State Level Research Articles

Cognitive Difficulty in Middle Eastern and North African Adults Living in the United States Compared With Other Racial and Ethnic Categories, 2017-2021.

Objectives. To estimate the odds of having cognitive difficulties among Middle Eastern and North African (MENA) American adults and compare these odds with those of White, Black, Hispanic/Latino, Asian, American Indian or Alaska Native (AI/AN), and Native Hawaiian/Other Pacific Islander adults nationally and in the 4 states with the largest MENA populations (California, New York, Michigan, and Texas) after adjusting for sociodemographic factors. Methods. We analyzed 2017-2021 American Community Survey data (aged ≥ 45 years; n = 7 284 988), comparing presence of cognitive difficulties by race/ethnicity. Results. MENA adults had greater odds of reporting cognitive difficulties than did White (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.42, 1.56), Black (OR = 1.20; 95% CI = 1.14, 1.26), Hispanic (OR = 1.46; 95% CI = 1.39, 1.53), Asian (OR = 1.31; 95% CI = 1.25, 1.38), and AI/AN (OR = 1.07; 95% CI = 1.01, 1.14) adults. In all 4 states, odds of having cognitive difficulties were higher among MENA than Asian adults. Other racial/ethnic comparisons differed by state. Conclusions. A separate checkbox for MENA Americans approved by the Office of Management and Budget is important so health outcomes can be studied in more detail and funds can be allocated for research and resources at state and national levels. (Am J Public Health. 2024;114(11):1265-1274. https://doi.org/10.2105/AJPH.2024.307803).

Gastronationalism in Cornwall

Discussions of gastronationalism have largely focused on nationalist politics at the state level, especially in the realm of European integration and Americanisation. This paper, therefore, explores how gastronationalism is manifested at the subnational level by asking the question ‘What role does food play in the construction of Cornish national identity vis-à-vis England?’ This paper first reviews the literature around gastronationalism to explore how the concept has developed. It shall raise the example of Cornwall as having much in common with previous case studies of gastronationalism in how heritage foods are protected in a politics concerned with homogenisation. A contrast will then be drawn between the generally discussed contexts, with the strong economic incentives to develop an inclusive food culture as part of a national brand that appeals to tourists in Cornwall, which also contributes to the ‘lived brand’ of Cornwall. To investigate this question, a thematic and qualitative content analysis of local tourist boards’ promotional content is conducted in comparison to other English counties. Finally, it shall conclude that gastronationalism is conceptually relevant to the Cornish context, but the specific nature of cultural revivalism suggests the concept should be expanded to better account for subnational gastronationalist efforts.

Machine Learning Analysis of Factors Influencing Pediatric Telehealth Visits During COVID-19: A State-Level Comparison Using 2021-22 National Survey of Children's Health Data.

Background/Objectives: The COVID-19 pandemic reduced in-person pediatric visits in the United States by over 50%, while telehealth visits increased significantly. The national use of telehealth for children and the factors influencing their use have been rarely studied. This study aimed to investigate the prevalence of telehealth use during the COVID-19 pandemic and explore the potential factors linked to its use at the state level. Methods: A cross-sectional study of the National Survey of Children's Health (2021-22) sponsored by the federal Maternal and Child Health Bureau was performed. We used the least absolute shrinkage and selection operator (LASSO) regression to predict telehealth use during the pandemic. A bar map showing the significant factors from the multivariable regression was created. Results: Of the 101,136 children, 15.25% reported using telehealth visits due to COVID-19, and 3.67% reported using telehealth visits due to other health reasons. The Northeast states showed the highest telehealth use due to COVID-19. In the Midwest and Southern states, children had a lower prevalence of telehealth visits due to other health reasons. The LASSO regressions demonstrated that telehealth visits were associated with age, insurance type, household income, usual source of pediatric preventive care, perceived child health, blood disorders, allergy, brain injury, seizure, ADHD, anxiety, depression, and special needs. Conclusions: This study demonstrated significant variability in the use of telehealth among states during the COVID-19 pandemic. Understanding who uses telehealth and why, as well as identifying access barriers, helps maximize telehealth potential and improve healthcare outcomes for all.

