bluuebunny/crossref_metadata_2025_split huggingface dataset:
The moderating effect of self-care self-efficacy and self-care behaviors on the relationship between symptom burden and frailty among heart failure inpatients
Authors: Qiu C , Yu S F 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The trajectory of heart failure is punctuated by episodes of repeated hospitalization due to heart failure exacerbation. Heart failure inpatients bear a heavy symptom burden, which acts as a strong stimulus to decrease patients' physiological reserve and lead to the development of frailty. Frailty has been shown to be a powerful predictor of heart failure inpatients' poor prognosis. Based on the theory of the Transactional Model of Stress, self-care behavior was suggested to be a cognitive-behavioral coping method to mitigate the detrimental effect elicited by symptom stimulus and improve patients' prognoses.

Purpose
This study was conducted to examine whether self-efficacy, self-care behaviors including self-care maintenance, symptom perception, and self-care management moderate the relationship between symptom burden and frailty.

Methods
This was a cross-sectional study with 207 participants recruited from June to December 2022. The Chinese versions of Memorial Symptom Assessment Scale-Heart Failure, Self-care self-efficacy scale, Self-care index of heart failure 7.2 and Edmonton frailty scale were adopted to capture corresponding variables. The moderation effects of self-care self-efficacy and three specific self-care behaviors were explored using the PROCESS macro for SPSS.

Results
Among recruited patients, most patients were male (61.8%), with the mean age of 71.23. As for the moderating effects analyses, self-care efficacy (P&lt;0.001, ΔR2=0.032), self-care maintenance (P&lt;0.001, ΔR2=0.039) and symptom perception (P&lt;0.001, ΔR2=0.031) rather than self-care management (P=0.06) moderated the detrimental effect of symptom burden on frailty. The results of further analysis showed that providers recommended (P&lt;0.001, ΔR2=0.036) rather than self-initiated (P=0.81) self-care management behaviors moderated the relationship between symptom burden and frailty.

Conclusions
This study identified the moderating effects of self-care self-efficacy, self-care behaviors in mitigating detrimental effect of symptom burden on frailty. Our study suggested one potential pathway to improve patients' prognoses by decreasing the deleterious effects of symptoms and highlighted the necessity of incorporating self-care into heart failure management.
Exploring how enrolment in the TARGET-CTCA clinical trial may modify patient perception of heart health
Authors: Ferry A , Schulberg S , Barker S , Souter G , Williams K , Taggart C , Wereski R , Tuck C , Mills N L 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background
The TARGET-CTCA trial aims to determine whether the use of high-sensitivity cardiac troponin to target computed tomography coronary angiography (CTCA) improves outcomes in patients presenting to hospital with suspected acute coronary syndrome in whom myocardial infarction has been ruled out. What patients understand of their subsequent risk of cardiovascular disease in this setting, and how intervention with CTCA may influence this is unknown.

Purpose
To explore how trial participants perceive their heart health and whether this has been modified by trial participation.

Methods
The TARGET-CTCA trial randomises patients with intermediate high sensitivity cardiac troponin levels to standard care, or CTCA plus standard care. Patients receive CTCA scan results informing them if they have a normal heart or they have mild, moderate or obstructive coronary artery disease. Forty semi-structured interviews were conducted with trial participants across standard care and intervention arms ensuring representation across disease category, age, sex and socioeconomic status groups. Data were coded and organized into themes.

Results
Emergent themes from the data included insights into attitudes to future health, perception of heart health, and health education needs. While some participants displayed a proactive approach to maintaining health, the consideration of future health goals was often a reactive process in response to the initial chest pain episode or the CTCA findings. While some patients discussed personal responsibility for health maintenance others described a passive approached requiring direct management from a health professional. For some standard care participants, the absence of myocardial infarction was a sign of a healthy heart. Others were left with unanswered questions after the hospital assessment. Confirmation of the absence of coronary artery disease with CTCA gave patients great confidence and a positive change to health seeking behaviour patterns was reported. Patients differed in their interpretation of the terms mild, moderate and obstructive coronary artery disease. This affected their subsequent action with some using the presence of disease as an opportunity to appraise their risk of future cardiac events and begin a preventative approach. Others reported fear and reducing activity to avoid precipitating a possible event. Many patients reported a desire to implement lifestyle changes but did not have the knowledge to do so.

