bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design of the COmbinatioN effect of FInerenone anD EmpaglifloziN in participants with chronic kidney disease and type 2 diabetes using a UACR Endpoint study (CONFIDENCE)
Authors: Green Jennifer B , Mottl Amy K , Bakris George , Heerspink Hiddo J L , Mann Johannes F E , McGill Janet B , Nangaku Masaomi , Rossing Peter , Scott Charlie , Gay Alain , Agarwal Rajiv 
Published: June 2022

ABSTRACTBackgroundDespite available interventions, people with type 2 diabetes (T2D) remain at risk of chronic kidney disease (CKD). Finerenone, a potent and selective nonsteroidal mineralocorticoid receptor antagonist, and sodium–glucose cotransporter 2 inhibitors (SGLT2is) can reduce both kidney and cardiovascular risks in people with CKD and T2D. Here we outline the design of a study to investigate whether dual therapy with finerenone and an SGLT2i is superior to either agent alone.MethodsCONFIDENCE (NCT05254002) is a randomized, controlled, double-blind, double-dummy, international, multicenter, three-armed, parallel-group, 7.5 - to 8.5-month, Phase 2 study in 807 adults with T2D, stage 2–3 CKD and a urine albumin:creatinine ratio (UACR) ≥300–&lt;5000 mg/g. The primary objective is to demonstrate that 6 months of dual therapy comprising finerenone and the SGLT2i empagliflozin is superior for reducing albuminuria versus either agent alone. Interventions will be once-daily finerenone 10 mg or 20 mg (target dose) plus empagliflozin 10 mg, or empagliflozin 10 mg alone, or finerenone 10 mg or 20 mg (target dose) alone.ResultsThe primary outcome is a relative change from baseline in UACR among the three groups. Secondary outcomes will further characterize efficacy and safety, including changes in estimated glomerular filtration rate and incident hyperkalemia.ConclusionsCONFIDENCE is evaluating the safety, tolerability and efficacy of dual use of finerenone and an SGLT2i in adults with CKD and T2D. Should an additive effect be shown, early and efficient intervention with dual finerenone and SGLT2i therapy could slow disease progression and provide long-term benefits for people with CKD and T2D.
Environmental regulation, taxes, and activism
Authors: Adetutu Morakinyo O , Odusanya Kayode A , Stathopoulou Eleni , Weyman-Jones Thomas G 
Published: June 2022

AbstractSocial activism is a burgeoning human response to pressing problems around the world, and nowhere is this response more apparent than in the ongoing global push back against environmental externalities. In this article, we explore—for the first time—whether there are degrees of activism that relate to degrees of regulatory stringency. Using data on environmental conflicts resulting from fossil fuel production across 68 countries over the period 1995–2014, we find that, for a given tax rate, a move from a lax to more stringent regime lowers the rate of environmental conflicts. These findings underscore the contingent role of policy stringency as a trigger for intense social movements.
Phytophthora effector PSR1 hijacks the host pre-mRNA splicing machinery to modulate small RNA biogenesis and plant immunity
Authors: Gui Xinmeng , Zhang Peng , Wang Dan , Ding Zhan , Wu Xian , Shi Jinxia , Shen Qian-Hua , Xu Yong-Zhen , Ma Wenbo , Qiao Yongli 
Published: June 2022

Abstract
Phytophthora effector PSR1 suppresses small RNA (sRNA)-mediated immunity in plants, but the underlying mechanism remains unknown. Here, we show that Phytophthora suppressor of RNA silencing 1 (PSR1) contributes to the pathogenicity of Phytophthora sojae and specifically binds to three conserved C-terminal domains of the eukaryotic PSR1-Interacting Protein 1 (PINP1). PINP1 encodes PRP16, a core pre-mRNA splicing factor that unwinds RNA duplexes and binds to primary microRNA transcripts and general RNAs. Intriguingly, PSR1 decreased both RNA helicase and RNA-binding activity of PINP1, thereby dampening sRNA biogenesis and RNA metabolism. The PSR1–PINP1 interaction caused global changes in alternative splicing (AS). A total of 5,135 genes simultaneously exhibited mis-splicing in both PSR1-overexpressing and PINP1-silenced plants. AS upregulated many mRNA transcripts that had their introns retained. The high occurrence of intron retention in AS-induced transcripts significantly promoted Phytophthora pathogen infection in Nicotiana benthamiana, and this might be caused by the production of truncated proteins. Taken together, our findings reveal a key role for PINP1 in regulating sRNA biogenesis and plant immunity.
Small Bank Lending in the Era of Fintech and Shadow Banks: A Sideshow?
Authors: Begley Taylor A , Srinivasan Kandarp 
Published: June 2022

