bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol and cause-specific mortality among 150,000 participants in the Mexico City Prospective Study
Authors: Trichia E , Alegre-Diaz J , Aguilar-Ramirez D , Ramirez-Reyes R , Gnatiuc Friedrichs L , Wade R , Collins R , Peto R , Berumen J , Emberson J , Kuri-Morales P , Tapia-Conyer R 
Published: November 2023

Abstract

Background
The Global Burden of Disease and Risk Factor models assess alcohol to be a leading cause of premature death both globally and in Mexico, but direct epidemiological evidence from Mexico is limited. We investigated the relevance of alcohol to mortality at ages 35-74 in a large prospective study of Mexican adults followed for nearly two decades.

Methods
Between 1998 and 2004, 150,000 adults aged ≥35 years were recruited into the Mexico City Prospective Study, and followed for median 19 years. Cox regression was used to relate baseline-reported alcohol consumption (never, former, ‘occasional’ [defined as less than monthly], and ‘regular’ [defined as at least monthly, and split into &lt;70, ≥70 to &lt;140, ≥140 to &lt;210 and ≥210g/week]) to mortality at ages 35-74 from all causes, and from underlying causes selected a priori as being potentially ‘alcohol-related’. Analyses were adjusted for age at risk, sex, residential district, education, smoking, physical activity and diabetes. They excluded those who at recruitment were aged ≥75 years, had incomplete data, or had vascular disease or any other chronic condition (except diabetes) recorded.

Results
Among 45,262 men and 93,607 women aged 35-74 years, 6% of men and 26% of women reported being never drinkers, 45% of men and 56% of women reported being occasional drinkers, and 33% of men and 7% of women reported being regular drinkers. There were 12,597 deaths from any cause before age 75, including 3,433 deaths from the selected underlying causes. Compared with occasional drinkers, never drinkers had 16% higher all-cause mortality (RR 1.16, 95% CI 1.10-1.22) but similar mortality from the subset of deaths considered potentially alcohol-related (RR 1.06, 95% CI 0.96-1.17). Among regular drinkers, all-cause mortality increased progressively across the four studied categories. Compared with occasional drinkers, regular drinkers of ≥140 to &lt;210g/week had 20% higher mortality (RR 1.20, 95% CI 1.08-1.34) while regular drinkers of &gt;210g/week had 46% higher mortality (RR 1.46, 95% CI 1.33-1.61). For the subset of deaths considered to be alcohol-related these RRs were 1.61 (1.35-1.93) and 2.42 (2.10-2.79) respectively. Liver disease was especially strongly related to alcohol consumption: the RR comparing regular drinkers of &gt;210g/week with occasional drinkers was 5.89 (95% CI 4.75-7.29). Associations were similar in those with and without diabetes, so the absolute relevance of alcohol to mortality was larger in those with diabetes.

Conclusions
In this Mexican cohort, higher alcohol consumption was associated with higher mortality.
Association of physical activity with the risk of major adverse cardiac and cerebrovascular events and mortality in patients with concomitant atrial fibrillation and coronary artery disease
Authors: Jin M , Lee H 
Published: November 2023

Abstract

Background
Although regular physical activity benefits cardiovascular health, there is a concern that intense exercise is linked to the promotion of atrial fibrillation (AF) and coronary plaque rupture. However, the impact of physical activity on the outcomes of patients with concomitant AF and coronary artery disease (CAD) remains unclear.

Purpose
This study aimed to evaluate the association with clinical outcomes according to the level of physical activity in patients with concomitant AF and CAD.

Methods
We assessed 551 patients with AF and CAD (mean age, 67.1±9.8 years) who completed a self-reported questionnaire for physical activity from 2015 to 2020 in a single tertiary-care hospital. Physical activity levels were converted into metabolic equivalent of task (MET) per week and categorized to correspond with multiple public health recommendations. We examined the association between physical activity, all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE).

Results
The risks of all-cause mortality (P for linear trend=0.017) and MACCE (P for linear trend=0.05) were appeared inverse trend with a greater level of physical activity. Compared with inactive patients, patients who met the recommended target range of physical activity (500–1,000 MET-min/week: unadjusted hazard ratio [HR]=0.58, 95% confidence interval [CI]=0.36–0.99) and highly active patients who exceeded the minimum recommended level (≥1,000 MET-min/week: unadjusted HR=0.47, 95% CI=0.25–0.88) had a lower risk of all-cause mortality in the unadjusted model; however, these associations did not remain significant after adjusting for the model. There was no evidence of increased risk of all-cause mortality and MACCE at levels of physical activity above the recommended target range, even with vigorous intensity physical activity exceeding the recommended target range.