Conclusion
Exploring how the information contained in participant result letters may contribute to the understanding of risk of future cardiac events has provided valuable information for application of the trial intervention outside of the main trial setting.
The af virtual ward, right care, right time and right team
Authors: Armstrong S , Kotb A , Bausor R , Neve C , Koev I , Ng G A 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial Fibrillation (AF) is the most common cardiac arrhythmia. AF related hospital admissions are rising, with significant cost and capacity implications. Virtual wards are novel pathways designed to support patients remotely, whilst maintaining safe high quality patient care, changing the landscape of care provision.

Purpose
The standard pathway for patients presenting acutely with AF or Atrial flutter (AFL), is to remain in hospital between 2-5 days, attached to a heart monitor until achieving rate or rhythm control. We developed an AF Virtual ward run by a specialist multi-disciplinary team; to provide remote out-of-hospital care for patients with AF or AFL and rapid ventricular response whilst focusing on improving patients’ care pathway and experience.

Methods
Patients presenting acutely with AF or AFL who met the criteria for our virtual ward, were on-boarded from an acute hospital admission area or outpatient department. Patients were given access to electronic platform (Dignio) via their smartphone or tablet. They were provided with instruction on how to use a blood pressure machine, single lead ECG device (Kardia) and a pulse oximeter. Once discharged they submitted readings, at least twice a day. Patients who didn’t have access to smart phones were provided with electronic tablets to ensure digital inclusion. Patients’readings, current medication and co-morbidities were assessed by Advanced Clinical Practitioners, Cardiology Registrars and Consultants on "virtual ward rounds". They were supported via messaging through the platform, telephone or video consultations. Health education, lifestyle advice, medication adjustments, and clinical decisions were undertaken remotely by the clinical team.

Results
A retrospective analysis of the first 50 virtual ward admissions from January - August 2022 was undertaken. Initial hospital admissions were completely avoided in 24 patients due to on-boarding from the outpatient department. Medical interventions by the specialist team prevented 25 readmissions, saving a total of 49 hospitalisations and between 98 - 245 bed days. A rhythm control strategy was pursued in 82% and sinus rhythm was achieved in 36% on discharge. A total of 28% patients were referred for direct current cardioversion (DCCV) and 30% for catheter ablation. The prompt development of a treatment plan avoided attendance in a specialist Cardiology outpatient clinic whose waiting time for an appointment is approximately 6 months. The NHS friends & family test was completed by 90% of the patients with 100% positive responses. Feedback themes revolved around empowerment, feeling safe, actively participating in their care, and avoiding hospital stay.

Conclusion
The innovative changes to create the AF Virtual ward has facilitated bed efficiencies allowing "hospital-at-home" remote care through prompt care by a specialist multidisciplinary team, with 100% patient satisfaction.
Knowledge on heart disease of the person with ischemic heart disease
Authors: Carneiro L , Rodrigues D , Paiva D 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Instruments that allow us to measure the users' knowledge about their health can be useful in clinical practice to allow adjusting interventions, quantifying health gains and developing cost-effective interventions.

Purpose
To determine knowledge about heart disease among the population with diagnosed ischemic heart disease.

Methods
Cross-sectional, descriptive study using a sequential sample of patients with ischemic heart disease admitted between May 2nd and July 30th, 2022 at the cardiology service of the Hospital Centre of our city. A self-administered questionnaire was developed and applied to 165 patients, encompassing several dimensions: sociodemographic characteristics, clinical history, lifestyle, number of hospitalizations due to heart disease and characterization of the current admission. An instrument was used to determine knowledge about heart disease (Questionário de Avaliação de Conhecimentos em Doença Cardíaca: QACDC - Questionnaire for the Assessment of Knowledge in Heart Disease), the Medical Term Recognition Test (METER) to assess literacy and the Hospital Anxiety and Depression Scale (HADS). Patients were assessed during their stay at the hospital unit where they had been admitted due to an acute illness or for elective procedures. Using, preferably, parametric tests, we studied the association between the average score obtained in the QAC-DC and the variables studied.

