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Tujuan Penelitian adalah mencari faktor dan indikator apa yang menyebabkan adanya Gap antara Realita dengan ekspektasi perusahaan dalam penggunaan Knowledge manajemen System pada PT Bank ABC, lalu membangun mode penggunaan KMS di perusahaan PT Bank ABC saat ini dan menentukan strategi implementasi KMS di PT Bank ABC pada masa mendatang. Metode penelitian yang digunakan adalah dengan menggunakan metode pengumpulan data dengan menyebarkan kuesioner kepada responden dan metode Analisa data hasil kuesioner dengan metode Analisa faktor dan Analisa Regresi. Hasil yang diperoleh dari penelitian ini adalah ditemukannya faktor baru beserta indikator penyusun faktor tersebut serta mode perancangan yang ideal. Simpulan yang diperoleh adalah faktor Analisa terkait perancangan Knowledge Management System bagi sales bank ABC antara Organizing Knowledge, Lack of Knowledge Quality, Controling the Knowledge dan Insufficient Knowledge Gathering.

ImportanceDapagliflozin has been shown to improve overall health status based on aggregate summary scores of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failure (HF) with mildly reduced or preserved ejection fraction enrolled in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial. A comprehensive understanding of the responsiveness of individual KCCQ items would allow clinicians to better inform patients on expected changes in daily living with treatment.ObjectiveTo examine the association of dapagliflozin treatment with changes in individual components of the KCCQ.Design, Setting, and ParticipantsThis is a post hoc exploratory analysis of DELIVER, a randomized double-blind placebo-controlled trial conducted at 353 centers in 20 countries from August 2018 to March 2022. KCCQ was administered at randomization and 1, 4, and 8 months. Scores of individual KCCQ components were scaled from 0 to 100. Eligibility criteria included symptomatic HF with left ventricular ejection fraction greater than 40%, elevated natriuretic peptide levels, and evidence of structural heart disease. Data were analyzed from November 2022 to February 2023.Main Outcomes and MeasuresChanges in the 23 individual KCCQ components at 8 months.InterventionsDapagliflozin, 10 mg, once daily or placebo.ResultsBaseline KCCQ data were available for 5795 of 6263 randomized patients (92.5%) (mean [SD] age, 71.5 [9.5] years; 3344 male [57.7%] and 2451 female [42.3%]). Dapagliflozin was associated with larger improvements in almost all KCCQ components at 8 months compared with placebo. The most significant improvements with dapagliflozin were observed in frequency of lower limb edema (difference, 3.2; 95% CI, 1.6-4.8; P P P Conclusions and RelevanceIn this study of patients with HF with mildly reduced or preserved ejection fraction, dapagliflozin was associated with improvement in a broad range of individual KCCQ components, with the greatest benefits in domains related to symptom frequency and physical limitations. Potential improvements in specific symptoms and activities of daily living might be more readily recognizable and easily communicated to patients.Trial RegistrationClinicalTrials.gov Identifier: NCT03619213

The disruptive changes of technological advancements and the COVID-19 pandemic have pushed the education sector to leap into a new learning model, known as hybrid learning. Hybrid learning implements both onsite and online learning to students simultaneously. This research aims to display the impacts of information technology (IT) usage, IT adoption, and innovation capabilities to increase learning process performance during hybrid learning. This research has used a quantitative approach by gathering survey data from 1,160 college students during a hybrid learning process. Hybrid learning had been conducted for four months before the survey was taken in December 2021. The findings show that IT usage, IT adoption, and innovation capabilities significantly affect the hybrid learning process performance. Moreover, IT adoption has the most robust beta coefficient, followed by innovation capabilities and IT usage. Therefore, this research posits that the hybrid learning process performance greatly depends on the adoption of IT, followed by the innovation capabilities of the lecturers. IT usage also supports the hybrid learning process performance. Thus, the three variables are essential in successfully maintaining the hybrid learning process.