Conclusions
There appears to be an inverse trend between physical activity levels and all-cause mortality and MACCE in patients with concomitant AF and CAD. No excess risk of mortality or MACCE was found at exercise levels above the recommended target range. Further large-scale studies are warranted to create an improved evidence base concerning the effects of physical activity in patients with AF and CAD.
Prognostic value of coronary computed tomography angiography parameters, non-alcoholic fatty liver and metabolic syndrome status in symptomatic patients suspected of coronary artery disease
Authors: Agoston Coldea L , Gligor R , Orzan R I , Agoston R 
Published: November 2023

Abstract

Background
Metabolic syndrome (MetS) is a well-established risk factor for major adverse cardiovascular events (MACE). Previous studies have shown the relationship between MetS, computed tomography derived epicardial fat volume (EFV), non-alcoholic fatty liver disease (NAFLD) status and coronary artery calcium score (CACS) in asymptomatic patients.

Objective
To assess the prognostic value of coronary computed tomography angiography (CCTA) derived EFV, NAFLD status, CACS and the number of plaques (NoP) in symptomatic patients with and without MetS and to design a new risk score for predicting MACE.

Methods
We conducted a single-centre, cross-sectional study on 2038 patients with intermediate risk of CAD, which underwent CCTA between March 2019 and May 2022. Data regarding MetS status and other comorbidities were assessed at the moment of the inclusion in the study. CCTA assessment included: CACS, NoP, EFV and NAFLD status. The endpoint was the occurrence of MACE (late revascularization, myocardial infarction, sudden cardiac death). Cox regression was used to assess the relationship between MetS and CCTA derived variables on the occurrence of MACE. Receiver operating characteristic curve analysis was used to determine the prediction value of CCTA derived parameters and of the new risk score. Net reclassification improvement was used to compare the risk score with CACS ability to predict MACE.

Results
Patients were prospectively followed up during a mean time of 26.9 (standard deviation: 9.5) months. 361 (17.7%) patients developed a MACE (myocardial infarction, n=67; late revascularization, n=282; sudden cardiac death, n=12). More events were seen in MetS+ patients (n=244) versus MetS- patients (n=117) (p&lt;0.001). MetS, age, male gender, CACS, NoP, EFV and NAFLD were all associated with the occurrence of MACE: unadjusted hazard ratios (HR) of: 1.56, 1.25, 1.87, 1.0013, 1.16, 1.053 and 1.67 (p&lt;0.001 for all). However, in the multivariate analysis only the CCTA derived variables showed a significant association with MACE: CCS HR=1.001, NoP HR=1.097, EFV HR=1.035, NAFLD HR=1.843 (p&lt;0.001 for all). Our risk score for predicting MACE included CACS, NoP, EFV and NAFLD. It had an area under the curve (AUC) of 0.948, a sensitivity of 89.7%, a specificity of 92.9% and a negative predicting value of 97.7%. When compared to CCS alone, the risk score correctly reclassified 24 (6.6%) events and 101 (6.2%) non-events, with a net reclassification index of 0.128 (p&lt;0.001).

Conclusion
MetS is associated with an increased risk for MACE, but not after adjustment for CCS, NoP, EFV, and NAFLD. Adding NoP, EFV and NAFLD to CCS in a risk score further improves the accuracy in predicting MACE, when compared to CCS alone.
Updating cardiovascular disease risk prediction equations to account for lipid lowering treatment drop-in during follow up: a national data-linkage cohort
Authors: Liang J , Jackson R , Pylypchuk R , Poppe K 
Published: November 2023

Abstract

Background and Purpose
No commonly recommended cardiovascular disease (CVD) risk prediction equations account for the effect of medications initiated during follow-up (treatment drop-in) in the cohort studies used to derive equations. We have previously demonstrated that treatment drop-in is common. In this study we aim to compare equations before and after accounting for lipid-lowering medication drop-in during follow-up.