Results
Women, the less educated and those with inadequate literacy levels were the groups with the lowest levels of knowledge. Regarding the areas of knowledge, the least recognized cardiovascular risk factors were the family history of ischemic heart disease (recognized by 86%), diabetes mellitus (recognized by 73%) and gender (marked by 19% of respondents). The most frequently identified symptom of heart disease was chest discomfort (92%), followed by difficulty breathing or shortness of breath (84%), while jaw, neck or interscapular discomfort was only recognized by 54% of respondents. Symptoms of stroke and acute myocardial infarction were confused by 88% of the sample.

Conclusions
There are important gaps in some areas of knowledge about heart disease among patients with ischemic heart disease. These gaps are particularly important in certain patient subgroups. Health intervention strategies must be sensitive to these data. The QAC-DC knowledge assessment instrument proved to be reliable, valid and applicable in clinical practice.
Examining cardiac cachexia in the thai heart failure patients
Authors: Thanapholsart J , Khan E , Janwanishstaporn S , Thongma P , Naowapanich S , Pramyothin P , Chirakarnjanakorn S , Sethalao P , Waldreus N , Tankumpuan T , Lee G 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Ministry of Public Health, Thailand

Background
Cardiac cachexia (CC) can occur in heart failure (HF)with weight and muscle loss. Screening for suspected CC and CC using Cachexia consensus, including CC symptoms, had not been examined among the Thai heart failure patients.

Purpose
To screen for suspected CC and CC in a HF out-patients setting in Thailand using the international cachexia consensus

Method
Anthropometric data, such as body weight, height, grip strength, skinfold thickness and waist circumferences, were collected. Bloods for haemoglobin, albumin, c-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum osmolarity were collected. Bioelectrical impedance analysis (BIA) measurement using INBODY S10 was conducted. Participants were asked to complete questionnaires that were Simplified on Nutrition Appetite Questionnaire (SNAQ), Thirst Distress Scale-Heart Failure (TDS-HF) and Kansas City Cardiomyopathy Questionnaire.

Results
Thirty-eight participants were recruited. Of these two participants had confirmed and five with suspected CC and the remainder did not have CC (n=31). We analysed the data by comparing between two groups: 1) highly suggestive CC (confirmed CC and suspected CC), 2) non-CC. Anthropometric measurements, BIA parameters and fatigue were not significantly different between those with confirmed and suspected CC and those who have not have CC (P&gt;0.05). CRP and NT-proBNP levels were higher in those with CC and suspected CC than those who have not have CC (CRP median 4.39 vs 1.25 and NT-proBNP median 3,889.00 vs 1,957.00, respectively). The SNAQ scores were significantly lower in highly suggestive CC than non-CC group (13.14±2.41 vs 15.07±2.28, p≤0.05), but TDS-HF scores were not significantly different (20.57±7.28 vs 19.74±9.54, p = 0.678). Quality of life scores were lower in highly suggestive CC group than non-CC group although it was not statistically significant (60.71±24.40 vs 66.67±24.06, p = 0.559). Phase angle positively correlated to SNAQ (r = 0.550, p = 0.015) and albumin (r = 0.622, p = 0.004).

