Medicine and Health Sciences Commons^™

An Observational Study Of Discourse Tasks And Running Speech Sampling In The Assessment Of Paediatric Voice Quality, Victoria Reynolds, Kristin Scavo-Smith, Kate Oteng-Bediako, Sophie Scanlon

Speech-Language Pathology Faculty Publications

Introduction

Running speech sampling is an essential component of a paediatric voice evaluation, in that it should provide the examiner with a representative vocal sample of the child's everyday voice use outside of the clinic setting. Current speech sampling practices, consisting of reading tasks, informal conversation sampling and the voice question ('Tell me about your voice problem'), may not elicit consistent samples or samples of sufficient length to allow the examiner to make a reliable and valid judgement about vocal quality. The aim of this study is to compare the voice quality of children produced in response to existing running …

Antibiotic Resistance: The Growing Threats And Potential Solutions, Olisaemeka Zikora Akunne, Blessing Nkechi Emmanuel, Umar Faruk Saidu, Ayobami Sunday Akinnawo, Nasiru Ademola Adeyemi, Livia Chinaza Egoh, Malami Aishatu Muhammad, Olusegun Ayo Ade-Adekunle, Deborah Ahuoyiza Peter, Anne Amina Freitas

Department of Biomedical and Translational Sciences Faculty Publications

Antibiotic resistance (AR) has become a critical global health crisis, threatening the efficacy of antibiotics and increasing healthcare costs, morbidity, and mortality. The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, is increasingly recognized as an essential framework for addressing the complex drivers of AR. This review explores the mechanisms of resistance, such as genetic mutations, horizontal gene transfer, and biofilm formation, along with contributing factors such as the overuse of antibiotics in healthcare and agriculture. We assess both traditional and emerging strategies to combat AR, including antimicrobial stewardship, the development of new antibiotics, and …

Epigenetic Regulation In Fibrosis, Qingping Wei, Xiaoru Hu, Yan Sanders

Department of Biomedical and Translational Sciences Faculty Publications

[Introduction] Fibrosis is one of the pathological conditions underlying the progression of numerous chronic diseases, and it contributes substantially to morbidity and mortality worldwide. Increasing amounts of evidence indicate that epigenetic mechanisms—including DNA methylation, histone modifications, RNA modifications, and non-coding RNAs—play pivotal roles in epithelial cell injury and maladaptive tissue repair, inflammatory cell and fibroblast activation, and extracellular matrix remodeling and accumulation. Compared to genetic alterations, epigenetic changes are relatively reversible, positioning them as promising therapeutic targets. The articles collected in this Research Topic highlight recent advances in understanding how epigenetic regulation shapes fibrotic processes across multiple organ systems and …

Global, Regional, And National Burden Of Cardiovascular Diseases And Risk Factors In 204 Countries And Territories, 1990-2023, Global Burden Of Cardiovascular Diseases And Risks 2023 Collaborators, Benjamin A. Stark, Nicole K. Decleene, Emily C. Desai, Johnathan M. Hsu, Catherine O. Johnson, Laura Lara-Castor, Kate E. Legrand, Prof Bhoomadevi A., Mohammad Amin Aalipour, Nasir Abbas, Madineh Abbasi, Mohammadreza Abbasian, Hedayat Abbastabar, Abdallah H. A. Abd Al Magied, Samar Abd Elhafeez, Gregory A. Roth, Et Al.

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging.

Objectives

We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure.

Methods

The Global Burden of Disease (GBD) 2023 study, a multinational …

Lost In Transition: The Need For Research On Immersive Clinical Experiences In Athletic Training Education, Julie M. Cavallario, Stephanie M. Singe

Rehabilitation Sciences Faculty Publications

Context

Immersive clinical experiences (ICEs) were integrated into athletic training education to enhance student learning. However, their structure and effect remain poorly understood.

Objective

To highlight the lack of research on ICEs and the need for data-driven improvements in athletic training education.

