Development of a percutaneous coronary intervention patient level composite measure for a clinical quality registry

© 2020 The Author(s). Background: Composite measures combine data to provide a comprehensive view of patient outcomes. Despite composite measures being a valuable tool to assess post-intervention outcomes, the patient perspective is often missing. The purpose of this study was to develop a composite measure for an established cardiac outcome registry, by combining clinical outcomes following percutaneous coronary interventions (PCI) with a patient-reported outcome measure (PROM) developed specifically for this population (MC-PROM). Methods: Two studies were undertaken. Study 1: Patients who had undergone a PCI at one of the three participating registry hospital sites completed the 5-item MC-PROM. Clinical outcome data for the patients (e.g. death, myocardial infarction, repeat vascularisation, new bleeding event) were collected 30 days post-intervention as part of routine data collection for the cardiac registry. Exploratory factor analysis of clinical outcomes and MC-PROM data was conducted to determine the minimum number of constructs to be included in a composite measure. Study 2: Clinical experts participated in a Delphi technique, consisting of three rounds of online surveys, to determine the clinical outcomes to be included and the weighting of the clinical outcomes and MC-PROM score for the composite measure. Results: Study 1: Routine clinical outcomes and the MC-PROM data were collected from 266 patients 30 days post PCI. The MC-PROM score was not significantly correlated with any clinical outcomes. Study 2: There was a relatively consistent approach to the weighting of the clinical outcomes and MC-PROM items by the expert panel (n = 18) across the three surveys with the exception of the clinical outcome of 'deceased at 30 days'. The final composite measure included five clinical outcomes within 30 days weighted at 90% (new heart failure, new myocardial infarction, new stent thrombosis, major bleeding event, new stroke, unplanned cardiac rehospitalisation) and the MC-PROM score (comprising 10% of the total weighting). Conclusions: A single patient level composite score, which incorporates weighted clinical outcomes and a PROM was developed. This composite score provides a more comprehensive reported measure of individual patient wellbeing at 30 days post their PCI-procedure, and may assist clinicians to further assess and address patient level factors that potentially impact on clinical recovery

Examining non-syndromic autosomal recessive intellectual disability (NS-ARID) genes for an enriched association with intelligence differences

AbstractTwo themes are emerging regarding the molecular genetic aetiology of intelligence. The first is that intelligence is influenced by many variants and those that are tagged by common single nucleotide polymorphisms account for around 30% of the phenotypic variation. The second, in line with other polygenic traits such as height and schizophrenia, is that these variants are not randomly distributed across the genome but cluster in genes that work together. Less clear is whether the very low range of cognitive ability (intellectual disability) is simply one end of the normal distribution describing individual differences in cognitive ability across a population. Here, we examined 40 genes with a known association with non-syndromic autosomal recessive intellectual disability (NS-ARID) to determine if they are enriched for common variants associated with the normal range of intelligence differences. The current study used the 3511 individuals of the Cognitive Ageing Genetics in England and Scotland (CAGES) consortium. In addition, a text mining analysis was used to identify gene sets biologically related to the NS-ARID set. Gene-based tests indicated that genes implicated in NS-ARID were not significantly enriched for quantitative trait loci (QTL) associated with intelligence. These findings suggest that genes in which mutations can have a large and deleterious effect on intelligence are not associated with variation across the range of intelligence differences

