Absolute Decrease Research Articles

Abstract 14147: Septal Longitudinal Strain Predicts Long-Term Mortality in Patients With Acute Pulmonary Embolism

Background Acute pulmonary embolism (PE) is associated with an increased risk of short- and long-term mortality. Since interventricular septal systolic function contributes to a third of right ventricular (RV) cardiac output, we sought to investigate the potential value of septal strain in PE. Methods This was a retrospective cohort study of patients admitted with acute pulmonary embolism. Patients underwent echocardiography during admission and included left ventricular (LV) speckle tracking, by which global longitudinal strain (GLS) and regional strain were acquired. Multivariable adjustments were made for age, sex, simplified PE index (sPESI), abnormal cardiac biomarkers (troponin or proBNP) and RV systolic function. The endpoint was all-cause death. Results The cohort consisted of 186 patients (mean age 68 years, 54% men), of whom 49 (26%) died during a median follow up of 3.5 years (IQR: 2.9-6.7 years). All LV systolic measures were univariable predictors of death (LVEF: HR: 1.04 (1.02-1.06), per 1% decrease; GLS: HR: 1.15 (1.07-1.22), per 1% absolute decrease; septal strain: HR: 1.15 (1.08-1.23), per 1% absolute decrease] (figure). RV systolic function was also associated with death [TAPSE: HR: 1.06 (1.01-1.12), per 1mm decrease). After multivariable adjustments, only septal strain remained significantly associated with outcome (HR: 1.09 (1.01-1.19), p=0.029, per 1% absolute decrease). Furthermore, septal strain significantly increased C-statistics when added to a base model of sPESI score, abnormal biomarkers and presence of hypotension (base model C-stat: 0.76; base model and septal strain C-stat: 0.83, p for increment = 0.006). Conclusion Septal strain is associated with death in acute PE and provides prognostic information beyond conventional risk assessment.

PSUN225 Assessment of Nutrition Knowledge and its Relationship with Metabolic Control in Patients with Diabetes

Abstract Introduction Medical nutrition therapy (MNT) is central in the overall diabetes management plan, with absolute decreases in HbA1c of up to 2.0% (in type 2 diabetes) and up to 1.9% (in type 1 diabetes) at 3–6 months. Continuing MNT support is helpful in maintaining glycemic improvements. We evaluated nutritional knowledge level about diabetes and its relation to metabolic control in 50 adult diabetic patients hospitalized in the medical-surgical area in our Hospital. Materials and methods We conducted a descriptive, observational and cross-sectional study from October to November 2020. We performed a validated structured survey that consists of 13 true or false questions about nutritional diabetes knowledge. In addition, patients were asked about the role of the nutritionist in the care of diabetic patients. Also, medical charts were reviewed. Results The mean age was 66 years (range 33-88), mostly males (62%). Sixty-percent of patients were older adults. Only one female patient had type-1 diabetes, the rest had type 2. Mean diabetes duration was 11±10 years. Fifty-six percent of patients had poor metabolic control. The mean glycosylated hemoglobin was 8,6%. The mean body mass index was 32,1Kg/m2. Ninety-two point nine percent of adults and 68,0% of elderly patients were overweight or obese. Sixty-four percent of patients had an appointment with nutritionist. Half of them considered having fulfilled the nutritional treatment. In regard to the survey the average number of correct answers was 8 questions (61,5%). Sufficient diabetic nutritional knowledge (≥70% of the correct answers) was recorded in 30,0% of patients, regular (between 51% and 69% of the correct answers) in 56,0% and insufficient (≤50% of the correct answers) in 14,0%. There was scant knowledge about vegetables and fruits in relation with diabetes. Those with high level of education did not display more knowledge. There was no association between level of knowledge and metabolic control. Eighty percent of those who showed sufficient knowledge had poor metabolic control, compared to 33.3% of those with insufficient knowledge. Of 32 patients that had a nutritionist appointment only 2 had insufficient knowledge and more than 90% had more than 50% of correct answers. In contrast, 71,4% of those without a nutritionist appointment showed insufficient knowledge. Conclusions The diabetic inpatients that had an appointment with nutritionist had regular and sufficient knowledge, compared to most of those without this appointment that showed insufficient knowledge. However, the overall awareness about fruits and vegetables was poor. Although most of the surveyed patients did not show insufficient knowledge, they were overweight or obese and had poor metabolic control. We believe the nutritionist is an essential part of the interdisciplinary team. More studies are warranted to evaluate nutrition knowledge in diabetic patients to plan educational strategies in this population. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

MRI Quantification of Placebo Effect in Nonalcoholic Steatohepatitis Clinical Trials.

