Increased prevalence of left ventricular hypertrophy in hypertensive women with type 2 diabetes mellitus

BACKGROUND: Left ventricular hypertrophy (LVH) is a powerful independent risk factor for cardiovascular morbidity and mortality among hypertensive patients. Data regarding relationships between diabetes and LVH are controversial and inconclusive, whereas possible gender differences were not specifically investigated. The goal of this work was to investigate whether gender differences in left heart structure and mass are present in hypertensive patients with type 2 diabetes. METHODS: Five hundred fifty hypertensive patients with at least one additional cardiovascular risk factor (314 men and 246 women, age 52 to 81, mean 66 ± 6 years), were enrolled in the present analysis. In 200 (36%) of them – 108 men and 92 women – type 2 diabetes mellitus was found upon enrollment. End-diastolic measurements of interventricular septal thickness (IVS), LV internal diameter, and posterior wall thickness were performed employing two-dimensionally guided M-mode echocardiograms. LVH was diagnosed when LV mass index (LVMI) was >134 g/m(2 )in men and >110 g/m(2 )in women. RESULTS: Mean LVMI was significantly higher among diabetic vs. nondiabetic women (112.5 ± 29 vs. 105.6 ± 24, p = 0.03). In addition, diabetic women presented a significantly higher prevalence of increased IVS thickness, LVMI and left atrial diameter on intra-gender comparisons. The age adjusted relative risk for increased LVMI in diabetics vs. nondiabetics was 1.47 (95% CI: 1.0–2.2) in females and only 0.8 (0.5–1.3) in males. CONCLUSION: Type 2 diabetes mellitus was associated with a significantly higher prevalence of LVH and left atrial enlargement in hypertensive women

Coordinate to cooperate or compete:Abstract goals and joint intentions in social interaction

Successfully navigating the social world requires reasoningabout both high-level strategic goals, such as whether to co-operate or compete, as well as the low-level actions neededto achieve those goals. While previous work in experimentalgame theory has examined the former and work on multi-agentsystems has examined the later, there has been little work in-vestigating behavior in environments that require simultaneousplanning and inference across both levels. We develop a hierar-chical model of social agency that infers the intentions of otheragents, strategically decides whether to cooperate or competewith them, and then executes either a cooperative or competi-tive planning program. Learning occurs across both high-levelstrategic decisions and low-level actions leading to the emer-gence of social norms. We test predictions of this model inmulti-agent behavioral experiments using rich video-game likeenvironments. By grounding strategic behavior in a formalmodel of planning, we develop abstract notions of both co-operation and competition and shed light on the computationalnature of joint intentionality

Reimagining the research-practice relationship: policy recommendations for informatics-enabled evidence-generation across the US health system

Abstract. The widespread adoption and use of electronic health records and their use to enable learning health systems (LHS) holds great promise to accelerate both evidence-generating medicine (EGM) and evidence-based medicine (EBM), thereby enabling a LHS. In 2016, AMIA convened its 10th annual Policy Invitational to discuss issues key to facilitating the EGM-EBM paradigm at points-of-care (nodes), across organizations (networks), and to ensure viability of this model at scale (sustainability). In this article, we synthesize discussions from the conference and supplements those deliberations with relevant context to inform ongoing policy development. Specifically, we explore and suggest public policies needed to facilitate EGM-EBM activities on a national scale, particularly those policies that can enable and improve clinical and health services research at the point-of-care, accelerate biomedical discovery, and facilitate translation of findings to improve the health of individuals and population

An Algorithm for the Fitting of Planet Models to Kepler Light Curves

We describe an algorithm which fits model planetary system parameters to light curves from Kepler Mission target stars. The algorithm begins by producing an initial model of the system which is used to seed the fit,with particular emphasis on obtaining good transit timing parameters. An attempt is then made to determine whether the observed transits are more likely due to a planet or an eclipsing binary. In the event that the transits are consistent with a transiting planet, an iterative fitting process is initiated: a wavelet-based whitening filter is used to eliminate stellar variations on timescales long compared to a transit; a robust nonlinear fitter operating on the whitened light curve produces a new model of the system; and the procedure iterates until convergence upon a self-consistent whitening filter and planet model. The fitted transits are removed from the light curve anda search for additional planet candidates is performed upon the residual light curve. The fitted models are used in additional tests which identify false positive planet detections: multiple planet candidates with near-identical fitted periods are far more likely to be an eclipsing binary, for example, while target stars in which the model lightcurve is correlated with the star centroid position may indicate a background eclipsing binary, and subtraction of all model planet candidates yields a light curve of pure noise and stellar variability, which can be used to study the probability that the planet candidates result from statistical fluctuations in the data

