Publications by authors named "Changyu Shen"

337 Publications

Development and validation of an echocardiographic algorithm to predict long-term mitral and tricuspid regurgitation progression.

Eur Heart J Cardiovasc Imaging 2021 Nov 29. Epub 2021 Nov 29.

Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th floor, Boston, MA 02215, USA.

Aims: Prediction of mitral (MR) and tricuspid (TR) regurgitation progression on transthoracic echocardiography (TTE) is needed to personalize valvular surveillance intervals and prognostication.

Methods And Results: Structured TTE report data at Beth Israel Deaconess Medical Center, 26 January 2000-31 December 2017, were used to determine time to progression (≥1+ increase in severity). TTE predictors of progression were used to create a progression score, externally validated at Massachusetts General Hospital, 1 January 2002-31 December 2019. In the derivation sample (MR, N = 34 933; TR, N = 27 526), only 5379 (15.4%) individuals with MR and 3630 (13.2%) with TR had progression during a median interquartile range) 9.0 (4.1-13.4) years of follow-up. Despite wide inter-individual variability in progression rates, a score based solely on demographics and TTE variables identified individuals with a five- to six-fold higher rate of MR/TR progression over 10 years (high- vs. low-score tertile, rate of progression; MR 20.1% vs. 3.3%; TR 21.2% vs. 4.4%). Compared to those in the lowest score tertile, those in the highest tertile of progression had a four-fold increased risk of mortality. On external validation, the score demonstrated similar performance to other algorithms commonly in use.

Conclusion: Four-fifths of individuals had no progression of MR or TR over two decades. Despite wide interindividual variability in progression rates, a score, based solely on TTE parameters, identified individuals with a five- to six-fold higher rate of MR/TR progression. Compared to the lowest tertile, individuals in the highest score tertile had a four-fold increased risk of mortality. Prediction of long-term MR/TR progression is not only feasible but prognostically important.
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http://dx.doi.org/10.1093/ehjci/jeab254DOI Listing
November 2021

Hollow-porous fibers for intrinsically thermally insulating textiles and wearable electronics with ultrahigh working sensitivity.

Mater Horiz 2021 Mar 11;8(3):1037-1046. Epub 2021 Jan 11.

School of Materials Science and Engineering, Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education; Henan Key Laboratory of Advanced Nylon Materials and Application (Zhengzhou University), Zhengzhou University, Zhengzhou, 450001, P. R. China.

Wearable smart devices should be flexible and functional to imitate the warmth and sensing functions of human skin or animal fur. Despite the recent great progress in wearable smart devices, it is still challenging to achieve the required multi-functionality. Here, stretchable hollow-porous fibers with self-warming ability are designed, and the properties of electrical heating, strain sensing, temperature sensing and pressure sensing are achieved. The hollow-porous TPU fiber possesses an ultra-high stretchability (1468%), and the textiles woven from the fibers present a splendid thermal insulation property (the absolute value difference in temperature |ΔT| = 68.5 and 44 °C at extreme temperatures of 115 and -40.0 °C). Importantly, after conductive filler decoration, the fiber-based strain sensor exhibits one of the highest reported gauge factor (2.3 × 10) towards 100% strain in 7200 working stretch-release cycles. A low detection limit of 0.5% strain is also achieved. Besides, the fibers can be heated to 40 °C in 18 s at a small voltage of 2 V as an electrical heater. The assembled thermal sensors can monitor the temperature from 30 to 90 °C in real time, and the fiber-based capacitive type pressure sensor exhibits good sensing performance under force from 1 to 25 N. The hollow-porous fiber based all-in-one integrated wearable systems illustrate promising prospects for next generation electronic skins to detect human motions and body temperature with thermal therapy and inherent self-warming ability.
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http://dx.doi.org/10.1039/d0mh01818jDOI Listing
March 2021

Variable-fiber optical power splitter design based on a triangular prism.

Appl Opt 2021 Oct;60(30):9390-9395

Fiber optical power splitters (OPSs) have been widely employed in optical communications, optical sensors, optical measurements, and optical fiber lasers. It has been found that OPSs with variable power ratios can simplify the structure and increase the flexibility of optical systems. In this study, a variable-fiber OPS based on a triangular prism is proposed and demonstrated. By adjusting the output beam width of the prism, the power ratio can be continuously tuned. The optical simulations show that the horizontal displacement design is better than the traditional tilt angle design. Our scheme combines a dual-fiber collimator, a focus lens, and a triangular prism with a vertex angle of 120°. By changing the axial displacement of the prism, the power splitting ratio can be altered from 50:50 to 90:10. The polarization and wavelength dependence of the variable OPS were also investigated.
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http://dx.doi.org/10.1364/AO.437983DOI Listing
October 2021

Deep-learning-assisted fiber Bragg grating interrogation by random speckles.

Opt Lett 2021 Nov;46(22):5711-5714

Fiber Bragg gratings (FBGs) have been widely employed as a sensor for temperature, vibration, strain, etc. measurements. However, extant methods for FBG interrogation still face challenges in the aspects of sensitivity, measurement speed, and cost. In this Letter, we introduced random speckles as the FBG's reflection spectrum information carrier for demodulation. Instead of the commonly used InGaAs cameras, a quadrant detector (QD) was first utilized to record the speckle patterns in the experiments. Although the speckle images were severely compressed into four channel signals by the QD, the spectral features of the FBGs can still be precisely extracted with the assistance of a deep convolution neural network (CNN). The temperature and vibration experiments were demonstrated with a resolution of 1.2 pm. These results show that the new, to the best of our knowledge, speckle-based demodulation scheme can satisfy the requirements of both high-resolution and high-speed measurements, which should pave a new way for the optical fiber sensors.
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http://dx.doi.org/10.1364/OL.445159DOI Listing
November 2021

Raman-scattering-assistant large energy dissipative soliton and multicolor coherent noise-like pulse complex in an Yb-doped fiber laser.

