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Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging

Military Medical Research 2017年第3期4卷 127-131页

作者： david e.winchester Alexander J.Bolanos Anita Wokhlu Rebecca J.Beyth Leslee J.Shaw Malcom Randall VAMC North Florida/South Georgia Veterans Health System Division of Cardiovascular Medicine University of Florida College of Medicine Malcom Randall VAMC Department of Medicine University of Florida College of Medicine Division of General Internal Medicine University of Florida College of Medicine Division of Cardiology Emory University School of Medicine

Background： The prevalence of ischemia on nuclear myocardial perfusion imaging （MPI） has been decreasing. Recent research has questioned the benefit of invasive revascularization for patients with moderate to severe ischemia. We hypothesized that patients with moderate to severe ischemia could routinely undergo successful revascularization. Methods： We analyzed data from 544 patients who underwent an MPI at a single academic Veterans Affairs Medical Center. Patients with moderate to severe ischemia, defined as a summed difference score （SDS） 8 or greater, were compared to the rest of the cohort. Results： Of the total cohort （n=544）, 39 patients had MPI studies with resultant moderate to severe ischemia. Patients with ischemia were more likely to develop coronary artery disease （74.4% versus 38.8%, P〈0.0001） and have successful revascularization （38.5% versus 4.0%, P〈0.0001） during the following year. Revascularization was attempted in 31 patients with moderate to severe ischemia, though only 15（47%） of these attempts were successful, Ischemia was predictive of myocardial infarction （5.1% versus 0.8%, P=0.01） within I year. Conclusion： Moderate to severe ischemia is an uncommon finding in a contemporary nuclear laboratory. Among patients with ischemia, revascularization is typically attempted but is frequently unsuccessful. Trial registration： This trial does not appear on a registry as it is neither randomized nor prospective.

关键词： Myocardial ischemia Nuclear myocardial perfusion imaqinq Veterans Revascularization

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Physician-level variation in the diagnosis of myocardial infarction and the use of angiography among veterans with elevated troponin

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Journal of Medical Colleges of PLA(China) 2016年第3期31卷 129-133页

作者： david e.winchester Nayan Agarwal Lucas Burke Steven Bradley Tatiana Schember Carsten Schmalfuss Division of Cardiovascular Medicine University of Florida College of MedicineGainesville FLUSA Malcom Randall Veterans Affairs Medical Center GainesvilleFLUSA Division of Cardiology Department of MedicineVA Eastern Colorado Health Care SystemDenverCOUSA Department of Medicine University of Colorado School of Medicine at the Anschutz Medical CampusAuroraCOUSA.

Background:Cardiac troponin assays have improved the ability to detect myocardial ***,ascertaining whether troponin elevation is due to myocardial infarction(MI) or secondary to another process can be *** aim is to evaluate provider-level variation in the diagnosis of MI and the use of invasive coronary angiography(ICA) among patients with undifferentiated elevations in cardiac ***:We analyzed data from all patients with elevated troponin levels in a single Veterans Affairs(VA) Medical Center between 2006 and *** of several cardiologists prospectively evaluated each patient's presentation and course of *** compared the frequency of MI diagnosis and ICA use between physicians using univariate odds ratios(OR).Results:Among 761 patients,34.0% were diagnosed with MI and 25.9% underwent *** unadjusted rates of MI(23.9% to 56.7%,P=0.02) and ICA(17.3% to 73.3%,Pered between *** the patient cohorts for each physician,baseline characteristics were similar except for chest *** multivariate regression,factors associated with the use of cardiac ICA included an abnormal electrocardiograph(eCG)(OR=1.89,P=0.014),level of troponin(OR=1.71,P=0.004),chest pain(OR=8.60,Pe by non-VA physicians(OR=4.45,P=0.006).One physician had a lower ICA use(OR=0.56,P=0.017).In multivariate regression of MI,no physician-level variation was ***:Among patients with elevated troponin,the likelihood of being diagnosed with MI and undergoing ICA is dependent on their clinical *** adjustment,physician-level variation in care was observed for the use of ICA,but not for the diagnosis of MI.