Background Several early-phase clinical trials for the treatment of nonalcoholic steatohepatitis (NASH) use liver fat content as measured with the MRI-derived proton density fat fraction (PDFF) for a primary outcome. These trials have shown relative reductions in liver fat content with placebo treatment alone, a phenomenon termed "the placebo effect." This phenomenon confounds the results and limits generalizability to future trials. Purpose To quantify the effect of placebo treatment on change in the absolute PDFF value and to identify variables associated with this observed change. Materials and Methods This is a secondary analysis of prospectively collected data from seven early phase clinical trials that included participants with a diagnosis of NASH based on MRI and/or liver biopsy who received placebo treatment. The primary outcome was a greater than or equal to 30% relative reduction in PDFF after placebo treatment. Normalization of PDFF, relative change in alanine aminotransferase (ALT) level, and normalization of ALT level were also examined. An exploratory linear mixed-effects model was used to estimate an overall change in absolute PDFF and to explore parameters associated with this response. Results A total of 187 participants (median age, 52 years [IQR, 43-60 years]; 114 women) who received placebo treatment were evaluated. A greater than or equal to 30% relative reduction in baseline PDFF was seen in 20% of participants after 12 weeks of placebo treatment (10 of 49), 9% of participants after 16 weeks (two of 22), and 28% of participants after 24 weeks (34 of 122). A repeated-measures linear mixed-effects model estimated a decrease of 2.3 units (median relative reduction of 13%) in absolute PDFF values after 24 weeks of placebo treatment (95% CI: 3.2, 1.4; P < .001). Conclusion In this analysis of 187 participants, a clinically relevant decrease in PDFF was observed with placebo treatment. Based on the study model, assuming an absolute PDFF decrease of approximately 3 units (upper limit of 95% CI) to account for this "placebo effect" in sample size calculations for future clinical trials is suggested. Clinical trial registration nos. NCT01066364, NCT01766713, NCT01963845, NCT02443116, NCT02546609, NCT02316717, and NCT02442687 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Yoon in this issue.

Improved anti-noise adaptive long short-term memory neural network modeling for the robust remaining useful life prediction of lithium-ion batteries

Safety assurance is essential for lithium-ion batteries in power supply fields, and the remaining useful life (RUL) prediction serves as one of the fundamental criteria for the performance evaluation of energy and storage systems. Based on an improved dual closed-loop observation modeling strategy, an improved anti-noise adaptive long short-term memory (ANA-LSTM) neural network with high-robustness feature extraction and optimal parameter characterization is proposed for accurate RUL prediction. Then, an adaptive state parameter feedback correction strategy is constructed through multiple feature collaboration with its internal coupling mechanism characterization, which considers varying current rates, ambient temperatures, and other influencing parameters. Subsequently, a collaborative multi-parameter optimization is carried out along with the model training and meta-structure fine-tuning. Compared with other optimal existing methods, the maximum root mean square error decreases by 51.80%, the mean absolute error reduces by 26.95%, the maximum mean absolute percentage error decreases by 33.87%, and the R-squared increases by 4.11%. The established multiple-feature collaboration model realizes multi-scale parameter optimization and robust RUL prediction, thus advancing the industrial application of lithium-ion batteries.

Inequities in ambient fine particulate matter: A spatiotemporal analysis in Canadian communities

BackgroundExposure to fine particulate matter (PM2.5) is associated with adverse health outcomes but communities are not randomly exposed to PM2.5. Previous cross-sectional environmental injustice analyses in Canada found disproportionately higher exposure to PM2.5 in low-income populations, visible minorities and immigrants. Beyond static surveillance, it is also important to evaluate how changes in PM2.5 exposure over time may differentially impact disadvantaged communities. We examine whether communities with different sociodemographic characteristics benefited equitably from the overall decreases in ambient concentrations of PM2.5 from 2001 to 2016 in Canada. MethodsWe derived census tract level estimates of average annual PM2.5 using validated satellite-based estimations of annual average PM2.5 concentration surfaces. We investigated how the spatial distribution of PM2.5 has evolved over 15 years (2001–2016) by comparing absolute values and rank percentiles of census tract level annual average PM2.5 concentrations in 2001 and 2016. Using decennial census data and multivariable linear regression, we determined if sociodemographic characteristics are associated with changes in exposure to PM2.5, accounting for geographic boundary changes between census periods. ResultsOverall, ambient PM2.5 concentrations decreased from 2001 (median of 9.1 μg/m3) to 2016 (median of 6.4 μg/m3), with varying provincial patterns. Across communities, ranked census tract specific PM2.5 in 2001 and in 2016 are highly correlated (Spearman's rho = 0.75). We found that, on average and accounting for provincial differences and baseline PM2.5, communities with greater density of aboriginal population, lower education, higher shelter-cost-to-income ratio, unemployment or lower income experienced smaller absolute decreases in PM2.5 from 2001 to 2016. ConclusionsIdentifying sociodemographic groups that benefit least from decreasing exposure to PM2.5 highlights the need to consider environmental injustice when designing or revising air pollution policies.

