bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of and Risk Factors for Peripheral Artery Disease in Rural South Africa: A Cross‐Sectional Analysis of the HAALSI Cohort
Authors: Beidelman Erika Teresa , Rosenberg Molly , Wade Alisha N. , Crowther Nigel J. , Kalbaugh Corey A. 
Published: December 2023

Background
The burden of peripheral artery disease (PAD) is increasing in low‐ and middle‐income countries. Existing literature from sub‐Saharan Africa is limited and lacks population‐representative estimates. We estimated the burden and risk factor profile of PAD for a rural South African population.

Methods and Results
We used data from 1883 participants from a rural, low‐income cohort of South African adults aged 40 to 69 years with available ankle‐brachial index measurements. We defined clinical PAD as ankle‐brachial index ≤0.90 or >1.40, and borderline PAD as ankle‐brachial index >0.90 and ≤1.00. We compared the distribution of sociodemographic variables, biomarkers, and comorbidities across PAD classifications. To identify associated factors, we calculated unadjusted and age‐sex‐adjusted prevalence ratios (PRs) with log‐binomial models. Overall, 6.6% (95% CI, 5.6–7.7) of the sample met the diagnostic criteria for clinical PAD, while 44.7% (95% CI, 42.4–47.0) met the diagnostic criteria for borderline PAD. Age (PR: 1.9 [95% CI, 1.2–3.1] for ages 50–59 years compared with 40–49 years; PR: 2.5 [95% CI, 1.5–4.0] for ages 60–69 years compared with 40–49 years); diagnosed hypertension (PR: 1.53 [95% CI, 1.08–2.17]); and C‐reactive protein (PR: 1.08 [95% CI, 1.03–1.12]) were associated with increased prevalence of clinical PAD. All other examined factors were not significantly associated with clinical PAD.

Conclusions
We found high PAD prevalence for younger age groups compared with previous research and a lack of statistical evidence for the influence of traditional risk factors for this rural, low‐income population. Future research should focus on identifying the underlying risk factors for PAD in this setting. South African policymakers and clinicians should consider expanded screening for early PAD detection in rural areas.
Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome
Authors: Bär Sarah , Kavaliauskaite Raminta , Otsuka Tatsuhiko , Ueki Yasushi , Häner Jonas , Lanz Jonas , Fürholz Monika , Praz Fabien , Hunziker Lukas , Siontis George CM , Pilgrim Thomas , Stortecky Stefan , Losdat Sylvain , Windecker Stephan , Räber Lorenz 
Published: December 2023

Background
The optimal time point of staged percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative flow ratio (QFR) is a novel noninvasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could refine the timing of staged PCI of non‐target vessels (non‐TVs) on top of clinical judgment for patients with ACS.

Methods and Results
For this cohort study, patients with ACS from Bern University Hospital, Switzerland, scheduled to undergo out‐of‐hospital non‐TV staged PCI were eligible. The primary end point was the composite of non‐TV myocardial infarction and urgent unplanned non‐TV PCI before planned staged PCI. The association between lowest QFR per patient measured in the non‐TV (from index angiogram) and the primary end point was assessed using multivariable adjusted Cox proportional hazards regressions with QFR included as linear or penalized spline (nonlinear) term.

QFR was measured in 1093 of 1432 patients with ACS scheduled to undergo non‐TV staged PCI. Median time to staged PCI was 28 days. The primary end point occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non‐TV QFR and the primary end point (hazard ratio, 0.87 [95% CI, 0.69–1.05] per 0.1 increase;
P
=0.125; nonlinear
P
=0.648).

Conclusions
In selected patients with ACS scheduled to undergo staged PCI at a median of 4 weeks after index PCI, QFR did not emerge as an independent predictor of non‐TV events before planned staged PCI. Thus, this study does not provide conceptual evidence that QFR is helpful to refine the timing of staged PCI on top of clinical judgment.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02241291.
Characteristics and Attitudes of Wearable Device Users and Nonusers in a Large Health Care System
Authors: Venn Rachael A. , Khurshid Shaan , Grayson Mia , Ashburner Jeffrey M. , Al‐Alusi Mostafa A. , Chang Yuchiao , Foulkes Andrea , Ellinor Patrick T. , McManus David D. , Singer Daniel E. , Atlas Steven J. , Lubitz Steven A. 
Published: December 2023

Background
Consumer wearable devices with health and wellness features are increasingly common and may enhance disease detection and management. Yet studies informing relationships between wearable device use, attitudes toward device data, and comprehensive clinical profiles are lacking.