Background

Since the transition to graduate-level education, ICEs have been required to provide students with uninterrupted exposure to professional practice. Despite this requirement, little evidence exists regarding their effectiveness or best implementation practices.

Synthesis

Authors of recent studies have revealed inconsistencies in implementation, limited placement diversity, and inadequate preceptor training. Despite widespread adoption, little evidence supports how ICEs …

Excitation And Polarization Of Isolated Neurons By High-Frequency Sine Waves For Temporal Interference Stimulation, Iurii Semenov, Vitalii Kim, Giedre Silkuniene, Andrei G. Pakhomov

Bioelectrics Publications

The capacity of temporal interference (TI) stimulation to target deep brain regions without affecting nearby surface electrodes remains uncertain. Using artifact-free optical recording, we compare excitation patterns and thresholds in hippocampal neurons stimulated by “pure” and amplitude-modulated sine waves, representing TI waveforms near electrodes and at the target, respectively. We show that pure 2- and 20-kHz sine waves induce repetitive firing at rates that increase up to 60–90 Hz with stronger electric fields. Beyond this limit, action potentials merge into sustained depolarization, resulting in an excitation block. Modulating the sine waves at 20 Hz aligns firing with amplitude “beats” and …

Time Of Urine Sampling May Influence The Association Between Urine Specific Gravity And Body Composition, Patrick B. Wilson, Brian K. Ferguson, Ian P. Winter

Exercise Science Faculty Publications

Urine specific gravity (USG) is frequently utilized in sports practice and research to assess hydration status. Prior research suggests that individuals with large amounts of fat-free mass (FFM) and muscle have elevated USG, but little is known about whether the time of collection (first-morning vs. spot sampling) and various nutritional factors influence these relationships. This cross-sectional, observational study assessed fasted first-morning (n = 55) and non-fasted spot USG (n = 51) samples in adults and evaluated relationships of USG with body composition and nutrition intake. The InBody 770 was used to estimate FFM, skeletal muscle mass (SMM), and total body …

Representative National Survey On Drug Use During The Covid-19 Stay-At-Home Order In The Usa, Soo-Hoon Lee, Bernadette Cullen, Alidon Athey, Calliope Holingue, Michelle R. Kaufman, Paul Nestadt, Jack Samuels, Tracy Vannorsdall, Phillip Phan

Management Faculty Publications

Objectives This study explores the drug use behaviour in the US general population in the early days of the COVID-19 pandemic with a focus on the relationship between sociopsychological factors, mobility restrictions from March to June 2020 and mental health conditions.

Design A retrospective anonymous online survey representing a cross-section of the US population in 2020.

Setting A qualified panel of 500 000 Qualtrics participants stratified by gender, race, age and geographical region to represent the US population.

Participants 3340 participants voluntarily consented to respond.

Measures Outcome measure for illicit and non-medical use of prescription drugs based on the National …

Schistosoma Mansoni Infection Causes Consistent Changes To The Fecal Bacterial Microbiota Of Mice Across And Within Sites, Mariam A. Mhanna, David T. Gauthier, Lisa M. Shollenberger

Biological Sciences Faculty Publications

Eggs of Schistosoma mansoni are produced by adult female worms in mesenteries of infected hosts. Eggs can cross the intestinal barrier and form granulomas in the tissue or breach and exit the host through fecal excretion. These interactions may affect the host microbiome assemblages. Given the potential for schistosomal alteration of host gut microbiome and subsequent effects on the fecal bacterial composition, it is important to conduct controlled microbiome studies on model animals. While pursuing these studies, it is important to take into account the different conditions in which microbiome studies are conducted and their consequent impacts on variability and …

Behavioral Health Training For Integrated Behavioral Health: A Delphi Study, Nicholas Schmoyer, Lisa Corbin, Jessica Huffman, Gülşah Kemer

Counseling & Human Services Faculty Publications

Using a classical Delphi design, the authors used an interdisciplinary panel of behavioral health experts in integrated behavioral health (IBH) to identify foundational skills and knowledge counselor educators need to teach clinical mental health counselors for IBH practice. Eighty-eight statements were identified. Implications are provided for counseling and other behavioral health educators.

