bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strengthening Deep-learning Models for Intracranial Hemorrhage Detection: Strongly Annotated Computed Tomography Images and Model Ensembles
Authors: Kang Dong-Wan , Park Gi-Hun , Ryu Wi-Sun , Schellingerhout Dawid , Kim Museong , Kim Yong Soo , Park Chan-Young , Lee Keon-Joo , Han Moon-Ku , Jeong Han-Gil , Kim Dong-Eog 
Published: August 2023

AbstractMultiple attempts at intracranial hemorrhage (ICH) detection using deep-learning techniques have been made and plagued with clinical failures. Most studies for ICH detection have insufficient data or weak annotations. We sought to determine whether a deep-learning algorithm for ICH detection trained on a strongly annotated dataset outperforms that trained on a weakly annotated dataset, and whether a weighted ensemble model that integrates separate models trained using datasets with different ICH subtypes is more accurate. We used publicly available brain CT scans from the Radiological Society of North America (27,861 CT scans, 3,528 ICHs) and AI-Hub (53,045 CT scans, 7,013 ICHs) for training datasets. For external testing, 600 CT scans (327 with ICH) from Dongguk University Medical Center and 386 CT scans (160 with ICH) from Qure.ai were used. DenseNet121, InceptionResNetV2, MobileNetV2, and VGG19 were trained on strongly and weakly annotated datasets and compared. We then developed a weighted ensemble model combining separate models trained on all ICH, subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), and small-lesion ICH cases. The final weighted ensemble model was compared to four well-known deep-learning models. Six neurologists reviewed difficult ICH cases after external testing. InceptionResNetV2, MobileNetV2, and VGG19 models outperformed when trained on strongly annotated datasets. A weighted ensemble model combining models trained on SDH, SAH, and small-lesion ICH had a higher AUC than a model only trained on all ICH cases. This model outperformed four well-known deep-learning models in terms of sensitivity, specificity, and AUC. Strongly annotated data are superior to weakly annotated data for training deep-learning algorithms. Since no model can capture all aspects of a complex task well, we developed a weighted ensemble model for ICH detection after training with large-scale strongly annotated CT scans. We also showed that a better understanding and management of cases challenging for AI and human is required to facilitate clinical use of ICH detection algorithms.Key PointsQuestionCan a weighted ensemble method and strongly annotated training datasets develop a deep-learning model with high accuracy to detect intracranial hemorrhage?FindingsA deep-learning algorithm for detecting ICH trained with a strongly annotated dataset outperformed models trained with a weakly annotated dataset. After ensembling separate models that were trained with only SDH, SAH, and small-lesion ICH, a weighted ensemble model had a higher AUC.MeaningThis study suggests that to enhance the performance of deep-learning models, researchers should consider the distinct imaging characteristics of each hemorrhage subtype and use strongly annotated training datasets.
“Someone who hates themselves doesn’t come for their drugs”:Experiences of Mental Health Along the HIV Care Continuum in South-Central, Uganda
Authors: West Nora S. , Ddaaki William , Murray Sarah M. , Nakyanjo Neema , Isabirye Dauda , Nakubulwa Rosette , Nalugoda Fred , Surkan Pamela J. , Hutton Heidi E. , Kennedy Caitlin E. 
Published: August 2023

ABSTRACTIntroductionPoor mental health occurs more frequently among people living with HIV. Understanding what mental health problems occur and at what point during the continuum of HIV care is critical to ensure these problems are identified and appropriately addressed. We explored how mental health is experienced along the HIV care continuum in Rakai, Uganda.MethodsWe conducted qualitative semi-structured in-depth interviews with 20 adults living with HIV and 10 health workers from March to December 2020. Interviews followed a timeline approach. Responses were analyzed using content analysis.ResultsAt the time of HIV diagnosis, nearly all participants described a range of strong emotions, including shock, fear and intense worry. Most participants described continued fear and intense worry leading up to, and at the time of, ART initiation. However, they said these emotions often subside after ART is initiated and viral suppression is achieved. Across interviews and at multiple points of the continuum, participants discussed how fear and worry led individuals to be “thinking too much” or be in “deep thoughts” and experience self-hatred. Individuals who stopped taking ART were thought to have more severe mental health problems (“madness”, psychosis, suicidality). Participants were divided about the mental health of persons who returned to care after disengagement.ConclusionIn this setting, mental health problems experienced by people living with HIV are dynamic across the care continuum. With expanded HIV testing campaigns and Universal Test and Treat policies, targeted interventions for psychosocial support at the time of testing and ART initiation remain critical.
Quantification of blood glial fibrillary acidic protein using a second-generation microfluidic assay. Validation and comparative analysis with two established assays
Authors: Fazeli Badrieh , Gómez de San José Nerea , Jesse Sarah , Senel Makbule , Oeckl Patrick , Erhart Deborah K , Otto Markus , Halbgebauer Steffen , Tumani Hayrettin 
Published: August 2023