Correlation of Left Anterior Descending Coronary Artery Radiation Dose with Major Adverse Cardiac Events and Feasibility of Coronary Artery Sparing Treatment Planning in Lung Cancer

<h3>Purpose/Objective(s)</h3> Radiation dose to the left anterior descending (LAD) coronary artery is associated with major adverse cardiac events (MACE) in patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, the newly identified LAD metric (percent volume receiving 15 Gy [LAD V15Gy]) has not been independently validated and the extent to which modern radiotherapy (RT) planning techniques can reduce LAD V15Gy without exceeding dose tolerances to other critical organs at risk (OAR) remains uncertain. <h3>Materials/Methods</h3> This is a single institution retrospective study of 98 patients with LA-NSCLC treated with RT between 2005-2020. The LAD was manually delineated for each patient. MACE (unstable angina, myocardial infarction, heart failure, coronary revascularization, and cardiac death) cumulative incidence was estimated and Fine and Gray regressions were performed, adjusting for non-cardiac death as a competing risk. Patients who received LAD V15Gy ≥10% and experienced MACE were re-planned with volumetric-modulated arc therapy (VMAT) to optimize reduction of LAD V15Gy while maintaining target coverage and meeting standard OAR constraints. <h3>Results</h3> The median follow up was 23.2 months. The median age was 69 years, 30.6% of patients had pre-existing coronary heart disease (CHD) or a CHD risk-equivalent. The mean LAD V15Gy was 32% (standard deviation [SD] 27.8%). Ten patients developed at least one MACE, with a 2-year cumulative incidence of 10.2% (95% CI: 3.1-17.0%). Adjusting for pre-existing CHD there was an increased risk of MACE with LAD V15Gy (subdistribution hazard ratio 1.03; 95% CI 1.00-1.06; p=.034), with a significant interaction between LAD V15Gy and CHD (p=.005). Among the 10 patients who developed a MACE, 6 (60%) had an LAD V15Gy ≥ 10% (mean 52%, range 10-100%). The original planning techniques included: 3-dimensional conformal RT (3D-CRT; n=2), static intensity-modulated RT (IMRT; n=2), and VMAT (n=2). In 4 of these plans (n=2 IMRT, n=1 3D-CRT, n=1 VMAT), the re-planned LAD V15Gy was reduced to <10%, however all 6/6 plans achieved some degree of LAD V15Gy reduction (range, 9-100%). Specifically, optimization with LAD-sparing VMAT achieved a mean absolute decrease of 35.1% for LAD V15Gy (SD 32.4%) and 6.2 Gy mean heart dose (SD 10.9 Gy), with a concomitant mean increase of 0.8 Gy mean lung dose (SD 1.8 Gy), and mean lung V20Gy of 0.2% (SD 4.1%). All re-plans achieved similar target coverage and remained within national guideline OAR constraints. <h3>Conclusion</h3> LAD V15Gy is associated with an increased risk of MACE in this independent retrospective cohort. VMAT-based LAD-sparing RT plan optimization is feasible and can achieve meaningful reductions in LAD V15Gy with potentially clinically acceptable tradeoffs in lung dose. Together, these findings underscore the need for more aggressive LAD-sparing RT planning approaches.

The use of cognitive psychology-based human-computer interaction tax system in ceramic industry tax collection and management and economic development of Jingdezhen city.

This work aims to solve the complex problems of non-linearity, instability, and multiple economic factors in the tax forecast of the ceramic industry to ensure the sustainable development of the ceramic industry. The key influential indicators of the tax forecast are obtained by analyzing the principal components affecting the tax index. In addition, a human-computer interaction (HCI) system is established based on cognitive psychology theory to improve the user-friendliness of tax analysis. At the same time, the tax data of the ceramic industry in Jingdezhen City, Jiangxi Province in different years are used for the empirical analysis of the tax prediction of different prediction models, including particle swarm optimization (PSO) algorithm, and fusion algorithm (FA), and support vector machine (SVM). This work comprehensively analyzes the influence of the optimized tax supervision mode on the economic development of the ceramic industry and provides ideas for the development of the ceramic industry in Jingdezhen. The research results demonstrate that the main indicator affecting tax revenue is the added value of the primary and secondary industries. The optimized SVM based on grid search method can provide a comprehensive data base for tax forecasting. The optimization of the computer system based on cognitive psychology improves the model prediction accuracy by 10%, and the absolute error decreases from 6.9 to 1.8%. The tax forecast results indicate that the tax imbalance in Jingdezhen is increasing. Therefore, the government needs to attach great importance to the development of the ceramic industry and strictly implement the tax policy. The tax supervision model can alleviate the problems of low fiscal contribution rate, tax evasion, and management loopholes. In addition, the SVM tax prediction model optimized by grid search method will lay a theoretical foundation for the research and application of taxation in the ceramic industry.

