bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity in the Association Between the Presence of Coronary Artery Calcium and Cardiovascular Events: A Machine-Learning Approach in the MESA Study
Authors: Inoue Kosuke , Seeman Teresa E. , Horwich Tamara , Budoff Matthew J. , Watson Karol E. 
Published: October 2022

Background:
Coronary artery calcium (CAC) has been widely recognized as an important predictor of cardiovascular disease (CVD). Given the finite resources, it is important to identify individuals who would receive the most benefit from detecting positive CAC by screening. However, the evidence is limited as to whether the burden of positive CAC on CVD differs by multidimensional individual characteristics. We sought to investigate the heterogeneity in the association between positive CAC and incident CVD.

Methods:
This cohort study included adults from MESA (Multi-Ethnic Study of Atherosclerosis) ages ≥45 years and free of cardiovascular disease. After propensity score matching in a 1:1 ratio, we applied a machine learning causal forest model to (1) evaluate the heterogeneity in the association between positive CAC and incident CVD, and (2) predict the increase in CVD risk at 10-years when CAC>0 (versus CAC=0) at the individual level. We then compared the estimated increase in CVD risk when CAC>0 to the absolute 10-year atherosclerotic CVD (ASCVD) risk calculated by the 2013 American College of Cardiology/American Heart Association pooled cohort equations.

Results:
Across 3328 adults in our propensity score–matched analysis, our causal forest model showed the heterogeneity in the association between CAC>0 and incident CVD. We found a dose–response relationship of the estimated increase in CVD risk when CAC>0 with higher 10-year ASCVD risk. Almost all individuals (2293 of 2428 [94.4%]) with borderline risk of ASCVD or higher showed ≥2.5% increase in CVD risk when CAC>0. Even among 900 adults with low ASCVD risk, 689 (69.2%) showed ≥2.5% increase in CVD risk when CAC>0; these individuals were more likely to be male, Hispanic, and have unfavorable CVD risk factors than others.

Conclusions:
The expected increases in CVD risk when CAC>0 were heterogeneous across individuals. Moreover, nearly 70% of people with low ASCVD risk showed a large increase in CVD risk when CAC>0, highlighting the need for CAC screening among such low-risk individuals. Future studies are needed to assess whether targeting individuals for CAC measurements based on not only the absolute ASCVD risk but also the expected increase in CVD risk when CAC>0 improves cardiovascular outcomes.
Dynamic Change of Cardiovascular Health Metrics and Long‐Term Risk of Sudden Cardiac Death: The ARIC Study
Authors: Zhai Yuan‐Sheng , Bi Wen‐Tao , Li Zhu‐Yu , Qu Li‐ping , Jia Yu‐He , Cheng Yun‐Jiu 
Published: October 2022

Background
The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD.

Methods and Results
Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow‐up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48–0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54–0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24–0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10–0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36–0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13–0.76]). Similar results were also observed for non‐SCD.

Conclusions
Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.
Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting
Authors: Naqvi Imama A. , Strobino Kevin , Kuen Cheung Ying , Li Hanlin , Schmitt Kevin , Ferrara Stephen , Tom Sarah E. , Arcia Adriana , Williams Olajide A. , Kronish Ian M. , Elkind Mitchell S.V. 
Published: October 2022

Background:
Hypertension is the most important modifiable stroke risk factor, but blood pressure (BP) remains poorly controlled after stroke, especially among Black and Hispanic patients. We tested the feasibility of TASC (Telehealth After Stroke Care), a post-acute stroke care model integrating nurse-supported home BP telemonitoring, tailored infographics, and multidisciplinary team video visits.

Methods:
Acute stroke patients with hypertension were randomized at discharge to usual care or usual care with TASC. Usual care patients received video visits with primary care and stroke. TASC included a tablet and monitor to wirelessly transmit BP data to the electronic health record, with telenursing support, tailored infographics to explain BP readings, and pharmacist visits. Outcomes assessment was blinded. Feasibility outcomes included recruitment, randomization, adherence, and retention. Systolic BP from baseline to 3 months after discharge was evaluated using generalized linear modeling.

