bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detecting a periodic signal by a population of spiking neurons in the weakly nonlinear response regime
Authors: Schlungbaum Maria , Lindner Benjamin 
Published: November 2023

Abstract
Motivated by experimental observations, we investigate a variant of the cocktail party problem: the detection of a weak periodic stimulus in the presence of fluctuations and another periodic stimulus which is stronger than the periodic signal to be detected. Specifically, we study the response of a population of stochastic leaky integrate-and-fire (LIF) neurons to two periodic signals and focus in particular on the question, whether the presence of one of the stimuli can be detected from the population activity. As a detection criterion, we use a simple threshold-crossing of the population activity over a certain time window. We show by means of the receiver operating characteristics (ROC) that the detectability depends only weakly on the time window of observation but rather strongly on the stimulus amplitude. Counterintuitively, the detection of the weak periodic signal can be facilitated by the presence of a strong periodic input current depending on the frequencies of the two signals and on the dynamical regime in which the neurons operate. Beside numerical simulations of the model, we present an analytical approximation for the ROC curve that is based on the weakly nonlinear response theory for a stochastic LIF neuron.

Graphic abstract
Abstract 19124: Systemic Sclerosis Masquerading as Heart Failure
Authors: Prathivadhi-Bhayankaram Sruti , Mansour Shareef 
Published: November 2023

Cardiac disease occurs in 80% of patients with systemic sclerosis (SS). Patients may present with various symptoms, including dyspnea, palpitations, chest pain, and heart failure. Of these, systolic heart failure has the rarest prevalence, estimated between 1-5% of patients. The mechanism behind myocardial damage is still unclear. Current literature supports a fibrotic process due to ischemic necrosis and reperfusion damage. There is a lack of representation of SS-related cardiac disease, but it is crucial to recognize it early for prompt intervention.
A 62-year-old male with a history of diastolic dysfunction presented with acute hypoxic respiratory failure. A transthoracic echocardiogram demonstrated a new severely reduced systolic function at 20%. Angiogram demonstrated non-obstructive coronary artery disease. Further autoimmune workup revealed a significantly elevated ANA and highly positive RNA polymerase III antibody. The patient underwent a cardiac magnetic resonance imaging (MRI) scan, which showed evidence of inflammation with diffuse myocardial fibrosis concerning an infiltrative process. Subsequent cardiac positron emission tomography (PET) showed increased uptake in the basal portions of the septum and anterior wall for myocarditis. Given his autoimmune workup results and imaging, the patient was subsequently diagnosed with rapidly progressive cutaneous systemic sclerosis and associated non-ischemic cardiomyopathy.
The patient was started on goal-directed medical therapy, including losartan, spironolactone, metoprolol, and empagliflozin. Additionally, he started on mycophenolate mofetil for immunosuppression. Roughly six months after discharge, his pulmonary function tests remain stable. His ejection fraction improved to 62%.
Roughly one-third of systemic sclerosis-related deaths are due to cardiac involvement. Yet, most patients are asymptomatic during the early stages, with a variable phenotype later in disease progression. We report a case of a patient who developed systemic sclerosis-related myocarditis with an initial presentation of acute systolic heart failure. His cardiac dysfunction recovered from optimal goal-directed therapy and immunosuppression.
Health Care Access and Cardiovascular Risk Factor Management Among Working-Age US Adults During the Pandemic
Authors: Marinacci Lucas X. , Bartlett Victoria , Zheng ZhaoNian , Mein Stephen , Wadhera Rishi K. 
Published: November 2023

BACKGROUND:
Low-income working-age US adults disproportionately experienced health care disruptions at the onset of the coronavirus disease 2019 pandemic. Little is known about how health care access and cardiovascular risk factor management changed as the pandemic went on or if patterns differed by state Medicaid expansion status.