Association of Serial High-Sensitivity Cardiac Troponin T With Subsequent Cardiovascular Events in Patients Stabilized After Acute Coronary Syndrome

Studies have demonstrated an association between single measures of high-sensitivity troponin (hsTn) and future cardiovascular events in patients with chronic coronary syndromes. However, limited data exist regarding the association between changes in serial values of hsTn and subsequent cardiovascular events in this patient population. To evaluate the association between changes in high-sensitivity troponin T (hsTnT) and subsequent cardiovascular events in patients stabilized after acute coronary syndrome (ACS). This is a secondary analysis from the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), a randomized clinical trial of ezetimibe vs placebo on a background of simvastatin in 18 144 patients hospitalized for an ACS across 1147 sites in 39 countries. The current biomarker substudy includes the 6035 participants consenting to the biomarker substudy with available hsTnT at months 1 and 4. Data were collected from October 26, 2005, through July 8, 2010, with the database locked October 21, 2014. Data were analyzed from February 28, 2021, through August 14, 2022. The outcomes of interest were cardiovascular death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HHF). Associations of absolute and relative changes in hsTnT between month 1 and month 4 as a function of the starting month 1 hsTnT and the composite outcome were examined using landmark analyses. Of 6035 patients in this analysis (median [IQR] age, 64 [57-71]), 1486 (24.6%) were female; 361 (6.0%) were Asian; 121 were (2.0%) Black; 252 (4.2%) were Spanish descent; 4959 were (82.2%) White; and 342 (5.7%) reported another race (consolidated owing to small numbers), declined to respond, or were not asked to report race owing to regulatory prohibitions. Most patients (4114 [68.2%]) had stable hsTnT values (change <3 ng/L), with 1158 (19.2%) and 763 (12.6%) having changes of 3 to less than 7 ng/L and 7 ng/L or more, respectively. After adjustment for clinical risk factors and stratification by the starting month 1 hsTnT level, an absolute increase in hsTnT of 7 ng/L or more was associated with a more than 3-fold greater risk of the composite outcome (adjusted hazard ratio [aHR], 3.33; 95% CI, 1.99-5.57; P < .001), whereas decreases of 7 ng/L or more were associated with similar to lower risk (aHR, 0.51; 95% CI, 0.26-1.03; P = .06) compared with stable values. There was a stepwise association moving from larger absolute decreases (aHR, 0.51; 95% CI, 0.26-1.03) to larger absolute increases (aHR, 3.33; 95% CI, 1.99-5.57) in hsTnT with future risk of the composite outcome (P trend <.001). A similar association was observed when analyzed on the basis of relative percent and continuous change. Among stable patients post-ACS, changes in hsTnT were associated with a gradient of risk of subsequent cardiovascular events across the range of starting hsTnT values. Serial assessment of hsTnT may refine risk stratification with the potential to guide therapy decisions in this patient population. ClinicalTrials.gov Identifier: NCT00202878.

Left atrial reservoir strain predicts ischemic stroke after coronary artery bypass grafting independent of postoperative atrial fibrillation

