Understanding Between-Person Interventions With Time-Intensive Longitudinal Outcome Data : Longitudinal Mediation Analyses

Acknowledgments The physical activity trial (Example 2) was funded by the Swiss National Science Foundation awarded to U.S. (PP00P1_133632/1). J.I. (P2ZHP1_155103) and C.B. (P2BEP1_158975) were supported by fellowships of the Swiss National Science Foundation. The authors thank Melanie Amrein, Pamela Rackow, and involved students for their contributions to the data collection in the eating behavior trial (Example 1). We also thank Niall Bolger for valuable discussions on this topic, and the New York University Couples Lab for helpful feedback on an earlier version of this manuscript.Peer reviewedPublisher PD

Fenómeno de Nano-lubricación en un Contacto Hdd/cabezal. Modelado y Simulación

En este trabajo se presenta un modelo teórico del fenómeno de lubricación de un contacto lineal lubricado entre elementos rígidos y lisos, cuya geometría se asemeja al contacto entre un dispositivo lecto-grabador y el disco rotante, incluyendo la existencia de un fluido lubricante no Newtoniano descripto por un modelo reológico de ley de potencia. El modelo contempla las fuerzas de origen molecular y se resuelve mediante una técnica numérica basada en el método de elementos finitos. Los resultados muestran que las fuerzas moleculares se manifiestan significativamente sobre la carga para espesores menores de 5 nm y velocidades tengenciales del disco menores a los 100 mm/s. En los discos actuales (velocidades superiores a 50 m/s), esto significa que la carga sería puramente hidrodinámica, mientras que en ciertos micro-motores con contactos similares (ej: micro motores para microelectromecánica) que desarrollan velocidades de 14 mm/s, las fuerzas moleculares podrían desestabilizar su funcionamiento

Investigaciones teórico-computacionales para el desarrollo de prótesis articulares de mayor duración para miembro inferior

El desgaste de las superficies articulares en prótesis de rodilla y cadera es uno de los principales mecanismos de falla de las mismas. La lubricación de las mismas es fundamental para reducir la fricción, disminuir el desgaste y extender la vida útil del implante. Además, el estudio de la lubricación en articulaciones naturales podría orientar acerca de cuáles son los factores determinantes de sus excelentes características tribológicas, guiando en la mejora del desempeño de articulaciones protésicas. Este proyecto pretendía contribuir a determinar un modelo apropiado para el estudio de la lubricación por película delgada. Mediante la adopción de parámetros adecuados, el modelo desarrollado en este proyecto es apto para su aplicación en articulaciones naturales o protésicas, de cadera o de rodilla. Se evaluó la influencia del comportamiento no-Newtoniano del fluido sinovial, usualmente considerado como fluido Newtoniano o Newtoniano generalizado. Se evaluó la influencia de la geometría adoptada y distintos modelos de deformación. Se obtuvieron resultados para distintos casos de estudio, los cuales han sido publicados en revistas científicas nacionales e internacionales

Módulos elásticos equivalentes para predicción de deformaciones en articulaciones

En el estudio de la mecánica de contacto de las articulaciones humanas, la deformación de las superficies en contacto es fundamental porque posibilita un canal por el que fluye el lubricante reduciendo el desgaste. Para determinar la validez de las predicciones de los desplazamientos de estas superficies a partir de distintos métodos, estos se aplican al estudio del contacto seco y estático de articulaciones de rodilla y de cadera, sanas y protésicas. Aplicando una carga hertziana, se evaluaron tres módulos elásticos equivalentes en un modelo simplificado de columna: el correspondiente a un sólido de pequeño espesor, el correspondiente a un sólido semiinfinito o de Winkler y el correspondiente a un sólido semiinfinito corregido. Los resultados se contrastaron con la solución obtenida resolviendo numéricamente las ecuaciones de elasticidad mediante el método de elementos finitos (MEF). Los resultados para el módulo de Young correspondiente a un material de pequeño espesor, son los que mejor se aproximan a los obtenidos por el MEF. Se demuestra también, que los módulos de Young derivados de la aproximación de sólido semiinfinito son inapropiados. Asimismo, con este trabajo se ha entrenado un becario en las artes de la Mecánica Computacional

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person

Wissenschaft als Beruf: Wissenschaftsforschung Jahrbuch 2020

Peer Reviewe

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms