bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient‐ and Process‐Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis
Authors: Flannery Laura , Etiwy Muhammad , Camacho Alexander , Liu Ran , Patel Nilay , Tavil‐Shatelyan Arpi , Tanguturi Varsha K. , Dal‐Bianco Jacob P. , Yucel Evin , Sakhuja Rahul , Jassar Arminder S. , Langer Nathaniel B. , Inglessis Ignacio , Passeri Jonathan J. , Hung Judy , Elmariah Sammy 
Published: May 2022

Background
Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS.

Methods and Results

We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area

≤

1.0 cm
2
. Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08–0.69];
P
=0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index [95% CI, 0.79–0.97];
P
=0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06–0.21]), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08–0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38–4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days.

Conclusions
The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.
Temporal Changes of Stable High‐Sensitivity Cardiac Troponin T Levels and Prognosis
Authors: Roos Andreas , Edgren Gustaf , Holzmann Martin J. 
Published: May 2022

Background
The prognostic implications of temporal change of previously stable high‐sensitivity cardiac troponin concentrations are unknown. We investigated the prognosis associated with temporal changes of stable high‐sensitivity cardiac troponin T (hs‐cTnT) concentrations.

Methods and Results
All patients presenting with cardiac symptoms and ≥2 hs‐cTnT measurements at the time of their first visit to 7 different emergency departments in Sweden between December 9, 2009, and December 31, 2016, were identified (n=66 159). We included all patients with stable hs‐cTnT but no acute coronary syndrome diagnosis who had ≥1 hs‐cTnT measured also at a second visit >30 days from the first visit. Hazard ratios (HRs) with 95% CIs were calculated for all‐cause mortality and cardiovascular events according to temporal change of hs‐cTnT between the visits, using patients without myocardial injury (<15 ng/L) at the first visit and persistently stable hs‐cTnT at the second visit as the reference. Altogether, 12 869 patients were included, of whom 5191 (40%) had myocardial injury (hs‐cTnT ≥15 ng/L). During a median follow‐up of 2.3 (interquartile range, 1.4–3.7) years, 3271 (25%) patients died. In patients with myocardial injury and a temporal increase in hs‐cTnT, the adjusted all‐cause and cardiovascular mortality was 4‐ and 5‐fold elevated (HR, 4.21; 95% CI, 3.55–5.00; and HR, 5.08; 95% CI, 3.73–6.92), and the adjusted risk of heart failure hospitalization almost 3‐fold (HR, 2.77; 95% CI, 2.26–3.39).

Conclusions
Temporal change of previously stable hs‐cTnT is associated with the risk of death and cardiovascular outcomes, with highest risks observed in patients with myocardial injury and increasing hs‐cTnT.
Impact of Fontan Fenestration on Long‐Term Outcomes: A Propensity Score–Matched Analysis
Authors: Daley Michael , Buratto Edward , King Gregory , Grigg Leeanne , Iyengar Ajay , Alphonso Nelson , Bullock Andrew , Celermajer David S. , Ayer Julian , Robertson Terry , d’Udekem Yves , Konstantinov Igor E. 
Published: May 2022

Background
The long‐term impact of fenestration at the time of Fontan operation remains unclear. We aimed to review the early and long‐term impact of Fontan fenestration in the Australia and New Zealand cohort.

Methods and Results

We reviewed 1443 patients (621 fenestrated, 822 nonfenestrated) from the Australia and New Zealand Fontan registry. Data were collected on preoperative demographics, operative details, and follow‐up. Propensity‐score matching was performed to account for the various preoperative and operative differences and risk factors. Primary outcomes were survival and freedom from failure. Median follow‐up was 10.6 years. After propensity‐score matching (407 matched pairs), there was no difference in survival (87% versus 90% at 20 years;
P
=0.16) or freedom from failure (73% versus 80% at 20 years;
P
=0.10) between patients with and without fenestration, respectively. Although patients with fenestration had longer bypass and cross‐clamp times (
P
<0.001), there was no difference in hospital length of stay or prolonged pleural effusions (
P
=0.80 and
P
=0.46, respectively). Freedom from systemic and Fontan circuit thromboembolism was higher in the nonfenestrated group (89%; 95% CI, 88%–95%) than the fenestrated group (84%; 95% CI, 77%–89%;
P
=0.03). There was no difference in incidence of plastic bronchitis, protein‐losing enteropathy, New York Heart Association Class III/IV symptoms, or Fontan takedown.