METHODS:
Cross-sectional data from the behavioral risk factor surveillance system were used to compare self-reported measures of health care access and cardiovascular risk factor management among US adults aged 18 to 64 years in 2021 (pandemic) to 2019 (prepandemic) using multivariable Poisson regression models. We assessed differential changes between low-income (<138% federal poverty level) and high-income (>400% federal poverty level) working-age adults by including an interaction term for income group and year. We then evaluated changes among low-income adults in Medicaid expansion versus nonexpansion states using a similar approach.

RESULTS:
The unweighted study population included 80 767 low-income and 184 136 high-income adults. Low-income adults experienced improvements in insurance coverage (relative risk [RR], 1.10 [95% CI, 1.08–1.12]), access to a provider (RR, 1.12 [95% CI, 1.09–1.14]), and ability to afford care (RR, 1.07 [95% CI, 1.05–1.09]) in 2021 compared with 2019. While these measures also improved for high-income adults, gains in coverage and ability to afford care were more pronounced among low-income adults. However, routine visits (RR, 0.96 [95% CI, 0.94–0.98]) and cholesterol testing (RR, 0.93 [95% CI, 0.91–0.96]) decreased for low-income adults, while diabetes screening (RR, 1.01 [95% CI, 0.95–1.08]) remained stable. Treatment for hypertension (RR, 1.05 [95% CI, 1.02–1.08]) increased, and diabetes-focused visits and insulin use remained stable. These patterns were similar for high-income adults. Across most outcomes, there were no differential changes between low-income adults residing in Medicaid expansion versus nonexpansion states.

CONCLUSIONS:
In this national study of working-age adults in the United States, measures of health care access improved for low- and high-income adults in 2021. However, routine outpatient visits and cardiovascular risk factor screening did not return to prepandemic levels, while risk factor treatment remained stable. As many coronavirus disease-era safety net policies come to an end, targeted strategies are needed to protect health care access and improve cardiovascular risk factor screening for working-age adults.
Myeloid Cell Derived IL1β Contributes to Pulmonary Hypertension in HFpEF
Authors: Agrawal Vineet , Kropski Jonathan A. , Gokey Jason J. , Kobeck Elizabeth , Murphy Matthew B. , Murray Katherine T. , Fortune Niki L. , Moore Christy S. , Meoli David F. , Monahan Ken , Ru Su Yan , Blackwell Thomas , Gupta Deepak K. , Talati Megha H. , Gladson Santhi , Carrier Erica J. , West James D. , Hemnes Anna R. 
Published: November 2023

BACKGROUND:
Pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is a common and highly morbid syndrome, but mechanisms driving PH-HFpEF are poorly understood. We sought to determine whether a well-accepted murine model of HFpEF also displays features of PH, and we sought to identify pathways that might drive early remodeling of the pulmonary vasculature in HFpEF.

METHODS:

Eight-week-old male and female C57BL/6J mice received either N
γ
-nitro-L-arginine methyl ester and high-fat diet or control water and diet for 2, 5, and 12 weeks. The db/db mice were studied as a second model of HFpEF. Early pathways regulating PH were identified by bulk and single-cell RNA sequencing. Findings were confirmed by immunostain in lungs of mice or lung slides from clinically performed autopsies of patients with PH-HFpEF. ELISA was used to verify IL-1β (interleukin-1 beta) in mouse lung, mouse plasma, and also human plasma from patients with PH-HFpEF obtained at the time of right heart catheterization. Clodronate liposomes and an anti–IL-1β antibody were utilized to deplete macrophages and IL-1β, respectively, to assess their impact on pulmonary vascular remodeling in HFpEF in mouse models.

RESULTS:

N
γ
-nitro-L-arginine methyl ester/high-fat diet–treated mice developed PH, small vessel muscularization, and right heart dysfunction. Inflammation-related gene ontologies were overrepresented in bulk RNA sequencing analysis of whole lungs, with an increase in CD68
+
cells in both murine and human PH-HFpEF lungs. Cytokine profiling showed an increase in IL-1β in mouse and human plasma. Finally, clodronate liposome treatment in mice prevented PH in N
γ
-nitro-L-arginine methyl ester/high-fat diet–treated mice, and IL-1β depletion also attenuated PH in N
γ
-nitro-L-arginine methyl ester/high-fat diet–treated mice.

