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1. A Community Ionosphere‐Thermosphere Observing System Simulation Experiment (OSSE) Tool: Geospace Dynamics Constellation Example

Author

Chih‐Ting Hsu, Tomoko Matsuo, Helen Kershaw, Nicholas Dietrich, Marlee Smith, Jeffrey Anderson, Katherine Garcia‐Sage, Jia Yue, Yuta Hozumi, and Min‐Yang Chou

Subjects
DART/TIEGCM, Observing System Simulation Experiment, thermospheric‐ionospheric data assimilation, Astronomy, QB1-991, Geology, QE1-996.5
Abstract

Abstract Observing System Simulation Experiments (OSSEs) provide an effective way to evaluate the impact of assimilating data from a specific observing system on hindcasting, nowcasting, and forecasting of environmental systems. The NSF NCAR's Data Assimilation (DA) Research Testbed/Thermosphere‐Ionosphere‐Electrodynamics General Circulation Model (DART/TIEGCM) tool, to be hosted at the NASA Community Coordinated Modeling Center, serves as a valuable and accessible community resource for quantitatively evaluating the impact of observations from both current and future ionosphere‐thermosphere (IT) observing systems. This study demonstrates the utility of DART/TIEGCM as an IT OSSE tool, using synthetic observations simulated using a currently planned NASA Geospace Dynamics Constellation (GDC) observing system design. Five sets of OSSEs are carried out to compare the effects of assimilating various combinations of prospective GDC observations (e.g., neutral temperature, neutral wind, neutral composition, atomic oxygen ion density, and ion and electron temperature) during a major geomagnetic storm period of the St Patrick's Day Storm on 17 March 2013. The maximum error reduction in neutral temperature and atomic ion oxygen density is 24.6% and 43.3% compared to the control experiment. These OSSEs indicate the benefits of coupled IT DA approaches implemented in DART/TIEGCM to maximize the impact of multi‐parameter IT observations, such as those expected from the GDC mission. Although more work is required to draw any definitive conclusion on the GDC data impact, the study provides an illustrative example of how the DART/TIEGCM community tool can be used to evaluate observational impacts of planned or existing missions for geospace research and applications.

Published
2024
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2. Enumeration potential of environmental DNA for Pacific salmon stock assessments

Author

Geoffrey Y. Su, Michael J. Allison, Jordan Beblow, Kevin Koch, Jeffrey Anderson, Leithen K. M'Gonigle, Mark Cleveland, Caren C. Helbing, and Vicki L. Marlatt

Subjects
British Columbia, enumeration, environmental DNA (eDNA), fisheries management, salmon, Environmental sciences, GE1-350, Microbial ecology, QR100-130
Abstract

AbstractThe field of environmental DNA (eDNA) has advanced over the past decade, with multiple approaches available for a variety of sampling media and species. While using eDNA for the purpose of simply detecting species is becoming a routine process, the utility of eDNA to estimate species abundance is not well understood. Here, we quantify salmon environmental DNA upstream of a fish counting fence along with river velocity, and together, use these values to determine the correlation between the number of salmon passing by the fish fence daily with daily eDNA rates in water before, during, and after the salmon spawning season for four Pacific salmonids (Oncorhynchus gorbuscha, O. kisutch, O. tshawytscha, and O. nerka; pink, coho, chinook, and sockeye, respectively). Throughout the spawning season, approximately 182,000 salmon were counted passing through the fence, of which >98% were pink salmon. Pink salmon exhibited strong correlation between human counts (effect size = 0.65, SE = 0.040) to eDNA rates in the present study and exhibited day‐to‐day variation and a unimodal profile rising and falling with human fish counts. However, the salmon species observed in much lower numbers exhibited a much weaker correlation with eDNA levels higher during the pre‐migratory period than during the migratory period for sockeye, coho, and chinook. Thus, for salmon spawning runs with less than ~1000 adults and daily counts of less than ~100, the juvenile and/or prior seasons eDNA signal appears to be indistinguishable from the adult spawning eDNA signal in our river system. However, for the large pink salmon run, eDNA rates appeared to reflect a local signal of salmon in space and time, essentially tracking these fish within days of passing through the eDNA sampling site.

Published
2024
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6. Association of dementia and patient outcomes among COVID-19 patients: A multi-center retrospective case-control study

Author

Pratikkumar H. Vekaria, Areej Syed, Jeffrey Anderson, Brendon Cornett, Amine Bourbia, Michael G. Flynn, Rahul Kashyap, and Asif R. Shah

Subjects
dementia, COVID-19, mortality, baseline characteristics, intensive care unit (ICU), Medicine (General), R5-920
Abstract