AbstractBackgroundIncreased levels of glial fibrillary acidic protein (GFAP) in blood have been identified as a valuable biomarker for some neurological disorders, such as Alzheimer’s disease and multiple sclerosis. However, most blood GFAP quantifications so far were performed using the same bead-based assay, and to date a routine clinical application is lacking.MethodsIn this study, we validated a novel second-generation (2ndgen) Ella assay to quantify serum GFAP. Furthermore, we compared its performance with a bead-based single molecule array (Simoa) and a homemade blood GFAP assay in a clinical cohort of neurological diseases, including 210 patients.ResultsValidation experiments resulted in an intra-assay variation of 10%, an inter-assay of 12%, a limit of detection of 0.9 pg/mL, a lower limit of quantification of 2.8_pg/mL, and less than 20% variation in serum samples exposed to up to five freeze-thaw cycles, 120_hours at 4 °C and room temperature. Measurement of the clinical cohort using all assays revealed the same pattern of GFAP distribution in the different diagnostic groups. Moreover, we observed a strong correlation between the 2ndgen Ella and Simoa (r=0.91 (95% CI: 0.88 - 0.93), p<0.0001) and the homemade immunoassay (r=0.77 (95% CI: 0.70 - 0.82), p<0.0001).ConclusionsOur results demonstrate a high reliability, precision and reproducibility of the 2ndgen Ella assay. Although a higher assay sensitivity for Simoa was observed, the new microfluidic assay might have the potential to be used for GFAP analysis in daily clinical workups due to its robustness and ease of use.What is already known on this topicBlood glial fibrillary acidic protein (GFAP) levels are an emerging biomarker for diagnosing, prognosis and treatment monitoring for AD, MS and other neurological disorders. However, so far, the application in clinical routine remains a challenge.What this study addsThis study validated a novel, easy-to-use second-generation microfluidic assay for the quantitative measurement of blood GFAP. Moreover, its performance was compared to two other GFAP immunoassays, including single molecule array.How this study might affect research, practice or policyThis study proved the reliability, precision and reproducibility of the novel second-generation microfluidic assay, which might be more easily implemented in daily clinical routine analyses and therefore facilitates the application of GFAP as a biomarker for neurological diseases.
An After-Action Review of COVID-19 Cases and Mitigation Measures at US Mission India, March 2020-July 2021
Authors: Singh Jaspreet , Yadav Rajesh , Robinson Samantha , Vanelli Mark , Nyendak Melissa , Desai Meghna 
Published: August 2023