Methods and Results
WATCH‐IT (Wearable Activity Tracking for Comprehensive Healthcare‐Integrated Technology) studied adults receiving longitudinal primary or ambulatory cardiovascular care in the Mass General Brigham health care system from January 2010 to July 2021. Participants completed a 20‐question electronic survey about perceptions and use of consumer wearable devices, with responses linked to electronic health records. Multivariable logistic regression was used to identify factors associated with device use. Among 214 992 individuals receiving longitudinal primary or cardiovascular care with an active electronic portal, 11 121 responded (5.2%). Most respondents (55.8%) currently used a wearable device, and most nonusers (95.3%) would use a wearable if provided at no cost. Although most users (70.2%) had not shared device data with their doctor previously, most believed it would be very (20.4%) or moderately (34.4%) important to share device‐related health information with providers. In multivariable models, older age (odds ratio [OR], 0.80 per 10‐year increase [95% CI, 0.77–0.82]), male sex (OR, 0.87 [95% CI, 0.80–0.95]), and heart failure (OR, 0.75 [95% CI, 0.63–0.89]) were associated with lower odds of wearable device use, whereas higher median income (OR, 1.08 per 1‐quartile increase [95% CI, 1.04–1.12]) and care in a cardiovascular medicine clinic (OR, 1.17 [95% CI, 1.05–1.30]) were associated with greater odds of device use.

Conclusions
Among patients in primary and cardiovascular medicine clinics, consumer wearable device use is common, and most users perceive value in wearable health data.
Association of Atrial Fibrillation Progression With Left Atrial Functional Reserve and Its Reversibility
Authors: Hirose Kazutoshi , Nakanishi Koki , Daimon Masao , Iwama Kentaro , Yoshida Yuriko , Mukai Yasuhiro , Yamamoto Yuko , Nakao Tomoko , Oshima Tsukasa , Matsubara Takumi , Shimizu Yu , Oguri Gaku , Kojima Toshiya , Hasumi Eriko , Fujiu Katsuhito , Morita Hiroyuki , Komuro Issei 
Published: December 2023

Background
Atrial fibrillation (AF) progression is closely related to heart failure occurrence, and catheter ablation carries a beneficial effect for heart failure prevention. Recently, particular attention has been given to left atrial (LA) function and functional reserve in the pathogenesis linking AF and heart failure, although its significance and reversibility is not well studied.

Methods and Results

We prospectively investigated 164 patients with AF with normal left ventricular systolic function and free from heart failure who underwent first catheter ablation and pre‐/postprocedural echocardiography. Conventional and speckle‐tracking echocardiography were performed at rest and during passive leg lifting to assess LA size, LA reservoir strain (LARS), and functional reserve calculated as passive leg lifting‐LARS – rest‐LARS. Patients were categorized into 3 AF subtypes: paroxysmal AF (N=95), persistent AF (PeAF; N=50), and long‐standing persistent AF (LS‐PeAF; N=19). The PeAF and LS‐PeAF groups had larger LA size and reduced LARS compared with the paroxysmal AF group (all
P
<0.05). LA functional reserve was significantly impaired in the LS‐PeAF group (
P
=0.003). In multivariable analysis, LS‐PeAF and advanced age were significantly associated with impaired LA functional reserve. Among 149 patients with sinus rhythm 1 to 2 days after catheter ablation, LARS was significantly improved in both PeAF and LS‐PeAF groups but was still lower than that in the paroxysmal AF group. Sinus rhythm restoration also led to amelioration of LA functional reserve in patients with LS‐PeAF.

Conclusions
AF progression was related to impaired LARS and LA functional reserve, and restoration of sinus rhythm might contribute to early LA reverse remodeling.
Process Evaluation of a Double‐Blind Randomized Controlled Trial to Assess the Efficacy and Safety of a Quadruple Ultra‐Low‐Dose Treatment for Hypertension Within a Federally Qualified Health Center Network (QUARTET USA)
Authors: Sanuade Olutobi A. , Jacobson Tyler A. , Quintana Adriana , Flowers Fallon M. , Abbasi Hiba , Vu My H. , Baldridge Abigail S. , Mejia Jairo , Lazar Danielle , Ciolino Jody D. , Huffman Mark D. , Kandula Namratha R. 
Published: December 2023

Background
This convergent parallel‐design mixed‐methods process evaluation of the QUARTET USA (Quadruple Ultra‐Low‐Dose Treatment for Hypertension USA) clinical trial (NCT03640312) explores patient and health care professional perceptions about the use of low‐dose quadruple therapy (LDQT) as a novel strategy for hypertension management.

