bluuebunny/crossref_metadata_2025 huggingface dataset:
Public connection repertoires and communicative figurations of publics: conceptualizing individuals’ contribution to public spheres
Authors: Hasebrink Uwe , Merten Lisa , Behre Julia
Published: July 2023

As public sphere(s) have been ascribed core functions for democratic societies, correlating theories have a long tradition in communications research. Yet they often fail to bridge the conceptual gap between the macro level of public sphere(s) and the micro level of individual citizens. In this article, we propose a conceptual approach that helps to describe and explain the contribution of individuals to the construction of publics. Following Elias’ figurational approach, we propose a framework for the analysis of different kinds of publics as communicative figurations. To capture individuals’ contribution to these publics, we introduce the concept of public connection repertoires which represent individuals’ structured patterns of connection to different publics. This results in the figurational analysis of publics, based on the public repertoires of all individuals who connect to that public. We discuss implications of this approach for theoretical work on public spheres in changing media environments.
Genetic variation in solute carrier family 5 member 2 mimicking sodium-glucose co-transporter 2-inhibition and risk of cardiovascular disease and all-cause mortality: reduced risk not explained by lower plasma glucose
Authors: Bechmann Louise E , Emanuelsson Frida , Nordestgaard Børge G , Benn Marianne
Published: July 2023

Aims

Treatment with sodium-glucose co-transporter 2 (SGLT2)-inhibitors reduces the risk of cardiovascular disease and mortality, but the mechanism is unclear. We hypothesized that a functional genetic variant in solute carrier family 5 member 2 (SLC5A2), known to be associated with familial renal glucosuria, would mimic pharmacological SGLT2-inhibition, and thus provide an opportunity to examine potential mediators of the effects on lower risk of cardiovascular disease and mortality.

Methods and results

We examined 112 712 individuals from the Copenhagen City Heart Study and Copenhagen General Population Study (CCHS + CGPS), 488 687 from the UK Biobank, and 342 499 from FinnGen, genotyped for SLC5A2 rs61742739, c.1961A > G; p.(Asn654Ser). The 2.0% heterozygotes and 0.01% homozygotes were pooled as carriers and compared with the 98% non-carriers. First, we examined the risk of cardiovascular disease and mortality; second, whether carrying the variant was associated with potential mediators of the effect; and third, whether identified potential mediators could explain the observed reduced risk of cardiovascular disease and mortality. In the CCHS + CGPS, carriers vs. non-carries had a 31% lower risk of heart failure, 21% lower risk of myocardial infarction, 16% lower risk of ischaemic heart disease, and 22% lower risk of all-cause mortality. Corresponding values in meta-analyses of the three studies combined were lower risk by 10%, 6%, 6%, and 10%, respectively. The SLC5A2 rs61742739 variant was not associated with a risk of ischaemic stroke or cardiovascular mortality. Of the lower risks observed in CCHS + CGPS, lower plasma glucose mediated 2.0%(P = 0.004) on heart failure, 3.1%(P = 0.09) on myocardial infarction, 4.1%(P = 0.02) on ischaemic heart disease, and 6.0%(P = 0.39) on all-cause mortality; corresponding values in the UK Biobank were 2.9%(P = 0.70), 1.5%(P = 0.77), 4.1%(P = 0.23), and 3.1%(P = 0.21), respectively.

Conclusion

A functional genetic variant in SLC5A2, mimicking SGLT2-inhibition, was associated with a lower risk of heart failure, myocardial infarction, ischaemic heart disease, and all-cause mortality. These effects were at most minimally mediated through lower plasma glucose.
The effect of mastic mouthwash on halitosis and oral hygiene in orthodontic patients: a randomized clinical trial
Authors: Tsironi Konstantina , Mylonopoulou Ioulia-Maria , Pandis Nikolaos , Vassilopoulos Spyridon , Sifakakis Iosif , Papaioannou William
Published: July 2023

Background/Objectives

The aim of this trial was to investigate the effect of mastic mouthwash on halitosis using as a proxy the levels of the Volatile Sulfur Compounds (VSCs), and the effect on plaque and gingival indices in adolescents undergoing orthodontic treatment with fixed conventional labial appliances.

Subjects/Methods

The study was a double-blinded, placebo-controlled, parallel-group, randomized clinical trial. Thirty patients with fixed orthodontic appliances were randomly allocated at a 1:1 ratio, to either the mastic-mouthwash or the placebo-mouthwash group. Eligibility criteria included ages between 13 and 18, active orthodontic treatment with fixed appliances, good general health, and total initial VSCs levels above 150 ppb. The primary outcome was the objective hydrogen sulfide (H2S) level, measured with the Oral ChromaTM device. The secondary outcomes were (1.) the methyl-mercaptan (CH3SH) and (2.) dimethyl sulfide [(CH3)2S] levels, measured with the same device, (3.) the subjective perception of the own malodour via questionnaires, and (4.) the oral hygiene assessed with the use of the Modified Silness and Löe Plaque Index (PI-M) and the Silness and Löe Gingival Index (GI) at baseline (T0) and after 2 weeks (T1). Stratified randomization by gender was used, and allocation was concealed with opaque numbered sealed envelopes.

