bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying and reducing inappropriate aspirin use in primary care
Authors: Brooker Christa , Compton Rebekah , Babineau Terri , Normeshie Cornelius Afetorli , Li Li , Blackstone Sarah Rachel 
Published: November 2023

ObjectiveRecent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were to (1) develop a systematic approach to identifying patients aged 70 and older taking aspirin for primary prevention, (2) provide patient and provider education about updated literature and recommendations regarding aspirin safety and (3) evaluate the impact of this intervention on aspirin de-prescribing.DesignThis was a quality improvement intervention with prospective, longitudinal follow-up.SettingThis study was conducted in two family medicine practices within an academic medical centre.ParticipantsPatients aged 70 years and older with aspirin listed on the current medication list.MethodsThis is an electronic medical record-based chart review and educational intervention based on shared decision-making to reduce inappropriate aspirin use in primary practice. A chart review process was developed to identify the clinical indication for aspirin use. Patients taking aspirin for primary prevention were flagged for the primary care providers to review. Multilevel logistic regression models assessed factors affecting aspirin de-prescribing and longitudinal trend.ResultsOf 361 patients aged 70 years or older, 145 (40%) were taking aspirin for primary prevention of atherosclerotic cardiovascular disease. After 9 months, aspirin was deprescribed in 42 (29%) of these patients. Patients seen by their providers during the study period had lower odds of having aspirin on their medication list (OR=0.87, 95% CI: 0.81, 0.94) as compared with patients taking aspirin who were not seen by their healthcare provider.ConclusionThis is the first study to develop and implement a method of identifying potentially inappropriate aspirin use based on recent clinical evidence highlighting the risk of aspirin use for primary prevention in older adults. Future initiatives can leverage existing electronic medical record platforms to efficiently identify patients and expand these efforts to larger patient populations.
Perioperative opioid prescribing and iatrogenic opioid use disorder and overdose: a state-of-the-art narrative review
Authors: Larach Daniel B , Waljee Jennifer F , Bicket Mark C , Brummett Chad M , Bruehl Stephen 
Published: November 2023

Background/importance
Considerable attention has been paid to identifying and mitigating perioperative opioid-related harms. However, rates of postsurgical opioid use disorder (OUD) and overdose, along with associated risk factors, have not been clearly defined.

Objective
Evaluate the evidence connecting perioperative opioid prescribing with postoperative OUD and overdose, compare these data with evidence from the addiction literature, discuss the clinical impact of these conditions, and make recommendations for further study.

Evidence review
State-of-the-art narrative review.

Findings
Nearly all evidence is from large retrospective studies of insurance claims and Veterans Health Administration (VHA) data. Incidence rates of new OUD within the first year after surgery ranged from 0.1% to 0.8%, while rates of overdose events ranged from 0.01% to 0.8%. Higher rates were seen among VHA patients, which may reflect differences in data completeness and/or risk factors. Identified risk factors included those related to substance use (preoperative opioid use; non-opioid substance use disorders; preoperative sedative, anxiolytic, antidepressant, and gabapentinoid use; and postoperative new persistent opioid use (NPOU)); demographic attributes (chiefly male sex, younger age, white race, and Medicaid or no insurance coverage); psychiatric comorbidities such as depression, bipolar disorder, and PTSD; and certain medical and surgical factors. Several challenges related to the use of administrative claims data were identified; there is a need for more granular retrospective studies and, ideally, prospective cohorts to assess postoperative OUD and overdose incidence with greater accuracy.

Conclusions
Retrospective data suggest an incidence of new postoperative OUD and overdose of up to 0.8% during the first year after surgery, but prospective studies are lacking.
A Few-Shot Transfer Learning Approach for Motion Intention Decoding from Electroencephalographic Signals
Authors: Mammone Nadia , Ieracitano Cosimo , Spataro Rossella , Guger Christoph , Cho Woosang , Morabito Francesco Carlo 
Published: November 2023