Abstract
Amid the emerging dominance of nonbanks, small banks use key financing advantages to persist in the mortgage market. We provide evidence of the heterogeneous impact of two shocks to the supply of mortgage credit: postcrisis regulatory burden and GSE financing cost changes. Small banks exploit regulation disproportionately affecting the largest four banks (Big4) and their ability to lend on balance sheet to strongly substitute for the retreating Big4. The erasure of guarantee fee (g-fee) discounts for large lenders facilitates small bank growth in GSE lending. Small banks also grow balance sheet loans in areas more exposed to g-fee hikes.
PATIENT PROFILING IN ACUTE DECOMPENSATED HEART FAILURE
Authors: Zinatulina Dinara , Karaulova Yulia , Tolkacheva Veronika , Montya Flora Kobello , Kotova Elizaveta , Misan Irina , Kobalava Zhanna 
Published: June 2022

Objective:
To evaluate the frequency of various profiles in patients, ospitalised with acute decompensated heart failure.

Design and method:
351 patients (72% males, mean age 66 (58; 76) years old) with ADHF were included. Coronary artery disease had 60%, arterial hypertension 94%, diabetes mellitus 40%, obesity-61%, cardiomyopathy-5%, rheumatic heart disease-4%. HFpEF was found in 31% of patients, HFmrEF – in 25%, HFrEF – in 44%. All patients were distributed according to the following phenotypes: 1 - low blood pressure (<90 mm Hg) and high heart rate (>90 bpm); 2 - low blood pressure (<90 mm Hg) and low heart rate (<60 bpm); 3 - paients with low blood pressure (<90 mm Hg) and normal heart rate (60–90 bpm); 4 - normal blood pressure (>90 mm Hg) and high heart rate (>90 bpm); 5 - normal blood pressure (>90 mm Hg) and low heart rate (<60 bpm); 6 - normal blood pressure (>90 mm Hg) and normal heart rate (60–90 bpm); 7 - atrial fibrillation and normal blood pressure (>90 mm Hg), 8- atrial fibrillation and low blood pressure (<90 mm Hg), 9 - high blood pressure (>140/90 mm Hg); 10 - chronic kidney disease (eGFR <60 ml/min/1,72).

Results:
The frequency of profile in patients, ospitalised with acute decompensated heart failure were the following: patients with low blood pressure and high heart rate - 0,85%; low blood pressure and low heart rate - 0,56%; patients with low blood pressure and normal heart rate - 1,13%; patients with normal blood pressure and high heart rate - 24,78%; normal blood pressure and low heart rate - 3,13%; patients with normal blood pressure and normal heart rate - 37,03%; patients with atrial fibrillation and normal blood pressure - 42,16%; atrial fibrillation and low blood pressure - 0,85%; high blood pressure - 22,22%; patients with chronic kidney disease - 65,81%.

Conclusions:
The most common profile in patients ospitalised with acute decompensated heart failure were patients with chronic kidney disease (65,81%), normal blood pressure (64,94%), atrial fibrillation (59,24%), normal blood pressure and normal heart rate (37,03%), high blood pressure (22,22%).
ACCULTURATION AND CARDIOVASCULAR DISEASE RISK-FACTOR CHANGES AMONG CHINESE IMMIGRANTS IN ITALY: GENDER DIFFERENCES
Authors: Modesti Pietro Amedeo Mo , Marzotti Ilaria , Calabrese Maria , Boddi Maria , Pellegrino Alessio 
Published: June 2022

Objective:
In recent decades, the Chinese presence in Southern Europe has grown rapidly but no data is available on the influence that residing in Mediterranean countries has on Chinese immigrants. In this study, we aim to examine the association between acculturation and cardiovascular risk factors among first-generation Chinese immigrants in Italy.