Results

H2S level dropped from 221.00 ppb (T0) to 125.00 ppb (T1), and the difference between treatment groups was statistically significant in favour of the mastic group (coef: 72.34, 95% CI: 8.48, 136.27, P = 0.03). The levels of the other VSCs, the subjective measurements of oral malodour, and the oral hygiene indices did not differ between treatment arms.

Limitations

The objective organoleptic assessment by a calibrated examiner was not performed.

Conclusions/Implications

Mastic mouthwashes could be an alternative treatment for adolescent patients suffering from halitosis during orthodontic treatment with fixed appliances.

Registration

The trial was registered at ClinicalTrials.gov (identifier: NCT05647369).
Infective endocarditis in octogenarians: a retrospective study in a single, high-volume surgical centre
Authors: Scheggi V , Menale S , Giovacchini J , Del Pace S , Tamburini M , Musmeci S , Alterini B , Stefano P L , Marchionni N
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality. Little is known about the best management of elderly patients with IE. In these patients, surgery may be challenging. Our study aimed to describe IE’s features in octogenarians and to identify the independent predictors of mortality, focusing on the prognostic impact of disability.

Methods

We retrospectively analyzed 551 consecutive patients admitted to a single surgical centre with a definite diagnosis of non-device-related infective endocarditis; of these, 97 (17.6%) were older than 80 years.

Results

In patients under eighty, males were mostly involved with a sex ratio exceeding 2:1. This ratio was inverted in older people, where the female gender represented 53.6% of the total. Enterococci (29.8 vs 17.4%, p = 0.005) were significantly more frequent than in younger people. Comorbidities were more frequent in elderly patients; consequently, EUROSCORE II was higher (median ± IQR 16.4 ± 21.1 vs 5.0 ± 10.3, p = 0.001). In octogenarians, IE was more frequently left-sided (97.9 vs 89.8%, p = 0.011). Octogenarians were more often excluded from surgery despite indication (23.7 vs 8.1%, p = 0.001) and had higher three-year mortality (45.3 vs 30.6%, p = 0.005) than younger patients. In elderly patients, age did not independently predict mortality, while exclusion from surgery and a high grade of disability did.

Conclusions

Octogenarians with IE have specific clinical and microbiological characteristics. Older patients are more often excluded from surgery, and the overall prognosis is poor. Age per se should not be a reason to deny surgery, while disability predicts futility.
The value of plasma NGAL and NT-proBNP in the diagnosis of type 1 cardiorenal syndrome
Authors: Phan H A O
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The presence of acute kidney injury in the setting of acute heart failure (AHF) is common occurrence and was termed type 1 cardiorenal syndrome (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. NT-proBNP has a role in the diagnosis of acute heart failure. Does the combination of NGAL and NT-proBNP increase diagnostic value of CRS1? This study was aimed to evaluate the diagnostic value of plasma NGAL and NT-proBNP in diagnosis of CRS1.

Methods

there were 139 patients with AHF in the department of Cardiovascular resuscitation and Interventional cardiology Ho Chi Minh City Vietnam 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study.

Results

the optimal cut-off plasma NGAL to diagnosing CRS1 was 353.23 ng/ml, Area Under Curve (AUC) 0.732 (95% CI 0.65-0.80, p < 0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, negative predictive value 84%. The optimal cut-off NT-proBNP to diagnosing CRS1 was 17681 pg/ml, AUC 0.710 (95% CI 0.627-0.784, p < 0.001), sensitivity 54.2%, specificity 80.2%, positive predictive value 59.1%, negative predictive value 76.8%. Combination of plasma NGAL and NT-proBNP in diagnosing CRS1 with AUC 0.756 (95% CI 0.676-0.825, p < 0.001), sensitivity 77.1%, specificity 69.2%, positive predictive value 56.9%, negative predictive value 85.1%.

Conclusions

Combination of plasma NGAL and NT-proBNP in the diagnosis of type 1 cardiorenal syndrome with higher sensivity than each biomarker.
Cardiac rehabilitation and caregivers challenges A scoping review
Authors: Loureiro M , Parola V P , Duarte J P , Oliveira I O , Coutinho G C , Martins M M M , Novo A N , Delgado B D
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Objective

Map the interventions directed to the caregiver of heart disease (HD)patients in cardiac rehabilitation programs (CRP) that promote their role and health.

Methods

Scoping Review guided by the Joanna Briggs Institute method. Two independent reviewers assessed articles for relevance and extracted and synthesized data. Inclusion criteria comprised articles published in English, Spanish and Portuguese since 1950. The following databases were searched: CINAHL Complete (Via EBSCO); Medline (via PubMed); Scopus, PEDro, e Repositórios Científicos de Acesso Aberto de Portugal (RCAAP).