BackgroundWe conducted a retrospective cohort study on COVID-19 patients with and without dementia by extracting data from the HCA Healthcare Enterprise Data Warehouse between January-September 2020.AimsTo describe the role of patients' baseline characteristics specifically dementia in determining overall health outcomes in COVID-19 patients.MethodsWe grouped in-patients who had ICD-10 codes for dementia (DM) with age and gender-matched (1:2) patients without dementia (ND). Our primary outcome variables were in-hospital mortality, length of stay, Intensive Care Unit (ICU) admission, ICU-free days, mechanical ventilation (MV) use, MV-free days and 90-day re-admission.ResultsMatching provided similar age and sex in DM and ND groups. BMI (median, 25.8 vs. 27.6) and proportion of patients who had smoked (23.3 vs. 31.3%) were lower in DM than in ND patients. The median (IQR) Elixhauser Comorbidity Index was higher in dementia patients 7 (5–10) vs. 5 (3–7, p < 0.01). Higher mortality was observed in DM group (30.8%) vs. ND group (26.4%, p < 0.01) as an unadjusted univariate analysis. The 90-day readmission was not different (32.1 vs. 31.8%, p = 0.8). In logistic regression analysis, the odds of dying were not different between patients in DM and ND groups (OR = 1.0; 95% CI 0.86–1.17), but the odds of ICU admissions were significantly lower for dementia patients (OR = 0.58, 95% CI 0.51–0.66).ConclusionsOur data showed that COVID-19 patients with dementia did not fare substantially worse, but in fact, fared better when certain metrics were considered.

Published
2022
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7. First Autonomous Underwater Vehicle Observations of a Potential Petrale Sole (Eopsetta jordani) Spawning Aggregation Off the US West Coast

Author

Abigail Powell, M. Elizabeth Clarke, Melissa A. Haltuch, Erica Fruh, Jeffrey Anderson, Curt E. Whitmire, and Melanie M. Johnson

Subjects
Petrale sole, Eopsetta jordani, autonomous underwater vehicle, spawning aggregation, spawning behavior, Pacific flatfish, Science, General. Including nature conservation, geographical distribution, QH1-199.5
Abstract

Understanding the timing and reproductive behavior of commercial fish species is a key part of well-informed stock assessments and fishery management, but this information is often limited, particularly for species that spawn in deep water. Petrale sole (Eopsetta jordani) is one of the most commercially important flatfish species in the US and is known to spawn off the West Coast during winter months. A number of spawning grounds have been identified using catch data and tagging studies, but to our knowledge there have been no direct visual observations of aggregating petrale sole. In 2018, we observed unusually high densities of petrale sole in autonomous underwater vehicle (AUV) imagery collected at a feature inshore of Santa Lucia Bank off the California coast. In addition to aggregations of fish, we observed fish in positions and configurations that we believe to be related to spawning behavior including physical contact between individuals and evidence of consistent size differentiation within clusters. We present images of the aggregating petrale sole and information on the physical and environmental conditions at this site. We also compare these observations to the results of AUV surveys carried out in 2005 at the same site. Analysis of commercial catch data from this area supports the hypothesis that this is a seasonal petrale sole aggregation as fishing at this location occurs mainly during winter months with catches dominated by petrale sole. In addition to the potential identification of a spawning aggregation, these observations show how advanced technologies can provide insight into the reproductive behavior of a commercially important species in-situ.

Published
2022
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8. Functional Hyperconnectivity and Task-Based Activity Changes Associated With Neuropathic Pain After Spinal Cord Injury: A Pilot Study

Author

Shana R. Black, Jace B. King, Mark A. Mahan, Jeffrey Anderson, and Christopher R. Butson

Subjects
functional connectivity, resting-state fMRI, task-based fMRI, functional magnetic resonance imaging, fMRI, spinal cord injury, Neurology. Diseases of the nervous system, RC346-429
Abstract

Neuropathic pain (NP) is a devastating chronic pain condition affecting roughly 80% of the spinal cord injury (SCI) patient population. Current treatment options are largely ineffective and neurophysiological mechanisms of NP are not well-understood. Recent studies in neuroimaging have suggested that NP patients have differential patterns of functional activity that are dependent upon the neurological condition causing NP. We conducted an exploratory pilot study to examine functional activation and connectivity in SCI patients with chronic NP compared to SCI patients without NP. We developed a novel somatosensory attention task to identify short term fluctuations in neural activity related to NP vs. non-painful somatosensation using functional magnetic resonance imaging (fMRI). We also collected high-resolution resting state fMRI to identify connectivity-based correlations over time between the two groups. We observed increased activation during focus on NP in brain regions associated with somatosensory integration and representational knowledge in pain subjects when compared with controls. Similarly, NP subjects showed increased connectivity at rest in many of the same areas of the brain, with positive correlations between somatomotor networks, the dorsal attention network, and regions associated with pain and specific areas of painful and non-painful sensation within our cohort. Although this pilot analysis did not identify statistically significant differences between groups after correction for multiple comparisons, the observed correlations between NP and functional activation and connectivity align with a priori hypotheses regarding pain, and provide a well-controlled preliminary basis for future research in this severely understudied patient population. Altogether, this study presents a novel task, identifies regions of increased task-based activation associated with NP after SCI in the insula, prefrontal, and medial inferior parietal cortices, and identifies similar regions of increased functional connectivity associated with NP after SCI in sensorimotor, cingulate, prefrontal, and inferior medial parietal cortices. This, along with our complementary results from a structurally based analysis, provide multi-modal evidence for regions of the brain specific to the SCI cohort as novel areas for further study and potential therapeutic targeting to improve outcomes for NP patients.

