bluuebunny/crossref_metadata_2025 huggingface dataset:
Does exercise intensity affect wellness scores in a dose‐like fashion?
Authors: Campbell Patrick G. , Stewart Ian B. , Sirotic Anita C. , Minett Geoffrey M.
Published: January 2020

Wellness questionnaires are common in monitoring systems, yet the sensitivity to variations in acute training intensity is unclear. This study examined the controlled dosage effects of differing exercise intensities on wellness variables and subsequent associations with neuromuscular performance. Participants (n = 10) completed low‐, moderate‐ and high‐intensity conditions of a 90 min simulated football match shuttle running protocol scaled relative to beep test scores. The protocols were completed in a randomised and counterbalanced fashion matched for time of day. Wellness (sleep quality, readiness to train, soreness, fatigue, stress, mood, motivation) and neuromuscular performance (maximal voluntary contraction, countermovement jump, 6 s cycle‐ergometer sprint) were assessed pre‐, post‐ and 24 h post‐exercise. Heart rate (HR) and rating of perceived exertion (RPE) were recorded during, and session RPE (sRPE) after exercise. Generalised linear mixed models demonstrated main effects between conditions with increased HR, RPE and sRPE (P < 0.03; d > 0.8) responses from the low‐high condition. Total and z‐score wellness showed no significant differences between trials at any time‐point (P > 0.05; d = 0.03–0.91). Fatigue was lower 24 h post‐exercise for the low, compared to moderate and high conditions (P = 0.006–0.047; d = 1.20–1.77). Ratings of fatigue and soreness increased from pre‐ to 24 h post‐trial (P < 0.003; d = 0.96–2.48), while total wellness and readiness to train decreased over time (P < 0.04; d = 0.91–1.86). Wellness showed limited capacity to differentiate training intensities. Practitioners should be aware while wellness may be highly practical, it may be limited to solely determine athlete accommodation of load considering the strength of association observed with the applied load.
Sound matters: The impact of auditory deprivation on movement precision in rowing
Authors: Schaffert Nina , Oldag Benedict , Cesari Paola
Published: January 2020

Purpose of the study was to quantify the importance of auditory feedback for movement precision in elevated rowing task difficulty with elite athletes under normal and masked hearing conditions. It was hypothesized that rowing with masked hearing would reduce the precision of movement, particularly at the non‐usual/less‐preferred stroke frequencies (SF). Self‐reported questionnaires helped to understand the difficulty of the task. Twenty rowers completed 2 × 1000 m‐distance‐blocks, each separated into 4 × 250 m, with increasing SF 18, 20, 22 24 strokes/minute once with normal and once with masked hearing. Precision was determined as the deviation between the SF target and the SF actually performed (DSF). Athletes’ subjective perception was requested before and after the experiment. A 2 (hearing condition) × 4 (SF 18, 20, 22, 24) repeated measures ANOVA showed systematically larger DSF during masked hearing for all SFs compared to the DSF in the normal hearing condition (p < .01). Further, the highest DSFs were found for SF 18 and 24 in both hearing conditions (no interaction effect). The athletes’ perception of the relevance of natural movement sounds for their rowing performance changed when evaluated before and after the experiment. Rowing without hearing was evaluated as mentally more demanding than physically. The results confirmed our initial assumptions and showed the relevance of natural auditory information for movement precision in rowing practice, even at a high level of expertise.
Picturing Charlotte Brontë’s Artistic Rebellion? Myths of the Woman Artist in Postfeminist Jane Eyre Screen Adaptations
Authors: Han Catherine Paula
Published: January 2020

Charlotte Brontë’s Jane Eyre: An Autobiography (1847) has been regularly adapted for the screen since the silent era. During the 1990s, a trend emerged in which cinematic and television versions of Brontë’s novel paid increased attention to the protagonists’ identities as amateur artists. To explain this phenomenon, this article examines Jane Eyre (Franco Zeffirelli, 1996), Jane Eyre (ITV/A&E, 1997), Jane Eyre (BBC, 2006), and Jane Eyre (Cary Fukunaga, 2011). It proposes that these productions contribute to the evolution of Brontë’s authorial mythology by heightening their heroines’ similarities with the writer, another amateur artist. In so doing, these adaptations benefit from the reputations of Brontë and her work as rebelliously feminist. Nevertheless, these women artists’ rebellions are distinctly postfeminist. To demonstrate its argument, the article contextualizes contemporary Jane Eyre adaptations within their postfeminist cultural landscape. Postfeminism, however, is a contested term. Hence, this analysis participates in broader debates that interrogate postfeminism as a concept and its persistent fascination with nineteenth-century creative women. Through comparisons of the adaptations, this article will delineate the development of the woman artist trope to reveal how postfeminist conceptualizations of women’s creativity have shifted since the 1990s. In particular, the woman artist displays an increased desire to ‘return home’. Such retreatist narratives exploit but also obscure the fact that Brontë has long signified the perceived tension between traditional, highly domestic female gender roles and women’s creativity. As such, these postfeminist adaptations have a shaping effect on the myths that continue to circulate about Brontë’s feminism and authorship.
Designing a Study of Correlates of Risk for Ebola Vaccination
Authors: Halloran M Elizabeth , Longini Ira M , Gilbert Peter B
Published: January 2020

