bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Associations of Accelerometer‐Assessed Physical Activity With Mortality and Incidence of Cardiovascular Disease Among Adults With Hypertension: The UK Biobank Study
Authors: del Pozo Cruz Borja , Ahmadi Matthew , Inan‐Eroglu Elif , Huang Bo‐Huei , Stamatakis Emmanuel 
Published: March 2022

Background
Despite the well‐established capacity of physical activity to reduce blood pressure, the associations between physical activity with cardiovascular disease (CVD) incidence and mortality in people living with hypertension are not well understood. We examine the dose‐response associations of device‐assessed physical activity with all‐cause and CVD mortality and CVD incidence (total, stroke, and coronary heart disease) in adults with hypertension.

Methods and Results
This prospective study included data from 39 294 participants with hypertension in the UK Biobank study who had valid accelerometry data and for whom mortality and CVD followed‐up data were available. We categorized moderate‐to‐vigorous physical activity and total physical activity volume into 4 categories based on the 10th, 50th, and 90th percentiles and used Cox regressions to estimate their associations with CVD mortality and incidence outcomes. Splines were used to assess the dose‐response associations. During a median follow‐up of 6.25 years (241 418 person‐years), 1518 deaths (549 attributable to CVD) and 4933 CVD (fatal and nonfatal) incident events were registered. Compared with the lowest category of moderate‐to‐vigorous physical activity, the relative risks (hazard ratios and 95% CIs) of all‐cause mortality for increasing categories were 0.53 (0.46–0.61), 0.41 (0.34–0.49), and 0.36 (0.26–0.49). We found associations of similar magnitude for total CVD incidence, stroke, and coronary heart disease; and for total physical activity volume across all outcomes. For all outcomes, there were linear or nearly linear inverse dose‐response relationships with no evidence of harms with high levels of physical activity. Results were robust to removing participants who died within the first 2 years.

Conclusions
Our findings underscore the importance of physical activity for people living with hypertension and provide novel insights to support the development of physical activity guideline recommendations for this high‐risk group.
Long‐Term Blood Pressure Variability and Major Adverse Cardiovascular and Cerebrovascular Events After Intracerebral Hemorrhage
Authors: Castello Juan Pablo , Teo Kay‐Cheong , Abramson Jessica R. , Keins Sophia , Takahashi Courtney E. , Leung Ian Y. H. , Leung William C. Y. , Wang Yujie , Kourkoulis Christina , Pavlos Myserlis Evangelos , Warren Andrew D. , Henry Jonathan , Chan Koon‐Ho , Cheung Raymond T. F. , Ho Shu‐Leong , Gurol M. Edip , Viswanathan Anand , Greenberg Steven M. , Anderson Christopher D. , Lau Kui‐Kai , Rosand Jonathan , Biffi Alessandro 
Published: March 2022

Background
Survivors of intracranial hemorrhage (ICH) are at increased risk for major adverse cardiovascular and cerebrovascular events (MACCE), in the form of recurrent stroke and myocardial Infarction. We investigated whether long‐term blood pressure (BP) variability represents a risk factor for MACCE after ICH, independent of average BP.

Methods and Results
We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital and the University of Hong Kong. We captured long‐term (ie, visit‐to‐visit) BP variability, quantified as individual participants’ variation coefficient. We explored determinants of systolic and diastolic BP variability and generated survival analyses models to explore their association with MACCE. Among 1828 survivors of ICH followed for a median of 46.2 months we identified 166 with recurrent ICH, 68 with ischemic strokes, and 69 with myocardial infarction. Black (coefficient +3.8, SE 1.3) and Asian (coefficient +2.2, SE 0.4) participants displayed higher BP variability. Long‐term systolic BP variability was independently associated with recurrent ICH (subhazard ratio [SHR], 1.82; 95% CI, 1.19–2.79), ischemic stroke (SHR, 1.62; 95% CI, 1.06–2.47), and myocardial infarction (SHR, 1.54; 95% CI, 1.05–2.24). Average BP during follow‐up did not modify the association between long‐term systolic BP variability and MACCE.