Despite mitigation and adaptation efforts, the residual risks of climate change will continue to impact the most vulnerable communities globally. Highly exposed regions, such as the Pacific Islands, will continue to experience profound negative loss and damage as a result of climate change, which will challenge current ways of life. Knowledge on the extent to which regional and national climate change polices can identify and respond to non-economic loss and damage (NELD) is limited. From the perspectives of stakeholders in the Pacific Islands region, this research aims to gain insights into how regional and national policies are responding to NELD, as the well as the barriers, shortcomings, and requirements for future responses. Utilising a mixed qualitative–quantitative approach, this research explores the perspectives of expert informants, including those from the government, donors and development partners, civil society, intergovernmental organisations, and other relevant bodies, such as universities. The key findings of this study indicate that current policy responses include a regional policy that integrates disaster and climate change losses, national efforts to preserve traditional and local knowledge, national adaptation and resilience planning, community-based projects, and relocation and resettlement. Additionally, NELD is a relatively new concept for policymakers, practitioners, and researchers, and it is difficult to conceptualise the diversity of issues related to NELD in the region. Owing to this poor understanding, a key gap relates to the dominance of the economic lens when characterising climate-induced impacts in the region. As such, there is a limited holistic consideration of climate change impacts, and thus a limited appreciation of the interrelated factors of NELD within policy responses that then cascade towards communities. Finally, the paper outlines key policy insights as follows: policies on integration, adaptation, resilience planning, relocation and resettlement have advanced; the economic lens dominates when characterising climate-induced impacts on the region; there is a limited appreciation of the interrelated factors of NELD; and there exists a need to account for residual and intangible losses to land, culture, traditional knowledge, biodiversity, ecosystem services, and human agency. The insights gained from this research can provide a practical basis for guiding local to regional action and help support and design comprehensive risk management solutions in order to address NELD associated with climate change.

Human society has experienced, and will continue to experience, extensive loss and damage from worsening anthropogenic climate change. Despite our natural tendencies to categorise and organise, it can be unhelpful to delineate clean boundaries and linear understandings for complex and messy concepts such as loss and damage. Drawing on the perspectives of 42 local and regional Pacific Islander stakeholders, an underexplored resource for understanding loss and damage, we explore the complexity and interconnectedness of non-economic loss and damage (NELD). According to participants, Pacific Islander worldviews, knowledge systems and cosmologies often make it difficult to separate and evaluate NELD independently, challenging the nomenclature of NELD categories developed through international mechanisms. Instead, NELD understandings are often centred on the interdependencies between losses, including the cascading flow-on effects that can occur and the nature of some losses as risk multipliers (i.e. one loss creating the risk for further losses). Most notably, losses to biodiversity, ecosystem services and land are critically linked to, and have cascading effects on, livelihoods, knowledge, ways of life, wellbeing, and culture and heritage. We argue that loss and damage is not always absolute, and that there are NELD that are arguably reparable. Concerning, however, is that biodiversity loss, as a risk multiplier, was considered the least reparable by participants. We put forward that NELD understandings must consider interconnectivity, and that biodiversity and ecosystem conservation and restoration must be the focus for interventions to prevent irreparable and cascading losses from climate change in the Pacific Islands.