The recombinant vesicular stomatitis virus (rVSV) Ebola vaccine was shown to be very efficacious in a novel ring vaccination trial in Guinea. However, no correlates of vaccine protection have been established for Ebola vaccines. Several Ebola vaccine candidates are available, but conducting randomized trials of additional candidates in outbreaks is difficult. Establishing correlates of vaccine protection is essential. Here we explore power and sample-size calculations to evaluate potential correlates of risk during an Ebola vaccination campaign in an outbreak. The method requires that a blood draw be made at a predetermined time after vaccination. The statistical analysis estimates the relative risk of the Ebola endpoint occurring from after the blood draw through to the end of follow-up, contrasting vaccine recipients with different values of the immune response marker. The analysis can be done assuming a trichotomous or continuous marker. Under certain assumptions, at an overall vaccine efficacy of 75%, 50 Ebola endpoints in the vaccinees provided good power. At an overall vaccine efficacy of 90%, 20 Ebola endpoints gave good power. Power was highest when more vaccinees were in the high- and low-responder groups versus the middle group and when vaccine efficacy differed the most between the high- and low-responder groups.
Migraine and Arterial Stiffness in the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil
Authors: Apelbaum Patricia Noemi , Goulart Alessandra Carvalho , Santos Itamar de Souza , Lotufo Paulo Andrade , Baena Cristina Pellegrino , Benseñor Isabela Judith Martins
Published: January 2020

Background

The mechanisms that underlie the link between migraine and cardiovascular diseases are not clear and arterial stiffness could play a role in that association. We analyzed the association between migraine and vascular stiffness measured by carotid-to-femoral pulse wave velocity (PWV-cf).

Methods

In a cross-sectional analysis of a well-defined population from the Longitudinal Study of Adult Health (ELSA-Brasil) with complete and validated information about migraine and aura according to the International Headache Society criteria, the association between arterial stiffness measured by PWV-cf was tested with multiple linear regression models [β (95% CI)] comparing migraine without aura (MO) and migraine with aura (MA) to the reference group no-migraine (NM). Subsequent adjustments were made for mean arterial pressure, age, sex, education level, physical activity, alcohol use, diabetes mellitus, smoking, antihypertensive medication, body mass index, waist circumference, triglycerides, and LDL-c level to test the independence of the association between migraine status and pulse wave velocity.

Results

We studied 4,649 participants, 2,521 women (25.7% MO and 15% MA) and 2,128 men (11% MO and 4.3% MA). In NM, MO, and MA standard PWV-cf were 8.67 (±1.71) 8.11 (±1.31) and 8.01 (±1.47) m/s, respectively. Unadjusted PWV-cf differed between NM, MA, and MO (P < 0.001). After adjustment for mean arterial pressure PWV-cf in NM did not differ anymore from MA (P = 0.525) and MO (P = 0.121), respectively. Fully adjusted models also yielded nonsignificant coefficients β (95% CI) −0.079 (−0.280; 0.122) and −0.162 (−0.391; 0.067) for MO and MA, respectively.

Conclusion

In this large cohort of middle-aged adults, aortic PWV was not associated with migraine.
A systematic overview of systematic reviews evaluating medication adherence interventions
Authors: Anderson Laura J , Nuckols Teryl K , Coles Courtney , Le Michael M , Schnipper Jeff L , Shane Rita , Jackevicius Cynthia , Lee Joshua , Pevnick Joshua M ,   Members of the PHARM-DC Group, Choudhry Niteesh K , O’Mahony Denis , Sarkisian Catherine
Published: January 2020

Purpose

To systematically summarize evidence from multiple systematic reviews (SRs) examining interventions addressing medication nonadherence and to discern differences in effectiveness by intervention, patient, and study characteristics.

MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for papers published from January 2004 to February 2017. English-language SRs examining benefits of medication adherence interventions were eligible. Inclusion was limited to adult patients prescribed medication for 1 of the following disease conditions: diabetes and prediabetes, heart conditions, hypertension and prehypertension, stroke, and cognitive impairment. Non–disease-specific SRs that considered medication adherence interventions for older adults, adults with chronic illness, and adults with known medication adherence problems were also included. Two researchers independently screened titles, abstracts, and full-text articles. They then extracted key variables from eligible SRs, reconciling discrepancies via discussion. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess SRs; those with scores below 8 were excluded. Conclusions regarding intervention effectiveness were extracted. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality.

Results

Of 390 SRs, 25 met the inclusion criteria and assessed adherence as a primary outcome. Intervention types most consistently found to be effective were dose simplification, patient education, electronic reminders to patients, and reduced patient cost sharing or incentives. Of 50 conclusions drawn by the SRs, the underlying evidence was low or very low quality for 45 SRs.