Methods and Results
A survey of all 62 patients enrolled in the QUARTET USA trial was conducted. A subsample of 13 patients and 11 health care professionals, recruited via purposive sampling, took part in semistructured interviews. At enrollment, 68% of participants (mean [SD] age, 51.7 [11.5] years; 56% self‐identified as Hispanic: Mexican ethnicity, 16% as Hispanic: other ethnicity, 16% as Black race, 8% as White race, and 1.6% as South Asian race) reported that their current health depended on blood pressure medications, and 48% were concerned about blood pressure medications. At trial completion, 80% were satisfied with LDQT, 96% were certain the benefits of taking LDQT outweighed the disadvantages, and 96% reported that LDQT was convenient to take. Both patients and health care professionals found LDQT acceptable because it reduced patients' perceived pill burden and facilitated medication adherence. Health care professionals stated that a perceived limitation of LDQT was the inability to titrate doses. Steps to facilitate LDQT implementation include introducing stepped‐care combinations and treatment protocols, inclusion in clinical practice guidelines, and eliminating patient cost barriers.

Conclusions
LDQT was an acceptable strategy for hypertension treatment among patients and health care professionals involved in the QUARTET USA clinical trial. Although LDQT was generally perceived as beneficial for maintaining patients' blood pressure control and facilitating adherence, some clinicians perceived limitations in titration inflexibility, adverse effects, and costs.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03640312.
Aortic Characteristic Impedance and Suspected Mild Cognitive Impairment in a Community‐Based Healthy Population
Authors: Liao Chao‐Feng , Chuang Shao‐Yuan , Cheng Hao‐Min , Lin Chen‐Hua , Chen Chen‐Huan 
Published: December 2023

Background
Aging of the proximal aorta can lead to increased pressure and flow pulsatility in the cerebral microcirculation, which may cause cognitive impairment. This study investigated the association between aortic characteristic impedance (Zc), an indicator of regional stiffness of the proximal aorta, and suspected mild cognitive impairment (MCI), compared with carotid–femoral pulse wave velocity (CFPWV).

Methods and Results
A total of 1461 healthy community residents (46.4% men; age range, 35–96 years [mean±SD, 59.9±11.8 years]) without a history of cardiovascular events or stroke were included in the study. Zc was estimated using applanation tonometry and echocardiography. Cognitive function was assessed using the Mini‐Mental State Examination. Education‐adjusted cut points were used to define suspected MCI. Subjects with suspected MCI (n=493 [33.7%]) had significantly higher Zc and CFPWV than those without. In multivariable analysis, both Zc and CFPWV were inversely associated with Mini‐Mental State Examination score. Zc (odds ratio per 1 SD, 1.22 [95% CI, 1.09–1.37] and CFPWV (odds ratio per 1 SD, 1.18 [95% CI, 1.01–1.38]) was also significantly associated with suspected MCI, after adjusting for age, sex, education level, mean arterial pressure, hypertension, diabetes, low‐density lipoprotein cholesterol, and smoking status. In joint analysis, Zc was significantly associated with suspected MCI, but CFPWV was not. In the age subgroups of <50 years and 50 to 70 years, only Zc was significantly associated with suspected MCI.

Conclusions
This study found that Zc was significantly associated with Mini‐Mental State Examination score and suspected MCI, especially in younger and middle‐aged adults. These findings suggest that Zc may be a useful biomarker for identifying individuals at risk for MCI.
High Amino Acid Intake in Early Life Is Associated With Systolic but Not Diastolic Arterial Hypertension at 5 Years of Age in Children Born Very Preterm
Authors: Rozé Jean‐Christophe , Bacchetta Justine , Lapillonne Alexandre , Boubred Farid , Picaud Jean‐Charles , Marchand‐Martin Laetitia , Bruel‐Tessoulin Alexandra , Harambat Jérome , Biran Valérie , Nuyt Anne‐Monique , Darmaun Dominique , Ancel Pierre‐Yves 
Published: December 2023

Background
The life course of individuals born very premature is a topic of increasing concern. The association between high early amino acid intake and later high blood pressure (HBP) in preterm neonates is debated.

