The Role of Epicardial Adipose Tissue in the Development of Atrial Fibrillation, Coronary Artery Disease and Chronic Heart Failure in the Context of Obesity and Type 2 Diabetes Mellitus: A Narrative Review

Cardiovascular diseases (CVDs) are a significant burden globally and are especially prevalent in obese and/or diabetic populations. Epicardial adipose tissue (EAT) surrounding the heart has been implicated in the development of CVDs as EAT can shift from a protective to a maladaptive phenotype in diseased states. In diabetic and obese patients, an elevated EAT mass both secretes pro-fibrotic/pro-inflammatory adipokines and forms intramyocardial fibrofatty infiltrates. This narrative review considers the proposed pathophysiological roles of EAT in CVDs. Diabetes is associated with a disordered energy utilization in the heart, which promotes intramyocardial fat and structural remodeling. Fibrofatty infiltrates are associated with abnormal cardiomyocyte calcium handling and repolarization, increasing the probability of afterdepolarizations. The inflammatory phenotype also promotes lateralization of connexin (Cx) proteins, undermining unidirectional conduction. These changes are associated with conduction heterogeneity, together creating a substrate for atrial fibrillation (AF). EAT is also strongly implicated in coronary artery disease (CAD); inflammatory adipokines from peri-vascular fat can modulate intra-luminal homeostasis through an “outside-to-inside” mechanism. EAT is also a significant source of sympathetic neurotransmitters, which promote progressive diastolic dysfunction with eventual cardiac failure. Further investigations on the behavior of EAT in diabetic/obese patients with CVD could help elucidate the pathogenesis and uncover potential therapeutic targets

Effect of glucagon-like peptide 1 receptor agonists on albuminuria in adult patients with type 2 diabetes mellitus: A systematic review and meta-analysis

Aims: To determine the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on albuminuria in adult patients with type 2 diabetes mellitus (T2DM). Methods: Medline Ovid, Scopus, Web of Science, EMCARE and CINAHL databases from database inception until 27 January 2022. Studies were eligible for inclusion if they were randomized controlled trials that involved treatment with a GLP-1RA in adult patients with T2DM and assessed the effect on albuminuria in each treatment arm. Data extraction was conducted independently by three individual reviewers. The PRISMA guidelines were followed regarding data extraction and quality assessment. Data were pooled using a random effects inverse variance model and all analysis was carried out with RevMan 5.4 software. The Jadad scoring tool was employed to assess the quality of evidence and risk of bias in the randomized controlled trials. Results: The initial search revealed 2419 articles, of which 19 were included in this study. An additional three articles were identified from hand-searching references of included reviews. Therefore, in total, 22 articles comprising 39 714 patients were included. Meta-analysis suggested that use of GLP1-RAs was associated with a reduction in albuminuria in patients with T2DM (weighted mean difference −16.14%, 95% CI −18.42 to −13.86%; p < .0001) compared with controls. Conclusions: This meta-analysis indicates that GLP-1RAs are associated with a significant reduction in albuminuria in adult patients with T2DM when compared with placebo

PENGARUH FASILITAS PAJAK DAN LEVERAGE TERHADAP MANAJEMEN PAJAK (Studi Kasus Pada Perusahaan Sub-Sektor Kimia Yang Terdaftar di BEI pada Tahun 2017-2019)

This study aims to show whether the effect of tax facilities and leverage on tax management in the chemical sub-sector in the years listed on the Indonesian stock exchange in 2017-2019. This research was conducted using quantitative methods, the research method to be carried out was purposive sampling method and the researchers collected various kinds of companies, namely 30 companies. The data used is secondary data on the financial statements of every chemical sub-sector company listed on the Indonesia Stock Exchange in 2017-2019. The method of testing this sample by researchers is used with the results of the normality test, multicollinearity test, heteroscedasticity test, autocorrelation test, r test, f test, t test. The way the researcher analyzes this data is by using multiple linear regression. The results of this study inform and conclude that tax facilities have an effect on tax management while leverage has no effect on tax management.This study aims to show whether the effect of tax facilities and leverage on tax management in the chemical sub-sector in the years listed on the Indonesian stock exchange in 2017-2019. This research was conducted using quantitative methods, the research method to be carried out was purposive sampling method and the researchers collected various kinds of companies, namely 30 companies. The data used is secondary data on the financial statements of every chemical sub-sector company listed on the Indonesia Stock Exchange in 2017-2019. The method of testing this sample by researchers is used with the results of the normality test, multicollinearity test, heteroscedasticity test, autocorrelation test, r test, f test, t test. The way the researcher analyzes this data is by using multiple linear regression. The results of this study inform and conclude that tax facilities have an effect on tax management while leverage has no effect on tax management

Development of an Objective Structured Clinical Examination as a Component of Assessment for Initial Board Certification in Anesthesiology.

