bluuebunny/crossref_metadata_2025 huggingface dataset:
P403 MITRAL VALVE PROLAPSE AND RISK OF SUDDEN CARDIAC DEATH IN A PATIENT WITH VENTRICULAR ARRHYTHMIAS: THE PROGNOSTIC ROLE OF CARDIAC MAGNETIC RESONANCE IMAGING
Authors: Mazza T , D’Ambrosi A , Lukic V , Fina P , Trambaiolo P , Romano S , Granatelli A
Published: May 2023

Introduction

in most cases mitral valve prolapse is a benign condition, however in 2% of cases it has been associated with the risk of sudden cardiac death (SCD). Basso et al have demonstrated papillary muscle’s and left ventricle’s inferolateral wall fibrosis on cardiac magnetic resonance imaging (MRI), in patients who died from SCD with mitral valve prolapse.

Clinical case

A 59–year–old patient was admitted to the Cardiology Department of Pertini Hospital (Rome, Italy) for episodes of vertigo and not sustained ventricular tachycardia in two morphologies at 24–hour ECG monitoring. The patient had negative history for cardiovascular risk factors, but an echocardiogram had demonstrated a moderate mitral valve regurgitation, secondary to valve prolapse with mitral annular disjunction (MAD) (Fig.1). Considering patient‘s age associated with low pre–test probability of coronary artery disease, the patient underwent coronary CT that showed a coronary artery tree free from injury. Cardiac MRI showed increased volumes in the left ventricle and slightly reduced systolic function and valve prolapse of both mitral leaflets determining moderate regurgitation. In addition, intra–myocardial Late Gadolinium Enhancement (LGE) showed fibrosis of the inferior and inferolateral wall with extension to the proximal portion of the inferior papillary muscle (Fig.2). Considering such findings, an intracavitary electrophysiological study (EPS) was performed for an evaluation of the arhythmic burden, by administrating the patient a double extra stimulus from the outflow tract of the right ventricle; the treatment induced a polymorphic ventricular tachycardia, starting from the inferior papillary muscle and degenerating into ventricular fibrillation (Fig.3).

Discussion

considering all the above findings, a mitral valve prolapse at high risk of malignant arrhythmias has been diagnosed and a subcutaneous cardiac defibrillator was implanted.

Conclusions

in mitral valve prolapse associated with complex ventricular arrhythmias, evaluation with cardiac MRI increasingly plays a crucial role in prognostic stratification for defibrillator implantation in primary prevention.
P427 IMPACT OF THE WAR IN UKRAINE ON CARDIOLOGY HEALTH CARE: A SINGLE CENTRE EXPERIENCE
Authors: Alonzo A , Castello L , Matteucci A , Di Fusco S , Colivicchi F
Published: May 2023

Background

Since the start of the conflict in Ukraine, a progressive migration flow from war regions to many European countries has been observed, with an unavoidable impact on health care systems of the individual host states. With this work, we aimed to evaluate the trend over time in the demand of cardiological services of Ukrainian patients in our centre.

Methods

We performed a retrospective analysis of the medical records of our Cardiology Department from January 2015 to December 2022. All cardiological services provided to Ukrainian patients, both in outpatient and inpatient setting, were counted. The average number of services performed annually from 2015 to 2021 was then compared with that observed in 2022.

Results

The average number of cardiology services annually provided to Ukrainian patients during 2015–2021 was 18.7 vs 60 in 2022. In 2022, compared to the previous period, the total number of services performed by our heart centre increased by 246% and the number of hospital admissions by 16.7%. In detail, we observed an increase in performed ECGs (+ 1125%), echocardiograms ( + 465%), Holter ECGs (+88%) and electrophysiological studies (+110%). The average age of Ukrainian patients referred to our centre in 2022 is similar to that of previous years (59.9±2.4 vs 59.8±2.3 years). Finally, an increase in the number of male subjects, who needed our cardiological services annually, was observed (74% vs 22.5%).

Conclusions

With the start of the war in Ukraine, compared to the previous six years, we observed an increase in the number of services provided to Ukrainian patients in our centre. These patients were mainly male, both in outpatient and inpatient settings. The NHS will have to cope with this demand, which is bound to increase over time, by promoting and facilitating the access to care for refugee patients not resident in Italy. These preliminary data can be a starting point for a larger multi–centre analysis, which may be helpful to understand the extent of this new challenge.
P428 NURSING AND AF: SIX YEARS EXPERIENCES OF THE DOAC CLINIC
Authors: Pagliani L , Magoga J , Colledan C , Denas G , Antonini–Canterin F , Bertoldo I
Published: May 2023