상태학업착수지연척도 개발 및 타당화

Objectives This study aimed to develop and validate a scale for intervening in academic procrastination. First, to easily capture improvement pre- and post-intervention, the scale was developed at the state level rather than the chronic level. Second, focusing on the specific phenomenon of academic procrastination as “delaying the initiation of studying” - a core characteristic in the definition of academic procrastination- an operational definition was es-tablished in developing this scale. Methods To this end, we developed a SAIPS and conducted reliability analysis and EFA with 417 college students randomly extracted from the first-round data) and extracted the main factor from it. Subsequently, we performed CFA on three validation samples and evaluated the model fit. In addition, we verified the convergent and discrim-inant validity. Results From this sample, the final 1-factor 10-item scale was derived, and a high reliability of .90 or higher was confirmed. In the first validation sample (417 college students not included in the estimation sample from the first-round data), CFA showed adequate fit, with CFI .954, TLI .941, RMSEA .077, and SRMR .040. In the second validation sample, comprising 249 college students from the second-round data, CFA showed relatively low fit (CFI=.862, TLI=.822, RMSEA=.158, SRMR=.067). However, the third validation sample (627 middle and high school students from the first-round data) showed considerably good model fit (CFI=.983, TLI=.978, RMSEA= .062, SRMR=.021). Correlation analysis revealed discriminant validity, demonstrating significant negative correla-tions with “regular and consistent practices”, “self-confidence”, “self-regulation efficacy”, “academic efficacy”, and “academic enthusiasm efficacy”. Additionally, significant positive correlations were found with “chronic pro-crastination”, “chronic academic procrastination”, “academic procrastination state inventory: academic pro-crastination”, and “academic procrastination state inventory: fear of failure”, ensuring convergent validity. Conclusions The findings suggested the clinical implications of the scale developed in this study for future educa-tional and counseling interventions. Finally, the significance and limitations of this study were discussed.

Unimolecular processes in diatomic carbon anions at high rotational excitation

On the millisecond to second time scale, stored beams of diatomic carbon anions C2− from a sputter ion source feature unimolecular decay of yet unexplained origin by electron emission and fragmentation. To account for the magnitude and time dependence of the experimental rates, levels with high rotational and vibrational excitation are modeled for the lowest electronic states of C2−, also including the lowest quartet potential. Energies, spontaneous radiative decay rates (including spin-forbidden quartet-level decay), and tunneling dissociation rates are determined for a large number of highly excited C2− levels and their population in sputter-type ion sources is considered. For the quartet levels, the stability against autodetachment is addressed and recently calculated rates of rotationally assisted autodetachment are applied. Nonadiabatic vibrational autodetachment rates of high vibrational levels in the doublet C2− ground potential are also calculated. The results are combined to model the experimental unimolecular decay signals. Comparison of the modeled to the experimental rates measured at the cryogenic storage ring facility CSR gives strong evidence that C2− ions in quasistable levels of the quartet electronic states are the so far unidentified source of unimolecular decay. Published by the American Physical Society 2024

São Luiz do Paraitinga: o rio e os cenários pós-enchentes

The city of São Luiz do Paraitinga has had a unique trajectory in relation to the context of cities in the Paraíba Valley region, in São Paulo, Brazil. Since the foundation of its settlement and the planning of its layout in the 18th century by Morgado de Mateus, the town has remained on the fringes of regional development, playing a less important role in the coffeeproduction circuit, which has allowed certain local traditions to remain, such as the caipira culture, the rural way of life and the religious festivities that are still local attractions today. In 2010, an unprecedented floodswept through its historic center. Buildings made of wattle and daub were unable to withstand the water and collapsed, with partial and total damage remaining. The reconstruction of the city, as well as the landmarks listed at state and federal level, represent a unique case among similar Brazilian cases, which justified a more in-depth study. The 1982 Conselho de Defesa do Patrimônio Histórico, Arqueológico, Artístico e Turístico do Estado and 2010 Instituto do Patrimônio Histórico e Artístico Nacional registrations reiterated the importance of the city center, its architectural ensemble and its landscape, as it was one of the first planned foundations. However, the social, cultural and economic contrasts between the Historic Center and other neighborhoods in the city raise the question of the effectiveness of landmarks and their management as a Historic and Landscape Heritage. In 2022, the cycle restarted and a flood again caused damage to at least 120 buildings. Faced with this fact, the question arises of how to preserve a landscape that is permanently at risk.