Heart failure (HF) is associated with poor health-related quality of life (HRQL). Patients with HF with preserved ejection fraction (HFpEF) have similar HRQL impairment as those with reduced ejection fraction. This study describes the impact of sacubitril/valsartan on HRQL in patients with HFpEF enrolled in the PARAGON-HF trial.Patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol (EQ-5D) at randomization, 4, 8 months, and annually thereafter. Changes in HRQL scores were evaluated using repeated measures models adjusted for treatment, baseline values and region. The pre-specified principal efficacy assessment was at 8 months at which time patients randomized to sacubitril/valsartan had borderline higher KCCQ clinical summary score (CSS) with least squares mean (LSM) adjusted difference of 1.0 (95% confidence interval [CI] 0.0, 2.1; p = 0.051). Including all visits up to 36 months, the LSM difference in KCCQ-CSS favoured sacubitril/valsartan with average adjusted difference of 1.1 (95% CI 0.1, 2.0; p = 0.034). Patients treated with sacubitril/valsartan had greater odds of clinically meaningful improvement (≥5-point increase) in KCCQ-CSS (odds ratio 1.31; 95% CI 1.06, 1.61) at 8 months. At 8 months, there was no significant difference in the EQ visual analogue scale between the treatment arms, but sacubitril/valsartan was associated with higher EQ-5D utility score (US-based) with LSM adjusted difference of 0.01 (95% CI 0.00, 0.02; p = 0.019).Compared with valsartan, sacubitril/valsartan had a borderline benefit on KCCQ-CSS at 8 months in patients with HFpEF. This benefit became more significant when data from all visits up to 36 months were included. This modest overall benefit was also supported by greater odds of patients reporting a clinically meaningful improvement in HRQL with sacubitril/valsartan.

The Innocor® device utilizes an insoluble gas (SF6) to estimate lung volume and the rate of disappearance of a soluble gas (N2O) to measure pulmonary blood flow (PBF), which approximates cardiac output assuming no shunt. We sought to identify error in the measurement of the insoluble gas in an effort to reduce variation in Innocor® measurement.We enrolled 28 participants from the Dallas Heart Study (mean age 63 years; 57% male; 43% white). Stroke volume was measured at rest and at submaximal (20 and 40 W) exercise using both echocardiography (Philips iE33) and the Innocor® device. We defined a priori peak and equilibrium SF6 measurement errors as greater or less than 20% of the mean observed value. Three Innocor measurements were obtained at rest (N = 27) for a total of 81 measurements. Of these, 22 % had SF6 measurements that fell outside of the priori range.Resting Innocor® stroke volume measures with peak SF6 measured above a priori range (0.12%) was associated with larger stroke volumes compared to stroke volume measures without peak SF6 error [101.4 (26.8) vs. 64.9 (8.7) mL, p = 0.006] and overestimated stroke volume when compared to stroke volume by echo [101.4 (26.8) vs. 59.9 (16.3) mL, p = 0.017]. A similar pattern was observed at submaximal exercise. In contrast, there was no consistent association between variation in equilibrium SF6 concentrations and measured stroke volume.Variability in peak SF6 concentration is common while using the Innocor® device and results in overestimated stroke volume. These findings have implications for research protocols using this device.

Gender differences exist throughout the medical field and significant progress has been made in understanding the effects of gender in many aspects of healthcare. The field of cardio-oncology is diverse and dynamic with new oncologic and cardiovascular therapies approved each year; however, there is limited knowledge regarding the effects of gender within cardio-oncology, particularly the impact of gender on cardiotoxicities. The relationship between gender and cardio-oncology is unique in that gender likely affects not only the biological underpinnings of cancer susceptibility, but also the response to both oncologic and cardiovascular therapies. Furthermore, gender has significant socioeconomic and psychosocial implications which may impact cancer and cardiovascular risk factor profiles, cancer susceptibility, and the delivery of healthcare. In this review, we summarize the effects of gender on susceptibility of cancer, response to cardiovascular and cancer therapies, delivery of healthcare, and highlight the need for further gender specific studies regarding the cardiovascular effects of current and future oncological treatments.