Methods and Results

In a national, prospective, population‐based birth cohort, EPIPAGE‐2 (Etude Epidémiologique sur Petits Ages Gestationnels), we assessed blood pressure at 5 years. Eligible infants were those born between 24 and 29 weeks of gestation. Infants were distributed in 2 groups of 717 infants matched on propensity score on whether or not they were exposed to high amino acid intake (>3.5 g/kg per day at day 7); 455 control term infants were also enrolled. A value ≥95th percentile of reference values for age and height defined systolic or diastolic HBP. Blood pressure at 5 years of age was assessed for 389 and 385 children in the exposed and nonexposed groups, respectively. Rates (in percent) of systolic and diastolic HBP were 18.0% (95% CI, 14.5%–22.2%
)
, 13.3% (95% CI, 10.3%–17.0%), 8.5% (95% CI, 6.5%–11.1%), and 9.0% (95% CI, 6.6%–12.3%), 10.2% (95% CI, 7.5%–13.6%), and 5.4% (95% CI, 3.8%–7.6%) in exposed, nonexposed, and term‐born groups, respectively. Exposure to high early amino acid intake and maximal serum creatinine (by 50 μmol/L) between day 3 and day 7 were 2 independent risk factors for systolic HBP (adjusted odds ratio [aOR], 1.60 [95% CI, 1.05–2.43] and aOR, 1.59 [95% CI, 1.12–2.26], respectively) but not for diastolic HBP (aOR, 0.84 [95% CI, 0.50–1.39] and aOR, 1.09 [95% CI, 0.71–1.67], respectively). After adjustment for 5‐year weight
Z
score, the aOR between high early amino acid intake and systolic HBP was 1.50 [95% CI, 0.98–2.30].

Conclusions
These results suggest that mechanisms of childhood systolic HBP involve neonatal renal challenge by high amino acid intake or dysfunction.
Effects of Continuous Accelerated Pacing on Cardiac Structure and Function in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the myPACE Randomized Clinical Trial
Authors: Wahlberg Kramer J. , Infeld Margaret , Plante Timothy B. , Novelli Alexandra E. , Habel Nicole , Burkhoff Daniel , Barrett Trace , Lustgarten Daniel , Meyer Markus 
Published: December 2023

Background
Heart failure with preserved ejection fraction ≥50% is prevalent with few evidence‐based therapies. In a trial of patients with heart failure with preserved ejection fraction with specialized pacemakers, treatment with accelerated personalized pacing averaging 75 bpm (myPACE) markedly improved quality of life, NT‐proBNP (N‐terminal pro–brain natriuretic peptide), physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60 bpm (usual care).

Methods and Results

In this exploratory study, provider‐initiated echocardiographic studies obtained before and after the trial were assessed for changes in left ventricular (LV) structure and function among participants who continued their pacing assignment. The analytic approach aimed to detect differences in standard and advanced echocardiographic parameters within and between study arms. Of the 100 participants, 16 myPACE and 20 usual care arm had a qualifying set of echocardiograms performed a mean (SD) 3 (2.0) years apart. Despite similar baseline echocardiogram measures, sustained exposure to moderately accelerated pacing resulted in reduced septal wall thickness (in cm: myPACE 1.1 [0.2] versus usual care 1.2 [0.2],
P
=0.008) and lower LV mass to systolic volume ratio (in g/mL: myPACE 4.8 [1.9] versus usual care 6.8 [3.1],
P
=0.038) accompanied by a minor reduction in LV ejection fraction (in %: myPACE 55 [5] versus usual care 60 [5],
P
=0.015). These changes were paralleled by improvements in heart failure‐related quality of life (myPACE Minnesota Living with Heart Failure Questionnaire improved by 16.1 [13.9] points, whereas usual care worsened by 6.9 [11.6] points,
P
<0.001). Markers of diastolic function and LV performance were not affected.