Results

From 351 articles retrieved, ten were included in the review. Different interventions were identified directed to the caregiver of HD patients: educational interventions and lifestyle changes, physical exercise, psychological interventions/stress management, and a category "Other" with training interventions in basic life support, elaboration of guidelines/recommendations and training for the role of caregiver. Regarding the population, heart failure patient caregivers are the primary intervention targets, followed by caregivers of patients with ischemic disease and integrated into CRP. Regarding the context, there is a concern that the professional intervention with the caregivers should be mainly at home (home-based), using face-to-face and telehealth monitoring, often combined, with references also to the hospital context, primary health care and rehabilitation center.

Conclusions and implications for the clinical practice: It was found that most of the identified cardiac rehabilitation interventions are aimed at the dyad HD patient and caregiver/family. Including specific interventions targeting caregivers improves the caregiver’s health and empowers him/her. Patients care planning should include interventions specifically aimed at them that result into health gains for caregivers and patients, aiming at the quality of care.
Role of compliance to dietary and physical activity recommendations for better quality of life in patients with chronic heart failure
Authors: Georgieva M , Rushid N , Nankova M , Borisova S , Yotov Y
Published: July 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Varna, fund Science

Background

Diet and physical activity are important non-pharmacological determinants for the prognosis in patients with chronic heart failure (HF). The role of nurse in patient education and follow-up of these factors is of paramount importance for improvement the quality of life.

Aim

to determine the effect of adherence to life style recommendations for the better quality of life of patients in ambulatory HF program.

Participants and methods: Overall, 72 patients with HF were included in a structured ambulatory program after hospital discharge, with the active participation of a nurse in it. After a 6-month follow-up, 61 finished the program. All patients were educated at the beginning and at the follow-up visits for their appropriate diet and physical activity by the health care practitioner. The adherence to the above mentioned life style measures was evaluated by asking the participants whether the follow the given recommendations. Quality of life was assessed by the change in NYHA class, 6-minute walking test (6MWT) distance, questionnaires (KCCQ, EQ-5) and self-assessment by visual analogue scale. For continuous variables, t-test and Mann-Whitney test was used depending on the normality of the distribution. For categorical variables, chi-square or Fisher’s exact test were applied where appropriate. Logistic regression was used to test the effect of adherence to advices for life- style parameters.

Results

There was no difference in age and sex distribution between the compliant (C) and non-compliant (NC) group (Table 1). All patients were medically treated according to the current guidelines. There was significant improvement in the functional capacity in adherent to treatment patients. The increase in 6MWT (Table 1) was on average 39.16 m more in the compliant group (p = 0.016). You have 6 times higher chance to improve your 6MWT performance if you are compliant – OR 6 (95%CI 1.02-31.11, p = 0.047). There was also slightly better improvement in NYHA class – mean change 0.9 vs 0.7, p = NS. The quality of life was also improved more significantly in the C than in NC group (Table 1). Clinically meaningful improvement in overall summary score (OSS) >5 points was observed in 92% in C vs 64% in NC (p = 0.0.029) and moderate to large improvement >10 points – in 82% vs 54.5% (p = 0.05). There was also a trend to better anxiety and depression attitudes at the end of the 6 months in the C than in NC patients.

Conclusions

The adherence to diet and physical activity advices improves the physical capacity and the quality of life in patients with HF even just after 6 months. In this respect, the role of the health care practitioner is of invaluable importance to promote the life style changes. This includes education and proper ambulatory follow-up by a trained nurse.Table 1
The transition to adult care for patients with congenital heart disease: Nurses' experiences. A qualitative study
Authors: Braanaas K , Lie I , Jerpseth H
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Most children with congenital heart disease survive into adulthood. The transition from pediatric care to adult care can be experienced as abrupt and uncomprehensive for these patients. The nurses play a critical role in the transition process. There is a lack of research highlighting the perspective of the nurses caring for grown-ups with congenital heart disease (GUCH).

Purpose

To explore the nurses’ experiences related to the transition to adult care for patients with congenital heart disease.

Methods

Qualitative methods with three focus group interviews were conducted at one university hospital in Norway. We included ten nurses from both the adult outpatient clinic and the cardiac ward. Data were collected between October 2022 and January 2023, and transcripts were analyzed using thematic analysis by Braun and Clarke.

Results

Three themes were defined; i) transition without communication, ii) nurses lacking knowledge about the transition process, and iii) challenges in interaction with GUCH patients. The first theme illustrates that communication regarding the transition is experienced as unpredictable. Secondly, the ward nurses identified the need for knowledge about the routines and the transition process. Thirdly, the nurses lack knowledge about the patient’s individual transition experiences.

Conclusion

Our study showed that the nurses request more communication and knowledge regarding the transition process to be prepared and able to care for patients with congenital heart disease into adulthood.