Opt Lett 2021 Nov;46(22):5695-5698

In this Letter, we have demonstrated the generation of dissipative solitons (DSs) or multi-wavelength noise-like pulses (NLPs) directly from a common linear Yb-doped fiber laser in the presence of stimulated Raman scattering (SRS). For the DSs, the pulse energy of the solitons with a pulse width of 74.2 ps reaches 21.2 nJ. For the NLPs, the generation of the main NLP (1032 nm) together with the first-order Raman NLP (1080 nm) is realized. The narrow peak of the double-scale autocorrelation trace is characterized by quasi-periodic beat pulses with a pulse beating of 40.6 fs and a pulse separation of 79 fs, indicating that the generated solitons at dual wavelengths are mutually coherent. Furthermore, a three-color stable NLP complex with a broader spectrum is also obtained. The results contribute to an in-depth understanding of nonlinear dynamics and ultrafast physics.
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http://dx.doi.org/10.1364/OL.443319DOI Listing
November 2021

The Role of Frailty in Identifying Benefit from Transcatheter Versus Surgical Aortic Valve Replacement.

Circ Cardiovasc Qual Outcomes 2021 Nov 15. Epub 2021 Nov 15.

Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.

Frailty is associated with a higher risk for adverse outcomes after aortic valve replacement (AVR) for severe aortic valve stenosis, but whether or not frail patients derive differential benefit from transcatheter (TAVR) vs. surgical (SAVR) AVR is uncertain. We linked adults ≥ 65 years old in the US CoreValve High Risk (HiR) or Surgical or Transcatheter Aortic-Valve Replacement in Intermediate Risk Patients (SURTAVI) trial to Medicare claims, 2/2/2011-9/30/2015. Two frailty measures, a deficit-based (DFI) and phenotype-based (PFI) frailty index, were generated. The treatment effect of TAVR vs. SAVR was evaluated within frailty index (FI) tertiles for the primary endpoint of death and non-death secondary outcomes, using multivariable Cox regression. Of 1,442 (linkage rate = 60.0%) individuals included, 741 (51.4%) individuals received TAVR and 701 (48.6%) received SAVR (mean age 81.8 ± 6.1 years, 44.0% female). Though 1-year death rates in the highest FI tertiles (DFI 36.7%, PFI 33.8%) were 2-3-fold higher than the lowest tertiles (DFI 13.4%, HR 3.02, 95% CI 2.26-4.02, p < 0.001; PFI 17.9%; HR 2.05, 95% CI 1.58-2.67, p < 0.001), there were no significant differences in the relative or absolute treatment effect of SAVR vs. TAVR across FI tertiles for all death, non-death, and functional outcomes (all interaction p-values > 0.05). Results remained consistent across individual trials, frailty definitions, and when considering the non-linked trial data. Two different frailty indices based on Fried and Rockwood definitions identified individuals at higher risk of death and functional impairment but no differential benefit from TAVR vs. SAVR.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.121.008566DOI Listing
November 2021

Estimation of DAPT Study Treatment Effects in Contemporary Clinical Practice: Findings from the EXTEND-DAPT Study.

Circulation 2021 Nov 8. Epub 2021 Nov 8.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Baim Institute for Clinical Research, Boston, MA.

Differences in patient characteristics, changes in treatment algorithms, and advances in medical technology could each influence the applicability of older randomized trial results to contemporary clinical practice. The Dual Antiplatelet Therapy (DAPT) Study found that longer duration DAPT decreased ischemic events at the expense of greater bleeding, but subsequent evolution in stent technology and clinical practice may attenuate the benefit of prolonged DAPT in a contemporary population. We evaluated whether the DAPT Study population is different from a contemporary population of US patients receiving percutaneous coronary intervention (PCI), and estimated the treatment effect of extended duration antiplatelet therapy after PCI in this more contemporary cohort. We compared characteristics of drug-eluting stent (DES)-treated patients randomized in the DAPT Study to a sample of more contemporary DES-treated patients in the NCDR CathPCI Registry from July 2016-June 2017. After linking trial and registry data, we employed inverse-odds of trial participation weighting to account for patient and procedural characteristics and estimated a contemporary "real-world" treatment effect of 30 vs. 12 months of DAPT after coronary stent procedures. The US DES-treated trial cohort included 8864 DAPT Study patients and the registry cohort included 568,540 patients. Compared to the trial population, registry patients had more comorbidities and were more likely to present with myocardial infarction and receive 2nd generation DES. After reweighting trial results to represent the registry population, there was no longer a significant effect of prolonged DAPT on reducing stent thrombosis (reweighted treatment effect: -0.40, 95% CI: -0.99%, 0.15%), major adverse cardiac and cerebrovascular events (reweighted treatment effect: -0.52, 95% CI: -2.62%, 1.03%), or myocardial infarction (reweighted treatment effect: -0.97%, 95% CI: -2.75%, 0.18%), but the increase in bleeding with prolonged DAPT persisted (reweighted treatment effect: 2.42%, 95% CI: 0.79%, 3.91%). Differences between patients and devices used in contemporary clinical practice compared with the DAPT Study were associated with attenuation of benefits and greater harms attributable to prolonged DAPT duration. These findings limit applicability of average treatment effects from the DAPT Study in modern clinical practice.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.121.056878DOI Listing
November 2021

Flexible layered cotton cellulose-based nanofibrous membranes for piezoelectric energy harvesting and self-powered sensing.