Conclusion
This is the first pilot study in Thailand screening for CC. SNAQ with the support of phase angle can be a useful and affordable tool to simply screen for CC. NT-proBNP might be associated with the development of CC and poor disease prognosis.
Sexually selected male weapon increases the risk of population extinction under environmental change: an experimental evidence
Authors: Łukasiewicz Aleksandra , Porwal Neelam , Niśkiewicz Małgorzata , Parrett Jonathan M , Radwan Jacek 
Published: July 2023

Abstract
Exaggerated sexually selected traits (SSTs), occurring more commonly in males, help individuals to increase reproductive success but are costly to produce and maintain. These costs on the one hand may improve population fitness by intensifying selection against maladapted males, but on the other hand, may increase the risk of extinction under environmental challenges. However, the impact of SSTs on extinction risk has not been investigated experimentally. We used replicate populations of a male-dimorphic mite, Rhizoglyphus robini, to test if the prevalence of a sexually selected weapon affected the risk of extinction under temperature increase (TI) (2°C per each of three consecutive generations). In two independent experiments that utilized either inbred lines or lines mass selected for or against the weapon to establish experimental replicate populations differing in the prevalence of the weapon, we found that populations with high weapon prevalence were more likely to go extinct. Extinctions occurred despite partial suppression of the weapon expression at increased temperature and were not explained by increased male mortality. Our results provide the first, to our knowledge, experimental evidence demonstrating the dramatic effect of elaborated sexual traits on the risk of extinction under environmental challenges.
Chromosomal-level reference genome of a wild North American mallard (Anas platyrhynchos)
Authors: Lavretsky Philip , Hernández Flor , Swale Thomas , Mohl Jonathon E 
Published: July 2023

Abstract
The mallard (Anas platyrhynchos) is one of the most common, economically, and socially important birds around the world. Mallards were not only an important food source for early humans but eventually becoming intimately linked with people as they were domesticated over the last 2,000 years. To date, mallard genomes are largely reconstructed from samples of domestic or unknown genetic heritage. Here, we report the first high-quality genome assembly and annotation of a genetically vetted wild mallard from North America (NAwild_v1.0). The genome was assembled using a combination of shotgun libraries, proximity ligation Chicago, and Dovetail Hi-C libraries. The final assembly is ∼1.04 Gb in size, with 98.3% of the sequence located in 30 full or nearly full chromosome-level scaffolds, and with a N50/L50 of 79.1 Mb/4 scaffolds. We used a combination of gene prediction and similarity approaches to annotate a total of 23,584 functional genes, of which 19,242 were associated to GO terms. The genome assembly and the set of annotated genes yielded a 95.4% completeness score when compared with the BUSCO aves_odb10 dataset. Next, we aligned 3 previously published mallard genomes to ours, and demonstrate how runs of homozygosity and nucleotide diversity are substantially higher and lower, respectively, to ours and how these artificially changed genomes resulted in profoundly different and biased demographic histories. Our wild mallard assembly not only provides a valuable resource to shed light onto genome evolution, speciation, and other adaptive processes, but also helping with identifying functional genes that have been significantly altered during the domestication process.
Genomic Analysis of Plastid–Nuclear Interactions and Differential Evolution Rates in Coevolved Genes across Juglandaceae Species
Authors: Yang Yang , Forsythe Evan S , Ding Ya-Mei , Zhang Da-Yong , Bai Wei-Ning 
Published: July 2023

Abstract
The interaction between the nuclear and chloroplast genomes in plants is crucial for preserving essential cellular functions in the face of varying rates of mutation, levels of selection, and modes of transmission. Despite this, identifying nuclear genes that coevolve with chloroplast genomes at a genome-wide level has remained a challenge. In this study, we conducted an evolutionary rate covariation analysis to identify candidate nuclear genes coevolving with chloroplast genomes in Juglandaceae. Our analysis was based on 4,894 orthologous nuclear genes and 76 genes across seven chloroplast partitions in nine Juglandaceae species. Our results indicated that 1,369 (27.97%) of the nuclear genes demonstrated signatures of coevolution, with the Ycf1/2 partition yielding the largest number of hits (765) and the ClpP1 partition yielding the fewest (13). These hits were found to be significantly enriched in biological processes related to leaf development, photoperiodism, and response to abiotic stress. Among the seven partitions, AccD, ClpP1, MatK, and RNA polymerase partitions and their respective hits exhibited a narrow range, characterized by dN/dS values below 1. In contrast, the Ribosomal, Photosynthesis, Ycf1/2 partitions and their corresponding hits, displayed a broader range of dN/dS values, with certain values exceeding 1. Our findings highlight the differences in the number of candidate nuclear genes coevolving with the seven chloroplast partitions in Juglandaceae species and the correlation between the evolution rates of these genes and their corresponding chloroplast partitions.
The Yin and Yang of Self-Regulation in Developing Vertebrates. An Energetics Perspective
Authors: Hunt von Herbing Ione 
Published: July 2023