Do State Legislative Staffer Networks Influence Roll-call Voting? Evidence from Shared Personal Staffers in Arizona, Indiana, and New Mexico

Abstract Legislative staffers are an invisible force in legislative bodies that provide every imaginable service. It is doubtful that modern legislatures could operate without them. Prior studies of Congressional staffers have found evidence that staffers not only aid but also exert an independent influence on the policy-making process through network effects. In this article, I test if this extends to state legislative staffers using novel data from shared staffer networks in Arizona, Indiana, and New Mexico. I argue that, compared to their Congressional counterparts, state legislative staffers are more akin to ‘clerks’ than ‘political professionals’ and this limits their ability to independently influence policymaking at the state level.

Text Analysis of the System of Changing Majors in Chinese Universities

The major, as the most basic unit for cultivating talents, has always been a subject of public concern. The choice of major affects the effectiveness of talent cultivation, and the correct choice of major is one of the key factors affecting the level of study commitment and state, as well as the student's college experience and the quality of undergraduate education. It is crucial to pay close attention to the adjustment and conversion of majors for students who are dissatisfied with their majors after entering a university. This paper lists the theoretical basis for major transfer, describes the development of relevant major regulations in China, and analyzes the implementation regulations of five randomly selected universities, it raises issues and provides relevant suggestions.

Maturity model for evaluating integrity management in public procurement

This article presents the maturity model for evaluating integrity management in public procurement developed from national and international practices for identifying, assessing, and mitigating integrity risks. The model consists of 30 assessment questions weighed across four maturity levels. It was formulated through a comprehensive literature review and validated in four Brazilian public agencies at municipal, state, and federal levels. This model allows for self-assessment of key weaknesses and strengths in contractual risk management and supports the continuous improvement process of internal controls to preserve public value.

Adequacy of measures to threats as one of the fundamental ­principles of safety riskology

Purpose. To justify the need to apply the “principle of adequacy of probabilities” as a measure to improve the risk management methodology, to prevent (counteract) existing and emerging risks (threats) to the security of complex systems. Methodology. The well-known methodological principle called “Ockam’s Razor” was used. In the course of the research, a complex method was used, which included formal and logical analysis of normative and scientific and technical literature, analysis of statistical data, synthesis, abstraction, experiment, observation, generalization of data, description. Findings. In the course of the research, one of the threats (danger, risk) was identified, which simultaneously affects the existence of such a system due to traffic safety of rolling stock of rail transport enterprises, and the full implementation of the system’s capabilities due to axle loads, mass and speed movement of rolling stock, level of operating costs, passenger flow, regularity of transportation, etc. Experimental application of the lubricant “Mariol NT” in SPP 12-5, GS-3 lubrication systems showed a decrease in wear intensity by 240 %. Due to the use of a new lubricating material applied to the friction surface of wheel rims as part of the paint coating, the wear intensity of flanges of twin-wheel rims is reduced by 2.2 times, and that of locomotives by 2.4 times. Originality. It was determined that the “principle of adequacy of probabilities” as a measure of improvement of the risk management methodology, prevention (counteraction) of existing and prospective risks (threats, dangers) during the safety assessment of complex systems is currently not applied, but its consideration helps to prevent (countermeasures) to existing and emerging risks (threats) to the safety of complex systems. Practical value. The use of the “principle of adequacy of probabilities” allows for the theoretical and experimental determination of the numerical value of the ratio between the probability of an event occurring, caused by the action of an identified threat that negatively affects the state (level) of safety and operability of system elements at all stages of its existence, and the probability of a positively compensatory effect of the developed countermeasure to the identified threat.

The Effectiveness of Face Mask Mandates on COVID-19 Transmission in Utah.

Throughout the COVID-19 pandemic, the effectiveness of face mask mandates was intensely debated. The objective of this study was to describe how face mask mandates at the state, county, and local levels differed in their effectiveness in reducing the number of COVID-19 cases in the jurisdiction where the mandate was implemented and throughout Utah. We used publicly available data from the Utah Department of Health and Human Services. We calculated the effectiveness of face mask mandates (EFm) in each local health district after 3 key mandates: the enactment of face mask mandates in Salt Lake and Summit counties (SLSC) on June 28, 2020, and June 27, 2020, respectively; the enactment of a statewide face mask mandate on November 9, 2020; and the lifting of the statewide face mask mandate on April 10, 2021. Most counties in Utah had a reduction in the growth rate of COVID-19 cases after enactment of face mask mandates. We found an average 11.9% reduction in EFm after the introduction of the SLSC face mask mandates, with 8 of 13 local health districts experiencing a reduction, and an average 12.7% reduction after introduction of the statewide mandate, with 12 of 13 local health districts experiencing a reduction. After mandates were lifted, many counties had an increase in EFm. Face mask mandates were an effective way to reduce transmission of COVID-19 in local jurisdictions and in neighboring jurisdictions in Utah. Our evidence supports the use of face mask mandates as a way to prevent disease transmission and be better equipped to respond to future pandemics.

