bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automatic measurements of left ventricular volumes and ejection fraction by artificial intelligence reduces time-consumption and inter-observer variability
Authors: Olaisen S , Smistad E , Espeland T , Hu J , Pasdeloup D , Ostvik A , Amundsen B , Aakhus S , Rosner A , Stylidis M , Holte E , Grenne B , Lovstakken L , Dalen H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Norwegian University of Science and Technology.

Background
Left ventricular (LV) volumes and ejection fraction (EF) are the most used and studied parameters in echocardiography, but they are hampered with the tedious nature and limited reproducibility of manual measurements. We developed an artificial intelligence (AI) decision-support software that automatically calculates LV volumes and EF by identifying the view, timing, and endocardial border from echo images.

Purpose
Our aim was to investigate the impact of using the AI decision-support software for automatic measurements of LV volumes and EF compared to standard care in real-time and large databases.

Methods
We compared biplane three-cycle averaged AI measurements of LV volumes and EF to manual references in multiple samples: 1) Real-time AI-support during scanning of 50 consecutive patients compared to standard care (test-retest) by two of three experts, 2) comparison of test-retest variability in inter- and intra-observer scenarios in 40 subjects with test-retest datasets by separate observers and measurements by AI and four experienced observers, 3) an internal database of 1881 subjects with manual references by Simpson’s method, and 4) an external population of 849 subjects with manual references by semi-automatic tracking-based software. The influence on time consumption was tested in Sample 1. The influence on test-retest variability was tested in Sample 1 and 2, while the other samples were used to test the agreement with echocardiographic references.

Results
Used in real-time the AI measurements reduced total time-consumption by median (95% CI) 5.3 (4.8–6.5) minutes per patient (p &lt;0.001). The test-retest variability for AI-measurements were superior to inter-observer scenarios (p &lt;0.05) and non-inferior to intra-observer scenarios (p &lt;0.025, one-sided, delta=46% increased variance). The agreement with echocardiographic references was good (Figure). The biases (AI minus reference) ranged −11.6 to 6.5 mL for end-diastolic LV volume and −5.5 to 0.3 %-points for EF.

Conclusion
Fully automatic AI measurements of LV volumes and EF reduced time-consumption with 5 minutes, reduced test-retest variability compared to inter-observer analyses, and showed acceptable agreement with manual measurements in a wide range of scenarios. Thus, implementation of real-time fully automatic measurements of LV volumes and EF during scanning may improve the everyday workflow and quality in the everyday clinic.
CMR reclassifies patients with suspected myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Bisaccia G , Liang K , Williams M G L , Leo I , Dastidar A , Sammut E , Johnson T , Bucciarelli-Ducci C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
This study sought to assess the role of cardiac magnetic resonance (CMR) in investigating patients presenting with suspected acute coronary syndrome (ACS) and non-obstructed coronary arteries.

Methods
Consecutive patients presenting to a tertiary cardiology centre with suspected ACS and non-obstructed coronary arteries and referred for CMR were retrospectively identified. A comprehensive imaging protocol was performed to include cines, T2-weighted, and late gadolinium enhancement (LGE) sequences. Final CMR diagnosis was based on established patterns of tissue characterisation from myocardial oedema and LGE imaging, with patients grouped into five: myocardial infarction, myocarditis, Takotsubo syndrome, cardiomyopathy, and a normal CMR.

Results
A total of 888 patients were identified. The mean age across the cohort was 57 years (SD ±15.9 years) with 51% female patients. Median time to CMR from acute presentation was 21 days (Figure 1). Aetiology of presentation was uncertain in more than half of patients referred for CMR (483, 54.1%). Of patients with an initial uncertain aetiology, CMR was able to identify an underlying diagnosis in 74.9%. Diagnosis across the whole cohort was reclassified in 691 patients (77.8%), with overall diagnostic yield (CMR identified underlying aetiology for presentation) of 75.6%. (Figure 2).