Carbohydr Polym 2022 Jan 16;275:118740. Epub 2021 Oct 16.

Key Laboratory of Materials Processing and Mold (Ministry of Education), National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China.

Cellulose has attracted an increasing attention for piezoelectric energy harvesting. However, the limited piezoelectricity of natural cellulose constraints the applications. Therefore, we demonstrate the development of piezoelectric nanogenerators based on robust, durable layered membranes composed of cotton cellulose interfaced maleic-anhydride-grafted polyvinylidene fluoride (PVDF-g-MA) nanofibers. Exploiting [email protected] (pBT) nanoparticles as interlayer bridges, interlocked layer-layer interfaces that covalently bind component layers are constructed by a facile and scalable approach. As-obtained membranes exhibit significantly improved piezoelectricity with a maximum piezoelectric coefficient of 27.2 pC/N, power density of 1.72 μW/cm, and stability over 8000 cycles. Substantial enhancement in piezoelectricity over pristine cellulose is ascribed to the synergy of components and the localized stress concentration induced by pBT nanoparticles. The self-powered device could also be used to detect human physiological motions in different forms. Such cellulose-based membranes can be up-scaled to fabricate ecofriendly, flexible and durable energy harvesters and self-powered wearable sensors.
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http://dx.doi.org/10.1016/j.carbpol.2021.118740DOI Listing
January 2022

Markedly improved hydrophobicity of cellulose film via a simple one-step aminosilane-assisted ball milling.

Carbohydr Polym 2022 Jan 24;275:118701. Epub 2021 Sep 24.

Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou, 450002, China.

Most cellulose products lack water resistance due to the existence of abundant hydroxyl groups. In this work, microfibrillated cellulose (MFC) was modified via 3-aminopropyltriethoxysilane (APTES)-assisted ball milling. Under the synergism between high-energy mechanical force field and APTES-modification, the fibrillation and hydrophobization of MFC were achieved simultaneously. Free-standing translucent cellulose films made of modified MFC were fabricated. The original crystal form of cellulose is maintained. The hydrophobicity of cellulose film markedly increases and the water contact angle goes up to 133.2 ± 3.4°, which might be ascribed to the combined effects of APTES-modification and rough film surface. In addition, the thermostability and mechanical properties of cellulose film are also improved via mechanochemical modification. This work provides a novel one-step fibrillation-hydrophobization method for cellulose.
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http://dx.doi.org/10.1016/j.carbpol.2021.118701DOI Listing
January 2022

High-sensitivity optical fiber hydrogen sensor based on the metal organic frameworks of UiO-66-NH.

Opt Lett 2021 Nov;46(21):5405-5408

A hydrogen sensor with high sensitivity was demonstrated by coating the metal organic frameworks of ${\rm{UiO}}\! -\! {\rm{66 \!-\! N}}{{\rm{H}}_2}$ on an optical fiber Mach-Zehnder interferometer (MZI). The MZI was made of a fiber mismatch structure by using a core-offset fusion splicing method. The effective refractive index of the ${\rm{UiO}}\! -\! {\rm{66\! -\! N}}{{\rm{H}}_2}$ film varied with the absorption and release of hydrogen, and the interference resonant dip wavelength and the intensity of the MZI changed with the variations of the concentration of hydrogen. The experimental results showed that the proposed sensor had a high hydrogen sensitivity of 8.78 dB/% in the range from 0% to 0.8%, which is almost seven times higher than the existing similar hydrogen sensor.
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http://dx.doi.org/10.1364/OL.443930DOI Listing
November 2021

Flexible Conductive Polyimide Fiber/MXene Composite Film for Electromagnetic Interference Shielding and Joule Heating with Excellent Harsh Environment Tolerance.

ACS Appl Mater Interfaces 2021 Oct 15;13(42):50368-50380. Epub 2021 Oct 15.

Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education; National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou, Henan 450002, China.

The development of flexible MXene-based multifunctional composites is becoming a hot research area to achieve the application of conductive MXene in wearable electric instruments. Herein, a flexible conductive polyimide fiber (PIF)/MXene composite film with densely stacked "rebar-brick-cement" lamellar structure is fabricated using the simple vacuum filtration plus thermal imidization technique. A water-soluble polyimide precursor, poly(amic acid), is applied to act as a binder and dispersant to ensure the homogeneous dispersion of MXene and its good interfacial adhesion with PIF after thermal imidization, resulting in excellent mechanical robustness and high conductivity (3787.9 S/m). Owing to the reflection on the surface, absorption through conduction loss and interfacial/dipolar polarization loss inside the material, and the lamellar structure that is beneficial for multiple reflection and scattering between adjacent layers, the resultant PIF/MXene composite film exhibits a high electromagnetic interference (EMI) shielding effectiveness of 49.9 dB in the frequency range of 8.2-12.4 GHz. More importantly, its EMI shielding capacity can be well maintained in various harsh environments (e.g., extreme high/low temperature, acid/salt solution, and long-term cyclic bending), showing excellent stability and durability. Furthermore, it also presents fast, stable, and long-term durable Joule heating performances based on its stable and excellent conductivity, demonstrating good thermal deicing effects under actual conditions. Therefore, we believe that the flexible conductive PIF/MXene composite film with excellent conductivity and harsh environment tolerance possesses promising potential for electromagnetic wave protection and personal thermal management.
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http://dx.doi.org/10.1021/acsami.1c15467DOI Listing
October 2021

Applicability of Transcatheter Aortic Valve Replacement Trials to Real-World Clinical Practice: Findings From EXTEND-CoreValve.