Results:

Fifty patients (64±14 years; 36% women‚ 44% Hispanic, 32% Black, 54% ≤high school education, 30% private insurance), and 75% of all eligible were enrolled over 6.3 months. Baseline systolic BP was similar in both (TASC n=25, 140±19 mm Hg; usual care n=25, 142±19 mm Hg). At 3 months, adherence to video visits (91% versus 75%,
P
=0.14) and retention (84% versus 64%,
P
=0.11) were higher with TASC. Home systolic BP declined by 16±19 mm Hg from baseline in TASC and increased by 3±24 mm Hg in usual care (
P
=0.01). Among Black patients, systolic BP control (<130 mm Hg) improved from 40% to 100% with TASC versus 14% to 29%, and among Hispanic patients, from 23% to 62% with TASC, versus 33% to 17% in usual care.

Conclusions:
Enhancing post-acute stroke care with home BP telemonitoring is feasible to improve hypertension in an underserved setting and should be tested in a definitive randomized clinical trial.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04640519.
Acute Infarcts on Brain MRI Following Aortic Arch Repair With Circulatory Arrest: Insights From the ACE CardioLink-3 Randomized Trial
Authors: Chen Chih-Hao , Peterson Mark D. , Mazer C. David , Hibino Makoto , Beaudin Andrew E. , Chu Michael W.A. , Dagenais François , Teoh Hwee , Quan Adrian , Dickson Jeffrey , Verma Subodh , Smith Eric E. 
Published: October 2022

Background:
to investigate the frequency and distribution of new ischemic brain lesions detected by diffusion-weighted imaging on brain magnetic resonance imaging after aortic arch surgery.

Methods:
This preplanned secondary analysis of the randomized, controlled ACE (Aortic Surgery Cerebral Protection Evaluation) CardioLink-3 trial compared the safety and efficacy of innominate versus axillary artery cannulation during elective proximal aortic arch surgery. Participants underwent pre and postoperative magnetic resonance imaging. New ischemic lesions were defined as lesions visible on postoperative, but not preoperative diffusion weighted imaging.

Results:

Of the 111 trial participants, 102 had complete magnetic resonance imaging data. A total of 391 new ischemic lesions were observed on diffusion-weighted imaging in 71 (70%) patients. The average number of lesions in patients with ischemic lesion were 5.5±4.9 with comparable numbers in the right (2.9±2.0) and left (3.0±2.3) hemispheres (
P
=0.49). Half the new lesions were in the middle cerebral artery territory; 63% of the cohort had ischemic lesions in the anterior circulation, 49% in the posterior circulation, 42% in both, and 20% in watershed areas. A probability mask of all diffusion-weighted imaging lesions revealed that the cerebellum was commonly involved. More severe white matter hyperintensity on preoperative magnetic resonance imaging (odds ratio, 1.80 [95% CI, 1.10–2.95];
P
=0.02) and lower nadir nasopharyngeal temperature during surgery (odds ratio per 1°C decrease, 1.15 [95% CI, 1.00–1.32];
P
=0.05) were associated with the presentation of new ischemic lesion; older age (risk ratio per 1-year increase, 1.02 [95% CI, 1.00–1.04];
P
=0.03) and lower nadir temperature (risk ratio per 1°C decrease, 1.06 [95% CI, 1.00–1.14];
P
=0.06) were associated with greater number of lesions.

Conclusions:
In patients who underwent elective proximal aortic arch surgery, new ischemic brain lesions were common, and predominantly involved the middle cerebral artery territory or cerebellum. Underlying small vessel disease, lower temperature nadir during surgery, and advanced age were risk factors for perioperative ischemic lesions.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02554032.
Dangerous Changes: When Military Innovation Harms Combat
Effectiveness
Authors: Kuo Kendrick 
Published: October 2022