CONCLUSIONS:
We report a novel model for the study of PH and right heart remodeling in HFpEF, and we identify myeloid cell–derived IL-1β as an important contributor to PH in HFpEF.
Hemodynamic Effects of the Osmopressor Response: A Systematic Review and Meta‐Analysis
Authors: Oyewunmi Oyebimbola A. , Lei Lucy Y. , Laurin Jill K. H. , Morillo Carlos A. , Sheldon Robert S. , Raj Satish R. 
Published: November 2023

Background
Rapidly consuming water may offer practical orthostatic hypotension therapy. However, its efficacy across disorders remains uncertain. This study aims to assess the impact of rapid 350‐ to 500‐mL water intake on systolic and diastolic blood pressure (BP) and heart rate (HR) through a systematic review and meta‐analysis.

Methods and Results
We systematically reviewed MEDLINE and Embase up to June 2023, including randomized controlled trials and prospective cohort studies. Using random‐effects meta‐analysis, we calculated pooled mean differences (MDs) for maximum hemodynamic effects of rapid 350‐ to 500‐mL water bolus consumption. Participants with orthostatic hypotension experienced increased systolic BP (MD, 24.18 [95% CI, 15.48–32.88]) and diastolic BP (MD, 11.98 [95% CI, 8.87–15.09]) with decreased HR (MD, −3.46 [95% CI, −5.21 to −1.71]). Similar results were observed in multiple system atrophy and pure autonomic failure subgroup analysis. Healthy participants showed modest increases in systolic BP (MD, 2.33 [95% CI, 1.02–3.64]) and diastolic BP (MD, 2.73 [95% CI, 1.15–4.30]), but HR changes were not significant (MD, −2.06 [95% CI, −5.25 to 1.13]). Water had no significant hemodynamic effects in patients with seated or supine postural tachycardia syndrome, although standing effects were unassessed. Our data do not exclude water's potential standing effect in postural tachycardia syndrome.

Conclusions
In patients with orthostatic hypotension, rapid water intake elevated short‐term systolic BP and diastolic BP, with mild HR reduction when seated or supine. Healthy participants exhibited similar but milder effects. However, patients with postural tachycardia syndrome did not experience these changes in seated or supine positions. Further research is needed to evaluate the promising impact of rapid water ingestion on patients with postural tachycardia syndrome in a standing position, which was not addressed in our study.
Benefits and Harms of Standard Versus Reduced‐Dose Direct Oral Anticoagulant Therapy for Older Adults With Multiple Morbidities and Atrial Fibrillation
Authors: Hayes Kaleen N. , Zhang Tingting , Kim Dae Hyun , Daiello Lori A. , Lee Yoojin , Kiel Douglas P. , Berry Sarah D. , Zullo Andrew R. 
Published: November 2023

Background
Dose reduction of direct oral anticoagulant (DOAC) medications is inconsistently applied to older adults with multiple morbidities, potentially due to perceived harms and unknown benefits of standard dosing.

Methods and Results

Using 2013 to 2017 US Medicare claims linked to Minimum Data Set records, we conducted a retrospective cohort study. We identified DOAC initiators (apixaban, dabigatran, rivaroxaban) aged ≥65 years with nonvalvular atrial fibrillation residing in a nursing home. We estimated inverse‐probability of treatment weights for DOAC dose using propensity scores. We examined safety (hospitalization for major bleeding) and effectiveness outcomes (all‐cause mortality, thrombosis [myocardial infarction, stroke, systemic embolism, venous thromboembolism]). We estimated hazard ratios (HRs) and 95% CIs using cause‐specific hazard‐regression models. Of 21 878 DOAC initiators, 48% received reduced dosing. The mean age of residents was 82.0 years, 66% were female, and 31% had moderate/severe cognitive impairment. After estimating inverse‐probability of treatment weights, standard dosing was associated with a higher rate of bleeding (HR, 1.18 [95% CI, 1.03–1.37]; 9.4 versus 8.0 events per 100 person‐years). Standard‐dose therapy was associated with the highest rates of bleeding among those aged >80 years (9.1 versus 6.7 events per 100 person‐years) and with a body mass index <30 kg/m
2
(9.4 versus 7.4 events per 100 person‐years). There was no association of dosing with mortality (HR, 0.99 [95% CI, 0.96–1.06]) or thrombotic events (HR, 1.16 [95% CI, 0.96–1.41]).