Conclusion

Despite an abundance of primary studies and despite only examining high-quality SRs, the vast majority of primary studies supporting SR authors’ conclusions were of low or very low quality. Nonetheless, health system leaders seeking to improve medication adherence should prioritize interventions that have been studied and found to be effective at improving patient adherence, including dose simplification, education, reminders, and financial incentives.
Implementation of a medication education training program for student pharmacists employed within an academic medical center
Authors: Dunkley Kisha A , Evelyn Doneisha , Timmons Veronica , Feller Tara T
Published: January 2020

Purpose

To describe the implementation of a student pharmacist medication education training program (the REWARDS Method), to determine if training was effective in preparing employed student pharmacists to provide medication education, and to assess medication education completion rates.

Hospital readmissions are often attributable to poor transitions of care (TOC), and medication education prior to discharge may improve TOC. To expand upon existing medication education efforts, the Johns Hopkins Hospital Adult Inpatient Pharmacy (AIP) designed and implemented the REWARDS Method, a training program to prepare employed second- and third-year student pharmacists to provide medication education. The REWARDS Method includes 6 distinct steps, which incorporate student self-directed and pharmacist-facilitated learning. Students were trained to provide patient education targeting 4 classes of high-risk medications (anticoagulants, inhalers, insulin, and naloxone) on multiple inpatient units served by the AIP. A total of 43 hours of pharmacist time was needed to complete training for the 10 employed student pharmacists. A survey was used to assess preparedness for completing medication education. Survey responses indicated that participants were sufficiently to exceedingly prepared to perform medication education. The division’s completion rate for patients requiring education was 79% in 2017, compared to 86% in 2018 (p = 0.006).

Conclusion

The REWARDS Method is an effective training program that successfully incorporated employed student pharmacists into medication education efforts. Our study demonstrated high rates of students successfully completing training and an increase in the rate of patient education completion.
A species-discriminatory single-nucleotide polymorphism set reveals maintenance of species integrity in hybridizing European white oaks (Quercus spp.) despite high levels of admixture
Authors: Reutimann Oliver , Gugerli Felix , Rellstab Christian
Published: January 2020

Background and Aims

Hybridization and introgression play an important role in the evolution and diversification of plants. To assess the degree of past and current hybridization, the level of genetic admixture in populations needs to be investigated. Ongoing hybridization and blurred species separation have made it challenging to assign European white oak taxa based on leaf morphology and/or genetic markers and to assess the level of admixture. Therefore, there is a need for powerful markers that differentiate between taxa. Here, we established a condensed set of single-nucleotide polymorphism (SNP) markers to reliably differentiate between the three most common oak species in temperate European forests (Quercus robur, Q. petraea, Q. pubescens) and to assess the degree of admixture in a large set of selected Swiss populations.

Methods

A training set of 194 presumably pure reference samples from Switzerland and Europe was used to assign 633 test individuals with two different approaches (population genetic-based/Bayesian vs. assumption-free/discriminative classifier) using 58 selected SNPs from coding regions. Admixture was calculated at the individual and population level with the Shannon diversity index based on individual assignment probabilities.

Key Results

Depending on the approach, 97.5–100 % of training individuals were assigned correctly, and additional analyses showed that the established SNP set could be further reduced while maintaining its discriminatory power. The two assignment approaches showed high overlap (99 %) in assigning training individuals and slightly less overlap in test individuals (84 %). Levels of admixture varied widely among populations. Mixed stands of Q. petraea and Q. pubescens revealed much higher degrees of admixture than mixed stands of the other two taxon pairs, accentuating high levels of gene flow between these two taxa in Switzerland.

Conclusions

Our set of SNPs warrants reliable taxon discrimination with great potential for further applications. We show that the three European white oak taxa have largely retained their species integrity in Switzerland despite high levels of admixture.
A Randomized Controlled Trial of Three Noninvasive Analgesic Techniques for the Prevention of Pain During Facial Injections
Authors: Salmerón-González Enrique , García-Vilariño Elena , Sánchez-García Alberto , Pérez-García Alberto , Ruiz-Cases Alberto , Valverde-Navarro Alfonso
Published: January 2020

Background

Injections are associated with a certain amount of pain, the tolerance of which can vary between individuals. With regard to noninvasive pain control techniques in subcutaneous injections, few studies with adequate levels of evidence and design quality exist to support any specific analgesic method.

Objectives

In this study, we evaluated the efficacy of 3 noninvasive analgesic techniques (cold, anesthetic cream, and vibration) during subcutaneous forehead injections in 100 healthy volunteers.

Methods

This randomized, single-blind, controlled trial comprised 100 healthy volunteers. Every patient received 4 forehead injections of 0.1 mL physiological saline through 29G needles after 1 of 3 noninvasive analgesic techniques (cold, vibration, or anesthetic cream) or control treatment was applied to each injection site. The results were evaluated through a survey that included a visual analog scale for pain measurements.

Results

All analgesic methods demonstrated better pain control than the no-treatment arm (P < 0.001), of which vibration performed better than the other analgesic techniques (P < 0.015 vs cold and P < 0.015 vs anesthetic cream). No differences were observed between cold and anesthetic cream. The average amount of pain per injection in males was higher than in females (P < 0.014).

Conclusions

Vibration analgesia effected significantly better pain control than cold and anesthetic cream. Nevertheless, the choice of anesthetic method should be adapted to the preferences and experiences of each patient to optimize pain control in procedures that involve subcutaneous injections.