Abstract Background Patients undergoing coronary artery bypass grafting (CABG) surgery face an elevated long-term risk of ischemic stroke. Left atrial (LA) mechanics including LA strain are known to predict both stroke and atrial fibrillation in other populations. Evidence is conflicting with regards to the clinical significance of postoperative atrial fibrillation (POAF) and its role in the association between LA mechanics and ischemic stroke is unclear. Purpose The aim of the study was to investigate the association between LA reservoir strain and long-term ischemic stroke in patients undergoing CABG surgery and whether the presence of POAF modified this relationship. Methods Patients undergoing isolated CABG were included from 2006–2011 as part of a retrospective cohort study. Echocardiography was performed prior to surgery. We included patients with available LA reservoir strain measurements, while patients with known atrial fibrillation and moderate to severe valvular disease were excluded. The primary endpoint was ischemic stroke. The association between LA reservoir strain and ischemic stroke was investigated in uni- and multivariable Cox proportional hazards regression models including adjustment for POAF. Poisson regression was used to create a restricted cubic spline model of the continuous association between LA reservoir strain and risk of ischemic stroke. Results We included 542 patients in the analysis. Mean age was 67.3±8.9 years, 89 (16.4%) were female, and median EuroSCORE II was 1.31 (IQR 0.93–1.96). Patients with LA reservoir strain &amp;lt;27.2% (median) were older, more likely to have diabetes, and had a higher EuroSCORE II. In total, 96 patients (17.7%) developed POAF. During a median follow-up period of 3.7 years (IQR 2.7–4.8 years), 21 (3.9%) patients experienced ischemic stroke. In univariable modeling, LA reservoir strain was significantly associated with ischemic stroke (HR 1.10 (95% CI 1.03–1.18, p=0.003) per 1% absolute decrease). After adjustment for EuroSCORE II, LA volume index (LAVi) and prior stroke, LA reservoir strain remained a significant predictor of ischemic stroke (HR 1.09 (95% CI 1.02–1.17, p=0.011) per 1% absolute decrease and HR 4.24 (95% CI 1.37–13.10, p=0.012) for &amp;lt; vs. &amp;gt;median). Adding POAF as a covariate did not alter the significance of LA reservoir strain in the model. In addition, POAF did not modify the association between LA reservoir strain and POAF (p for interaction = 0.07). The association between LA reservoir strain and ischemic stroke persisted in multiple sensitivity analyses including restricting the analysis to patients with normal left atrial volumes (LAVi &amp;lt;34 ml/m2), patients without POAF, and when excluding patients who developed atrial fibrillation during follow-up. Conclusion In patients undergoing CABG, LA reservoir strain was an independent long-term predictor of ischemic stroke. The predictive value of LA reservoir strain was unaffected by the presence of POAF. Funding Acknowledgement Type of funding sources: None.

POSITIVE ENVISIA GENOMIC CLASSIFIER RESULT PREDICTS CLINICAL PROGRESSION IN FIBROTIC INTERSTITIAL LUNG DISEASE

POSITIVE ENVISIA GENOMIC CLASSIFIER RESULT PREDICTS CLINICAL PROGRESSION IN FIBROTIC INTERSTITIAL LUNG DISEASE

Effect of Admission Hyperglycemia on Safety and Efficacy of Intravenous Alteplase Before Thrombectomy in Ischemic Stroke: Post-hoc Analysis of the DIRECT-MT trial.

Hyperglycemia is associated with decreased recanalization probability and increased risk of hemorrhagic complications for stroke patients treated with intravenous alteplase. However, whether hyperglycemia modifies alteplase treatment effect on clinical outcome in patients with large vessel occlusion stroke undergoing endovascular thrombectomy is uncertain. We conducted this study to determine a possible interaction effect between admission hyperglycemia and intravenous alteplase prior to thrombectomy in patients with large vessel occlusion stroke. In this post-hoc analysis of a randomized trial (DIRECT-MT) comparing intravenous alteplase before endovascular treatment vs. endovascular treatment only, 649 with available baseline glucose measurements were included. The treatment-by-admission hyperglycemia (defined as plasma glucose levels ≥ 7.8mmol/L [140mg/dL]) interaction was assessed using logistic regression models. As a result, among 649 patients included, 224 (34.5%) were hyperglycemic at admission. There was evidence of alteplase treatment effect modification by hyperglycemia (Pinteraction = 0.025). In patients without hyperglycemia, combination therapy was associated with better outcomes compared to mechanical thrombectomy alone (adjusted common odd ratio [acOR] 1.46, 95% CI [1.04-2.07]), but not in hyperglycemic patients (acOR 0.74, 95% CI [0.46-1.20]). Combination therapy led to an absolute increase of 6% excellent outcome (mRS 0-1) in non-hyperglycemic patients (aOR 1.71, 95% CI [1.05-2.79]), but resulted in a 12.3% absolute decrease (aOR 0.42 [95% CI, 0.19-0.95] in hyperglycemic patients (Pinteraction = 0.003). In conclusion, for large vessel occlusion patients directly presenting to a thrombectomy-capable hospital, hyperglycemia modified combination treatment effect on clinical outcome. Combination therapy was beneficial in patients without hyperglycemia, while thrombectomy alone may be preferred in hyperglycemic patients. Further studies are needed to confirm this result.Trial Registration Information: clinicaltrials.gov Identifier: NCT03469206.

Hypotension Prediction Index Software to Prevent Intraoperative Hypotension during Major Non-Cardiac Surgery: Protocol for a European Multicenter Prospective Observational Registry (EU-HYPROTECT).