JACC Cardiovasc Interv 2021 10;14(19):2112-2123

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. Electronic address:

Objectives: The aim of this study was to examine the applicability of pivotal transcatheter aortic valve replacement (TAVR) trials to the real-world population of Medicare patients undergoing TAVR.

Background: It is unclear whether randomized controlled trial results of novel cardiovascular devices apply to patients encountered in clinical practice.

Methods: Characteristics of patients enrolled in the U.S. CoreValve pivotal trials were compared with those of the population of Medicare beneficiaries who underwent TAVR in U.S. clinical practice between November 2, 2011, and December 31, 2017. Inverse probability weighting was used to reweight the trial cohort on the basis of Medicare patient characteristics, and a "real-world" treatment effect was estimated.

Results: A total of 2,026 patients underwent TAVR in the U.S. CoreValve pivotal trials, and 135,112 patients underwent TAVR in the Medicare cohort. Trial patients were mostly similar to real-world patients at baseline, though trial patients were more likely to have hypertension (50% vs 39%) and coagulopathy (25% vs 17%), whereas real-world patients were more likely to have congestive heart failure (75% vs 68%) and frailty. The estimated real-world treatment effect of TAVR was an 11.4% absolute reduction in death or stroke (95% CI: 7.50%-14.92%) and an 8.7% absolute reduction in death (95% CI: 5.20%-12.32%) at 1 year with TAVR compared with conventional therapy (surgical aortic valve replacement for intermediate- and high-risk patients and medical therapy for extreme-risk patients).

Conclusions: The trial and real-world populations were mostly similar, with some notable differences. Nevertheless, the extrapolated real-world treatment effect was at least as high as the observed trial treatment effect, suggesting that the absolute benefit of TAVR in clinical trials is similar to the benefit of TAVR in the U.S. real-world setting.
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http://dx.doi.org/10.1016/j.jcin.2021.08.006DOI Listing
October 2021

Race, sex and age disparities in echocardiography among Medicare beneficiaries in an integrated healthcare system.

Heart 2021 Oct 6. Epub 2021 Oct 6.

Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Objective: To identify potential race, sex and age disparities in performance of transthoracic echocardiography (TTE) over several decades.

Methods: TTE reports from five academic and community sites within a single integrated healthcare system were linked to 100% Medicare fee-for-service claims from 1 January 2005 to 31 December 2017. Multivariable Poisson regression was used to estimate adjusted rates of TTE utilisation after the index TTE according to baseline age, sex, race and comorbidities among individuals with ≥2 TTEs. Non-white race was defined as black, Asian, North American Native, Hispanic or other categories using Medicare-assigned race categories.

Results: A total of 15 870 individuals (50.1% female, mean 72.2±12.7 years) underwent a total of 63 535 TTEs (range 2-55/person) over a median (IQR) follow-up time of 4.9 (2.4-8.5) years. After the index TTE, the median TTE use was 0.72 TTEs/person/year (IQR 0.43-1.33; range 0.12-26.76). TTE use was lower in older individuals (relative risk (RR) for 10-year increase in age, 0.91, 95% CI 0.89 to 0.92, p<0.001), women (RR 0.97, 95% CI 0.95 to 0.99, p<0.001) and non-white individuals (RR 0.95, 95% CI 0.93 to 0.97, p<0.001). Black women in particular had the lowest relative use of TTE (RR 0.92, 95% CI 0.88 to 0.95, p<0.001). The only clinical conditions associated with increased TTE use after multivariable adjustment were heart failure (RR 1.04, 95% CI 1.00 to 1.08, p=0.04) and chronic obstructive pulmonary disease (RR 1.05, 95% CI 1.00 to 1.10, p=0.04).

Conclusions: Among Medicare beneficiaries with multiple TTEs in a single large healthcare system, the median TTE use after the index TTE was 0.72 TTEs/person/year, although this varied widely. Adjusted for comorbidities, female sex, non-white race and advancing age were associated with decreased TTE utilisation.
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http://dx.doi.org/10.1136/heartjnl-2021-319951DOI Listing
October 2021

Strain-, curvature- and twist-independent temperature sensor based on a small air core hollow core fiber structure.

Opt Express 2021 Aug;29(17):26353-26365

Cross-sensitivity (crosstalk) to multiple parameters is a serious but common issue for most sensors and can significantly decrease the usefulness and detection accuracy of sensors. In this work, a high sensitivity temperature sensor based on a small air core (10 µm) hollow core fiber (SACHCF) structure is proposed. Co-excitation of both anti-resonant reflecting optical waveguide (ARROW) and Mach-Zehnder interferometer (MZI) guiding mechanisms in transmission are demonstrated. It is found that the strain sensitivity of the proposed SACHCF structure is decreased over one order of magnitude when a double phase condition (destructive condition of MZI and resonant condition of ARROW) is satisfied. In addition, due to its compact size and a symmetrical configuration, the SACHCF structure shows ultra-low sensitivity to curvature and twist. Experimentally, a high temperature sensitivity of 31.6 pm/°C, an ultra-low strain sensitivity of -0.01pm/µε, a curvature sensitivity of 18.25 pm/m, and a twist sensitivity of -22.55 pm/(rad/m) were demonstrated. The corresponding temperature cross sensitivities to strain, curvature and twist are calculated to be -0.00032 °C/µε, 0.58 °C/m and 0.71 °C/(rad/m), respectively. The above cross sensitivities are one to two orders of magnitude lower than that of previously reported optical fiber temperature sensors. The proposed sensor shows a great potential to be used as a temperature sensor in practical applications where influence of multiple environmental parameters cannot be eliminated.
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http://dx.doi.org/10.1364/OE.433580DOI Listing
August 2021

Identification of Frailty Using a Claims-Based Frailty Index in the CoreValve Studies: Findings from the EXTEND-FRAILTY Study.