In this study, a few-shot transfer learning approach was introduced to decode movement intention from electroencephalographic (EEG) signals, allowing to recognize new tasks with minimal adaptation. To this end, a dataset of EEG signals recorded during the preparation of complex sub-movements was created from a publicly available data collection. The dataset was divided into two parts: the source domain dataset (including 5 classes) and the support (target domain) dataset, (including 2 classes) with no overlap between the two datasets in terms of classes. The proposed methodology consists in projecting EEG signals into the space-frequency-time domain, in processing such projections (rearranged in channels × frequency frames) by means of a custom EEG-based deep neural network (denoted as EEGframeNET5), and then adapting the system to recognize new tasks through a few-shot transfer learning approach. The proposed method achieved an average accuracy of 72.45 ± 4.19% in the 5-way classification of samples from the source domain dataset, outperforming comparable studies in the literature. In the second phase of the study, a few-shot transfer learning approach was proposed to adapt the neural system and make it able to recognize new tasks in the support dataset. The results demonstrated the system’s ability to adapt and recognize new tasks with an average accuracy of 80 ± 0.12% in discriminating hand opening/closing preparation and outperforming reported results in the literature. This study suggests the effectiveness of EEG in capturing information related to the motor preparation of complex movements, potentially paving the way for BCI systems based on motion planning decoding. The proposed methodology could be straightforwardly extended to advanced EEG signal processing in other scenarios, such as motor imagery or neural disorder classification.
The end of the Cretaceous: depositional palaeogeographical reconstruction of the Gulf of Mexico and adjacent areas just prior to the Chicxulub impact
Authors: Snedden John William , Lowery Christopher M. , Lawton Timothy F. 
Published: November 2023

Abstract
Until recently, information about the end of the Cretaceous was based upon investigation of global outcrop sections. New subsurface drilling and characterization from well cores and logs in the Gulf of Mexico Basin have greatly illuminated the end Cretaceous event. However, the palaeogeography of the late Maastrichtian just prior to bolide impact is less well understood and is of great importance in terms of modelling the resulting distribution and composition of the Chicxulub impact material, as well as tsunami and seiche wave height. Here, we examine the Maastrichtian strata in the basin, synthesizing lithostratigraphy and chronostratigraphy, tectonic plate reconstructions, global and local sea level history, palaeoclimate and depositional systems. Our new Maastrichtian palaeogeographical reconstruction shows the basin prior to the Chicxulub impact at a time of globally high sea level, with widespread deposition of deepwater chalks and shallow marine carbonates and local siliciclastic shorelines fed by the nascent Cordilleran belt. Stratigraphic correlations of wells and outcrops illustrate the range of palaeoenvironments from coastal plain to deep marine. As much as 610 m (2000 ft) of Maastrichtian and Campanian section is mapped around the basin, reflecting accommodation provided by basin subsidence, salt deflation and palaeophysiography. A large thickness of carbonates accumulated in the basin centre, with steep shoreline to basin gradients particularly in Mexico. At the end of the Cretaceous, carbonate palaeoenvironments probably covered 96% of the Gulf of Mexico Basin, with less than 4% of the area likely occupied by siliciclastic systems, a distribution that evolved from the Early Cretaceous. Our maps thus explain dominance of carbonate breccia and chalks in K–Pg boundary units deposited over the basin sites proximal or distal to the Chicxulub impact crater. This also elucidates the large impedance contrast and high amplitude seismic response of the K–Pg boundary horizon, mappable over vast portions of the basin.
Vitamin B6 Competition in the Tumor Microenvironment Hampers Antitumor Functions of NK Cells
Authors: He Chunbo , Wang Dezhen , Shukla Surendra K. , Hu Tuo , Thakur Ravi , Fu Xiao , King Ryan J. , Kollala Sai Sundeep , Attri Kuldeep S. , Murthy Divya , Chaika Nina V. , Fujii Yuki , Gonzalez Daisy , Pacheco Camila G. , Qiu Yudong , Singh Pankaj K. , Locasale Jason W. , Mehla Kamiya 
Published: November 2023

Abstract

Nutritional factors play crucial roles in immune responses. The tumor-caused nutritional deficiencies are known to affect antitumor immunity. Here, we demonstrate that pancreatic ductal adenocarcinoma (PDAC) cells can suppress NK-cell cytotoxicity by restricting the accessibility of vitamin B6 (VB6). PDAC cells actively consume VB6 to support one-carbon metabolism, and thus tumor cell growth, causing VB6 deprivation in the tumor microenvironment. In comparison, NK cells require VB6 for intracellular glycogen breakdown, which serves as a critical energy source for NK-cell activation. VB6 supplementation in combination with one-carbon metabolism blockage effectively diminishes tumor burden in vivo. Our results expand the understanding of the critical role of micronutrients in regulating cancer progression and antitumor immunity, and open new avenues for developing novel therapeutic strategies against PDAC.