SynopsisAll living organisms are thermodynamic open systems constantly exchanging energy with the environment to maintain organization and structure. In a state of nonequilibrium they undergo a back-and-forth pattern of self-regulation and dysregulation in energy exchange. This state of dynamic nonequilibrium can be observed during vertebrate development in which high phenotypic variation and plasticity exists, especially in the presence of stressors. While investigations of the effects of stressors on mechanisms of self-regulation are usually measured by systemic changes (e.g. metabolic rate) between baseline (control) and stimulus (or stressor), real-world stressors do not switch on and off in predictable patterns, rarely occur alone, and can be acute (short-term) or chronic (long-term). In this short review, application of two processes underlying self-regulation and dysregulation are explored, (1) allostasis, stability through change or the processes underlying self-regulation and, (2) metastasis, instability through change or the processes underlying dysregulation, to understand the effects of environmental stressors on the energetics of fish early life history stages (embryos and larvae). In mammalian physiology, allostasis theory was developed to maximize the probability of survival under stress, while reducing or limiting somatic damage. Yet, allostatic responses have energetic costs. Multiple stress responses over time result in systemic somatic damage accompanied by a loss of resilience due to an inability to self-regulate. Allostatic costs and their systemic effects on neuroendocrine, metabolic, cardiovascular, and immune systems are cumulative and understood for adults but not yet for earlier stages. Developing stages with greater challenges for allostatic self-regulation than older stages because of limited resources have higher growth rates, smaller aerobic scopes, elevated metabolic costs, tight energy budgets, and employ compensatory versus additive energy budgets. Along with high mortality, early stages are expected to exhibit decreased physiological resilience and increased vulnerability in response to stressors, but little examination of energetic strategies to preserve functional stability in the face of stressors exists. While dysregulation/metastatic processes are more difficult to document in development, they increase our understanding of how organisms exposed to chronic/multiple stressors may reach allostatic overload leading to either, (1) systemic dysfunction and/or death or possibly, (2) novel physiological adaptive states. Evaluation of factors driving the yin and yang of self-regulation and dysregulation will provide knowledge of factors triggering or retarding metastatic processes, thus identifying those that prevent or reduce their affects, important in a world undergoing rapid global change.
Large Deviation Estimates of Selberg’s Central Limit Theorem and Applications
Authors: Arguin Louis-Pierre , Bailey Emma 
Published: July 2023

Abstract
For $V\sim \alpha \log \log T$ with $0&lt;\alpha &lt;2$, we prove $$\begin{align*} & \frac{1}{T}\textrm{meas}\{t\in [T,2T]: \log|\zeta(1/2+ \textrm{i} t)|&gt;V\}\ll \frac{1}{\sqrt{\log\log T}} e^{-V^{2}/\log\log T}. \end{align*}$$This improves prior results of Soundararajan and of Harper on the large deviations of Selberg’s Central Limit Theorem in that range, without the use of the Riemann hypothesis. The result implies the sharp upper bound for the fractional moments of the Riemann zeta function proved by Heap, Radziwiłł, and Soundararajan. It also shows a new upper bound for the maximum of the zeta function on short intervals of length $(\log T)^{\theta }$, $0&lt;\theta &lt;3$, that is expected to be sharp for $\theta&gt; 0$. Finally, it yields a sharp upper bound (to order one) for the moments on short intervals, below and above the freezing transition. The proof is an adaptation of the recursive scheme introduced by Bourgade, Radziwiłł, and one of the authors to prove fine asymptotics for the maximum on intervals of length $1$.