tbuckley/cabot-search huggingface dataset:
Transitioning gender, transitioning race: transgender people and multiracial positionality
Authors: Kylan Mattias de Vries, Carey Jean Sojka
Journal: International Journal of Transgender Health (2020)

Background: While research on trans People of Color's experiences has been increasing in recent years, this intersectional work has often not included a focus on the specificities of multiracial and multiethnic trans experiences. Aims: This study explores shifts in racial identity by multiracial/multiethnic trans people as they transition gender and the ways Whiteness and nationalist ideology shape their racialized gender experiences. Methods: This paper is based on six in-depth, semi-structured interviews with self-identified multiracial, multiethnic, and multi-heritage trans people in the USA. Data collection centered participants' experiences of self-identification and interactions with others (e.g., family, acquaintances, and strangers). Results: As participants transitioned gender and were acknowledged by others in their gender identity, shifts in their embodiment were used by others to ascribe a new racialized gender. This often resulted in participants reflecting on their sense of self and racialized gender identities in new ways. Discussion: Multiracial and multiethnic transgender people's experiences in transitioning race confirm the importance of intersectional analysis, reveal the intersectional fluidity of social categories, explicate how social understandings of one category (e.g., race) influence another category (e.g., gender), demonstrate that the meanings associated with racialized gender are based in relations of power, and show that, in transgender studies particularly, we must attend to the ways that the concept of transition implicates not only gender, but also other categories such as race and nationality.
Abstract 346: Targeted Temperature Management is Associated with Improved Neurological Outcomes in Witnessed Out-of-hospital Cardiac Arrest Patients Who Achieve Early Return of Spontaneous Circulation
Authors: Nobuyuki Enzan, Ken-ichi Hiasa, Kenzo Ichimura, Masaaki Nishihara, Takeshi Iyonaga, Yuji Shono, Takanari Kitazono, Hiroyuki Tsutsui
Journal: Circulation (2020)

Background: Previous randomized controlled trials demonstrated the efficacy of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA) patients with both shockable and non-shockable rhythm. Real-world evidence for TTM using large OHCA database are scarce, and no study has investigated the relationship between TTM and time-to-return of spontaneous circulation (ROSC). Methods: The Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients with witnessed non-traumatic OHCA who had been resuscitated and were in a coma were included. Eligible patients were divided into two groups according to the use of TTM. The primary outcome was defined as a Cerebral Performance Categories (CPC) Scale 1-2 at 30 days after OHCA. The propensity score matching analysis was used. The cubic spline analysis of the odds ratio of CPC 1-2 for TTM use by time-to-ROSC was performed. Results: Out of 34,754 patients with OHCA, 5,261 patients were included. The mean age was 70.3 years, and 3,417 (65.0%) were male. CPC 1-2 was more frequently observed in the TTM group in propensity score matching analysis (15.1% vs. 8.5%; odds ratio 1.92; 95% confidence interval 1.04-3.53; P=0.037). The cubic spline analysis showed that TTM was associated with CPC 1-2 in witnessed OHCA patients, which did not reach statistical significance in patients with time-to-ROSC longer than 50 min. Conclusions: TTM was associated with better neurological outcomes in witnessed OHCA patients, especially when patients were resuscitated within 50 min after collapse.
Abstract 297: Identifying Optimization Targets in 911 Dispatch Workflows for Out-of-hospital Cardiac Arrest Management
Authors: Woodrow Sams, Stephen Dowker, Brad Trumpower, Michael O'Leary, Neil Kamdar, Graham C Smith, Nathaniel R Hunt, Emilee Coulter-thompson, Michelle Williams, Randy Bloom, Cindy Polydoras, Kevin Irwin, Robert Swor, Mahshid Abir, Robert Domeier, Charles Friedman, Robert W Neumar, Brahmajee K Nallamothu
Journal: Circulation (2020)