Published
2021
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9. Mechanical performance and healing patterns of the novel sirolimus-eluting bioresorbable Fantom scaffold: 6-month and 9-month follow-up by optical coherence tomography in the FANTOM II study

Author

Jo Krogsgaard Simonsen, Emil Nielsen Holck, Didier Carrié, Norbert Frey, Matthias Lutz, Joachim Weber-Albers, Dariusz Dudek, Bernard Chevalier, Joost Daemen, Jouke Dijkstra, Camilla Fox Maule, Omeed Neghabat, Jens Flensted Lassen, Jeffrey Anderson, Evald Høj Christiansen, Alexandre Abizaid, and Niels Ramsing Holm

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objectives We aimed to evaluate the mechanical properties and healing patterns 6 and 9 months after implantation of the sirolimus-eluting Fantom bioresorbable scaffold (BRS).Background The Fantom BRS (Reva Medical, San Diego, USA) has differentiating properties including radiopacity, strut thickness of 125 µm, high expansion capacity and has demonstrated favourable mid-term clinical and angiographic outcomes.Methods and results FANTOM II was a prospective, single arm study with implantation of the Fantom BRS in 240 patients with stable angina pectoris. Guidance by optical coherence tomography (OCT) was encouraged and was repeated at 6-month (cohort A) or 9-month follow-up (cohort B). Matched baseline and follow-up OCT recordings were available in 152 patients. In-scaffold mean lumen area in cohort A was 6.8±1.7 mm2 and 5.7±1.4 mm2 at baseline and follow-up (p

Published
2019
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10. Ensemble Kalman filter assimilation of near-surface observations over complex terrain: comparison with 3DVAR for short-range forecasts

Author

Zhaoxia Pu, Hailing Zhang, and Jeffrey Anderson

Subjects
data assimilation, ensemble Kalman filter, 3DVAR, complex terrain, short-range weather forecasting, surface observations, Oceanography, GC1-1581, Meteorology. Climatology, QC851-999
Abstract

Surface observations are the main conventional observations for weather forecasts. However, in modern numerical weather prediction, the use of surface observations, especially those data over complex terrain, remains a unique challenge. There are fundamental difficulties in assimilating surface observations with three-dimensional variational data assimilation (3DVAR). In this study, a series of observing system simulation experiments is performed with the ensemble Kalman filter (EnKF), an advanced data assimilation method to compare its ability to assimilate surface observations with 3DVAR. Using the advanced research version of the Weather Research and Forecasting (WRF) model, results from the assimilation of observations at a single observation station demonstrate that the EnKF can overcome some fundamental limitations that 3DVAR has in assimilating surface observations over complex terrain. Specifically, through its flow-dependent background error term, the EnKF produces more realistic analysis increments over complex terrain in general. More comprehensive comparisons are conducted in a short-range weather forecast using a synoptic case with two severe weather systems: a frontal system over complex terrain in the western US and a low-level jet system over the Great Plains. The EnKF is better than 3DVAR for the analysis and forecast of the low-level jet system over flat terrain. However, over complex terrain, the EnKF clearly performs better than 3DVAR, because it is more capable of handling surface data in the presence of terrain misrepresentation. In addition, results also suggest that caution is needed when dealing with errors due to model terrain representation. Data rejection may cause degraded forecasts because data are sparse over complex terrain. Owing to the use of limited ensemble sizes, the EnKF analysis is sensitive to the choice of horizontal and vertical localisation scales.

Published
2013
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11. A randomized, double-blind, placebo-controlled assessment of BMS-936558, a fully human monoclonal antibody to programmed death-1 (PD-1), in patients with chronic hepatitis C virus infection.

Author

David Gardiner, Jay Lalezari, Eric Lawitz, Michael DiMicco, Rheem Ghalib, K Rajender Reddy, Kyong-Mi Chang, Mark Sulkowski, Steven O' Marro, Jeffrey Anderson, Bing He, Vikram Kansra, Fiona McPhee, Megan Wind-Rotolo, Dennis Grasela, Mark Selby, Alan J Korman, and Israel Lowy