J Am Heart Assoc 2021 10 29;10(19):e022150. Epub 2021 Sep 29.

Department of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MA.

Background In aortic valve disease, the relationship between claims-based frailty indices (CFIs) and validated measures of frailty constructed from in-person assessments is unclear but may be relevant for retrospective ascertainment of frailty status when otherwise unmeasured. Methods and Results We linked adults aged ≥65 years in the US CoreValve Studies (linkage rate, 67%; mean age, 82.7±6.2 years, 43.1% women), to Medicare inpatient claims, 2011 to 2015. The Johns Hopkins CFI, validated on the basis of the Fried index, was generated for each study participant, and the association between CFI tertile and trial outcomes was evaluated as part of the EXTEND-FRAILTY substudy. Among 2357 participants (64.9% frail), higher CFI tertile was associated with greater impairments in nutrition, disability, cognition, and self-rated health. The primary outcome of all-cause mortality at 1 year occurred in 19.3%, 23.1%, and 31.3% of those in tertiles 1 to 3, respectively (tertile 2 versus 1: hazard ratio, 1.22; 95% CI, 0.98-1.51; =0.07; tertile 3 versus 1: hazard ratio, 1.73; 95% CI, 1.41-2.12; <0.001). Secondary outcomes (bleeding, major adverse cardiovascular and cerebrovascular events, and hospitalization) were more frequent with increasing CFI tertile and persisted despite adjustment for age, sex, New York Heart Association class, and Society of Thoracic Surgeons risk score. Conclusions In linked Medicare and CoreValve study data, a CFI based on the Fried index consistently identified individuals with worse impairments in frailty, disability, cognitive dysfunction, and nutrition and a higher risk of death, hospitalization, bleeding, and major adverse cardiovascular and cerebrovascular events, independent of age and risk category. While not a surrogate for validated metrics of frailty using in-person assessments, use of this CFI to ascertain frailty status among patients with aortic valve disease may be valid and prognostically relevant information when otherwise not measured.
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http://dx.doi.org/10.1161/JAHA.121.022150DOI Listing
October 2021

Flexible Ag Microparticle/MXene-Based Film for Energy Harvesting.

Nanomicro Lett 2021 Sep 24;13(1):201. Epub 2021 Sep 24.

College of Materials Science and Engineering, Key Laboratory of Advanced Material Processing & Mold (Ministry of Education), National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou, 450002, People's Republic of China.

Ultra-thin flexible films have attracted wide attention because of their excellent ductility and potential versatility. In particular, the energy-harvesting films (EHFs) have become a research hotspot because of the indispensability of power source in various devices. However, the design and fabrication of such films that can capture or transform different types of energy from environments for multiple usages remains a challenge. Herein, the multifunctional flexible EHFs with effective electro-/photo-thermal abilities are proposed by successive spraying Ag microparticles and MXene suspension between on waterborne polyurethane films, supplemented by a hot-pressing. The optimal coherent film exhibits a high electrical conductivity (1.17×10 S m), excellent Joule heating performance (121.3 °C) at 2 V, and outstanding photo-thermal performance (66.2 °C within 70 s under 100 mW cm). In addition, the EHFs-based single-electrode triboelectric nanogenerators (TENG) give short-circuit transferred charge of 38.9 nC, open circuit voltage of 114.7 V, and short circuit current of 0.82 μA. More interestingly, the output voltage of TENG can be further increased via constructing the double triboelectrification layers. The comprehensive ability for harvesting various energies of the EHFs promises their potential to satisfy the corresponding requirements.
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http://dx.doi.org/10.1007/s40820-021-00729-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463646PMC
September 2021

Bioinspired Multifunctional Photonic-Electronic Smart Skin for Ultrasensitive Health Monitoring, for Visual and Self-Powered Sensing.

Adv Mater 2021 Nov 23;33(45):e2102332. Epub 2021 Sep 23.

School of Materials Science and Engineering, Key Laboratory of Materials Processing and Mold, Ministry of Education, Zhengzhou University, Zhengzhou, 450001, P. R. China.