Methods
De-identified individual-level linkage of multiple administrative health datasets in Aotearoa New Zealand was undertaken to establish a cohort of almost all New Zealanders without CVD or heart failure, alive and aged 30-74 years on December 31, 2006, with follow-up linkage to hospitalisations and mortality until 31 December 2018. We derived age- and sex-specific Cox regression models to predict 5-year CVD risk, using pre-defined routinely available CVD risk predictors, both with and without a time-dependent lipid-lowering medication drop-in variable. The drop-in effect was set at a 20% CVD risk reduction, based on randomised controlled trial evidence. We compared the observed and predicted risks of the two equations using calibration plots.

Results
During 19,728,300 person-years of follow-up (mean: 11.3 years), 1,746,695 people had 155,943 first CVD events. Kaplan-Meier adjusted 5-year CVD risk was 2.36% (95% CI: 2.33%, 2.39%) in women and 4.36% (95% CI: 4.31%, 4.40%) in men. 1,586,421 individuals were not taking lipid-lowering medications at baseline, among whom 371,415 initiated lipid-lowering medications during follow-up. Median predicted five-year CVD risk was slightly higher when using equations that accounted for lipid-lowering medication drop-in and identified significantly more individuals as ≥15% 5-year CVD risk than equations that did not (15,355 vs 9,680 in women and 46,603 vs 36,460 in men). As expected, the increased predicted risk in equations accounting for medication drop-in was most marked in the high-risk groups.

Conclusions
CVD risk prediction equations that do not adjust for treatment drop-in will underestimate risk and lead to undertreatment, particularly among the highest risk patients. Traditional methods to evaluate model performance are unable to identify the impact of treatment drop-in. We demonstrate that incorporating a time-dependent lipid-lowering medication effect from trials is likely to be an effective approach for addressing treatment drop-in in CVD risk prediction equations. Future studies will also need to address the impact of other common drop-in treatments, particularly blood pressure-lowering medications.
L-shaped association of lipoprotein(a) on long-term bleeding risk in patients with coronary heart disease: insight from a multicenter cohort in Asia
Authors: Wang P , Yuan J 
Published: November 2023

Abstract

Background
Lipoprotein(a), or Lp(a), has been recognized as a strong risk factor for atherosclerotic cardiovascular disease. However, the relationship between Lp(a) and bleeding remains indistinct, especially in the secondary prevention population of coronary artery disease (CAD). This investigation aimed to evaluate the association of Lp(a) with long-term bleeding among patients with CAD.

Methods
Based on a prospective multicenter cohort of patients with CAD consecutively enrolled from January 2015 to May 2019 in China, the current analysis included 16,150 participants. Thus, according to Lp(a) quintiles, all subjects were divided into five groups. The primary endpoint was bleeding at 2-year follow-up, and the secondary endpoint was major bleeding at 2-year follow-up.

Results
A total of 2,747 (17.0%) bleeding and 525 (3.3%) major bleeding were recorded during a median follow-up of 2.0 years. Kaplan-Meier survival analysis showed the highest bleeding incidence in Lp(a) quintile 1, compared with patients in Lp(a) quintiles 2-5 (p &lt; 0.001), while the incidence of major bleeding seemed similar between two groups. Moreover, restricted cubic spline analysis suggested that there was a L-shaped association between Lp(a) and 2-year bleeding after adjustment for potential confounding factors, whereas there was no significant association between Lp(a) and 2-year major bleeding.

Conclusion
There was the inverse and L-shaped association of Lp(a) with bleeding at 2-year follow-up in patients with CAD. More attention and effort should be made to increase the clinician awareness of Lp(a)’s role, as a novel marker for bleeding risk in order to better guide shared-decision making in clinical practice.Figure 1
The Novavax Heterologous Coronavirus Disease 2019 Booster Demonstrates Lower Reactogenicity Than Messenger RNA: A Targeted Review
Authors: Marchese Anthony M , Rousculp Matthew , Macbeth John , Beyhaghi Hadi , Seet Bruce T , Toback Seth 
Published: November 2023

