Could Artificial Intelligence be a Therapeutic for Mental Issues?

The utilization of artificial intelligence (AI) possesses the capacity to fundamentally transform the landscape of mental health care through the provision of very valuable therapeutic interventions. AI possesses the capacity to evaluate extensive quantities of data, enabling it to aid in the identification of early signs of mental health concerns and provide tailored solutions that cater to specific requirements. The utilization of virtual therapists powered by AI has the potential to provide a secure environment for persons experiencing social anxiety or worries associated with stigma. This form of therapy offers continuous support and diminishes the obstacles that hinder individuals from seeking assistance. In addition, AI algorithms possess the capability to effectively identify and analyze patterns and trends derived from many sources, including social media posts and smartphone usage. This enables the assessment of an individual’s mental health and facilitates the provision of timely solutions. Through the utilization of natural language processing and sentiment analysis, AI has the potential to augment current therapeutic practices by proficiently monitoring patient advancements and analyzing therapeutic dialogues. Therefore, the incorporation of AI into the realm of mental health intervention holds promise in enhancing accessibility, cost, and efficacy, while mitigating the strain on conventional healthcare systems

Safety, feasibility, and outcomes of transcaval access for the delivery of Impella microaxial-flow pump 5.0 in patients with acute heart failure

Background: Transcaval access (TCA) may enable fully percutaneous mechanical circulatory support (MCS) without the hazards of vascular complication in patients with heart failure that require left ventricular unloading. Purpose: To review the safety, feasibility, and outcomes of using TCA to deliver Impella 5.0 MCS in patients with ischemic and non-ischemic systolic acute heart failure. Methods: This single center retrospective study included all patients that underwent TCA placement of a 5.0 Impella from June 2015 to January 2021. Demographic, clinical and procedural variables, and in-hospital outcomes were collected. The procedure was performed by electrifying a caval guidewire and advancing it into a pre-positioned aortic snare. After exchanging for a rigid guidewire, a 22 or 24Fr sheath was delivered into the aorta and then the Impella 5.0 was placed in the left ventricle through TCA sheaths. Results: A total of 43 patients were included in the analysis. The average age was 56.9 years (interquartile range [IQR], 52-65.5), of which, 70%(n=30) were males. Fifteen patients had non-ischemic cardiomyopathy and 28 had ischemic cardiomyopathy. Baseline average left ventricular ejection fraction prior to implantation was 23.6% (IQR, 13.75-29.75). 86% of the patients were in category C-D of the SCAI classification schema for cardiogenic shock (CS), 39.5% required inotropes and 48.8% required pressors prior to the procedure; 54% had a prior MCS in place. Only 18.6% of the cases had prior CT imaging reviewed for planning. TCA was successful in all attempted patients and the MCS delivery was achieved in 100% of the cohort. The available hemodynamic parameters prior and after Impella 5.0 implantation via Table 1 TCA are summarized in table 1. From the total cohort, only 29 patients survived to explant device and TCA sheath. The explant was successful in all patients using nitinol occluders; two patients required a covered stent at the arteriotomy site due to right sided heart failure from residual fistula; no surgical repair was necessary. All residual fistulous tracks were graded as1 from Impella insertion/removal site was observed in 9.3%,which didn\u27t require further intervention. No vascular complication of the access site was observed with TCA. During hospitalization, 20.9% had VT/VF and 4.7% a PEA after implantation (all CS patients). 13.9% of the patients had AKI requiring hemodialysis and no stroke was observed in the entire group. The average length of stay for entire cohort was 16.3 days (IQR, 3.25-18.75). Conclusions: Transcaval access of 5.0 Impella is safe and feasible under expert hands for patients where more conventional MCS devices do not provide enough support or have inadequate peripheral arterial access

National Landscape of Hospitalizations in Patients with Left Ventricular Assist Device. Insights from the National Readmission Database 2010-2015

The number of patients with left ventricular assist devices (LVAD) has increased over the years and it is important to identify the etiologies for hospital admission, as well as the costs, length of stay and in-hospital complications in this patient group. Using the National Readmission Database from 2010 to 2015, we identified patients with a history of LVAD placement using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code V43.21. We aimed to identify the etiologies for hospital admission, patient characteristics, and in-hospital outcomes. We identified a total of 15,996 patients with an LVAD, the mean age was 58 years and 76% were males. The most common cause of hospital readmission after LVAD was heart failure (HF, 13%), followed by gastrointestinal (GI) bleed (11.8%), device complication (11.5%), and ventricular tachycardia/fibrillation (4.2%). The median length of stay was 6 days (3-11 days) and the median hospital costs was $12,723 USD. The in-hospital mortality was 3.9%, blood transfusion was required in 26.8% of patients, 20.5% had acute kidney injury, 2.8% required hemodialysis, and 6.2% of patients underwent heart transplantation. Interestingly, the most common cause of readmission was the same as the diagnosis for the preceding admission. One in every four LVAD patients experiences a readmission within 30 days of a prior admission, most commonly due to HF and GI bleeding. Interventions to reduce HF readmissions, such as speed optimization, may be one means of improving LVAD outcomes and resource utilization