Smart skin is highly desired to be ultrasensitive and self-powered as the medium of artificial intelligence. Here, an ultrasensitive self-powered mechanoluminescence smart skin (SPMSS) inspired by the luminescence mechanism of cephalopod skin and the ultrasensitive response of spider-slit-organ is developed. Benefitting from the unique strain-dependent microcrack structure design based on Ti C T (MXene)/carbon nanotube synergistic interaction, SPMSS possesses excellent strain sensing performances including ultralow detection limit (0.001% strain), ultrahigh sensitivity (gauge factor, GF = 3.92 × 10 ), ultrafast response time (5 ms), and superior durability and stability (>45 000 cycles). Synchronously, SPMSS exhibits tunable and highly sensitive mechanoluminescence (ML) features under stretching. A relationship between ML features, strain sensing performances, and the deformation has been established successfully. Importantly, the SPMSS demonstrates excellent properties as triboelectric nanogenerator (4 × 4 cm ), including ultrahigh triboelectric output (open-circuit voltage V  = 540 V, short-circuit current I  = 42 µA, short-circuit charge Q  = 317 nC) and power density (7.42 W m ), endowing the smart skin with reliable power source supply and self-powered sensing ability. This bioinspired smart skin exhibits multifunctional applications in health monitoring, visual sensing, and self-powered sensing, showing great potential in artificial intelligence.
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http://dx.doi.org/10.1002/adma.202102332DOI Listing
November 2021

Effect of intensive versus limited monitoring on clinical trial conduct and outcomes: A randomized trial.

Am Heart J 2022 Jan 14;243:77-86. Epub 2021 Sep 14.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston MA; Harvard Medical School, Boston, MA. Electronic address:

Background: Regulatory agencies have endorsed more limited approaches to clinical trial site monitoring. However, the impact of different monitoring strategies on trial conduct and outcomes is unclear.

Methods: We conducted a patient-level block-randomized controlled trial evaluating the effect of intensive versus limited monitoring on cardiovascular clinical trial conduct and outcomes nested within the CoreValve Continued Access and Expanded Use Studies. Intensive monitoring included complete source data verification of all critical datapoints whereas limited monitoring included automated data checks only. This study's endpoints included clinical trial outcome ascertainment as well as monitoring action items, protocol deviations, and adverse event ascertainment.

Results: A total of 2,708 patients underwent transcatheter aortic valve replacement (TAVR) and were randomized to either intensive monitoring (n = 1,354) or limited monitoring (n = 1,354). Monitoring action items were more common with intensive monitoring (52% vs 15%; P < .001), but there was no difference in the percentage of patients with any protocol deviation (91.6% vs 90.4%; P = .314). The reported incidence of trial outcomes between intensive and limited monitoring was similar for mortality (30 days: 4.8% vs 5.5%, P = .442; 1 year: 20.3% vs 21.3%, P = .473) and stroke (30 days: 2.8% vs 2.4%, P = .458), as well as most secondary trial outcomes with the exception of bleeding (intensive: 36.3% vs limited: 32.0% at 30 days, P = .019). There was a higher reported incidence of cardiac adverse events reported in the intensive monitoring group at 1 year (76.7% vs 72.4%; P = .019).

Conclusions: Tailored limited monitoring strategies can be implemented without influencing the integrity of TAVR trial outcomes.
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http://dx.doi.org/10.1016/j.ahj.2021.09.002DOI Listing
January 2022

Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia.

J Gen Intern Med 2021 Sep 10. Epub 2021 Sep 10.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, MA, Boston, USA.

Background: The Centers for Medicare and Medicaid Services' Hospital Value-Based Purchasing program uses 30-day mortality rates for acute myocardial infarction, heart failure, and pneumonia to evaluate US hospitals, but does not account for neighborhood socioeconomic disadvantage when comparing their performance.

Objective: To determine if neighborhood socioeconomic disadvantage is associated with worse 30-day mortality rates after a hospitalization for acute myocardial infarction (AMI), heart failure (HF), or pneumonia in the USA, as well as within the subset of counties with a high proportion of Black individuals.

Design And Participants: This retrospective, population-based study included all Medicare fee-for-service beneficiaries aged 65 years or older hospitalized for acute myocardial infarction, heart failure, or pneumonia between 2012 and 2015.

Exposure: Residence in most socioeconomically disadvantaged vs. less socioeconomically disadvantaged neighborhoods as measured by the area deprivation index (ADI).

Main Measure(s): All-cause mortality within 30 days of admission.

Key Results: The study included 3,471,592 Medicare patients. Of these patients, 333,472 resided in most disadvantaged neighborhoods and 3,138,120 in less disadvantaged neighborhoods. Patients living in the most disadvantaged neighborhoods were younger (78.4 vs. 80.0 years) and more likely to be Black adults (24.6% vs. 7.5%) and dually enrolled in Medicaid (39.4% vs. 21.8%). After adjustment for demographics (age, sex, race/ethnicity), poverty, and clinical comorbidities, 30-day mortality was higher among beneficiaries residing in most disadvantaged neighborhoods for AMI (adjusted odds ratio 1.08, 95% CI 1.06-1.11) and pneumonia (aOR 1.05, 1.03-1.07), but not for HF (aOR 1.02, 1.00-1.04). These patterns were similar within the subset of US counties with a high proportion of Black adults (AMI, aOR 1.07, 1.03-1.11; HF 1.02, 0.99-1.05; pneumonia 1.03, 1.00-1.07).

Conclusions: Neighborhood socioeconomic disadvantage is associated with higher 30-day mortality for some conditions targeted by value-based programs, even after accounting for individual-level demographics, clinical comorbidities, and poverty. These findings may have implications as policymakers weigh strategies to advance health equity under value-based programs.
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http://dx.doi.org/10.1007/s11606-021-07090-zDOI Listing
September 2021

Synergistic Effect of Pressurization Rate and β-Form Nucleating Agent on the Multi-Phase Crystallization of iPP.

Polymers (Basel) 2021 Sep 3;13(17). Epub 2021 Sep 3.

Key Laboratory of Materials Processing and Mold, National Engineering Research Center for Advanced Polymer Processing Technology, Ministry of Education, Zhengzhou University, Zhengzhou 450002, China.

