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All sourcesNASA NTRSDOE OSTI
DOE OSTI2024

Seroprevalence and risk factors for brucellosis amongst livestock and humans in a multi-herd ranch system in Kagera, Tanzania

Background Brucellosis remains a significant health and economic challenge for livestock and humans globally. Despite its public health implications, the factors driving the endemic persistence ofBrucellaat the human-livestock interface in Tanzania remain poorly elucidated. This study aimed to identify the seroprevalence ofBrucellainfection in livestock and humans within a ranching system and determine associated risk factors for disease endemicity. Methods A cross-sectional sero-epidemiological study was conducted in 2023 in Tanzania’s Karagwe District, involving 725 livestock (cattle, goats, sheep) from 10 herds and 112 humans from associated camps. Seroprevalence was assessed using competitive ELISA while epidemiological data were collected via questionnaires. Generalized Linear Models and Contrast Analysis were used to identify risk factors for infection. Results Overall seroprevalence was 34% in livestock and 41% in humans. Goats exhibited the highest prevalence (69.2%), while cattle had the lowest (22.6%). Mixed-species herds (Odds Ratio, OR = 2.96, CI [1.90–4.60]) and small ruminants-only herds (OR = 6.54, CI [3.65–11.72]) showed a significantly higher risk of seropositivity compared to cattle-only herds. Older cattle (OR = 5.23, CI [2.70–10.10]) and lactating females (OR = 2.87, CI [1.78–4.63]) represented significant risks for brucellosis in livestock. In humans, close contact with animals (OR = 7.20, CI [1.97–36.31]) and handling animals during parturition or aborted fetuses (OR = 2.37, CI [1.01–5.58]) were significant risk factors. Notably, no spatial association was found in seroprevalence between herds and nearby human communities. Conclusion The lack of spatial correlation between livestock and human seroprevalence suggests complex transmission dynamics, potentially involving endemic circulation in livestock and human infections from multiple sources of exposure to livestock. This study highlights the need for comprehensive zoonotic risk education and targeted intervention strategies. Further research is crucial to elucidate transmission pathways and improveBrucellainfection control. This includes developing robust methods for identifying infective species and implementing effective strategies to mitigateBrucellainfection in endemic regions.

Public, Environmental & Occupational Health↗
DOE OSTI2024

Diabetes-specific formula with standard of care improves glycemic control, body composition, and cardiometabolic risk factors in overweight and obese adults with type 2 diabetes: results from a randomized controlled trial

Background and aims Medical nutrition therapy is important for diabetes management. This randomized controlled trial investigated the effects of a diabetes-specific formula (DSF) on glycemic control and cardiometabolic risk factors in adults with type 2 diabetes (T2D). Methods Participants ( n = 235) were randomized to either DSF with standard of care (SOC) (DSF group; n = 117) or SOC only (control group; n = 118). The DSF group consumed one or two DSF servings daily as meal replacement or partial meal replacement. The assessments were done at baseline, on day 45, and on day 90. Results There were significant reductions in glycated hemoglobin (−0.44% vs. –0.26%, p = 0.015, at day 45; −0.50% vs. −0.21%, p = 0.002, at day 90) and fasting blood glucose (−0.14 mmol/L vs. +0.32 mmol/L, p = 0.036, at day 90), as well as twofold greater weight loss (−1.30 kg vs. –0.61 kg, p < 0.001, at day 45; −1.74 kg vs. –0.76 kg, p < 0.001, at day 90) in the DSF group compared with the control group. The decrease in percent body fat and increase in percent fat-free mass at day 90 in the DSF group were almost twice that of the control group (1.44% vs. 0.79%, p = 0.047). In addition, the percent change in visceral adipose tissue at day 90 in the DSF group was several-fold lower than in the control group (−6.52% vs. –0.95%, p < 0.001). The DSF group also showed smaller waist and hip circumferences, and lower diastolic blood pressure than the control group (all overall p ≤ 0.045). Conclusion DSF with SOC yielded significantly greater improvements than only SOC in glycemic control, body composition, and cardiometabolic risk factors in adults with T2D.