Level of Evidence: 2
Myosin VI maintains the actin-dependent organization of the tubulobulbar complexes required for endocytosis during mouse spermiogenesis†‡
Authors: Zakrzewski Przemysław , Suwińska Anna , Lenartowski Robert , Rędowicz Maria Jolanta , Buss Folma , Lenartowska Marta
Published: January 2020

Myosin VI (MYO6) is an actin-based motor that has been implicated in a wide range of cellular processes, including endocytosis and the regulation of actin dynamics. MYO6 is crucial for actin/membrane remodeling during the final step of Drosophila spermatogenesis, and MYO6-deficient males are sterile. This protein also localizes to actin-rich structures involved in mouse spermiogenesis. Although loss of MYO6 in Snell’s waltzer knock-out (KO) mice causes several defects and shows reduced male fertility, no studies have been published to address the role of MYO6 in sperm development in mouse. Here we demonstrate that MYO6 and some of its binding partners are present at highly specialized actin-based structures, the apical tubulobulbar complexes (TBCs), which mediate endocytosis of the intercellular junctions at the Sertoli cell-spermatid interface, an essential process for sperm release. Using electron and light microscopy and biochemical approaches, we show that MYO6, GIPC1 and TOM1/L2 form a complex in testis and localize predominantly to an early endocytic APPL1-positive compartment of the TBCs that is distinct from EEA1-positive early endosomes. These proteins also associate with the TBC actin-free bulbular region. Finally, our studies using testis from Snell’s waltzer males show that loss of MYO6 causes disruption of the actin cytoskeleton and disorganization of the TBCs and leads to defects in the distribution of the MYO6-positive early APPL1-endosomes. Taken together, we report here for the first time that lack of MYO6 in mouse testis reduces male fertility and disrupts spatial organization of the TBC-related endocytic compartment during the late phase of spermiogenesis.
Uterine epithelial expression of the tumor necrosis factor superfamily: a strategy for immune privilege during pregnancy in a true epitheliochorial placentation species
Authors: Yoo Inkyu , Kye Yoon Chul , Han Jisoo , Kim Minjeong , Lee Soohyung , Jung Wonchul , Hong Minsun , Park Tae Sub , Yun Cheol-Heui , Ka Hakhyun
Published: January 2020

The maternal immune system tolerates semi-allogeneic placental tissues during pregnancy. Fas ligand (FASLG) and tumor necrosis factor superfamily 10 (TNFSF10) are known to be components of maternal immune tolerance in humans and mice. However, the role of FASLG and TNFSF10 in the tolerance process has not been studied in pigs, which form a true epitheliochorial type placenta. Thus, the present study examined the expression and function of FASLG and TNFSF10 and their receptors at the maternal-conceptus interface in pigs. The endometrium and conceptus tissues expressed FASLG and TNFSF10 and their receptor mRNAs during pregnancy in a stage-specific manner. During pregnancy, FASLG and TNFSF10 proteins were localized predominantly to endometrial luminal epithelial cells with strong signals on Day 30 to term and on Day 15, respectively, and receptors for TNFSF10 were localized to some stromal cells. Interferon-γ (IFNG) increased the expression of TNFSF10 and FAS in endometrial tissues. Co-culture of porcine endometrial epithelial cells over-expressing TNFSF10 with peripheral blood mononuclear cells yielded increased apoptotic cell death of lymphocytes and myeloid cells. In addition, many apoptotic T cells were found in the endometrium on Day 15 of pregnancy. The present study demonstrated that FASLG and TNFSF10 were expressed at the maternal-conceptus interface and conceptus-derived IFNG increased endometrial epithelial TNFSF10, which, in turn, induced apoptotic cell death of immune cells. These results suggest that endometrial epithelial FASLG and TNFSF10 may be critical for the formation of micro-environmental immune privilege at the maternal-conceptus interface for the establishment and maintenance of pregnancy in pigs.
Baseline reward processing and ventrostriatal dopamine function are associated with pramipexole response in depression
Authors: Whitton Alexis E , Reinen Jenna M , Slifstein Mark , Ang Yuen-Siang , McGrath Patrick J , Iosifescu Dan V , Abi-Dargham Anissa , Pizzagalli Diego A , Schneier Franklin R
Published: January 2020