Conclusions
Exposure to continuous accelerated pacing in heart failure with preserved ejection fraction is associated with a reduced LV wall thickness and a small amount of LV dilation with small reduction in ejection fraction.
Influence of Crystal Disorder on the Forced Oxidative Degradation of Vortioxetine HBr
Authors: Modhave Dattatray , Barrios Brenda , Iyer Jayant , Paudel Amrit 
Published: December 2023

AbstractThe present study investigates the impact of the solid-state disorder of vortioxetine hydrobromide (HBr) on oxidative degradation under accelerated conditions. A range of solid-state disorders was generated via cryogenic ball milling. The solid-state properties were evaluated by calorimetry, infrared-, and Raman spectroscopies. While salt disproportionation occurred upon milling, no chemical degradation occurred by milling. The amorphous fraction remained physically intact under ambient storage conditions. Subsequently, samples with representative disordered fractions were mixed with a solid oxidative stressor (PVP-H2O2 complex) and were compressed to compacts. The compacts were exposed to 40°C/75% RH for up to 6 h. The sample was periodically withdrawn and analyzed for the physical transformations and degradation. Two oxidative degradation products (DPs) were found to be formed, for which dissimilar relations to the degree of disorder and kinetics of formation were observed. The degradation rate of the major DP formation obtained by fitting the exponential model to the experimental data was found to increase up to a certain degree of disorder and decrease with a further increase in the disordered fraction. In contrast, the minor DP formation kinetics was found to increase monotonically with the increase in the disorder content. For the similar crystallinity level, the degradation trend (rate and extent) differed between the single-phase disorder generated by milling and physically mixed two-phase systems. Overall, the study demonstrates the importance of evaluating the physical and chemical (in)stabilities of the disordered solid state of a salt form of a drug substance, generated through mechano-activation.
Graphical Abstract
Effects of Apex Size on Dissolution Profiles in the USP II Paddle Apparatus
Authors: Yoshida Hiroyuki , Morita Tokio , Abe Yasuhiro , Inagaki Aoi , Tomita Naomi , Izutsu Ken-ichi , Sato Yoji 
Published: December 2023

AbstractThe use of apex vessels may solve coning problems associated with dissolution testing. However, excessive dissolution acceleration can reduce the discriminatory power. This study aimed to clarify how different apex vessel sizes affect the dissolution behavior of cone-forming formulations. Five apex vessels with different heights, centralities, and compendial vessels were used. The paddle rotation speed at which the coning phenomenon resolved was measured using standard particles of different densities. Three model formulations—USP prednisone tablets, atorvastatin calcium hydrate tablets, and levofloxacin fine granules—were selected, and dissolution tests were conducted at 30–100 revolutions per minute (rpm). Compared to the compendial vessels, the disappearance of standard particles at the apex base at lower paddle speeds in apex vessels was observed. Standard particles tended to remain in the center of the apex vessels and disappear at rotational speeds comparable to those of the compendial vessels. Dissolution increased in an apex height-dependent manner in the model formulations, except for the atorvastatin calcium hydrate tablets at 50 rpm. For levofloxacin fine granules, dissolution was also improved by reducing the paddle agitation speed to 30 rpm in the compendial vessels. Differences in apex centrality by 3 mm did not affect the dissolution rate. Our results indicate that apex vessels with low apex heights have a mount-resolving effect, but the degree of dissolution improvement by avoiding the coning phenomenon depends on the formulation characteristics used in the dissolution tests.
Graphical abstract
Magical Monsters: Hybrids and Witchcraft in Early Modern Art
Authors: Tal Guy 
Published: December 2023

Abstract
Studies of early modern images of witchcraft interpret the motif of hybrid creatures as representations of demonic incarnations intended in part to demonstrate the artists’ inventive prowess and capacity for phantasia. This article broadens the scope of analysis by arguing that the hybrid functions as a prolific site of reflection on the symbolic analogy between art and witchcraft, highlighting the common creativity attributed to the artist and the magician both. A comparative analysis of Italian, German, and Dutch images produced in the long sixteenth century identifies three distinctive aspects of the hybrid: as the offspring of Circe's magic of transformation in the works of Pellegrino Tibaldi and Annibale Carracci, as the figurative expression of witchcraft-associated features in Jacques de Gheyn II's engraving, and as an artistic invention in a theatrical design after Raffaello Gualterotti and an engraved grotesque ornament by Heinrich Aldegrever.