Geoprocessamento como Ferramenta de Análise de Possíveis Grandes Geradores de Resíduos Sólidos

Em 2010, o Governo Federal criou a Política Nacional de Resíduos Sólidos (PNRS), Lei 12.305/2010 (Brasil, 2010a), a respeito da gestão e do gerenciamento adequado dos resíduos sólidos no Brasil. Em 2012, o Município de Campo Grande, Estado de Mato Grosso do Sul, criou a Lei Complementar 209/2012 (Campo Grande, 2012), que instituiu o Código Municipal de Resíduos Sólidos e tratou da limpeza urbana e de diretrizes sobre o gerenciamento de seus resíduos sólidos. A Lei Complementar definiu o que são Grandes Geradores de Resíduos Sólidos determinou suas responsabilidades, sendo, então, necessária a identificação desses locais. O presente trabalho utilizou de ferramentas de geoprocessamento para identificação e análise desses locais. Foram obtidos o mapa de densidade de possíveis Grandes Geradores e mapas de intensidade de resíduos gerados através de dois diferentes interpoladores, que foram comparados com uma lista tabelada do Índice de Qualidade de Vida (IQV) de cada bairro do município. A utilização do geoprocessamento mostrou-se eficiente, sendo possível identificar os prováveis locais dos Grandes Geradores. Também foi possível observar que esses locais coincidiram com bairros com altos valores de IQV. Assim, o poder público pode fazer uso dessa ferramenta para identificar, monitorar e fiscalizar esse tipo de estabelecimento

Plankton networks driving carbon export in the oligotrophic ocean

The biological carbon pump is the process by which CO 2 is transformed to organic carbon via photosynthesis, exported through sinking particles, and finally sequestered in the deep ocean. While the intensity of the pump correlates with plankton community composition, the underlying ecosystem structure driving the process remains largely uncharacterized. Here we use environmental and metagenomic data gathered during the Tara Oceans expedition to improve our understanding of carbon export in the oligotrophic ocean. We show that specific plankton communities, from the surface and deep chlorophyll maximum, correlate with carbon export at 150 m and highlight unexpected taxa such as Radiolaria and alveolate parasites, as well as Synechococcus and their phages, as lineages most strongly associated with carbon export in the subtropical, nutrient-depleted, oligotrophic ocean. Additionally, we show that the relative abundance of a few bacterial and viral genes can predict a significant fraction of the variability in carbon export in these regions

Modelling impacts of food industry co-regulation on noncommunicable disease mortality, Portugal.

OBJECTIVE: To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met. METHODS: The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030. FINDINGS: If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021. CONCLUSION: The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets

TCT-308 Cardiogenic Shock–Associated Cardiorenal Syndrome Improves With the Use of Left Atrial Venous Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO)

Background: Cardiorenal syndrome (CRS) can complicate cardiogenic shock (CS) in 60% of cases. A strong predictor of CRS is elevated right atrial (RA) pressure. Left atrial venous arterial extracorporeal membrane oxygenation (LAVA-ECMO) uses a long fenestrated trans-septal cannula that unloads the left and right atrium simultaneously. We describe the impact of rapidly decompressing RA pressure and improved perfusion on renal function with LAVA-ECMO. Methods: From July 2020 to August 2021, 15 patients underwent LAVA-ECMO cannulation at Henry Ford Hospital. Patient characteristics, procedural data, and outcomes were analyzed. Variables are expressed as proportions and medians (interquartile range [IQR]). The Wilcoxon signed rank test was used with 95% confidence intervals for comparisons. Results: The median age was 62 years (IQR: 52-71 years), and 13% were women. Most patients had pure CS (87%) and mixed distributive CS in 2 patients (13%). Most patients had severe valvular heart disease (80%). LAVA-ECMO caused a significant reduction in RA pressure (Figure 1A) and increased pulmonary artery saturation from 48% (IQR: 37-56) to 72% (IQR: 64-81) (P = 0.002). Of the 12 patients not receiving renal replacement therapy, 75% patients experienced improvement in renal function, 2 had no change, and 1 worsened. The distribution of serum creatinine (Cr) is shown in Figure 1B between baseline Cr, day of LAVA-ECMO, 1 day post-LAVA ECMO, and at the time of destination. Conclusion: LAVA-ECMO lowers RA pressure, improves perfusion, and is associated with rapid reversal of cardiorenal syndrome in most patients. Prospective studies using LAVA-ECMO for cardiogenic shock are warranted