Conclusions
Long‐term BP variability is a potent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction after ICH, even among survivors with well‐controlled hypertension. Our findings support the hypothesis that combined control of average BP and its variability after ICH is required to minimize incidence of MACCE.
Human Factors Integration in Robotic Surgery
Authors: Catchpole Ken , Cohen Tara , Alfred Myrtede , Lawton Sam , Kanji Falisha , Shouhed Daniel , Nemeth Lynne , Anger Jennifer 
Published: March 2022

Objective Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. Background New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. Results Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. Conclusion There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care. Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
Glutaraldehyde fixation of venous valve tissue: A benchmark for alternative fixation methods
Authors: Laughlin Megan , Kapales Makenzie , Thakali Keshari , Girardot Marc , Jensen Morten 
Published: March 2022

Objective Bioprosthetic venous valves have yet to achieve long-term patency due to issues with calcification following implantation that is influenced by current xenograft fixation methods, most notably glutaraldehyde. The goal of this study was to investigate the effects of glutaraldehyde fixation on the functional properties of venous tissue to establish a benchmark for the evaluation of alternative fixation methods. Methods The degree of crosslinking was evaluated by determining shrink temperature and the stability of tissue with pronase and collagenase digestion. Results Glutaraldehyde fixation of venous tissue was confirmed by a significant difference in the shrink temperature between fresh and glutaraldehyde treated samples. Significant differences in the amount of tissue remaining following digestion were observed for venous versus cardiac tissue. Conclusions This study demonstrates the importance of tissue-specific evaluation in the development of alternative xenograft fixation methods to improve outcomes with bioprosthetic venous valves.
Prevalence of Suicidality and its Association with Quality of Life in Older Patients with Clinically Stable Psychiatric Disorders in China During the COVID-19 Pandemic
Authors: Liu Rui , Xu Xiuying , Zou Siyun , Li Yulong , Wang Huan , Yan Xiaona , Du Xiangdong , Zhang Lan , Zhang Qinge , Li Wen , Cheung Teris , Ungvari Gabor S. , Ng Chee H. , Xiang Yu-Tao 
Published: March 2022

Aims The pattern of suicidality in older patients with psychiatric disorders during the COVID-19 pandemic is not clear. This study examined the prevalence of suicidality and its association with quality of life (QOL) among older clinically stable patients with psychiatric disorders during the COVID-19 pandemic. Methods A multicenter, cross-sectional study was conducted from May 22 to July 15, 2020, among four major tertiary psychiatric hospitals in China. Suicidality was assessed by asking 3 standardized questions. Depressive symptoms, pain, and QOL were assessed with the 9-item Patient Health Questionnaire (PHQ-9), the numeric pain rating scale (NPRS), and the World Health Organization Quality of Life Questionnaire-brief version, respectively. Results A total of 1063 clinically stable patients participated and completed the assessment. The prevalence of suicidality was 11.8% (95% CI: 9.9%–13.7%) during the COVID-19 pandemic. Multiple logistic regression analysis revealed that poor treatment adherence (P = .009, OR = 1.86, 95% CI: 1.17–2.96) and perceived illness worsening during the COVID-19 outbreak (P = .02, OR = 2.07, 95% CI: 1.15–3.73), being diagnosed with major depressive disorder (P < .001, OR = 2.79, 95% CI: 1.68–4.64), PHQ-9 total score (P < .001, OR = 1.20, 95% CI: 1.15–1.24) and NPRS total score (P = .002, OR = 1.17, 95% CI: 1.06–1.29) were associated with higher risk of suicidality. After controlling for covariates, older psychiatric patients with suicidality had lower QOL compared to those without (F(1, 1063) =16.5, P<.001). Conclusions Suicidality was common in older patients with clinically stable psychiatric disorders during the COVID-19 pandemic. Considering its negative impact on QOL and personal suffering, routine screening and preventive suicide measures should be implemented for older psychiatric patients.
Network Analysis of Depression, Anxiety, Posttraumatic Stress Symptoms, Insomnia, Pain, and Fatigue in Clinically Stable Older Patients With Psychiatric Disorders During the COVID-19 Outbreak
Authors: Li Wen , Zhao Na , Yan Xiaona , Xu Xiuying , Zou Siyun , Wang Huan , Li Yulong , Du Xiangdong , Zhang Lan , Zhang Qinge , Cheung Teris , Ungvari Gabor S. , Ng Chee H. , Xiang Yu-Tao 
Published: March 2022