Introduction: Dispatch processes for prehospital management of out-of-hospital cardiac arrest (OHCA) vary greatly by region, and so do the barriers and facilitators of rapid time-to-first-treatment within those systems. In order to optimize local OHCA response, we sought to identify improvement targets by tracking time intervals during OHCA 911 calls and evaluating associated barriers and facilitators to timely OHCA prehospital care delivery. Methods: We developed a data abstraction tool to collect quantitative and qualitative data regarding key events in a random sample of 23 of emergency medical services (EMS)-confirmed, second-party, non-traumatic, non-overdose, non-facility adult OHCAs occurring prior to first responder arrival from November 2017 to November 2019 in Washtenaw County, Michigan. Trained abstractors double reviewed calls. We calculated descriptive statistics of key event times to summarize a timeline of care and evaluated qualitative data using thematic analysis to assess event intervals. Results: Based on quantitative and qualitative analyses, we created a timeline with summary data of dispatcher OHCA response based on an aggregate of 23 calls to 911 dispatch (see Figure 1). Data abstractors identified two intervals-of-interest as containing barriers to optimizing time-to-first treatment: 1) time between the first report of abnormal breathing and call taker statement of CPR need (Interval 1), and 2) time from patient positioning to the first compression instruction (Interval 2). Qualitative data suggested that these interval delays were a result of extensive efforts on the part of the call taker to reconfirm breathing status in particular. Additional barriers, such as the callers misunderstanding instruction, and on-scene physical limitations, were also identified. Conclusions: We identified two primary time intervals to target for improvement as well as barriers present in our local 911 system. These data may serve as a foundation to develop targeted interventions to optimize local systems of care for 911 dispatch workflows. Figure 1
Abstract 16323: Ruling Out Sars-cov-2 Infection With a Fast-track 0/1,5-hour Molecular Testing in Patients With Acute Coronary Syndromes
Authors: Carmen Spaccarotella, serena migliarino, annalisa mongiardo, Antonio Curcio, Salvatore De rosa, Angela Quirino, Giorgio Barreca, Aida Giancotti, Cinzia Peronace, Nadia Marascio, Giovanni Matera, Ciro Indolfi
Journal: Circulation (2020)

Introduction: Timely reperfusion with PCI remains the main goal in STEMI patients. In the Covid 19 period, the fear of contagion reduced the number of hospitalized patients for myocardial infarction, and a substantial delay in the hospitalizations was also observed. The fear of the operators to treat non-tested patients did not facilitate the hospitalization and treatment of ACS patients with suspected Covid-19. Hypothesis: This study aimed to evaluate the feasibility of a fast-tract protocol to rule out SARS-CoV-2 infection in patients with suspected acute coronary syndrome. Methods: In fifty-one patients (mean age 65 ± 12 y) the real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated FDA-approved molecular test (Xpert Xpress Cepheid, Sunnyvale, USA). With its 45-minute processing time and with very high sensitivity, this system was tested in patients transferred from spokes centers or from the field to our HUB center. As soon as the patient had arrived in the Cath Lab, the interventional cardiologist, with adequate protection systems, performed the nasopharyngeal swab that was processed with the rapid Cepheid system. In the meanwhile, coronary angiography (CA) or PCI were performed. At the end of the CA/PCI, based on the test response, patients were transferred to the Covid or non Covid areas. Results: The time to perform the nasopharyngeal swab in the cath lab was: 10 + 10 minutes. The time spent to transport the nasopharyngeal test to the laboratory was: 30 + 20 minutes. The time to load 300 ul of biological material and extraction, amplification, and detection of viral nucleic acid, targeting the viral genomic regions N2 and E using the rapid test was 68 + 15 minutes. The result of the test was immediately made readily available through the hospital computer system. The total time from the execution of the nasopharyngeal swab to the result was 109 ± 26 minutes. Conclusions: This study demonstrates the feasibility of a fast-track protocol with a rapid test to ruling out SARS-CoV-2 Infection in ACS. This pathway allows quick patient stratification and it could of particular importance to detect asymptomatic Covid-19 positive patients with ACS.
Co-occurrence of mcr-9, extended spectrum β-lactamase (ESBL) and AmpC genes in a conjugative IncHI2A plasmid from a multidrug-resistant clinical isolate of Salmonella diarizonae
Authors: Yuanlong Pan, Yuan Fang, Xiaofeng Song, Na Lyu, Luping Chen, Yuqing Feng, Xuebin Xu, Baoli Zhu, Yongfei Hu
Journal: Journal of Infection (2020)
Abstract 370: Electrical Features Of Pulseless Electrical Activity Associated With Cardiac Arrest Outcomes
Authors: Steve Balian, David Alanis Garza, Mikel Leturiondo, Joshua R Lupton, James K Russell, Mohamud R Daya, Benjamin Abella
Journal: Circulation (2020)

