著者

Seiji Hokimoto Koichi Kaikita Satoshi Yasuda Kenichi Tsujita Masaharu Ishihara Tetsuya Matoba Yasushi Matsuzawa Yoshiaki Mitsutake Yoshihide Mitani Toyoaki Murohara Takashi Noda Koichi Node Teruo Noguchi Hiroshi Suzuki Jun Takahashi Yasuhiko Tanabe Atsushi Tanaka Nobuhiro Tanaka Hiroki Teragawa Takanori Yasu Michihiro Yoshimura Yasuhide Asaumi Shigeo Godo Hiroki Ikenaga Takahiro Imanaka Kohei Ishibashi Masanobu Ishii Takayuki Ishihara Yunosuke Matsuura Hiroyuki Miura Yasuhiro Nakano Takayuki Ogawa Takashi Shiroto Hirofumi Soejima Ryu Takagi Akihito Tanaka Atsushi Tanaka Akira Taruya Etsuko Tsuda Kohei Wakabayashi Kensuke Yokoi Toru Minamino Yoshihisa Nakagawa Shozo Sueda Hiroaki Shimokawa Hisao Ogawa on behalf of the Japanese Circulation Society and Japanese Association of Cardiovascular Intervention and Therapeutics and Japanese College of Cardiology Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0779, (Released:2023-03-10)

被引用文献数

39

著者

Masato Nakamura Hitoshi Yaku Junya Ako Hirokuni Arai Tohru Asai Taishiro Chikamori Hiroyuki Daida Kiyoshi Doi Toshihiro Fukui Toshiaki Ito Kazushige Kadota Junjiro Kobayashi Tatsuhiko Komiya Ken Kozuma Yoshihisa Nakagawa Koichi Nakao Hiroshi Niinami Takayuki Ohno Yukio Ozaki Masataka Sata Shuichiro Takanashi Hirofumi Takemura Takafumi Ueno Satoshi Yasuda Hitoshi Yokoyama Tomoyuki Fujita Tokuo Kasai Shun Kohsaka Takashi Kubo Susumu Manabe Naoya Matsumoto Shigeru Miyagawa Tomohiro Mizuno Noboru Motomura Satoshi Numata Hiroyuki Nakajima Hirotaka Oda Hiromasa Otake Fumiyuki Otsuka Ken-ichiro Sasaki Kazunori Shimada Tomoki Shimokawa Toshiro Shinke Tomoaki Suzuki Masao Takahashi Nobuhiro Tanaka Hiroshi Tsuneyoshi Taiki Tojo Dai Une Satoru Wakasa Koji Yamaguchi Takashi Akasaka Atsushi Hirayama Kazuo Kimura Takeshi Kimura Yoshiro Matsui Shunichi Miyazaki Yoshitaka Okamura Minoru Ono Hiroki Shiomi Kazuo Tanemoto on behalf of the Japanese Circulation Society Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-1282, (Released:2022-01-31)