Abstract
Prevailing wisdom suggests that innovation dramatically enhances the effectiveness of a state's armed forces. But self-defeating innovation is more likely to occur when a military service's growing security commitments outstrip shrinking resources. This wide commitment-resource gap pressures the service to make desperate gambles on new capabilities to meet overly ambitious goals while cannibalizing traditional capabilities before beliefs about the effectiveness of new ones are justified. Doing so increases the chances that when wartime comes, the service will discover that the new capability cannot alone accomplish assigned missions, and that neglecting traditional capabilities produces vulnerabilities that the enemy can exploit. To probe this argument's causal logic, a case study examines British armor innovation in the interwar period and its impact on the British Army's poor performance in the North African campaign during World War II. The findings suggest that placing big bets on new capabilities comes with significant risks because what is lost in an innovation process may be as important as what is created. The perils of innovation deserve attention, not just its promises.
Changes in Tropical Cyclone–Induced Extreme Hourly Precipitation over China during 1975–2018
Authors: Liu Lu , Yang Baochen , Jiang Xiaoling , Luo Yali , Ren Fuming 
Published: October 2022

Abstract
This study analyzes the spatiotemporal distributions and climate trends of tropical cyclone (TC)-induced extreme hourly precipitation (EXHP) in the warm season (May–September) during 1975–2018 over China and the involved mechanisms. Each TC is classified as a high-, mid-, and low-EXHP TC according to the total amount of EXHP it produces over China during its lifetime. Results show that low-EXHP TCs have a greater contribution to the total TC-induced EXHP over southern and southwestern China, whereas high-EXHP TCs make greater contributions over eastern and northeastern China as they tend to move northwestward after making landfall. It is shown that, although the total frequency of EXHP-producing TCs displays a decreasing trend, the total frequency of TC-induced EXHP over China shows a significant increasing trend, which is largely contributed by the high-EXHP TCs. To explore the possible mechanisms responsible for the different characteristics in EXHP-producing TC groups, we further analyze the large-scale environmental conditions with respect to three groups by composite analysis. The cooperation of large-scale environmental fields between high and low levels provides favorable conditions for the intensification of TCs and the enhancement of the TC-induced precipitation for the high-EXHP group, such as stronger divergence at high levels, weaker vertical wind shear, more sufficient water vapor, and more conducive steering airflow over the southeastern and eastern area of mainland China. The westward and northward movement of western North Pacific subtropical high is conducive to the northward shift of TC tracks, thus contributing to the high frequency of TC-induced EXHP over the eastern area of mainland China.
Strong Coupling in Diurnal Variations of Clouds, Radiation, Winds, and Precipitation during the East Asian Summer Monsoon
Authors: Wu Ruoting , Chen Guixing , Luo Zhengzhao Johnny 
Published: October 2022

Abstract
This study investigates the diurnal cycles of convective activities and low-level winds with emphasis on their interactions during the East Asian summer monsoon. We categorize atmospheric convection states using satellite-derived cloud regimes and group southerly monsoon flows with different characteristics of diurnal cycles, and found that they are closely related to each other. Over South China, deep convection and associated cirrus anvils produce a strongly negative shortwave cloud radiative effect and induce anomalous cooling in the ABL in the daytime, which reduces the diurnal amplitude of monsoon flows during the night that follows. Conversely, a fair-weather state in the daytime leads to an anomalously warm ABL that enhances the subsequent nighttime acceleration of the monsoon southerlies. The dominant cloud regimes in the daytime over South China are closely related to whether the organized deep convection over the Yun-Gui Plateau (southeast of the Tibetan Plateau) propagates eastward during the preceding night. Such a precursor of clouds/convection governing wind diurnal amplitude indicates a possible predictability of monsoon diurnal cycles over South China. Further analyses show that the cloud regimes and induced monsoon diurnal cycles over South China can regulate the moist convection over the downstream region (central China) through modulating moisture transport and convergence. Therefore, the observational statistics of this study reveal a strong coupling of clouds, radiation, winds, and precipitation at the diurnal time scale over the summer monsoon regions, in which the cloud radiative effects of atmospheric convection can strongly regulate the diurnal variations of low-level winds that further influence precipitation downstream.
Radiative Effects on Tropical Cyclone Development in Different Life Stages
Authors: Xu Menggeng , Takemi Tetsuya 
Published: October 2022