Subjects
Medicine, Science
Abstract

Expression of the programmed death 1 (PD-1) receptor and its ligands are implicated in the T cell exhaustion phenotype which contributes to the persistence of several chronic viral infections, including human hepatitis C virus (HCV). The antiviral potential of BMS-936558 (MDX-1106) - a fully human anti-PD-1 monoclonal immunoglobulin-G4 that blocks ligand binding - was explored in a proof-of-concept, placebo-controlled single-ascending-dose study in patients (N = 54) with chronic HCV infection. Interferon-alfa treatment-experienced patients (n = 42) were randomized 5∶1 to receive a single infusion of BMS-936558 (0.03, 0.1, 0.3, 1.0, 3.0 mg/kg [n = 5 each] or 10 mg/kg [n = 10]) or of placebo (n = 7). An additional 12 HCV treatment-naïve patients were randomized to receive 10 mg/kg BMS-936558 (n = 10) or placebo (n = 2). Patients were followed for 85 days post-dose. Five patients who received BMS-936558 (0.1 [n = 1] or 10 mg/kg) and one placebo patient achieved the primary study endpoint of a reduction in HCV RNA ≥0.5 log10 IU/mL on at least 2 consecutive visits; 3 (10 mg/kg) achieved a >4 log10 reduction. Two patients (10 mg/kg) achieved HCV RNA below the lower limit of quantitation (25 IU/mL), one of whom (a prior null-responder) remained RNA-undetectable 1 year post-study. Transient reductions in CD4(+), CD8(+) and CD19(+) cells, including both naïve and memory CD4(+) and CD8(+) subsets, were observed at Day 2 without evidence of immune deficit. No clinically relevant changes in immunoglobulin subsets or treatment-related trends in circulating cytokines were noted. BMS-936558 exhibited dose-related exposure increases, with a half-life of 20-24 days. BMS-936558 was mostly well tolerated. One patient (10 mg/kg) experienced an asymptomatic grade 4 ALT elevation coincident with the onset of a 4-log viral load reduction. Six patients exhibited immune-related adverse events of mild-to-moderate intensity, including two cases of hyperthyroidism consistent with autoimmune thyroiditis. Further investigation of PD-1 pathway blockade in chronic viral disease is warranted.ClinicalTrials.gov NCT00703469.

Published
2013
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12. Service-Learning in Teacher Education: Accomplishments, Challenges, and Promising Developments

Author

Marian McKenna, Jeffrey Anderson, John Traynor, and Melvin Pedras

Subjects
Special aspects of education, LC8-6691, Theory and practice of education, LB5-3640
Abstract

This paper will present a brief history of the role of service in higher education, and demonstrate its effectiveness as a full partner to teacher education. We then focus on service-learning in teacher education and how it has enjoyed a strong resurgence in the last 15 years. Finally, we offer a rationale for and a model of service-learning in the northwest region of the US, supported and endorsed by the Northwest Center for Service Learning in Teacher Education.

Published
2004
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18. How to Be a More Effective Author

Author

David M. Schultz, Jeffrey Anderson, Tommaso Benacchio, Kristen L. Corbosiero, Matthew D. Eastin, Clark Evans, Jidong Gao, Joshua P. Hacker, Daniel Hodyss, Daryl Kleist, Matthew R. Kumjian, Ron McTaggart-Cowan, Zhiyong Meng, Justin R. Minder, Derek Posselt, Paul Roundy, Angela Rowe, Michael Scheuerer, Russ S. Schumacher, Stan Trier, and Christopher Weiss

Subjects
Atmospheric Science
Published
2022
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22. Inflamed and non-inflamed classes of HCC: a revised immunogenomic classification

Author

Carla Montironi, Florian Castet, Philipp K Haber, Roser Pinyol, Miguel Torres-Martin, Laura Torrens, Agavni Mesropian, Huan Wang, Marc Puigvehi, Miho Maeda, Wei Qiang Leow, Elizabeth Harrod, Patricia Taik, Jigjidsuren Chinburen, Erdenebileg Taivanbaatar, Enkhbold Chinbold, Manel Solé Arqués, Michael Donovan, Swan Thung, Jaclyn Neely, Vincenzo Mazzaferro, Jeffrey Anderson, Sasan Roayaie, Myron Schwartz, Augusto Villanueva, Scott L Friedman, Andrew Uzilov, Daniela Sia, and Josep M Llovet

Subjects
Carcinoma, Hepatocellular, Liver Neoplasms, Mutation, Gastroenterology, Humans, Interferons, DNA Methylation, Wnt Signaling Pathway, Article
Abstract

ObjectiveWe previously reported a characterisation of the hepatocellular carcinoma (HCC) immune contexture and described an immune-specific class. We now aim to further delineate the immunogenomic classification of HCC to incorporate features that explain responses/resistance to immunotherapy.DesignWe performed RNA and whole-exome sequencing, T-cell receptor (TCR)-sequencing, multiplex immunofluorescence and immunohistochemistry in a novel cohort of 240 HCC patients and validated our results in other cohorts comprising 660 patients.ResultsOur integrative analysis led to define: (1) the inflamed class of HCC (37%), which includes the previously reported immune subclass (22%) and a new immune-like subclass (15%) with high interferon signalling, cytolytic activity, expression of immune-effector cytokines and a more diverse T-cell repertoire. A 20-gene signature was able to capture ~90% of these tumours and is associated with response to immunotherapy. Proteins identified in liquid biopsies recapitulated the inflamed class with an area under the ROC curve (AUC) of 0.91; (2) The intermediate class, enriched inTP53mutations (49% vs 29%, p=0.035), and chromosomal losses involving immune-related genes and; (3) the excluded class, enriched inCTNNB1mutations (93% vs 27%, pPTK2overexpression due to gene amplification and promoter hypomethylation.CTNNB1mutations outside the excluded class led to weak activation of the Wnt-βcatenin pathway or occurred in HCCs dominated by high interferon signalling and type I antigen presenting genes.ConclusionWe have characterised the immunogenomic contexture of HCC and defined inflamed and non-inflamed tumours. Two distinctCTNNB1patterns associated with a differential role in immune evasion are described. These features may help predict immune response in HCC.