Conclusions
In the propensity score–matched analysis we have demonstrated no difference in long‐term survival or freedom from Fontan failure in patients with and without fenestration. There was a higher incidence of long‐term thromboembolic events in patients with fenestration. Overall, it appears that fenestration in Fontan circulation does not bring long‐term benefits.
Clinical and Angiographic Imaging Features of Isolated Cortical Venous Thrombosis
Authors: Amuluru Krishna , Al‐Mufti Fawaz , Sahlein Daniel H. , Denardo Andrew , Scott John , Hayrynen Annaliise , Payner Troy , Kulwin Charles , Romero Charles E. 
Published: May 2022

Background
Cerebral venous thrombosis usually presents as dural sinus thrombosis. More rarely, it occurs in an isolated form (isolated cortical vein thrombosis; ICoVT). ICoVT is poorly recognized and underdiagnosed, and noninvasive imaging remains nebulous. The digital subtraction angiographic (DSA) patterns of ICoVT are neither well known nor documented. We present clinical and imaging details of the largest series of ICoVT, with all cases demonstrating both noninvasive imaging findings, along with angiographic confirmation. We propose a preliminary compilation of the DSA patterns of ICoVT.

Methods
We identified all patients with cerebral venous thrombosis at our institution between January 2013 and June 2019. Only patients in whom ICoVT was diagnosed and/or suspected with computed tomographic venography and/or magnetic resonance imaging/MR venogram with subsequent DSA confirmation were included. DSA imaging was reviewed for direct and indirect signs. Clinical data, outcomes, and follow‐up imaging were analyzed.

Results
We identified 109 patients with cerebral venous thrombosis; in 21 patients ICoVT was suspected on noninvasive imaging and eventually had DSA confirmation. Headache and focal neurological deficit were the most common presentations (each 67%). Ten patients (47%) presented with parenchymal changes due to ICoVT and 15 patients (71%) presented with subarachnoid hemorrhage. We identified 5 DSA patterns of ICoVT (3 direct; 2 indirect). Filling defects in cortical veins and the regional absence of cortical veins and decreased subcortical opacification were the most common patterns (52% and 90%, respectively). Sixteen patients (76%) were anticoagulated. Eighteen patients were discharged without disability or minor disability (84%). No deaths occurred.

Conclusions
Catheter angiography/venography may be important in diagnosing ICoVT, especially when magnetic resonance imaging/MR venogram is unclear. The angiographic patterns of ICoVT are presented.
Observed Subcloud-Layer Moisture and Heat Budgets in the Trades
Authors: Albright Anna Lea , Bony Sandrine , Stevens Bjorn , Vogel Raphaela 
Published: May 2022

Abstract
The trade wind subcloud layer is an important structural component of the atmosphere. Its thermodynamic variability has long been characterized using simple frameworks, of which mixed-layer theory is the simplest kind. Past studies qualitatively support such a description, yet the adequacy of mixed-layer theory as a quantitative description has not been tested. Here we use observations collected during the Elucidating the Role of Clouds–Circulation Coupling in Climate (EUREC4A) field campaign to test this framework and evaluate our understanding of the trade wind subcloud layer. We find evidence for a transition layer separating the mixed-layer and subcloud-layer tops. The presence of such a finitely thick transition layer with vertical gradients complicates the application of mixed-layer theory, which assumes an abrupt gradient, or “jump” at the subcloud-layer top. This ambiguity introduces effective parameters and motivates their estimation through a Bayesian methodology. Results from this Bayesian inversion further reflect a finite-depth entrainment zone. We find that subcloud-layer moisture and heat budgets close for synoptic variability and a monthly campaign mean, yielding a campaign-mean residual of 3.6 W m−2 for moisture and 2.9 W m−2 for heat. Surface wind speed variability influences the subcloud-layer depth and fluxes, yet thermodynamic variability above the subcloud-layer top emerges as the primary control on subcloud-layer moisture and heat variability. Given that this simple theoretical framework can explain observed variability, it offers an appealing framework for evaluating larger-scale models that must parameterize the processes regulating this fundamental part of the atmosphere.
An Analysis of Tropical Cyclone Vortex and Convective Characteristics in Relation to Storm Intensity Using a Novel Airborne Doppler Radar Database
Authors: Fischer Michael S. , Reasor Paul D. , Rogers Robert F. , Gamache John F. 
Published: May 2022