DKVMN&MRI: A new deep knowledge tracing model based on DKVMN incorporating multi-relational information.

Knowledge tracing is a technology that models students' changing knowledge state over learning time based on their historical answer records, thus predicting their learning ability. It is the core module that supports the intelligent education system. To address the problems of sparse input data, lack of interpretability and weak capacity to capture the relationship between exercises in the existing models, this paper build a deep knowledge tracing model DKVMN&MRI based on the Dynamic Key-Value Memory Network (DKVMN) that incorporates multiple relationship information including exercise-knowledge point relations, exercise-exercise relations, and learning-forgetting relations. In the model, firstly, the Q-matrix is utilized to map the link between knowledge points and exercises to the input layer; secondly, improved DKVMN and LSTM are used to model the learning process of learners, then the Ebbinghaus forgetting curve function is introduced to simulate the process of memory forgetting in learners, and finally, the prediction strategies of Item Response Theory (IRT) and attention mechanism are used to combine the similarity relationship between learners' knowledge state and exercises to calculate the probability that learners would correctly respond during the subsequent time step. Through extensive experiments on three real-world datasets, we demonstrate that DKVMN&MRI has significant improvements in both AUC and ACC metrics contrast with the latest models. Furthermore, the study provides explanations at both the exercise level and learner knowledge state level, demonstrating the interpretability and efficacy of the proposed model.

Heterogeneous influences of specialization and diversification on regional R&D performance: a China, Europe, and US comparison

Abstract We study the impact of industrial specialization and diversification on regional R&D performance. We respond to a need to consider specialization and diversification as being complementary and to cover a broad geographical scope. Based on Malmquist-based data envelopment analysis, we disclose disparity in R&D productivity and underlying efficiency and technical change in regions in China, Europe, and in the USA in the period 2015–19. For provinces in China, industrial diversification affects regional R&D productivity growth and efficiency enhancement in a U-shape mode. For European countries, specialization has a U-shaped influence on R&D productivity change, and diversification has an inverted U-shaped influence on productivity and efficiency change. We find no significant influence of specialization and diversification on the improvement of R&D performance at the level of states in the USA. Our findings point to place-based specificities and complementarity between specialization and diversification and come with policy recommendations for enhancing regional R&D performance.

Standing on the shoulders of giants: molecular data confirm Kükenthal’s systematic placement of the Australian endemic Carex archeri (Cyperaceae)

Archer’s sedge (Carex archeri Boott) is a small, rare (or possibly overlooked by collectors due to the diminutive size) species restricted to alpine and subalpine habitats in south-eastern mainland Australia and Tasmania. The systematic placement has been obscure with the species having been historically associated with sections in four of the six recognised Carex subgenera. We investigated the placement of C. archeri by addition to the available Carex molecular phylogenetic framework. Our results support C. archeri belonging to sect. Junciformes (in subg. Psyllophorae), making this the only representative of the subgenus in Australia. This placement was first proposed by Kükenthal (1909) who regarded C. archeri as a synonym of the New Zealand endemic C. acicularis Boott but our phylogenetic analyses support C. archeri as a separate taxon. Our approach highlights the utility of molecular barcoding for elucidating systematic relationships of poorly known taxa. Biogeographic reconstruction suggests Late Miocene dispersal from South America to the south-western Pacific but does not clarify whether New Zealand or Australia was colonised first. We evaluate the conservation status of Carex archeri using IUCN criteria as Endangered at the global level. At the state level, we propose Critically Endangered status in New South Wales, Endangered in Victoria and Data Deficient in Tasmania.

PUBLIC POLICIES OF THE STATE OF SANTA CATARINA FOR REGULATING THE PEDAGOGICAL TECHNICAL ASSISTANT

This text aims to analyze the public policies of the state of Santa Catarina that regulate the duties of the Technical Pedagogical Assistant - ATP, a professional position assigned to educational institutions and various agencies responsible for education at the state level, in order to identify the conception and expected contribution of this professional position to the quality of education. The research highlighted theoretical aspects of the conception of public policies, including the identification of the main policies in the Constitution, in the Law of Guidelines and Bases of Education - LDB and State Law No. 1,139/1992. This is a bibliographical research that was based on the classical theoretical aspect and on legislation, enabling the conclusions that are in the sense that the creation of a technical position of pedagogical assistant with clear and objective duties makes the organizational structure of education solid, strengthened and that streamlines the pedagogical process by ensuring technical and management support in the educational routine for efficiency in educational practice, enabling the overcoming of the challenges of contemporary education.