Published
2022
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23. Exploring Non-Gaussian Sea Ice Characteristics via Observing System Simulation Experiments

Author

Christopher Riedel and Jeffrey Anderson

Abstract

The Arctic is warming at a faster rate compared to the globe on average, commonly referred to as Arctic amplification. Sea ice has been linked to Arctic amplification and gathered attention recently due to the decline in summer sea ice extent. Data assimilation (DA) is the act of combining observations with prior forecasts to obtain a more accurate model state. Sea ice poses a unique challenge for DA because sea ice variables have bounded distributions, leading to non-Gaussian distributions. The non-Gaussian nature violates Gaussian assumptions built into DA algorithms. This study configures different observing system simulated experiments (OSSEs) to find the optimal sea ice and snow observation subset for assimilation to produce the most accurate analyses and forecasts. Findings indicate that not assimilating sea ice concentration observations while assimilating snow depth observation produced the best sea ice and snow forecasts. A simplified DA experiment helped demonstrate that the DA solution is biased when assimilating sea ice concentration observations. The biased DA solution is related to the observation error distribution being a truncated normal distribution and the assumed observation likelihood is normal for the DA method. Additional OSSEs show that using a non-parametric DA method does not alleviate the non-Gaussian effects of the sea ice concentration observations, and assimilating sea ice surface temperatures have a positive impact on snow updates. Lastly, it is shown that perturbed sea ice model parameters, used to create additional ensemble spread in the free forecasts, lead to a year-long negative snow volume bias.

Published
2023

38. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author

Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah 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Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira Mokhtar, Noppon Taksaudom, Nor Asiah Basri, Nora Marchelletta, Norma Hogg, Nungshi Jungla, Nuno Ferreira, Oksana A Lubyanaya, Olga B Nikolaeva, Olga Cañavate, Olga Sobrino, Olga Walesiak, Olga Walter, Olga Zdończyk, Olivia J Lim, Olivia Anaya, Olivia Mancilla, Olivier Dubourg, Olugbenga Bello, Omar Almousalli, Omar Thompson, Oni Olurinde, Or Harel, Osama Raheem, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, P Christian Schulze, Pachara Panpunuan, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Julian, Pamela Ouyang, Pamela Sigel, Pamela Woodard, Panpan Zhou, Paola Emanuela Poggio, Paola Smanio, Paolo Calabro, Paramjit Jeetley, Pascal Goube, Patricia K Nguyen, Patricia Alarie, Patricia Arakelian, Patricia Arsenault, Patricia Blaise, Patricia Brito, Patricia Cowper, Patricia Endsley, Patricia Mieses, Patrick B Alexander, Patrick Donnelly, Patrick Wilmot, Patrycja Lebioda, Paul C Gordon, Paul Der Mesropian, Paul Galiwango, Paul Hauptman, Paul Kennedy, Paula Beardsley, Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, Raewyn Fisher, Rafael Beyar, Rafael Diaz, Rafael Selgas, Raffaele Bugiardini, Raffaele Fanelli, Raisa Kavalakkat, V S Rajalekshmi, Rajat S Barua, Rajeev Menon, Rajesh Gopalan Nair, Rajesh Francis, Rajiv Narang, Rakesh Yadav, Ralph Alan Huston, T Ramakrishnan, Ramesh de Silva, Rami El Mahmoud, Ramiro Carvalho, Ramon de Jesús-Pérez, Ramona Stevens, Ran Leng, Ranjan Kachru, Ranjit Kumar Nath, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Raymond W Little, Raymundo Ocaranza Sanchez, Rebecca J Wimmer, Rebecca Bariciano, Rebecca Otis, Rebekah R Herrmann, Reem Yunis, Reinette Hampson, Renato Abdala Karam, Renee C Hessian, Renee Kaneshiro, Reshma Ravindran, Reto Andreas Gamma, Reyna Bhandari, Reza Arsanjani, Ricardo L Lopes, Ricardo Mendes Oliveira, Ricardo Costa, Richa Bhatt, Richard F Davies, Richard H J Trimlett, Richard Goldweit, Rik Hermanides, Rine Nakanishi, Rinu R Sidh, Risha Patel, Rita Coram, Rizwan A Siddiqui, Rob S Beanlands, Robert J Hamburger, Robert K Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits

Subjects
Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Published
2020
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39. Association of Dementia and Patient Outcomes among COVID-19 Patients: A Multi-center Rétrospective Case-Control Study

Author

Pratikkumar H Vekaria, Areej Syed, Jeffrey Anderson, Brendon Cornett, Amine Bourbia, Michael G Flynn, Rahul Kashyap, and Asif R Shah