The efficacy of dopamine agonists in treating major depressive disorder has been hypothesized to stem from effects on ventrostriatal dopamine and reward function. However, an important question is whether dopamine agonists are most beneficial for patients with reward-based deficits. This study evaluated whether measures of reward processing and ventrostriatal dopamine function predicted response to the dopamine agonist, pramipexole (ClinicalTrials.gov Identifier: NCT02033369). Individuals with major depressive disorder (n = 26) and healthy controls (n = 26) (mean ± SD age = 26.5 ± 5.9; 50% female) first underwent assessments of reward learning behaviour and ventrostriatal prediction error signalling (measured using functional MRI). 11C-(+)-PHNO PET before and after oral amphetamine was used to assess ventrostriatal dopamine release. The depressed group then received open-label pramipexole treatment for 6 weeks (0.5 mg/day titrated to a maximum daily dose of 2.5 mg). Symptoms were assessed weekly, and reward learning was reassessed post-treatment. At baseline, relative to controls, the depressed group showed lower reward learning (P = 0.02), a trend towards blunted reward-related prediction error signals (P = 0.07), and a trend towards increased amphetamine-induced dopamine release (P = 0.07). Despite symptom improvements following pramipexole (Cohen’s d ranging from 0.51 to 2.16 across symptom subscales), reward learning did not change after treatment. At a group level, baseline reward learning (P = 0.001) and prediction error signalling (P = 0.004) were both associated with symptom improvement, albeit in a direction opposite to initial predictions: patients with stronger pretreatment reward learning and reward-related prediction error signalling improved most. Baseline D2/3 receptor availability (P = 0.02) and dopamine release (P = 0.05) also predicted improvements in clinical functioning, with lower D2/3 receptor availability and lower dopamine release predicting greater improvements. Although these findings await replication, they suggest that measures of reward-related mesolimbic dopamine function may hold promise for identifying depressed individuals likely to respond favourably to dopaminergic pharmacotherapy.
Non-Parametric Combined Reference Regions and Prediction of Clinical Risk
Authors: Malka Roy , Brugnara Carlo , Cialic Ron , Higgins John M
Published: January 2020

Background

Many clinical decisions depend on estimating patient risk of clinical outcomes by interpreting test results relative to reference intervals, but standard application of reference intervals suffers from two major limitations that reduce the accuracy of clinical decisions: (1) each test result is assessed separately relative to a univariate reference interval, ignoring the rich pathophysiologic information in multivariate relationships, and (2) reference intervals are intended to reflect a population’s biological characteristics and are not calibrated for outcome prediction.

Methods

We developed a combined reference region (CRR), derived CRRs for some pairs of complete blood count (CBC) indices (RBC, MCH, RDW, WBC, PLT), and assessed whether the CRR could enhance the univariate reference interval’s prediction of a general clinical outcome, 5-year mortality risk (MR).

Results

The CRR significantly improved MR estimation for 21/21 patient subsets defined by current univariate reference intervals. The CRR identified individuals with >2-fold increase in MR in many cases and uniformly improved the accuracy for all five pairs of tests considered. Overall, the 95% CRR identified individuals with a >7× increase in 5-year MR.

Conclusions

The CRR enhances the accuracy of the prediction of 5-year MR relative to current univariate reference intervals. The CRR generalizes to higher numbers of tests or biomarkers, as well as to clinical outcomes more specific than MR, and may provide a general way to use existing data to enhance the accuracy and precision of clinical decisions.
Mass Spectrometry for Identification, Monitoring, and Minimal Residual Disease Detection of M-Proteins
Authors: Zajec M , Langerhorst P , VanDuijn M M , Gloerich J , Russcher H , van Gool A J , Luider T M , Joosten I , de Rijke Y B , Jacobs J F M
Published: January 2020

Background

Monoclonal gammopathies (MGs) are plasma cell disorders defined by the clonal expansion of plasma cells, resulting in the characteristic excretion of a monoclonal immunoglobulin (M-protein). M-protein detection and quantification are integral parts of the diagnosis and monitoring of MGs. Novel treatment modalities impose new challenges on the traditional electrophoretic and immunochemical methods that are routinely used for M-protein diagnostics, such as interferences from therapeutic monoclonal antibodies and the need for increased analytical sensitivity to measure minimal residual disease.

Content

Mass spectrometry (MS) is ideally suited to accurate mass measurements or targeted measurement of unique clonotypic peptide fragments. Based on these features, MS-based methods allow for the analytically sensitive measurement of the patient-specific M-protein.

This review provides a comprehensive overview of the MS methods that have been developed recently to detect, characterize, and quantify M-proteins. The advantages and disadvantages of using these techniques in clinical practice and the impact they will have on the management of patients with MGs are discussed.
A machine learning cardiac magnetic resonance approach to extract disease features and automate pulmonary arterial hypertension diagnosis
Authors: Swift Andrew J , Lu Haiping , Uthoff Johanna , Garg Pankaj , Cogliano Marcella , Taylor Jonathan , Metherall Peter , Zhou Shuo , Johns Christopher S , Alabed Samer , Condliffe Robin A , Lawrie Allan , Wild Jim M , Kiely David G
Published: January 2020

Aims

Pulmonary arterial hypertension (PAH) is a progressive condition with high mortality. Quantitative cardiovascular magnetic resonance (CMR) imaging metrics in PAH target individual cardiac structures and have diagnostic and prognostic utility but are challenging to acquire. The primary aim of this study was to develop and test a tensor-based machine learning approach to holistically identify diagnostic features in PAH using CMR, and secondarily, visualize and interpret key discriminative features associated with PAH.

Methods and results

Consecutive treatment naive patients with PAH or no evidence of pulmonary hypertension (PH), undergoing CMR and right heart catheterization within 48 h, were identified from the ASPIRE registry. A tensor-based machine learning approach, multilinear subspace learning, was developed and the diagnostic accuracy of this approach was compared with standard CMR measurements. Two hundred and twenty patients were identified: 150 with PAH and 70 with no PH. The diagnostic accuracy of the approach was high as assessed by area under the curve at receiver operating characteristic analysis (P < 0.001): 0.92 for PAH, slightly higher than standard CMR metrics. Moreover, establishing the diagnosis using the approach was less time-consuming, being achieved within 10 s. Learnt features were visualized in feature maps with correspondence to cardiac phases, confirming known and also identifying potentially new diagnostic features in PAH.

