tbuckley/cabot-search huggingface dataset:
Characterization of COVID-19 in Assisted Living Facilities — 39 States, October 2020
Authors: Sarah H. Yi, Isaac See, Alyssa G. Kent, Nicholas Vlachos, J. Carrie Whitworth, Kerui Xu, Katryna A. Gouin, Shirley Zhang, Kara Jacobs Slifka, Ann Goding Sauer, Preeta K. Kutty, Joseph F. Perz, Nimalie D. Stone, Matthew J. Stuckey
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the vulnerability of residents and staff members in long-term care facilities (LTCFs) (1).Although skilled nursing facilities (SNFs) certified by the Centers for Medicare & Medicaid Services (CMS) have federal COVID-19 reporting requirements, national surveillance data are less readily available for other types of LTCFs, such as assisted living facilities (ALFs) and those providing similar residential care.However, many state and territorial health departments publicly report COVID-19 surveillance data across various types of LTCFs.These data were systematically retrieved from health department websites to characterize COVID-19 cases and deaths in ALF residents and staff members.Limited ALF COVID-19 data were available for 39 states, although reporting varied.By October 15, 2020, among 28,623 ALFs, 6,440 (22%) had at least one COVID-19 case among residents or staff members.Among the states with available data, the proportion of COVID-19 cases that were fatal was 21.2% for ALF residents, 0.3% for ALF staff members, and 2.5% overall for the general population of these states.To prevent the introduction and spread of SARS-CoV-2, the virus that causes COVID-19, in their facilities, ALFs should 1) identify a point of contact at the local health department; 2) educate residents, families, and staff members about COVID-19; 3) have a plan for visitor and staff member restrictions; 4) encourage social (physical) distancing and the use of masks, as appropriate; 5) implement recommended infection prevention and control practices and provide access to supplies; 6) rapidly identify and properly respond to suspected or confirmed COVID-19 cases in residents and staff members; and 7) conduct surveillance of COVID-19 cases and deaths, facility staffing, and supply information (2).LTCFs comprise a broad range of nursing and residential care facilities that provide varying degrees of health and social services.LTCFs include ALFs and similar residential care facilities, SNFs and other nursing homes, and residential facilities for persons with intellectual and developmental disabilities.As of 2016, the 28,900 U.S. ALFs accounted for approximately 44% of the nation's LTCFs and had 811,500 residents and 298,800 full-time equivalent care staff members (3).Resident care in ALFs is focused on activities of daily living, such as bathing and toileting, and assisting with skills needed for independent living, such as medication management and housekeeping (3).As of 2016, 52% of ALF residents were aged ≥85 years, 30%
Abstract 17355: Rural-Urban Differences in the Association of Change in County-Level Physician Density With Cardiovascular Disease Mortality
Authors: Jacob B Pierce, Lucia Petito, Sadiya Khan
Journal: Circulation (2020)

Introduction: Rural areas face greater challenges in access to cardiovascular care related to lower physician density compared with urban areas. However, whether the association between recent changes in primary care physicians (PCP) and cardiologist density and contemporary CVD mortality differs by county-level urbanization is unknown. Hypothesis: Decreases in county-level physician density per capita between 2011-2017 will be associated with higher CVD mortality in rural compared with urban counties in 2017-18 in the US. Methods: Death certificates from CDC WONDER with CVD (ICD-10 codes I00-09, I11, I13, I20-51) listed as the underlying cause of death between 2017-2018 were queried to calculate age-adjusted mortality rate (AAMR) at the county-level. Changes in county-level PCPs (2011-2017) and cardiologists (2011-2017) per 100,000 population were derived from the Area Health Resources Files. We performed univariable and multivariable linear regression to determine the association between change in physician density and county-level CVD AAMR adjusted for county-level demographic and socioeconomic characteristics and baseline physician density. Results: PCP and cardiologist density was lower in rural counties compared with urban counties (Table). Between 2011 and 2017, PCP density decreased in rural (-2.2 [SD 15.8]) and increased in urban counties (0.8 [9.1]). Conversely, cardiologist density increased in rural (0.1 [1.8]) and decreased in urban counties (-0.1 [2.1]). Increases in PCP density were associated with lower CVD AAMR in both rural and urban counties (p&lt;0.01). However, changes cardiologist density were not associated with lower CVD AAMR in multivariable analyses. Conclusion: Cardiologist density in rural counties was less than one-third that of urban counties and was not associated with CVD mortality. Increases in PCP density between 2011-17 was significantly associated with lower CVD AAMR in 2017-18 in both rural and urban counties.