To include the patient perspective, there is also a need for improved knowledge about the patients’ and parents' perspectives for a successful transition of GUCH patients.
Health-related quality of life and psychosocial effects of the diagnosis of aortovascular manifestations in Marfan syndrome patients: a qualitative study
Authors: Magboo R , Oo A , Gibbs D , Owens G , Sanders J
Published: July 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Barts Charity

Background

Marfan Syndrome (MFS) is a rare autosomal-dominant connective tissue disorder with serious and life-threatening cardiovascular manifestations. Despite the severity of this life-long condition, there is very little evidence on the health-related quality of life (HRQoL) and psychosocial effects of living with MFS and no available evidence on the effect of the aortovascular manifestations.

Purpose

This study is part of a programme of work aiming to identify the HRQoL and the psychosocial factors affecting MFS patients following the diagnosis of an aortovascular manifestation.

Methods

This single site qualitative exploratory study was designed to identify quality of life issues affected by the aortovascular diagnosis in MFS from patients’ lived experience. Convenience sampling was employed for this study, with an expected sample size of 20 adult participants who had validated diagnosis of MFS using the revised Ghent criteria[1] and diagnosed with aortovascular manifestations. Interviews, lasting up to 1 hour, were conducted using a semi-structured interview schedule. Each interview was audio-taped and transcribed verbatim. Data saturation assessment was done using the Guest et al.[2] method. Data analysis was undertaken using the Framework method[3], which follows a seven-stage process

Results

Twenty interviews were undertaken, transcribed and analysed. Participants ranged from 24 to 71 years old (M = 39.6); were 55% male, were primarily Caucasian (n=17, 85%), and 80% completed secondary and post-secondary education. Majority were employed (n=12, 70%) and 40% had greater than average household income.

The results identified that patient reported HRQoL and psychosocial factors affecting MFS patients following aortovascular diagnosis include: social and self-stigma, depression, social and health anxiety, loss of personal efficacy, financial burden, loss of self-esteem, worry in building a relationship or family and vital exhaustion. However, patients also expressed that the diagnosis led to disease acceptance, constructive engagement in coping with the condition and self-acceptance.

Conclusion

These results assist in better understanding the HRQoL and psychosocial factors that affect patients with MFS. This information can support the development of a patient care pathway that includes HRQoL and psychosocial aspects of care to provide a holistic and comprehensive service for this patient group.
The impact of the frailty syndrome on the functioning of patients with atrial fibrillation
Authors: Banaszak-Zak B , Domin K , Mlynarska A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial fibrillation is one of the most common supraventricular arrhythmias, which are related to the patient's health condition in progressive treatment.

The aim of the study was to evaluate the relationship between the frailty syndrome and the functioning of patients with atrial fibrillation.

Material and methods

98 patients (64 women and 34 men) over 65 years of age suffering from atrial fibrillation were included in the study. In the study 2 questionaries have been used: The Frailty Indicator (TFI) and The Functioning in the Chronic Illness Scale (FCIS). The frailty syndrome was recognized at values of 5 or more.

Results

Frailty syndrome was recognized in 96,94% of cases. The total value of the frailty syndrome correlates negatively and significantly with all components of functioning in a chronic illness. A similar correlation is also found in the physical domain and the components of functioning in chronic illness. The social domain correlates statistically negatively with the patient's impact on the illness. Exact results are presented in the table below.

Conclusions

Atrial fibrillation has an indirect impact on the lives of patients. The attitude of patients has an indirect influence on the course of atrial fibrillation, and patients are pessimistic about the future. Frailty syndrome worsens the functioning of patients in atrial fibrillation.The correlation between FCIS and TFI
Anxiety, age, education and activities of daily living as predictors of the occurrence of frailty syndrome in patient with heart rhythm disorders
Authors: Mlynarska A , Mlynarski R
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac arrhythmias associated with psychological changes that occur in the conducting system and frequent coexistence of coronary artery disease and hypertension are more common in elderly patients than in younger ones. Aim of the study was to evaluate the relationships between anxiety and depression and the presence of frailty syndrome in patients with heart rhythm disorder who had been qualified for pacemaker implantation.

Methods

171 consecutive patients (mean age 73,91 ± 6,72; 48,5% woman) with qualified to pacemaker implantation were included into the study. Patients were divided according type of heart rhythm disorders: 90 patients with atrio-ventricular blocks (AVB) and 81 with sinus node dysfunction (SND). To evaluate frailty syndrome we used Tilburg Frailty Indicator (TFI), to recognize anxiety and depression Hospital Anxiety and Depression Scale (HADS) was used. Obtained data were analyzed and multiple regression model using stepwise input was created.

Results

Frailty syndrome was diagnosed in 54,46% of the included patients. Average general TFI score was 4,60 ± 2,34: in the physical component 2,90 ± 1,65; in the psychological component 0,69 ± 0,76 and 1.05 ± 0,74 in the social components. Age, number of years education anxiety and activities of daily living were found to be important predictors of the higher level of frailty syndrome. Detail results are presented in table below.