Introduction: The cardiac arrest rhythm of pulseless electrical activity (PEA) poses various diagnostic and therapeutic challenges. PEA may represent a spectrum of arrest conditions with variable responses to resuscitation care. Aim: We analyzed PEA rhythms to identify diagnostic patterns associated with survival in cardiac arrest. Methods: In this retrospective cohort study, we utilized the Portland Resuscitation Outcomes Consortium database of out-of-hospital cardiac arrests compiled by the Tualatin Valley Fire and Rescue from 2006-2016. Recordings from defibrillation pads included compression waveforms, electrocardiogram, and transthoracic impedance signals. For each patient, we analyzed the first two pauses in chest compressions, characterized by flat compression and impedance signals. Features extracted from raw ECG signals included contraction frequency and variability. Signal Fourier transformation and 0-100 Hz band pass filtering yielded signals’ distribution across a frequency spectrum from which signal power was extracted. Extraction of the three most prominent frequencies was performed from the Gaussian filtered frequency spectrum. Non-parametric tests (Mann-Whitney, Fisher) and logistic regression methods were used for analysis. Results: Fifty-nine ECG recordings were analyzed corresponding to 7 (11.9%) survivors and 52 (88.1%) non-survivors. Median age was 72 (IQR 20), and 28.8% (17/59) were female. No significant differences were noted in sex or median age between survivors and non-survivors. Analysis of the first ECG pause showed a higher first peak median frequency among survivors (2.15 vs 0.06 Hz, p=0.049). We did not find a significant association between the second peak median frequency of the first ECG segment (6.46 vs 1.49 Hz, p=0.882) or the signal power of the second ECG segment (108.04 vs 100.77 Hz, p=0.647) with survival. Regression analysis did not provide reliable outcome prediction models for survival in this preliminary cohort. Conclusion: Computerized analysis of PEA ECG waveforms offers alternate approaches to bedside signal interpretation that may correlate with survival. Our preliminary work offers a potential approach to PEA analysis that will require application to a larger PEA arrest cohort.
Abstract 14456: Left Atrial Pressure Overload in Relation to N-terminal Pro-brain Natriuretic Peptide Level on Prognosis in Patients With Heart Failure With Preserved Ejection Fraction With and Without Atrial Fibrillation
Authors: Shiro Hoshida, Yukinori Shinoda, koichi tachibana, Tomoko Minamisaka, Takahisa Yamada, Yoshio Yasumura, Shunsuke Tamaki, Takaharu Hayashi, Masamichi Yano, Shungo Hikoso, Yasushi Sakata
Journal: Circulation (2020)

Objective: We aimed to clarify the differences in the significance of the ratio of diastolic elastance (Ed) to arterial elastance (Ea), [Ed/Ea=(E/e’)/(0.9 х systolic blood pressure)], a relative index of left atrial (LA) pressure overload, in relation to N-terminal pro-brain natriuretic peptide (NT-proBNP) level on prognosis between patients with heart failure with preserved ejection fraction (HFpEF) with and without atrial fibrillation (AF). Methods: We studied 297 HFpEF patients hospitalized for acute decompensated heart failure (sinus rhythm/AF: 192/105). Blood testing and transthoracic echocardiography were performed before discharge. All-cause mortality was evaluated at &gt;1 year after discharge. Results: During a median follow-up of 626 days, 47 patients (sinus rhythm/AF: 30/17) had all-cause mortality. In the subgroup with sinus rhythm, but not AF, Ed/Ea was significantly higher in patients with than without all-cause mortality. In a multivariate Cox hazard analysis, Ed/Ea was significantly associated with all-cause mortality independent of NT-proBNP in patients with sinus rhythm, but not with AF. Among patients with higher NT-proBNP levels, the effect of higher Ed/Ea on prognosis was prominent only in those with sinus rhythm (p=0.037). Conclusions: Ed/Ea provides additional prognostic information to serum NT-proBNP level for predicting all-cause mortality only in HFpEF patients with sinus rhythm. The prognostic risk factors differed between elderly HFpEF patients with and without AF.
A Novel Neoplastic Fusion Transcript, <i>RAD51AP1-DYRK4</i>, Confers Sensitivity to the MEK Inhibitor Trametinib in Aggressive Breast Cancers
Authors: Chia-Chia Liu, Jamunarani Veeraraghavan, Ying Tan, Jin-Ah Kim, Xian Wang, Suet Kee Loo, Sanghoon Lee, Yiheng Hu, Xiao-Song Wang
Journal: Clinical Cancer Research (2020)