Background Low cardiorespiratory fitness (CRF), high body mass index, and excess visceral adiposity are each associated with impairment in left ventricular (LV) peak circumferential strain (Ecc), an intermediate phenotype that precedes the development of clinical heart failure (HF). However, the association of regional fat distribution and CRF with Ecc independent of each other and other potential confounders is not known. Methods Participants from the Dallas Heart Study Phase 2 who underwent dual energy X-ray absorptiometry assessment of regional fat distribution, CRF assessment by submaximal treadmill test, and Ecc quantification by tissue-tagged cardiovascular magnetic resonance were included in the analysis. The cross-sectional associations of measures of regional adiposity, namely visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and lower-body fat (LBF) with Ecc after adjustment for CRF and other potential confounders (independent variables) were assessed using multivariable linear regression analysis. Results The study included 1089 participants (55% female, 39% black). In the unadjusted analysis, higher VAT was associated with greater impairment in Ecc. After adjustment for baseline risk factors, CRF, parameters of LV structure and function, and other fat depots such as SAT and LBF, higher VAT remained associated with greater impairment in Ecc (β: 0.19, P = 0.002). SAT and LBF were not significantly associated with Ecc, however, CRF remained associated with Ecc in the fully adjusted model including all fat depots (β: − 0.15, P Conclusions VAT and CRF are each independently associated with impairment in Ecc, suggesting that higher VAT burden and low CRF mediate pathological cardiac remodeling through distinct mechanisms.

Non-economic loss and damage induced by climate change in the Pacific Islands region has been reported as fears of cultural loss, deterioration of vital ecosystem services, and dislocation from ancestral lands, among others. This paper undertakes an in-depth systematic review of literature from the frontlines of the Pacific Islands to ascertain the complexities of non-economic loss and damage from climate change. We synthesise knowledge to date on different but inter-connected categories of non-economic loss and damage, namely: human mobility and territory, cultural heritage and Indigenous knowledge, life and health, biodiversity and ecosystem services, and sense of place and social cohesion. Identifying gaps and possibilities for future research agendas is presented. Synthesising knowledge to date and identifying remaining gaps about non-economic loss and damage is an important step in taking stock of what we already know and fostering action and support for addressing loss and damage in the years to come.

Introduction: Diabetic cardiomyopathy (DbCM) is characterized by abnormal cardiac structure/function, associated with incident HF, and has a 67% prevalence in the community. However, the prevalence of DbCM in a real-world, electronic health record (EHR) system is not known. Methods: Adult patients with DM in a single center EHR free of CVD with available data on HF risk factors were included. The presence of DbCM was defined using different definitions (Figure) . DbCM prevalence was compared across subgroups with differences assessed using the chi-squared test. Adjusted logistic regression models were constructed to evaluate significant predictors of DbCM. Results: Among 1,921 individuals with DM, prevalence of DbCM in the overall cohort was 8.7% and 64.4% in the most and least restrictive definitions, respectively. Across all definitions, increasing age and Hispanic ethnicity was associated with higher proportion of DbCM (Figure A,D) . No consistent differences in DbCM prevalence were observed across sex and race-based subgroups across definitions (Figure B-C) . In multivariable-adjusted logistic regression, higher creatinine and longer QRS duration were associated with higher risk of DbCM across all definitions. Conclusions: In a single-center, EHR cohort, the prevalence of DbCM was up to 64.4%. Increasing age and Hispanic ethnicity had a higher prevalence of DbCM. Disclosure M.W.Segar: None. K.Patel: None. M.Vaduganathan: Advisory Panel; American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Pharmacosmos, Relypsa, Roche Diagnostics, and Sanofi, Other Relationship; Novartis and Galmed , Research Support; Amgen, AstraZeneca, Boehringer Ingelheim, Novartis, Roche Diagnostics, and Sanofi, Speaker's Bureau; Novartis and Roche Diagnostics. A.Chandra: None. D.L.Willett: None. A.Pandey: Advisory Panel; Lilly, Consultant; Tricog, Research Support; Applied Therapeutics, Gilead Sciences, Inc.

