tbuckley/cabot-search huggingface dataset:
Abstract MP20: Implementation Of Social Determinants Of Health Screening And Referrals In A Medicaid Accountable Care Organization: A Qualitative Study
Authors: Jessica McCurley, Julia Browne, Vicki Fung, Douglas Levy, Cheryl Clark, Anne N Thorndike
Journal: Circulation (2021)

Introduction: Systematic screening for social determinants of health (SDOH), such as food and housing insecurity, is increasingly implemented in primary care, particularly in the context of Accountable Care Organizations (ACO), to improve health outcomes. The objective of this study was to explore aspects of implementation of annual SDOH screening and referrals in a Medicaid ACO, including facilitators and barriers and experiences of community resource staff. Methods: Qualitative interviews were conducted between January and March 2020 with fifteen staff (eight frontline resource staff and seven managers) in a large health care system in Massachusetts. Interviews focused on barriers and facilitators of screening for and addressing SDOH and the experiences of staff involved in this process. Interviews were audio recorded, transcribed, coded, and analyzed using the Framework Method of qualitative analysis. Results: Facilitators for addressing SDOH included close collaborations with community organizations, updated resource lists, leadership buy-in, and trusting relationships with patients. Barriers that prevented staff from addressing patients’ social needs effectively included high caseloads, time constraints, inefficiencies in workflows, lack of availability of resources, and patient characteristics (e.g., immigration status, mental health challenges). Resource staff described rewarding and stressful aspects of their jobs, including distress when unable to address challenging social needs such as housing. The Table provides examples of quotes from staff related to the themes identified in this study. Conclusions: Facilitators and barriers for successful SDOH screening and referrals occur at the health system, community, and individual levels and must be considered for developing effective screening and referral processes. The psychological burden on resource staff is an important and underrecognized factor that could impact patient care and contribute to staff burnout.
Abstract 15617: Atrial Fibrillation Prevalence, Anticoagulation Practices, and Long-term Outcomes for Patients Discharged With Atrial Fibrillation After Tavr: Results From the Partner 2a and S3i Trials
Authors: Michael I Brener, Susheel K Kodali, Tamim Nazif, Zixuan Zhang, Ioanna Kosmidou, Vinod H Thourani, Jose Dizon, Hasan Garan, Martin B Leon, Angelo B Biviano
Journal: Circulation (2020)

Background: Atrial fibrillation (AF) is associated with worse outcomes, including increased mortality, in patients undergoing transcatheter and surgical aortic valve replacement (TAVR/SAVR). Objective: To assess: (i) the short- and long-term prevalence of AF in intermediate surgical risk patients undergoing TAVR and SAVR; (ii) determine rates of anticoagulation (AC) prescription in patients with AF; and (iii) evaluate differences in outcomes. Methods: A total of 2663 patients from the PARTNER 2A and S3i trials were categorized into 3 groups by their baseline and discharge rhythm (sinus rhythm [SR] vs. AF): SR/SR, SR/AF, and AF/AF. Patients were followed for up to two years. Results: Table 1 presents the frequency of AF, AC prescription, and outcomes at 30-days, 1-year, and 2-year follow-up. SR/AF TAVR and SAVR patients continued to manifest relatively high rates of AF at each follow-up point. SR/AF patients were prescribed AC less often than AF/AF patients. For TAVR patients, the development of and discharge in AF was associated with increased bleeding (OR 1.59, 95% CI 1.11-2.26, p=0.01, SR/AF vs. AF/AF) and mortality (OR 1.77, 95% CI 1.04-3.00, p=0.03, SR/AF vs. AF/AF), but not stroke. There were no significant differences in outcomes in the SAVR patients. Conclusion: TAVR/SAVR patients who developed and were discharged in AF (SR/AF) were often in AF at 30 days, 1 year, and 2 year follow-up. While anticoagulation rates were lower in the SR/AF vs. the AF/AF group, bleeding and mortality, but not stroke, rates were higher for TAVR SR/AF vs. AF/AF patients. Further analyses of the associations between AF development, anticoagulation use, and outcomes in TAVR and SAVR patients are warranted.
Deep learning for predicting COVID-19 malignant progression
Authors: Cong Fang, Song Bai, Qianlan Chen, Yu Zhou, Liming Xia, Lixin Qin, Shi Gong, Xudong Xie, Chunhua Zhou, Dandan Tu, Changzheng Zhang, Xiaowu Liu, Weiwei Chen, Xiang Bai, Philip H.S. Torr
Journal: Medical Image Analysis (2021)
Abstract 067: Does BP Trajectory Across Childhood Predict Adult HTN? <i>The International Childhood CV Cohorts Consortium</i>
Authors: Elaine M Urbina, Philip R Khoury, Lydia A Bazzano, Trudy L Burns, Terence Dwyer, David R Jacobs, Markus Juonala, Ronald J Prineas, Olli T Raitakari, Alan Sinaiko, Julia Steinberger, Alison Venn, Jessica G Woo
Journal: Circulation (2021)