Conclusion

Anxiety, age, education and the activities of daily living can be predictors factors of the occurrence of frailty syndrome in patients with heart rhythm disorders who have been qualified for pacemaker implantation.
The moderating effect of self-care self-efficacy and self-care behaviors on the relationship between symptom burden and frailty among heart failure inpatients
Authors: Qiu C , Yu S F
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The trajectory of heart failure is punctuated by episodes of repeated hospitalization due to heart failure exacerbation. Heart failure inpatients bear a heavy symptom burden, which acts as a strong stimulus to decrease patients' physiological reserve and lead to the development of frailty. Frailty has been shown to be a powerful predictor of heart failure inpatients' poor prognosis. Based on the theory of the Transactional Model of Stress, self-care behavior was suggested to be a cognitive-behavioral coping method to mitigate the detrimental effect elicited by symptom stimulus and improve patients' prognoses.

Purpose

This study was conducted to examine whether self-efficacy, self-care behaviors including self-care maintenance, symptom perception, and self-care management moderate the relationship between symptom burden and frailty.

Methods

This was a cross-sectional study with 207 participants recruited from June to December 2022. The Chinese versions of Memorial Symptom Assessment Scale-Heart Failure, Self-care self-efficacy scale, Self-care index of heart failure 7.2 and Edmonton frailty scale were adopted to capture corresponding variables. The moderation effects of self-care self-efficacy and three specific self-care behaviors were explored using the PROCESS macro for SPSS.

Results

Among recruited patients, most patients were male (61.8%), with the mean age of 71.23. As for the moderating effects analyses, self-care efficacy (P<0.001, ΔR2=0.032), self-care maintenance (P<0.001, ΔR2=0.039) and symptom perception (P<0.001, ΔR2=0.031) rather than self-care management (P=0.06) moderated the detrimental effect of symptom burden on frailty. The results of further analysis showed that providers recommended (P<0.001, ΔR2=0.036) rather than self-initiated (P=0.81) self-care management behaviors moderated the relationship between symptom burden and frailty.

Conclusions

This study identified the moderating effects of self-care self-efficacy, self-care behaviors in mitigating detrimental effect of symptom burden on frailty. Our study suggested one potential pathway to improve patients' prognoses by decreasing the deleterious effects of symptoms and highlighted the necessity of incorporating self-care into heart failure management.
Exploring how enrolment in the TARGET-CTCA clinical trial may modify patient perception of heart health
Authors: Ferry A , Schulberg S , Barker S , Souter G , Williams K , Taggart C , Wereski R , Tuck C , Mills N L
Published: July 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

The TARGET-CTCA trial aims to determine whether the use of high-sensitivity cardiac troponin to target computed tomography coronary angiography (CTCA) improves outcomes in patients presenting to hospital with suspected acute coronary syndrome in whom myocardial infarction has been ruled out. What patients understand of their subsequent risk of cardiovascular disease in this setting, and how intervention with CTCA may influence this is unknown.

Purpose

To explore how trial participants perceive their heart health and whether this has been modified by trial participation.

Methods

The TARGET-CTCA trial randomises patients with intermediate high sensitivity cardiac troponin levels to standard care, or CTCA plus standard care. Patients receive CTCA scan results informing them if they have a normal heart or they have mild, moderate or obstructive coronary artery disease. Forty semi-structured interviews were conducted with trial participants across standard care and intervention arms ensuring representation across disease category, age, sex and socioeconomic status groups. Data were coded and organized into themes.

Results

Emergent themes from the data included insights into attitudes to future health, perception of heart health, and health education needs. While some participants displayed a proactive approach to maintaining health, the consideration of future health goals was often a reactive process in response to the initial chest pain episode or the CTCA findings. While some patients discussed personal responsibility for health maintenance others described a passive approached requiring direct management from a health professional. For some standard care participants, the absence of myocardial infarction was a sign of a healthy heart. Others were left with unanswered questions after the hospital assessment. Confirmation of the absence of coronary artery disease with CTCA gave patients great confidence and a positive change to health seeking behaviour patterns was reported. Patients differed in their interpretation of the terms mild, moderate and obstructive coronary artery disease. This affected their subsequent action with some using the presence of disease as an opportunity to appraise their risk of future cardiac events and begin a preventative approach. Others reported fear and reducing activity to avoid precipitating a possible event. Many patients reported a desire to implement lifestyle changes but did not have the knowledge to do so.

Conclusion

Exploring how the information contained in participant result letters may contribute to the understanding of risk of future cardiac events has provided valuable information for application of the trial intervention outside of the main trial setting.
The af virtual ward, right care, right time and right team
Authors: Armstrong S , Kotb A , Bausor R , Neve C , Koev I , Ng G A
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial Fibrillation (AF) is the most common cardiac arrhythmia. AF related hospital admissions are rising, with significant cost and capacity implications. Virtual wards are novel pathways designed to support patients remotely, whilst maintaining safe high quality patient care, changing the landscape of care provision.