Objectives This study analyzed changes in depressive symptoms in patients with heart failure and preserved ejection fraction (HFpEF) who were enrolled in the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial. Background There are limited longitudinal data for depressive symptoms in patients with HFpEF. Methods In patients enrolled in the United States and Canada (n = 1,431), depressive symptoms were measured using Patient Health Questionnaire-9 (PHQ-9). Clinically meaningful changes in PHQ-9 scores were defined as worse (≥3-point increase) or better (≥3-point decrease). Multivariate models were used to identify predictors of change in depressive symptoms. Cox proportional hazard models were used to determine the impact of symptom changes from baseline on subsequent incident cardiovascular events. Results At 12 months, 19% of patients experienced clinically worsening depressive symptoms, 31% better, and 49% unchanged. Independent predictors of clinically meaningful improvement in depressive symptoms included higher baseline PHQ-9 scores, male sex, lack of chronic obstructive pulmonary disease, and randomization to spironolactone. After data were adjusted for cardiovascular comorbidities, higher baseline PHQ-9 was associated with all-cause mortality (hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 1.02 to 1.16; p = 0.011), whereas worsening depressive symptoms at 12 months were associated with cardiovascular death (HR: 2.47; 95% CI: 1.32 to 4.63; p = 0.005) and all-cause mortality (HR: 1.82; 95% CI: 1.13 to 2.93; p = 0.014). Randomization to spironolactone was associated with modest but statistically significant reduction in depressive symptoms over the course of the trial (p = 0.014). Conclusions Higher baseline depressive symptoms and worsening depressive symptoms were associated with all-cause mortality. Randomization to spironolactone was associated with modest reduction in depressive symptoms. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302)

Nanocellular polymer foams have shown significant potential for industrial applications because of their superior thermal, mechanical, and optical properties. Some of these properties may be further improved by enhancing the ordering of cell structures. However, it is challenging for conventional foaming methods to control both the cell size and ordering at the nanoscale. Here, we show an innovative method to produce highly ordered nanocellular polymer foams by incorporating the self-assembly of an asymmetric diblock copolymer with the UV-induced chemical foaming technique. The minor domains are designed to generate a gaseous compound from the partial cleavage of the functional group. It is demonstrated that the gas-producing reaction can be accelerated at a temperature low enough to prevent melting of the whole self-assembled template, by mixing a small amount of photoacid generator into the copolymer, followed by UV irradiation. The result is the production of polymer foams with the nanoscale cells highly aligned to the self-assembled domains.

Supplemental Digital Content is available in the text., Background: High-density lipoprotein (HDL) cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and myocardial infarction (MI) among women and Blacks have not been well studied. We hypothesized that HDL-P would consistently be associated with MI and stroke among women and Blacks compared with HDL-C. Methods: We analyzed individual-level participant data in a pooled cohort of 4 large population studies without baseline atherosclerotic cardiovascular disease: DHS (Dallas Heart Study; n=2535), ARIC (Atherosclerosis Risk in Communities; n=1595), MESA (Multi-Ethnic Study of Atherosclerosis; n=6632), and PREVEND (Prevention of Renal and Vascular Endstage Disease; n=5022). HDL markers were analyzed in adjusted Cox proportional hazard models for MI and ischemic stroke. Results: In the overall population (n=15 784), HDL-P was inversely associated with the combined outcome of MI and ischemic stroke, adjusted for cardiometabolic risk factors (hazard ratio [HR] for quartile 4 [Q4] versus quartile 1 [Q1], 0.64 [95% CI, 0.52–0.78]), as was HDL-C (HR for Q4 versus Q1, 0.76 [95% CI, 0.61–0.94]). Adjustment for HDL-C did not attenuate the inverse relationship between HDL-P and atherosclerotic cardiovascular disease, whereas adjustment for HDL-P attenuated all associations between HDL-C and events. HDL-P was inversely associated with the individual end points of MI and ischemic stroke in the overall population, including in women. HDL-P was inversely associated with MI among White participants but not among Black participants (HR for Q4 versus Q1 for Whites, 0.49 [95% CI, 0.35–0.69]; for Blacks, 1.22 [95% CI, 0.76–1.98]; Pinteraction=0.001). Similarly, HDL-C was inversely associated with MI among White participants (HR for Q4 versus Q1, 0.53 [95% CI, 0.36–0.78]) but had a weak direct association with MI among Black participants (HR for Q4 versus Q1, 1.75 [95% CI, 1.08–2.83]; Pinteraction