The relationship between single measures of systolic blood pressure (SBP) in youth and adult levels is weak. We sought to define trajectories of SBP over childhood to determine ability to predict adult hypertension (HTN). In the International Childhood CV Cohort (i3C) Consortium, we constructed SBP trajectories in 11,482 participants (mean age 8.0 + 2.0 years at time of first measure, 47% male, 25% non-Caucasian) who had at least 3 SBPs in youth between the ages of 4 and &lt;20 years assessed with at least 5 years between measures. To account for differences in normal BP by age, sex and height, trajectories were constructed using SBP percentile as defined by the 2017 Clinical Practice Guideline for BP management in youth. We then assessed HTN status (by survey) at mean age 46.7 years in 5,357 of the participants (mean age at first assessment 8.1 + 1.9 years, at self-assessment of HTN 46.7 + 5.7 years. 41% male, 23% non-Caucasian). SAS Proc Traj was employed to construct models with differing numbers of trajectories where all individual trajectories were significant (whether linear, quadratic or cubic). Model fit for each number of trajectories (up to 9) was assessed and trajectories were examined for clinical relevance. The final model selected included 6 trajectories. The prevalence of adult HTN was lowest in the group with low SBP across childhood and adolescence (Low-Low = 20%) and was highest in the group with persistently high SBP (High-High, 49%, chi square &lt;0.001). At first assessment, participants in the High-High group were slightly older (8.7 vs 7.7 years), heavier (BMI 65.2 vs 45.1%), had higher BP (112/61 vs 90/48 mmHg; 27% vs 86% for SBP) and, higher Tchol, LDL, TG, Insulin, Glucose and lower HDL although means were within normal limits (all p&lt;0.001). We conclude that trajectories of BP across childhood may identify youth at high risk for development of HTN in adulthood.
Race/Ethnicity and Prevalence of Aortic Stenosis by Echocardiography in the Multi-Ethnic Study of Atherosclerosis
Authors: Matthew J. Czarny, Sanjiv J. Shah, Seamus P. Whelton, Michael J. Blaha, Michael Y. Tsai, Rimsky Denis, Alain Bertoni, Wendy S. Post
Journal: Journal of the American College of Cardiology (2021)
EXERCISE LOWERS STRESS-ASSOCIATED NEUROBIOLOGICAL ACTIVITY:POTENTIAL MECHANISM CONTRIBUTING TO CARDIOVASCULAR RISK REDUCTION
Authors: Hadil Zureigat, Michael Osborne, Shady Abohashem, Kenechukwu Mezue, Taimur Abbasi, Ahmed Ghoneem, Tawseef Dar, Nicki Naddaf, Emma Akuffo, Aaron Baggish, Ahmed Tawakol
Journal: Journal of the American College of Cardiology (2021)
ICU mobility and improved outcomes: still searching for the Holy Grail
Authors: Matthew R Stutz, John P Kress, Krysta S Wolfe
Journal: Thorax (2021)

A growing number of patients are surviving critical illness, many of whom will experience long-term impairments in cognition and physical function. These enduring effects represent a significant burden for patients, their families and society. Unfortunately, interventions aimed at preventing the development of functional or cognitive disability due to critical illness are limited. Strategies to minimise sedation and initiate early physical rehabilitation have been associated with reductions in physical impairment and delirium, but the results of studies have been mixed and the impact on long-term outcomes has not been well established.1 The implementation of rehabilitation with mobilisation within 72 hours of mechanical ventilation has the most promising results, but occurs in less than 10% eligible patients, with barriers, including the availability of trained physiotherapists and the ability of a patient to participate in rehabilitation sessions.2 3 Therefore, there is intense interest in novel rehabilitation strategies to overcome these barriers.

