0.25], respectively). At end diastole, when atrioventricular area difference reached its largest positive value in controls, 11 HTx patients (44%) had a negative atrioventricular area difference, indicating impaired diastolic filling.

Conclusions
Diastolic filling is impaired in HTx patients due to an altered geometrical relationship between the left atrium and ventricle. When performing cardiac transplantation, a surgical technique that creates a smaller left atrium may improve diastolic filling by aiding hydraulic forces.
Linking Survivor Stories to Forensic Engineering: How an Interscience Approach Reveals Opportunities for Reducing Tornado Vulnerability in Residential Structures
Authors: LaDue Daphne S. , Roueche David , Lombardo Frank , Mayeux Lara 
Published: May 2024

Abstract
When a tornado strikes a permanent or mobile/manufactured home, occupants are at risk of injury and death from blunt force trauma caused by debris-loaded winds and failure of the structure. Mechanisms for these failures have been studied for the past few decades and identified common weaknesses in the structural load path. Also under study in recent decades, much has been learned about how people receive and understand warnings and determine how, when, and if they will shelter in advance. Recent research, for example, shows most people do not shelter until close to impact, after seeing, hearing, or feeling the approaching tornado. To advance beyond these innovations, a new, multidisciplinary approach was fielded in nine southeast U.S. tornadoes between 2019 and 2022. For each tornado, 1) wind engineering assessments documented near-surface wind fields, 2) structural engineering assessments documented the primary wind load path for each structure, and 3) social science interviews captured the survivor’s narrative and asked several follow-up questions to assure key items of interest were addressed in each interview. When possible, the team was multidisciplinary during the interview, enabling survivors to ask questions and better understand their experiences. Most survivors became aware of the approaching tornado with at least a few minutes of lead time, and most were able to reach a place of refuge. Most survivors recalled sensory experiences during the tornado, and about half could describe the direction or temporal sequences of damage. A case study of the Cookeville, Tennessee, tornado of 3 March 2020 illustrates the power of the integrated data assessment.
Development of Multiscale EnKF within GSI and Its Applications to Multiple Convective Storm Cases with Radar Reflectivity Data Assimilation Using the FV3 Limited-Area Model
Authors: Tong Chong-Chi , Xue Ming , Liu Chengsi , Luo Jingyao , Jung Youngsun 
Published: May 2024

Abstract
To improve the representation of all relevant scales in initial conditions for large-domain convection-allowing models, a new multiscale ensemble Kalman filter (MEnKF) algorithm is developed and implemented within the Gridpoint Statistical Interpolation analysis system (GSI) data assimilation framework coupled with the Finite-Volume Cubed-Sphere Dynamical Core (FV3) limited-area model. The algorithm utilizes ensemble background error covariances filtered to match the observations assimilated. This is realized in a sequential manner. 1) When assimilating coarse-resolution observations such as radiosondes, ensemble background perturbations are filtered to remove scales smaller than those the observations can represent, along with relatively large horizontal localization radii to ensure low-noise and balanced analysis increments. 2) The resulting ensemble analyses from the first step then serve as the background to assimilate denser observations such as radar data with smaller localization radii. Several passes can be taken to assimilate all observations. In this paper, vertically increasing horizontal filter scales are used when assimilating rawinsonde and surface observations together, while radar data are assimilated in the second step. The algorithm is evaluated through six convective storm cases during May 2021, with cycled assimilation of either conventional data only or with additional radar reflectivity followed by 24-h ensemble forecasts. Overall, positive impacts of the MEnKF on forecasts are obtained regardless of reflectivity data; its advantage over the single-scale EnKF is most significant in surface humidity and temperature forecasts up to at least 12 h. More accurate hourly precipitation forecasts with MEnKF can last up to 24 h for light rain. Furthermore, MEnKF forecasts higher ensemble probabilities for the observed hazardous events.
Increased phosphatidylcholine and its hydroperoxides in serum low-density lipoproteins from patients with non-alcoholic steatohepatitis
Authors: Murakami Nanao , Sakurai Toshihiro , Yamahata Arisa , Sakurai Akiko , Nouso Kazuhiro , Fujii Yuki , Chiba Hitoshi , Hui Shu-Ping 
Published: May 2024