Significance:
The nutrient competition among the different tumor microenvironment components drives tumor growth, immune tolerance, and therapeutic resistance. PDAC cells demand a high amount of VB6, thus competitively causing NK-cell dysfunction. Supplying VB6 with blocking VB6-dependent one-carbon metabolism amplifies the NK-cell antitumor immunity and inhibits tumor growth in PDAC models.
This article is featured in Selected Articles from This Issue, p. 5
Characterizing Mechanisms of Ischemia in Patients With Myocardial Bridges
Authors: Sinha Aish , Rahman Haseeb , Rajani Ronak , Demir Ozan M. , Li KamWa Matthew , Morgan Holly , Ezad Saad M. , Ellis Howard , Hogan Dexter , Gulati Ankur , Shah Ajay M. , Chiribiri Amedeo , Webb Andrew J. , Marber Michael , Perera Divaka 
Published: November 2023

BACKGROUND:
Myocardial bridges (MBs) are prevalent and can be associated with acute and chronic ischemic syndromes. We sought to determine the substrates for ischemia in patients with angina with nonobstructive coronary arteries and a MB in the left anterior descending artery.

METHODS:
Patients with angina with nonobstructive coronary arteries underwent the acquisition of intracoronary pressure and flow during rest, supine bicycle exercise, and adenosine infusion. Coronary wave intensity analysis was performed, with perfusion efficiency defined as accelerating wave energy/total wave energy (%). Epicardial endothelial dysfunction was defined as a reduction in epicardial vessel diameter ≥20% in response to intracoronary acetylcholine infusion. Patients with angina with nonobstructive coronary arteries and a MB were compared with 2 angina with nonobstructive coronary arteries groups with no MB: 1 with coronary microvascular disease (CMD: coronary flow reserve, <2.5) and 1 with normal coronary flow reserve (reference: coronary flow reserve, ≥2.5).

RESULTS:

Ninety-two patients were enrolled in the study (30 MB, 33 CMD, and 29 reference). Fractional flow reserve in these 3 groups was 0.86±0.05, 0.92±0.04, and 0.94±0.05; coronary flow reserve was 2.5±0.5, 2.0±0.3, and 3.2±0.6. Perfusion efficiency increased numerically during exercise in the reference group (65±9%–69±13%;
P
=0.063) but decreased in the CMD (68±10%–50±10%;
P
<0.001) and MB (66±9%–55±9%;
P
<0.001) groups. The reduction in perfusion efficiency had distinct causes: in CMD, this was driven by microcirculation-derived energy in early diastole, whereas in MB, this was driven by diminished accelerating wave energy, due to the upstream bridge, in early systole. Epicardial endothelial dysfunction was more common in the MB group (54% versus 29% reference and 38% CMD). Overall, 93% of patients with a MB had an identifiable ischemic substrate.

CONCLUSIONS:
MBs led to impaired coronary perfusion efficiency during exercise, which was due to diminished accelerating wave energy in early systole compared with the reference group. Additionally, there was a high prevalence of endothelial and microvascular dysfunction. These ischemic mechanisms may represent distinct treatment targets.
Impact of Receiving Hospital on Out‐of‐Hospital Cardiac Arrest Outcome: Racial and Ethnic Disparities in Texas
Authors: Huebinger Ryan , Del Rios Marina , Abella Benjamin S. , McNally Bryan , Bakunas Carrie , Witkov Richard , Panczyk Micah , Boerwinkle Eric , Bobrow Bentley 
Published: November 2023

Background
Factors associated with out‐of‐hospital cardiac arrest (OHCA) outcome disparities remain poorly understood. We evaluated the role of receiving hospital on OHCA outcome disparities.