Abstract 13682: Single Nucleotide Polymorphisms in the Ddah1 Gene Are Associated With Delayed Cerebral Ischemia in Patients With Subarachnoid Hemorrhage
Authors: Juliane Hannemann, Daniel Appel, Miriam Seeberger-Steinmeister, Tabea Brüning, Julia Zummack, Rainer Boeger
Journal: Circulation (2020)

Introduction: Delayed cerebral ischemia (DCI) is a major cause of lethality and poor long-term neurological outcome in patients with subarachnoid hemorrhage (SAH). Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) are regulators of vascular NO synthesis from L-arginine. We previously reported that elevated concentrations of both, ADMA and SDMA at ICU admission are associated with the incidence of DCI during follow-up. Dimethylarginines (DMAs) are synthesized by PRMT enzymes; ADMA is metabolized by DDAH1 and DDAH2, whilst SDMA is metabolized by AGXT2. Hypothesis: We hypothesized that common genetic variants in genes encoding the core enzymes of DMA metabolism may predispose individuals for the development of DCI after SAH. Methods: We measured L-arginine, ADMA and SDMA in plasma and cerebrospinal fluid (CSF) of 51 SAH patients at ICU admission and followed them for clinical status and neurological outcome until 30 days post-discharge. Single nucleotide polymorphisms (SNPs) in the NOS3, DDAH1, DDAH2, PRMT1, and AGXT2 genes were analyzed by PCR, and genotypes were related to biomarker levels and outcome. The primary outcome was the incidence of DCI, which was defined as the appearance of new infarctions on cranial computed tomography or magnetic resonance imaging. Results: 18 out of 51 SAH patients developed DCI. DCI patients did not significantly differ from those without DCI in clinical scores. However, patients who developed DCI had higher plasma ADMA and SDMA levels and higher SDMA levels in CSF at admission. DDAH1 gene variation was associated with plasma ADMA (p=0.02), whilst AGXT2 gene variation was associated with plasma SDMA (p=0.02). There was a strong association of all three DDAH1 SNPs that we analyzed with DCI, with carriers of the minor allele of DDAH1 rs233112 having a significantly increased relative risk of developing DCI (RR=2.61 (1.25-5.43), p=0.002). Conclusions: Sequence variation in the DDAH1 gene is associated with the incidence of DCI in SAH patients, suggesting that SNPs in the DDAH1 gene, which regulates plasma ADMA concentration, significantly influences the risk of cerebral ischemia after subarachnoid hemorrhage.