Background Non-alcoholic fatty liver disease is classified into simple steatosis (SS) and non-alcoholic steatohepatitis (NASH) according to histological findings from liver biopsies. Phosphatidylcholine (PC), the main component of phospholipids in serum lipoproteins, is easily oxidized to phosphatidylcholine hydroperoxide (PC-OOH). Although a lipid composition in the low-density lipoproteins (LDL) from patients with NASH could be abnormal, it remains unclear. Here, to better understand the characteristics of lipids in the LDL from NASH and SS, we compared the composition of PC and PC-OOH species in LDL particles (LDL-PC, LDL-PCOOH) from these patients, then clarified the association between these lipids and NASH severity. Methods The serum samples from patients with NASH (female, n = 9) and SS (female, n = 4; male, n = 2) were used for isolation of LDL. Total lipids were extracted from isolated LDL, and the species of PC and PC-OOH were measured using liquid chromatography-mass spectrometry/mass spectrometry. Results The sum of LDL-PC and the sum of LDL-PCOOH were significantly higher in NASH than in SS. Several LDL-PC (PC 32:0, 32:1, 32:2, 34:3, 36:2, sum of PC with saturated fatty acyl chains and sum of LDL-PC with polyunsaturated fatty acyl chains) and several LDL-PCOOH (34:2, 36:2, 36:3 and total) were increased significantly with increasing fibrosis score. In particular, a series of LDL-PCOOH were more reflective of the severity of fibrosis score. Conclusions LDL-PC and LDL-PCOOH species were strongly correlated with the fibrosis score in NASH, which suggests that abnormal LDL is involved in the development of liver fibrosis.
Expanded beads of polyethylene moldable at low steam pressure
Authors: Tammaro Daniele , Strasser Jean Paul 
Published: May 2024

In this study, we explored an innovative approach to extrude expanded polyethylene (ePE) bead foam by utilizing a blend of two types of polyethylene, specifically low-density and linear low-density polyethylene. The intention behind this mixture was to enhance the molding process’s flexibility during steam chest molding. The outcomes of our investigation reveal the adaptability of the devised method and formulation, enabling the production of a broad spectrum of foam densities ranging from 20 to 100 kg/m³. Additionally, we achieved successful molding at remarkably low steam pressures, below 0.6 bar. Our research focuses on the strategic adjustment of processing parameters, including temperature and pressure, along with optimized die geometry for the extrusion foam process. To comprehensively evaluate the foamed molded components, we conducted a comprehensive mechanical and optical analysis. The findings underscore the flexibility and cost-effectiveness of ePE produced through foam extrusion. This method emerges as a promising alternative to expandable polystyrene, especially in applications requiring flexible materials and convenient recyclability without contributing to microplastic pollution in the environment.
Lack of awareness of secondary rheumatic prevention in preoperative candidates for mitral valve surgery – alarming situation
Authors: Khowaja Raheela , Khowaja Aamir , Mangi Ali Raza , Ammar Ali , Khan Waqar , Patel Nehrish , Nizar Rabia , Khursheed Munawar , Sial Jawaid Akbar , Memon Rizwan Aziz 
Published: May 2024

Background We conducted this study to assess the compliance with secondary rheumatic prophylaxis among preoperative patients with rheumatic mitral valve disease undergoing valvular heart surgery at a tertiary care cardiac hospital in a developing country. Methods This is a descriptive cross-sectional study conducted at a tertiary care cardiac hospital in Karachi, Pakistan. The inclusion criteria encompassed patients of any sex, aged between 18 and 80 years, who had been diagnosed with rheumatic mitral valve disease through transthoracic echocardiography and had undergone valvular heart surgery. The level of compliance with secondary rheumatic prophylaxis and barriers toward noncompliance was assessed during routine preoperative interview session. This preventive measure plays a crucial role in reducing the progression of the disease and improving patient outcomes. Results Out of the 239 patients included in the study, 125 (52.3%) were females, with a mean age of 38.8 ± 11.8 years. The majority of patients (88.7%) came from rural areas. Among the patients, 79 (33.1%) received rheumatic prophylaxis, while 160 (66.9%) did not adhere to it regularly. The common barriers for receiving rheumatic prophylaxis were non availability (41.0%) and nonaffordability (40.6%). Additionally, 28.0% of patients had lacked awareness of the importance of rheumatic prophylaxis, and 2.5% expressed fear of injection site pain and subsequent symptoms. Conclusions A concerning level of noncompliance with secondary rheumatic prophylaxis was observed. The barriers identified in patients who did not receive rheumatic prophylaxis were primarily related to affordability, availability, lack of awareness, and fear of injection site pain and subsequent symptoms.
A case series of non-small cell lung cancer patients with EGFR or HER2 exon 20 insertion in Li Fraumeni syndrome
Authors: Cognigni Valeria , Capelletto Enrica , Bordi Paola , Pavese Valeria , Carfì Federica Maria , Gelsomino Francesco , De Giglio Andrea , Chiari Rita , Minari Roberta , Ambrosini Enrico , Percesepe Antonio , Giachino Daniela , Bironzo Paolo , Tiseo Marcello 
Published: May 2024