Tey, Siew Ling↗
DOE OSTI2025

National serosurvey and risk mapping reveal widespread distribution of Coxiella burnetii in Kenya

Coxiella burnetii, the causative agent of Q fever, is an emerging pathogen that has the potential to cause severe chronic infections in animals and humans worldwide. The detrimental impact on public health is projected to be higher in the low- and middle-income countries given their lower capacity to sustain effective surveillance and response measures. We implemented a national serosurvey of cattle in Kenya to map the spatial distribution of the pathogen. The study used serum samples that were collected from randomly selected cattle in different ago-ecological zones across the country. These samples were screened for the pathogen using PrioCHECK Ruminant Q Fever AB Plate ELISA kit. The laboratory findings were analyzed using INLA package to identify risk factors for C. burnetii exposure from herd- and animal-level factors, area, and bioclimatic datasets accessed from online databases. A total of 6,593 cattle were recruited for the study; of these, 7.9% (95% CI; 7.2–8.5) were seropositive. Outputs from the multivariable analysis revealed that the animal age and some of the geographical variables including wind speed, area under shrubs and “petric calcisols” type of soil were significantly associated with C. burnetii seropositivity. Being a calf, weaner or subadult was associated with lower odds of exposure compared to being an adult by 0.24 (credibility interval: 2.5% and 97.5%), 0.41 (0.30–0.55) and 0.51 (0.38–0.69), respectively. In addition, a unit increase in the wind speed increased the odds of C. burnetii seropositivity by 1.27 (1.05–1.52) while an increase on the land area under shrubs was associated with lower odds of exposure (0.67 [0.47–0.69]). The effect of petric calcisols was non-linear; an increase of the land area with this soil type was associated with an exponential increase in C. burnetii seropositivity. This study provides new data on C. burnetii seroprevalence, information of its risk factors and a prevalence map that can be used for C. burnetii risk surveillance and control. The identification of environmental risk factors for C. burnetii exposure, and the increasing awareness of the zoonotic potential of the pathogen, calls for the need to enhance the existing collaborations for the surveillance and control of C. burnetii in line with the One Health framework. The evidence generated on the potential role of environmental factors can also be used to design nature-based interventions, such as replacement of vegetation in denuded areas, to reduce potential for the aerosolization of the pathogen. Livestock vaccination in the hotspots would also reduce animal infections and hence the contamination of the environment.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Risk Assessment Considerations for Underground Hydrogen Storage in Depleted Gas Reservoirs

Underground hydrogen storage (UHS) in depleted reservoirs presents a promising solution for large-scale energy storage as hydrogen demand grows. As the UHS industry emerges, robust risk assessments are critical to ensuring safe operation of the storage facilities and minimizing the risk of accidents. This work explores risk assessment protocols for underground natural gas storage (UGS) in depleted reservoirs and identifies key considerations for repurposing these facilities for UHS. By examining the differences in physical and chemical properties between hydrogen and natural gas, this work highlights new and modified hazards that merits a reevaluation of traditional natural gas risk assessment practices. This investigation synthesizes insights from previous literature reviews and interviews with UGS industry experts and operators to identify key areas for adapting risk assessment methodologies for hydrogen. The insights gleaned from expert interviews indicate that existing risk assessment standards are non-prescriptive, leading to diverse company-specific risk assessment methodologies requiring substantial additions to become practical. Due to a lack of concrete risk assessment requirements, experience, and relevant data, this uncertainty is expected to be magnified considerably when considering hydrogen. This study identifies several areas for potential modification of existing risk assessment practices that could be considered by those developing standards or performing risk assessments for UHS. Specifically, risk assessments may be improved by including risks unique to hydrogen in existing standards, changing the magnitude of different risk factors in existing risk assessment protocols, and improving methods of data collection and communication across the industry to address large areas of uncertainty.