Eftilagimod alpha, a soluble lymphocyte activation gene-3 (LAG-3) protein plus pembrolizumab in patients with metastatic melanoma
Authors: Victoria Atkinson, Adnan Khattak, Andrew Haydon, Melissa Eastgate, Amitesh Roy, Prashanth Prithviraj, Christian Mueller, Chrystelle Brignone, Frederic Triebel
Journal: Journal for ImmunoTherapy of Cancer (2020)

To evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of eftilagimod alpha (efti), a soluble lymphocyte activation gene-3 protein, in combination with the programmed cell death-1 (PD-1) antagonist pembrolizumab.The study was divided into two parts; parts A and B, where part A was the dose escalation part and part B was an extension part of the study. Patients with metastatic melanoma were treated with efti plus the standard dose of pembrolizumab. Blood samples were assayed to determine plasma pharmacokinetic parameters, detect efti antibody formation and determine long-lived CD8 T cell responses and associated pharmacodynamic parameters.Twenty-four patients with melanoma received pembrolizumab and bi-weekly subcutaneous (s.c.) injections of efti at doses 1 mg, 6 mg or 30 mg/injection for up to 6 months (part A) or 30 mg/injection for up 12 months (part B). No dose-limiting toxicities were reported and the main adverse event for efti was injection site reactions. Sustained systemic exposure to the product was obtained in all patients following s.c. injections of 30 mg dose. Treatment induced an increase in activated CD8 and CD4 T cell counts, and in some of the soluble biomarkers, particularly interferon (IFN)-γ, a Th1 signature cytokine. An overall response rate (ORR) of 33% was observed in patients partly with pembrolizumab-refractory of part A and ORR of 50% was observed in patients with PD-1 naïve of part B.Efti was well tolerated in combination with pembrolizumab with encouraging antitumor activity. This warrants further clinical studies of this new combination therapy combining an antigen-presenting cell activator with an immune checkpoint inhibitor.
Abstract 15330: Association Between Elective Percutaneous Coronary Intervention Appropriateness and Publicly Reported Outcomes
Authors: Vinay Kini, Paul Hess, Wenhui Liu, Gary Grunwald, Michael Ho, Steven M Bradley
Journal: Circulation (2020)

Introduction: Public reporting of percutaneous coronary intervention (PCI) outcomes such as readmission and mortality may cause harm by adversely affecting patient selection for PCI. Little is known about the relationship between these outcomes and elective PCI appropriateness - a validated metric of PCI quality. Methods: We identified all patients in the national Veterans Administration healthcare system who underwent elective PCI for stable coronary disease between 2013 and 2015. We defined PCI appropriateness using 2012 criteria. The primary outcome was 90-day all-cause hospitalization or mortality. We used hierarchical Cox proportional hazards regression models adjusted for patient- and facility-level covariates to compare outcomes across PCI appropriateness categories, and a joint survival/logistic model to compare facility-level variation in inappropriate PCI and 90-day outcomes. Results: Among 2,561 patients (mean age 66 years, 99% men) undergoing PCI across 59 sites, 29.6% were classified as appropriate, 10.4% as inappropriate, and 60% as uncertain. The proportion of patients who were readmitted or died were 15.6%, 16.4%, and 15.3% among patients who received appropriate, inappropriate, and uncertain PCI respectively. There were no significant differences in 90-day outcomes between the groups (hazard ratio for appropriate compared to inappropriate PCI 0.82 [CI 0.57 to 1.17; p=0.28]). The site level covariance between inappropriate PCI and 90-day outcomes was -0.033 (95% CI -0.117 to 0.047), indicating no site-level correlation between appropriateness and 90-day outcomes (Figure). Conclusion: We found no association between elective PCI appropriateness and 90-day outcomes among a national cohort of Veterans. Including appropriateness in public reports may 1) characterize PCI quality more fully and 2) potentially mitigate the harms of reporting outcomes by empowering providers to perform appropriate PCI in higher-risk patients.
Abstract 15911: Is There a Relationship Between Sports Participation and Peak Aerobic Capacity in Children With Congenital Heart Disease?