Abstract Purpose: Luminal B breast tumors are more aggressive estrogen receptor–positive (ER+) breast cancers characterized by aggressive clinical behavior and a high risk of metastatic dissemination. The underlying pathologic molecular events remain poorly understood with a paucity of actionable genetic drivers, which hinders the development of new treatment strategies. Experimental Design: We performed large-scale RNA sequencing analysis to identify chimerical transcripts preferentially expressed in luminal B breast cancer. The lead candidate was validated by reverse transcription PCR in breast cancer tissues. The effects of inducible ectopic expression or genetic silencing were assessed by phenotypic assays such as MTS, transwell, and transendothelial migration assays, and by clonogenic assays to assess MEK inhibitor sensitivity. Subcellular fractionation, Western blots, and immunoprecipitation were performed to characterize the protein products and elucidate the engaged mechanisms. Results: Here we report a novel tumor-specific chimeric transcript RAD51AP1-DYRK4 preferentially expressed in luminal B tumors. Analysis of 200 ER+ breast tumors detected RAD51AP1-DYRK4 overexpression in 19 tumors (9.5%), which is markedly enriched in the luminal B tumors (17.5%). Ectopic expression of RAD51AP1-DYRK4, but not wild-type RAD51AP1, leads to marked activation of MEK/ERK signaling, and endows increased cell motility and transendothelial migration. More importantly, RAD51AP1-DYRK4 appears to endow increased sensitivity to the MEK inhibitor trametinib through attenuating compensatory activation of HER2/PI3K/AKT under MEK inhibition. Conclusions: This discovery sheds light on a new area of molecular pathobiology of luminal B tumors and implies potential new therapeutic opportunities for more aggressive breast tumors overexpressing this fusion.
Abstract 15296: Systemic Lupus Erythematosus Patients Admitted for Atrial Fibrillation Do Not Have Worse Outcomes: Analysis of the National Inpatient Sample
Authors: Ehizogie Edigin, precious O Eseaton, Mavi M Rivera Pavon, Emmanuel Akuna, Iriagbonse R Asemota, Pius E Ojemolon, Hafeez Shaka, augustine manadan
Journal: Circulation (2020)

Introduction: Systemic Lupus Erythematosus (SLE) is known to increase the risk of atrial fibrillation (AF), however it is unclear if SLE worsens outcomes in patients admitted for AF. This study aims to compare the outcomes of patients primarily admitted for AF with and without a secondary diagnosis of SLE. Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using ICD-10 codes. Hospitalizations for adult patients from the above groups were identified. The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic, and electrical cardioversion were secondary outcomes of interest. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to analyze the data. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal ICD-10 code for AF. 2,645 (0.3%) of these hospitalizations have co-existing SLE. SLE group were younger (67 vs 71 years, P &lt; 0.0001) and had more females (85% vs 51%, P &lt; 0.0001). Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, AOR: 1.0, 95% CI 0.47-2.14, P=0.991), LOS ( 4.2 vs 3.4 days, P=0.525), total hospital charges ( $51,351vs $39,121, P=0.056), odds of undergoing pharmacologic cardioversion ( 0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22-3.69, P=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66-1.15, P=0.324) compared to those without SLE. Hospitalizations for AF with SLE had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3-2.7, P&lt;0.0001) compared to those without SLE. Conclusions: Patients admitted primarily for AF with co-existing SLE had similar inpatient mortality, LOS, total hospital charges, likelihood of undergoing pharmacologic and electrical cardioversion compared to those without SLE. However, SLE group had more odds of undergoing ablation.
Association of Inflammatory Activity With Larger Neural Responses to Threat and Reward Among Children Living in Poverty
Authors: Gregory E. Miller, Stuart F. White, Edith Chen, Robin Nusslock
Journal: American Journal of Psychiatry (2020)