Conclusions
In a large single-centre cohort of patients presenting with suspected ACS and non-obstructed coronary arteries, diagnostic yield with CMR was high at 76%. CMR reclassified nearly 80% of patients. Our results highlight the importance of CMR in the diagnostic pathway of suspected ACS and potential implications on clinical management.
LV and LA mechanics in pediatric HCM : a CMR study of phenotype-genotype correlation
Authors: Panaioli E , Volodia Dangouloff-Ros V D , Nathalie Boddaert N B , Damien Bonnet D B , Diala Khraiche D K 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Paediatric hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death. The relationship between the genotype variation and phenotype expression has not been fully elucidated, with some studies showing association with an increased hypertrophy and MYH7 or multiple genetic variations. In HCM fibrosis and hypertrophy contribute to left ventricular (LV) mechanics’ alteration resulting in subendocardial dysfunction. The latter is associated with a decreased global longitudinal and radial strains (GLS, GRS), whereas epicardial thickening leads to preserved global circumferential strain (GCS) and LV twist. Children with HCM have reduced LA function, measurable by both volumetric and strain analysis and reduced LA mechanics are associated with poor exercise capacity. Feature tracking –cardiac magnetic resonance (FT-CMR) has enhanced the non-invasive assessment of myocardial deformation in HCM. The main aim of our study was to assess differences of LV and LA mechanics features on CMR between patients harbouring multiple pathogenic or likely pathogenic variants (MGv, n=16) or single genetic variations (SGv, n=35).

Methods
Our retrospective CMR study included 51 patients (1.7–18.8 years ago). CMR data were: LV and LA’s morphological values, late gadolinium enhancement (LGE) of LA and LV walls, LV feature tracking (FT) derived strain and LV twist (LVT). LV twist was calculated as the difference between basal and apical rotation. The LA feature FT derived strain, LA conduit function, reservoir function and pump function were computed.

Results
In MGv group, the indexed LV mass 108.8 +/-53.0 vs 74.3+/- 22.2 in SGv (p = 0.03). LGE was present in 51% patients of the whole cohort, with LGE in 64 % of MGv group. LV FT derived strain values and LA function were not statistically significant different between groups (MGv vs SGv: GLS −15.8+/−5.3 vs −18.7+/−4.8, GCS −27.8+/8 vs −31.1+/−8.6, GRS 44.7+/−24.6 vs 62.3+/−32). LVT was reduced in MGv group (0.04+/−7.6) vs (7.4+/−7.4) in SGv (p = 0.003). LA contractile function did not differ between the groups (MGv vs SGv: GLS LA 25.1+/−14.2 vs 27.6+/−13.5). LA reservoir, conduction and pump function did not differ between the groups. LVT was significantly correlated with the LA contractile function. An increased of LVT was associated with an increased LA GLS and EF (p = 0.011; p = 0.004).

Conclusions
Patients with multiple genetic variants have a greater LV mass and altered LV mechanics with reduced LV twist. This study gives insights in phenotype- genotype correlation in paediatric HCM and warrants larger longitudinal studies to assess its clinical significance.
Prognostic impact of cardiac resynchronization therapy guided by phase analysis: a CZT study
Authors: Liga Riccardo , Startari Umberto , Spatafora Davide , Michelotti Erica , Gimelli Alessia 
Published: June 2023

Abstract

Aims
To evaluate whether phase analysis imaging may predict treatment response and long-term prognosis after cardiac resynchronization therapy (CRT).