Toward Efficient Modeling of Nonradiative Decay in Extended INVEST: Overcoming Computational Challenges in Quantum Dynamics Simulations.

In recent years, an increasing number of fully organic molecules capable of thermally activated delayed fluorescence (TADF) have been reported, often with very small or even inverted singlet-triplet (INVEST) energy gaps. These molecules typically exhibit complex photophysics due to the close energy levels of multiple singlet and triplet states, which create various transition pathways toward emission. A predictive model for the rates of these transitions is thus essential for assessing the suitability of new materials for light-emitting devices. Quantum Dynamics (QD) calculations are ideal for this purpose, as they include quantum effects, without the limitations of first-order perturbative approaches, also allowing taking into account more than two electronic states at once. However, the huge computational demands of QD methodologies, especially for large molecules, currently limit their use as a standard tool. To address this problem, we here employ a strategy that allows us to include almost the whole set of the vibrational coordinates by selecting the key elements of the Hilbert space that significantly impact dynamics, thereby hugely reducing the computational burden. Application of this protocol to two relatively large INVEST molecules reveals that internal conversion in these systems is very fast, making indirect emissive pathways a possible channel for the population of the S1 state. More importantly, this study demonstrates that the dynamics can be accurately described even with a significantly reduced vibrational space, thus allowing quantum dynamics calculations that yield accurate transition rates in a few minutes of computational time.

Prevalence of Adverse Childhood Experiences Among Adolescents.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events with lifelong negative impacts. Population-level data on ACEs among adolescents have historically relied on parent reports and excluded abuse-related ACEs. We present the self-reported prevalence of ACEs among a large population-based sample of US high school students. Using cross-sectional, state-representative data from 16 states that included core ACE questions on their 2021 Youth Risk Behavior Survey, we estimate the prevalence of 8 individual (lifetime emotional, physical, or sexual abuse, physical neglect, witnessed intimate partner violence, household substance use, household poor mental health, incarcerated parent or guardian) and cumulative ACEs (0, 1, 2-3, ≥4) among a large population-based sample of adolescents, overall and by demographic characteristics (sex, race and ethnicity, age, sexual orientation). Emotional abuse (65.8%), household poor mental health (36.1%), and physical abuse (32.5%) had the highest prevalence. ACEs were very common, with 80.5% of adolescents experiencing at least 1 ACE and 22.4% experiencing ≥4 ACEs. Experiencing ≥4 ACEs was highest among adolescents who were female (27.7%), non-Hispanic multiracial (33.7%), non-Hispanic American Indian or Alaska Native (27.1%), gay or lesbian (36.5%), bisexual (42.1%), or who described their sexual identity some other way or were not sure of their sexual identity (questioning) (36.5%). Self-reported ACE estimates among adolescents exceed previously published parent-reported estimates. ACEs are not equally distributed, with important differences in individual and cumulative ACEs by demographic characteristics. Collecting ACE data directly from adolescents at the state level provides actionable data for prevention and mitigation.

Operationalizing Macro-Level Structural Sexual Minority Stigma: A Scoping Review of the Literature

Abstract Background Structural stigma, including discriminatory laws, inequitable policies, and negative attitudes, has been conceptualized as the general societal climate and institutional conditions that shape sexual minorities’ lives, mental, and physical health. While multidimensional indices have been used globally, U.S.-based studies have largely relied on single indicators (e.g., a law or policy; presence of resources). This scoping review aimed to identify structural sexual minority stigma indicators relevant to the U.S. context, to inform comprehensive, multidimensional future operationalizations. Methods Systematic database searches in PubMed, PsycINFO, and JSTOR, and snowball techniques resulted in 70 articles. After duplicate deletion and abstract review, 25 unique indices were long-listed relevant to structural sexual minority stigma at country or state level (i.e., macro level). School (district) and county (i.e., exo level) indicators were excluded. Results From the long-listed indices, a total of 112 legal and policy indicators were narrowed down to relevant 33 macro-level indicators and grouped across seven domains: criminal justice, hate crime protections, non-discrimination, religious refusal, relationship recognition, parenting, and youth laws and policies. Two different quantifications of population attitudes were identified that aggregated social and policy opinions across states regarding sexual minority adoption, hate crimes, health benefits, labor and housing, public speaking or teaching, marriage, sodomy, and civil unions. Discussion While a large variety of legal and attitudinal indicators was identified, few U.S.-based studies used multidimensional operationalizations (e.g., law, policy, opinion) needed to reduce risk of confounding bias through population-attitudes-to-law/policy backdoor pathways. To further advance the science on structural sexual minority stigma and health globally, future studies may benefit from multidimensional approaches. Key messages • With many legal and attitudinal indicators identified, few studies used multidimensional operationalizations (e.g., law, policy, opinion) needed to reduce risk of confounding bias. • To further advance the science on structural sexual minority stigma and health globally, future studies may benefit from multidimensional approaches.