08 HYDROGEN↗
DOE OSTI2026

Quantifying mean, variability, and uncertainty in indoor radon exposure in Pennsylvania using random forest and quantile regression forest models

Radon is a naturally occurring radioactive gas that poses a serious health risk as the primary cause of lung cancer in non-smokers. Despite the well-known adverse association with health outcomes, current radon exposure assessments are limited to county-level or average-level estimates, which fail to capture regional variability. This study uses Machine Learning models, including Random Forest (RF) and Quantile Regression Forest (QRF), to estimate the indoor radon concentrations at the ZCTA (Zip code tabulation area)-level and characterize uncertainties in model estimates. Incorporating geological, meteorological, and building-specific data, the models aim to improve radon risk assessment by capturing mean exposure, variability, and extreme concentration levels. Processed radon test data (n = 718,111) were analyzed using average, variability, and quantile prediction methods. Models that estimate the average radon exposure at the ZCTA-level can yield promising model-fit results, but they do not capture the underlying variability of indoor radon exposure within a ZCTA. We utilize volatility analyses to identify characteristics indicative of high variability of indoor radon exposure. We also show that a QRF model can be used to estimate upper quantiles of residential radon exposure, thereby uncovering localized areas of elevated exposure that were not apparent in mean estimates. The results highlighted the need for a deep characterization of exposure risk and show that regions with moderate average exposure levels could still harbor extreme outliers with implications for evaluating health risks. Utilizing multiple radon exposure models allows for a deeper characterization of radon risk within a geographic area and can better identify high-risk areas. The results from this study provide a foundation for developing mitigation strategies and examining associations between radon exposure and health outcomes at fine scales. Future research should extend the geographic scope and incorporate additional environmental risk factors to establish a comprehensive framework for risk assessment.

Lee, Heechan [ORNL]↗
DOE OSTI2025

Scaling Up: Demonstrating Risk Reduction and Cost Compression for Commercial Heat Pump Water Heaters (CRADA 625) (Final Report)

This report is a final deliverable for project 81966: Scaling Up: Demonstrating Risk Reduction and Cost Compression for Commercial Heat Pump Water Heaters (CRADA 625) Commercial heat pump water heater (CHPWH) systems can significantly improve the energy efficiency of service water heating (SWH), aka domestic hot water (DHW), in commercial and multifamily buildings but have not yet achieved widespread adoption due to pricing, complexity, and perceived risk factors. The goal of this project – Scaling Up: Demonstrating Risk Reduction and Cost Compression for Commercial HPWHs (Scaling Up) – was to demonstrate and validate a holistic systems approach for CHPWHs that de-risks the technology, creating a reliable, cost-effective, and repeatable approach to CHPWH deployment.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗
DOE OSTI2026

Longitudinal Plasma Proteomic Profiling Reveals Divergent Immune Responses in Durably Cured and Relapsed Pulmonary Tuberculosis

Background: Predicting the risk of tuberculosis (TB) relapse is vital to improving treatment outcomes. Although clinical risk factors of relapse are well characterized, the biological mechanisms driving relapse, particularly host immune responses, remain poorly understood. Elucidating these mechanisms is necessary to better predict relapse risk. Methods: We conducted a longitudinal, global proteomic study on 60 participants with active pulmonary TB, half who were durably cured and half who relapsed. Plasma was collected at seven time-points: at treatment initiation (baseline), during therapy, and 52 weeks post-baseline. Samples were analyzed by high-resolution LC-MS/MS. Results: 2,418 proteins were identified across all samples, with 1,756 being differentially expressed relative to baseline (unadjusted p < 0.05). 956 proteins were differentially abundant between cured and relapsed participants. Relapsed participants showed heightened humoral immunity throughout treatment, as well as upregulated complement activation and HDL particles. Cured participants exhibited elevated recovery-related pathways by week 4, including downregulated epithelial invasion and upregulated oxygen transport. Conclusions: Heightened humoral and innate immune responses were associated with relapse, whereas recovery signatures were associated with durable cure. These findings advance our understanding of host responses to treatment and provide a basis for developing blood-based biomarkers to identify patients at increased risk of relapse.

LC-MS/MS↗
DOE OSTI2026

YAP1 Dysfunction Promotes Molecular Properties Linked to Breast Cancer Susceptibility