Subjects
General Medicine
Abstract

BackgroundWe conducted a retrospective cohort study on COVID-19 patients with and without dementia by extracting data from the HCA Healthcare Enterprise Data Warehouse between January-September 2020.AimsTo describe the role of patients' baseline characteristics specifically dementia in determining overall health outcomes in COVID-19 patients.MethodsWe grouped in-patients who had ICD-10 codes for dementia (DM) with age and gender-matched (1:2) patients without dementia (ND). Our primary outcome variables were in-hospital mortality, length of stay, Intensive Care Unit (ICU) admission, ICU-free days, mechanical ventilation (MV) use, MV-free days and 90-day re-admission.ResultsMatching provided similar age and sex in DM and ND groups. BMI (median, 25.8 vs. 27.6) and proportion of patients who had smoked (23.3 vs. 31.3%) were lower in DM than in ND patients. The median (IQR) Elixhauser Comorbidity Index was higher in dementia patients 7 (5–10) vs. 5 (3–7, p < 0.01). Higher mortality was observed in DM group (30.8%) vs. ND group (26.4%, p < 0.01) as an unadjusted univariate analysis. The 90-day readmission was not different (32.1 vs. 31.8%, p = 0.8). In logistic regression analysis, the odds of dying were not different between patients in DM and ND groups (OR = 1.0; 95% CI 0.86–1.17), but the odds of ICU admissions were significantly lower for dementia patients (OR = 0.58, 95% CI 0.51–0.66).ConclusionsOur data showed that COVID-19 patients with dementia did not fare substantially worse, but in fact, fared better when certain metrics were considered.

Published
2022
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40. 513 Lovenox Titration in Burn Patients: Does a One Size Fits All Model Work?

Author

Anita Wamakima, Jeffrey Anderson, Lisa Rae, Jessica Hyman, Devon Romano, Huaqing Zhao, and Xiaoning Lu

Subjects
Rehabilitation, Emergency Medicine, Surgery
Abstract

Introduction Venous thromboembolism (VTE) presents a significant morbidity to burn injured patients. The Western Trauma Association (WTA) and American Association of Trauma Surgeons (AAST) have recently developed guidelines for VTE prophylaxis dosing in trauma patients in which doses are adjusted based on anti-Xa levels. We sought to determine whether adopting these guidelines would lead to improved VTE prophylaxis in patients admitted to our burn service. Methods We initiated a protocol at our American Burn Association verified burn center of titrating VTE prophylaxis for our patients based on anti-Xa levels consistent with the WTA and AAST guidelines. We performed a retrospective chart review of all patients in which anti-Xa levels were measured between May and October 2022. Chi square, Fisher's exact, and ANOVA were used to analyze the data. Results A total of thirty six patients met our inclusion criteria. Age (49 [35.0, 61.0]), BMI (26.7 [6.8]), gender (67% male), and percent total body surface area (4.5 [2.0, 10.5]) were not statistically significant. Patients with a final lovenox dose of 30mg twice daily required a significantly lower dose adjustment than patients with a final lovenox dose of greater than 30mg (5.1 vs 7.9, p=0.0003). While not statistically significant, there was a trend for patients with a final lovenox dose of greater than 30mg twice daily to have larger percent TBSA affected (6.0 vs 13.6, p = 0.079). When comparing patients whose final dose of lovenox was less than, equal to, or greater than their initial dose, there was a significant difference in dose adjustment between patients whose lovenox had to be decreased as opposed to those who had to be increased (10.0 vs 15.8, p< 0.0001). None of our patients suffered a VTE event over the study period. Conclusions A “one size fits all” approach to VTE prophylaxis in burn patients may lead to inappropriate prophylaxis. Our study demonstrates that titration of VTE prophylaxis with lovenox using anti-Xa levels in the burn population is feasible and that patients with burns may require individualized dosing for appropriate prophylaxis. Applicability of Research to Practice Our research demonstrates that titration of VTE prophylaxis in a burn population may be more appropriate than the traditional “one size fits all” approach.

Published
2023
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41. 778 Epidemiology of Food Access in an Urban Burn Population

Author

Brienne Donovan, Daniel Wiese, Jingwei Wu, Kevin Henry, Lisa Rae, and Jeffrey Anderson