The analysis of orientational metaphor of ‘Zhōng’ (中) in Chinese traditional classic The Doctrine of the Mean

Abstract This paper studies the orientational metaphor of zhōng (中, ‘middle’) and its cultural values behind this metaphor in Chinese Traditional Classic The Doctrine of Mean. It is found that there are three metaphorical meanings for the orientational metaphor of zhōng (中, ‘middle’), including “an emotion of calm.”; “a moderate degree” and “an ethical standard”. The ethical standard of zhōng is the judge criteria for the Chinese traditional role schemas jūnzǐ (君子, ‘a person of noble character’) and xiǎorén (小人,‘a person of petty character’). In addition, the cultural values of Chinese society revealed by the ethical standard of zhōng (中, ‘middle’) are concluded systematically from the levels of individual, family and state.

Atrial and ventricular mitral regurgitation in the general population

Abstract Background Functional mitral valve regurgitation (FMR) is the result of two concurrent pathomechanisms: (1) the dilatation of mitral valve annulus (atrial) or (2) remodelling of the left ventricle (ventricular) in the absence of relevant leaflet degeneration¹. Even though FMR has been reported to be the most common cause of relevant MR², there is no general accepted definition of the two subtypes, nor are there population-based data regarding their prevalence, distribution and risk profiles¹. Purpose We aimed to evaluate the prevalence of FMR and to provide an in-depth characterisation of the subtypes aFMR and vFMR in the general population. Methods The study included the first 10,000 participants of the population-based Hamburg City Health Study enrolled between 2016 and 2019. Of these, 8.543 echocardiographic samples were available for analysis. Mitral valve was assessed by two independent investigators. Isolated degenerative MRs as determined by valve mobility (prolapse or restrictive) were excluded. FMR was classified as ventricular when fulfilling one of the following criteria: history of myocardial infarction or coronary artery disease, left ventricular ejection fraction (LVEF) ≤ 40%, restrictive leaflet, tenting area ≥ 150 mm² or coaptation depth ≥ 10 mm. All FMR with LVEF > 55% were classified as atrial. Results After excluding the samples with an insufficient image quality or missing data and re-assessment by the second investigator, 216 of 282 participants with a relevant MR (i.e. moderate or severe) remained (2,6% of the total cohort, see figure 1). In the next step, 153 participants were classified as pure FMR (68.9%), the remaining were mainly functional with minor degenerative features. A total of 31 (14.4%) MRs were classified as vFMR, the remaining 185 participants had an aFMR. Female gender was significantly more common in the aFMR cohort. The remaining demographic variables (age, body mass index) as well as established cardiovascular risk factors (i.e., diabetes, smoking, hypertension) were comparable between the vFMR and aFMR cohort. However, vFMR patients had significantly higher levels of NT-proBNP or NHYA state and presented more frequently with an atrial fibrillation (see figure 2). LVEF and LV stroke volume, TAPSE, left atrial ejection fraction and E/A ratio as a parameter of diastolic dysfunction were lower in the vFMR cohort whereas tenting area and left atrial endsystolic volume was significantly increased. Conclusion In our population-based study, aFMR was found to be the predominant subtype of FMR. The established cardiovascular risk factors were comparable in the vFMR and aFMR cohort. Echocardiographic variables differed significantly and indicate more advanced heart failure and LV remodelling in the vFMR cohort. Further categorization of FMR, in particular regarding the prognostic impact and long-term outcomes, is strongly warranted to allow a clinically relevant definition of aFMR and vFMR.Figure 1:Overview of sample sizeFigure 2:Baseline characteristics