Introduction: Germline pathogenic mutations in TP53 gene are associated with a cancer predisposition syndrome known as Li Fraumeni syndrome. Albeit infrequently, non-small cell lung cancer, especially as oncogene-addicted disease, may be diagnosed in young patients with Li Fraumeni syndrome. Case description: We report three cases of patients affected by Li Fraumeni syndrome who developed non-small cell lung cancer with EGFR or HER2 exon 20 insertions. The first patient suffered from liposarcoma and, then, brain metastases from HER2-mutated non-small cell lung cancer: after stereotactic radiotherapy, he benefited from enrollment in a clinical trial with a HER2-targeted therapy. The second young patient was a female with personal history of rhabdomyosarcoma, diagnosed with brain metastases from EGFR-mutated non-small cell lung cancer: enrollment in a clinical trial led to a temporary clinical benefit. The last case was a female diagnosed with breast carcinoma, ovarian granulosa cell tumor and advanced EGFR-mutated non-small cell lung cancer at a young age. Conclusions: Young patients affected by oncogene-addicted non-small cell lung cancer and with a positive familial cancer history should be referred for an accurate genetic counselling to look for Li Fraumeni syndrome. The underlying molecular connection between TP53 and HER family receptor tyrosine kinases remains unclear, but an extensive molecular characterization of tumors from patients with Li Fraumeni syndrome should always be performed, to offer patients a personalized therapeutic approach.
Embedding research within occupational therapy pre-registration training: A concept mapping study engaging staff and student voices
Authors: Hackett Katie L , Atkin Helen , Kamalakannan Sureshkumar , Murray Mendes Savannah , Lowe Julie Anne , Whitehead Phillip , Bradley Gemma 
Published: May 2024

Introduction: Occupational therapists require research and evaluation skills to deliver evidence-based care, making research education integral to their training. We aimed to develop a student and staff-informed strategy to further embed research into the occupational therapy programmes and enhance the research culture at a United Kingdom Higher Education Institution. Method: We used group concept mapping to gather ideas from students and staff on how to embed research and improve research culture within the occupational therapy programmes at a United Kingdom Higher Education Institution. Participants generated, sorted and rated ideas for importance and success. We analysed the data to create a concept map and identified rating values for the themed clusters and their ideas. Results: The concept map contained four themed clusters of ideas: Wider research community, Integration of research into the core programme, Advanced research support and capacity building and Research awareness. Successes and improvement targets were identified within each cluster. Conclusion: Group concept mapping provided a structured and comprehensive method to develop a strategy for embedding research and fostering a research culture in occupational therapy programmes at a higher education institution. The four-themed concept map and identified priority targets serve as a foundation for implementing the strategy and improving research integration in occupational therapy education.
Life satisfaction and awareness of meaningful activities among middle-aged adults: A population-based study
Authors: Akaida Shoma , Shiratsuchi Daijo , Tateishi Mana , Kuratsu Ryota , Makizako Hyuma 
Published: May 2024

Introduction: Meaningful activities have been suggested to contribute to life satisfaction. Investigating the association between the awareness of meaningful activities and life satisfaction will help us develop a population-based occupational therapy strategy. The purpose of this study was to investigate the proportion of people who were aware of meaningful activities among middle-aged adults, and the relationship between the awareness of meaningful activities and life satisfaction. Method: A cross-sectional analysis was conducted on 2698 middle-aged adults who participated in an online survey conducted in Japan by the Y-Cloud system. Participants responded to demographic questions, life satisfaction, and awareness of meaningful activities. We examined the association between the awareness of meaningful activities and life satisfaction using binomial logistic regression analysis. Results: Of the respondents, 77.4% were aware of meaningful activities. Binomial logistic regression analysis adjusted for covariates showed that the awareness of meaningful activities was significantly associated with higher life satisfaction (odds ratio, 2.97; 95% confidence interval: 2.45–3.61, p < 0.001). Conclusion: The results suggest the value of presenting that the awareness of meaningful activities should be considered in preventive population-based occupational therapy strategies for life satisfaction.