Methods and Results
We studied people with OHCA who survived to hospital admission from TX‐CARES (Texas Cardiac Arrest Registry to Enhance Survival), 2014 to 2021. Using census data, we stratified OHCAs into majority (>50%) strata: non‐Hispanic White race and ethnicity, non‐Hispanic Black race and ethnicity, and Hispanic or Latino ethnicity. We stratified hospitals into performance quartiles based on the primary outcome, survival with good neurologic outcome. We evaluated the association between race and ethnicity and care at higher‐performance hospitals. We compared 3 models evaluating the association between race and ethnicity and outcome: (1) ignoring hospital, (2) adjusting for hospital as a random intercept, and (3) adjusting for hospital performance quartile. We adjusted models for possible confounders. We included 10 434 OHCAs. Hospital performance quartile outcome rates ranged from 11.3% (fourth) to 37.1% (first). Compared with OHCAs in neighborhoods of majority White race, those in neighborhoods of majority Black race (odds ratio [OR], 0.1 [95% CI, 0.1–0.1]) and Hispanic or Latino ethnicity (OR, 0.2 [95% CI, 0.2–0.2]) were less likely to be cared for at higher‐performing hospitals. Compared with White neighborhoods (30.1%) and ignoring hospital, outcomes were worse in Black neighborhoods (15.4%; adjusted OR [aOR], 0.5 [95% CI, 0.4–0.5]) and Hispanic or Latino neighborhoods (19.2%; aOR, 0.6 [95% CI, 0.5–0.7]). Adjusting for hospital as a random intercept, outcomes improved for Black neighborhoods (aOR, 0.9 [95% CI, 0.7–1.05]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8–0.99]). Adjusting for hospital performance quartile, outcomes improved for Black neighborhoods (aOR, 0.8 [95% CI, 0.7–1.01]) and Hispanic or Latino neighborhoods (aOR, 0.9 [95% CI, 0.8–0.996]).

Conclusions
In Black and Hispanic or Latino communities, OHCAs were less likely to be cared for at higher‐performing hospitals, and adjusting for receiving hospital improved OHCA outcome disparities.
The EVA (Early Vascular Aging) Study: Association of Central Obesity With Worse Arterial Health After Preeclampsia
Authors: Paquin Amélie , Werlang Ana , Coutinho Thais 
Published: November 2023

Background
Women with preeclampsia have a higher risk of cardiovascular disease. This is partly explained by the worse arterial health after preeclampsia. Central obesity (CO) is a risk factor for both preeclampsia and cardiovascular disease. Whether CO contributes to further worsening of arterial health after preeclampsia remains unclear. Our objective was to evaluate the effect of CO and previous preeclampsia on arterial hemodynamics.

Methods and Results

We studied 40 women with previous preeclampsia (<6 years) and 40 age‐matched controls with previous normotensive pregnancy in the same timeframe. We estimated arterial hemodynamics with validated techniques combining applanation tonometry and echocardiography. CO was defined as a waist‐to‐hip ratio ≥0.85. Differences in arterial hemodynamics across the 3 groups (preeclampsia with CO, preeclampsia without CO, and controls) were assessed with multivariable linear regression models adjusted for potential confounders. Twenty‐six (65%) of the participants with preeclampsia had CO compared with 18 (45%) controls. Mean waist‐to‐hip ratio in patients with preeclampsia with CO, those with preeclampsia and no CO, and controls was 0.94±0.05, 0.80±0.04, and 0.83±0.07, respectively. In multivariable analyses, women with preeclampsia and CO had higher central blood pressure, arterial stiffness (carotid‐femoral pulse wave velocity), steady arterial load (systemic vascular resistance), and wave reflections (reflected pressure wave amplitude, augmentation index) compared with controls (
P
<0.05 for each). Fewer hemodynamic domains were altered in the preeclampsia with no CO group, with higher central diastolic blood pressure, systemic vascular resistance, and wave reflections than controls (
P
<0.05).

Conclusions
Women with previous preeclampsia who also experience CO have the greatest alterations in arterial health and hemodynamics. Patients with preeclampsia with CO may represent a higher‐risk subgroup who could be targeted for risk stratification and primary prevention of cardiovascular disease.
Novel Size‐Based High‐Density Lipoprotein Subspecies and Incident Vascular Events
Authors: Deets Austin , Joshi Parag H. , Chandra Alvin , Singh Kavisha , Khera Amit , Virani Salim S. , Ballantyne Christie M. , Otvos James D. , Dullaart Robin P. F. , Gruppen Eke G. , Connelly Margery A. , Ayers Colby , Navar Ann Marie , Pandey Ambarish , Wilkins John T. , Rohatgi Anand 
Published: November 2023

Background
High‐density lipoprotein (HDL) particle concentration likely outperforms HDL cholesterol in predicting atherosclerotic cardiovascular events. Whether size‐based HDL subspecies explain the atheroprotective associations of HDL particle concentration remains unknown. Our objective was to assess whether levels of specific size‐based HDL subspecies associate with atherosclerotic cardiovascular disease in a multiethnic pooled cohort and improve risk prediction beyond traditional atherosclerotic cardiovascular disease risk factors.