Methods and results
Sixty-nine patients underwent myocardial perfusion imaging followed by CRT. Patients with ischaemic heart disease and non-ischaemic cardiomyopathy (NICM) were identified. Left ventricular (LV) mechanical dyssynchrony (LVMD) was assessed at phase analysis and the region of the latest mechanical activation was identified. LV pacing lead position was considered ‘concordant’ when located in the region of the latest mechanical activation, and ‘discordant’ otherwise. The ‘6 months post-CRT’/‘baseline’ ratio of LV ejection fraction was computed as a measure of CRT response. LVMD was revealed in 47/69 patients, 27 of whom (57%) had a concordant LV lead implantation. Only concordant pacing was associated with LV functional improvement (ejection fraction ratio: 1.28 ± 0.25 vs. 1.11 ± 0.32 in discordant stimulation, P = 0.028). However, this relationship persisted only in patients with NICM (P &lt; 0.001), while it disappeared in those with ischaemic heart disease (P = NS). Twenty-eight events occurred during 30 ± 21 months follow-up. While discordant LV lead location was the major predictor of unfavourable prognosis (hazard ratio 3.29, 95% confidence interval 1.25–8.72; P = 0.016), this relationship was confirmed only in patients with NICM.

Conclusions
Phase analysis of myocardial perfusion imaging may guide CRT implantation, identifying patients who would most likely benefit from this procedure.
Long-term cardiovascular outcomes among immigrants and non-immigrants in cardiac resynchronization therapy: a nationwide study
Authors: Krøll Johanna , Kristensen Søren Lund , Jespersen Camilla H B , Philbert Berit , Vinther Michael , Risum Niels , Johansen Jens Brock , Nielsen Jens Cosedis , Riahi Sam , Haarbo Jens , Fosbøl Emil L , Torp-Pedersen Christian , Køber Lars , Tfelt-Hansen Jacob , Weeke Peter E 
Published: June 2023

Abstract

Aims
To date, potential differences in outcomes for immigrants and non-immigrants with a cardiac resynchronization therapy (CRT), in a European setting, remain underutilized and unknown. Hence, we examined the efficacy of CRT measured by heart failure (HF)-related hospitalizations and all-cause mortality among immigrants and non-immigrants.

Methods and results
All immigrants and non-immigrants who underwent first-time CRT implantation in Denmark (2000–2017) were identified from nationwide registries and followed for up to 5 years. Differences in HF related hospitalizations and all-cause mortality were evaluated by Cox regression analyses. From 2000 to 2017, 369 of 10 741 (3.4%) immigrants compared with 7855 of 223 509 (3.5%) non-immigrants with a HF diagnosis underwent CRT implantation. The origins of the immigrants were Europe (61.2%), Middle East (20.1%), Asia-Pacific (11.9%), Africa (3.5%), and America (3.3%). We found similar high uptake of HF guideline-directed pharmacotherapy before and after CRT and a consistent reduction in HF-related hospitalizations the year before vs. the year after CRT (61% vs. 39% for immigrants and 57% vs. 35% for non-immigrants). No overall difference in 5-year mortality among immigrants and non-immigrants was seen after CRT [24.1% and 25.8%, respectively, P-value = 0.50, hazard ratio (HR) = 1.2, 95% confidence interval (CI): 0.8–1.7]. However, immigrants of Middle Eastern origin had a higher mortality rate (HR = 2.2, 95% CI: 1.2–4.1) compared with non-immigrants. Cardiovascular causes were responsible for the majority of deaths irrespective of immigration status (56.7% and 63.9%, respectively).

Conclusion
No overall differences in efficacy of CRT in improving outcomes between immigrants and non-immigrants were identified. Although numbers were low, a higher mortality rate among immigrants of Middle Eastern origin was identified compared with non-immigrants.
Experimental estimates of germline mutation rate in eukaryotes: a phylogenetic meta-analysis
Authors: Wang Yiguan , Obbard Darren J 
Published: June 2023