YAP1 is a cotranscription factor that promotes malignant and stem cell properties in cancer. We previously found that YAP1 dysregulation is associated with aging in human mammary epithelia. With increased age, YAP1 expression changes in luminal epithelial cells, the prospective breast cancer cell of origin. Because age is a significant risk factor for breast cancer, we tested whether YAP1 dysregulation acted early in cancer progression by conferring cellular states associated with increased cancer susceptibility. In this study, we find that with increased age and genetic risk for developing cancer, human breast tissues showed significantly increased YAP1 expression, and cultured primary human mammary epithelial cells (HMEC) showed significantly increased expression of both YAP1 and its transcriptional targets. Increased YAP1 expression in cultured HMEC induced gene expression changes associated with increased cancer susceptibility, such as genes associated with stem cell states, increased telomerase activity, breast cancer progression, and increased age and genetic breast cancer risk. Furthermore, overexpression of YAP1 in post-stasis HMEC—finite lifespan cells that have bypassed a retinoblastoma-mediated senescence barrier—promoted properties related to increased growth potential. We found that YAP1 dysregulation in finite epithelial cells allows for access to gene programs and functions that are typically thought to be restricted to stem cells. We hypothesize that YAP1 acts early in breast cancer progression, long before the development of a tumor, to impose cancer-susceptible molecular states.

YAP1↗
DOE OSTI2025

DOME: Directional medical embedding vectors from Electronic Health Records

Motivation: The increasing availability of Electronic Health Record (EHR) systems has created enormous potential for translational research. Recent developments in representation learning techniques have led to effective large-scale representations of EHR concepts along with knowledge graphs that empower downstream EHR studies. However, most existing methods require training with patient-level data, limiting their abilities to expand the training with multi-institutional EHR data. On the other hand, scalable approaches that only require summary-level data do not incorporate temporal dependencies between concepts. Methods: We introduce a DirectiOnal Medical Embedding (DOME) algorithm to encode temporally directional relationships between medical concepts, using summary-level EHR data. Specifically, DOME first aggregates patient-level EHR data into an asymmetric co-occurrence matrix. Then it computes two Positive Pointwise Mutual Information (PPMI) matrices to correspondingly encode the pairwise prior and posterior dependencies between medical concepts. Following that, a joint matrix factorization is performed on the two PPMI matrices, which results in three vectors for each concept: a semantic embedding and two directional context embeddings. They collectively provide a comprehensive depiction of the temporal relationship between EHR concepts. Results: We highlight the advantages and translational potential of DOME through three sets of validation studies. First, DOME consistently improves existing direction-agnostic embedding vectors for disease risk prediction in several diseases, for example achieving a relative gain of 5.5% in the area under the receiver operating characteristic (AUROC) for lung cancer. Second, DOME excels in directional drug-disease relationship inference by successfully differentiating between drug side effects and indications, correspondingly achieving relative AUROC gain over the state-of-the-art methods by 10.8% and 6.6%. Finally, DOME effectively constructs directional knowledge graphs, which distinguish disease risk factors from comorbidities, thereby revealing disease progression trajectories. The source codes are provided at https://github.com/celehs/Directional-EHRembedding.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2025

Threat Landscape for BESS and IBR

The cyber risk landscape for BESS and IBR can be broken up by threats, vulnerabilities, and consequences for these systems. This presentation walks through the cyber risk landscape for BESS through the lens of consequence-informed awareness and mitigation for each risk factor. Threats with varying capabilities have been demonstrated in real-world events. Though threat actors can rarely be directly influenced by organizations, exposure of systems to adversaries can be limited (a known issue with IBR systems) to reduce likelihood of adversaries accessing systems with disruptive consequences. Common trends in disclosed IBR vulnerabilities include weak password generation or managements for various devices or services and web portal vulnerabilities that provide unauthorized access to data or capabilities or elevated user privileges. Understanding these common vulnerabilities and considering the consequences if these types of vulnerabilities were to occur can help mitigate risk. Consequences range from loss-of-view events that have no reliability impact to asset damage or grid stability impacts. Five case studies are briefly shared to highlight trends in real-world events affecting IBR.