Authors: Astrid M De Souza, Nicholas Tran, Kaelan Naylor, Kim Hoskins, Hilary Romans, Jim Potts, David C Clarke, Kathryn Armstrong
Journal: Circulation (2020)

Introduction: Underlying structural lesions in congenital heart disease (CHD) result in differences in anatomy and physiology that may affect peak aerobic capacity (VO 2peak ). The relationship between sports participation and VO 2peak is unclear in these patients. The aim of this study was to determine if children with CHD who participated in sports had a higher VO 2peak than those who did not. Methods: Two-year, single-centre, retrospective review (May 2016-November 2018). Fifty-eight CHD patients were included: 9 aortic valve disease; 13 coarctation; 6 Ross procedure for aortic stenosis; 20 tetralogy of Fallot, and 10 transposition of the great arteries. Sports participation was categorized into 3 groups: 0-1 days/week; 2-3 days/week; and ≥4 days/week. A validated institutional treadmill protocol (BCCH) was used. Criteria for a maximal test included: VO 2 plateau, respiratory exchange ratio&gt;1.0, and/or a peak heart rate &gt;200 bpm. VO 2peak z-scores, % VO 2 at ventilatory threshold, and O 2 Pulse were calculated. Medians and interquartile ranges are reported. P&lt;0.05 was considered statistically significant. Results: Those who participated in sports ≥2-3 days/week had a significantly higher VO 2peak [39.9 (34.6, 48.1) vs 30.3 (27.8, 39.6) mL/min/kg; p&lt;0.001], VO 2peak z-score [-0.84 (-1.28,-0.30) vs -1.89 (-2.37, -1.16); p=0.002], and O 2 Pulse [0.20 (0.19, 0.25) vs 0.16 (0.14, 0.21) mL/beat/kg; p=0.004] compared to those who participated 0-1 day/week, respectively. There were no differences between those who participated in sports 2-3 days/week and ≥4 days/week. VO 2peak was similar between CHD lesions (p=0.21). Conclusions: VO 2peak is higher in those who participate in sports compared to those who do not. It is unclear whether those who have a higher VO 2peak are more inclined to participate in sports or whether sports participation leads to a higher VO 2peak . The role of exercise rehabilitation in the 0-1 day/week group needs to be explored.
Abstract 14053: Problematic Feeding is Common and Related to Gastroesophageal Reflux in the First 6 Months After Neonatal Cardiac Surgery
Authors: Britt F Pados, Tondi M Harrison
Journal: Circulation (2020)

Introduction: Feeding problems are often reported in infants after cardiac surgery. To date, no studies have followed the development of feeding after cardiac surgery using valid and reliable measures. Purpose: To describe feeding problems and the relationship between feeding and gastrointestinal tract symptoms in infants over the first 6 months (mos) after neonatal cardiac surgery. Methods: Parents of neonates requiring cardiac surgery were invited to complete surveys when their infant was 2, 4, and 6 mos old. The survey included the Neonatal Eating Assessment Tool (NeoEAT), Infant Gastroesophageal Reflux Questionnaire – Revised (I-GERQ-R), and Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Scores on the NeoEAT subscales ( Infant Regulation, Energy &amp; Physiologic Stability, Gastrointestinal Tract Function, Sensory Responsiveness , and Compelling Symptoms of Problematic Feeding) were categorized as problematic (≥ 90 th percentile) or not problematic (&lt; 90 th percentile) based on reference data. Percent of the sample with problematic feeding at each time point was determined. Bivariate correlations were calculated between the NeoEAT, IGSQ, and I-GERQ-R. Results: 27 parents completed the surveys, reporting on 6 infants with single ventricle and 21 with two ventricle conditions. Problematic feeding scores were common at all times and in both cardiac conditions. Problematic scores were reported on Compelling Symptoms of Problematic Feeding for 52% of the sample at 2 mos, 36% at 4 mos, and 22% at 6 mos. Problematic scores occurred in Gastrointestinal Tract Function for 22% at 2 mos, 10% at 4 mos, and 39% at 6 mos. Problems occurred in Sensory Responsiveness in 17% at 2 mos, 24% at 4 mos, and 33% at 6 mos. Energy &amp; Physiologic Stability problems occurred in 13%, 10%, and 22%, respectively. None reported problems in Infant Regulation . Symptoms of gastroesophageal reflux (I-GERQ-R) were significantly correlated with the NeoEAT ( p &lt; .05), but gastrointestinal symptoms (IGSQ) were not. Conclusions: Problematic feeding is common in the first 6 mos after neonatal cardiac surgery and is related to gastroesophageal reflux symptoms. Some areas of feeding improved over time, while others worsened, likely related to developmental and disease-related changes.