Abstract
Mutation is the ultimate source of all genetic variation, and over the last 10 years the ready availability of whole-genome sequencing has permitted direct estimation of mutation rate for many non-model species across the tree of life. In this meta-analysis, we make a comprehensive search of the literature for mutation rate estimates in eukaryotes, identifying 140 mutation accumulation (MA) and parent–offspring (PO) sequencing studies covering 134 species. Based on these data, we revisit differences in the single-nucleotide mutation (SNM) rate between different phylogenetic lineages and update the known relationships between mutation rate and generation time, genome size, and nucleotide diversity—while accounting for phylogenetic nonindependence. We do not find a significant difference between MA and PO in estimated mutation rates, but we confirm that mammal and plant lineages have higher mutation rates than arthropods and that unicellular eukaryotes have the lowest mutation rates. We find that mutation rates are higher in species with longer generation times and larger genome sizes, even when accounting for phylogenetic relationships. Moreover, although nucleotide diversity is positively correlated with mutation rate, the gradient of the relationship is significantly less than one (on a logarithmic scale), consistent with higher mutation rates in populations with smaller effective size. For the 29 species for which data are available, we find that indel mutation rates are positively correlated with nucleotide mutation rates and that short deletions are generally more common than short insertions. Nevertheless, despite recent progress, no estimates of either SNM or indel mutation rates are available for the majority of deeply branching eukaryotic lineages—or even for most animal phyla. Even among charismatic megafauna, experimental mutation rate estimates remain unknown for amphibia and scarce for reptiles and fish.
Conformational comparisons of Pasteurella multocida types B and E and structurally related capsular polysaccharides
Authors: Richardson Nicole I , Ravenscroft Neil , Kuttel Michelle M 
Published: June 2023

Abstract
Pasteurella multocida, an encapsulated gram-negative bacterium, is a significant veterinary pathogen. The P. multocida is classified into 5 serogroups (A, B, D, E, and F) based on the bacterial capsular polysaccharide (CPS), which is important for virulence. Serogroups B and E are the primary causative agents of bovine hemorrhagic septicemia that is associated with significant yearly losses of livestock worldwide, primarily in low- and middle-income countries. The P. multocida disease is currently managed by whole-cell vaccination, albeit with limited efficacy. CPS is an attractive antigen target for an improved vaccine: CPS-based vaccines have proven highly effective against human bacterial diseases and could provide longer-term protection against P. multocida. The recently elucidated CPS repeat units of serogroups B and E both comprise a N-acetyl-β-D-mannosaminuronic acid/N-acetyl-β-D-glucosamine disaccharide backbone with β-D-fructofuranose (Fruf) side chain, but differ in their glycosidic linkages, and a glycine (Gly) side chain in serogroup B. Interestingly, the Haemophilus influenzae types e and d CPS have the same backbone residues. Here, comparative modeling of P. multocida serogroups B and E and H. influenzae types e and d CPS identifies a significant impact of small structural differences on both the chain conformation and the exposed potential antibody-binding epitopes (Ep). Further, Fruf and/or Gly side chains shield the immunogenic amino-sugar CPS backbone—a possible common strategy for immune evasion in both P. multocida and H. influenzae. As the lack of common epitopes suggests limited potential for cross-reactivity, a bivalent CPS-based vaccine may be necessary to provide adequate protection against P. multocida types B and E.
ChatGPT and the clinical informatics board examination: the end of unproctored maintenance of certification?
Authors: Kumah-Crystal Yaa , Mankowitz Scott , Embi Peter , Lehmann Christoph U 
Published: June 2023

Abstract
We aimed to assess ChatGPT’s performance on the Clinical Informatics Board Examination and to discuss the implications of large language models (LLMs) for board certification and maintenance. We tested ChatGPT using 260 multiple-choice questions from Mankowitz’s Clinical Informatics Board Review book, omitting 6 image-dependent questions. ChatGPT answered 190 (74%) of 254 eligible questions correctly. While performance varied across the Clinical Informatics Core Content Areas, differences were not statistically significant. ChatGPT’s performance raises concerns about the potential misuse in medical certification and the validity of knowledge assessment exams. Since ChatGPT is able to answer multiple-choice questions accurately, permitting candidates to use artificial intelligence (AI) systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust. The advent of AI and LLMs threatens to upend existing processes of board certification and maintenance and necessitates new approaches to the evaluation of proficiency in medical education.
Using Omaha System data to explore relationships between client outcomes, phenotypes, and targeted home intervention approaches: an exemplar examining practice effectiveness for older women with circulation problems
Authors: Schwartz Cathy I , Farag Amany , Lopez Karen Dunn , Moorhead Sue , Monsen Karen A 
Published: June 2023