14 - SOLAR ENERGY↗
DOE OSTI2026

Analyzing historical snow trends in interior Alaska

Study region The Chena River watershed in Interior Alaska, USA Study focus This study examines 40 years (water years 1982–2021) of snowpack characteristics to consider its hydrological implications in the 5350 km² Chena River basin. Using observations and a fine-scale physics model, we analyzed trends of snow water equivalent (SWE), snow onset and disappearance, and snow cover duration (SCD). New hydrological insights for the region Results indicate a decline in SWE across the modeled domain, averaging a decrease of 3 mm per decade, with larger decreases (up to 10 mm per decade) at lower elevations. While domain-averaged SWE trends were not statistically significant, observed SCD showed statistically significant decreases: −5.2, −5.0, and −4.4 days per decade at Teuchet Creek, Fairbanks F.O., and Little Chena Ridge, respectively. Notably, observations at SNOTEL stations and modeling revealed no statistically significant change in domain-averaged Rain-on-Snow (ROS) events over the 40-year period, contrasting some regional future estimates of increased ROS frequency. Peak streamflow did not consistently correlate with peak SWE levels, suggesting that other environmental factors such as ROS events and rapid temperature increases (e.g., a 10°C spike observed in 1992) are key drivers of hydrological outcomes. These findings improve understanding of complex subarctic hydrological processes impacting permafrost and highlight the need for adaptive water resource management to mitigate multi-factor risks like flooding and wildfire, requiring proactive planning.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2025

Lipid and lipoprotein metabolism in microglia: Alzheimer’s disease mechanisms and interventions

Alzheimer's disease (AD) presents a significant challenge owing to its widespread prevalence and complex neuropathogenesis, affecting millions worldwide. Current therapeutic strategies that predominantly target amyloid-beta accumulation are insufficient, particularly for ApoE4 carriers. Alterations in lipid composition are well documented in AD, characterized by reductions in phospholipids and sulfatides, along with increases in cholesterol, cholesteryl esters, and triglycerides (TGs). Microglia, the brain's resident immune cells, link dysfunctional lipid processing to AD neuropathogenesis. For example, genetic studies have pointed to microglial lipid and lipoprotein processing gene variants as some of the strongest risk factors for AD. In addition, microglial dysfunction, characterized by lipid droplet accumulation, increased cholesterol and TG levels, and altered lipid transport, may exacerbate the pathological hallmarks of AD, such as amyloid-beta and tau accumulation. Conversely, emerging studies have shown that strategies aimed at inhibiting lipid droplet accumulation in microglia, reducing TG synthesis, and promoting the activity of lipoprotein receptors expressed by microglia can improve cell functions and markers of AD pathology. This review dissects the interplay between microglial lipid metabolism and AD, highlighting the significance of lipid transport and trafficking within the CNS. Given the intrinsic link between microglial metabolism and AD progression, emerging and potential therapeutic strategies aimed at restoring lipid handling and improving microglial function are explored. This review provides a comprehensive examination of the emerging literature, detailing the current state of knowledge on microglial lipid metabolism, its genetic underpinnings, and the potential for novel interventions targeting these mechanisms to ameliorate AD pathology.

Alzheimer's disease↗
DOE OSTI2025

Subventricular Accumulation of Cu in the Aging Mouse Brain Does Not Associate with Anticipated Increases in Markers of Oxidative Stress

Natural aging is associated with mild memory loss and cognitive decline, and age is the greatest risk factor for neurodegenerative diseases, such as Alzheimer’s disease. There is substantial evidence that oxidative stress is a major contributor to both natural aging and neurodegenerative disease, and coincidently, levels of redox active metals such as Fe and Cu are known to be elevated later in life. Recently, a pronounced age-related increase in Cu content has been reported to occur in mice and rats around a vital regulatory brain region, the subventricular zone of lateral ventricles. In our study herein, we have characterized lateral ventricle Cu content in a unique murine model of accelerated aging, senescence accelerated mouse-prone 8 (SAMP8) mice. Our results confirm an age-related increase in ventricle Cu content, consistent with the studies by others in wild-type mice and rats. Specifically, we observed Cu content to increase over the time frame 1 to 5 months and 5 to 9 months, but interestingly, no significant increase occurred between 9 and 12 months (although brain Cu content at 12 months was significantly elevated relative to 1 and 5 month-old animals). Despite the magnitude of Cu increase observed within the cells that comprise the subventricular zone of lateral ventricles (average 3 mM Cu, with isolated subcellular concentrations of 17 mM), we did not detect spectroscopic markers of thiol oxidation, protein aggregation, or lipid oxidation. The lack of evidence for oxidative stress in ex vivo animal tissue is in contrast to in vitro studies demonstrating that thiol, protein, and lipid oxidation is pronounced at these Cu concentrations. We suggest that our findings most likely indicate that the Cu ions in this brain region are sequestered in an unreactive form, possibly extended chains of Cu-thiolate complexes, which do not readily redox cycle in the aqueous cytosol. In conclusion, these results also appear to partially challenge the long-held view that age-related increases in brain metal content drive oxidative stress as we did not observe a concomitant association between age-related Cu increase and markers of oxidative stress, nor did we observe a net increase in Cu content between mice aged 9 and 12 months.