Objectives The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis. Methods Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively. Results A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30). Conclusions Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.
Meibomian gland alteration in patients with systemic lupus erythematosus
Authors: Li Yixuan , Ou Shangkun , Lin Sijie , Qian Hongyan , Zhao Zhongyang , Zhang Mengqin , Li Siyang , Liu Yuan , Shi Guixiu 
Published: March 2022

Purpose To investigate meibomian gland (MG) alteration in patients with systemic lupus erythematosus (SLE). Methods This study included 23 SLE patients evaluated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and 21 healthy controls (HCs). All the subjects were evaluated with Ocular Surface Disease Index (OSDI) questionnaire, and the eyes were performed examinations of tear meniscus height (TMH), non-invasive keratographic tear film break-up time (NIKBUT), Schirmer I Test, MG eyelid score, meibography score, and in vivo confocal microscopy (IVCM) on the meibomian gland. Results There was no significant difference between the SLE patients and the HCs in the TMH, NIKBUT, and Schirmer I Test. However, the SLE patients had higher MG eyelid scores and meibography scores on both upper eyelid and lower eyelid than the HCs. Through meibography observation, 34.8% of the SLE patients presented MG deficiency in Grade 3, whereas that of all the HCs were less than Grade 3. The SLE patients were found to have significant MG atrophy and vascular enrichment around the meibomian glands (MGs). The SLE patients were also found to have excessive inflammatory cell infiltration around the MGs, especially the typical lymph node-like foci of inflammatory cell infiltration. Conclusions MG alteration can be found in the SLE patients. Examinations of the MGs can help diagnose or infer ocular diseases at an early stage of SLE.
Psychiatrists’ views on the New Zealand End of Life Choice Act
Authors: Cassidy Helen , Sims Adam , Every-Palmer Susanna 
Published: March 2022

Objective This cross-sectional survey aimed to establish the views and intentions of New Zealand (NZ) psychiatrists regarding their role as competence assessors in the NZ End of Life Choice Act (‘Act’). Some questions were replicated from a pre-existing Ministry of Health workforce survey regarding the Act, for comparative analysis between psychiatrists and other health professionals. Methods The survey was disseminated via email to all NZ psychiatrists registered with the Royal Australia and NZ College of Psychiatry and promoted by snowballing methods to reach non-members. Results There were similar (moderate) levels of understanding of the Act, compared to other health professionals. Psychiatrists show similar levels of support for assisted dying as other health professionals (55% and 47%, respectively), however psychiatrists are significantly less likely to be willing to provide assisted dying services than other health professionals. Concerns were raised regarding the challenges faced by psychiatrists and need for more clarity around the psychiatrist’s role. Conclusions Few NZ psychiatrists were willing to be involved with the Act. There was a perceived lack of information around a psychiatrist’s role, responsibilities and legal protections. Further guidance is needed regarding the concept of capacity in assisted dying and the factors that challenge these assessments.
Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors
Authors: MacDonald Madeline , Mirza Abu-Sayeef , Mhaskar Rahul , Ewing Aldenise , Chen Liwei , Robinson Katherine , Lu Yuanyuan , Ayoubi Noura , Gonzalez Eduardo , Guerra Lucy , Roetzheim Richard , Woodard Laurie , Pabbathi Smitha 
Published: March 2022

Background There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.
News comment sections and online echo chambers: The ideological alignment between partisan news stories and their user comments
Authors: Han Jiyoung , Lee Youngin , Lee Junbum , Cha Meeyoung 
Published: March 2022