Subjects
Rehabilitation, Emergency Medicine, Surgery
Abstract

Introduction Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Food deserts are areas with low or no access to nutritious, healthy foods while food swamps are areas with much higher access to high-calorie, unhealthy foods than to foods with good nutritious value. The purpose of our investigation was to determine the prevalence of residency in food deserts and food swamps in burn patients evaluated at an urban academic center and to determine the relationship between residency in these areas and the presence of patient comorbidities. Methods We performed a retrospective chart review of patients with burn injuries seen at an ABA verified urban academic center between January 2016 and January 2022. All patients over age 18 seen in the emergency department or admitted to the burn service were included in the study. Patient residential locations were used in conjunction with the Modified Retail Food Environment Index (mREFI) data to classify residency in food deserts and food swamps. Patient demographics and comorbidities were also recorded. Chi square and ANOVA analyses were completed to determine differences between the food desert, food swamp, and good access groups. Results A total of 3064 subjects were included in the study, of these 1370 (44.7%) were female and 1694 (55.3%) were male. In terms of access, 96 (3.1%) individuals lived in food deserts, 477 (15.6%) lived in good access areas, and 2490 (81.3%) resided in food swamps. This difference was found to be statistically significant (p < 0.0001). Age, sex, and BMI did not differ significantly between the three groups. A significantly higher percentage of food swamp residents had a diagnosis of diabetes (15.0%) as compared to subjects living in good food access areas (11.7%) and food deserts (8.3%), (p < 0.043). Hypertension was also found to be more prevalent in food swamps (24.8%) than food deserts (20.8%) and good access areas (19.3%), (p < 0.028). Finally, smoking was more common in food swamps (45.3%) than good access areas (40.4%) and food deserts (27.9%), (p < 0.0028). Conclusions A majority of burn patients reside in food swamps and residency in these areas is associated with a higher prevalence of hypertension, diabetes, and tobacco smoking. This is the first study to investigate the epidemiology of food access in an urban burn population. Applicability of Research to Practice Nutrition is known to be important to overall health and to wound healing in the setting of an acute injury. Our data contributes to the current literature on the role of nutrition in burns.

Published
2023
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42. 777 Food Swamps, Food Deserts, and Wound Healing in Burn Patients at an Urban Academic Center

Author

Brienne Donovan, Daniel Wiese, Jingwei Wu, Lisa Rae, Jeffrey Anderson, and Kevin Henry

Subjects
Rehabilitation, Emergency Medicine, Surgery
Abstract

Introduction Many victims of burn injury live in food deserts or food swamps. Food deserts are low-income areas with minimal or no access to nutritious foods while food swamps are areas with much greater access to unhealthy, high-calorie foods. We examined the relationship between residency in a food swamp or food desert by census tract and wound healing. Methods We performed a retrospective review of burn patients who underwent split-thickness skin grafting at an ABA verified urban academic burn center between September 2018 and August 2022. Inclusion criteria were burn area less than 20% total body surface area (TBSA), age ≥ 18, and single operation for split-thickness skin grafting. Patient residential locations were used in conjunction with Modified Retail Food Environment Index (mREFI) data to classify residency in food deserts and food swamps. The primary outcome was time to donor site healing. Time-to-event Cox proportional regression analysis was performed to evaluate risk factors for poor wound healing. Results A total of 238 patients were included in the study, of whom 110 (46.2%) were female and 128 (53.8%) were male. Mean age was 48, BMI was 28.5, TBSA 3.7, and average days to donor site healing was 26. In categorizing residency by mREFI data, 45 (18.9%) individuals had good access, 11 (4.6%) resided in food deserts, and 182 (76.5%) resided in food swamps. Although time to healing was longer on average in the food desert (25.8 days) and food swamp (26.4 days) groups compared to the group with good access to food within ½ mile (22.9 days), this difference was not statistically significant. Not having diabetes was found to be associated with shorter time to wound healing (HR=1.68, 95% CI [1.15, 2.47], p=0.007). Living in a good access area was associated with faster wound healing (compared to swamp: HR=1.23, 95% CI [0.86, 1.75], compare to desert: HR=1.06, 95% CI [0.51, 2.20]), however this association was not statistically significant. Conclusions Residency in a food swamp or food desert does not significantly influence time to healing in burn injured patients. However, not having diabetes was associated with a shorter time to wound healing. This is the first study to compare residency in food deserts or food swamps by census tract level data with time to wound healing in an urban burn population. Applicability of Research to Practice Wound healing is a complex and important process known to be affected by malnutrition. Our data contributes to the current body of literature on nutrition and wound healing.

Published
2023
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46. Inequitable Access: Factors Associated with Incomplete Referrals to Pediatric Cardiology

Author

Paul W. Warren, Andrew F. Beck, Huaiyu Zang, Jeffrey Anderson, and Christopher Statile

Subjects
Pediatrics, Perinatology and Child Health, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Objective: To assess the variables associated with incomplete and unscheduled cardiology clinic visits among referred children with a focus on equity gaps. Study design: We conducted a retrospective chart review for patients less than 18 years of age who were referred to cardiology clinics at a single quaternary referral centre from 2017 to 2019. We collected patient demographic data including race, an index of neighbourhood socio-economic deprivation linked to a patient’s geocoded address, referral information, and cardiology clinic information. The primary outcome was an incomplete clinic visit. The secondary outcome was an unscheduled appointment. Independent associations were identified using multivariable logistic regression. Results: There were 10,610 new referrals; 6954 (66%) completed new cardiology clinic visits. Black race (OR 1.41; 95% CI 1.22–1.63), public insurance (OR 1.29; 95% CI 1.14–1.46), and a higher deprivation index (OR 1.32; 95% CI 1.08–1.61) were associated with higher odds of incomplete visit compared to the respective reference groups of White race, private insurance, and a lower deprivation index. The findings for unscheduled visit were similar. A shorter time elapsed from the initial referral to when the appointment was made was associated with lower odds of incomplete visit (OR 0.62; 95% CI 0.52–0.74). Conclusion: Race, insurance type, neighbourhood deprivation, and time from referral date to appointment made were each associated with incomplete referrals to paediatric cardiology. Interventions directed to understand such associations and respond accordingly could help to equitably improve referral completion.