X-ray fluorescence↗
DOE OSTI2024

Analyzing Residential Charging Demand for Light-Duty Electric Vehicles in Colorado

The past decade has witnessed a remarkable surge in adoption of electric vehicles (EVs). The momentum is expected to continue with strong support from governments and industry. Rapid EV adoption will add significant electricity demand, making it critical to plan for and manage EV charging to avoid causing additional stress and non-negligible risks to the already-aging power grid. To help power grid operators understand the impacts of residential EV charging and identify risk factors, this study presents a data-driven charging demand analysis for light-duty vehicles. This study considers two real-world grid service regions in Colorado and merges multiple data sources and state-of-the-art tools that characterize EV adoption projections, vehicle travel patterns, seasonal variations, residential charging accessibility, ambient temperature impact, EV charging behaviors, grid utility customers, vehicle registration, and household-level EV charging demand distribution. We characterize potential residential charging demand in 2030 for two regions within the state of Colorado: Boulder and Aurora regions. We project that EVs will be 26% of the light-duty vehicle population in Boulder and 16% in Aurora areas. Charging demand is characterized for ten power grid feeders (five for each study region). Across the ten feeders, peak total EV charging powers during wintertime range from less than 1 MW to more than 4 MW.

ADVANCED PROPULSION SYSTEMS↗
DOE OSTI2024

Multi-modal characterisation of early-stage, subclinical cardiac deterioration in patients with type 2 diabetes

Abstract Background Type 2 diabetes mellitus (T2DM) is a major risk factor for heart failure with preserved ejection fraction and cardiac arrhythmias. Precursors of these complications, such as diabetic cardiomyopathy, remain incompletely understood and underdiagnosed. Detection of early signs of cardiac deterioration in T2DM patients is critical for prevention. Our goal is to quantify T2DM-driven abnormalities in ECG and cardiac imaging biomarkers leading to cardiovascular disease. Methods We quantified ECG and cardiac magnetic resonance imaging biomarkers in two matched cohorts of 1781 UK Biobank participants, with and without T2DM, and no diagnosed cardiovascular disease at the time of assessment. We performed a pair-matched cross-sectional study to compare cardiac biomarkers in both cohorts, and examined the association between T2DM and these biomarkers. We built multivariate multiple linear regression models sequentially adjusted for socio-demographic, lifestyle, and clinical covariates. Results Participants with T2DM had a higher resting heart rate (66 vs. 61 beats per minute,p < 0.001), longer QTc interval (424 vs. 420ms,p < 0.001), reduced T wave amplitude (0.33 vs. 0.37mV,p < 0.001), lower stroke volume (72 vs. 78ml,p < 0.001) and thicker left ventricular wall (6.1 vs. 5.9mm,p < 0.001) despite a decreased Sokolow-Lyon index (19.1 vs. 20.2mm,p < 0.001). T2DM was independently associated with higher heart rate (beta = 3.11, 95% CI = [2.11,4.10],p < 0.001), lower stroke volume (beta = −4.11, 95% CI = [−6.03, −2.19],p < 0.001) and higher left ventricular wall thickness (beta = 0.133, 95% CI = [0.081,0.186],p < 0.001). Trends were consistent in subgroups of different sex, age and body mass index. Fewer significant differences were observed in participants of non-white ethnic background. QRS duration and Sokolow-Lyon index showed a positive association with the development of cardiovascular disease in cohorts with and without T2DM, respectively. A higher left ventricular mass and wall thickness were associated with cardiovascular outcomes in both groups. Conclusion T2DM prior to cardiovascular disease was linked with a higher heart rate, QTc prolongation, T wave amplitude reduction, as well as lower stroke volume and increased left ventricular wall thickness. Increased QRS duration and left ventricular wall thickness and mass were most strongly associated with future cardiovascular disease. Although subclinical, these changes may indicate the presence of autonomic dysfunction and diabetic cardiomyopathy. Graphical Abstract

Cardiovascular System & Cardiology↗