This study explored the presence of digital echo chambers in the realm of partisan media’s news comment sections in South Korea. We analyzed the political slant of 152 K user comments written by 76 K unique contributors on NAVER, the country’s most popular news aggregator. We found that the political slant of the average user comments to be in alignment with the political leaning of the conservative news outlets; however, this was not true of the progressive media. A considerable number of comment contributors made a crossover from like-minded to cross-cutting partisan media and argued with their political opponents. The majority of these crossover commenters were “headstrong ideologues,” followed by “flip-floppers” and “opponents.” The implications of the present study are discussed in light of the potential for the news comment sections to be the digital cafés of Public Sphere 2.0 rather than echo chambers.
Factors associated with participation in life situations in people with COPD
Authors: D’Amore Cassandra , O’Hoski Sachi , Griffith Lauren E , Richardson Julie , Goldstein Roger S , Beauchamp Marla K 
Published: March 2022

Objective To examine potential determinants of participation frequency and limitations in people with Chronic Obstructive Pulmonary Disease (COPD). Methods For this secondary analysis, we grouped the following factors using the International Classification of Functioning, Disability and Health (ICF) components: age, psychological distress (Hospital Anxiety and Depression Scale (HADS)), gait aid use, supplemental oxygen use, grip strength, modified Medical Research Council Dyspnea scale, Short Physical Performance Battery, and Six-Minute Walk Test (6MWT). Participation was measured using the frequency and limitation domains of the Late Life Disability Instrument (LLDI). Relationships between factors and participation were examined using linear regression. Results Ninety-six participants (age 68.7 ± 8.1 yrs; FEV1 %pred 34 IQR 25–54) were included in the analysis. Factors were linked to four ICF components: activity, body functions, personal, and environmental factors. The final model for LLDI-frequency contained HADS, use of gait aid, and 6MWT (F (3, 81) = 27.69 ( p < .001), R2 = 0.51), and for LLDI-limitations, the final model included age, HADS, and 6MWT (F (3, 82) = 19.74 ( p < .001), R2 = 0.42). Discussion Participation in life situations in people with COPD is associated with multiple ICF components. Psychological distress (i.e., anxiety and depression symptoms) and mobility were important determinants of participation frequency and limitations. Prospective studies are needed to confirm these relationships.
Cross-Cultural Adaptation of Chinese Victorian Institute of Sports Assessment–Achilles (VISA-A) Questionnaire for Achilles Tendinopathy
Authors: Ko Violet Man Chi , Lau Ngo Nam , Qiu Ji Hong , Fu Sai-Chuen , Yung Patrick Shu-Hang , Ling Samuel Ka-Kin 
Published: March 2022

Background: Victorian Institute of Sports Assessment (VISA-A) is a patient-reported outcome for assessing symptoms severity associated with Achilles tendinopathy (AT). It is a valid and reliable tool that has been used widely for measuring and monitoring treatment outcomes for AT. This clinical measurement study aims to develop a Chinese version of the VISA-A questionnaire. The study objective is to adapt the VISA-A questionnaire cross-culturally and assess its psychometric property for Chinese-speaking individuals. Methods: VISA-A was translated and adapted cross-culturally according to international guidelines for self-reported questionnaires. During the establishment of Chinese VISA-A, there are 5 stages involved in the creation process, including translation, synthesis, reverse translation, review, and pretesting, which are performed by professionals in various fields, including orthopaedic surgeons, physiotherapists, and professional translators. Results: A total of 60 participants were recruited to complete the Chinese VISA-A and 36-Item Short Form Health Survey (SF-36) questionnaires. The overall test-retest reliability was 0.98 (intraclass correlation coefficient = 0.97-0.99). The correlation between Chinese VISA-A and physical function subscale ( r = 0.70) was strong and statistically significant. There were moderate correlations between Chinese VISA-A, limitations to role of physical function subscale ( r = 0.30), and bodily pain subscale ( r = 0.42), which were also statistically significant. There were statistically significant differences in Chinese VISA-A scores between healthy control and pathologic group ( P < .001), at-risk group, and pathologic group ( P < .001) respectively. Conclusion: Chinese VISA-A demonstrated good reliability and validity for measuring symptom severity in patients with AT. Chinese VISA-A can be recommended as a self-reported measure for monitoring symptoms severity and treatment progress of patients with Achilles tendinopathy. Level of Evidence: Level II, cohort study.