Small studies have suggested that moderate alcohol consumption increases HDL cholesterol (HDL-C) levels and cholesterol efflux capacity (CEC), a main anti-atherosclerotic HDL function.This study aimed to understand the degree to which alcohol intake is associated with various HDL markers in a large, multiethnic population cohort, the Dallas Heart Study (DHS), and whether alcohol modifies the link between HDL markers and atherosclerotic cardiovascular disease (ASCVD).Participants of the DHS were included if they had self-reported alcohol intake and CEC measurements (N=2,919). Alcohol intake was analyzed continuously (grams/week) and as an ordered categorical variable (never, past, light, moderate, heavy, and binge drinkers). HDL-C, CEC, HDL particle number (HDL-P), HDL particle size (HDL-size), and ApoA-I were the primary HDL measures.After adjustment for confounding variables, increasing continuous measure of alcohol intake was associated with increased levels of all HDL markers. Moreover, as compared to moderate drinkers, light drinkers had decreased levels of the HDL markers.In a large, multiethnic cohort, increased alcohol intake was associated with increased levels of multiple markers of HDL metabolism. However, the association of HDL markers with ASCVD risk as modified by alcohol consumption is unable to be determined in this low-risk cohort.

Supranormal ejection fraction by echocardiography in clinically referred patient populations has been associated with an increased risk of cardiovascular disease (CVD). The prognostic implication of supranormal left ventricular ejection fraction (LVEF)-assessed by cardiac magnetic resonance (CMR)-in healthy, community-dwelling individuals is unknown.The purpose of this study is to investigate the prognostic implication of supranormal LVEF as assessed by CMR and its inter-relationship with stroke volume among community-dwelling adults without CVD.Participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and DHS (Dallas Heart Study) cohorts free of CVD who underwent CMR with LVEF above the normal CMR cutoff (≥57%) were included. The association between cohort-specific LVEF categories and risk of clinically adjudicated major adverse cardiovascular events (MACE) was assessed using adjusted Cox models. Subgroup analysis was also performed to evaluate the association of LVEF and risk of MACE among individuals stratified by left ventricular stroke volume index.The study included 4,703 participants from MESA and 2,287 from DHS with 727 and 151 MACE events, respectively. In adjusted Cox models, the risk of MACE was highest among individuals in LVEF Q4 (vs Q1) in both cohorts after accounting for potential confounders (MESA: HR = 1.27 [95% CI: 1.01-1.60], P = 0.04; DHS: HR = 1.72 [95% CI: 1.05-2.79], P = 0.03). A significant interaction was found between the continuous measures of LVEF and left ventricular stroke volume index (P interaction = 0.02) such that higher LVEF was significantly associated with an increased risk of MACE among individuals with low but not high stroke volume.Among community-dwelling adults without CVD, LVEF in the supranormal range is associated with a higher risk of adverse cardiovascular outcomes, particularly in those with lower stroke volume.

The ongoing COVID-19 pandemic highlighted a significant interplay between cardiovascular disease (CVD), COVID-19 related inflammatory status, and depression. Cardiovascular (CV) injury is responsible for a substantial percentage of COVID-19 deaths while COVID-19 social restrictions emerged as a non-negligible risk factor for CVD as well as a variety of mental health issues, and in particular, depression. Inflammation seems to be a shared condition between these two disorders. Gender represents a potential modifying factor both in CVD and depression, as well as in COVID-19 short- and long-term outcomes, particularly in cases involving long-term COVID complications. Results from emerging studies indicate that COVID-19 pandemic affected male and female populations in different ways. Women seem to experience less severe short-term complications but suffer worse long-term COVID complications, including depression, reduced physical activity, and deteriorating lifestyle habits, all of which may impact CV risk. Here, we summarize the current state of knowledge about the interplay between COVID-19, depression, and CV risk in women.