Abstract

Background
Improved health among older women remains elusive and may be linked to limited knowledge of and interventions targeted to population subgroups. Use of structured community nurse home visit data exploring relationships between client outcomes, phenotypes, and targeted intervention approaches may reveal new understandings of practice effectiveness.

Materials and Methods
Omaha System data of 2363 women 65 years and older with circulation problems receiving at least 2 community nurse home visits were accessed. Previously identified phenotypes (Poor circulation; Irregular heart rate; and Limited symptoms), 7 intervention approaches (High-Surveillance; High-Teaching/Guidance/Counseling; Balanced-All; Balanced-Surveillance-Teaching/Guidance/Counseling; Low-Teaching/Guidance/Counseling-Balanced Other; Low-Surveillance-Mostly-Teaching/Guidance/Couseling-TreatmentProcedure-CaseManagement; and Mostly-TreatementProcedure+CaseManagement), and client knowledge, behavior, and status outcomes were used. Client-linked intervention approach counts, proportional use per phenotypes, and associations with client outcome scores were descriptively analyzed. Associations between intervention approach proportional use by phenotype and outcome scores were analyzed using parallel coordinate graph methodology for intervention approach effectiveness.

Results
Percent use of intervention approach differed significantly by phenotype. The 2 most widely employed intervention approaches were characterized by either a high use of surveillance interventions or a balanced use of all intervention categories (surveillance, teaching/guidance/counseling, treatment-procedure, case-management). Mean outcome discharge and change scores significantly differed by intervention approach. Proportionally deployed intervention approach patterns by phenotype were associated with outcome small effects improvement.

Discussions and Conclusions
The Omaha System taxonomy supported the management and exploration of large multidimensional community nursing data of older women with circulation problems. This study offers a new way to examine intervention effectiveness using phenotype- and targeted intervention approach-informed structured data.
Screening Mammography Utilization in the United States
Authors: Funaro Kimberly , Niell Bethany 
Published: June 2023

Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
The survival and growth of honey bee (Hymenoptera: Apidae) colonies overwintered in cold storage: the effects of time and colony location
Authors: DeGrandi-Hoffman Gloria , Corby-Harris Vanessa , Graham Henry , Watkins-deJong Emily , Chambers Mona , Snyder Lucy 
Published: June 2023

AbstractFor over a decade, high percentages of honey bee colonies have been perishing during the winter creating economic hardship to beekeepers and growers of early-season crops requiring pollination. A way to reduce colony losses might be moving hives into cold storage facilities for the winter. We explored factors that could affect the size and survival of colonies overwintered in cold storage and then used for almond pollination. The factors were when hives were put into cold storage and their location prior to overwintering. We found that colonies summered in North Dakota, USA and moved to cold storage in October were larger after cold storage and almond pollination than those moved in November. Colony location prior to overwintering also affected size and survival. Colonies summered in southern Texas, USA and moved to cold storage in November were smaller after cold storage and almond pollination than those from North Dakota. The colonies also were smaller than those overwintered in Texas apiaries. Fat body metrics of bees entering cold storage differed between summer locations. North Dakota bees had higher lipid and lower protein concentrations than Texas bees. While in cold storage, fat bodies gained weight, protein concentrations increased, and lipids decreased. The decrease in lipid concentrations was correlated with the amount of brood reared while colonies were in cold storage. Our study indicates that in northern latitudes, overwintering survival might be affected by when colonies are put into cold storage and that colonies summered in southern latitudes should be overwintered there.