Abstract
This analysis introduces a novel airborne Doppler radar database, referred to as the Tropical Cyclone Radar Archive of Doppler Analyses with Re-centering (TC-RADAR). TC-RADAR comprises over 900 analyses from 273 flights into TCs in the North Atlantic, eastern North Pacific, and central North Pacific basins between 1997 and 2020. This database contains abundant sampling across a wide range of TC intensities, which facilitated a comprehensive observational analysis on how the three-dimensional, kinematic TC inner-core structure is related to TC intensity. To examine the storm-relative TC structure, we implemented a novel TC center-finding algorithm. Here, we show that TCs below hurricane intensity tend to have monopolar radial profiles of vorticity and a wide range of vortex tilt magnitudes. As TC intensity increases, vorticity becomes maximized within an annulus inward of the peak wind, the vortex decays more slowly with height, and the vortex tends to be more aligned in the vertical. The TC secondary circulation is also strongly linked to TC intensity, as more intense storms have shallower and stronger lower-tropospheric inflow as well as larger azimuthally averaged ascent. The distribution of vertical velocity is found to vary with TC intensity, height, and radial domain. These results—and the capabilities of TC-RADAR—motivate multiple avenues for future work, which are discussed.

Significance Statement
Acquiring observations of the inner core of tropical cyclones (TCs) is a challenge due to the hazardous conditions inherent to the storm. A proven method of sampling the TC core region is the use of airborne radar. This study presents a novel database comprising over 900 airborne radar analyses collected in storms between 1997 and 2020, which is freely available to the research community. Here we demonstrate the utility of the database by examining how the three-dimensional structure of the TC core region changes depending upon the intensity of the storm. By identifying how the baseline TC vortex structure varies with TC intensity, this work provides the foundation for multiple future research avenues and model evaluation efforts.
Triglyceride Glucose Index for Predicting Major Adverse Cardiovascular Events in Chinese Patients with Hypertension
Authors: Zhang Fomin , Kadierding Rena , Zhang Shihan , Yang Hua , Ren Libin , Ren Min , Ma Yue , Wang Le , Zhang Rui , Li Wenyu , Cong Hongliang , Zhang Yingyi 
Published: May 2022

We conducted a longitudinal study (from February 2017 to July 2017) to explore whether the triglyceride glucose index (TyG) index has a prognostic value for major adverse cardiovascular events (MACE) among high-risk Chinese hypertensives. The study population were from 6 districts of Tianjin, China. Finally, a total of 2250 patients were enrolled in this 3.5 year cohort study. The patients were divided into two groups according to the cut-off value of the TyG index: Low-TyG group (n = 901, TyG ≤ 8.87), High-TyG group (n = 1349, TyG > 8.87). Univariate and multivariate Cox regression analyses were used to estimate the relationship between the TyG and MACE. In multivariate cox regression analyses, the hazard ratio (HR) (95% confidence interval (CI)) of the high-TyG group was 1.313 (1.010, 1.708) compared with the low-TyG group. In those with an age ≤65 years and male subgroups, the prediction value of TyG was higher, and the risk of occurrence of MACE greater after adjusting other risk factors. The TyG index is an indicator to predict the development of MACE in hypertensive patients.
Midterm Outcomes of Talocalcaneal Coalition Arthroscopic Resection in Adults
Authors: Wang Anhong , Chen Linxin , Pi Yanbin , Zhao Feng , Xie Xing , Jiao Chen , Hu Yuelin , Jiang Dong , Guo Qinwei 
Published: May 2022

Background: Arthroscopic resection of the talocalcaneal coalition (TCC) has been reported to be associated with good short-term outcomes. However, the midterm outcomes of this approach remain uncertain. Methods: We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed. Results: Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0±8.5 years, and the mean follow-up period was 56.9±18.0 months. Thirteen (41%) patients were in group P, whereas 19 (59%) patients were in group MP. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0±7.0 vs 85.8±10.8, P = .532) and VAS score (2.1±1.7 vs 4.0±2.6, P = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%. There were no statistical differences in postoperative VAS score (1.8±1.3 vs 2.6±2.2, P = .236) and AOFAS score (92.5±5.6 vs 89.2±8.7, P = .297) between group P (n=13) and group MP (n=19), either. Three patients (9.4%) had complications, including these notable findings: 1 patient complained of restricted dorsal flexion, 1 with computed tomography–proven coalition recurrence, and 1 with partial tibial nerve injury. Conclusion: We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up. Level of Evidence: Level IV, case series.
Effect of Aerobic, Resistance, and Combined Exercise Training on Depressive Symptoms, Quality of Life, and Muscle Strength in Healthy Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Mahmoudi Ahmad , Amirshaghaghi Farahnaz , Aminzadeh Reza , Mohamadi Turkmani Ehsan 
Published: May 2022