Cardiovascular Events in Patients Received Combined Fibrate/Statin Treatment versus Statin Monotherapy: Acute Coronary Syndrome Israeli Surveys Data

The effect of combination of fibrate with statin on major adverse cardiovascular events (MACE) following acute coronary syndrome (ACS) hospitalization is unclear. The main aim of this study was to investigate the 30-day rate of MACE in patients who participated in the nationwide ACS Israeli Surveys (ACSIS) and were treated on discharge with a fibrate (mainly bezafibrate) and statin combination vs. statin alone.The study population comprised 8,982 patients from the ACSIS 2000, 2002, 2004, 2006, 2008 and 2010 enrollment waves who were alive on discharge and received statin. Of these, 8,545 (95%) received statin alone and 437 (5%) received fibrate/statin combination. MACE was defined as a composite measure of death, recurrent MI, recurrent ischemia, stent thrombosis, ischemic stroke and urgent revascularization.Patients from the combination group were younger (58.1±11.9 vs. 62.9±12.6 years). However, they had significantly more co-morbidities (hypertension, diabetes), current smokers and unfavorable cardio-metabolic profiles (with respect to glucose, total cholesterol, triglyceride and HDL-cholesterol). Development of MACE was recorded in 513 (6.0%) patients from the statin monotherapy group vs. 13 (3.2%) from the combination group, p = 0.01. 30-day re-hospitalization rate was significantly lower in the combination group: 68 (15.6%) vs. 1691 (19.8%) of patients, respectively; p = 0.03. Multivariable analysis identified the fibrate/statin combination as an independent predictor of reduced risk of MACE with odds ratio of 0.54, 95% confidence interval 0.32–0.94.A significantly lower risk of 30-day MACE rate was observed in patients receiving combined fibrate/statin treatment following ACS compared with statin monotherapy. However, caution should be exercised in interpreting these findings taking into consideration baseline differences between our observational study groups

Bezafibrate treatment is associated with a reduced rate of re-hospitalization in smokers after acute coronary syndrome

Background: Significantly increased rate of hospitalizations in current smokers is a major smoking-related problem which is associated with a heavy economic burden, whereas car­diovascular disease accounted for nearly half of hospitalizations. The effect of bezafibrate on the rate of re-hospitalization in smokers already treated with statin immediately post-acute coronary syndrome (ACS) is unknown. The aim of this study was to investigate 30-day rate of re-hospitalization in current smokers participating in the ACS Israeli Surveys (ACSIS) and who were treated on discharge with a bezafibrate/statin combination vs. statin alone. Methods: The study population comprised 3392 patients with confirmed current smoking status from the ACSIS 2000, 2002, 2004, 2006, 2008 and 2010 enrollment waves who were alive on discharge and received statin. Of these, 3189 (94%) were discharged with statin alone, 203 (6%) with a combination of a statin and bezafibrate. Results: Thirty-day re-hospitalization rate was significantly lower in patients from the com­bination group than in their counterparts from the statin monotherapy group: 12.8% vs. 19%, p = 0.028. Multivariable analysis identified the combined bezafibrate/statin treatment as an independent predictor of reduced risk of 30-day re-hospitalization rate with odds ratio (OR) 0.53 (95% confidence interval [CI] 0.31–0.91), and it corresponded to 47% risk reduction. Other significant variables in our model associated with independent risk of 30-day re-hospi­talization rate during the follow-up were female gender (OR 1.43, CI 1.05–1.95, p = 0.03) and age > 65 years (OR 1.49, CI 1.13–1.95, p = 0.004). Conclusions: Adding bezafibrate to statin in smokers was associated with a significantly reduced 30-day rate of re-hospitalization after ACS.

Photometric Analysis in the Kepler Science Operations Center Pipeline

We describe the Photometric Analysis (PA) software component and its context in the Kepler Science Operations Center (SOC) pipeline. The primary tasks of this module are to compute the photometric flux and photocenters (centroids) for over 160,000 long cadence (~thirty minute) and 512 short cadence (~one minute) stellar targets from the calibrated pixels in their respective apertures. We discuss the science algorithms for long and short cadence PA: cosmic ray cleaning; background estimation and removal; aperture photometry; and flux-weighted centroiding. We discuss the end-to-end propagation of uncertainties for the science algorithms. Finally, we present examples of photometric apertures, raw flux light curves, and centroid time series from Kepler flight data. PA light curves, centroid time series, and barycentric timestamp corrections are exported to the Multi-mission Archive at Space Telescope [Science Institute] (MAST) and are made available to the general public in accordance with the NASA/Kepler data release policy