Objective: Children exposed to severe, chronic stress are vulnerable to mental and physical health problems across the lifespan. To explain how these problems develop, the neuroimmune network hypothesis suggests that early-life stress initiates a positive feedback loop between peripheral inflammatory cells and networked brain regions involved in threat and reward processing. The authors sought to test this hypothesis by studying a sample of urban children from diverse socioeconomic backgrounds. Methods: The authors examined the basic predictions of the neuroimmune network hypothesis in 207 children (mean age=13.9 years, 63% female; 33% Black; 30% Hispanic), focusing on poverty as a stressor. The children had fasting blood drawn to quantify five inflammatory biomarkers—C-reactive protein, tumor necrosis factor-α, and interleukins-6, -8, and -10—which were averaged to form a composite score. Children also completed two functional MRI tasks, which measured amygdala responsivity to angry facial expressions and ventral striatum responsivity to monetary rewards. Results: Poverty status and neural responsivity interacted statistically to predict inflammation. Among children living in poverty, amygdala threat responsivity was positively associated with inflammation, and the same was true for ventral striatum responsivity to reward. As children’s socioeconomic conditions improved, these brain-immune associations became weaker. In sensitivity analyses, these patterns were robust to alternative measures of socioeconomic status and were independent of age, sex, racial and ethnic identity, and pubertal status. The associations were also condition specific; no interactions were apparent for amygdala responsivity to neutral faces, or striatal responsivity to monetary losses. Conclusions: These findings suggest that childhood poverty is associated with accentuated neural-immune signaling, consistent with the neuroimmune network hypothesis.
Abstract 306: Out-of-hospital Cardiac Arrest Response Characteristics Moderate the Effect of Response Time on Survival
Authors: Justin J Boutilier, Clara Stoesser, Christopher L.F. Sun, Steven Brooks, Sheldon Cheskes, Katie N Dainty, Michael Feldman, Dennis T Ko, Steve Lin, Laurie Morrison, Damon Scales, Timothy C.Y. Chan
Journal: Circulation (2020)

Background: Research has shown that each minute delay in response time reduces survival from OHCA. Although Utstein variables like public location, witnessed, bystander CPR, and bystander AED shock are known to independently improve survival, how they moderate the effect of response time delays on survival is unknown. Methods: We included OHCAs from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database from December 1, 2005 to June 30, 2015. We included all adult, non-traumatic, non-EMS witnessed, and EMS-treated OHCA episodes. We used a logistic regression model to estimate survival to hospital discharge as a function of response time. We adjusted for standard Utstein variables and included interaction terms between response time and public location, bystander witnessed, bystander CPR, and bystander AED shock. With four binary interacted variables, there were a total of sixteen subpopulations, each with a different effect of response time on survival. Results: 83,275 patients were included (15% public, 45% witnessed, 47% CPR, 2% AED shock). Across the 10 subpopulations that comprise 99%+ of the data, a one-minute delay in response time reduced the odds of survival from 1.7% to 10.9%, depending on the arrest characteristics. All interaction tests for effect modification were significant. The reduction in odds of survival was largest for witnessed arrests (OR=0.961; 95% CI: 0.944-0.978), followed by arrests with bystander CPR (OR=0.965; 95% CI: 0.948-0.982) and in public locations (OR=0.978; 95% CI: 0.960-0.996). In contrast, a one-minute delay for arrests with bystander AED shock (OR=1.086; 95% CI: 1.058-1.114) increased the odds of survival. Conclusions: Utstein predictors significantly moderate the effect of response time on survival. Arrests that are witnessed, public location, and/or receive bystander CPR are negatively affected by slower response time. Arrests with a bystander AED shock are not sensitive to response time delays.