Background Aerobic training, resistance training, or combined training are interventions that can be modified to suit the needs of aged people. Objective This meta-analysis aimed to investigate the impact of exercise training on depression symptoms, quality of life, and muscle strength in healthy people aged 60 or more. Data Sources Searches were conducted in PubMed, Web of Science, Medline, Google Scholar, and Scopus databases from inception to February 2022. Results Eighteen studies, totaling 1354 participants, were included in the meta-analysis. Overall, exercise training significantly declined depressive symptoms (standard mean difference (SMD): −.52, 95% confidence interval (CI): −.76 to −.28; p < .001). Moreover, there was a significant reduction in bodily pain ( p < .05) and body mass ( p < .01), and a significant increase in mental health ( p < .001), physical functioning ( p < .01), and general health ( p < .001) subscales of quality of life as well as upper- ( p < .001) and lower-limb strength ( p < .001). Subgroup analysis revealed that depression decreased significantly when aerobic training ( p = .000) and resistance training ( p = .003) were applied, and for studies including both genders ( p = .000) or men subjects ( p = .002). Moreover, subgroup analysis demonstrated that depression reduced following both medium- ( p = .006) and long-term ( p = .002) interventions. Conclusion These findings demonstrate that exercise interventions may produce improvements in depressive symptoms, some components of quality of life, muscle strength, and body mass. Additional research is required to define the optimal dose of exercise training interventions.
Living losses in stroke caregiving: A qualitative systematic review of systematic reviews on psycho-socio-emotional challenges and coping mechanisms
Authors: Choo Ping Ying , Shaik Muhammad Amin , Tan-Ho Geraldine , Lee Jimmy , Ho Andy Hau Yan 
Published: May 2022

Background: Stroke compromises the quality of life and wellbeing of stroke survivors and families as a whole. The unexpected caregiving responsibilities often cause psychological distress, overwhelming emotions, living losses and grief, and relational conflicts with stroke survivors. Despite the increasing research to better understand their needs, empirically sound and holistic psychosocial interventions for stroke caregivers are lacking. Aims: This study aims to consolidate psycho-socio-emotional needs and challenges in the existing systematic reviews and offer potential directions for psychosocial interventions to better support caregivers at a psycho-socio-emotional level. Methods: This systematic review adhered to the PRISMA guideline and employed the PICo (population, phenomena of interest, context) framework to screen for relevant systematic reviews for analysis. Six major databases were searched, including Academic Search Premier, CINAHL, Global Health, Medline, PsycArticles, and PsycInfo between 2010 and 2020. Ten systematic reviews were selected for full-text analysis using thematic synthesis. Summary of review: Data synthesis revealed eight themes with sixteen sub-themes, all together organized into two main theme categories. The psycho-socio-emotional challenges included disruptions to (1) psychological homeostasis, (2) role equilibrium, (3) familial connection, and (4) caregiving empowerment. The psycho-socio-emotional coping mechanisms, which could be adopted to buffer against the identified challenges, involved (1) recalibration of normality and balance, (2) psychosocial support and caregiver relief, (3) relational reorientation and dyadic coping, and (4) institutional holistic care and support. Conclusion: The findings accentuate the importance of addressing living losses and grief emerging from the caregiving journey, as well as facilitating meaning reconstruction to safeguard caregivers’ wellbeing. Clinical implications and future research directions are discussed.
Tobacco Cessation Counseling and Medications Provided by Physicians to Tobacco Users During Primary Care Visits
Authors: Geletko Karen W. , Graves Katelyn , Lateef Hanna , Harman Jeffrey 
Published: May 2022

Introduction: The established guidelines for treating tobacco use and dependency is brief provider intervention to assist those willing to quit by providing access to medication and/or behavioral counseling. The purpose of the study is to determine the extent of cessation treatment offered by providers during primary care visits by patients who are current tobacco users, and to examine associations between patient factors and treatment received. Methods: Using data from the 2015 to 2018 National Ambulatory Medical Care Survey (NAMCS), we examined tobacco cessation counseling and medications from 4590 visits by patients with current tobacco use. Separate multivariate logistic regressions were used to assess whether the odds of receiving tobacco cessation treatment varied by age, gender, race/ethnicity, and payment source. Results: Of visits by current tobacco users, 18.4% included cessation counseling, 5.5% included cessation medication, and 22.1% included at least 1 type of treatment. Visits by patients with Medicare had 44% greater odds of including counseling (CI = 1%-205%) and treatment (OR = 1.44; 95% CI = 1.01-2.06). Visits classified as “other payment type” had 73% greater odds of including counseling (OR = 1.73; 95% CI = 1.05-2.84). Visits by women had 86% greater odds of including medication (CI = 17%-294%). Conclusions: Tobacco cessation treatment is underutilized by providers during primary care visits. Further research is necessary to understand and address barriers to providing routine cessation assistance.