关键词： Acute coronary syndrome Coronary angiography Variation in care Cardiac troponin

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Quality Improvement in Cardiovascular Imaging

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Cardiovascular Innovations and Applications 2019年第B4期4卷 1-7页

作者： david e.winchester,MD,MS R.Beyth,MD,MS Malcom Randall VA Medical Center GainesvilleFL 32608USA

Implementation of quality improvement(QI)activities is growing in health care settings across the *** cardiovascular imaging,areas for improvement include consistency of result reporting,greater patient safety through reductions in radiation exposure,and greater effi ciency of care delivery by elimination of wasteful practices and elimination of low-value or rarely appropriate *** in health care is often driven through one of several endorsed frameworks,such as Lean,Six Sigma,and the Model for *** examples of how to teach QI to medical trainees and physicians have been *** this narrative review,we explore the growth and impact of QI in cardiovascular imaging,providing specifi c examples of successful projects,barriers to conducting QI,and rewards of persistent effort toward improving care.

关键词： quality improvement cardiovascular non-invasive imaging graduate medical education audit and feedback

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Better Than You Think—Appropriate Use of Implantable Cardioverter-Defi brillators at a Single Academic Center:A Retrospective Review

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Cardiovascular Innovations and Applications 2021年第2期5卷 235-243页

作者： Nikhil H.Shah Steven J.Ross Steve A.Noutong Njapo Justin Merritt Andrew Kolarich Michael Kaufmann William M.Miles david e.winchester Thomas A.Burkart Matthew McKillop UF Division of Cardiovascular Medicine 1600 SW Archer RdPO Box 100277GainesvilleFL 32610USA UVA Division of Cardiovascular Medicine PO Box *** Lee St.CharlottesvilleVA 22908-0158USA The Johns Hopkins Hospital Department of Radiology 601 N Caroline StBaltimore 21287USA The Heart Center 930 Franklin Street SEHuntsvilleAL358015USA Intermountain Medical Center 1380 E Medical Center DrSte 1500St.GeorgeUT 847906USA Carolina Cardiology Consultants Prisma Health1005 Grove RoadGreenvilleSC 29605USA

Background:Implantable cardioverter-defi brillators(ICDs)can be life-saving devices,although they are expensive and may cause *** 2013,several professional societies published joint appropriate use criteria(AUC)assessing indications for ICD *** evaluating the clinical application of AUC are *** registry-based studies estimated that 22.5%of primary prevention ICD implantations were“non-evidence-based”*** the basis of AUC,we aimed to determine the prevalence of“rarely appropriate”ICD implantation at our institution for comparison with previous ***:We reviewed 286 patients who underwent ICD implantation between 2013 and *** of each ICD implantation was assessed by independent review and rated on the basis of ***:Of 286 ICD implantations,two independent reviewers found that 89.5%and 89.2%,respectively,were appropriate,5.6%and 7.3%may be appropriate,and 1.8%and 2.1%were rarely *** AUC indication was found for 3.5%and 3.4%of ICD implantations,*** prevention ICD implantations were more likely rarely appropriate(2.6%vs.1.2%and 3.6%vs.1.1%)or unrated(6.0%vs.1.2%and 2.7%vs.0.6%).The reviewers found 3.5%and 3.4%of ICD implantations,respectively,were non-evidence-based *** difference in rates between reviewers was not statistically signifi ***:Compared with prior reports,our prevalence of rarely appropriate ICD implantation was very *** high appropriate use rate could be explained by the fact that AUC are based on current clinical *** AUC could benefi t from additional secondary prevention *** importantly,clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.

关键词： Appropriate use appropriate use criteria implantable cardioverter-defi brillator

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Mitochondrial recruitment in myelin:an anchor for myelin dynamics and plasticity?

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Neural Regeneration Research 2024年第7期19卷 1401-1402页

作者： Jean-david M.Gothié Timothy e.Kennedy Department of Neurology and Neurosurgery Montreal Neurological InstituteMcGill UniversityMontrealQCCanada

Optimal propagation of neuronal electrical impulses depends on the insulation of axons by myelin,produced in the central nervous system by *** is an extension of the oligodendrocyte plasma membrane,which wraps around an axon to form a compact multi-layered *** is composed of a substantially higher proportion of lipids compared to other biological membranes and enriched in a small number of specialized proteins.