Oral anticoagulant therapy (OAT) is the treatment of choice in thromboembolic prevention in patients with AF. Starting from the indications of the regional laws that outline the Diagnostic Therapeutic Path, the need arose in our area to create a divisional clinic dedicated to the diagnosis and treatment of AF. The task of the team (Cardiologists, Nurses, GPs, secretariat) was to monitor the number of patients being treated with DOACs through AIFA PTs drawn up; Verify adherence to regional guidelines, analyze adherence to therapy; Prepare a protocol for the management of complications and emergencies; Ensure that the departments and services authorized to prescribe OACs take charge, in close collaboration with GPs who since June 2020 have become active prescribers and also actors in patient follow–up; Taking care of the training of the prescribers themselves and the education of patients through hospital meetings dedicated to guided counseling and, finally, monitoring the pharmaceutical expenditure of the OAC on the total prescriptions of the local health unit of competence in compliance with the regional indicators prepared. In our hospital, the pilot project started in 2017 (7632 patients currently in FU). In the three–year period 2017–19, an average of 700 therapeutic plans were collected for renewal/first prescription per year (58.3 plans/month) to be monitored in subsequent years. In the three–year period 2020–2022, which saw the difficulty of organizing activities due to the pandemic emergency, 903, 945 and 1090 PTs were analyzed respectively with an average of 89 plans/month, maintaining almost 75% of face–to–face visits compared to telemedical contacts set up in the pandemic context. As appears from the data, therefore, there is a strong need for diagnostic and therapeutic assistance pathways to be increasingly organised. Despite the emergency period and despite a framework in which local medicine could have assisted the clinical and bureaucratic effort, no reduction in the care burden has occurred and indeed the constant increase in patients intercepted makes the complexity and difficulty of a correct clinical classification understandable and management support of the patient with the need for OAT.
P450 ADVANCED ATRIOVENTRICULAR BLOCK AT LOOP RECORDER MONITORING IN A YOUNG PATIENT WITH BRUGADA SYNDROME AND CONDUCTION ABNORMALITIES: CAUSE OF SYNCOPE OR INCIDENTAL FINDING?
Authors: Martini N , Prete G , Sottini S , Porcelli G , D‘addazio M , De Lazzari M , Bertaglia E , Migliore F
Published: May 2023

A 32–year–old man healthy man presented to the emergency department because of remittent fever. His past medical history, physical examination and chest X–ray were unremarkable except for a body temperature of 39 Celsius degrees. Laboratory exams showed a marked elevation of transaminases, cholestasis markers and C–reactive protein, while an abdomen ultrasound revealed hepatomegaly and diffuse hyperechogenicity of the liver. He was diagnosed with acute hepatitis and admitted to the Gastroenterology Unit. Due to the persistent hyperpyrexia despite antipyretics and antibiotics, he was successfully treated with intravenous diclofenac, resulting in temporary remission of fever. First electrocardiogram during apyrexia showed sinus rhythm, first–degree atrioventricular block (PR interval 240 milliseconds), and non–specific intraventricular conduction delay. In the following days, liver and cholestasis markers improved, but he underwent two syncopal episodes without prodromes, the former while he was walking and the latter during meal. A new electrocardiogram revealed a type 1 Brugada pattern. At the time of its recording, however, his body temperature was 38.6 Celsius degrees. He was then admitted to the Cardiology Unit for monitoring and further investigations. 2D–echocardiogram and cardiac magnetic resonance imaging were unremarkable. Telemetry monitoring showed nocturnal episodes of marked sinus bradycardia (up to 35 beats per minute), but no ventricular arrhythmias were documented. He also underwent an invasive electrophysiological study with programmed ventricular stimulation, but again no ventricular arrhythmias were induced. Recording of His bundle electrogram, however, revealed the prolongation of both AH and HV interval (190 and 76 milliseconds respectively). Given the syncopal episodes, an implantable cardioverter defibrillator implantation was proposed, but the patient refused, so he underwent an implantable loop recorder implantation. After three months, at remote monitoring, a nocturnal episode of complete atrioventricular block with a pause of 15 seconds was recorded, thus he was again admitted to the Cardiology Unit. This time he was apyretic, but his electrocardiogram showed a spontaneous type 1 Brugada pattern with “high arrhythmic risk” features as first–degree atrioventricular block and a prominent S wave in lead I. He then underwent a successful implantable cardioverter defibrillator implantation with still an uneventful follow up.
P456 SUBACUTE STEMI AND ISCHEMIC STROKE DURING SARS–COV2 INFECTION: A CASE REPORT
Authors: Sias E , Farina G , Fiori M , Polo F
Published: May 2023

A 71–year–old woman arrived in the ER for left hemiparesis and dysarthria. The Patient was oriented, collaborative. Stable hemodynamics. Left hemiparesis. Dysarthria. NIHSS 8, Ranking 2. Blood tests, EGA, swab for SARS–Cov2 were performed (hsTnI 9433 ng, PCR 15.6 mg/dl, Sars–Cov2 positive test). ECG showed evidence of inferolateral ST–segment elevation with Q waves in the inferior site and negative T waves in the inferolateral leads. An episode of chest pain radiating to the left upper limb two days ago was reported. The echocardiography showed non–dilated left ventricle with global systolic function at the lower limits. Inferior, infero–lateral and medio–basal akinesia with hyper–refractive wall and preserved thicknesses were found. Moreover, a slight layer of circumferential pericardial effusion, without any hemodynamic importance was showed. In order to exclude an aortic syndrome, a CT angiography of the brain, neck and chest was performed for recent lesions, with negative result. Angiography showed the left vertebral artery up to the V3 segment, suspected by dissection. Recommendations on performing fibrinolysis in adults, with concurrent ischemic stroke and subacute STEMI, are conflicting: according to ASA/AHA guidelines in recent 3–month infarction, treatment is reasonable if the inferior or right wall is involved. According to ESO guidelines, fibrinolysis is not recommended if the subacute STEMI is seven days old. The Italian guidelines consider the treatment of acute stroke with r–TPA with subsequent PTCA, with possible stent, and recognize a very low risk of consequent hemopericardium. Depending on the timing of the anginal symptoms, the presence of Q waves on the ECG and the echocardiographic alterations, the AMI was considered subacute with no indication for urgent coronary angiography. For the patient of this case report, a conservative attitude for both pathologies was decided, performing an antiplatelet therapy with ASA and continuous ECG monitoring. Despite the treatment, the patient suffered heart failure and exitus after 10 days hospitalization. The lack of unequivocal guidelines on the treatment of patients with simultaneous ischemic stroke and subacute STEMI, require careful evaluation of the individual case, searching for possible predisposing factors of a poor prognosis.
P458 AN UNUSUAL REINDEER–IS LEFT VENTRICULAR MASS
Authors: Galanti K , Genovesi E , Alberto D , Verrengia E , Magnano R , Di Marco M , Paloscia L
Published: May 2023

A 90–year–old woman is brought to the closest emergency room after being found in a confusional state of mind, with lateral–sided sight deviation with normal cardiovascular findings. Her past medical history is characterized by the presence of systemic hypertension, moderate–to–severe chronic disease. The 12–lead electrocardiogram showed sinus rhythm and aspecific anomalies of the left ventricular repolarization. Lab tests showed normal white blood cells count with increased creatinine levels and quite normal flogosis indices. An initial transthoracic echocardiogram (TTE) showed mild left ventricular concentric hypertrophy with preserved systolic function, but also revealed the presence of a moving posterior mitral leaflet mass, determining mild mitral regurgitation. A head CT scan was performed, showing a right temporo–insular ischemic ipodensity. Considering the echocardiographic and neuronal findings, a transesophageal echocardiogram (TEE) was indicated to look for and better describe the suspicious mass, after beginning an antibiotic therapy in an empiric regimen. TEE revelead a multi–lobular mass characterized by inhomogeneous echogenicity, leaning on the annulus and the atrial side of the posterior mitral leaflet that was fissurated, leading to mild mitral regurgitation. The left appendage showed normal emptying velocity and absence of thrombi. It was not easy to describe this mass morphology and dimensions, but in some projections, it reminded us of a reindeer with various antlers. This case could resemble a classic mitral valve endocarditis, evolved into valve fissuration and arterial embolization leading to ischemic stroke, but the unusual fact is that the laboratory tests showed no white blood cells alteration during the whole hospitalization, with a really minimal CRP change and always negative procalcitonin. That is why we came into the idea that such a mass could also not represent a classical endocarditis. Considering that the echocardiographic characteristics of a thrombus were not encountered, the mass may be a tumor. The most frequent tumors involving the heart valves are papillary fibroelastomas. Considering the absence of clinic endocarditis, some hints led to consider this differential diagnosis: fibroelastomas mostly occur during older ages, they frequently have a mitral or aortic location and they can embolize, differently from vegetations, they are located mostly on the annulus and the basal posterior mitral leaflet.
P467 CHALLENGING MANAGEMENT OF ORAL ANTICOAGULANT THERAPY IN A OBESE PATIENT WITH DILATED CARDIOMYOPATHY, ATRIAL FIBRILLATION AND ICD LEAD THROMBUS
Authors: Massa L , Buratti S , Guazzi M , Garattini D
Published: May 2023

Obesity is a worldwide epidemic condition at high risk for AF development; nevertheless, obese patients are underrepresented in RCTs of anticoagulant agents. Robust evidence assessing efficacy of DOACs in these patients is lacking and, to date, major Associations do not recommend DOACs in patients > 120 Kg (BMI>40 Kg/m2). The use of implantable cardiac devices has substantially increased in recent years; among potential complications are sterile intracardiac clots on the leads, typically discovered as incidental echocardiographic findings. 46 ys old male patient, III degree obesity (160 Kg,BMI 51 Kg/m2), ex–smoker. In 2012, acute heart failure and diagnosis of non–ischemic dilated cardiomyopathy (EF 20%). During the follow–up by a tertiary Center, in 2021 he was implanted with single–chamber ICD in primary prevention. At presentation, HFrEF pharmacological therapy was optimal (ARNI,SLGT2i,MRA,B–blocker). He came to the ED complaining of weakness; ECG showed atrial fibrillation, mean ventricular rate 160 bpm. CHA2DS2–VASc was 1. Anticoagulation with subcutaneous enoxaparin 10000UI twice daily was started. He was admitted to the cardiology ward and remained hemodynamically stable, with persistence of AF. Transesophageal echocardiography excluded thrombus in the left atrial appendage; unexpectedly, a filamentous, floating formation of about 30mm on the atrial side of the ICD lead was observed, compatible with a thrombotic formation, since the patient, afebrile, didn’t show any suggestive sign of endocarditis nor past history of infection; blood cultures, CRP and Procalcitonin were negative. In the absence of any shunt at the level of interatrial septum, it was felt safe to proceed to electrical cardioversion, able to restore sinus rhythm with a single 250J biphasic synchronized shock. Oral anticoagulation with warfarin was started, since no DOAC was considered adequate for effective anticoagulation. The following in hospital course and post–discharge weeks were uneventful, despite unstable INR values. Follow–up is ongoing; the patient has not yet repeated imaging to check for mass resolution. Stroke prevention in severely obese patients with AF is challenging and points toward warfarin use, as the evidence of DOACs efficacy is sparse. In our case, anticoagulant choice was also motivated by concomitant presence of a lead thrombus, a scenario in which optimal management and anticoagulation regimen are not clearly established yet.
P469 UP TO 12 MONTH TRENDS IN CLINICAL AND BIOCHEMICAL PARAMETERS AFTER SGLT2I THERAPY IN PATIENTS AFFECTED BY HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION
Authors: Pugliese R , Alcidi G , Ioannoni S , Diomede D , Romano M , Correale M , Benvenuto M , Gronda E , Brunetti N , Iacoviello M
Published: May 2023

