Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults with Atrial Fibrillation

Objective: To examine the extent of, and factors associated with, patient engagement in shared decision-making (SDM) for stroke prevention among patients with atrial fibrillation (AF). Methods: We used data from the Systematic Assessment of Geriatric Elements-Atrial Fibrillation study which includes older ( \u3e /=65 years) patients with AF and a CHA2DS2-VASc \u3e /=2. Participants reported engagement in SDM by answering whether they actively participated in choosing to take an oral anticoagulant (OAC) for their condition. Multiple logistic regression was used to assess associations between sociodemographic, clinical, geriatric, and psychosocial factors and patient engagement in SDM. Results: A total of 807 participants (mean age 75 years; 48% female) on an OAC were studied. Of these, 61% engaged in SDM. Older participants ( \u3e /=80 years) and those cognitively impaired were less likely to engage in SDM, while those very knowledgeable of their AF associated stroke risk were more likely to do so than respective comparison groups. Conclusions: A considerable proportion of older adults with AF did not engage in SDM for stroke prevention with older patients and those cognitively impaired less likely to do so. Clinicians should identify patients who are less likely to engage in SDM, promote patient engagement, and foster better patient-provider communication which may enhance long-term patient outcomes

Use of natural variation reveals core genes in the transcriptome of iron-deficient Arabidopsis thaliana roots

Iron (Fe) is an essential mineral micronutrient for plants and animals. Plants respond to Fe deficiency by increasing root uptake capacity. Identification of gene networks for Fe uptake and homeostasis could result in improved crop growth and nutritional value. Previous studies have used microarrays to identify a large number of genes regulated by Fe deficiency in roots of three Arabidopsis ecotypes. However, a large proportion of these genes may be involved in secondary or genotype-influenced responses rather than in a universal role in Fe uptake or homeostasis. Here we show that a small percentage of the Fe deficiency transcriptome of two contrasting ecotypes, Kas-1 and Tsu-1, was shared with other ecotypes. Kas-1 and Tsu-1 had different timing and magnitude of ferric reductase activity upon Fe withdrawal, and different categories of overrepresented Fe-regulated genes. To gain insights into universal responses of Arabidopsis to Fe deficiency, the Kas-1 and Tsu-1 transcriptomes were compared with those of Col-0, Ler, and C24. In early Fe deficiency (24–48 h), no Fe-downregulated genes and only 10 upregulated genes were found in all ecotypes, and only 20 Fe-downregulated and 58 upregulated genes were found in at least three of the five ecotypes. Supernode gene networks were constructed to visualize conserved Fe homeostasis responses. Contrasting gene expression highlighted different responses to Fe deficiency between ecotypes. This study demonstrates the use of natural variation to identify central Fe-deficiency-regulated genes in plants, and identified genes with potential new roles in signalling during Fe deficiency

CH and CC bond activation reactions in silver alkynyl cluster cations, RCCAg2+

A range of silver alkynyl cations RCCAg2 + (R = H, Me, Et, Pr, Bu, tBu and Ph) can be "synthesized" in the gas phase via two approaches using electrospray ionization (ESI) multistage mass spectrometry experiments. The first involves injecting a solution of AgNO3 and the appropriate acid RCCCO2H in a MeOH/H2O solvent mixture into the ESI source, which yields the cluster cations (RCCAg)nAg + (n = 1-12) via decarboxylation. The second involves direct ESI of solutions of pre-synthesized silver acetylides, which yields a series of silver acetylide cluster cations of the type (RCCAg)nAg+ (n = 4-18), which upon CID yield RCCAg2 +. The low energy CID reactions of the silver alkynyl cations RCCAg2 + have been studied in a linear ion trap mass spectrometer. The rich fragmentation reactions observed included various combinations of CC and CH bond activation to yield the ionic products: (1) CH3CCAg2 + (R = Pr, Bu); (2) Ag2H+ (R = Et, Pr, Bu, tBu); and (3) HCCAg 2 + (R = tBu). Other fragmentation channels observed include; AgC bond cleavage and loss of Ag+. CID of the deuterium labelled cation, CD3CH2CH2CCAg2 + (m/z 284), show that: H/D scrambling is not involved in either the loss of CD2CH2 or the formation of Ag2H + (m/z 215). Formation of the latter ion involves the regioselective activation of the CH bond β to the triple bond, as revealed by the formation of Ag2D+ (m/z 216) in the CID spectrum of the deuterium labelled cation, CD3CD2CH2CCAg 2 + (m/z 286)

DeepSlice: rapid fully automatic registration of mouse brain imaging to a volumetric atlas

Abstract Registration of data to a common frame of reference is an essential step in the analysis and integration of diverse neuroscientific data. To this end, volumetric brain atlases enable histological datasets to be spatially registered and analyzed, yet accurate registration remains expertise-dependent and slow. In order to address this limitation, we have trained a neural network, DeepSlice, to register mouse brain histological images to the Allen Brain Common Coordinate Framework, retaining registration accuracy while improving speed by >1000 fold

Association between risk of obstructive sleep apnea and cognitive performance, frailty, and quality of life among older adults with atrial fibrillation

STUDY OBJECTIVES: Geriatric impairments and obstructive sleep apnea (OSA) are prevalent among older patients with atrial fibrillation (AF). Little is known about the association between OSA and geriatric impairments including frailty, cognitive performance, and AF-related quality of life. The objective of this study was to examine the associations of OSA with frailty, cognitive performance, and AF-related quality of life among older adults with AF. METHODS: Data from the Systemic Assessment of Geriatrics Elements-AF study were used which included AF participants 65 years and older and with a CHA2DS2-VASc \u3e /=2. The STOP-BANG questionnaire was used to assess the risk of OSA. Multivariable logistic regression models were used to examine the association between risk of OSA and geriatric impairments, adjusting for sociodemographic, geriatric, and clinical characteristics. RESULTS: A total of 970 participants (mean age 75 years; 51% male) were studied. Of the 680 participants without a medical history of OSA, 26% (n=179) of participants had a low risk of OSA, 53% (n=360) had an intermediate risk, and 21% (n=141) had a high risk for OSA. Compared to those with low risk of OSA, participants with an intermediate or high risk of OSA were more likely to be frail (adjusted odds ratio [aOR]= 1.67, 95% confidence interval [CI]: 1.08-2.56; aOR= 3.00, 95% CI: 1.69-5.32, respectively) in the fully adjusted models. CONCLUSIONS: Our findings identify a group of patients at high risk who would benefit from early screening for OSA. Future longitudinal studies are needed to assess the effect of OSA treatment on frailty, physical functioning, and QoL among patients with AF