Sea-air CO2 fluxes in the Southern Ocean for the period 1990–2009

The Southern Ocean (44–75°S) plays a critical role in the global carbon cycle, yet remains one of the most poorly sampled ocean regions. Different approaches have been used to estimate sea–air CO2 fluxes in this region: synthesis of surface ocean observations, ocean biogeochemical models, and atmospheric and ocean inversions. As part of the RECCAP (REgional Carbon Cycle Assessment and Processes) project, we combine these different approaches to quantify and assess the magnitude and variability in Southern Ocean sea–air CO2 fluxes between 1990–2009. Using all models and inversions (26), the integrated median annual sea–air CO2 flux of −0.42 ± 0.07 PgC yr−1 for the 44–75°S region, is consistent with the −0.27 ± 0.13 PgC yr−1 calculated using surface observations. The circumpolar region south of 58°S has a small net annual flux (model and inversion median: −0.04 ± 0.07 PgC yr−1 and observations: +0.04 ± 0.02 PgC yr−1), with most of the net annual flux located in the 44 to 58°S circumpolar band (model and inversion median: −0.36 ± 0.09 PgC yr−1 and observations: −0.35 ± 0.09 PgC yr−1). Seasonally, in the 44–58°S region, the median of 5 ocean biogeochemical models captures the observed sea–air CO2 flux seasonal cycle, while the median of 11 atmospheric inversions shows little seasonal change in the net flux. South of 58°S, neither atmospheric inversions nor ocean biogeochemical models reproduce the phase and amplitude of the observed seasonal sea–air CO2 flux, particularly in the AustralWinter. Importantly, no individual atmospheric inversion or ocean biogeochemical model is capable of reproducing both the observed annual mean uptake and the observed seasonal cycle. This raises concerns about projecting future changes in Southern Ocean CO2 fluxes. The median interannual variability from atmospheric inversions and ocean biogeochemical models is substantial in the Southern Ocean; up to 25% of the annual mean flux, with 25% of this interannual variability attributed to the region south of 58°S. Resolving long-term trends is difficult due to the large interannual variability and short time frame (1990–2009) of this study; this is particularly evident from the large spread in trends from inversions and ocean biogeochemical models. Nevertheless, in the period 1990–2009 ocean biogeochemical models do show increasing oceanic uptake consistent with the expected increase of −0.05 PgC yr−1 decade−1. In contrast, atmospheric inversions suggest little change in the strength of the CO2 sink broadly consistent with the results of Le Quéré et al. (2007)

The Association between Metabolic Syndrome, Frailty and Disability-Free Survival in Healthy Community-dwelling Older Adults

Published online November 14, 2022OBJECTIVES: To examine the association between metabolic syndrome (MetS) and frailty, and determine whether co-existent MetS and frailty affect disability-free survival (DFS), assessed through a composite of death, dementia or physical disability. DESIGN: Longitudinal study. SETTING AND PARTICIPANTS: Community-dwelling older adults from Australia and the United States (n=18,264) from “ASPirin in Reducing Events in the Elderly” (ASPREE) study. MEASUREMENTS: MetS was defined according to American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018). A modified Fried phenotype and a deficit accumulation Frailty Index (FI) were used to assess frailty. Association between MetS and frailty was examined using multinomial logistic regression. Cox regression was used to analyze the association between MetS, frailty and DFS over a median followup of 4.7 years. RESULTS: Among 18,264 participants, 49.9% met the criteria for MetS at baseline. Participants with Mets were more likely to be prefrail [Relative Risk Ratio (RRR): 1.22; 95%Confidence Interval (CI): 1.14, 1.30)] or frail (RRR: 1.66; 95%CI: 1.32, 2.08) than those without MetS. MetS alone did not shorten DFS while pre-frailty or frailty alone did [Hazard Ratio (HR): 1.68; 95%CI: 1.45, 1.94; HR: 2.65; 95%CI:1.92, 3.66, respectively]. Co-existent MetS with pre-frailty/ frailty did not change the risk of shortened DFS. CONCLUSIONS: MetS was associated with pre-frailty or frailty in community-dwelling older individuals. Pre-frailty or frailty increased the risk of reduced DFS but presence of MetS did not change this risk. Assessment of frailty may be more important than MetS in predicting survival free of dementia or physical disability.A.R.M. Saifuddin Ekram, S.E. Espinoza, M.E. Ernst, J. Ryan, L. Beilin, N.P. Stocks, S.A. Ward, J.J. McNeil, R.C. Shah, R.L. Wood