Abstract 15796: The Inverse Correlation Between Lifetime Occupational Radiation Exposure Duration and Prevalence of Atrial Arrhythmia
Authors: Rithika Thirumal, Catherine Vanchiere, Ruchi Bhandari, Sania Jiwani, Ronald Horswell, San Chu, Angela Bennett, Surbhi Chamaria, Pavan Katikaneni, Steven Bailey, Paari Dominic
Journal: Circulation (2020)

Introduction: Fluoroscopy assisted procedures have increased occupational radiation exposure among Cardiologists. Radiation has been linked to cardiovascular complications but its effects on cardiac rhythm has not been extensively explored. Hypothesis: We hypothesized that radiation exposure is associated with increased risk of atrial arrhythmias (AA) despite appropriate leaded body coverage. Methods: Demographic, social, occupational, and medical history was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed. Results: We received 1478 responses from cardiologists; 85.4% were males, 79% were White and 66.1% were ≤65 yrs of age. 35.6% of respondents were interventional cardiologists and 16.4% were electrophysiologists, and of those, 92.2% wore lead apparel during all times of radiation exposure. Cardiologists &gt;50 yrs of age, with &gt;10,000 hours of occupational radiation exposure, had a significantly lower prevalence of AA compared to those with ≤10,000 hours of radiation exposure (11.1% vs 16.7%, p =0.019). A multivariate logistic regression was performed and among cardiologists &gt;50 years of age, exposure to &gt;10,000 radiation hours was significantly associated with lower likelihood of AA, after adjusting for age, sex, DM, HTN and OSA (adjusted OR 0.57; 95% CI 0.38 - 0.85, p =0.007). Traditional risk factors such as age, sex, HTN, DM and OSA were more prevalent in those with AA and cataracts, a well-established complication of radiation exposure in cardiologists, was more prevalent in those exposed to &gt;10,000 radiation hours compared to those exposed to ≤10,000 radiation hours, validating the dependent (AA) and independent variables (radiation exposure), respectively. Conclusions: Radiation exposure in Cardiologists with appropriate lead apparel is inversely related to AA. Large scale prospective studies are needed to validate our findings.
Characterization of pre-existing and induced SARS-CoV-2-specific CD8+ T cells
Authors: Isabel Schulien, Janine Kemming, Valerie Oberhardt, Katharina Wild, Lea M. Seidel, Saskia Killmer, None Sagar, Franziska Daul, Marilyn Salvat Lago, Annegrit Decker, Hendrik Luxenburger, Benedikt Binder, Dominik Bettinger, Oezlem Sogukpinar, Siegbert Rieg, Marcus Panning, Daniela Huzly, Martin Schwemmle, Georg Kochs, Cornelius F. Waller, Alexandra Nieters, Daniel Duerschmied, Florian Emmerich, Henrik E. Mei, Axel Ronald Schulz, Sian Llewellyn-Lacey, David A. Price, Tobias Boettler, Bertram Bengsch, Robert Thimme, Maike Hofmann, Christoph Neumann-Haefelin
Journal: Nature Medicine (2020)
Abstract 12728: Untreated Sleep Apnea Syndrome is Associated With Higher Incidence of Cardiovascular Events After Percutaneous Coronary Intervention
Authors: Kazuhiro Fujiyoshi, Yoshiyasu Minami, Kohki Ishida, Miwa Ishida, Ken-ichiro Wakabayashi, Junya Ako, Takayuki Inomata
Journal: Circulation (2020)

