Effects of Age and Comorbidities on Intensive Care and 1-year Mortality after HeartMate 3 Implantation

Background: The use of left ventricular assist devices (LVAD) has been rapidly increasing in older people over the past two decades due to their availability as destination therapy. This study aimed to assess the effect of age and comorbidities on the intensive care unit (ICU) and 1-year mortality after HeartMate 3 LVAD implantation. Methods: From 2016 to 2023, all consecutive adult patients implanted with HeartMate 3 LVAD in our tertiary referral center were enrolled in the study. Patients were stratified according to their age at implantation into Group-1 (&lt;45 years), Group-2 (46–64 years), and Group-3 (&gt;65 years). The effect of age and comorbidities on ICU and 1-year mortality were assessed. Results: In total, 135 patients were included (mean age 54±13 years, 79% males). Baseline vital signs, comorbidities, and hemodynamic support were not different between age groups. The older population had significantly lower eGFR (p=0.025), ischemic cardiac diseases as the underlying heart problem (p&lt;0.001), and LVAD as destination therapy (p&lt;0.001). The mortality rate at the ICU and at one year were 90% and 83%, respectively. The median age of the patients who died in the ICU was significantly higher than 63 [56–65] years versus 57 years [49–62, p=0.034). However, age lost its significance with logistic regression analysis. Having a recent major myocardial infarct, high preoperative leukocyte count, and cardiopulmonary bypass time were independent risk factors for ICU mortality. On the other hand, age was an independent risk factor for one-year mortality. Conclusion: Older age predicts increased one-year but not ICU mortality after HeartMate 3 LVAD implantation, while recent major myocardial infarction, high preoperative leukocyte count, and longer cardiopulmonary bypass time were independent risk factors for ICU mortality. Careful patient selection is critical to optimize outcomes after HeartMate 3 LVAD implantation.</p

Mitigating Gender Bias in Machine Learning Data Sets

Artificial Intelligence has the capacity to amplify and perpetuate societal biases and presents profound ethical implications for society. Gender bias has been identified in the context of employment advertising and recruitment tools, due to their reliance on underlying language processing and recommendation algorithms. Attempts to address such issues have involved testing learned associations, integrating concepts of fairness to machine learning and performing more rigorous analysis of training data. Mitigating bias when algorithms are trained on textual data is particularly challenging given the complex way gender ideology is embedded in language. This paper proposes a framework for the identification of gender bias in training data for machine learning.The work draws upon gender theory and sociolinguistics to systematically indicate levels of bias in textual training data and associated neural word embedding models, thus highlighting pathways for both removing bias from training data and critically assessing its impact.Comment: 10 pages, 5 figures, 5 Tables, Presented as Bias2020 workshop (as part of the ECIR Conference) - http://bias.disim.univaq.i

Compact left-handed metamaterial based on double-layer planar metal strip arrays

The existence of a left-handed transmission peak of a metamaterial consisting of double-layer planar metal strip arrays at 15 GHz is demonstrated. This design is very suitable to submicron scales required at communication wavelengths. © 2006 Optical Society of America

Dynamical transition, hydrophobic interface, and the temperature dependence of electrostatic fluctuations in proteins

Molecular dynamics simulations have revealed a dramatic increase, with increasing temperature, of the amplitude of electrostatic fluctuations caused by water at the active site of metalloprotein plastocyanin. The increased breadth of electrostatic fluctuations, expressed in terms of the reorganization energy of changing the redox state of the protein, is related to the formation of the hydrophobic protein/water interface allowing large-amplitude collective fluctuations of the water density in the protein's first solvation shell. On the top of the monotonic increase of the reorganization energy with increasing temperature, we have observed a spike at 220 K also accompanied by a significant slowing of the exponential collective Stokes shift dynamics. In contrast to the local density fluctuations of the hydration-shell waters, these spikes might be related to the global property of the water solvent crossing the Widom line.Comment: 9 pages, 8 figure

The role of long-term mechanical circulatory support in patients with advanced heart failure

In patients with end-stage heart failure, advanced therapies such as heart transplantation and long-term mechanical circulatory support (MCS) with a left ventricular assist device (LVAD) have to be considered. LVADs can be implanted as a bridge to transplantation or as an alternative to heart transplantation: destination therapy. In the Netherlands, long-term LVAD therapy is gaining importance as a result of increased prevalence of heart failure together with a low number of heart transplantations due to shortage of donor hearts. As a result, the difference between bridge to transplantation and destination therapy is becoming more artificial since, at present, most patients initially implanted as bridge to transplantation end up receiving extended LVAD therapy. Following LVAD implantation, survival after 1, 2 and 3 years is 83%, 76% and 70%, respectively. Quality of life improves substantially despite important adverse events such as device-related infection, stroke, major bleeding and right heart failure. Early referral of potential candidates for long-term MCS is of utmost importance and positively influences outcome. In this review, an overview of the indications, contraindications, patient selection, clinical outcome and optimal time of referral for long-term MCS is given