Functional electrical stimulation-assisted cycle ergometry (FES-cycling) combines neuromuscular electrical stimulation (NMES) with in-bed cycling. FES-cycling offers theoretical advantages as it is feasible to integrate early in the course of critical illness, including in non-volitional patients, and mimics typical exercise by coupling the peripheral neuromuscular systems. Prior studies examining the effects of cycling and NMES delivered separately on functional outcomes have been mixed.4 …
SARS-CoV-2 infects human pancreatic β cells and elicits β cell impairment
Authors: Chien-Ting Wu, Peter V. Lidsky, Yinghong Xiao, Ivan T. Lee, Ran Cheng, Tsuguhisa Nakayama, Sizun Jiang, Janos Demeter, Romina J. Bevacqua, Charles A. Chang, Robert L. Whitener, Anna K. Stalder, Bokai Zhu, Han Chen, Yury Goltsev, Alexandar Tzankov, Jayakar V. Nayak, Garry P. Nolan, Matthias S. Matter, Raul Andino, Peter K. Jackson
Journal: Cell Metabolism (2021)
Abstract 13164: Tm6sf2 is a Regulator of Liver Fat Metabolism in Smooth Er Influencing Vldl Lipidation
Authors: Fei Luo, Helen H Hobbs, Jonathan C Cohen
Journal: Circulation (2020)

Backgrounds: A variant in Transmembrane 6 Superfamily Member 2 [ TM6SF2 (E167K)] that is associated with a loss of function is strongly associated with both alcoholic and nonalcoholic fatty liver disease. TM6SF2 is a polytopic protein that is expressed predominantly in the liver and small intestines. Immunolocalization studies are consistent with the protein being present in the endoplasmic reticulum (ER) and the Golgi complex. Tm6sf2 -/- mice replicate the phenotype of individuals with TM6SF2 -167K variant: hepatic steatosis accompanied by hypocholesterolemia, and transaminitis. These mice have a reduced rate of secretion of VLDL-TG without any change in the rate of secretion of ApoB. Thus, TM6SF2 is required for normal lipidation of VLDL. To determine where in the secretory pathway TM6SF2 promotes lipid addition to nascent VLDL, we have generated Tm6sf2 -/- rats. Methods: Two lines of Tm6sf2 -/- rats with different frameshift mutations in exon 1 were generated using CRISPR/Cas9 technology. Rats were fasted 4 hours and tissues were collected and frozen at -80°C. Cell fractionation studies were performed to isolate the smooth and rough ER along with trans - and cis -Golgi membranes. Result: Both lines of rats were confirmed by immunoblotting to produce no TM6SF2 in the liver or intestines. The phenotype of the Tm6sf2 -/- rats resembles that of mice and humans. Cell fractionation studies revealed that TM6SF2 mainly localized to the smooth ER. Unlike what was observed previously by immunocytochemistry, no TM6SF2 was found in the Golgi fraction. Analysis of the lipid profile of the Golgi apparatus in the KO rat revealed that the majority triglyceride (TG) and fatty acids (FA) subclasses were decreased by one to two folds compared to WT in terms of TG or FA to ApoB48 ratios. Conclusions: TM6SF2 is localized predominantly in the smooth ER and regulates the lipidation of VLDL.
Vulnerable Plaque can Be the Predominant Source of Interleukin-6 but not of C-Reactive Protein in Patients With Acute Myocardial Infarction
Authors: Higo S, Nanto S, Uematsu M, Ohara T, Morozumi T, Kotani J, Awata M, Onishi T, Iida O
Journal: Circulation (2004)
Novel Biomarkers of Habitual Alcohol Intake and Associations With Risk of Pancreatic and Liver Cancers and Liver Disease Mortality
Authors: Erikka Loftfield, Magdalena Stepien, Vivian Viallon, Laura Trijsburg, Joseph A Rothwell, Nivonirina Robinot, Carine Biessy, Ingvar A Bergdahl, Stina Bodén, Matthias B Schulze, Manuela Bergman, Elisabete Weiderpass, Julie A Schmidt, Raul Zamora-Ros, Therese H Nøst, Torkjel M Sandanger, Emily Sonestedt, Bodil Ohlsson, Verena Katzke, Rudolf Kaaks, Fulvio Ricceri, Anne Tjønneland, Christina C Dahm, Maria-Jose Sánchez, Antonia Trichopoulou, Rosario Tumino, María-Dolores Chirlaque, Giovanna Masala, Eva Ardanaz, Roel Vermeulen, Paul Brennan, Demetrius Albanes, Stephanie J Weinstein, Augustin Scalbert, Neal D Freedman, Marc J Gunter, Mazda Jenab, Rashmi Sinha, Pekka Keski-Rahkonen, Pietro Ferrari
Journal: JNCI Journal of the National Cancer Institute (2021)