关键词： plasticity insulation dynamics

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A systematic scoping review of study methodology for randomized controlled trials investigating probiotics in athletic and physically active populations

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Journal of Sport and Health Science 2024年第1期13卷 61-71页

作者： Alex e.Mohr david B.Pyne Geovana Silva Fogaça Leite Deborah Akins Jamie Pugh College of Health Solutions Arizona State UniversityPhoenixAZ 85004USA Research Institute for Sport and exercise University of CanberraCanberraACT 2617Australia Laboratory of Functional Fermented Food Faculty of Pharmaceutical SciencesUniversity of São PauloSão Paulo 05508-030Brazil Research Institute for Sport and exercise Sciences Liverpool John Moores UniversityLiverpool L33AFUK

Background:The purported ergogenic and health effects of probiotics have been a topic of great intrigue among researchers,practitioners,and the lay public *** has also been an increased research focus within the realm of sports science and exercise medicine on the athletic gut ***,compared to other ergogenic aids and dietary supplements,probiotics present unique study *** objectives of this systematic scoping review were to identify and characterize study methodologies of randomized controlled trials investigating supplementation with probiotics in athletes and physically active ***:Four databases(MeDLINe,CINAHL,Cochrane CeNTRAL,and Cochrane Database of Systematic Reviews)were searched for randomized controlled studies involving healthy athletes or physically active *** intervention with probiotics and inclusion of a control and/or placebo group were *** peer-reviewed articles in english were considered,and there were no date *** were extracted and presented in tabular form to detail study protocols,characteristics,and *** in randomized controlled trials was determined with the RoB 2.0 ***:A total of 45 studies were included in the review,with 35 using a parallel group design and 10 using a cross-over *** half the studies used a single probiotic and the other half a multi-strain *** probiotic dose ranged from 2×10^(8)to 1×10^(11)colony forming units daily,and the length of intervention was between 7 and 150 *** than half the studies directly assessed gastrointestinal symptoms,gut permeability,or the gut *** sex ratio of participants was heavily weighted toward males,and only 3 studies exclusively investigated ***-level adverse events were reported in only 2 studies,although the methodology of reporting varied *** risk of bias was generally low,although details on randomization were lacking in some s

关键词： exercise experimental methodology Gastrointestinal symptoms Gut microbiota Probiotic supplementation

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Instance Segmentation of Characters Recognized in Palmyrene Aramaic Inscriptions

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Computer Modeling in engineering & Sciences 2024年第9期140卷 2869-2889页

作者： Adéla Hamplová Alexey Lyavdansky TomášNovák Ondrej Svojše david Franc Arnošt Veselý Czech University of Life Sciences in Prague(CULS) Faculty of Economics and ManagementDepartment of Information EngineeringPrague16500Czech Republic National Research University Higher School of economics(HSe) Faculty of HumanitiesInstitute for Oriental and Classical StudiesMoscow101000The Russian Federation

This study presents a single-class and multi-class instance segmentation approach applied to ancient Palmyrene inscriptions,employing two state-of-the-art deep learning algorithms,namely YOLOv8 and Roboflow *** goal is to contribute to the preservation and understanding of historical texts,showcasing the potential of modern deep learning methods in archaeological *** research culminates in several key findings and scientific *** comprehensively compare the performance of YOLOv8 and Roboflow 3.0 in the context of Palmyrene character segmentation—this comparative analysis mainly focuses on the strengths and weaknesses of each algorithm in this *** also created and annotated an extensive dataset of Palmyrene inscriptions,a crucial resource for further research in the *** dataset serves for training and evaluating the segmentation *** employ comparative evaluation metrics to quantitatively assess the segmentation results,ensuring the reliability and reproducibility of our findings and we present custom visualization tools for predicted segmentation *** study advances the state of the art in semi-automatic reading of Palmyrene inscriptions and establishes a benchmark for future *** availability of the Palmyrene dataset and the insights into algorithm performance contribute to the broader understanding of historical text analysis.

关键词： Optical character recognition instance segmentation Palmyrene ancient languages computer vision

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Kerogen Kinetic Distributions and Simulations Provide Insights into Petroleum Transformation Fraction (TF) Profiles of Organic-Rich Shales

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Journal of earth Science 2024年第3期35卷 747-757页

作者： david A.Wood DWA energy Limited Lincoln LN59JPUnited Kingdom

Two hundred and fifty single first-order Arrhenius reactions are simulated to generate S2 pyrograms at three heating rates 25,15,and 5°C·*** activation energy(e)and pre-exponential factor(A)of the reactions simulated follow a long-established trend of those variable values displayed by shales and *** characteristics of the transformation fraction(TF)profiles(product generation window temperatures)of the simulated single reactions are compared to the TF profiles of recorded shale pyrograms generated by multiple reactions with different e-A values lying near the defined e-A *** similarities and differences are observed between the TF profile values of the two *** similarities support the spread of e-A values involved in shale pyrogram best *** differences are most likely explained by the complexity of the multiple kerogen first-order and second-order reactions contributing to the recorded shale pyrograms versus the simplicity and crispness of the single first-order reactions *** results also justify the validity of using the previously described“variable e-A pyrogram-fitting method”of multi-heating-rate shale pyrograms enabling optimizers to choose multiple reactions from an unlimited range of e-A *** contrast,further doubt is cast on the validity of the constant-A pyrogram-fitting method used by the easy%Ro technique,in that a distribution of reactions with a single A value is unlikely to represent the complex variety of kerogen macerals observed in shale *** profiles generated by the variable e-A pyrogram-fitting method lie close to the established e-A trend and are likely to provide more realistic TF generation window temperatures than TF profiles generated by the constant-A pyrogram-fitting method.

关键词： transformation fraction profiles simulated S2 pyrograms multiple heating rates kerogen/shale kinetics S2 pyrogram fitting techniques kerogen petroleum research.

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Transjugular Intrahepatic Portosystemic Shunt Linked to Increased Risk of Hepatocellular Carcinoma:A VA Matched Cohort Study

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Journal of Clinical and Translational Hepatology 2024年第5期12卷 534-538页

作者： Shalini Bansal Tamar Taddei Rebecca Wells Marina Serper Theresa Bittermann Nadim Mahmud david e.Kaplan Sidney Kimmel Medical College at Thomas Jefferson University PhiladelphiaPAUSA Division of Gastroenterology and Hepatology Perelman School of Medicine University of PennsylvaniaPhiladelphiaPAUSA Corporal Michael J.Crescenz VA Medical Center PhiladelphiaPAUSA Division of Gastroenterology and Hepatology Yale University School of MedicineNew HavenCTUSA VA Connecticut Healthcare System West HavenCTUSA

Hepatocellular carcinoma(HCC)is the most common primary tumor of the liver and often evolves from regenerating nodules in liver *** there have been significant advances in the treatment of HCC,the overall prognosis in patients with a large tumor burden,vascular invasion,or extrahepatic spread remains poor.1 The magnitude of liver stiffness in cirrhosis has been consistently associated with an increased risk of development of HCC.

关键词： Carcinoma invasion cirrhosis

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Role of climatic variability in shaping intraspecific variation of thermal tolerance in Mediterranean water beetles

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Insect Science 2024年第1期31卷 285-298页

作者： Susana Pallarés david Garoffolo Belén Rodríguez david Sánchez-Fernández Department of Zoology University of SevilleSevilleSpain Faculty of Biology Department of Ecology and HydrologyUniversity of MurciaCampus EspinardoMurciaSpain

The climatic variability hypothesis(CVH)predicts that organisms in more thermally variable environments have wider thermal breadths and higher thermal plasticity than those from more stable ***,due to evolutionary trade-offs,taxa with greater absolute thermal limits may have little plasticity of such limits(trade-off hypothesis).The CVH assumes that climatic variability is the ultimate driver of thermal tolerance variation across latitudinal and altitudinal gradients,but average temperature also varies along such *** explored intraspecific variation of thermal tolerance in three typical Mediterranean saline water beetles(families Hydrophilidae and Dytiscidae).For each species,we compared two populations where the species coexist,with similar annual mean temperature but contrasting thermal variability(continental *** population).We estimated thermal limits of adults from each population,previously acclimated at 17,20,or 25℃.We found species-specific patterns but overall,our results agree with the CVH regarding thermal ranges,which were wider in the continental(more variable)*** the two hydrophilid species,this came at the cost of losing plasticity of the upper thermal limit in this population,supporting the trade-off hypothesis,but not in the dytiscid *** results support the role of local adaptation to thermal variability and trade-offs between basal tolerance and physiological plasticity in shaping thermal tolerance in aquatic ectotherms,but also suggest that intraspecific variation of thermal tolerance does not fit a general pattern among aquatic *** such intraspecific variation could lead to inaccurate predictions of the vulnerability of aquatic insects to global warming.

关键词： acclimation capacity aquatic insects climate change heat coma temperature supercooling point thermal plasticity

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