Design and method:
This was a population-based, cross-sectional study. A sample of 2589 Chinese first-generation immigrants (1599 women and 990 men) living in Prato, Italy, underwent blood pressure measurement, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. The influence of length of residence (dependent variable) on hypertension, type 2 diabetes, overweight/obesity, and hyperlipidemia (high cholesterol) (independent variables) was investigated with multivariable logistic regression adjusted for age, sex, education and urban/rural home area in China before migration.

Results:
Mean age of Chinese participants was 47.2 ± 10.7 years and 61.7% were women. Immigrants residing in Italy for > 20 years were more likely to be hypertensive [odd ratio (OR) 1.84; 95% confidence interval (CI) 1.33 to 2.59], or diabetic (1.91; 1.26 to 2.86) than those residing in Italy for < 10 years. Differently, prevalence of hypercholesterolemia (total cholesterol > 240 mg/dl) was lower in immigrants residing in Italy for > 20 years than in those with < 10 years of residence (0.52; 0.32 to 0.83). Data stratified by age (< or > 45 years) are presented in the table. The association between indicators of acculturation and cardiovascular risk factors appeared to differ by sex.

Conclusions:
Acculturation of Chinese immigrants in Italy was associated with hypertension and type 2 diabetes whereas a favorable effect on hypercholesterolemia was observed.
HYPERTENSION AND ARTERIAL STIFFNESS IN PRETERM CHILDREN AND ADOLESCENTS
Authors: Chainoglou Athanasia , Sarafidis Kosmas , Chrysaidou Katerina , Farmaki Evangelia , Kolios Konstantinos , Economou Marina , Kotsis Vasilios , Stabouli Stella 
Published: June 2022

Objective:
The aim of the current study was to investigate the association between preterm birth and ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence.

Design and method:
In this prospective case control study we included children and adolescents born preterm (cases) and children born full-term (controls) aged 5–19 years old. The participants underwent measurement of somatometric characteristics, office BP, central systolic BP, ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV). According to the Body Mass Index (BMI), the study population was classified as preterm-normal BMI, preterm-overweight/obese, full term- normal BMI and full term-overweight/obese.

Results:
Overall, 74 children participated in the study with a mean age of 10.7 (±3.63) years old out of which 52 were preterm and 22 were full-term children. Preterm children presented higher night SBP z score values compared to controls (p < 0.05), but did not differ in other BP parameters. Preterm birth and BMI z score were predictors of night SBP z score. Preterm children also presented marginally higher PWV z score values (p = 0.06). Prematurity was an independent predictor of PWV z score. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95%CI 0.431–0.975 versus -0.19, 95%CI -0.574–0.536, respectively, p = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score.

Conclusions:
Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Early detection of hypertension and prevention of obesity in childhood could prevent future adverse health outcomes in individuals born preterm.
HARNESSING HUMAN-CENTRED DESIGN APPROACHES TO BUILD A CHATBOT FOR PEOPLE LIVING WITH HYPERTENSION
Authors: Jacobs Mina , Ogboye Ayoposi , Mobisson Nneka 
Published: June 2022

Objective:
To describe how human-centered design was used to create an artificial intelligence (AI) enabled chatbot for people living with hypertension.

Design and method:
The project focused on technology augmentation and testing to strengthen the mDoc’s CompleteHealthTM platform (an omnichannel platform that provides self-management techniques digitally to people with chronic diseases) to enable us to drive scale in providing self-care support. We leveraged Human-Centered Design principles to guide our pathway based on inspiration, ideation, and implementation to design a chatbot called “Kem’’, aimed to provide real-time response to members living with hypertension.
In the inspiration phase, our clinical and tech teams hypothesized that 80% of our growing members’ questions on hypertension could be answered by Kem at scale. In the ideation phase, we leveraged our members to understand and develop the conversation structure and conducted extensive research on how to provide real-time responses to as many members as possible. Kem’s prototype was developed on Botmock (a tool used for designing and fleshing out conversational design flow) with a persona designed to function as a health coach to help bridge the gap in knowledge of health topics, guide, and answer mDoc members.
After a series of iterations based on users’ feedback, during the implementation phase, Kem was integrated into a chat platform, Telegram, and was tested with a larger group of users.

Results:
By applying human-centered design and integrating user feedback into the design and creation of a chatbot to answer questions around hypertension, we were able to create a tool that will help members increase their knowledge of the prevention and management of hypertension.