Conclusion

A tensor-based machine learning approach has been developed and applied to CMR. High diagnostic accuracy has been shown for PAH diagnosis and new learnt features were visualized with diagnostic potential.
Clinical feasibility and safety of transoesophageal motor-evoked potential monitoring
Authors: Shiiya Norihiko , Tsuda Kazumasa , Yamanaka Ken , Takahashi Daisuke , Washiyama Naoki , Yamashita Katsushi , Kando Yumi , Ohashi Yuko
Published: January 2020

OBJECTIVES

Canine experiments have shown that transoesophageal motor-evoked potential monitoring is feasible, safe and stable, with a quicker response to ischaemia and a better prognostic value than transcranial motor-evoked potentials. We aimed to elucidate whether or not these findings were clinically reproducible.

METHODS

A bipolar oesophageal electrode mounted on a large-diameter silicon tube and a train of 5 biphasic wave stimuli were used for transoesophageal stimulation. Results of 18 patients (median age 74.5 years, 13 males) were analysed.

RESULTS

There were no mortalities, spinal cord injuries or complications related with transoesophageal stimulation. Transcranial motor-evoked potential could not be monitored up to the end of surgery in 3 patients for unknown reasons, 2 of whom from the beginning. Transoesophageal motor-evoked potential became non-evocable after manipulation of a transoesophageal echo probe in 2 patients. Strenuous movement of the upper limbs during transoesophageal stimulation was observed in 3 patients. In 14 patients who successfully completed both monitoring methods up to the end of surgery (11 thoraco-abdominal and 3 descending aortic repair), the final results were judged as false positives in 6 by transcranial stimulation and in 1 by transoesophageal stimulation. The stimulation intensity was significantly lower and the upper limb amplitude was significantly higher by transoesophageal stimulation, while the lower limb amplitude was comparable.

CONCLUSIONS

Transoesophageal motor-evoked potential monitoring is clinically feasible and safe with a low false positive rate. A better electrode design is required to avoid its migration by transoesophageal echo manipulation. Further studies may be warranted.

Clinical registration number

UMIN000022320.
Impact of minimally invasive extracorporeal circulation on coagulation—a randomized trial
Authors: Modrau Ivy Susanne , Halle Debbie Richards , Nielsen Per Hostrup , Kimose Hans Henrik , Greisen Jacob Raben , Kremke Michael , Hvas Anne-Mette
Published: January 2020

OBJECTIVES

Minimally invasive extracorporeal circulation (MiECC) is suggested to have favourable impact on blood loss compared to conventional extracorporeal circulation. We aimed to compare the impact of both systems on coagulation.

METHODS

Randomized trial comparing endogenous thrombin-generating potential early after elective coronary surgery employing either MiECC group (n = 30) or conventional extracorporeal circulation group (n = 30). Secondary outcomes were in vivo thrombin generation, bleeding end points and haemodilution, as well as morbidity and mortality up to 30-day follow-up.

RESULTS

Compared to the conventional extracorporeal circulation group, the MiECC group showed (i) a trend towards a higher early postoperative endogenous thrombin-generating potential (P = 0.06), (ii) lower intraoperative levels of thrombin–antithrombin complex and prothrombin fragment 1 + 2 (P < 0.001), (iii) less haemodilution early postoperatively as measured by haematocrit and weight gain, but without correlation to coagulation factors or bleeding end points. Moreover, half as many patients required postoperative blood transfusion in the MiECC group (17% vs 37%, P = 0.14), although postoperative blood loss did not differ between groups (P = 0.84). Thrombin–antithrombin complex levels (rs = 0.36, P = 0.005) and prothrombin fragment 1 + 2 (rs = 0.45, P < 0.001), but not early postoperative endogenous thrombin-generating potential (rs = 0.05, P = 0.72), showed significant correlation to increased transfusion requirements. The MiECC group demonstrated significantly lower levels of creatine kinase-MB, lactate dehydrogenase and free haemoglobin indicating superior myocardial protection, less tissue damage and less haemolysis, respectively. Perioperative morbidity and 30-day mortality did not differ between groups.

CONCLUSIONS

Conventional but not MiECC is associated with significant intraoperative thrombin generation despite full heparinization. No correlation between coagulation factors or bleeding end points with the degree of haemodilution could be ascertained.

ClinicalTrials.gov identifier

NCT03216720.
Diagnostic yield of hypertrophic cardiomyopathy in first-degree relatives of decedents with idiopathic left ventricular hypertrophy
Authors: Finocchiaro Gherardo , Dhutia Harshil , Gray Belinda , Ensam Bode , Papatheodorou Stathis , Miles Chris , Malhotra Aneil , Fanton Zeph , Bulleros Paulo , Homfray Tessa , Witney Adam A , Bunce Nicholas , Anderson Lisa J , Ware James S , Sharma Rajan , Tome Maite , Behr Elijah R , Sheppard Mary N , Papadakis Michael , Sharma Sanjay
Published: January 2020

Aims

Idiopathic left ventricular hypertrophy (LVH) is defined as LVH in the absence of myocyte disarray or secondary causes. It is unclear whether idiopathic LVH represents the phenotypic spectrum of hypertrophic cardiomyopathy (HCM) or whether it is a unique disease entity. We aimed to ascertain the prevalence of HCM in first-degree relatives of decedents from sudden death with idiopathic LVH at autopsy. Decedents also underwent molecular autopsy to identify the presence of pathogenic variants in genes implicated in HCM.

Methods and results 

Families of 46 decedents with idiopathic LVH (125 first-degree relatives) were investigated with electrocardiogram, echocardiogram exercise tolerance test, cardiovascular magnetic resonance imaging, 24-h Holter, and ajmaline provocation test. Next-generation sequencing molecular autopsy was performed in 14 (30%) cases. Decedents with idiopathic LVH were aged 33 ± 14 years and 40 (87%) were male. Fourteen families (30%) comprising 16 individuals were diagnosed with cardiac disease, including Brugada syndrome (n = 8), long QT syndrome (n = 3), cardiomyopathy (n = 2), and Wolff–Parkinson–White syndrome (n = 1). None of the family members were diagnosed with HCM. Molecular autopsy did not identify any pathogenic or likely pathogenic variants in genes encoding sarcomeric proteins. Two decedents had pathogenic variants associated with long QT syndrome, which were confirmed in relatives with the clinical phenotype. One decedent had a pathogenic variant associated with Danon disease in the absence of any histopathological findings of the condition or clinical phenotype in the family.

Conclusion 

Idiopathic LVH appears to be a distinct disease entity from HCM and is associated with fatal arrhythmias in individuals with primary arrhythmia syndromes. Family screening in relatives of decedents with idiopathic LVH should be comprehensive and encompass the broader spectrum of inherited cardiac conditions, including channelopathies.
Energetic and Environmental Constraints on the Community Structure of Benthic Microbial Mats in Lake Fryxell, Antarctica
Authors: Dillon Megan L , Hawes Ian , Jungblut Anne D , Mackey Tyler J , Eisen Jonathan A , Doran Peter T , Sumner Dawn Y
Published: January 2020

Ecological communities are regulated by the flow of energy through environments. Energy flow is typically limited by access to photosynthetically active radiation (PAR) and oxygen concentration (O2). The microbial mats growing on the bottom of Lake Fryxell, Antarctica, have well-defined environmental gradients in PAR and (O2). We analyzed the metagenomes of layers from these microbial mats to test the extent to which access to oxygen and light controls community structure. We found variation in the diversity and relative abundances of Archaea, Bacteria and Eukaryotes across three (O2) and PAR conditions: high (O2) and maximum PAR, variable (O2) with lower maximum PAR, and low (O2) and maximum PAR. We found distinct communities structured by the optimization of energy use on a millimeter-scale across these conditions. In mat layers where (O2) was saturated, PAR structured the community. In contrast, (O2) positively correlated with diversity and affected the distribution of dominant populations across the three habitats, suggesting that meter-scale diversity is structured by energy availability. Microbial communities changed across covarying gradients of PAR and (O2). The comprehensive metagenomic analysis suggests that the benthic microbial communities in Lake Fryxell are structured by energy flow across both meter- and millimeter-scales.
Functional Connectivity of the Supplementary Motor Network Is Associated with Fried’s Modified Frailty Score in Older Adults
Authors: Lammers Florian , Zacharias Norman , Borchers Friedrich , Mörgeli Rudolf , Spies Claudia Doris , Winterer Georg
Published: January 2020

Frailty is a geriatric syndrome defined by coexistence of unintentional weight loss, low physical reserve, or activity and is associated with adverse health events. Neuroimaging studies reported structural white matter changes in frail patients. In the current study, we hypothesized that clinical frailty is associated also with functional changes in motion-related cortical areas, that is, (pre-)supplementary motor areas (SMA, pre-SMA). We expected that observed functional changes are related to motor-cognitive test performance. We studied a clinical sample of 143 cognitively healthy patients ≥65 years presenting for elective surgery, enrolled in the BioCog prospective multicentric cohort study on postoperative cognitive disorders. Participants underwent preoperative resting-state functional magnetic resonance imaging, motor-cognitive testing, and assessment of Fried’s modified frailty criteria. We analyzed functional connectivity associations with frailty and motor-cognitive test performance. Clinically robust patients (N = 60) showed higher connectivity in the SMA network compared to frail (N = 13) and prefrail (N = 70) patients. No changes were found in the pre-SMA network. SMA connectivity correlated with motor speed (Trail-Making-Test A) and manual dexterity (Grooved Pegboard Test). Our results suggest that diminished functional connectivity of the SMA is an early correlate of functional decline in the older adults . The SMA may serve as a potential treatment target in frailty.
Predictors of Unmet Need Among Informal Caregivers
Authors: Campione Joanne R , Zebrak Katarzyna A
Published: January 2020

Objectives

This study investigates the relationship of caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation to a self-reported measure of unmet need among U.S. informal caregivers of older adults living at home with various conditions.