AbstractIntroductionBetween March 2020-June 2021, over 30 million COVID-19 cases were reported in India. We assessed the COVID-19 response across the US Mission India (US Embassy New Delhi, US Consulates – Mumbai, Hyderabad, Chennai and Kolkata) to plan future mitigation efforts and fill gaps in knowledge about COVID-19 transmission in a unique community like the US Mission.MethodWe described COVID-19 mitigation activities undertaken by the five US Mission India posts and conducted a secondary analysis of case investigation and contact tracing program data collected by the Health Unit from March 2020–July 2021.ResultsUS Mission in India, in collaboration with multiple internal agencies, initiated COVID-19 mitigation activities in March 2020. Activities included educational sessions, training for infection prevention and control, health and safety assessments, and the development of standard operating procedures (SOPs). The Health Unit and US CDC India office initiated COVID-19 case investigations and conducted contact tracing. Between March 2020-July 2021, 636 COVID-19 cases (72% males), including 48 clusters (size range 2-10 cases), were reported. Overall case fatality rate was 1.5%. Of case patients, 82% (523) were Indians, and 18% (113) were Americans. On presentation, 22% (138/625) of cases were asymptomatic. The median time from symptom onset to notification to the Health Unit was three days (Interquartile range 1-5). The Health Unit identified 2,484 contacts (positivity rate 25%). Frequency of case presentation in the US Mission India closely resembled the pattern of COVID-19 waves in India. The attack rates ranged over the time period between 10-19%, the highest at 19% in Delhi.ConclusionsCOVID-19 mitigation strategies were implemented in collaboration with multiple agencies and helped prevent the transmission of COVID-19 and large COVID-19 clusters in the US Mission India.
Trends of enterovirus D68 concentrations in wastewater in two California communities parallel trends of statewide confirmed cases, February 2021 – April 2023
Authors: Boehm Alexandria B. , Wadford Debra A. , Hughes Bridgette , Duong Dorothea , Chen Alice , Padilla Tasha , Wright Chelsea , Moua Lisa , Bullick Teal , Salas Maria , Morales Christina , White Bradley J. , Glaser Carol A. , Vugia Duc J. , Yu Alexander T. , Wolfe Marlene K 
Published: August 2023

AbstractIn this retrospective study, enterovirus D68 (EVD68) genomic RNA in wastewater solids was measured longitudinally at two California wastewater treatment plants twice per week for 26 months. EVD68 RNA was undetectable except when concentrations increased between mid-July and mid-December 2022, during which time EVD68 cases were confirmed in the state.
Lysophosphatidylcholines are associated with P-tau181 levels in early stages of Alzheimer’s Disease
Authors: Kalia Vrinda , Reyes-Dumeyer Dolly , Dubey Saurabh , Nandakumar Renu , Lee Annie J. , Lantigua Rafael , Medrano Martin , Rivera Diones , Honig Lawrence S. , Mayeux Richard , Miller Gary W. , Vardarajan Badri N. 
Published: August 2023

AbstractBackgroundWe investigated systemic biochemical changes in Alzheimer’s disease (AD) by investigating the relationship between circulating plasma metabolites and both clinical and biomarker-assisted diagnosis of AD.MethodsWe used an untargeted approach with liquid chromatography coupled to high-resolution mass spectrometry to measure exogenous and endogenous small molecule metabolites in plasma from 150 individuals clinically diagnosed with AD and 567 age-matched elderly without dementia of Caribbean Hispanic ancestry. Plasma biomarkers of AD were also measured including P-tau181, Aβ40, Aβ42, total tau, neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP). Association of individual and co-expressed modules of metabolites were tested with the clinical diagnosis of AD, as well as biologically-defined AD pathological process based on P-tau181 and other biomarker levels.ResultsOver 4000 metabolomic features were measured with high accuracy. First principal component (PC) of lysophosphatidylcholines (lysoPC) that bind to or interact with docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and arachidonic acid (AHA) was associated with decreased risk of AD (OR=0.91 [0.89-0.96], p=2e-04). Restricted to individuals without anAPOEε4 allele(OR=0.89 [0.84-0.94], p= 8.7e-05), the association remained. Among individuals carrying at least oneAPOEε4allele, PC4 of lysoPCs moderately increased risk of AD (OR=1.37 [1.16-1.6], p=1e-04). Essential amino acids including tyrosine metabolism pathways were enriched among metabolites associated with P-tau181 levels and heparan and keratan sulfate degradation pathways were associated with Aβ42/Aβ40 ratio reflecting different pathways enriched in early and middle stages of disease.ConclusionsOur findings indicate that unbiased metabolic profiling can identify critical metabolites and pathways associated with β-amyloid and phosphotau pathology. We also observed anAPOEε4dependent association of lysoPCs with AD and that biologically-based diagnostic criteria may aid in the identification of unique pathogenic mechanisms.Graphical Abstract
Feasibility of FFR-CT and CCTA features to predict the hemodynamic changes of high take-off coronary artery
Authors: Ni Jiong , Cheng Shuihua , Wang Peijun , Ge Chenjin 
Published: August 2023