Conclusions
In this nationwide study of nursing home residents with nonvalvular atrial fibrillation, we found a higher rate of bleeding and little difference in effectiveness of standard versus reduced‐dose DOAC treatment. Our results support the use of reduced‐dose DOACs for many older adults with multiple morbidities.
Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data
Authors: Sá Michel Pompeu , Jacquemyn Xander , Van den Eynde Jef , Serna‐Gallegos Derek , Chu Danny , Clavel Marie‐Annick , Pibarot Philippe , Sultan Ibrahim 
Published: November 2023

Background
We performed a meta‐analysis of reconstructed time‐to‐event data from randomized controlled trials (RCTs) and propensity‐score matched (PSM) studies comparing transcatheter versus surgical aortic valve replacement (TAVR versus SAVR) to evaluate midterm outcomes in patients considered low risk for SAVR.

Methods and Results

Study‐level meta‐analysis of reconstructed time‐to‐event data from Kaplan–Meier curves of RCTs and PSM studies published by December 31, 2022 was conducted. Eight studies (3 RCTs, 5 PSM studies) met our eligibility criteria and included 5444 patients; 2639 patients underwent TAVR, and 2805 patients underwent SAVR. TAVR showed a higher risk of all‐cause mortality at 8 years of follow‐up (hazard ratio [HR] 1.22, [95% CI, 1.03–1.43],
P
=0.018). Up to 2 years of follow‐up, TAVR was not inferior to SAVR (HR, 1.08 [95% CI, 0.89–1.31],
P
=0.448); however, we observed a statistically significant difference after 2 years with higher mortality with TAVR (HR, 1.51 [95% CI, 1.14–2.00];
P
=0.004). This difference was driven by PSM studies; our sensitivity analysis showed a statistically significant difference between TAVR and SAVR when we included only PSM studies (HR, 1.41 [95% CI, 1.16–1.72],
P
=0.001) but no statistically significant difference when we included only RCTs (HR, 0.89 [95% CI, 0.69–1.16],
P
=0.398).

Conclusions
In comparison with TAVR, SAVR appeared to be associated with improved survival beyond 2 years in low‐risk patients. However, the survival benefit of SAVR was observed only in PSM studies and not in RCTs. The addition of data from ongoing RCTs as well as longer follow‐up in previous RCTs will help to confirm if there is a difference in mid‐ and long‐term survival between TAVR versus SAVR in the low‐risk population.
Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review
Authors: McNeill Elizabeth , Lindenfeld Zoe , Mostafa Logina , Zein Dina , Silver Diana , Pagán José , Weeks William B. , Aerts Ann , Des Rosiers Sarah , Boch Johannes , Chang Ji Eun 
Published: November 2023

Background
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity.

Methods and Results
After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk.

Conclusions
Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.
Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia
Authors: Seng Loraine Liping , Hai Kiat Troy Puar , Bee Yong Mong , Jafar Tazeen H. 
Published: November 2023

BACKGROUND
Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with risk of CVD mortality in patients with T2D.

METHODS AND RESULTS
We used data on 83 721 patients with T2D from a multi‐institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using Cox multivariable regression analysis stratified by preexisting CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined via linkage with the national registry. Among 83 721 patients with T2D (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person‐years experienced the primary outcome. Systolic BP had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in those aged ≥65 years. In addition, diastolic BP <70 mm Hg was associated with a significantly higher risk of CVD mortality in all patients.