Abstract
Coronavirus disease 2019 (COVID-19) continues to be a global health concern, and booster doses are necessary for maintaining vaccine-mediated protection, limiting the spread of severe acute respiratory syndrome coronavirus 2. Despite multiple COVID-19 vaccine options, global booster uptake remains low. Reactogenicity, the occurrence of adverse local/systemic side effects, plays a crucial role in vaccine uptake and acceptance, particularly for booster doses. We conducted a targeted review of the reactogenicity of authorized/approved messenger RNA (mRNA) and protein-based vaccines demonstrated by clinical trials and real-world evidence. It was found that mRNA-based boosters show a higher incidence and an increased severity of reactogenicity compared with the Novavax protein-based COVID-19 vaccine (NVX-CoV2373). In a recent study from the National Institute of Allergy and Infectious Diseases, the incidence of pain/tenderness, swelling, erythema, fatigue/malaise, headache, muscle pain, or fever was higher in individuals boosted with BNT162b2 (0.4% to 41.6% absolute increase) or mRNA-1273 (5.5% to 55.0% absolute increase) compared with NVX-CoV2373. Evidence suggests that NVX-CoV2373, when utilized as a heterologous booster, demonstrates less reactogenicity compared with mRNA vaccines, which, if communicated to hesitant individuals, may strengthen booster uptake rates worldwide.
Clinical Trials Registration NCT04889209.
Global International Relations and Worlding Beyond the West: A Pedagogical Critique
Authors: Ettinger Aaron 
Published: November 2023

AbstractThis paper addresses the pedagogical implications of the “Global International Relations (GIR)” and “Worlding Beyond the West” agendas. These two programs have criticized IR’s Western-centrism and offered systematic ways to expand beyond IR’s Euro-Atlantic roots. Their development coincides with other high-profile theoretical and historiographic developments, not to mention societal imperatives, to expand the substantive remit of the discipline. However, the diversification agenda has been mostly concerned with the research output of IR and has treated the pedagogical side of IR’s intellectual life as a secondary consideration. Proponents of the GIR and Worlding agendas have yet to convert these programs into a classroom pedagogy. This paper fills that gap. It critiques the practical and intellectual limits of GIR and Worlding pedagogies. More importantly, it provides theoretically informed ways to transpose their diversification projects into the undergraduate classroom. In doing so, this paper bridges disciplinary analysis, IR theory, and IR pedagogy in an integrated analysis of IR’s much-needed attempts at diversification.
Family Rules and Routines During the Early Phases of Pediatric Cancer Treatment: Associations With Child Emotional and Behavioral Health
Authors: Bates Carolyn R , Staggs Vincent S , Dean Kelsey M , August Keith J , Befort Christie A , Covitz Lynne M , Dreyer Gillette Meredith L 
Published: November 2023

Abstract

Objective
Consistent family rules and routines promote positive adaptation to stress and may be protective to child emotional and behavioral functioning. Few studies have quantified family engagement in these behaviors during pediatric cancer treatment or examined associations with child emotional and behavioral health.

Methods
In this cross-sectional observational study, 86 primary caregivers of youth ages 2–14 years (M = 7.9) with an initial diagnosis of cancer within 16 weeks reported on their frequency of engagement in family rules and routines (e.g., sleep, schoolwork, and meal routines) before their child’s cancer diagnosis and their current frequency of engagement in the same routines. Caregivers also reported demographics, psychosocial distress, and child emotional and behavioral health outcomes. Analyses examined demographic and psychosocial factors associated with engagement in rules and routines during cancer treatment, and associations with child emotional and behavioral health.

Results
Families reported a lower frequency of engagement in rules and routines during cancer treatment, compared to before treatment (mean difference 0.8 SDs [95% confidence interval 0.7–1.1 SDs]). Caregiver factors associated with lower engagement in rules and routines during treatment included being married, having lower educational attainment, and higher levels of psychosocial distress. Families who engaged in higher levels of rules and routines during treatment reported fewer child externalizing and behavioral challenges. There was limited evidence of association between family rules and routines and child internalizing outcomes.