Confidentiality In Addiction Treatment: Navigating 42 Cfr Part 2 Within Human Services, Chaniece Winfield, Jessica Huffman

Counseling & Human Services Faculty Publications

Recent federal legislation, including the Mental Health Parity and Addiction Equity Act (MHPAE) and the Comprehensive Addiction and Recovery Act (CARA), has placed greater emphasis on quality integrated health care, with a focus on access, treatment options, and evidence-based practices. Changes to Federal 42 CFR privacy protections also impact individuals seeking substance use disorder treatment, either as a primary diagnosis or comorbidity. Human service professionals, as generalists in the behavioral health field, provide vital treatment, recovery, and prevention services for individuals with substance use and addictive disorders. This paper explores the implications of these legislative changes, particularly regarding privacy protections …

The Nohs 2024 Code Of Ethics Update, Kevin C. Snow, Christian Williams, Ed Neukrug, Kristin Barker, Kristin Ballard, Braxton A. Morrison, Leslie C.M. Mcclane, Meghan N. Morgan, Stephanie Collins

Counseling & Human Services Faculty Publications

The NOHS Ethics committee engaged in a revision of the Ethical Standards for Human Services Professionals (2024). This update focused on significant changes in the field of human services as they relate to a broad group of human services professionals. The article explores interviews with key members of the revision committee sharing their thoughts on the necessity for the current revision and the ever-present importance for human service professionals to understand and engage with the NOHS ethics code as an essential living document for the benefit of client well-being, to promote the integrity of the human services profession, and to …

Navigating Recovery: Insights From Distance Learning Human Services Students' Abstinence Experience, Chaniece Winfield, Jill Kivikoski, Catalina Kraft

Counseling & Human Services Faculty Publications

With the rise in overdose and problematic drug use in the United States, it is crucial to develop competent human service practitioners in addiction treatment and recovery settings. This qualitative study explores the virtual abstinence experience of distance learning human services students, using Mezirow’s transformative learning theory to examine how a 21-day experiential abstinence prompts critical reflection and perspective transformation. The study investigates the socio-emotional and physiological factors influencing participants' progress toward sobriety, including cravings, withdrawal, isolation, and relapse triggers. Findings highlight how participants' critical reflection leads to a deeper understanding of addiction and recovery, as well as an enhanced …

Maternal Mortality According To State Abortion Legislative Climate Following The Us Supreme Court's Dobbs V. Jackson Women's Health Organization Ruling, Emily Nuss, Mari Iwasaki, Lindsay Robbins, Peggy Ye, Misa Hayasaka, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

We aimed to evaluate how maternal mortality rates have evolved across US states following the Dobbs ruling, while accounting for the confounding influence of the coronavirus disease 2019 (COVID-19) pandemic.

Study Design

We conducted a retrospective analysis of publicly available data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database from January 2018 to December 2024. This study period was divided into three intervals: (1) pre-COVID (January 2018 to February 2020), (2) pandemic (March 2020 to September 2022), and (3) post-Dobbs (October 2022 to December 2024). Using the Kaiser Family Foundation …

Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

[Introduction] We read with interest the recent study by Rosenfeld et al.¹ However, we have several clinical and methodological concerns about this study.¹

First, this study's propensity score matching (PSM) lacked key clinical confounders, including perinatal risk factors and the highest systolic/diastolic blood pressures. Smoking, alcohol use, and multifetal gestation, which influence blood pressure during pregnancy,²,³ potentially affect both primary and secondary outcomes. Additionally, the authors did not report standardized mean differences before and after PSM, which are essential for assessing balance.⁴

Diagnosis Of Hypertensive Disorders In Pregnancy, Rebecca Horgan, Yara Hage Diab, Maged Costantine, George Saade, Baha Sibai