Alcohol is an established risk factor for several cancers, but modest alcohol-cancer associations may be missed because of measurement error in self-reported assessments. Biomarkers of habitual alcohol intake may provide novel insight into the relationship between alcohol and cancer risk.
Combination of Model for End‐Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding
Authors: Aurélie Walter, Marika Rudler, Pol Olivas, Lucile Moga, Eric Trépo, Marie Angèle Robic, Isabelle Ollivier‐Hourmand, Anna Baiges, Olivier Sutter, Charlotte Bouzbib, Jean Marie Peron, Vincent Le Pennec, Nathalie Ganne‐Carrié, Juan Carlos Garcia‐Pagán, Maxime Mallet, Hélène Larrue, Thong Dao, Dominique Thabut, Virginia Hernández‐Gea, Jean‐Charles Nault, Christophe Bureau, Manon Allaire
Journal: Hepatology (2021)

Background and Aims Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients. Approach and Results One hundred sixty‐four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann‐Whitney and Fischer’s exact test. Six‐week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan‐Meier curves with log‐rank test and univariate/multivariate analyses using the Cox model. Eighty‐three patients were included in the derivation cohort (male, 78%; age, 55 years, alcohol‐associated cirrhosis, 88%; Model for End‐Stage Liver Disease [MELD], 19 [15‐27]; arterial lactate, 3.7 mmol/L [2.0‐8.3]). Six‐week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005‐1.126; P = 0.028) and arterial lactate (OR, 1.063; 95% CI, 1.013‐1.114; P = 0.032) were associated with 6‐week OS. Six‐week OS rates were 100% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 5% in patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94 vs 106 µmol/L, P = 0.008); 6‐week OS was 67%. Six‐week OS rates were 86% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 10% for patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. In the overall cohort, rebleeding rate was 15.8% at 6 weeks, and the acute‐on‐chronic liver failure grade (OR, 1.699; 95% CI, 1.056‐1.663; P = 0.040) was independently associated with rebleeding. Conclusions After salvage TIPS, 6‐week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6 weeks was &gt;85% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15, while mortality was &gt;90% for lactate ≥12 mmol/L and/or MELD score ≥ 30.
Abstract 14782: Sex Comparisons in Anticoagulation Treatment for Atrial Fibrillation in a Large Rural Healthcare System
Authors: Macaela N Rudeck, Catherine P Benziger
Journal: Circulation (2020)

Introduction: Atrial fibrillation (AF) and flutter lead to increased risk of thromboembolism (TE). The CHA 2 DS 2 -VASc score is used to determine the risk of TE. Objective: We aim to evaluate the anticoagulation use across CHA 2 DS 2 -VASc scores calculated using a validated automatic calculator. Methods: An AF registry was created for patients with AF or atrial flutter who had seen a primary care or cardiology provider within the past 2 years (5/28/2018-5/28/2020). An automatic CHA 2 DS 2 -VASc calculator was integrated into the electronic medical record system at Essentia Health on 10/1/2019. High-risk of TE was defined as a score of ≥3 for females and a score of ≥2 for males. AF registry included demographics, anticoagulation prescription, CHA 2 DS 2 -VASc and ATRIA bleed score, contraindications, and presence of left atrial appendage (LAA) occlusion device. Results: A total of 10992 patients with AF or atrial flutter were included in the registry (74.8 ±11.8 years, 41.7% female). A total of 6703 (61.0%) had a CHA 2 DS 2 -VASc score calculated (mean score 3.9 ± 1.5). Mean ATRIA bleed score was 3.0 ± 2.0. Within these patients, 90.7% of males and 93.0% of females were at high-risk of TE. Of these high-risk patients, anticoagulation use was 82.7% for females and 83.5% for males and increased with increasing score (p&lt;0.01 for males, p&lt;0.01 for females) (Figure 1). Overall, 36.9% were prescribed NOAC, 47.0% warfarin, and 0.8% heparin. There was no sex difference in the prescription of NOAC (37.7% male vs. 35.9% female, p=0.1). Fewer than 1% had WATCHMAN LAA device (0.3% male vs. 0.4% female, p=0.5). Conclusion: Four out of 5 patients at increased risk of TE are prescribed an anticoagulant. Interventions to improve anticoagulation use in high-risk patients are needed. Figure 1. Anticoagulation prescription use in atrial fibrillation patients by CHA 2 DS 2 -VASc score and sex between 5/28/2018-5/28/2020 at Essentia Health (N=6703).
Abstract 14825: Efficacy and Safety of Dabigatran, Rivaroxaban, and Apixaban Compared to Warfarin in Asian Patients With Non-valvular Atrial Fibrillation: A Systemic Review and Meta-analysis
Authors: Weijia Li, Damianos Kokkinidis, Yu Chiang Wang
Journal: Circulation (2020)