Methods and Results
Seven HDL size‐based subspecies were quantified by nuclear magnetic resonance (LP4 algorithm; H1=smallest; H7=largest) among participants without prior atherosclerotic cardiovascular disease in ARIC (Atherosclerosis Risk in Communities), MESA (Multi‐Ethnic Study of Atherosclerosis), PREVEND (Prevention of Renal and Vascular Endstage Disease), and DHS (Dallas Heart Study) cohorts (n=15 371 people). Multivariable Cox proportional hazards models were used to evaluate the association between HDL subspecies and incident myocardial infarction (MI) or ischemic stroke at follow‐up (average 8–10 years) adjusting for HDL cholesterol and risk factors. Improvement in risk prediction was assessed via discrimination and reclassification analysis. Within the pooled cohort (median age 57 years; female 54%; Black 22%) higher H1 (small) and H4 (medium) concentrations were inversely associated with incident MI (hazard ratio [HR]/SD, H1 0.88 [95% CI, 0.81–0.94]; H4 0.89 [95% CI, 0.82–0.97]). H4 but not H1 improved risk prediction indices for incident MI. Increasing H2 and H4 were inversely associated with improved risk prediction indices for composite end point of stroke, MI, and cardiovascular death (HR/SD, H2 0.94 [95% CI, 0.88–0.99]; H4 0.91 [95% CI, 0.85–0.98]). Levels of the large subspecies (H6 and H7) were not associated with any vascular end point.

Conclusions
Two of 7 HDL size‐based subspecies modestly improved risk prediction for MI and composite vascular end points in a large multiethnic pooled cohort. These findings support assessment of precise HDL subspecies for future studies regarding clinical utility.
Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients
Authors: Jentzer Jacob C. , Van Diepen Sean , Patel Parag C. , Henry Timothy D. , Morrow David A. , Baran David A. , Kashani Kianoush B. 
Published: November 2023

Background
One‐time assessment of the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification robustly predicts mortality in the cardiac intensive care unit (CICU). We sought to determine whether serial SCAI shock classification could improve risk stratification.

Methods and Results

Unique admissions to a single academic level 1 CICU from 2015 to 2018 were included in this retrospective cohort study. Electronic health record data were used to assign the SCAI shock stage during 4‐hour blocks of the first 24 hours of CICU admission. Shock was defined as hypoperfusion (SCAI shock stage C, D, or E). In‐hospital death was evaluated using logistic regression. Among 2918 unique CICU patients, 1537 (52.7%) met criteria for shock during ≥1 block, and 266 (9.1%) died in the hospital. The SCAI shock stage on admission was: A, 37.6%; B, 31.5%; C, 25.9%; D, 1.8%; and E, 3.3%. Patients who met SCAI criteria for shock on admission (first 4 hours) and those with worsening SCAI shock stage after admission were at higher risk for in‐hospital death. Each higher admission (adjusted odds ratio, 1.36 [95% CI, 1.18–1.56]; area under the receiver operating characteristic curve, 0.70), maximum (adjusted odds ratio, 1.59 [95% CI, 1.37–1.85]; area under the receiver operating characteristic curve, 0.73) and mean (adjusted odds ratio, 2.42 [95% CI, 1.99–2.95]; area under the receiver operating characteristic curve, 0.78) SCAI shock stage was incrementally associated with a higher in‐hospital mortality rate. Discrimination was highest for the mean SCAI shock stage (
P
<0.05). Each additional 4‐hour block meeting SCAI criteria for shock predicted a higher mortality rate (adjusted odds ratio, 1.15 [95% CI, 1.07–1.24]).

Conclusions
Dynamic assessment of shock using serial SCAI shock classification assignment can improve mortality risk stratification in CICU patients by quantifying the magnitude and duration of shock.