Cardiovascular imaging is an evolving component in the care of cancer patients. With improved survival following prompt cancer treatment, patients are facing increased risks of cardiovascular complications. While currently established imaging modalities are providing useful structural mechanical information, they continue to develop towards increased specificity. New modalities, emerging from basic science and oncology, are being translated, targeting earlier stages of cardiovascular disease. Besides these technical advances, matching an imaging modality with the patients' individual risk level for a specific pathological change is part of a successful imaging strategy. The choice of suitable imaging modalities and time points for specific patients will impact the cardio-oncological risk stratification during surveillance and follow-up monitoring. In addition, future imaging tools are poised to give us important insights into the underlying cardiovascular molecular pathology associated with cancer and oncological therapies. This review aims at giving an overview of the novel imaging technologies that have the potential to change cardio-oncological science and clinical practice in the near future.

Although heart failure (HF) risk and cardiac structure/function reportedly differ according to race and gender, limited data exist in late life when risk of HF is highest.The goal of this study was to evaluate race/gender-based differences in HF risk factors, cardiac structure/function, and incident HF in late life.This analysis included 5,149 HF-free participants from ARIC (Atherosclerosis Risk In Communities), a prospective epidemiologic cohort study, who attended visit 5 (2011-2013) and underwent echocardiography. Participants were subsequently followed up for a median 5.5 years for incident HF/death.Patients' mean age was 75 ± 5 years, 59% were women, and 20% were Black. Male gender and Black race were associated with lower mean left ventricular ejection fraction. Black race was also associated with greater left ventricular wall thickness and concentricity, differences that persisted after adjusting for cardiovascular comorbidities. After adjusting for cardiovascular comorbidities, men were at higher risk for HF and heart failure with reduced ejection fraction (HFrEF) in Black participants compared with White participants (HF: HR of 2.36 [95% CI: 1.37-4.08] vs 1.16 [95% CI: 0.89-1.51], interaction P = 0.016; HFrEF: HR of 3.70 [95% CI: 1.72-7.95] vs 1.55 [95% CI: 1.01-2.37] respectively, interaction P = 0.039). Black race was associated with a higher incidence of HF overall and HFrEF in men only (HF: 1.65 [95% CI: 1.07-2.53] vs 0.76 [95% CI: 0.49-1.17]; HFrEF: HR of 2.55 [95% CI: 1.46-4.44] vs 0.91 [95% CI: 0.46-1.83]). No race/gender-based differences were observed in risk of incident heart failure with preserved ejection fraction.Among older persons free of HF, men and Black participants exhibit worse systolic performance and are at heightened risk for HFrEF, whereas the risk of heart failure with preserved ejection fraction is similar across gender and race groups.

Objectives This study sought to describe baseline health-related quality of life (HRQL) in the PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HFpEF) trial, the largest heart failure with preserved ejection fraction (HFpEF) trial to date. Background There are limited data characterizing HRQL in patients with HFpEF using validated metrics. Methods The PARAGON-HF trial randomized symptomatic patients with HFpEF (≥45%) ≥50 years of age to either sacubitril/valsartan or valsartan. The study reports comprehensive baseline HRQL using Kansas City Cardiomyopathy Questionnaire (KCCQ) administered at randomization after active run-in period. The study then compares baseline HRQL with patients with heart failure with reduced ejection fraction (HFrEF) (≤40%) enrolled in the PARADIGM-HF (Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. Forward multivariable stepwise regression modeling was performed separately in both trials to identify independent clinical correlates of KCCQ-Overall Summary (KCCQ-OS) score. PARADIGM-HF trial patients Results In the PARAGON-HF trial, 4,735 of 4,822 patients (mean age 73 ± 8 years; 48% men) completed baseline KCCQ at randomization. Mean KCCQ-OS score was 71. Women had worse mean KCCQ-OS score than men did. Patients in the PARAGON-HF trial reported lower KCCQ scores in nearly all domains when compared with the PARADIGM-HF trial (KCCQ-OS score 71 ± 19 vs. 73 ± 19; p Conclusions HRQL was largely worse in women and was similar in HFpEF and HFrEF after accounting for variation in demographics, functional status, and symptom burden. Prospective Comparison of ARNI with ARB Global Outcomes in HFpEF [PARAGON-HF] NCT01920711; Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255)