Department of Obstetrics & Gynecology Faculty Publications

Hypertensive disorders of pregnancy, including chronic hypertension, superimposed preeclampsia, gestational hypertension, and preeclampsia, affect 10-20% of pregnancies and are a significant cause of maternal and perinatal mortality. The incidence of these disorders is rising due to factors such as advanced maternal age, obesity, assisted reproductive technology, and increased rates of preexisting comorbidities. Differentiating pregnancy-associated hypertension from pre-existing chronic hypertension is challenging, as the overlap between the two may be broadening due to the changing demographics of the pregnant population. This review critically evaluated the evidence regarding the current time periods recommended to make a diagnosis of a hypertensive disorder of …

[Review Of The Book The Pioneer And The Innkeeper: Adventures In Uncertainty And Faith Around The World, By C. & M. Wilson], John E. Snellings

Department of Family and Community Medicine Faculty Publications

[First paragraph] The full breadth and powerful impact of family medicine as a global specialty is on full display in The Pioneer and the Innkeeper: Adventures in Uncertainty and Faith Around the World. In this compelling memoir, readers follow the life and career of Dr Cal Wilson, a family physician and global health expert, as he and his family pursue medical missions across the world. Not to be outdone by her husband, Mimi Wilson’s life story is co-featured in the book, and her own heart for service (in forms slightly different from those of her husband), create a dynamic …

Analysis Of Errors In The Management Of Cutaneous Disorders, Robert J. Pariser, Sarah Alnaif

Department Dermatology Faculty Publications

In this study, we prospectively and retrospectively evaluated the occurrence of errors in the management of cutaneous disorders from patient visits and medical records in a single dermatology practice in southeast Virginia over a 3-year period (June 2020-July 2023). Providers should be able to improve diagnostic accuracy by utilizing established rapid bedside diagnostic techniques.

Engaging The Community, Providing Hopes, Mackenzie Peeke, Margaret West, Alyssa Wilkinson, Matthew Serrata, Michael Baroody, Conner Tembe, Chrisney Yerena

HOPES Free Clinic Publications

Founded in the 1970s as a grassroots effort to provide care to the underserved population of Hampton Roads, Eastern Virginia Medical School (EVMS) has long been committed to community-centered care. The HOPES Free Clinic is a manifestation of that mission. Launched in 2011 as a student-run phone triage service, the Health Outreach Partnership of EVMS Students (HOPES) later transitioned to provide direct clinical services—becoming the first student-run free clinic in the Commonwealth of Virginia. In 2014, HOPES integrated into Community Engaged Learning to enhance and solidify its efforts. Since its inception, medical and health professions students have partnered with volunteer …

Systemic Therapy Targeting Psoriatic Inflammation Is Associated With Decreased Incidence Of Dementia: An Observational Retrospective Cohort Study, Madison P. Olexson, Ana Ormaza Vera, Chunghwan Ro, Clinton W. Enos

Department Dermatology Faculty Publications

[Introduction] To the Editor: Psoriasis, an immune-mediated chronic inflammatory skin disorder, has been implicated in cognitive impairment and dementia.1, 2, 3 Emerging evidence suggests that systemic inflammation contributes to neuroinflammation and resultant cytokine-driven neurodegeneration, although findings remain inconclusive.1, 2, 3 While systemic therapies such as biologics and conventional disease-modifying antirheumatic drugs are routinely used in psoriasis management, their role in modulating dementia in this population remains underexplored, with research yielding mixed results.1, 2, 3 We conducted a large-scale, retrospective cohort study to investigate the relationship between psoriasis and dementia and whether systemic treatments for psoriasis impact this association.