参考文献数

1179

被引用文献数

38

著者

Masakazu Yamagishi Nagara Tamaki Takashi Akasaka Takanori Ikeda Kenji Ueshima Shiro Uemura Yutaka Otsuji Yasuki Kihara Kazuo Kimura Takeshi Kimura Yoshiki Kusama Shinichiro Kumita Hajime Sakuma Masahiro Jinzaki Hiroyuki Daida Yasuchika Takeishi Hiroshi Tada Taishiro Chikamori Kenichi Tsujita Kunihiko Teraoka Kenichi Nakajima Tomoaki Nakata Satoshi Nakatani Akihiko Nogami Koichi Node Atsushi Nohara Atsushi Hirayama Nobusada Funabashi Masaru Miura Teruhito Mochizuki Hiroyoshi Yokoi Kunihiro Yoshioka Masafumi Watanabe Toshihiko Asanuma Yuichi Ishikawa Takahiro Ohara Koichi Kaikita Tokuo Kasai Eri Kato Hiroshi Kamiyama Masaaki Kawashiri Keisuke Kiso Kakuya Kitagawa Teruhito Kido Toshio Kinoshita Tomonari Kiriyama Teruyoshi Kume Akira Kurata Satoshi Kurisu Masami Kosuge Eitaro Kodani Akira Sato Yasutsugu Shiono Hiroki Shiomi Junichi Taki Masaaki Takeuchi Atsushi Tanaka Nobuhiro Tanaka Ryoichi Tanaka Takuya Nakahashi Takehiro Nakahara Akihiro Nomura Akiyoshi Hashimoto Kenshi Hayashi Masahiro Higashi Takafumi Hiro Daisuke Fukamachi Hitoshi Matsuo Naoya Matsumoto Katsumi Miyauchi Masao Miyagawa Yoshitake Yamada Keiichiro Yoshinaga Hideki Wada Tetsu Watanabe Yukio Ozaki Shun Kohsaka Wataru Shimizu Satoshi Yasuda Hideaki Yoshino on behalf of the Japanese Circulation Society Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-1131, (Released:2021-02-16)

参考文献数

1401

被引用文献数

50

著者

Yasushi Ueki Shoichi Kuramitsu Tatsuya Saigusa Keisuke Senda Hitoshi Matsuo Kazunori Horie Hiroaki Takashima Hidenobu Terai Yuetsu Kikuta Takayuki Ishihara Tomohiro Sakamoto Nobuhiro Suematsu Yasutsugu Shiono Taku Asano Kenichi Tsujita Katsuhiko Masamura Tatsuki Doijiri Yohei Sasaki Manabu Ogita Tairo Kurita Akiko Matsuo Ken Harada Kenji Yaginuma Noriyoshi Kanemura Shinjo Sonoda Hiroyoshi Yokoi Nobuhiro Tanaka on behalf of the J-CONFIRM Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-21-1024, (Released:2022-03-12)

参考文献数

19

被引用文献数

1

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Background:Little evidence is available regarding the long-term outcome in elderly patients after deferral of revascularization based on fractional flow reserve (FFR).Methods and Results:From the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicenter registry), 1,262 patients were divided into 2 groups according to age: elderly and younger patients (aged ≥75 or <75 years, respectively). The primary endpoint was the cumulative 5-year incidence of target vessel failure (TVF), defined as a composite of cardiac death, target vessel-related myocardial infarction (TVMI), and clinically driven target vessel revascularization (CDTVR). Cumulative 5-year incidence of TVF was not significantly different between elderly and younger patients (14.3% vs. 10.8%, P=0.12). Cardiac death occurred more frequently in elderly patients than younger patients (4.4% vs. 0.8%, P<0.001), whereas TVMI and CDTVR did not differ between groups (1.3% vs. 0.9%, P=0.80; 10.7% vs. 10.1%, P=0.80, respectively). FFR values in lesions with diameter stenosis <50% were significantly higher in elderly patients than in younger patients (0.88±0.07 vs. 0.85±0.07, P=0.01), whereas this relationship was not observed in those with diameter stenosis ≥50%.Conclusions:Elderly patients had no excess risk of ischemic events related to the deferred coronary lesions by FFR, although FFR values in mild coronary artery stenosis were modestly different between elderly and younger patients.

著者

Masao Daimon Hiroyuki Watanabe Yukio Abe Kumiko Hirata Takeshi Hozumi Katsuhisa Ishii Hiroshi Ito Katsuomi Iwakura Chisato Izumi Masunori Matsuzaki Shinichi Minagoe Haruhiko Abe Kazuya Murata Satoshi Nakatani Kazuaki Negishi Ken Yoshida Kazuaki Tanabe Nobuhiro Tanaka Kotaro Tokai Junichi Yoshikawa The JAMP Study Investigators

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.72, no.11, pp.1859-1866, 2008 (Released:2008-10-24)

