The Morbidity & Mortality of Prevalent Heart Failure

The first study population included 292 unselected consecutive patients from the LLUMC heart failure clinic who were enrolled in the study from January to July 2006 and were followed up through the end of December 2010. The treatment policy at the clinic was to uptitrate dosages of beta-adrenergic blockade (β-blockers), angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) to the most tolerable levels in order to reach target dosages, as recommended by the Heart Failure Society of America (HFSA). Patients were classified into systolic heart failure (ejection fraction (EF) \u3c 40%) or diastolic heart failure (EF≥40%). All dosages of β-blockers, ACEi and ARB were extracted through chart reviews and were used as the main predictors of the patients\u27 survival. Results from analyses showed that reaching target dosages of β-blockers and ACEi/ARB may increase survival when compared to not reaching target among the systolic HF population (HRβ_biockers= 0.64, 95% CI 0.26-1.56 and HRACEi/ARB=0.50, 95% Cl 0.22-1.14). Similarly, the HR of 0.48 (95% Cl 0.13-1.81) for β-blocker therapy and HR of 0.21 (95% Cl 0.04-1.07) for ACEi/ARB therapy suggests improvements in survival with these drug regiments among the diastolic HF population. Unfortunately, the study lacked power to make the observations statistically significant. A larger sample size is needed to adequately address the possible benefits of these drugs for heart failure patients. The second study is comprised of a random, representative sample of 200 cases of self-reported congestive health failure (CHF) and 260 non-cases from the Adventist Health Study-2 (AHS-2). A total of 67 cases and 147 non-cases were successfully contacted or contacted through proxy and their consents were obtained for medical record review. Consenting participants’ medical records were retrieved and examined for the validity of self-reported heart failure. The sensitivity of self-reported CHF was calculated as 97.4% and the specificity was 83.4%. The positive predictive value was 56.7% and the negative predictive value was 99.3 %. Total agreement (accuracy) between presence of self-reported heart failure and obtained physician-diagnosed heart failure from medical records was 86.0%. Further study with a larger sample is necessary to obtain reliable measures of validity of self-reported CHF in this population

Inducibility of Latent HIV-1 in Resting CD4+ Memory T-cell Subsets

The latent reservoir (LR) for HIV-1 in resting memory CD4+ T-cells harbors integrated, replication-competent proviruses that are not actively transcribed while the T-cell remains in a resting state. Recent work has shown that proliferation of infected cells is a major factor in the generation, persistence, and stability of the latent reservoir. Given that the latent reservoir is the major barrier to HIV-1 cure, it is important to understand the proliferative process that contributes to the persistence of the LR. Stimuli that drive T-cell proliferation can also reactivate latent HIV-1, but productively infected cells have a short half-life. Several groups have shown that latently infected cells that clonally expand in vivo can be reactivated in vitro without producing virus. One hypothesis to explain this observation is that certain latently infected memory CD4+ subsets may be in a deeper state of latency and therefore may be able to proliferate without producing virus. To evaluate this possibility, we cultured resting naïve (TN), central memory (TCM), transitional memory (TTM), and effector memory (TEM) CD4+ T-cells from 10 HIV patients on suppressive ART in a multiple stimulation viral outgrowth assay (MSVOA). The frequencies of viral outgrowth calculated from p24 ELISAs were compared to the frequencies of intact proviral DNA copies calculated by the droplet digital PCR-based Intact Proviral DNA Assay (IPDA), and on average, only 1.5% of intact proviruses across all subsets were induced by multiple rounds of global T-cell activation. In addition, there was no enrichment of intact proviruses in any specific subset nor any correlation between the inducibility of intact proviruses and memory subset phenotype. Furthermore, we observed significant plasticity among the canonical memory subset surface markers during culture of the cells and saw significant patient-to-patient variability in inducibility patterns that complicates the vision for a targeted cure approach based on T-cell subsets

Electromyographic Comparison Between the Rear-Foot-Elevated vs. B-Stance Unilateral Back Squat Techniques

The Rear-Foot-Elevated back squat (RFE) and B-Stance (BS) are two unilateral back squat techniques with the latter commonly proposed as the more stable of the two. There is currently a lack of research comparing these two techniques with respect to neuromuscular demand and movement characteristics. PURPOSE: The purpose of this study was to examine the muscle activation differences via surface electromyography (EMG) between the RFE vs. BS unilateral back squat techniques with equated load. METHODS: Thirteen healthy college-aged, resistance-trained male (n=10) and female (n=3) subjects were recruited for this study. Subjects visited the laboratory on two occasions separated by 5-7 days. Visit 1 included descriptive measurements and one-repetition max (1RM) testing for the RFE back squat. For visit 2, subjects performed the RFE and BS unilateral squat techniques under a load of 85% of RFE 1RM. Electromyographic assessment of the external oblique (OBL), rectus femoris (RF), gluteus maximums (GM) and biceps femoris (BF) was administered during each technique and subsequently compared. RESULTS: A paired sample t-test was used to compare mean and peak normalized root mean square (RMS) EMG between the RFE and BS techniques. There was no significant difference in mean and peak eccentric, concentric, and total activation between the RFE vs. BS for the OBL and RF. For GM, mean and peak eccentric, concentric, and total activation was greater during the RFE vs. BS (pCONCLUSION: The RFE unilateral back squat technique elicited overall greater activation of the hip extensors, GM and BF vs. BS. Based on these findings, the two unilateral squat techniques are not interchangeable from a muscle activation perspective which should be considered when employing unilateral back squat variations in training or rehabilitation programs