Conclusions:
Co-creation should occur at every step of the journey when designing for members’ needs and behaviors. The users’ expressed excitement about Kem and the design process revealed that we needed to be more intentional about making the conversation with the bot interesting, user-friendly, and less technical. As the implementation phase continues and more members use Kem, we will be able to educate them about the prevention and management of hypertension.
Practical management of Raynaud's phenomenon – a primer for practicing physicians
Authors: Ramahi Ahmad , Hughes Michael , Khanna Dinesh 
Published: June 2022

Purpose of review
Raynaud's phenomenon (RP) is a common vasospastic condition that results in digital hypoperfusion in response to cold and/or emotional stress and is associated with significant pain and disability. The aim of our review is to provide a practical approach for clinicians to inform assessment and management of patients with RP.

Recent findings
Autoantibodies and nailfold capillaroscopy are key investigations to stratify the risk of progression to systemic sclerosis (SSc) in patients RP, which was recently confirmed in the multicenter, very early diagnosis of systemic sclerosis (VEDOSS) project. Research has explored the complex lived-patient experience of RP including digital vasculopathy in SSc and has highlighted the need for outcome measure development to facilitate research in the field. Pharmacological treatment strategies vary significantly internationally and there is continued interest in developing surgical approaches.

Summary
We provide a practical and up-to-date approach to inform the assessment and management of patients with RP including guidance on drug initiation and escalation. Calcium channel blockers are first-line treatment and can be initiated by primary care physicians. We also highlight second-line drug therapies used for refractory RP and the potential role for surgical intervention.
Dr. YouTube: A Snapshot of Credential Disclosure by Health Care Professionals
Authors: Carlson Kyle , Ejiofor Beverly , Dow Serena , Kind Terry , Chretien Katherine C. 
Published: June 2022

Introduction:
YouTube is a popular source of health care information for consumers. The use of “Dr” or “Doctor” in a channel name is a way contributors establish expertise. The current study sought to understand the degree by which popular YouTube channels belonging to individuals who self-identify as doctors disclose their credentials and the nature of their disclosures.

Methods:
Two raters extracted descriptive characteristics from the most viewed public YouTube channel names meeting keyword search criteria of “Doctor” and “Dr”. Channel-level disclosure was captured by examining a channel's “About” section. Video-level disclosure was captured by watching the first 2 minutes of the five most viewed videos from each channel.

Results:
Forty-eight channels (45.7%; 48/105) disclosed degree, 60 channels (57.1%; 60/105) disclosed specialty, and 26 channels (24.8%; 26/105) disclosed the level of training. Two hundred thirty-six videos (46.6%; 236/506) disclosed degree, 201 videos (39.7%; 201/506) disclosed specialty, and 81 videos (16%; 81/506) disclosed the level of training.

Discussion:
Our findings suggest that the most viewed YouTube health channels and videos demonstrate inconsistent credential disclosure, occurring less than half of the time. Current professional guidance from licensing boards on social media encourages transparency around expertise and credential sharing. In addition, it remains unclear what guidance other health care professionals receive about disclosure practices online. Future recommendations and training to health care professionals should include explicit language for transparent disclosure of credentials.
A Novel Dual Incretin Agent, Tirzepatide (LY3298176), for the Treatment of Type 2 Diabetes Mellitus and Cardiometabolic Health
Authors: Bucheit John , Ayers Jessica , Pamulapati Lauren , Browning Audrieanna , Sisson Evan 
Published: June 2022