CONCLUSIONS
In patients with T2D, clinic systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with higher risk of CVD mortality. Diastolic BP <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out.
High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization
Authors: Gold Daniel A. , Sandesara Pratik B. , Jain Vardhmaan , Gold Matthew E. , Vatsa Nishant , Desai Shivang R. , Hassan Malika Elhage , Yuan Chenyang , Ko Yi‐An , Alkhoder Ayman , Ejaz Kiran , Alvi Zain , Rahbar Alireza , Murtagh Gillian , Jaber Wissam A. , Nicholson William J. , Quyyumi Arshed A. 
Published: November 2023

Background
The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin‐I (hsTn‐I) levels as an estimate of myocardial ischemia in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of hsTn‐I than patients without CTO, (2) hsTn‐I levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated hsTn‐I levels will have a survival benefit from CTO revascularization.

Methods and Results

In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between hsTn‐I level and incident event rates in patients with CTO. HsTn‐I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L,
P
=0.002). An elevated hsTn‐I level was associated with higher adverse event rates (adjusted all‐cause mortality hazard ratio, 1.19 [95% CI, 1.08–1.32];
P
=0.030) for every doubling of hsTn‐I level. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn‐I level, CTO revascularization was associated with substantially lower all‐cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.88];
P
=0.030) compared with those who did not undergo revascularization. In patients with a low (
<
median) hsTn‐I level, event rates were similar in those with and without CTO revascularization.

Conclusions
HsTn‐I levels may help identify individuals who benefit from CTO revascularization.
Enhancing pulmonary function and arterial blood gas readings through immediate chest physiotherapy among extubated patients in ICU
Authors: Reshia Fadia Ahmed Abdelkader , Salameh Basma , Alsadaan Nourah , Alqahtani Mohammed , Ayed Ahmad , Kassabry Maysa Fareed , Abo Seada Asmaa Ibrahem 
Published: November 2023

Objective To examine the effect of immediate chest physiotherapy (ICPT) on pulmonary function and arterial blood gases among extubated patients. Method This prospective study enrolled patients aged 20–60 years who had been intubated for 48 h. They were randomly assigned to either a control or study group. The study group received ICPT by trained critical care nurses and physiotherapists, which included early mobilization, breathing exercises and airway clearance. The control group received standard nursing chest care (positioning, oral and endotracheal suctioning) without ICPT. Researchers evaluated participants using pulmonary function tests, arterial blood gas tests and mechanical ventilation parameters. Results The study enrolled 70 patients. There were no significant differences in the sociodemographic characteristics and medical data before intubation between the two groups except for preparatory education. After extubation, the vital capacity was significantly higher in the study group compared with the control group. There were also significant differences between the two groups in other lung function tests and arterial blood gas tests. After extubation, the total lung capacity, functional residual capacity and residual volume were significantly higher in the study group compared with the control group. Conclusion The use of ICPT improved both pulmonary function and arterial blood gases.
Is comprehensiveness in making strategic decisions always helpful?
Authors: Chanda Sasanka Sekhar , Ray Sougata 
Published: November 2023

Extant research provides incongruous answers to the question whether higher comprehensiveness in making strategic decisions is always desirable. To motivate a resolution, we study outcomes of decision-comprehensiveness by modeling strategic decision-making as an emergent process, accomplished through learning by managers over time for organizations focusing on exploration or exploitation, over short or long time horizons, in stable and changing environments. Three out of the eight resultant scenarios favor higher comprehensiveness, and two favor lower comprehensiveness. The remaining three scenarios call for a more nuanced consideration of the comprehensiveness construct. Our research enriches managerial decision-making by highlighting circumstances where higher comprehensiveness is beneficial or detrimental to the quality of a strategic decision. JEL Classification: D70, D81, D91