Background: Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF) originated from western countries. We aimed to systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran, rivaroxaban, and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF. Methods: Medline and Cochrane databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. The primary outcome was ischemic stroke. The secondary outcomes were all-cause mortality, major bleeding, intracranial hemorrhage, and gastrointestinal bleeding. Results: Twelve studies from East Asia or Southeast Asia and 429496 patients in total were included. Dabigatran, rivaroxaban, and apixaban were associated with a significant reduction in the incidence of ischemic stroke (HR=0.78, 95% CI, 0.65-0.94; HR=0.79, 95% CI, 0.74-0.85, HR=0.70, 95% CI, 0.62-0.78; respectively), all-cause mortality (HR=0.68, 95% CI, 0.56-0.83; HR=0.66, 95% CI, 0.52-0.84; HR=0.66, 95% CI, 0.49-0.90; respectively), and major bleeding (HR=0.61, 95%CI, 0.54-0.69; HR=0.70, 95% CI, 0.54-0.90; HR=0.58, 95% CI, 0.43-0.78; respectively) compared to warfarin. Conclusion: Dabigatran, rivaroxaban, and apixaban appear to be superior to warfarin in both efficacy and safety in Asian patients with non-valvular AF.
Abstract 12558: Primary Cilia of Cardiac Neural Crest Cells Modulate Both Outflow Tract Development and Ventricular Trabeculation
Authors: Lindsey A Fitzsimons, Adrian M Moran, Kerry L Tucker
Journal: Circulation (2018)

Introduction: Cardiac neural crest cells (CNCC) are a specialized progenitor population of migratory neural crest cells that contribute to the developing cardiac outflow tract (OFT) and endocardial...
Abstract MP09: Untargeted <sup>1</sup> H Nmr Metabolomics Metabolomic Analysis Reveals Pathways Of Protection Between Mediterranean-style Diet And Incident Cardiovascular Disease In The Multi-ethnic Study Of Atherosclerosis.
Authors: Alexis C Wood, Georgina Saylor, Ioanna Tzoulaki, Philip Greenland, Russell P Tracy, Wendy S Post, John Lindon, Christina L Wassel, Mimi Phan, Shabnam Momin, Tim Ebbels, Claire Boulange, Goncalo Graça, Ibrahim Karaman, Meghana Gadghil, Elena Chekmeneva, Manuja Kaluarachchi, Paul Elliott, David M Herrington
Journal: Circulation (2021)

Background: The metabolites associated with a Mediterranean-style (AMED) diet may give insight into why AMED is robustly associated with protection against CVD. Previous investigations seeking to identify these have been limited by the use of modest sample sizes and targeted assays. Methods: Using samples from the Multi-Ethnic Study of Atherosclerosis (MESA), we conducted untargeted 1 H NMR spectroscopy (600 MHz) with internal and external annotation on the sera of ~3,698 participants, ages 45-84, who were free from overt CVD. We included data on baseline dietary intake (self-reported), and all incident CVD events (excluding stroke) over a 10-year period. From &gt;100,000 spectral features, 845 significant associations (P&lt;2.2*10 -6 ) were identified via linear regression, and reduced to a putative list of 46 via elastic net regularized models. Hierarchical clustering identified 11 feature groups, from which cluster scores were constructed. The ‘mediate’ package in R used bootstrapping (1000 simulations) to partition the association between AMED and incident CVD into the effects of dietary intake on CVD which are mediated by the metabolomic cluster scores (the “indirect” / mediated effects) and those effects which are not (“direct effects”). All association analyses controlled for age, sex, ethnicity, data collection site and daily caloric intake. Results: AMED score was associated with reductions in the incidence of CVD (HR=0.95; 95% CI: 0.91 - 0.99; P=0.02). All metabolomic cluster scores were associated with AMED (all P&lt;2*10 -06 ; Table 1 ), with 6 significantly associated with incident CVD (all P&lt;2.0*10 -4 ) in the expected direction given their associations with AMED score. Four of these six significantly mediated the association of AMED score with incident CVD (P&lt;0.05; Table 1 ). Conclusions: These preliminary data suggest that specific molecules, if replicated in other studies, hold promise to identify the underlying pathways by which an AMED diet offers protection against CVD.