Abstract:
The incretin hormone system is the target of multiple type 2 diabetes mellitus (T2DM) treatments because defects in this system play major roles in the pathogenesis of diabetes. Currently, the glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recommended for patients with atherosclerotic cardiovascular (CV) disease and those at high risk for atherosclerotic CV disease. In addition to the favorable CV effects, GLP-1 RAs also provide robust lowering of hemoglobin A1c and weight. Although these factors make GLP-1 RAs attractive options for T2DM, the currently available agents have no effect on glucose-dependent insulinotropic polypeptide (GIP). Patients with T2DM are known to have GIP defect which is significant due to its profound insulinotropic effects. Tirzepatide is a novel incretin agent currently recently approved by the Food and Drug Administration for the treatment of T2DM. This first-in-class agent serves as a coagonist for both the GLP-1 and GIP receptors. In this review, we report on the pharmacologic mechanism of GLP-1, GIP, and coagonist effects on the cardiometabolic system. In addition, we review the glycemic lowering, weight loss effects, and other cardiometabolic outcomes of tirzepatide based on phase 2 and 3 data. The safety profile of tirzepatide is consistent across all phase 3 trials. The most common adverse effects are gastrointestinal symptoms, but they generally have a low risk for discontinuation. Overall, preliminary data suggest that tirzepatide is an efficacious and safe agent for the treatment of T2DM.
Incidence of difficult airway among adult patients of undiagnosed obstructive sleep apnea who are undergoing elective surgery: a prospective cohort study
Authors: Muzien Sulaiman J. , Gelgelo Kuchulo G. , Woldeyohans Misrak 
Published: June 2022

Introduction:
Obstructive sleep apnea (OSA) is a dangerous medical disorder marked by obstruction of the upper airway during sleep that is frequently undiagnosed before surgery. Preoperative identification of suspected OSA patients necessitates appropriate preparation and prevents unfavorable outcomes. The incidence of difficult airway in adult patients with OSA who are undergoing elective surgery is significantly increased.

Materials and method:
The study population was separated into high and low-risk groups based on STOP-BANG scores of ≥3 and <3, respectively. The rate of occurrence was compared between the study groups. SPSS version 23 was used for statistical analysis. P-values <0.05 are considered significant. To find characteristics that predict problematic airway, researchers used logistic regression.

Result:
A total of 113 participants was enrolled. Based on STOP-BANG 77 patients and 36 patients were grouped in to low risk OSA and high risk OSA, respectively, the incidence of difficult intubation (DI) was significantly higher (22.2%) in high risk OSA group versus 5.2% in low risk OSA group, relative risk of 4.278 (95% confidence interval: 1.378–13.2). Mask ventilation was significantly more problematic for the high-risk group (P=0.011) (25% against 6.5%). Male sex, neck circumference >40 cm, Mallampati class 3, and 12.5 cm stern mental distance were all linked to DI. Age above 50 years, snoring history, and a neck circumference of >40 cm were all found to be predictors.

Conclusion:
Patients who scored ≥3 on the STOP-BANG had a significantly higher rate of DI and difficult mask ventilation. As a result, the STOP-BANG questionnaire should be used to screen every adult patient undergoing elective surgery for OSA.
Knowledge and practice of Nepalese doctors on reutilization of medical/surgical tools from developed nations: a national level online cross-sectional survey
Authors: Babel Shrinit , Baral Suman , Subedi Nuwadatta , Karn Mitesh , Poudel Shasi , Regmi Astha 
Published: June 2022

Background:
A manifold cause of global disparity in medical and surgical care exists, among which lack of access to proper biomedical equipment including surgical tools are a recurrent theme. Use and reuse of such donated tools are common in low resource settings including countries like Nepal; however, there is a lack of adequate data and less has been explored. Through this nationwide study, we aimed to discover the knowledge of donated medical and surgical devices and the practice of reusing single-use equipment by Nepalese medical practitioners and surgeons.

Methods:
An online, questionnaire-based cross-sectional study was conducted using SurveyMonkey from October 2020 through January 2021. The link was sent to target respondents via email and social media and responses were recorded. Data processing and analysis were done using the same platform.

Results:
Among 466 respondents, 349 completed the survey. Around 81.5% recorded that their institute has never received medical devices or donations in the past, while 18.34% believed they had received such commodities. Most of the donations were received from countries like the United States, China, Japan, and India. Around 24% of the respondents reused the tools meant for single-use and only 5% communicated with the donors. Commodities like laparoscopic sets, sutures, dialysis machines, magnetic resonance imaging machines, surgical retractors, face masks, sanitizers, personal protective equipment, endoscopy apparatus, etc., were received. The majority of them were concerned about national guidelines regarding donating reusable tools which might not be acceptable through custom rules of the country, although the facilitation of functional yet unused tools is always welcome in the underserved regions of Nepal.

Conclusion:
Nepalese medical professionals had adequate knowledge about the donated medical devices and only a few of them had practiced reusing single-use equipment. Mutual cooperation between donors and recipients is one of the most important aspects of safe medical/surgical tools delivery.