Using a homemade pressure device, we explored the synergistic effect of pressurization rate and β-form nucleating agent (β-NA) on the crystallization of an isotactic polypropylene (iPP) melt. The obtained samples were characterized by combining small angle X-ray scattering and synchrotron wide angle X-ray diffraction. It was found that the synergistic application of pressurization and β-NA enables the preparation of a unique multi-phase crystallization of iPP, including β-, γ- and/or mesomorphic phases. Pressurization rate plays a crucial role on the formation of different crystal phases. As the pressurization rate increases in a narrow range between 0.6-1.9 MPa/s, a significant competitive formation between β- and γ-iPP was detected, and their relative crystallinity are likely to be determined by the growth of the crystal. When the pressurization rate increases further, both β- and γ-iPP contents gradually decrease, and the mesophase begins to emerge once it exceeds 15.0 MPa/s, then mesomorphic, β- and γ- iPP coexist with each other. Moreover, with different β-NA contents, the best pressurization rate for β-iPP growth is the same as 1.9 MPa/s, while more β-NA just promotes the content of β-iPP under the rates lower than 1.9 MPa/s. In addition to inducing the formation of β-iPP, it shows that β-NA can also significantly promote the formation of γ-iPP in a wide pressurization rate range between 3.8 to 75 MPa/s. These results were elucidated by combining classical nucleation theory and the growth theory of different crystalline phases, and a theoretical model of the pressurization-induced crystallization is established, providing insight into understanding the multi-phase structure development of iPP.
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http://dx.doi.org/10.3390/polym13172984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434399PMC
September 2021

Optical Fiber Based Mach-Zehnder Interferometer for APES Detection.

Sensors (Basel) 2021 Aug 31;21(17). Epub 2021 Aug 31.

Institute of Optoelectronic Technology, China Jiliang University, Hangzhou 310018, China.

A 3-aminopropyl-triethoxysilane (APES) fiber-optic sensor based on a Mach-Zehnder interferometer (MZI) was demonstrated. The MZI was constructed with a core-offset fusion single mode fiber (SMF) structure with a length of 3.0 cm. As APES gradually attaches to the MZI, the external environment of the MZI changes, which in turn causes change in the MZI's interference. That is the reason why we can obtain the relationships between the APES amount and resonance dip wavelength by measuring the transmission variations of the resonant dip wavelength of the MZI. The optimized amount of 1% APES for 3.0 cm MZI biosensors was 3 mL, whereas the optimized amount of 2% APES was 1.5 mL.
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http://dx.doi.org/10.3390/s21175870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434240PMC
August 2021

Days Out of Institution Following Tracheostomy and Gastrostomy Placement in Critically Ill Older Adults.

Ann Am Thorac Soc 2021 Aug 13. Epub 2021 Aug 13.

Boston University School of Medicine, Pulmonary Center, Boston, Massachusetts, United States.

Rationale Tracheostomy and gastrostomy tubes are frequently placed during critical illness for long-term life-support, with the majority placed in older adults. Large knowledge gaps exist regarding outcomes expressed as most important to patients. Objectives To determine days alive and out of institution and mortality after tracheostomy and gastrostomy placement during critical illness; to evaluate associations between health states prior to critical illness and outcomes. Methods In this retrospective cohort study of Medicare beneficiaries admitted to an intensive care unit (ICU) who received a tracheostomy, gastrostomy, or both, we determined number of days alive and out of institution (DAOI) following procedure date; 90-day, 6-month, and 1-year mortality; hospital discharge destination; and hospital length of stay. We used claims from the year prior to admission to define eight mutually exclusive pre-ICU health states (permutations of one or more of: Cancer, Chronic Organ Failure, Frail, Robust) and assessed their association with DAOI in 90 days and 1-year mortality. Results Among 3,365 patients who received a tracheostomy, 6,709 patients who received a gastrostomy tube, and 3,540 patients who received both procedures, the median DAOI in the first 90 days after placement was 3 (IQR 0-46), 12 (0-61), and 0 (0-37), respectively. Over half died within 180 days. 1-year mortality was 62%, 60%, and 64%, respectively. When compared to the Robust state, all other pre-ICU health states were associated with loss of DAOI and increased 1-year mortality; however, between the seven non-Robust pre-ICU health states, there were no differences in outcomes. Conclusions Medicare beneficiaries with prior comorbidity who received tracheostomy, gastrostomy tube, or both during critical illness spent few days alive and out of institution and had high short- and long-term mortality.
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http://dx.doi.org/10.1513/AnnalsATS.202106-649OCDOI Listing
August 2021

Racial/Ethnic Disparities in Hypertension Prevalence, Awareness, Treatment, and Control in the United States, 2013 to 2018.

Hypertension 2021 Dec 9;78(6):1719-1726. Epub 2021 Aug 9.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology (R.A., N.C., R.K.W., I.R., C.S., R.W.Y., D.S.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

[Figure: see text].
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.121.17570DOI Listing
December 2021

Cost-effectiveness of Dapagliflozin for the Treatment of Heart Failure With Reduced Ejection Fraction.

JAMA Netw Open 2021 Jul 1;4(7):e2114501. Epub 2021 Jul 1.

Harvard Medical School, Boston, Massachusetts.

Importance: Heart failure with reduced ejection fraction produces substantial morbidity, mortality, and health care costs. Dapagliflozin is the first sodium-glucose cotransporter 2 inhibitor approved for the treatment of heart failure with reduced ejection fraction.