Abstract
A tropical cyclone (TC) is a powerful, rotating storm that typically originates over warm tropical oceans and creates strong winds and heavy rain; it is usually a natural disaster with respect to human life and property if it moves over land. This work examines effects of varying radiative forcing on the evolution of two typhoon cases—Typhoon Lionrock (2016) and Typhoon Hagibis (2019)—with the Weather Research and Forecasting (WRF) Model. Hagibis was a rapidly intensifying and quickly moving TC, whereas Lionrock gradually developed and was slow moving. Numerous sensitivity experiments in which shortwave and longwave radiative heating rates were modified were conducted. This study examined latent heating and radiative heating for each experiment. Substantial differences between the sensitivity simulation members indicated that radiative effects can strongly influence TC development. The analysis of diabatic heating sources shows that, before eyewall formation, the differential cooling effect, which indicates that longwave cooling rates between cloud clusters and clear sky differ, can promote low-level inflow and increase relative humidity in the cloud clusters. If the initial relative humidity is low, this effect becomes important because, without differential cooling, the relative humidity remains low, which can promote the generation of cold pools that will prevent cyclone development. After eyewall formation, both the change in temperature lapse rate due to a vertical gradient of radiative heating/cooling and the change in the warm core due to radiative heating/cooling can affect the intensity of a TC; however, the net effect may depend on the magnitude of these influences.
The Effects of Postconflict Memory: Forced Sterilization in Peru
Authors: Ballón Gutiérrez Alejandra , Ortega-Breña Mariana 
Published: October 2022

Forced sterilization was common practice in Peru in the 1990s, especially under the national reproductive health and family planning program developed in the midst of the armed conflict (1980–2000). However, in spite of the concomitant serious violations of fundamental rights, this practice was not included in the investigations of the Truth and Reconciliation Commission. Recently published images, videos, testimonies, and texts provide new evidence regarding the role of the armed forces in these eugenic procedures, the largest state-run population control program in the Americas. La esterilización forzada fue una práctica común en el Perú durante la década de 1990, especialmente dentro del marco del programa nacional de salud reproductiva y planificación familiar que se desarrolló en medio del conflicto armado (1980-2000). Sin embargo, a pesar de las concomitantes graves violaciones a los derechos humanos fundamentales, esta práctica no fue incluida en las investigaciones de la Comisión de la Verdad y la Reconciliación. Imágenes, videos, testimonios y textos recientemente publicados nos dan nuevas evidencias en torno al papel de las fuerzas armadas en estos procedimientos eugenésicos y lo que fuera el programa estatal de control de población más grande de las Américas.
A rare case of bronchogenic cyst in the parapharyngeal space
Authors: Jiang Zheng , Yang Xin , Liu Jun , Chen Fei 
Published: October 2022

Ectopic bronchogenic cyst arising from the parapharyngeal space is extremely rare and has only been reported once in a case report written in Chinese. Here, we reported one case with such a rare congenital abnormality. The patient accidentally found a mass in the parapharyngeal space when taking the head MRI scan. The CT scan showed a 2.6 × 1.9 cm low-density nodule with a well-defined border. The pathological exam confirmed its diagnosis of parapharyngeal bronchogenic cyst.
Effects of discontinuation of antihypertensive drugs on frailty syndrome in outpatients: a 1-year prospectively designed retrospective chart-review pilot study
Authors: Hasegawa Sho , Mizokami Fumihiro , Mase Hiroki , Hayakawa Yuji , Shimizu Atsuya , Matsui Yasumoto 
Published: October 2022