AbstractBackgroundHigh take-off coronary artery (HTCA) is a neglected coronary artery anomaly with debated clinical importance. Determining the pathophysiological significance of this anomaly remains challenging. The aim of this study was to explore clinical symptoms, anatomic features based on CCTA and FFR-CT which will help to predict significant hemodynamic change of HTCA.MethodsThis retrospective study recruited 72 patients with HTCA undergoing CCTA and invasive coronary angiography. Demographic, clinical characteristics, anatomic and functional features based on CCTA were collected to identified independent risk factors by multivariate logistical analysis. Receiver operating characteristic curve analysis was performed to determine the predictive accuracy of these factors.ResultsChest pain and the angle at the HTCA were identified as independent risk factors (p=0.005, p=0.002) associated hemodynamical significant HTCA. The value of FFR-CT was consistency with FFR in HTCA patients (VIF=73.811). The index of FFR-CT had significantly larger AUC than the index of chest pain (p=0.003) and similar AUC with the angel at the HTCA (p=0.059). Compared with combined index of angle at HTCA plus chest pain, FFR-CT had a larger AUC (p=0.000). The similar AUC was found between FFR-CT and the combined index of chest pain, angle at the HTCA plus FFR-CT (p=0.2359).ConclusionsFFR-CT, chest pain and angel at HTCA based on CCTA played a great role to predict significant hemodynamic changes of HTCA. FFR-CT had a superior diagnostic performance to predict abnormal hemodynamic changes in patients with HTCA.
Knowledge, Attitudes and Demand Toward Cardiovascular Polygenic Risk Testing in Clinical Practice: Cross-Sectional Survey of Patients
Authors: Brar Shanjot , Townsend Jared , Phulka Joban , Halperin Laura , Liew Janet , Parker Jeremy , Brunham Liam R. , Laksman Zachary 
Published: August 2023

ABSTRACTBackgroundThe goal of this study was to assess patients’ prior exposure and current level of knowledge of polygenic risk scores (PRSs). We also explored reactions to receiving a high-risk or low-risk score, and gauged the overall attitudes and demand patients have with regards to PRSs.MethodsWe developed an online investigator-designed survey based on existing validated tools and previously designed surveys on genetic testing. There were two versions of the survey, one including a hypothetical high-risk PRS and one with a low-risk PRS. We administered the survey among patients attending a specialized cardiovascular prevention clinic.ResultsA total of 226 participants responded to the survey. The study population was predominantly high-income earning, educated, and of European descent. 177 patients (79%) had never read or heard about polygenic testing. 209 patients (93%) had never discussed polygenic testing with their health care professional (HCP). 208 patients (93%) had never received polygenic testing.The average score on the knowledge quiz was 2.47/10 [95% C.I. (2.17, 2.78)]. Participants that received a high-risk survey scored 20.52/35 [95% C.I. (16.14, 24.9)] with regards to negative emotions while low-risk survey participants scored 17.96/35 [95% C.I. (13.98, 21.94)] (p<0.001). Participants that received a high-risk survey scored 5.78/10 [95% C.I. (3.77, 7.79)] with regards to uncertainty and low-risk survey participants scored 4.34/10 [95% C.I. (2.50, 6.18)] (p<0.001). Participants that received a high-risk survey scored 12.42/15 [95% C.I. (10.43, 14.41)] for demand and low-risk survey participants scored 12.22/15 [95% C.I. (9.66, 14.78)] (p=0.549).ConclusionsPatients have limited prior exposure and knowledge of PRSs. Compared to receiving a low-risk score, participants receiving a high-risk score have more negative emotions and feelings of uncertainty. Despite the lack of knowledge, and the high rate of negative emotions and uncertainty, demand for PRSs in cardiology practice is high and expected to increase.
Cardiac Abnormalities in Hispanic Women with Prior De Novo Hypertensive Disorders of Pregnancy
Authors: Quesada Odayme , Kulandavelu Shathiyah , Vladutiu Catherine J. , DeFranco Emily , Minissian Margo B. , Makarem Nour , Bello Natalie A. , Wong Melissa S. , Pabón Maria , Chandra Alvin A. , Avilés-Santa Larissa , Rodríguez Carlos J. , Merz C. Noel Bairey , Sofer Tamar , Hurwitz Barry E , Talavera Gregory A. , Claggett Brian L. , Solomon Scott D. , Cheng Susan 
Published: August 2023