Published
2022

47. Impact of Anticoagulation Therapy on the Cognitive Decline and Dementia in Patients with Non-Valvular Atrial Fibrillation (Cognitive Decline and Dementia in Patients with Non-Valvular Atrial Fibrillation (CAF) Trial)

Author

Thomas Bunch, Heidi May, Michael Cutler, Scott Woller, Victoria Jacobs, Scott M. Stevens, John Carlquist, Kirk Knowlton, Joseph Muhlestein, Benjamin Steinberg, and Jeffrey Anderson

Abstract

Background: Atrial fibrillation (AF) is associated with a risk for cognitive impairment and dementia, which is more pronounced in patients with a history of clinical stroke. Anticoagulation use and efficacy impact long-term risk of dementia in AF patients in observational trials. Methods: The Cognitive Decline and Dementia in Patients with Non-Valvular Atrial Fibrillation (CAF) Trial was a randomized, prospective, open-label vanguard clinical study with blinded endpoint assessment involving patients with moderate- to high-risk (CHADS2 or CHA2DS2-Vasc scores of ≥2) non-valvular AF assigned to dabigatran etexilate or warfarin. The primary endpoint was incident dementia or moderate cognitive decline at 24 months. Results: A total of 101 patients were enrolled, of which 50 received dabigatran and 51 warfarin anticoagulation. The mean age was 73.7±6.0 years and 54(53.5%) were male. Prior stroke and stroke risk factors were similar between groups. Average INR over the study was 2.41±0.68 in the warfarin group. No patient experienced a stroke or developed dementia. Mini-Mental Status Evaluation, Hachinski Ischemic scale, cognitive subscale of the Alzheimer’s Disease Assessment Scale, Disability Assessment for Dementia, Quality of Life Improvement as assessed by Minnesota Living with Heart Failure Scale and the Anti-Clot Treatment Scale Quality of Life Survey scores did not vary at baseline or change over 2 years. Biomarker analysis indicated a similar efficacy of anticoagulation strategies Conclusion: Use of dabigatran and well-managed warfarin therapy were associated with similar risks of stroke, cognitive decline, and dementia at 2 years, suggestive that either strategy is acceptable to mitigate these risks. The results of this Vanguard study did not support the pursuit of a larger formally powered study.

Published
2022
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49. 913-P: The Relationship between ASK12 Patient-Reported Medication Adherence Scores and Objective Measures of Adherence among Patients with Type 2 Diabetes

Author

PAMALA PAWLOSKI, JEANETTE ZIEGENFUSS, PATRICK J. O'CONNOR, STEVEN P. DEHMER, HEIDI EKSTROM, JACOB HAAPALA, JOANN M. SPERL-HILLEN, MARY BECKER, ANJALI TRUITT, MELISSA PANKONIN, DANIEL REHRAUER, CAITLIN FRAIL, JEFFREY ANDERSON, and LILIAN CHUMBA

Subjects
Endocrinology, Diabetes and Metabolism, Internal Medicine
Abstract

Background: Medication adherence may be measured either by (a) patient-reported measurement or (b) objective measurement using medication dispense data. Proportion of days covered (PDC) is an objective measure of adherence becoming more readily available in the electronic health record (EHR) and a threshold of < 80% is commonly used to identify a potential adherence problem. Using PDCs may be more efficient and clinically practical than using longer patient-reported adherence questionnaires. However, it is unknown how well the PDC and patient reported measures correlate. Methods: As part of a pragmatic randomized trial to evaluate an intervention designed to improve medication adherence in a Midwest health care system, 1,423 adults with type 2 diabetes (T2D) were identified at an index visit in primary care based on suboptimal diabetes control (AIC >8%) and at least one oral diabetes medication with PDC < 80%. They were surveyed shortly after the index visit to assess adherence using a validated 12 question ASK-12 instrument, with a response rate of 29% (80/280) . We evaluated the relationship between PDC and ASK-12 total/subscale scores using linear regression. Results: There were no significant associations found between PDC scores and the total ASK-12 score (β=-0.4, p=0.47) , or ASK-12 subscales of inconvenience/forgetfulness (β=-1.1, p=0.42) , treatment beliefs (β=-0.4, p=0.77) , behavior (β=-0.7, p=0.55) , or barriers (β=-0.7, p=0.44) . Conclusions: For patients above recommended A1C goal with a medication PDC < 80%, there was no correlation between PDC scores and patient-reported measures of adherence using ASK-12 total or component scores. This analysis raises questions about the validity and usefulness of EHR-derived PDC scores to identify poor medication adherence for patients with T2D. Disclosure P.Pawloski: None. M.Pankonin: None. D.Rehrauer: None. C.Frail: None. J.Anderson: None. L.Chumba: None. J.Ziegenfuss: None. P.J.O'connor: None. S.P.Dehmer: None. H.Ekstrom: None. J.Haapala: None. J.M.Sperl-hillen: None. M.Becker: None. A.Truitt: None. Funding NHLBI #R01HL136937

Published
2022
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