Pricing Bodies: A Feminist New Materialist Approach to the Relations Between the Economic and Socio-Cultural

Arguments that the economic and socio-cultural should be understood as relational and intertwined, and that price involves a reciprocal relationship between the economic and socio-cultural, are increasingly prevalent in the social sciences. I develop these notions of relationality and reciprocation through a feminist new materialist perspective, which emphasises the entanglement of and intra-action between what might usually be seen as independent and autonomous entities. To do this, I focus on a range of recent body-image initiatives, led by government, corporate and non-profit organisations, which aim to improve girls’ and young women’s levels of confidence and self-esteem. I explore how feminist theory tends to see such initiatives in terms of the expansion of the economic sphere into the socio-cultural, which involves a tainting or contamination of embodiment and feeling. Rather than dispute these arguments, I take seriously theories and practices from cultural economy that see the economic and socio-cultural as co-constitutive. I augment these ideas with a feminist new materialist approach and argue that the economic and socio-cultural are in intra-active relations: they do not precede or exist apart from each other. In doing so, I consider how body-image initiatives can be understood as phenomena produced through these entangled intra-active relations, and offer an understanding of pricing as a simultaneously socio-cultural and economic process, where value and values become. I also raise questions regarding how, ethically and politically, boundary making and unmaking can be conceived, and how despite being in entangled relations, asymmetries between economic and socio-cultural relations may be approached

The HgMn Binary Star Phi Herculis: Detection and Properties of the Secondary and Revision of the Elemental Abundances of the Primary

Observations of the Mercury-Manganese star Phi Herculis with the Navy Prototype Optical Interferometer (NPOI) conclusively reveal the previously unseen companion in this single-lined binary system. The NPOI data were used to predict a spectral type of A8V for the secondary star Phi Her B. This prediction was subsequently confirmed by spectroscopic observations obtained at the Dominion Astrophysical Observatory. Phi Her B is rotating at 50 +/-3 km/sec, in contrast to the 8 km/sec lines of Phi Her A. Recognizing the lines from the secondary permits one to separate them from those of the primary. The abundance analysis of Phi Her A shows an abundance pattern similar to those of other HgMn stars with Al being very underabundant and Sc, Cr, Mn, Zn, Ga, Sr, Y, Zr, Ba, Ce, and Hg being very overabundant.Comment: Accepted to ApJ, 45 pages, 11 figure

Paget's disease of the breast in a male with lymphomatoid papulosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Paget's disease is an eczematous skin change of the nipple that is usually associated with an underlying breast malignancy. Male breast cancer represents only 1-3% of all breast malignancies and Paget's disease remains very rare.</p> <p>Case presentation</p> <p>We present the case of a 67-year-old Caucasian man with lymphomatoid papulosis who was diagnosed with Paget's disease of the nipple and who was treated successfully with surgery alone. We discuss the presentation, investigations, management and pathogenesis of Paget's disease of the nipple.</p> <p>Conclusion</p> <p>The case highlights the need to be vigilant when new skin lesions arise in the context of an underlying chronic skin disorder.</p

No relationship between left ventricular radial wall motion and longitudinal velocity and the extent and severity of noncompaction cardiomyopathy

<p>Abstract</p> <p>Background</p> <p>Noncompaction cardiomyopathy (NCCM) is characterized by a prominent trabecular meshwork and deep intertrabecular recesses. Although systolic dysfunction is common, limited information is available on differences in wall motion of the normal compacted and noncompacted segments. The purpose of this study was to assess radial wall motion and longitudinal wall velocity in patients with NCCM, according to the extent and severity of noncompaction.</p> <p>Methods</p> <p>The study comprised 29 patients in sinus rhythm (age 41 ± 15 years, 15 men), who fulfilled stringent diagnostic criteria for NCCM and compared to 29 age and gender matched healthy controls. Segmental radial wall motion of all compacted and noncompacted segments was assessed with the standard visual wall motion score index and longitudinal systolic (Sm) wall velocity with tissue Doppler imaging of the mitral annulus. For each LV wall a normalized Sm value was calculated. The extent and severity of NC in each LV segment was assessed both in a qualitative and quantitative manner.</p> <p>Results</p> <p>Heart failure was the primary clinical presentation in half of the patients. NCCM patients had a wall motion score index of 1.68 ± 0.43 and a normalized Sm of 82 ± 20%. The total and maximal noncompaction scores were not related to the wall motion score index and the normalized Sm. NCCM patients with and without heart failure had similar total and maximal noncompaction scores.</p> <p>Conclusions</p> <p>In NCCM patient's radial wall motion and longitudinal LV wall velocity is impaired but not related to the extent or severity of noncompaction.</p