Purpose

The standard pathway for patients presenting acutely with AF or Atrial flutter (AFL), is to remain in hospital between 2-5 days, attached to a heart monitor until achieving rate or rhythm control. We developed an AF Virtual ward run by a specialist multi-disciplinary team; to provide remote out-of-hospital care for patients with AF or AFL and rapid ventricular response whilst focusing on improving patients’ care pathway and experience.

Methods

Patients presenting acutely with AF or AFL who met the criteria for our virtual ward, were on-boarded from an acute hospital admission area or outpatient department. Patients were given access to electronic platform (Dignio) via their smartphone or tablet. They were provided with instruction on how to use a blood pressure machine, single lead ECG device (Kardia) and a pulse oximeter. Once discharged they submitted readings, at least twice a day. Patients who didn’t have access to smart phones were provided with electronic tablets to ensure digital inclusion. Patients’readings, current medication and co-morbidities were assessed by Advanced Clinical Practitioners, Cardiology Registrars and Consultants on "virtual ward rounds". They were supported via messaging through the platform, telephone or video consultations. Health education, lifestyle advice, medication adjustments, and clinical decisions were undertaken remotely by the clinical team.

Results

A retrospective analysis of the first 50 virtual ward admissions from January - August 2022 was undertaken. Initial hospital admissions were completely avoided in 24 patients due to on-boarding from the outpatient department. Medical interventions by the specialist team prevented 25 readmissions, saving a total of 49 hospitalisations and between 98 - 245 bed days. A rhythm control strategy was pursued in 82% and sinus rhythm was achieved in 36% on discharge. A total of 28% patients were referred for direct current cardioversion (DCCV) and 30% for catheter ablation. The prompt development of a treatment plan avoided attendance in a specialist Cardiology outpatient clinic whose waiting time for an appointment is approximately 6 months. The NHS friends & family test was completed by 90% of the patients with 100% positive responses. Feedback themes revolved around empowerment, feeling safe, actively participating in their care, and avoiding hospital stay.

Conclusion

The innovative changes to create the AF Virtual ward has facilitated bed efficiencies allowing "hospital-at-home" remote care through prompt care by a specialist multidisciplinary team, with 100% patient satisfaction.
Knowledge on heart disease of the person with ischemic heart disease
Authors: Carneiro L , Rodrigues D , Paiva D
Published: July 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Instruments that allow us to measure the users' knowledge about their health can be useful in clinical practice to allow adjusting interventions, quantifying health gains and developing cost-effective interventions.

Purpose

To determine knowledge about heart disease among the population with diagnosed ischemic heart disease.

Methods

Cross-sectional, descriptive study using a sequential sample of patients with ischemic heart disease admitted between May 2nd and July 30th, 2022 at the cardiology service of the Hospital Centre of our city. A self-administered questionnaire was developed and applied to 165 patients, encompassing several dimensions: sociodemographic characteristics, clinical history, lifestyle, number of hospitalizations due to heart disease and characterization of the current admission. An instrument was used to determine knowledge about heart disease (Questionário de Avaliação de Conhecimentos em Doença Cardíaca: QACDC - Questionnaire for the Assessment of Knowledge in Heart Disease), the Medical Term Recognition Test (METER) to assess literacy and the Hospital Anxiety and Depression Scale (HADS). Patients were assessed during their stay at the hospital unit where they had been admitted due to an acute illness or for elective procedures. Using, preferably, parametric tests, we studied the association between the average score obtained in the QAC-DC and the variables studied.

Results

Women, the less educated and those with inadequate literacy levels were the groups with the lowest levels of knowledge. Regarding the areas of knowledge, the least recognized cardiovascular risk factors were the family history of ischemic heart disease (recognized by 86%), diabetes mellitus (recognized by 73%) and gender (marked by 19% of respondents). The most frequently identified symptom of heart disease was chest discomfort (92%), followed by difficulty breathing or shortness of breath (84%), while jaw, neck or interscapular discomfort was only recognized by 54% of respondents. Symptoms of stroke and acute myocardial infarction were confused by 88% of the sample.

Conclusions

There are important gaps in some areas of knowledge about heart disease among patients with ischemic heart disease. These gaps are particularly important in certain patient subgroups. Health intervention strategies must be sensitive to these data. The QAC-DC knowledge assessment instrument proved to be reliable, valid and applicable in clinical practice.
Examining cardiac cachexia in the thai heart failure patients
Authors: Thanapholsart J , Khan E , Janwanishstaporn S , Thongma P , Naowapanich S , Pramyothin P , Chirakarnjanakorn S , Sethalao P , Waldreus N , Tankumpuan T , Lee G
Published: July 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Ministry of Public Health, Thailand

Background

Cardiac cachexia (CC) can occur in heart failure (HF)with weight and muscle loss. Screening for suspected CC and CC using Cachexia consensus, including CC symptoms, had not been examined among the Thai heart failure patients.