参考文献数

20

被引用文献数

73 168

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Background Normal values for echocardiographic measurements and the relationship between these parameters and age in a large Japanese population are still unknown. Methods and Results A total of 700 healthy Japanese aged 20-79 years underwent 2-dimensional and Doppler echocardiography at collaborating institutions. The respective mean values obtained in men and women were as follows: septal wall thickness, 0.9±0.1 and 0.8±0.1 cm; posterior wall thickness, 0.9±0.1 and 0.8±0.1 cm; left ventricular (LV) diastolic diameter, 4.8±0.4 and 4.4±0.3 cm; LV systolic diameter, 3.0±0.4 and 2.8±0.3 cm; LV diastolic volume, 93±20 and 74±17 ml; LV systolic volume, 33±20 and 25±7 ml; LV ejection fraction, 64±5 and 66±5%; maximum left atrial (LA) volume, 42±14 and 38±12 ml. Aortic root diameter, LV wall thickness, and LV mass slightly increased with age, whereas indexed LA volume did not vary with age. Diastolic parameters assessed by mitral inflow and mitral annular velocities declined with age, as previously reported. Conclusions Normal values of echocardiographic measurements in a large Japanese population are reported for the first time; several systolic and diastolic parameters varied with age. These results provide important reference values that should be useful in routine clinical practice as well as in clinical trials. (Circ J 2008; 72: 1859 - 1866)

著者

Masafumi Nakayama Nobuhiro Tanaka Kunihiro Sakoda Yohei Hokama Kou Hoshino Yo Kimura Masashi Ogawa Jun Yamashita Yuichi Kobori Takashi Uchiyama Yoshifusa Aizawa Akira Yamashina

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.79, no.3, pp.530-536, 2015-02-25 (Released:2015-02-25)

参考文献数

38

被引用文献数

20 19

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Background:Papaverine is useful for evaluating the functional status of a coronary artery, but it may provoke malignant ventricular arrhythmia (VA). The aim of this study was to investigate the incidence, and clinical and ECG characteristics of patients with papaverine-induced VAs.Methods and Results:The 182 consecutive patients underwent fractional flow reserve (FFR) measurement of 277 lesions. FFR was determined after intracoronary papaverine administration by standard procedures. The clinical and ECG characteristics were compared between patients with and without ventricular tachycardia (VT: ≥3 successive premature ventricular beats (PVBs), or ventricular fibrillation (VF)). After papaverine administration, the QTc interval, QTUc interval, and T-peak to U-end interval were prolonged significantly. Single PVBs on the T-wave or U-wave type developed in 29 patients (15.9%). Polymorphic VT (torsade de pointes) occurred in 5 patients (2.8%), and of those, VF developed in 3 patients (1.7%). No clinical and baseline ECG parameters were predictors for VT or VF except for sex and administration of papaverine into the left coronary artery. Excessive prolongation of QT (or QTU), T-peak to U-end intervals and giant T-U waves were found immediately prior to the ventricular tachyarrhythmias (VTAs), which were unpredictable from the baseline data.Conclusions:Intracoronary administration of papaverine induced fatal VTAs, although the incidence is rare. Excessive prolongation of the QT (and QTU) interval appeared prior to VTAs; however, they were unpredictable. (Circ J 2015; 79: 530–536)

著者

Masafumi Nakayama Takashi Uchiyama Nobuhiro Tanaka Takaaki Ohkawauchi Shunsuke Miwa Nobuhiro Hijikata Yuichi Kobori Hitoshi Matsuo Kiyotaka Iwasaki

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.11, pp.665-673, 2020-11-10 (Released:2020-11-10)

参考文献数

38

被引用文献数

2

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Background:We hypothesized that the intracoronary-electrocardiogram (IC-ECG)-based pressure index would be more stable and precise than the instantaneous flow reserve (iFR). We investigated the usefulness of the IC-ECG-based pressure index for diagnosing myocardial ischemia.Methods and Results:Thirty-seven consecutive patients with coronary stenosis requiring physiological assessment were enrolled in the study. iFR was measured at rest and under hyperemia in 51 and 40 lesions, respectively. The IC-ECG-triggered distal pressure (Pd)/aortic pressure (Pa) ratio (ICE-T) was defined as the mean Pd/Pa ratio in the period corresponding to the isoelectric line. The ICE-T was significantly lower than the iFR both at rest and during hyperemia (P<0.00001 for both). Fluctuations in the ICE-T pressure parameters (Pd/Pa, Pa, and Pd) were significantly smaller than those of iFR both at rest and during hyperemia. The diagnostic accuracy of predicting a fractional flow reserve (FFR) ≤0.80 of the ICE-T at rest was significantly higher than that of iFR (P=0.008). Receiver operating characteristic curve analyses showed that the ICE-T predicts FFR ≤0.80 more accurately than the iFR (area under curve 0.897 vs. 0.810 for ICE-T and iFR, respectively).Conclusions:We identified the period in the IC-ECG in which resting Pd/Pa was low and constant. The IC-ECG-based algorithm may improve the accuracy of diagnosing myocardial ischemia, without increasing invasiveness, compared with pressure-dependent indices.

著者

Hitoshi Matsuo Tomohiro Kawasaki Tetsuya Amano Yoshiaki Kawase Yoshihiro Sobue Takeshi Kondo Yoshihiro Morino Shunichi Yoda Tomohiro Sakamoto Hiroshi Ito Junya Shite Hiromasa Otake Nobuhiro Tanaka Mitsuyasu Terashima Kazushige Kadota Manesh R. Patel Koen Nieman Campbell Rogers Bjarne L. Norgaard Jeroen J. Bax Kavitha M. Chinnaiyan Daniel S. Berman Timothy A. Fairbairn Lynne M. Hurwitz Koweek Jonathon Leipsic Takashi Akasaka

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.7, pp.364-371, 2020-07-10 (Released:2020-07-10)

参考文献数

9

被引用文献数

1

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Background:Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is an established tool for identifying lesion-specific ischemia that is now approved for use by the Japanese insurance system. However, current clinical reimbursement is strictly limited to institutions with designated appropriate use criteria (AUC). This study assessed differences in physicians’ behavior (e.g., use and interpretation of FFRCT, final management) according to Japanese AUC and non-AUC site designation.Methods and Results:Of 5,083 patients in the ADVANCE Registry, 1,829 from Japan were enrolled in this study. Physicians’ behavior after interrogating CCTA and FFRCTwas analyzed separately according to AUC and non-AUC site designation. Compared with AUC sites, patients referred for FFRCTfrom non-AUC sites had a higher rate of negative FFRCT, less severe anatomic stenosis, and a slightly lower rate of management plan reclassification (51.2% vs. 61.3%), with near-identical utility in both groups. Actual care corresponded equally well to post-FFRCTplans in both groups. The likelihood of revascularization for positive or negative FFRCTwas similar between the 2 groups. Importantly, AUC and non-AUC sites were equally unlikely to revascularize patients with negative FFRCTand stenosis >50% or patients with positive FFRCTand stenosis <50%.Conclusions:Compared with AUC sites, non-AUC sites had lower disease burden and reclassification of management plans, but nearly identical clinical integration. Actual care corresponded equally well to post-FFRCTrecommendations at both sites.

著者

Shiro Uemura Hiroshi Okamoto Michikazu Nakai Kunihiro Nishimura Yoshihiro Miyamoto Satoshi Yasuda Nobuhiro Tanaka Shun Kohsaka Kazushige Kadota Yoshihiko Saito Hiroyuki Tsutsui Issei Komuro Yuji Ikari Hisao Ogawa Masato Nakamura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0004, (Released:2019-04-24)

参考文献数

33

被引用文献数

17

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Background:Primary percutaneous coronary intervention (pPCI) is strongly recommended by guidelines for patients presenting with acute myocardial infarction (AMI), but its applications in elderly patients are less clear.Methods and Results:The JROAD-DPC is a Japanese nationwide registry for patients with cardiovascular diseases combined with an administrative claim-based database. Among 2,369,165 records from 2012 to 2015, data for 115,407 AMI patients were extracted for this study. Elderly patients (≥75 years) comprised 45,645 subjects (39.6%), and received pPCI less frequently (62.2%) than younger patients (79.2%, P<0.001). Clinical variables such as higher age, female sex, higher Killip class, and renal dysfunction, but not functional status on admission, were predictors of non-application of pPCI. Endpoint 30-day mortality increased with aging, and was significantly higher in elderly patients (10.7%) than in younger patients (3.8%, P<0.001). Indeed, pPCI was independently associated with lower 30-day mortality only in subgroups of patients aged ≥60 years. Propensity score-matching analysis confirmed a similar reduction in endpoint 30-day mortality with pPCI in elderly patients. Duration of hospitalization was significantly shorter and functional ability on discharge was significantly better in elderly patients who underwent pPCI.Conclusions:Elderly patients with AMI underwent pPCI less frequently, but it was consistently associated with better clinical outcome in these patients. Our findings support the proactive application of pPCI for elderly AMI patients when they are eligible for an invasive strategy.

著者

Masao Daimon Hiroyuki Watanabe Yukio Abe Kumiko Hirata Takeshi Hozumi Katsuhisa Ishii Hiroshi Ito Katsuomi Iwakura Chisato Izumi Masunori Matsuzaki Shinichi Minagoe Haruhiko Abe Kazuya Murata Satoshi Nakatani Kazuaki Negishi Ken Yoshida Kazuaki Tanabe Nobuhiro Tanaka Kotaro Tokai Junichi Yoshikawa The Japanese Normal Values for Echocardiographic Measurements Project (JAMP) Study Investigators

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.75, no.12, pp.2840-2846, 2011 (Released:2011-11-25)

参考文献数

24

被引用文献数

22 50

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Background: The purpose of the present study was to investigate gender differences in age-related changes of left ventricular (LV) and right ventricular (RV) geometries and functions throughout the entire adult age range using the Japanese Normal Values for Echocardiographic Measurements Project (JAMP) study database. Methods and Results: Seven hundred healthy volunteers (aged 20-79 years) underwent 2-dimensional and Doppler echocardiography. The subjects were stratified into 6 different age groups and then stratified by gender in each age group. LV diastolic function was assessed from pulsed wave Doppler measurements of mitral early (E) and late (A) inflow velocities and tissue Doppler measurements of mitral early (e') and late (a') annular velocities. LV volume decreased and LV mass increased with age to a similar extent in both men and women. Furthermore, for subjects <50 years, women had significantly greater E, E/A ratio and e' than men, but these parameters were similar between genders in subjects >50 years. In addition, there was a significant interaction between age and gender that affected the differences in E, e' and E/e' among the groups (P<0.03, P<0.01, and P<0.03, respectively; ANOVA). There were no gender differences in age-related changes in RV parameters. Conclusions: Gender differences were found in age-related changes in LV diastolic function in a healthy population. Gender differences should be considered for optimal diagnosis and management of cardiovascular disease. (Circ J 2011; 75: 2840-2846)

著者

Shota Fukuda Hiroyuki Watanabe Masao Daimon Yukio Abe Akihiro Hirashiki Kumiko Hirata Hiroshi Ito Masumi Iwai-Takano Katsuomi Iwakura Chisato Izumi Takayuki Hidaka Toshinori Yuasa Kazuya Murata Satoshi Nakatani Kazuaki Negishi Kazuhiro Nishigami Tomoko Nishikage Takahiro Ota Akihiro Hayashida Konomi Sakata Nobuhiro Tanaka Satoshi Yamada Kazuhiro Yamamoto Junichi Yoshikawa

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.76, no.5, pp.1177-1181, 2012 (Released:2012-04-25)

