Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Objective To assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease. Design Registry based observational study. Setting 74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021 Participants All adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients). Main outcome measures Any cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease. Results Of 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07). Conclusions In patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research

Evidence-based practice in well-child care

Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one’s own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time. Conclusions: Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems. What is Known: • Conducting an evidence-based practice search is considered indispensable to determine the best management of the patient’s problem. • Conducting such a search is still considered challenging in many medical disciplines, including pediatrics. What is New: • There is a need to strengthen skills of community pediatricians to find evidence on psychosocial problems and to present this effectively in multidisciplinary teams. • The pediatricians’ broad use of other sources of evidence, like experts and online sources, shows the importance of critical evaluation skills

Self-assembly of soft nanoparticles with tunable patchiness

Details of the forces between nanoparticles determine the waysin which the nanoparticles can self-assemble into larger structures.The use of directed interactions has led to new conceptsin self-assembly such as asymmetric dendrons1,2, Janus particles3,patchy colloids46 and colloidal molecules7. Recentmodels that include attractive regions or patches on thesurface of the nanoparticles predict a wealth of intricatemodes of assembly812. Interactions between such particlesare also important in a range of phenomena including proteinaggregation13,14 and crystallization15, re-entrant phase transitions1618, assembly of nanoemulsions19 and the organizationof nanoparticles into nanowires20. Here, we report the synthesisof 6-nm nanoparticles with dynamic hydrophobicpatches and show that they can form reversible self-assembledstructures in aqueous solution that become topologically moreconnected upon dilution. The organization is based onguesthost supramolecular chemistry with the nanoparticlescomposed of a hydrophobic dendrimer host molecule andwater-soluble hydrophilic guest molecules. The work demonstratesthat subtle changes in hierarchal composition and/orconcentration can dramatically change mesoscopic ordering

Stepwise noncovalent synthesis leading to dendrimer-based assemblies in water

We provide detailed insight into complex supramolecular assembly processes by fully characterizing a multicomponent model system using dynamic light scattering, cryogenic transmission electron microscopy, atomic force microscopy, and various NMR techniques. First, a preassembly of a host molecule (the fifth-generation urea-adamantyl poly(propylene imine) dendrimer) and 32 guest molecules (a water- and chloroform-soluble ureidoacetic acid guest) was made in chloroform. The association constant in chloroform is concealed by guest self-association and is therefore higher than 103 M-1. Via the neat state the single-host complex was transferred to water, where larger dendrimer-based assemblies were formed. The core of these assemblies, consisting of multiple host molecules (on average three), is kinetically trapped upon dissolution in water, and its size is constant irrespective of the concentration. The guest molecules forming the corona of the assemblies, however, stay dynamic since they are still in rapid exchange on the NMR time scale, as they were in chloroform. A stepwise noncovalent synthesis provides a means to obtain metastable dynamic supramolecular assemblies in water, structures that cannot be formed in one step.status: publishe

Stepwise noncovalent synthesis leading to dendrimer-based assemblies in water

We provide detailed insight into complex supramolecular assembly processes by fully characterizing a multicomponent model system using dynamic light scattering, cryogenic transmission electron microscopy, atomic force microscopy, and various NMR techniques. First, a preassembly of a host molecule (the fifth-generation urea-adamantyl poly(propylene imine) dendrimer) and 32 guest molecules (a water- and chloroform-soluble ureidoacetic acid guest) was made in chloroform. The association constant in chloroform is concealed by guest self-association and is therefore higher than 103 M-1. Via the neat state the single-host complex was transferred to water, where larger dendrimer-based assemblies were formed. The core of these assemblies, consisting of multiple host molecules (on average three), is kinetically trapped upon dissolution in water, and its size is constant irrespective of the concentration. The guest molecules forming the corona of the assemblies, however, stay dynamic since they are still in rapid exchange on the NMR time scale, as they were in chloroform. A stepwise noncovalent synthesis provides a means to obtain metastable dynamic supramolecular assemblies in water, structures that cannot be formed in one step

The 2005 and 2006 DANDELIONS NO2 and aerosol intercomparison campaigns

Dutch Aerosol and Nitrogen Dioxide Experiments for Validation of OMI and SCIAMACHY (DANDELIONS) is a project that encompasses validation of spaceborne measurements of NO\u3csub\u3e2\u3c/sub\u3e by the Ozone Monitoring Instrument (OMI) and Scanning Imaging Absorption Spectrometer for Atmospheric Cartography (SCIAMACHY), and of aerosol by OMI and Advanced Along-Track Scanning Radiometer (AATSR), using an extensive set of ground-based and balloon measurements over the polluted area of the Netherlands. We present an extensive data set of ground-based, balloon, and satellite data on NO\u3csub\u3e2\u3c/sub\u3e, aerosols, and ozone obtained from two campaigns within the project, held during May-June 2005 and September 2006. We have used these data for first validation of OMI NO\u3csub\u3e2\u3c/sub\u3e, and the data are available through the Aura Validation Data Center website for use in other validation efforts. In this paper we describe the available data, and the methods and instruments used, including the National Institute of Public Health and the Environment (RIVM) NO\u3csub\u3e2\u3c/sub\u3e lidar. We show that NO\u3csub\u3e2\u3c/sub\u3e from Multi-Axis Differential Optical Absorption Spectroscopy (MAX-DOAS) compares well with in situ measurements. We show that different MAX-DOAS instruments, operating simultaneously during the campaign, give very similar results. We also provide unique information on the spatial homogeneity and the vertical and temporal variability of NO\u3csub\u3e2\u3c/sub\u3e, showing that during a number of days, the NO\u3csub\u3e2\u3c/sub\u3e columns derived from measurements in different directions varied significantly, which implies that, under polluted conditions, measurements in one single azimuth direction are not always representative for the averaged field that the satellite observes. In addition, we show that there is good agreement between tropospheric NO\u3csub\u3e2\u3c/sub\u3e from OMI and MAX-DOAS, and also between total NO\u3csub\u3e2\u3c/sub\u3e from OMI and direct-sun observations. Observations of the aerosol optical thickness (AOT) show that values derived with three ground-based instruments correspond well with each other, and with aerosol optical thicknesses observed by OMI. Copyright 2008 by the American Geophysical Union. U7 - Export Date: 2 August 2010 U7 - Source: Scopus U7 - Art. No.: D16S4