Purpose

To screen for suspected CC and CC in a HF out-patients setting in Thailand using the international cachexia consensus

Method

Anthropometric data, such as body weight, height, grip strength, skinfold thickness and waist circumferences, were collected. Bloods for haemoglobin, albumin, c-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum osmolarity were collected. Bioelectrical impedance analysis (BIA) measurement using INBODY S10 was conducted. Participants were asked to complete questionnaires that were Simplified on Nutrition Appetite Questionnaire (SNAQ), Thirst Distress Scale-Heart Failure (TDS-HF) and Kansas City Cardiomyopathy Questionnaire.

Results

Thirty-eight participants were recruited. Of these two participants had confirmed and five with suspected CC and the remainder did not have CC (n=31). We analysed the data by comparing between two groups: 1) highly suggestive CC (confirmed CC and suspected CC), 2) non-CC. Anthropometric measurements, BIA parameters and fatigue were not significantly different between those with confirmed and suspected CC and those who have not have CC (P>0.05). CRP and NT-proBNP levels were higher in those with CC and suspected CC than those who have not have CC (CRP median 4.39 vs 1.25 and NT-proBNP median 3,889.00 vs 1,957.00, respectively). The SNAQ scores were significantly lower in highly suggestive CC than non-CC group (13.14±2.41 vs 15.07±2.28, p≤0.05), but TDS-HF scores were not significantly different (20.57±7.28 vs 19.74±9.54, p = 0.678). Quality of life scores were lower in highly suggestive CC group than non-CC group although it was not statistically significant (60.71±24.40 vs 66.67±24.06, p = 0.559). Phase angle positively correlated to SNAQ (r = 0.550, p = 0.015) and albumin (r = 0.622, p = 0.004).

Conclusion

This is the first pilot study in Thailand screening for CC. SNAQ with the support of phase angle can be a useful and affordable tool to simply screen for CC. NT-proBNP might be associated with the development of CC and poor disease prognosis.
Sexually selected male weapon increases the risk of population extinction under environmental change: an experimental evidence
Authors: Łukasiewicz Aleksandra , Porwal Neelam , Niśkiewicz Małgorzata , Parrett Jonathan M , Radwan Jacek
Published: July 2023

Exaggerated sexually selected traits (SSTs), occurring more commonly in males, help individuals to increase reproductive success but are costly to produce and maintain. These costs on the one hand may improve population fitness by intensifying selection against maladapted males, but on the other hand, may increase the risk of extinction under environmental challenges. However, the impact of SSTs on extinction risk has not been investigated experimentally. We used replicate populations of a male-dimorphic mite, Rhizoglyphus robini, to test if the prevalence of a sexually selected weapon affected the risk of extinction under temperature increase (TI) (2°C per each of three consecutive generations). In two independent experiments that utilized either inbred lines or lines mass selected for or against the weapon to establish experimental replicate populations differing in the prevalence of the weapon, we found that populations with high weapon prevalence were more likely to go extinct. Extinctions occurred despite partial suppression of the weapon expression at increased temperature and were not explained by increased male mortality. Our results provide the first, to our knowledge, experimental evidence demonstrating the dramatic effect of elaborated sexual traits on the risk of extinction under environmental challenges.
Chromosomal-level reference genome of a wild North American mallard (Anas platyrhynchos)
Authors: Lavretsky Philip , Hernández Flor , Swale Thomas , Mohl Jonathon E
Published: July 2023

The mallard (Anas platyrhynchos) is one of the most common, economically, and socially important birds around the world. Mallards were not only an important food source for early humans but eventually becoming intimately linked with people as they were domesticated over the last 2,000 years. To date, mallard genomes are largely reconstructed from samples of domestic or unknown genetic heritage. Here, we report the first high-quality genome assembly and annotation of a genetically vetted wild mallard from North America (NAwild_v1.0). The genome was assembled using a combination of shotgun libraries, proximity ligation Chicago, and Dovetail Hi-C libraries. The final assembly is ∼1.04 Gb in size, with 98.3% of the sequence located in 30 full or nearly full chromosome-level scaffolds, and with a N50/L50 of 79.1 Mb/4 scaffolds. We used a combination of gene prediction and similarity approaches to annotate a total of 23,584 functional genes, of which 19,242 were associated to GO terms. The genome assembly and the set of annotated genes yielded a 95.4% completeness score when compared with the BUSCO aves_odb10 dataset. Next, we aligned 3 previously published mallard genomes to ours, and demonstrate how runs of homozygosity and nucleotide diversity are substantially higher and lower, respectively, to ours and how these artificially changed genomes resulted in profoundly different and biased demographic histories. Our wild mallard assembly not only provides a valuable resource to shed light onto genome evolution, speciation, and other adaptive processes, but also helping with identifying functional genes that have been significantly altered during the domestication process.
Genomic Analysis of Plastid–Nuclear Interactions and Differential Evolution Rates in Coevolved Genes across Juglandaceae Species
Authors: Yang Yang , Forsythe Evan S , Ding Ya-Mei , Zhang Da-Yong , Bai Wei-Ning
Published: July 2023