Variation in Treatment of Patients With Inflammatory Bowel Diseases at Major Referral Centers in the United States

We performed a prospective study of patients with inflammatory bowel diseases to examine variations in treatment among medical centers. In a prospective cohort study of 1659 patients with CD and 946 patients with UC seen at 7 high-volume referral centers, we collected data on demographics, disease characteristic, and medical and surgical treatments. We used logistic regression to determine differences in treatment among centers, controlling for potential confounders. We found significant variations among centers in treatment of CD with immunomodulators (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.09 – 5.32) but not anti-tumor necrosis factor agents (OR, 1.64; 95% CI, 0.97 – 2.77). There was less variation in treatment of UC; we found no difference in use of immunomodulators (OR,1.83 95% CI, 1.00 – 3.36) or anti-TNF therapy (OR, 0.81; 95% CI, 0.40 – 1.65). Development and implementation of evidence-based standards of care for IBD may help reduce variation and improve outcomes

Visit-to-Visit Blood Pressure Variability and Sleep Architecture

Visit‐to‐visit blood pressure (BP) variability (BPV) is an independent risk factor of cardiovascular disease (CVD). Sleep architecture characterizes the distribution of different stages of sleep and may be important in CVD development. We examined the association between visit‐to‐visit BPV and sleep architecture using in‐lab polysomnographic data from 3,565 patients referred to an academic sleep center. BPV was calculated using the intra‐individual coefficient of variation of BP measures collected 12 months before the sleep study. We conducted multiple linear regression analyses to assess the association of systolic and diastolic BPV with sleep architecture—rapid eye movement (REM) and non‐rapid eye movement (NREM) sleep duration. Our results show that systolic BPV was inversely associated with REM sleep duration (p = .058). When patients were divided into tertile groups based on their BPV, those in the third tertile (highest variability) spent 2.7 fewer minutes in REM sleep than those in the first tertile (lowest variability, p = .032), after adjusting for covariates. We did not find an association of systolic BPV with other measures of sleep architecture. Diastolic BPV was not associated with sleep architecture either. In summary, our study showed that greater systolic BPV was associated with lower REM sleep duration. Future investigation is warranted to clarify the directionality, mechanism, and therapeutic implications

The Quest for National Digital Agility: Digital Responses to Covid-19 in Five Countries

Countries worldwide have employed different digital solutions to contain and cope with the Covid-19 pandemic. In this explorative case research, we examine national-level digital responses to the pandemic in four specific areas—tracking and tracing, health data reporting, teleconsultation, and vaccination mobilization—across five countries: China, Denmark, Germany, South Korea, and the U.S. Drawing on the notion of agility and digital infrastructures, our cross-case analysis unveils how the countries’ digital responses to the pandemic have been shaped by their national health system characteristics. In addition, we highlight how existing digital health infrastructures, regulatory adaptations, and industry collaborations fostered the alacrity with which nations responded to the pandemic. We define national-level digital agility as the ability of a nation to leverage digital infrastructure capabilities to address urgent societal challenges in a contextually appropriate way. Our key contribution is a model of this complex, but urgently needed concept containing five building blocks, each of which is a critical prerequisite to building such agility. Despite focusing on addressing the existing challenges of the ongoing Covid-19 pandemic, we believe that researchers and policymakers can also take pointers away from our framework to tackle other socio-environmental challenges

A Culturally Adapted Diabetes Prevention Intervention in the New York City Sikh Asian Indian Community Leads to Improvements in Health Behaviors and Outcomes

Sikh Asian Indians are an underserved, minority group demonstrating high rates of diabetes. Community health workers (CHWs) are effective in addressing health disparities by reaching socially and linguistically isolated populations. There are no culturally adapted programs for diabetes prevention among Sikh Asian Indians, thus, this study tests the efficacy of a culturally tailored CHW intervention to improve diabetes prevention-related outcomes among Sikh Asian Indians at risk for diabetes. A quasi-experimental two-arm intervention among Sikh Asian Indian adults at risk for diabetes and living in New York City (n = 160) was conducted in 2013-2014. The treatment group received six monthly CHW group education sessions and ten follow-up phone calls; the control group received the first session. Main outcome categories included weight, body mass index (BMI), blood pressure (BP), physical activity (PA), diet, and health self-efficacy. Positive and significant changes in weight, BMI, and diabetes prevention-related indicators were seen among both study groups. However, only treatment group participants showed significant changes over time for weight, BMI, PA self-efficacy, and health-related self-efficacy. Significant between-group differences were seen in adjusted analyses for weight, BMI, systolic BP, total weekly PA, PA self-efficacy, PA social interaction, portion control, barriers to healthy eating, and health self-efficacy. At 6 months, treatment participants were more likely to lose ≥ 5% and ≥ 7% of their weight compared to control participants (p = .071, and p = .015, respectively). Findings demonstrate that a culturally adapted CHW diabetes prevention program in the Sikh community is efficacious, adding to the growing literature on CHWs’ capacity to address health inequity among underserved populations

Knowledge of Chronic Kidney Disease Among Liver Transplant Recipients

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146385/1/lt25302-sup-0001-Supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146385/2/lt25302_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146385/3/lt25302.pd