Methods

Response data from 1,558 caregiver participants interviewed by telephone during the December 2016 baseline period of the Outcome Evaluation of the National Family Caregiver Support Program were used. Caregivers who responded “Definitely No” to the question “Are you receiving all the help you need?” were classified as reporting unmet need. Logistic regression was used to find significant factors associated with unmet need among the full sample and among caregivers tiered by three levels of burden.

Results

Unmet need was reported by 22% of the caregivers. In a fully adjusted model, unmet need was predicted by higher levels of caregiving intensity, non-White race of the caregiver, and the caregiver not feeling appreciated by their care recipient. Other predictors associated with unmet need were no use of caregiver educational services, fewer respite hours, not living in a rural area, and caregiver having an education past high school.

Discussion

Caregivers who do not feel appreciated by their care recipient and non-White caregivers should be identified as potential targets for intervention to address unmet need, especially if they are also reporting higher levels of caregiver burden. Understanding the factors associated with self-reported unmet need can assist caregiver support programs in measuring and addressing the needs of informal caregivers to support their continued caregiving.
The Public Health Road Map to Respond to the Growing Dementia Crisis
Authors: Olivari Benjamin S , French Molly E , McGuire Lisa C
Published: January 2020

As the proportion of older adults in the United States is projected to increase dramatically in the coming decades, it is imperative that public health address and maintain the cognitive health of this growing population. More than 5 million Americans live with Alzheimer’s disease and related dementias (ADRD) today, and this number is projected to more than double by 2050. The public health community must be proactive in outlining the response to this growing crisis. Promoting cognitive decline risk reduction, early detection and diagnosis, and increasing the use and availability of timely data are critical components of this response. To prepare state, local, and tribal organizations, CDC and the Alzheimer’s Association have developed a series of Road Maps that chart the public health response to dementia. Since the initial Healthy Brain Initiative (HBI) Road Map release in 2007, the Road Map has undergone two new iterations, with the most recent version, The HBI’s State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map, released in late 2018. Over the past several years, significant advances were made in the science of risk reduction and early detection of ADRD. As a result, the public health response requires a life-course approach that focuses on reducing risk and identifying memory issues earlier to improve health outcomes. The most recent Road Map was revised to accommodate these strides in the science and to effect change at the policy, systems, and environment levels. The 2018–2023 Road Map identifies 25 actions that state and local public health agencies and their partners can implement to promote cognitive health and address cognitive impairment and the needs of caregivers. The actions are categorized into four traditional domains of public health, and the Road Map can help public health and its partners chart a course for a dementia-prepared future.
Earthquake source arrays: optimal configuration and applications in crustal structure studies
Authors: Karamzadeh N , Heimann S , Dahm T , Krüger F
Published: January 2020

A collection of earthquake sources recorded at a single station, under specific conditions, are considered as a source array (SA), that is interpreted as if earthquake sources originate at the station location and are recorded at the source location. Then, array processing methods, that is array beamforming, are applicable to analyse the recorded signals. A possible application is to use source array multiple event techniques to locate and characterize near-source scatterers and structural interfaces. In this work the aim is to facilitate the use of earthquake source arrays by presenting an automatic search algorithm to configure the source array elements. We developed a procedure to search for an optimal source array element distribution given an earthquake catalogue including accurate origin time and hypocentre locations. The objective function of the optimization process can be flexibly defined for each application to ensure the prerequisites (criteria) of making a source array. We formulated four quantitative criteria as subfunctions and used the weighted sum technique to combine them in one single scalar function. The criteria are: (1) to control the accuracy of the slowness vector estimation using the time domain beamforming method, (2) to measure the waveform coherency of the array elements, (3) to select events with lower location error and (4) to select traces with high energy of specific phases, that is, sp- or ps-phases. The proposed procedure is verified using synthetic data as well as real examples for the Vogtland region in Northwest Bohemia. We discussed the possible application of the optimized source arrays to identify the location of scatterers in the velocity model by presenting a synthetic test and an example using real waveforms.
Recreation and collaboration within the Expanded Chronic Care Model: working towards social transformation
Authors: Hutchinson Susan L , Lauckner Heidi
Published: January 2020

Assisting people to live well with a chronic physical or mental health condition requires the creation of intersectoral community-based supports for chronic condition self-management. One important but underutilized resource for supporting chronic condition self-management in the community is recreation, which refers to relatively self-determined and enjoyable physical, social or expressive everyday activities. The Expanded Chronic Care Model (ECCM) provides a framework for identifying systems-level strategies to support self-management through increased access to community recreation opportunities. In this article, an occupation-based social transformation approach, which involves examining assumptions, considering contexts of daily activities and partnering to create meaningful social change, is used to examine the ECCM. Recommendations related to strengthening social change with a specific focus on collaborations and networks through recreation are provided. Through such collaborations, self-management of chronic conditions in community recreation contexts is advanced. Health providers and community-based recreation services providers are invited to be part of these intersectoral changes that will promote health amongst those living with chronic conditions.