Introduction: Sleep apnea syndrome (SAS) is a risk factor of cardiovascular disease. However, the impact of SAS on the clinical course after percutaneous coronary intervention (PCI) remains to be elucidated. Methods: A total of 206 consecutive patients who underwent PCI were included. The incidence of major adverse cardiovascular events (MACE) at 3-year was compared among patients with untreated SAS (untreated SAS group; n=60), those with SAS treated by continuous positive alveolar pressure (CPAP group; n=20) and those without SAS (non-SAS group; n=96). MACE included cardiac death, non-fatal myocardial infarction, target vessel revascularization (TVR), and non-TVR (NTVR). Results: There was no significant difference in baseline clinical characteristics among the untreated SAS group, the CPAP group and the non-SAS groups, other than in age (74.1 ± 9.6 vs. 71.2 ± 0.33 vs. 68.2 ± 10.7, p = 0.002) and hemoglobin A1c levels (6.54 ± 0.87 vs. 6.61 ± 0.58 vs. 6.09 ± 0.70 %, p &lt; 0.001). The incidence of MACE, TLR and TVR was significantly higher in the untreated SAS group than in the CPAP group and the Non-SAS group although there was no significant difference in the incidence of NTVR among the three groups (Figure). The untreated SAS was independently associated with the incidence of 3-year MACE (odds ratio 3.24, 95% confidence interval 1.36-8.20, p = 0.008). Conclusions: The incidence of MACE was significantly higher in patients with untreated SAS than in those treated with CPAP and those without SAS after PCI. The present findings may highlight the importance of SAS management in patients requiring PCI.
COVID-19, Decarceration, and the Role of Clinicians, Health Systems, and Payers
Authors: Emily A. Wang, Bruce Western, Donald M. Berwick
Journal: JAMA (2020)

Monik C. Jiménez, ScD; Tori L. Cowger, MPH; Lisa E. Simon, DMD, MD; Maya Behn, BA; Nicole Cassarino, BA; Mary T. Bassett, MD, MPH
Abstract 17128: Sleep Irregularity is Associated With Increased All-Cause Mortality
Authors: Adarsh Katamreddy, Dipan Uppal, Gokul Ramani, Saul Rios, Jeremy Miles, Yu Chiang Wang, Robert Faillace
Journal: Circulation (2020)

Introduction: Circadian rhythm disruptions are associated with increased cardiovascular disease risk. We aim to investigate if day-to-day variation in sleep duration and onset of sleep are associated with cardiovascular and all-cause mortality. Methods: 388 subjects with sleep data from Midlife in the United States(MIDUS) 2 Biomarker study(2004-09) were included. Objective sleep data was measured using the Actiwatch® device. Sleep onset, duration, sleep-wake cycles were collected for 7 consecutive days. Mean and standard deviations in sleep duration and time of onset of sleep over 7 days were calculated to assess for sleep irregularity and tertiles created. Mortality data was available with a follow up until December 2016. Cox proportional regression analysis was performed. Competing risk analysis for cardiovascular mortality was done with fine and gray subdistribution hazard. Results: Mean age 54.56±11.79 years; females 230(59.3%). BMI 30.56±7.06 kg/m 2. Over a median of 8.6 years follow up, 37 patients died including 10 deaths due to cardiovascular mortality. Sleep duration SD tertiles ranges were: 11-41 minutes, 42-67 minutes and 68-257 minutes in lowest to highest tertiles respectively. There was no statistically significant increase in cardiovascular mortality with variation in sleep duration. Tertile 3 vs 1: HR 4.00(0.45-35.48,p 0.21), but there was statically significant increase in all-cause mortality tertile 2vs1 and 3vs1 -HR 3.63(1.19-10.99, p 0.02), HR 3.99(1.33-11.94, p 0.01) respectively. Fully adjusted model showed tertile 2vs1 and 3vs1 HR 3.51(1.12-10.99, p 0.03), HR 4.85(1.52-15.49, P &lt; 0.01) respectively. Conclusions: Day to day variation in sleep duration is associated with increased all-cause mortality but not cardiovascular mortality after adjusting for mean sleep duration, inflammation, diabetes, age, BMI, renal function and blood pressure.