Barriers And Facilitators To Accessing Mental And Physical Health Care Among Sexual Minority Women: A Qualitative Exploration, Charlotte A. Dawson, A. Moulder, Kristin E. Heron

Department Psychiatry & Behavioral Science Faculty Publications

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18-40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders …

Strategies To Enhance Gme Program Coordinator Job Satisfaction And Well-Being, Stuart Slavin, Julie Beckerdale, April L. Mcguire, Linda Ortiz Morrison, Melanie Pigott, Carrie L. Racsumberger, Evangelina Rangel, Bret Stevens, Ramona Tirado, Cynthia D. Thompson, Latoya Wright

Department Dermatology Faculty Publications

[Introduction] Program and institutional coordinators in graduate medical education (GME) have very complex jobs that are often highly pressured and demanding, requiring a diverse skill set to manage effectively. While these positions can be immensely gratifying, the demands and pressures inherent in the roles pose threats to job satisfaction as well as risks to mental health and well-being. A national survey of 6372 coordinators found that 20.4% reported being dissatisfied or very dissatisfied with work, and 27.9% reported being likely or very likely to leave their job in the next year. ¹ Of the coordinators surveyed 36.3% screened positive for …

Igf-1 As A Biomarker For Symptom Severity In Adult Traumatic Brain Injury: Evidence From An Observational Study, Justin Weppner, Kimberly Rosenthal, Jennifer Bath, Tonja Locklear, Melissa Martinez

Department of Physical Medicine & Rehabilitation Faculty Publications

Traumatic brain injury (TBI)-related growth hormone deficiency is often undertreated, despite documented physical, metabolic, and neuropsychiatric effects. Insulin-like growth factor (IGF-1), with neuroreceptors located in brain regions responsible for learning, memory, and mood, regulates cerebral blood flow, neurogenesis, and neuroplasticity. The aim of this study was to determine associations between IGF-1 levels and post-TBI symptom severity, anxiety, and depression. This retrospective observational study at an Academic Brain Injury Center included participants evaluated 3-12 months post-TBI with available IGF-1 values and complete Rivermead Post-Concussion Symptoms Questionnaire (RPQ-13), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) responses. Patients under 18 or …

Translating Cardiovascular Clinical Practice Guidelines On Nutrition Therapy: Validation Of The Portfolio Diet Toolkit For Healthcare Providers, Gabrielle Viscardi, Sahba Eskandari, Alyssa Chen, Nicholas Chiang, Meaghan E. Kavanagh, Songhee Back, Micheal Vallis, Mary J. Scourboutakos, Vasanti S. Malik, Cyril W.C. Kendall, David J.A. Jenkins, John L. Sievenpiper, Laura Chiavaroli

Department of Family and Community Medicine Faculty Publications

Background

Cardiovascular disease (CVD) remains a leading cause of death in Canada. Although the Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is supported by CVD clinical practice guidelines, its uptake in clinical practice remains limited. This study assessed the content and face validity of a healthcare provider (HCP)-facing toolkit (infographic and video), designed to support implementation of the Portfolio Diet.

Methods

HCPs were recruited for a 2-round evaluation. They assessed the toolkit using a questionnaire. Content validity of the infographic was assessed using a 4-point Likert scale (1 = irrelevant to 4 = extremely relevant) and face validity of …

Neuroinflammatory Signaling And Immune Cell Infiltration Differ In Brains Of Rats Exposed To Space Radiation And Social Isolation, Austin M. Adkins, Zachary N. M. Luyo, Alea F. Boden, Riley S. Heerbrandt, Richard A. Britten, Laurie L. Wellman, Larry D. Sanford

Center for Integrative Neuroscience and Inflammatory Diseases (CINID) Faculty Publications

Astronauts on the proposed Mars missions will be exposed to extended periods of social isolation (SI) and space radiation (SR). SI and SR-induced immune dysregulation can result in persistent neuroinflammation and neuronal damage which could negatively impact an astronaut’s health and ability to maintain adequate levels of performance. The synergistic effects of combined SI and SR on immune system functionality and the brain remain unknown. Determining how single and combined inflight stressors modulate the immune system is crucial for fully understanding pathways impacting astronaut health and performance. We used ground-based analogs of SI and SR in rodent models to investigate …

Improving Dental Hygiene Students' Knowledge, Attitudes, And Confidence Toward Prenatal Oral Health Through Experiential Learning, Denise C. Mckinney, Sinjini Sikdar, Shillpa Naavaal

Dental Hygiene Faculty Publications

Purpose Maintaining optimal oral health is essential for maternal health as well as the health of their child. The purpose of this pilot study was to examine dental hygiene (DH) students' knowledge of prenatal oral health before and after receiving an asynchronous prenatal oral health care training (POHCT), and their attitudes and self-perceived confidence before and after receiving an experiential learning opportunity with a pregnant and/or post-partum client at a Women's Infants and Children nutrition program (WIC) clinic.