Objective: To examine the cost-effectiveness of adding dapagliflozin to guideline-directed medical therapy for heart failure with reduced ejection fraction in patients with or without diabetes.

Design, Setting, And Participants: This economic evaluation developed and used a Markov cohort model that compared dapagliflozin and guideline-directed medical therapy with guideline-directed medical therapy alone in a hypothetical cohort of US adults with similar clinical characteristics as participants of the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) trial. Dapagliflozin was assumed to cost $4192 annually. Nonparametric modeling was used to estimate long-term survival. Deterministic and probabilistic sensitivity analyses examined the impact of parameter uncertainty. Data were analyzed between September 2019 and January 2021.

Main Outcomes And Measures: Lifetime incremental cost-effectiveness ratio in 2020 US dollars per quality-adjusted life-year (QALY) gained.

Results: The simulated cohort had a starting age of 66 years, and 41.8% had diabetes at baseline. Median (interquartile range) survival in the guideline-directed medical therapy arm was 6.8 (3.5-11.3) years. Dapagliflozin was projected to add 0.63 (95% uncertainty interval [UI], 0.25-1.15) QALYs at an incremental lifetime cost of $42 800 (95% UI, $37 100-$50 300), for an incremental cost-effectiveness ratio of $68 300 per QALY gained (95% UI, $54 600-$117 600 per QALY gained; cost-effective in 94% of probabilistic simulations at a threshold of $100 000 per QALY gained). Findings were similar in individuals with or without diabetes but were sensitive to drug cost.

Conclusions And Relevance: In this study, adding dapagliflozin to guideline-directed medical therapy was projected to improve long-term clinical outcomes in patients with heart failure with reduced ejection fraction and be cost-effective at current US prices. Scalable strategies for improving uptake of dapagliflozin may improve long-term outcomes in patients with heart failure with reduced ejection fraction.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.14501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317009PMC
July 2021

Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease Among Medicare Beneficiaries Between 2017 and 2018: Participation Rates and Outcomes.

Circ Cardiovasc Qual Outcomes 2021 08 23;14(8):e007953. Epub 2021 Jul 23.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (B.J.C., S.C., C.S., E.A.S.), Beth Israel Deaconess Medical Center, Boston, MA.

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http://dx.doi.org/10.1161/CIRCOUTCOMES.121.007953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373731PMC
August 2021

Highly Thermal Conductive Poly(vinyl alcohol) Composites with Oriented Hybrid Networks: Silver Nanowire Bridged Boron Nitride Nanoplatelets.

ACS Appl Mater Interfaces 2021 Jul 29;13(27):32286-32294. Epub 2021 Jun 29.

National Engineering Research Center for Advanced Polymer Processing Technology, The Key Laboratory of Material Processing and Mold of Ministry of Education, College of Materials Science and Engineering, Zhengzhou University, Zhengzhou 450002, P. R. China.

With the increasing demand for thermal management materials in the highly integrated electronics area, building efficient heat-transfer networks to obtain advanced thermally conductive composites is of great significance. In the present work, highly thermally conductive poly(vinyl alcohol) (PVA)/boron nitride [email protected] nanowires ([email protected]) composites were fabricated via the combination of the electrospinning and the spraying technique, followed by a hot-pressing method. BNNS are oriented along the in-plane direction, while AgNWs with a high aspect ratio can help to construct a thermal conductive network effectively by bridging BNNS in the composites. The PVA/[email protected] composites showed high in-plane thermal conductivity (TC) of 10.9 W/(m·K) at 33 wt % total fillers addition. Meanwhile, the composite shows excellent thermal dispassion capability when it is taken as a thermal interface material of a working light-emitting diode (LED) chip, which is certified by capturing the surface temperature of the LED chip. In addition, the out-of-plane electrical conductivity of the composites is below 10 S/cm. The composites with outstanding thermal conductive and electrical insulating properties hold promise for application in electrical packaging and thermal management.
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http://dx.doi.org/10.1021/acsami.1c08408DOI Listing
July 2021

Tunable and Nacre-Mimetic Multifunctional Electronic Skins for Highly Stretchable Contact-Noncontact Sensing.

Small 2021 08 26;17(31):e2100542. Epub 2021 Jun 26.

School of Materials Science and Engineering, Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou, 450001, China.

Electronic skins (e-skins) have attracted great attention for their applications in disease diagnostics, soft robots, and human-machine interaction. The integration of high sensitivity, low detection limit, large stretchability, and multiple stimulus response capacity into a single e-skin remains an enormous challenge. Herein, inspired by the structure of nacre, an ultra-stretchable and multifunctional e-skin with tunable strain detection range based on nacre-mimetic multi-layered silver nanowires /reduced graphene oxide /thermoplastic polyurethane mats is fabricated. The e-skin possesses extraordinary strain response performance with a tunable detection range (50 to 200% strain), an ultralow response limit (0.1% strain), a high sensitivity (gauge factor up to 1902.5), a fast response time (20 ms), and an excellent stability (stretching/releasing test of 11 000 cycles). These excellent response behaviors enable the e-skin to accurately monitor full-range human body motions. Additionally, the e-skin can detect relative humidity quickly and sensitively through a reversible physical adsorption/desorption of water vapor, and the assembled e-skin array exhibits excellent performance in noncontact sensing. The tunable and multifunctional e-skins show promising applications in motion monitoring and contact-noncontact human machine interaction.
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http://dx.doi.org/10.1002/smll.202100542DOI Listing
August 2021
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