ABSTRACTBackgroundHypertensive disorders of pregnancy (HDP) are associated with longer-term maternal risks for cardiovascular disease for reasons that remain incompletely understood.MethodsThe Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center community-based cohort of Hispanic/Latino adults recruited 2008 to 2011 was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of left ventricular (LV) structure and function in Hispanic/Latina women with ≥1 prior pregnancy and the proportion of association mediated by current hypertension.ResultsThe study cohort included 5,168 Hispanic/Latina women. Prior de novo HDP was reported by 724 (14%) of the women studied with an average age of 58.7 ± 9.7 years at time of echocardiogram and was associated with lower ejection fraction −0.66 (−1.21, −0.11), greater relative wall thickness (RWT) 0.09 (0, 0.18), and 1.39 (1.02, 1.89) greater odds of abnormal LV geometry after adjusting for blood pressure and other risk factors. The proportion of association mediated by current hypertension between HDP and LV ejection fraction was 0.09 (95% CI 0.03, 0.45), any abnormal LV geometry was 0.14 (0.12, 0.48), LV RWT 0.28 (0.16, 0.51), concentric LVH was 0.31 (0.19, 0.86), and abnormal LV diastolic dysfunction was 0.58 (0.26, 1.79).ConclusionsIn a large cohort of Hispanic/Latina women those with de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension.
Risk factors and outcomes associated with heart failure with preserved and reduced ejection fraction in persons with chronic kidney disease
Authors: Bansal Nisha , Zelnick Leila , Scherzer Rebecca , Estrella Michelle , Shlipak Michael 
Published: August 2023

ABSTRACTBackgroundHeart failure (HF) is associated with poor outcomes in persons with chronic kidney disease (CKD), yet there are limited data on whether outcomes differ by HF subtype. This study aimed to examine associations of incident preserved (HFpEF) versus reduced (HFrEF) ejection fraction (EF) with risk of progression to end-stage-kidney-disease (ESKD) and mortality.MethodsWe studied individuals with mild to severe CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study who were free of HF at cohort entry. Incident HF hospitalizations were adjudicated during study follow-up and classified into HFpEF (EF>50%) or HFrEF (EF<50%) based on echocardiograms performed during the hospitalization or at a research study visit within one year of the hospitalization. ESKD was defined as need for chronic dialysis or kidney transplant during follow-up. Cox proportional hazards were used to evaluate the association of time-updated HF subtype with risk of ESKD and mortality, adjusting for demographics, comorbidities and medication use.ResultsAmong the 3,557 study participants without HF at cohort entry, mean age was 57 years and mean eGFR 45 ml/min/1.73 m2at baseline. Incidence rates for HFpEF and HFrEF were 0.9 (95% CI 0.8, 1.0) and 0.7 (95% CI 0.6, 0.8) per 100 person-years, respectively. Adjusted associations of incident HF with progression to ESKD were similar for HFpEF (HR 1.59, 95% CI: 1.24, 2.02) and HFrEF (HR 1.26, 95% CI: 0.93, 1.70) (test for difference p-value=0.35). The adjusted associations of HFpEF and HFrEF HF with mortality were stronger for HFrEF (HR 1.68, 95% CI: 1.34, 2.11) compared with HFpEF (HR 1.24, 95% CI: 1.00, 1.54) (test for difference p-value = 0.02).ConclusionsIn a large U.S. CKD population, the rates of HFpEF hospitalizations were greater than that of HFrEF. Both types of HF had similar associations with risk of ESKD; however, there was a stronger association of HFrEF with mortality. Prevention and treatment of both HFpEF and HFrEF should be central priorities to improve clinical outcomes in patients with CKD.