The interaction between the nuclear and chloroplast genomes in plants is crucial for preserving essential cellular functions in the face of varying rates of mutation, levels of selection, and modes of transmission. Despite this, identifying nuclear genes that coevolve with chloroplast genomes at a genome-wide level has remained a challenge. In this study, we conducted an evolutionary rate covariation analysis to identify candidate nuclear genes coevolving with chloroplast genomes in Juglandaceae. Our analysis was based on 4,894 orthologous nuclear genes and 76 genes across seven chloroplast partitions in nine Juglandaceae species. Our results indicated that 1,369 (27.97%) of the nuclear genes demonstrated signatures of coevolution, with the Ycf1/2 partition yielding the largest number of hits (765) and the ClpP1 partition yielding the fewest (13). These hits were found to be significantly enriched in biological processes related to leaf development, photoperiodism, and response to abiotic stress. Among the seven partitions, AccD, ClpP1, MatK, and RNA polymerase partitions and their respective hits exhibited a narrow range, characterized by dN/dS values below 1. In contrast, the Ribosomal, Photosynthesis, Ycf1/2 partitions and their corresponding hits, displayed a broader range of dN/dS values, with certain values exceeding 1. Our findings highlight the differences in the number of candidate nuclear genes coevolving with the seven chloroplast partitions in Juglandaceae species and the correlation between the evolution rates of these genes and their corresponding chloroplast partitions.
The Yin and Yang of Self-Regulation in Developing Vertebrates. An Energetics Perspective
Authors: Hunt von Herbing Ione
Published: July 2023

Synopsis

All living organisms are thermodynamic open systems constantly exchanging energy with the environment to maintain organization and structure. In a state of nonequilibrium they undergo a back-and-forth pattern of self-regulation and dysregulation in energy exchange. This state of dynamic nonequilibrium can be observed during vertebrate development in which high phenotypic variation and plasticity exists, especially in the presence of stressors. While investigations of the effects of stressors on mechanisms of self-regulation are usually measured by systemic changes (e.g. metabolic rate) between baseline (control) and stimulus (or stressor), real-world stressors do not switch on and off in predictable patterns, rarely occur alone, and can be acute (short-term) or chronic (long-term). In this short review, application of two processes underlying self-regulation and dysregulation are explored, (1) allostasis, stability through change or the processes underlying self-regulation and, (2) metastasis, instability through change or the processes underlying dysregulation, to understand the effects of environmental stressors on the energetics of fish early life history stages (embryos and larvae). In mammalian physiology, allostasis theory was developed to maximize the probability of survival under stress, while reducing or limiting somatic damage. Yet, allostatic responses have energetic costs. Multiple stress responses over time result in systemic somatic damage accompanied by a loss of resilience due to an inability to self-regulate. Allostatic costs and their systemic effects on neuroendocrine, metabolic, cardiovascular, and immune systems are cumulative and understood for adults but not yet for earlier stages. Developing stages with greater challenges for allostatic self-regulation than older stages because of limited resources have higher growth rates, smaller aerobic scopes, elevated metabolic costs, tight energy budgets, and employ compensatory versus additive energy budgets. Along with high mortality, early stages are expected to exhibit decreased physiological resilience and increased vulnerability in response to stressors, but little examination of energetic strategies to preserve functional stability in the face of stressors exists. While dysregulation/metastatic processes are more difficult to document in development, they increase our understanding of how organisms exposed to chronic/multiple stressors may reach allostatic overload leading to either, (1) systemic dysfunction and/or death or possibly, (2) novel physiological adaptive states. Evaluation of factors driving the yin and yang of self-regulation and dysregulation will provide knowledge of factors triggering or retarding metastatic processes, thus identifying those that prevent or reduce their affects, important in a world undergoing rapid global change.
Large Deviation Estimates of Selberg’s Central Limit Theorem and Applications
Authors: Arguin Louis-Pierre , Bailey Emma
Published: July 2023

For $V\sim \alpha \log \log T$ with $0<\alpha <2$, we prove $$\begin{align*} & \frac{1}{T}\textrm{meas}\{t\in [T,2T]: \log|\zeta(1/2+ \textrm{i} t)|>V\}\ll \frac{1}{\sqrt{\log\log T}} e^{-V^{2}/\log\log T}. \end{align*}$$This improves prior results of Soundararajan and of Harper on the large deviations of Selberg’s Central Limit Theorem in that range, without the use of the Riemann hypothesis. The result implies the sharp upper bound for the fractional moments of the Riemann zeta function proved by Heap, Radziwiłł, and Soundararajan. It also shows a new upper bound for the maximum of the zeta function on short intervals of length $(\log T)^{\theta }$, $0<\theta <3$, that is expected to be sharp for $\theta> 0$. Finally, it yields a sharp upper bound (to order one) for the moments on short intervals, below and above the freezing transition. The proof is an adaptation of the recursive scheme introduced by Bourgade, Radziwiłł, and one of the authors to prove fine asymptotics for the maximum on intervals of length $1$.