Background: Intraoperative hypotension is common in patients having non-cardiac surgery and associated with postoperative acute myocardial injury, acute kidney injury, and mortality. Avoiding intraoperative hypotension is a complex task for anesthesiologists. Using artificial intelligence to predict hypotension from clinical and hemodynamic data is an innovative and intriguing approach. The AcumenTM Hypotension Prediction Index (HPI) software (Edwards Lifesciences; Irvine, CA, USA) was developed using artificial intelligence—specifically machine learning—and predicts hypotension from blood pressure waveform features. We aimed to describe the incidence, duration, severity, and causes of intraoperative hypotension when using HPI monitoring in patients having elective major non-cardiac surgery. Methods: We built up a European, multicenter, prospective, observational registry including at least 700 evaluable patients from five European countries. The registry includes consenting adults (≥18 years) who were scheduled for elective major non-cardiac surgery under general anesthesia that was expected to last at least 120 min and in whom arterial catheter placement and HPI monitoring was planned. The major objectives are to quantify and characterize intraoperative hypotension (defined as a mean arterial pressure [MAP] < 65 mmHg) when using HPI monitoring. This includes the time-weighted average (TWA) MAP < 65 mmHg, area under a MAP of 65 mmHg, the number of episodes of a MAP < 65 mmHg, the proportion of patients with at least one episode (1 min or more) of a MAP < 65 mmHg, and the absolute maximum decrease below a MAP of 65 mmHg. In addition, we will assess causes of intraoperative hypotension and investigate associations between intraoperative hypotension and postoperative outcomes. Discussion: There are only sparse data on the effect of using HPI monitoring on intraoperative hypotension in patients having elective major non-cardiac surgery. Therefore, we built up a European, multicenter, prospective, observational registry to describe the incidence, duration, severity, and causes of intraoperative hypotension when using HPI monitoring in patients having elective major non-cardiac surgery.

Medical therapy for patients with recent-onset heart failure with reduced ejection fraction during the COVID-19 pandemic: Insights from the Veteran's affairs healthcare system

This study aims to evaluate trends in guideline-directed medical therapy (GDMT) for patients with recent-onset heart failure with reduced ejection fraction (HFrEF) following the onset of the COVID-19 pandemic using an interrupted time series analysis in the Veteran's Affairs Healthcare System. Among 71,428 patients with recent-onset HFrEF between 1/1/2018 and 2/28/2021, we found the pandemic was not associated with differences in treatment rates for beta-blockers, renin-angiotensin-aldosterone system inhibitors, or mineralocorticoid receptor antagonists; there was a 2.6 % absolute decrease (95 % CI: 0.5 %–4.7 %) in ARNI rates in April 2020; which decreased over the pandemic. Despite the changes to healthcare delivery, the COVID-19 pandemic was associated with minimal changes in GDMT rates among patients with recent-onset HFrEF.

Improving N-Best Rescoring in Under-Resourced Code-Switched Speech Recognition Using Pretraining and Data Augmentation

In this study, we present improvements in N-best rescoring of code-switched speech achieved by n-gram augmentation as well as optimised pretraining of long short-term memory (LSTM) language models with larger corpora of out-of-domain monolingual text. Our investigation specifically considers the impact of the way in which multiple monolingual datasets are interleaved prior to being presented as input to a language model. In addition, we consider the application of large pretrained transformer-based architectures, and present the first investigation employing these models in English-Bantu code-switched speech recognition. Our experimental evaluation is performed on an under-resourced corpus of code-switched speech comprising four bilingual code-switched sub-corpora, each containing a Bantu language (isiZulu, isiXhosa, Sesotho, or Setswana) and English. We find in our experiments that, by combining n-gram augmentation with the optimised pretraining strategy, speech recognition errors are reduced for each individual bilingual pair by 3.51% absolute on average over the four corpora. Importantly, we find that even speech recognition at language boundaries improves by 1.14% even though the additional data is monolingual. Utilising the augmented n-grams for lattice generation, we then contrast these improvements with those achieved after fine-tuning pretrained transformer-based models such as distilled GPT-2 and M-BERT. We find that, even though these language models have not been trained on any of our target languages, they can improve speech recognition performance even in zero-shot settings. After fine-tuning on in-domain data, these large architectures offer further improvements, achieving a 4.45% absolute decrease in overall speech recognition errors and a 3.52% improvement over language boundaries. Finally, a combination of the optimised LSTM and fine-tuned BERT models achieves a further gain of 0.47% absolute on average for three of the four language pairs compared to M-BERT. We conclude that the careful optimisation of the pretraining strategy used for neural network language models can offer worthwhile improvements in speech recognition accuracy even at language switches, and that much larger state-of-the-art architectures such as GPT-2 and M-BERT promise even further gains.