We report a facile synthetic approach to create stable radical block copolymers containing a secondary fluorinated block via anionic polymerization using a bulky, sterically hindered countercation composed of a sodium ion and di-benzo-18-crown-6 complex. The synthetic conditions described in this report allowed for controlled molecular weights and dispersity (

Nowadays many information can be easily accessed through the internet. Some of social media web applications, such as Facebook, Twitter and Instagram, even provide user with an easy information sharing features. However, the information is presented in the form of a timeline or a feed, which is sometimes not relevant to the user or quite hard to accessed by user because of the redundancy of the information. This situation can be resolved with a Web Scraping method proposed in this paper, that able to search information, combine and present it in a better way according to user preferences. A system is developed to implement the proposed method by using an API that Facebook Developers and Twitter Developers provided. In addition, regular expression (or Regex) which is a language construction that can be used for matching text by using some patterns. Based on experiment conducted in this research, overload information could be suppressed into structure data that store in a database, less redundancy information is presented, and information relevancy could be adjusted to user preferences.

Background: Heart failure (HF) risk and the underlying risk factors vary by race. Traditional models for HF risk prediction treat race as a covariate in risk prediction and do not account for significant parameters such as cardiac biomarkers. Machine learning (ML) may offer advantages over traditional modeling techniques to develop race-specific HF risk prediction models and to elucidate important contributors of HF development across races. Methods: We performed a retrospective analysis of 4 large, community cohort studies (ARIC [Atherosclerosis Risk in Communities], DHS [Dallas Heart Study], JHS [Jackson Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) with adjudicated HF events. The study included participants who were >40 years of age and free of HF at baseline. Race-specific ML models for HF risk prediction were developed in the JHS cohort (for Black race–specific model) and White adults from ARIC (for White race–specific model). The models included 39 candidate variables across demographic, anthropometric, medical history, laboratory, and electrocardiographic domains. The ML models were externally validated and compared with prior established traditional and non–race-specific ML models in race-specific subgroups of the pooled MESA/DHS cohort and Black participants of ARIC. The Harrell C-index and Greenwood-Nam-D’Agostino χ 2 tests were used to assess discrimination and calibration, respectively. Results: The ML models had excellent discrimination in the derivation cohorts for Black (n=4141 in JHS, C-index=0.88) and White (n=7858 in ARIC, C-index=0.89) participants. In the external validation cohorts, the race-specific ML model demonstrated adequate calibration and superior discrimination (Black individuals, C-index=0.80–0.83; White individuals, C-index=0.82) compared with established HF risk models or with non–race-specific ML models derived with race included as a covariate. Among the risk factors, natriuretic peptide levels were the most important predictor of HF risk across both races, followed by troponin levels in Black and ECG-based Cornell voltage in White individuals. Other key predictors of HF risk among Black individuals were glycemic parameters and socioeconomic factors. In contrast, prevalent cardiovascular disease and traditional cardiovascular risk factors were stronger predictors of HF risk in White adults. Conclusions: Race-specific and ML-based HF risk models that integrate clinical, laboratory, and biomarker data demonstrated superior performance compared with traditional HF risk and non–race-specific ML models. This approach identifies distinct race-specific contributors of HF.

Immune checkpoint inhibitors (ICI) have revolutionized the field of oncology. Although rare (

Background Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions. Objective The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients. Methods We generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF Results Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT. Conclusions EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations.