Mineralocorticoid receptor antagonists for heart failure: a real-life observational study

Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients.Aims Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients. Methods and results We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n= 3163) and not treated (n= 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years\u2019survival was analysed through Kaplan\u2013Meier, compared by log-rank test and propensity score matching. At 10 years\u2019follow-up, the MRA-untreated group had a significantly lower number of events than the MRA-treated group (P<0.001). MRA-treated patients had more severe heart failure (higher New York Heart Association class and lower left ventricular ejection fraction, kidney function, and peak VO2). At a propensity-score-matching analysis performed on 1587 patients, MRA-treated and MRA-untreated patients showed similar study endpoint values. Conclusions In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplanta- tion or left ventricular assist device implantation in a real-life setting. A meticulous patient follow-up, as performed in trials, is likely needed to match the positive MRA-related benefits observed in clinical trials

Characteristics associated with improved knee extension after strength training for individuals with cerebral palsy and crouch gait

ReviewMuscle weakness may contribute to crouch gait in individuals with cerebral palsy, and some individuals participate in strength training programs to improve crouch gait. Unfortunately, improvements in muscle strength and gait are inconsistent after completing strength training programs. The purpose of this study was to examine changes in knee extensor strength and knee extension angle during walking after strength training in individuals with cerebral palsy who walk in crouch gait and to determine subject characteristics associated with these changes. A literature review was performed of studies published since January 2000 that included strength training, three-dimensional motion analysis, and knee extensor strength measurements for individuals with cerebral palsy. Three studies met these criteria and individual subject data was obtained from the authors for thirty crouch gait subjects. Univariate regression analyses were performed to determine which of ten physical examination and motor performance variables were associated with changes in strength and knee extension during gait. Change in knee extensor strength ranged from a 25% decrease to a 215% increase, and change in minimum knee flexion angle during gait ranged from an improvement of 9° more knee extension to 15° more knee flexion. Individuals without hamstring spasticity had greater improvement in knee extension after strength training. Hamstring spasticity was associated with an undesired increase in knee flexion during walking. Subject-specific factors such as hamstring spasticity may be useful for predicting which subjects will benefit from strength training to improve crouch gait. © 2012 - IOS Press and the authors. All rights reserved

The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits

Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte’s method of categorizing people’s perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/ low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child’s age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.Natoshia M. Askelson, Donald L. Chi, Elizabeth T. Momany, Raymond A. Kuthy, Knute D. Carter, Kathryn Field, and Peter C. Damian

Mining gait pattern for clinical locomotion diagnosis based on clustering techniques

Scientific gait (walking) analysis provides valuable information about an individual's locomotion function, in turn, to assist clinical diagnosis and prevention, such as assessing treatment for patients with impaired postural control and detecting risk of falls in elderly population. While several artificial intelligence (AI) paradigms are addressed for gait analysis, they usually utilize supervised techniques where subject groups are defined a priori. In this paper, we explore to investigate gait pattern mining with clustering-based approaches, in which k-means and hierarchical clustering algorithms are employed to derive gait pattern. After feature selection and data preparation, we conduct clustering on the constructed gait data model to build up pattern-based clusters. The centroids of clusters are then treated as the subject profiles to model the various kinds of gait pattern, e.g. normal or pathological. Experiments are undertaken to visualize the derived subject clusters, evaluate the quality of clustering paradigm in terms of silhouette and mean square error and compare the results with the discovery derived from hierarchy tree analysis. In addition, analysis conducted on test data demonstrates the usability of the proposed paradigm in clinical applications. © Springer-Verlag Berlin Heidelberg 2006

NCS Assessments of the Motor, Sensory, and Physical Health Domains

As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place. Copyright © 2021 Clark, Pate, Rine, Christy, Dalton, Damiano, Daniels, Holmes, Katzmarzyk, Magasi, McCreery, McIver, Newell, Sanger, Sugden, Taveras and Hirschfeld.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]