Impact of the COVID-19 Pandemic on Myocardial Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation

Aim. To compare and analyze the results of myocardial revascularization in the Russian Federation (RF) with acute coronary syndrome (ACS) before the onset (2018-2019) and during the novel coronavirus infection (COVID-19) pandemic (2020-2021).Material and methods. The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the number of cases of myocardial revascularization in the above forms of ACS, the number of deaths depending on the form of ACS and the method performed revascularization. The period of time before the start of the coronavirus pandemic corresponded to the annual data received in the Russian Federation for 2018-2019. The period of the coronavirus disease pandemic corresponded to the annual data received in the country for 2020-2021. Absolute, relative, estimated values of patient hospitalization, myocardial revascularization procedures, and mortality in ACS were compared between time periods before and during the COVID-19 pandemic. The data for analysis were obtained from the monitoring of the Ministry of Health of Russia.Results. In 2018 and 2019 in the RF, 531,019 and 501,238 patients were hospitalized with a diagnosis of ACS, and during the pandemic (2020-2021) - 403,931 and 397,930 patients, respectively. Reduction in the number of patients diagnosed with ACS admitted to hospitals in Russia by 22.32% in 2020-2021 years was mainly due to a significant decrease in hospitalizations of patients with a diagnosis of NSTE-ACS (by 29.03%). At the same time, admission to clinics of patients with STEMI decreased only by 6.02%. During the COVID-19 pandemic, mortality increased significantly in PPCI (by 9.6%) and in the general STEMI group (by 12.3%); significantly increased mortality both in the general group (by 48%) and during PCI in patients with NSTE-ACS (by 28.6%); there was an increase in the average annual number of PPCI (by 12.6%), which was accompanied by an increased average annual number of PPCI per 1 million of population (up to 451 per 1 million of population); a slight increase in the average time "symptom-balloon" (by 2 minutes) was recorded; there was an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS (by 2.7% and 37.1%, respectively). In 2021, in the Russian Federation, primary PCI was performed in 50.2%, thrombolytic therapy - in 23.1%, and 26.7% of patients remained without reperfusion. Pharmacoinphasive strategy was applied in 60%, and isolated thrombolysis - in 40% of patients.Conclusion. During the COVID-19 pandemic, revascularization in patients with ACS in Russia corresponded to the following trends recorded in the literature: increased hospital mortality in PPCI and in the general STEMI group; hospital mortality both in the general group and during PCI in patients with NSTE-ACS. The indicators of myocardial revascularization in ACS in the RF during the pandemic were fundamentally different from the data of Western countries: there was an increase in the average annual number of PPCI and the average annual number of PPCI per 1 million population; a slight increase in the average symptom-balloon time was recorded; revealed an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS.

Two-Year Utilization and Expenditures for Children After a Firearm Injury

Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury. A retrospective cohort study was conducted between 2020 and 2022 of children aged 0-18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests. Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p<0.001), and 10,228 total encounters in the second year (p<0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p<0.001) and a $0.8 million decrease 2 years after the firearm injury (p=0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury. Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.

Interrupted-time-series analysis of the immediate impact of COVID-19 mitigation measures on preterm birth in China

Preliminary evidence from China and other countries has suggested that coronavirus disease 2019 (COVID-19) mitigation measures have caused a decline in preterm births, but evidence is conflicting. Utilising a national representative data of 11,714,947 pregnant women in China, we explored the immediate changes in preterm birth rates during the COVID-19 mitigation period using an interrupted-time-series analysis. We defined the period prior to February 1, 2020 as the baseline, followed by the COVID-19 mitigation stage. In the first month of the COVID-19 mitigation, a significant absolute decrease in preterm birth rates of 0.68% (95%CI:−1.10% to −0.26%) in singleton, and of 2.80% (95%CI:−4.51% to −1.09%) in multiple births was noted. This immediate decline in Wuhan was greater than that at the national level among singleton births [−2.21% (95%CI:−4.09% to −0.34% vs. −0.68%)]. Here we report an immediate impact of COVID-19 mitigation measures on preterm birth in China.

Extent of Ejection Fraction Improvement After Revascularization Associated with Outcomes Among Patients with Ischemic Left Ventricular Dysfunction.

PurposeEjection fraction (EF) has been reported to be a major predictor of improved survival in patients with heart failure. However, it is largely unknown whether the extent of improvement in EF affects the subsequent risk of mortality. This study sought to investigate change in EF after revascularization and the implication of these changes on clinical outcomes among patients with ischemic left ventricular dysfunction.Patients and MethodsWe conducted a cohort study (No. ChiCTR2100044378) of patients with reduced EF (≤40%) who received revascularization and had EF reassessment by echocardiography 3 months after revascularization. Patients were categorized according to the absolute change in EF: 1) EF worsened group (absolute decrease in EF >5%); 2) EF unchanged group (absolute change in EF −5% to 5%); 3) EF improved group (absolute increase in EF >5%).ResultsOf 974 patients, 84 (8.6%) had EF worsened, 317 (32.5%) had EF unchanged and 573 (58.8%) had EF improved. The median follow-up time was 3.5 years, during which 143 patients died. For each 5-unit increments in EF, the risk of death decreased by 20% (hazard ratio, HR, per 5% increases, 0.80; 95% CI, 0.73–0.86; P<0.001). Compared with EF improvement group, patients with EF worsened (HR, 3.35; 95% CI, 2.07–5.42; P<0.001) and patients with EF unchanged (HR, 2.05; 95% CI, 1.40–3.01; P<0.001) had significantly higher risk of all-cause death.ConclusionChanges in EF were inversely associated with the risk of mortality. The extent of EF improvement after revascularization might be a potential factor which defines clinical outcomes.

Effect of dietary NSP level and bile acid supplementation on nutrient digestibility and the bile acid metabolism in rainbow trout (Oncorhynchus mykiss)

The effects of dietary bile acid supplementation (BAS) on apparent digestibility coefficients (ADC) and the bile acid metabolism in rainbow trout (Oncorhynchus mykiss) were investigated for diets differing in non-starch polysaccharide (NSP) level. Four experimental diets were formulated according to an 2 by 2 factorial design. A low-NSP and High-NSP diet (0 vs. 160 g kg−1 inclusion of an NSP-rich ingredient mixture) were first formulated. The aim of this was to create differences in the amount of faecal waste produced, and consequently as previously shown in rainbow, the amount of faecal bile acid loss (FBAL). Both NSP-level diets were tested with 0% and 0.3% BAS (0 vs. 3 g kg−1 inclusion of a bile acid mixture). The bile acid mixture contained taurocholic acid (T-CA) and glycocholic acid (G-CA) in a 2:1 ratio. Glycocholic acid does not naturally occur in trout and was used as marker to see if supplemented bile acids are efficiently absorbed and enter enterohepatic circulation (EHC). Fish were fed to apparent satiation for 42 days. Dietary NSP level did not enhance FBAL. BAS was beneficial for fat ADC, but not for the ADC of protein and carbohydrates. BAS improved fat ADC regardless of NSP level, which suggests that bile acids are a limiting factor for fat digestion in rainbow trout. Total bile acid synthesis was a 4-fold lower in fish fed the 0.3% BAS diets compared to the 0% BAS diets. Lower bile acid synthesis with BAS occurred alongside enlarged body and liver + gallbladder bile acid pools and a higher content of bile acids in the chyme. These higher bile acid levels most likely caused a negative feedback inhibition of bile acid synthesis. Negative synthesis rates of G-CA were found when feeding the 0.3% BAS diets, which suggests that this bile acid is catabolised or converted into other bile acid types in rainbow trout. The enlarged pool of T-CA, but especially of the body foreign G-CA, with BAS in both the body and liver + gallbladder shows that dietary bile acids are effectively taking part in EHC. The relative absorption of T-CA and G-CA over the different intestinal compartments was comparable, which shows that EHC does not differentiate between T-CA and G-CA. While relative absorption of bile acids was highest between the distal intestine and the faeces, the absolute decrease in chyme bile acid content was highest between the pyloric region and the mid intestine. The latter shows that significant bile acid absorption occurs more proximal in the intestine of rainbow trout than previously thought.

The long-term evolution of melanocytic nevi among high-risk adults.

There is little understanding regarding the long-term natural history of melanocytic nevi among adults. The objective of the study was to describe the long-term natural history of individual nevi located on the torso of high-risk patients. All patients attending Memorial Sloan Kettering Cancer Center (MSKCC) who underwent two total body photography (TBP) sessions 15+ years apart were included ('retrospective' group). To account for a potential selection bias, we also included consecutive patients who had TBP 15+ years ago and consented to undergo follow-up TBP ('prospective' group). We compared baseline and follow-up torso images on the TBPs and evaluated the number of total, new and disappearing nevi; number of seborrheic keratoses and actinic keratoses; each nevus' diameter at both time points; each nevus' colour change; the presence of clinical atypia; and when dermoscopy was available, the dermoscopic features at each time point. One hundred six patients were included in the study. Although the average age of the patients was 40 at baseline TBP, most patients developed new nevi between imaging sessions (median 16.4 years) with an average of 2.6 (SD = 4.8) nevi per participant. The average number of disappearing nevi was 0.3 (SD = 0.6). In addition, 62/106 (58%) patients had an absolute increase, and 9/106 (8%) patients had an absolute decrease in their total nevus count. Roughly half (49%: 1416/2890) of the nevi that could be evaluated at both time points increased in diameter by at least 25%. Only 6% (159/2890) of nevi shrunk in diameter by at least 25%. Patients with a history of melanoma had a higher rate of disappearing nevi, and their nevi were more likely to grow. Most nevi demonstrated no significant dermoscopic changes. High-risk patients acquire new nevi throughout life with very few nevi disappearing over time. Contrary to prior reports, most nevi in adults increase in diameter, while few nevi shrink.