Objective To investigate the effects of discontinuing antihypertensive drugs on the characteristics of patients with frailty syndrome. Methods This prospective pilot study was conducted between March 2016 and July 2019. Among patients who visited the frailty clinic within this period, outpatients who received antihypertensive drugs at their first visit and were followed-up for about 1 year were enrolled. Participants who discontinued or continued antihypertensive drugs during 1 year of follow-up were classified into a discontinuation group or continuation group, respectively. Each domain in the Kihon checklist (KCL), fall risk score, short physical performance battery (SPPB) score, and skeletal muscle index (SMI) were assessed at the first visit and 1-year follow-up assessment, and were compared between the two groups. Results Among 498 patients who attended the frailty clinic, 78 were enrolled (discontinuation group, n = 19; continuation group, n = 59). At the first visit, SMI scores were significantly higher in the discontinuation versus continuation group. At the 1-year assessment, physical strength in the KCL for the discontinuation group and various SPPB scores for both groups were significantly improved, and the fall risk score was improved in the continuation group. Conclusion Discontinuation of antihypertensive drugs may positively affect physical performance.
Study of over-examination on tire induced by pressure correction process in flywheel tests
Authors: Wang Congwen , Xiao Chi , Feng Yihui , Dai Yujing , Wang Jun , Huan Yan , Huan Yong 
Published: October 2022

In this paper, the strain energy density (SED) is used to study the over-examination to tire in flywheel test induced by pressure correction process. Flywheel test is the main method for evaluating tire durability, which cannot be measured on flat ground due to the variable road conditions. “Pressure Correction” is a necessary step in flywheel tests, but this process can lead to an over-examination of tire durability, which means the tire durability will be underestimated. However, it is impossible to obtain the tire durability from ideal flat ground test, so this paper utilizes the finite element method (FEM) to simulate the tire rolling condition on flat ground and differently sized flywheels, and the SED is used to evaluate the over-examination of tire durability in flywheel test. According to the results, a flywheel with too small diameter has a large amount of over-examination, and the amount caused by a large flywheel is acceptable. This methodology can be a guideline to assess the over-examination on different sized flywheel tests relative to the flat ground, and for the certain tire in this study, flywheels with 3–5 times the tire diameter appear to have an acceptable over-examination.
Angiotensin II Use in Treatment of Refractory Shock Due to Benazepril and Amlodipine Toxic Ingestion
Authors: Gutierrez G. Christina , Dayton Christopher , Attridge Rebecca L. , Smedley Lucas , Saikumar Haritha , Everett Christopher , Rodriguez Abraham , Varney Shawn 
Published: October 2022

Introduction: Calcium channel blockers (CCB) are a leading cause of ingestion-associated fatality. Angiotensin-converting enzyme inhibitor (ACEi) overdose as part of co-ingestion is common and associated with refractory shock. Treatment options to manage this profound vasoplegia are limited. We describe the first case of use of newly formulated Angiotensin II for treatment of severe ACEi and CCB poisoning. Case Report: A 57-year-old man presented after suicide attempt by ingesting 20 tablets each of amlodipine 10 mg and benazepril 20 mg. His hypotension was initially managed with 35 mL/kg of crystalloid, norepinephrine, and hyperinsulinemic euglycemic therapy (HIET). His hemodynamics further deteriorated, and he developed lactic acidosis, electrolyte derangements, and renal dysfunction. Further complications of his ingestion included cardiac arrest, subsequent requirement for emergency cricothyrotomy, and renal replacement therapy. Maximal hemodynamic support with HIET therapy insulin drip 4.4 units/kg/hour, norepinephrine 2 mcg/kg/min, epinephrine 1 mcg/kg/min, vasopressin .06 units/hour, and intravenous lipid emulsion was unsuccessful. Ang II was started and titrated to maximal doses with dramatic improvement in hemodynamics. Within hours of starting Ang II, epinephrine was stopped and norepinephrine decreased by 50%. He was downgraded from the intensive care unit without any ongoing end-organ dysfunction. Discussion: Isolated CCB overdoses have high complication rates and well-established treatments. Therefore, management of CCB and ACEi co-ingestion is typically driven by CCB poisoning algorithm. There are multiple reports of CCB and ACEi co-ingestions causing treatment-refractory shock. Therapeutic options are limited by toxicities and availability of salvage therapies. Ang II is a safe and highly effective option to manage these patients.