Methods A one-group pre/post-test design was used. This IRB-approved study (#2027439-4) utilized a convenience sample of DH student participants (n=37) in their …

Use Of Clinical Competency Examinations For Dental Hygiene Licensure, Jocelyn D. Weinhagen, Tara L. Newcomb, Brenda T. Bradshaw

Dental Hygiene Faculty Publications

Dental hygiene licensure with a clinical competency examination (CCE) using a live patient has been required by state licensing boards since 1929. Clinical competency examinations were initially used when dental training was poorly developed, non-standardized, and largely based on the apprenticeship model. Currently, Canada and the state of California have removed the requirement of passing a CCE for dental hygiene licensure, provided certain requirements have been met. Dentistry is the last health care profession to mandate that graduates pass a CCE. The vast majority of dental licensing boards continue to require that third party testing agencies validate the clinical skills …

Exploring Institutional Stratification: Minority-Serving Institutional Pathways To Medical School Acceptance In The United States, Amanda K. Burbage, Eushekia Y. Hewitt

EVMS School of Health Professions Faculty Publications

Introduction

Recruiting and training a diverse pool of physicians from historically excluded groups is vital to solving complex scientific problems and increasing access to patient care. Disparate educational and health outcomes of COVID-19 amplified this need. In stratified higher education systems, underfunded institutions that serve greater numbers of underrepresented in medicine (URM) students face unique barriers to entering physician training. However, pathways from historically underfunded minority-serving institutions (MSIs) in the United States to medical school (MD) are not well understood.

Method

A hierarchical logistic regression analysis of 328 488 de-identified applicants to US MD-granting medical schools for academic years 2017-2018 …

Team Science In Interdisciplinary Health Professions Education Research: A Multi-Institutional Case Study, Peggy Gesing, Joni Tornwall, Violet Kulo, Sarah Mcbrien, Thuha Hoang, Hyun-Jin Jun, Amanda Burbage, Yuane Jia, Christina Cestone

EVMS School of Health Professions Faculty Publications

The interdisciplinary nature of health professions education requires exploration of problems by interdisciplinary research teams. Drawing on the Dynamics of Cross-disciplinary Research Development conceptual framework, this study explores the processes and experiences of an interdisciplinary research team, identifying elements of successful collaboration. Case study data were collected from a team of nine researchers from six universities. Data included meeting minutes and researcher reflections. Researcher reflection and meeting minute themes converged within the framework constructs: Contexts and inputs, social learning processes, social capital outcomes, and knowledge and human capital outcomes. This study provides a blueprint for interdisciplinary researchers indicating that successful …

The Short And Sweet On Sodium-Glucose Cotransporter Inhibitors And Glucagon-Like Peptide-1 Receptor Agonists In Heart Failure, Jose L. Batista, Tracy Makuvire, Jonathan D. Davis, Salvatore Carbone

EVMS School of Health Professions Faculty Publications

Heart failure (HF) affects 6 million people in the US, and type 2 diabetes (T2D) is a significant risk factor for HF. Since 2008, regulatory agencies have required cardiovascular safety trials for new T2D therapies, and these have consistently demonstrated the cardiovascular benefits of glucose-lowering drugs. Sodium-glucose cotransporter inhibitors (SGLTi) and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs)/glucose-dependent insulinotropic polypeptide (GIP) reduce major adverse cardiovascular events and deaths, regardless of diabetes status, and improve cardiorespiratory fitness. SGLTis, such as dapagliflozin and empagliflozin, benefit patients with reduced and preserved ejection fraction, significantly reducing HF hospitalizations and cardiovascular deaths. The DAPA-HF and EMPEROR-Reduced …