参考文献数

27

被引用文献数

27 67

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Background: The recently developed real-time 3-dimensional echocardiography (RT3DE) is a promising imaging method to quantify cardiac chamber volumes and their functions in clinical practice. However, normal reference values of RT3DE parameters have not been fully investigated in a large, healthy Japanese population. Methods and Results: This study consisted of 410 healthy subjects aged from 20 to 69 years who had a RT3DE at one of the 23 collaborating institutions. All subjects had no history of cardiac disease and no risk factors. The mean values in men and women were as follows: 50±12ml/m2 and 46±9ml/m2 for left ventricular (LV) end-diastolic volume index, 19±5ml/m2 and 17±4ml/m2 for end-systolic volume index, 61±4% and 63±4% for ejection fraction, 64±12g/m2 and 56±11g/m2 for mass index, 23±6ml/m2 and 24±6ml/m2 for left atrial (LA) maximum volume index, 10±3ml/m2 and 10±3ml/m2 for minimum volume index, and 58±6% and 58±6% for percent volume change. LV sizes decreased with age, whereas LV mass index did not change. LA sizes slightly increased with age. Conclusions: This multicenter investigation determined normal reference values for LV and LA sizes, and their functional parameters on RT3DE in a large, healthy Japanese population. The results of the present study support the use of RT3DE for the diagnosis and management of cardiovascular disease. (Circ J 2012; 76: 1177-1181)

著者

Nobuhiro Tanaka Masato Nakamura Takashi Akasaka Kazushige Kadota Shirou Uemura Tetsuya Amano Nobuo Shiode Yoshihiro Morino Kenshi Fujii Yutaka Hikichi for the CVIT-DEFER Registry Investigators

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-16-1213, (Released:2017-04-26)

参考文献数

14

被引用文献数

22

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Background:Clinical use of fractional flow reserve (FFR) has been rapidly increasing, but outcomes after FFR-based coronary intervention in Japanese daily clinical practice have not been well investigated.Methods and Results:The prospective multicenter cardiovascular intervention therapeutics registry (CVIT)-DEFER enrolled consecutive patients for whom FFR measurement was clinically indicated. This study comprised 3,857 vessels in 3,272 patients. Lesions were categorized into 4 groups according to FFR result and revascularization strategy: group 1: FFR >0.8, and deferral of PCI (n=1992); group 2: FFR >0.8, then PCI (n=230); group 3: FFR ≤0.8, and deferral of PCI (n=506); and group 4: FFR ≤0.8, then PCI (n=1,129). The event rate for deferred lesions was significantly low compared with that for PCI lesions (3.5% vs. 6.6%; P<0.05). Vessel-related events occurred in 62 (3.1%), 11 (4.8%), 25 (4.9%), and 79 (7.0%) patients in groups 1, 2, 3, and 4, respectively. PCI for lesions in which FFR was >0.8 (group 2) showed no improvement in the event rate compared with a defer-strategy. On the other hand, deferred lesions with lower FFR values had a higher risk of vessel-related events.Conclusions:A FFR-based revascularization strategy in daily clinical practice was safe with regard to vessel-related events.

著者

Hiromasa Otake Charles A. Taylor Hitoshi Matsuo Nobuhiro Tanaka Takashi Akasaka

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-16-0503, (Released:2017-04-11)

参考文献数

36

被引用文献数

5

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Despite the clinical importance of ischemia evaluation, obtaining fractional flow reserve (FFR) value has, heretofore, only been available during invasive cardiac catheterization. Although there is a clear linkage between morphology and physiology, a significant gap still exists. FFR derived from coronary computed tomography angiography (FFRCT) is a novel method of quantifying the hemodynamic significance of coronary artery stenoses by translating morphological information into hemodynamic data. Improved diagnostic performance of FFRCThas been repeatedly demonstrated in comparison with coronary computed tomography angiography alone with an invasive FFR reference standard. More recently, the potential benefit of this technology to safely defer non-indicated catheterizations and reduce healthcare costs has been established and indicates this technology may improve the management of patients with coronary artery disease. In this review, we summarize the scientific basis of FFRCTand evidence from clinical trials, provide illustrative examples of clinical applications, discuss potential limitations, and outline avenues for future research.