Background

The type–2 sodium–glucose cotransporters inhibitors (SGLT2i) are a new relevant therapeutic option for patients affected by chronic heart failure with reduced ejection fraction (HFrEF). The aim of this study was to evaluate the effects of SGLT2i on some clinical and biochemical parameters as well as the persistence of SGLT2i therapy up to 12 months.

Methods

We evaluated the consecutive patients affected by HFrEF in whom the SGLT2i therapy was prescribed since December 2021. The patients were followed–up after 1, 3, 6 and 12 months with a clinical visit, ECG, echocardiography, assessment of sodium, potassium, fasting glucose, hemoglobin, hematocrit and glomerular filtration rate (GFR) by creatinine. The data were analyzed by linear mixed models.

Results

Ninety patients were enrolled (age 60±9 years, 83% males, 20% diabetics, 38% affected by ischemic cardiomyopathy, NYHA class 2.24±0.43, 98% with ACEi/ARB/ARNi, 99% with beta–blockers, 84% with mineralcorticoid receptor antagonists). During the follow–up SGLT2i therapy was well tolerated in most of the patients. Five patients withdrew the therapy, 2 for hypotension, 2 for poor adherence, 1 for genital infection. As shown in the Figure, after SGLT2i therapy a significant reduction in weight and fasting glucose and a slight increase in LVEF were observed. Systolic arterial pressure did not show significant differences. As expected a significant short–term reduction in estimated GFR occurred, associated with a reduction of sodium serum levels. Hemoglobin and hematocrit progressively and significantly increased during follow–up.

Conclusions

In this “real world” study, among patients with HFrEF, the administration of SGLT2i resulted well tolerated in most of the patients. It was associated with the improvement of metabolic parameters (weight and fasting glucose), a slight temporary reduction in GFR, an increase in hemoglobin and systolic function. These data further support the use of this therapeutic approach in routine clinical practice.
P485 CONSERVATIVE MANAGEMENT OF A BIOLOGICAL MITRAL VALVE THROMBOSIS IN A PATIENT WITH RECENT COVID19 INFECTION
Authors: Colarusso L , Paradossi U , Giacomo B , Margaryan R , Solinas M , Marchi F , Pizzino F , Chiappino S , Sorbo S , Benedetti G
Published: May 2023

Prosthetic valve thrombosis is defined as the presence of non–infectious material, within the valve apparatus, that interferes with the normal function of the prosthesis itself. The rate of thrombosis is normally higher in patients with mechanical valves respect to those with a biological valve. It is a potentially fatal complication of valve replacement surgery. Treatment options include: surgery, fibrinolysis, and anticoagulant therapy; those depending on multiple factors: position of the valve, thrombotic burden, surgical risk, clinical presentation and patient‘s wishes. Complications of SARS–CoV2 infections can also extend beyond the respiratory system, triggering sometimes a systemic pro–inflammatory and pro–thrombotic state with potential cardiovascular complications. We present the case of a 74–year–old man with a mitral bioprosthetic valve (Carpentier–Edwards n29) and an aortic bioprosthesis valve (Carpentier–Edwards pericardial n27) taking anticoagulant therapy (Apixaban) for previous episodes of atrial fibrillation. One year after the surgery, the patient was affected by COVID19 infection characterized by fever and asthenia lasting for about 14 days. Subsequently, he experienced exertional dyspnea with a mitral valve thrombosis (25 mm) as echocardiographic finding and with pulmonary hypertension (PAPs 50 mmHg). After a multidisciplinary team discussion, once signs of peripheral embolization had been ruled out and considering NOAC therapy, it was decided to modify the therapy with low–molecular heparin and subsequently with Warfarin (INR 2.5–3.5). Four days later during a follow–up examination, was observed the improvement of dyspnoea and flow parameters and the reduction of thrombus size (21 mm) without any sign of embolic complications. Considering clinical stability in the following period, it was decided to continue with the same therapy. Subsequent checks showed an unchanged echocardiographic examination with same thrombus dimensions. In order to verify echocardiographic findings, a cardiac CT was performed which confirmed the presence of hypodense material compatible with thrombus formation (11 mm by 15 mm) on the mitral prosthesis.
Factors affecting women’s participation in cardiovascular research: a scoping review
Authors: Matthews Stacey , Cook Samantha , Clayton Tim , Murray Sarah , Wynne Rochelle , Sanders Julie
Published: May 2023

Aims

Women are underrepresented in cardiovascular trials. We sought to explore the proportional representation of women in contemporary cardiovascular research and the factors (barriers and enablers) that affect their participation in cardiovascular studies.

Methods and results

Multiple electronic databases were searched between January 2011 and September 2021 to identify papers that defined underrepresentation of women in cardiovascular research and/or reported sex-based differences in participating in cardiovascular research and/or barriers for women to participate in cardiovascular research. Data extraction was undertaken independently by two authors using a standardised data collection form. Results were summarised using descriptive statistics and narrative synthesis as appropriate.

From 548 identified papers, 10 papers were included. Of those, four were conducted prospectively and six were retrospective studies. Five of the retrospective studies involved secondary analysis of trial data including over 780 trials in over 1.1 million participants. Overall, women were reported to be underrepresented in heart failure, coronary disease, myocardial infarction, and arrhythmia trials, compared to men. Barriers to participation included lack of information and understanding of the research, trial-related procedures, the perceived health status of the participant, and patient-specific factors including travel, childcare availability, and cost. A significantly higher likelihood of research participation was reported by women following a patient educational intervention.

Conclusion

This review has highlighted the underrepresentation of women in a range of cardiovascular trials. Several barriers to women’s participation in cardiovascular studies were identified. Researchers could mitigate against these in future trial planning and delivery to increase women’s participation in cardiovascular research.

Registration

The protocol was published on the public Open Science Framework platform on 13th August 2021 (no registration reference provided) and can be accessed at https://osf.io/ny4fd/.
What motivates heart transplantation patients to exercise and engage in physical activity? A network analysis
Authors: Marques-Sule Elena , Hansen Dominique , Almenar Luis , Deka Pallav , Sentandreu-Mañó Trinidad , López-Vilella Raquel , Klompstra Leonie , Machado Felipe V C
Published: May 2023

Aims

After heart transplantation (HTx), increments in physical activity (PA) are strongly recommended. However, participation rates in exercise-based cardiac rehabilitation and engagement in PA are insufficient in many patients. Hence, this study aimed to explore the central factors and the interconnections among distinct types of motivation to exercise, PA, sedentary time, psychosomatic, diet, and activity limitation characteristics in post-HTx patients.

Methods and results

This is a cross-sectional study involving 133 post-HTx patients (79 men, mean age 57 ± 13 years, mean time from transplantation 55 ± 42 months) recruited from an outpatient clinic in Spain. The patients were asked to fill in questionnaires measuring self-reported PA, motivation to exercise, kinesiophobia, musculoskeletal pain, quality of sleep, depression, functional capacity, frailty, sarcopenia risk, and diet quality. Two network structures were estimated: one network including PA and one network including sedentary time as nodes. The relative importance of each node in the network structures was determined using centrality analyses. According to the strength centrality index, functional capacity and identified regulation (subtypes of motivation to exercise) are the two most central nodes of the network (strength: z-score = 1.35–1.51). Strong and direct connections emerged between frailty and PA and between sarcopenia risk and sedentary time.

Conclusion

Functional capacity and autonomous motivation to exercise are the most promising targets of interventions to improve PA levels and sedentary time in post-HTx patients. Furthermore, frailty and sarcopenia risk were found to mediate the effects of several other factors on PA and sedentary time.
Character displacement of egg colors during tinamou speciation
Authors: Li Qin , Chen Dahong , Wang Silu
Published: May 2023

The divergence of reproductive traits frequently underpins the evolution of reproductive isolation. Here we investigated whether tinamou (Tinamidae) egg colorations function as mating signals that diverged as character displacement (mating signal character displacement hypothesis). We tested three evolutionary predictions behind the hypothesis: (a) egg colors coevolve with known mating signals; (b) signal divergence is associated with divergent habitat adaptation; and (c) sympatric tinamou species with similar songs have different egg colors as character displacement during speciation. We found support for all three predictions. In particular, egg colors coevolved with songs; songs and egg colors coevolved with habitat partitioning; and tinamou species that were likely sympatric with similar songs tended to have different egg colors. In conclusion, the mating signal character displacement hypothesis is well supported in which egg colors serve as mating signals that undergo character displacement during tinamou speciation.
Effects of a Family Caregiver-Delivered MultiSensory Cognitive Stimulation Intervention for Older People With Dementia During Coronavirus 2019: A Randomized Controlled Trial
Authors: Kor Patrick Pui Kin , Parial Laurence Lloyd , Yu Clare Tsz Kiu , Liu Justina Yat Wah , Liu Denise Pik Mei , Hon Joan Mo King
Published: May 2023

Background and Objectives

Many community dementia services such as home-visiting services and center-based activities were suspended during the coronavirus 2019 pandemic. This study investigated the efficacy of a caregiver-delivered cognitive stimulation therapy (CDCST) on people with dementia during the pandemic.

Research Design and Methods

This was a 2-arm randomized controlled trial involving 241 patient–caregiver dyads assigned to a 15-week CDCST or control group (usual care). We hypothesized that CDCST would facilitate significant improvements among people with dementia (cognition, behavioral/psychiatric symptoms, and quality of life) and their caregivers (caregiving appraisal, attitudes, and psychological well-being) at postintervention (T1) and at the 12-week follow-up (T2). Generalized estimating equations evaluated the study outcomes.

Results

A total of 230 dyads completed the study, with good program adherence (93%). Participants in the CDCST showed significant improvements in cognition (p < .001), behavioral and psychiatric symptoms (p =. 027), and quality of life (p =.001) at the 3-month follow-up period. Family caregivers had improved positive aspects of caregiving (p = .008; p = .049) and decreased negative attitudes toward people with dementia (p =. 013; p < .001) at both T1 and T2. There were nonsignificant changes in the caregivers’ perceived burden, distress, and psychological well-being.

Discussion and Implications

Family caregivers could be trained to provide cognitive stimulation at home for people with dementia, which could benefit both parties. CDCST could manage to improve the cognition, neuropsychiatric symptoms, and quality of life of people with dementia, while also improving caregiving appraisal and negative attitudes among family caregivers.

Clinical Trial Registration Number

NCT03803592
Evasive Manoeuvres: Strasbourg, the Hague Child Abduction Convention and the Absolute Prohibition on Ill-Treatment
Authors: Robinson Edmund
Published: May 2023

This article identifies a troubling omission on the part of the European Court of Human Rights, when it considers cases involving the Hague Convention on the Civil Aspects of International Child Abduction. Such cases often involve one parent, who has abducted the child, alleging that their actions were necessary to protect themselves or the child from violence by the other parent. The Court has avoided considering arguments based on Article 3 of the European Convention on Human Rights in such cases, despite the now established relevance of that Article to the risks of family violence. A change of course is needed, in order to articulate clear principles for the ECtHR’s own Hague cases, and reinforce the absoluteness of Article 3 protection elsewhere.
Habitual social media and smartphone use are linked to task delay for some, but not all, adolescents
Authors: Meier Adrian , Beyens Ine , Siebers Teun , Pouwels J Loes , Valkenburg Patti M
Published: May 2023

There is a popular concern that adolescents’ social media use, especially via smartphones, leads to the delay of intended, potentially more important tasks. Automatic social media use and frequent phone checking may especially contribute to task delay. Prior research has investigated this hypothesis through between-person associations. We advance the literature by additionally examining within-person and person-specific associations of automatic social media use and mobile phone checking frequency with each other and task delay. Preregistered hypotheses were tested with multilevel modeling on data from 3 weeks of experience sampling among N = 312 adolescents (ages 13–15), including T = 22,809 assessments. More automatic social media use and more frequent phone checking were, on average, associated with more task delay at the within-person level. However, heterogeneity analyses found these positive associations to be significant for only a minority of adolescents. We discuss implications for the media habit concept and adolescents’ self-regulation.
Real-Time Identification and High-Frequency Analysis of Deposits Outflows
Authors: Rainone Edoardo
Published: May 2023

We propose a method based on control charts to identify in real-time sudden deposits outflows through the payment system. The performance of the methodology is assessed with both Monte Carlo simulations and real transaction-level TARGET2 data for a large sample of Italian banks. We identify a set of idiosyncratic bank stress episodes. Using high-frequency payment system data, we provide new evidences on the interaction between retail, wholesale, and central bank funding in the post global financial crisis period.
Blinding of Admissions Committee to MCAT Scores: Is There a Difference in Subsequent Medical School Performance Between Cohorts?
Authors: Teng Yating , Dong Ting , Durning Steven J , Jung Eulho , Saguil Aaron , Liotta Robert
Published: May 2023

Background

The Medical College Admission Test (MCAT) is designed to inform members of the admissions committee about applicants’ academic readiness for medical school. Although previous work has shown that MCAT scores have some predictive validity evidence for a variety of medical student outcomes, there is also a concern that the MCAT is overly emphasized by admissions committees, which may, for example, affect matriculant diversity. The purpose of this study was to understand whether deemphasizing the MCAT by blinding committee members to applicants’ specific scores has resulted in matriculants with different pre-clerkship and clerkship performance.

Method

The Admissions Committee from the Uniformed Services University of the Health Sciences (USU) created a policy to blind admissions committee members to MCAT scores. The MCAT-blinded policy was implemented for classes of 2022 to 2024. This MCAT-blinded cohort’s performance was compared with a previous cohort, classes of 2018 to 2020. Two analyses of covariance were performed to test for differences in the pre-clerkship and clerkship module scores. Undergraduate grade point average (uGPA) and MCAT percentile for matriculants were included as covariates.

Results

There were no statistically significant differences in either pre-clerkship or clerkship performance between the MCAT-revealed and MCAT-blinded cohorts.

Conclusion

This study found similar medical school performance between the MCAT-blinded and MCAT-revealed cohorts. The research team plans to continuously follow these two cohorts to understand their performance further down their education path, including step 1 and step 2 examinations.
Shorter and Stronger: Revision of a Resident Performance Evaluation Survey
Authors: Witkop Catherine T , Dong Ting , Durning Steven
Published: May 2023

Introduction

In order to evaluate the outcomes of a USU School of Medicine (SOM) education, a program director (PD) evaluation survey was developed in 2005 and is completed annually by PDs regarding trainees who graduated from USU and are in their first post-graduate training year (PGY-1) and their third post-graduate training year (PGY-3). The survey was last reviewed and revised in 2010 to better align with the competencies established by the Accreditation Council for Graduate Medical Education but has not been further evaluated or revised. The objective of the study was to utilize 12 years of aggregated data to improve the psychometric properties of the survey, with an emphasis on shortening the survey. A secondary objective was to refine the verbiage of the existing questions and add new items to assess health systems science competencies.

Methods

The survey was sent out to PDs who supervised USU SOM graduates in the classes of 2008 to 2019 (n = 1,958) with 997 responses for the PGY-1 PD survey and 706 responses to the PGY-3 PD survey. Exploratory factor analysis (EFA) was conducted on 334 complete responses of the PGY-1 survey and 327 responses of the PGY-3 survey. A working group of PDs, USU Deans, and health professions education scholars reviewed the results from the EFA and from a survey of experienced PDs and, in an iterative process, developed a proposed revised survey.

Results

The EFA for both the PGY-1 data and the PGY-3 data yielded three factors, and a total of 17 items were identified with cross-loading across the factors in the PGY-1 and/or PGY-3 surveys. Items without clean loadings or that were determined to be unclear, redundant, or difficult to assess by PDs were revised or removed. Items were revised or added to address needs within the SOM curriculum, including the new health systems science competencies. The proposed revised survey had 36 items in place of the original 55 items and contained at least four items for each of the six competency domains (patient care, communication and interpersonal skills, medical knowledge, professionalism, system-based practice and practice-based learning and improvement, and military-unique practice, deployment, and humanitarian missions).

Conclusions

The USU SOM has benefited from over 15 years of results from the PD surveys. We identified those questions that performed well, and these were refined and augmented in order to optimize the performance of the survey and fill gaps in our knowledge of graduates’ performance. To determine how well the revised set of questions performs, efforts will be made to increase the response rate and completion of 100% of items on the survey, and the EFA should be repeated after about 2-4 years. Furthermore, the USU graduates should continue to be tracked longitudinally past residency to determine if PGY-1 and PGY-3 survey measures predict long-term performance and patient outcomes.
MUSE-ALMA Haloes XI: gas flows in the circumgalactic medium
Authors: Weng Simon , Péroux Céline , Karki Arjun , Augustin Ramona , Kulkarni Varsha P , Hamanowicz Aleksandra , Zwaan Martin , Sadler Elaine M , Nelson Dylan , Hayes Matthew J , Kacprzak Glenn G , Fox Andrew J , Bollo Victoria , Casavecchia Benedetta , Szakacs Roland
Published: May 2023

The flow of gas into and out of galaxies leaves traces in the circumgalactic medium which can then be studied using absorption lines towards background quasars. We analyse 27 ${{\log [N({\textrm {H}}\, {\small {I}})/\rm {cm}^{-2}]}} > 18.0$ H i absorbers at z = 0.2 to 1.4 from the MUSE-ALMA Haloes survey with at least one galaxy counterpart within a line of sight velocity of ±500 km s−1. We perform 3D kinematic forward modelling of these associated galaxies to examine the flow of dense, neutral gas in the circumgalactic medium. From the VLT/MUSE, HST broad-band imaging, and VLT/UVES and Keck/HIRES high-resolution UV quasar spectroscopy observations, we compare the impact parameters, star-formation rates, and stellar masses of the associated galaxies with the absorber properties. We find marginal evidence for a bimodal distribution in azimuthal angles for strong H i absorbers, similar to previous studies of the Mg ii and O vi absorption lines. There is no clear metallicity dependence on azimuthal angle, and we suggest a larger sample of absorbers is required to fully test the relationship predicted by cosmological hydrodynamical simulations. A case-by-case study of the absorbers reveals that ten per cent of absorbers are consistent with gas accretion, up to 30 per cent trace outflows, and the remainder trace gas in the galaxy disc, the intragroup medium, and low-mass galaxies below the MUSE detection limit. Our results highlight that the baryon cycle directly affects the dense neutral gas required for star-formation and plays a critical role in galaxy evolution.
Introduction
Authors: Dasgupta Sangeeta
Published: May 2023

Adivasi communities have been increasingly visible as subjects in debates around indigeneity, identity, development, and conversion. The introduction discusses events in contemporary Jharkhand, and emphasizes the need to look at the colonial past to understand some of these developments. It engages with debates on the production of colonial knowledge and the creation of social categories, focusing especially on the term tribe, and with debates on adivasi protest and resistance. It discusses the complex interplay between the written and the oral, the colonial archive and adivasi voices. Adivasi communities, it is pointed out, are, and always have been, differentiated among themselves along several axes. Their voices, multiple and fractured, although marginalized, can be heard as they assert their identity, express their politics and creatively negotiate with the state and its institutions. Finally, it advocates the importance of the using the term ‘adivasi’ over the contending categories of ‘tribe’, ‘Scheduled Tribe’, and ‘Indigenous People’, and discusses the politics of representation.
Heathen Aboriginals, Animistic Races
Authors: Dasgupta Sangeeta
Published: May 2023

Chapter 2 examines representations of the Oraons in the nineteenth- and early twentieth-century missionary writings on Chhotanagpur. When they initially encountered the Oraons, the missionaries drew upon their experiences in the mission field, but framed their depictions in biblical and evangelical language. The Oraons were represented as heathen and savage, immersed in idolatry and demonology, awaiting salvation. However, by the 1850s, as missionaries engaged with emerging disciplines and a scientific temperament, sometimes consciously and often tangentially, their narratives were gradually transformed. The Oraons became part of the universal category of the tribe; their ‘primitive’ religion was termed as ‘animism’. A new set of cultural co-ordinates—language, folklore, myths, tradition and history—marked their distinct identity. And if missionary voices were powerful in understanding the Oraons in the middle of the nineteenth century, paradoxically these voices, from the second half of the nineteenth century, became epistemically marginalized, subsumed within the ethnographic observations and ethnological surveys conducted by the colonial state.
Gandhi, Charkha, Swaraj
Authors: Dasgupta Sangeeta
Published: May 2023

Chapter 6 analyses the Tana Bhagats’ relationship with the Congress, their perception of ‘Gandhi Baba’, his charkha and swaraj. Drawing particularly on the missionary archive, it looks at the workings of Congress propaganda at the local level, and the myths, rumours, and lore that grew around the person of Gandhi. Congress ‘nationalists’, this chapter argues, adapted their politics to local conditions, refiguring thereby their slogans in locally cognizable terms; local elements, more aware of the Tana cultural world, adopted a different mode of propaganda to popularize their messages in Gandhi’s name; Tana leaders and their bhagat followers, as they spoke in the name of Gandhi, interpreted these open-ended messages in many ways, but often continued with their earlier modes of protest.
Originating
Authors: Dutton William H.
Published: May 2023

Originating information is the most pivotal way in which the internet supports the network power of individuals. The internet and social media enhance the ability of ordinary users to originate online content. Not everyone online originates content, such as posting blogs, videos, or photos, but a critical mass do, creating a rich body of user-generated content (UGC). This chapter discusses critical perspectives on bloggers and other users posting on social media platforms like Twitter. Critics of UGC see the amateurs of the commentariat lacking the professionalism of journalists and intellectuals. But they have become a new and complementary source of expertise and original information, not a substitute for traditional sources, such as journalists. Increasingly, networked individuals are the most credible source of original news and information, such as providing eyewitness accounts and genuine expertise on a subject. Internet users, like others, can be a source of misinformation, but they are also empowered online to fact-check themselves and other users, such as by using search. Malicious disinformation campaigns are most likely to be orchestrated by state-sponsored, criminal, or economically driven organizations—not individuals—and can be detected.
Collaborating
Authors: Dutton William H.
Published: May 2023

Collaborating presents itself once you can search, create, and network information online. Early initiatives online sought to enable collaboration in responding to national emergencies, allowing the right experts to be assembled from anywhere to address the problems. Since the early days of computer-mediated communication, collaboration has been an increasingly prominent application of online networks. There are major examples of managing online networks of collaboration to create information, films, experiments, and many jointly authored texts, such as Wikipedia. Networked individuals can be distributed locally and globally but still collaborate and combine in ways that create collective intelligence to serve many civic-minded roles of the Fifth Estate, such as in crowdsourcing, crowdsolving, and the management of collaborative networks to create collective and open-source intelligence. More routinely, remote work is changing the workplace as more individuals work collaboratively from anywhere at any time rather than go into an office on a fixed schedule.
Leaking
Authors: Dutton William H.
Published: May 2023

Leaking did not begin with the internet, but the internet has enabled the scale and significance of leaks to become far more prominent. Facilitating the flow of information across geographical and organizational boundaries is what the internet was designed to do. When information is confidential, secret, or otherwise restricted, then there is increasing reliance on the insiders within the organization to respect those boundaries. However, WikiLeaks, OpenLeaks, and many other organizations have helped insiders leak information more anonymously or safely. Leaking is one of the most controversial Fifth Estate strategies, but it clearly exploits and enhances the network power of individuals to hold their own organization more accountable. The leaking and distribution of leaked information is developed through a discussion of WikiLeaks along with other remarkable cases. It might lead one to reconsider views on leaking even if one objects to particular cases.
Threats to the Fifth Estate
Authors: Dutton William H.
Published: May 2023

Threats to the Fifth Estate pose major challenges to its future. Even if the Fifth Estate has been a gift to democracy and accountability across society, there are risks that threaten its continued role in supporting democratic political processes and the Fifth Estate. Changes in technology, internet governance, policy, regulation, and industry and governmental practices around the internet and related digital media could undermine the Fifth Estate. This chapter identifies and illustrates major threats, including perspectives formed from a technologically deterministic—media-centric—logic, the use of harms to frame discussion of internet impacts, the rise of American big-tech platforms, and the increasing geopolitical fragmentation of the online world—a splinternet. Examples, such as the Cambridge Analytica scandal, are used to critically assess these threats and their impact on trust in the internet and the institutions using and providing internet services.