Conclusions
Results found that engaging in family rules and routines during cancer treatment was associated with fewer child behavioral challenges during treatment. Future directions include longitudinal examinations of family rules, routines, and child emotional/behavioral outcomes to examine directional impact over time.
Alternative paths of professionalism at the margins of the healthcare system: The case of spiritual caregivers in Israel
Authors: Keshet Yael , Popper-Giveon Ariela , Avnoon Netta 
Published: November 2023

Abstract
Much of the research on professions in the field of healthcare focuses on standard bodies of knowledge, jurisdictional claims, state regulations, and professional closure, which are characteristics of professions like medicine. However, new notions such as client-based professionalization, professional fluidity, and connective professionalism have recently emerged in the sociology of professions literature. This article suggests a new perspective on alternative paths of professionalism at the margins of the healthcare system, drawing on the case of spiritual caregivers. Semi-structured in-depth interviews were conducted with 15 Israeli spiritual caregivers. The interviewees presented themselves as professionals by describing characteristics resembling the new notions of professionalism: the centrality of the patient, the fluid nature of the practice of spiritual care, and their connectivity with other healthcare practitioners. New notions in the sociological study of professions can help us understand alternative paths of professionalism at the margins of the healthcare system and to characterize the practitioners in these margins. This could contribute to a better understanding of the new sources of gaining legitimacy in the healthcare system to the benefit of patients, medical practitioners, other staff members, and medical institutions at large.
Incorporating short data into large mixed-frequency vector autoregressions for regional nowcasting
Authors: Koop Gary , McIntyre Stuart , Mitchell James , Poon Aubrey , Wu Ping 
Published: November 2023

Abstract
Interest in regional economic issues coupled with advances in administrative data is driving the creation of new regional economic data. Many of these data series could be useful for nowcasting regional economic activity, but they suffer from a short (albeit constantly expanding) time series which makes incorporating them into nowcasting models problematic. Regional nowcasting is already challenging because the release delay on regional data tends to be greater than that at the national level, and ‘short’ data imply a ‘ragged edge’ at both the beginning and the end of regional data sets, which adds a further complication. In this paper, via an application to the UK, we investigate various ways of including a wide range of short data into a regional mixed-frequency vector autoregression (MF-VAR) model. These short data include hitherto unexploited regional value-added tax turnover data. We address the problem of the two ragged edges by estimating regional factors using different missing data algorithms that we then incorporate into our MF-VAR model. We find that nowcasts of regional output growth are generally improved when we condition them on the factors, but only when the regional nowcasts are produced before the national (UK-wide) output growth data are published.
Cystic lymphangioma causing intussusception of the right colon: a case report and review of current literature
Authors: Park Jae Hyun , Park Jesung , Ku Ga Yoon , Moon Do Kyoon , Ahn Jong Sung , Kim Hyo Jun , Kim Min Jung , Park Ji Won , Ryoo Seung-Bum , Jeong Seung-Yong , Park Kyu Joo 
Published: November 2023

Abstract
Among intraabdominal lymphangiomas, colonic lymphangiomas are rare. These cystic tumors are generally asymptomatic and incidentally found but may present with bleeding or obstructive symptoms. Intussusception by such tumors is scarcely reported, with only nine previously reported cases listed in Pubmed. We report a case of a 41-year-old female Asian patient who presented with acute abdomen and was diagnosed with colonic intussusception caused by lymphangioma. She received emergent right hemicolectomy, recovered well without complications, and was discharged on the 5th postoperative day.
Recent progress in understanding the cellular and genetic basis of plant responses to low oxygen holds promise for developing flood-resilient crops
Authors: Fagerstedt Kurt V , Pucciariello Chiara , Pedersen Ole , Perata Pierdomenico 
Published: November 2023

Abstract
With recent progress in active research on flooding and hypoxia/anoxia tolerance in native and agricultural crop plants, vast knowledge has been gained on both individual tolerance mechanisms and the general mechanisms of flooding tolerance in plants. Research on carbohydrate consumption, ethanolic and lactic acid fermentation, and their regulation under stress conditions has been accompanied by investigations on aerenchyma development and the emergence of the radial oxygen loss barrier in some plant species under flooded conditions. The discovery of the oxygen-sensing mechanism in plants and unravelling the intricacies of this mechanism have boosted this very international research effort. Recent studies have highlighted the importance of oxygen availability as a signalling component during plant development. The latest developments in determining actual oxygen concentrations using minute probes and molecular sensors in tissues and even within cells have provided new insights into the intracellular effects of flooding. The information amassed during recent years has been used in the breeding of new flood-tolerant crop cultivars. With the wealth of metabolic, anatomical, and genetic information, novel holistic approaches can be used to enhance crop species and their productivity under increasing stress conditions due to climate change and the subsequent changes in the environment.