With its first administration of an Objective Structured Clinical Examination (OSCE) in 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate this type of assessment into its high-stakes certification examination system. The fundamental rationale for the ABA's introduction of the OSCE is to include an assessment that allows candidates for board certification to demonstrate what they actually "do" in domains relevant to clinical practice. Inherent in this rationale is that the OSCE will capture competencies not well assessed in the current written and oral examinations-competencies that will allow the ABA to judge whether a candidate meets the standards expected for board certification more properly. This special article describes the ABA's journey from initial conceptualization through first administration of the OSCE, including the format of the OSCE, the process for scenario development, the standardized patient program that supports OSCE administration, examiner training, scoring, and future assessment of reliability, validity, and impact of the OSCE. This information will be beneficial to both those involved in the initial certification process, such as residency graduate candidates and program directors, and others contemplating the use of high-stakes summative OSCE assessments

Comparison of ecosystem processes in a woodland and prairie pond with different hydroperiods

Shallow lakes and ponds constitute a significant number of water bodies worldwide. Many are heterotrophic, indicating that they are likely net contributors to global carbon cycling. Climate change is likely to have important impacts on these waterbodies. In this study, we examined two small Minnesota ponds; a permanent woodland pond and a temporary prairie pond. The woodland pond had lower levels of phosphorus and phytoplankton than the prairie pond. Using the open water oxygen method, we found the prairie pond typically had a higher level of gross primary production (GPP) and respiration (R) than the woodland pond, although the differences between the ponds varied with season. Despite the differences in GPP and R between the ponds the net ecosystem production was similar with both being heterotrophic. Since abundant small ponds may play an important role in carbon cycling and are likely to undergo changes in temperature and hydroperiod associated with climate change, understanding pond metabolism is critical in predicting impacts and designing management schemes to mitigate changes

CAMERA - complete assessment of elderly patients with cancer: A non-randomised feasibility study

One of the primary risk factors in the development of cancer is older age. The demographic shift to an ageing population has given rise to an increased number of older patients with cancer. The extreme heterogeneity within this population renders applying standardised treatment pathways hazardous [1]. Disparities in physiological reserve and an increased risk of multiple comorbidities further exacerbates the complexity of cancer treatment management in older patients [2]. Individual modifications to tailor treatment for each specific patient would be the gold standard; thus, detailed patient assessment providing a comprehensive health profile in addition to existing diagnostic test results are paramount when devising a personalised treatment care approach [3]

Incremental bounded model checking for embedded software

Program analysis is on the brink of mainstream usage in embedded systems development. Formal verification of behavioural requirements, finding runtime errors and test case generation are some of the most common applications of automated verification tools based on bounded model checking (BMC). Existing industrial tools for embedded software use an off-the-shelf bounded model checker and apply it iteratively to verify the program with an increasing number of unwindings. This approach unnecessarily wastes time repeating work that has already been done and fails to exploit the power of incremental SAT solving. This article reports on the extension of the software model checker CBMC to support incremental BMC and its successful integration with the industrial embedded software verification tool BTC EMBEDDED TESTER. We present an extensive evaluation over large industrial embedded programs, mainly from the automotive industry. We show that incremental BMC cuts runtimes by one order of magnitude in comparison to the standard non-incremental approach, enabling the application of formal verification to large and complex embedded software. We furthermore report promising results on analysing programs with arbitrary loop structure using incremental BMC, demonstrating its applicability and potential to verify general software beyond the embedded domain

Assessment of saddle fit in racehorses using infrared thermography

The aim of this study was to assess the influence of horse, saddle, and rider on saddle fit in racehorses by detecting pressure distribution using infrared thermography. In this study, 22 saddles used on 65 racing horses ridden by 21 riders were used. Data from horses including gender, breed, age, training intensity, and level of performance were collected. Type and mass of the saddle were also obtained, along with information about the rider's body mass and riding skills. Thermographic images of the saddle's panels were captured immediately after untacking the horse at each thermographic examination. On each thermographic image of the saddle panels, six regions of interest (ROIs) were marked, with mean temperature calculated within each ROI to indicate pressure distribution. Saddle fit was evaluated for right/left panel pressure, bridging/rocking pressure, and front/back pressure according to horse's: gender, breed, age, training intensity, level of conditioning, rider's skills, and load (saddle plus rider mass). There were statistically significant relationships (P < .05) between left/right asymmetry and age, training, intensity and load. In front/back pressure, there was a statistically significant relationship (P < .05) for load. No statistically significant relationships were observed between bridging/rocking pressure and the rest of the aforementioned variables. The study indicated that load, horse age, and training intensity influence pressure distribution in racing saddles. Therefore, animal age and load have to be considered in saddle fit. Infrared thermography has been confirmed as a useful tool in the evaluation of saddle fit in racing horses

Observation of a low-lying metastable electronic state in highly charged lead by Penning-trap mass spectrometry

Highly charged ions (HCIs) offer many opportunities for next-generation clock research due to the vast landscape of available electronic transitions in different charge states. The development of XUV frequency combs has enabled the search for clock transitions based on shorter wavelengths in HCIs. However, without initial knowledge of the energy of the clock states, these narrow transitions are difficult to be probed by lasers. In this Letter, we provide experimental observation and theoretical calculation of a long-lived electronic state in Nb-like Pb$^{41+}$ which could be used as a clock state. With the mass spectrometer Pentatrap, the excitation energy of this metastable state is directly determined as a mass difference at an energy of 31.2(8) eV, corresponding to one of the most precise relative mass determinations to date with a fractional uncertainty of $4\times10^{-12}$. This experimental result agrees within 1 $\sigma$ with two partially different \textit{ab initio} multi-configuration Dirac-Hartree-Fock calculations of 31.68(13) eV and 31.76(35) eV, respectively. With a calculated lifetime of 26.5(5.3) days, the transition from this metastable state to the ground state bears a quality factor of $1.1\times10^{23}$ and allows for the construction of a HCI clock with a fractional frequency instability of $<10^{-19}/\sqrt{\tau}$