The Heart Failure Overweight/Obesity Survival Paradox : The Missing Sex Link

Objectives: This study sought to determine whether body mass index (BMI) has a differential impact on survival for females versus males with advanced systolic heart failure (HF). Background: Females have a survival advantage in HF, the mechanisms of which are unclear. There is also a proposed “obesity survival paradox” in which excess adiposity promotes HF survival. Methods: We reviewed 3,811 patients with left ventricular ejection fraction ≤40% who had undergone cardiopulmonary exercise testing between 1995 and 2011. The endpoint was all-cause mortality. Multivariable analysis was performed using a Cox proportional hazards model. Because of the nonlinearity of BMI, a restricted cubic spline was used. An interaction term was added to investigate the impact of BMI on mortality by sex. Results: The unadjusted data demonstrated an overall obesity survival paradox in HF. This survival paradox disappeared for males after adjustment for potential confounders, with overweight and obese males showing higher adjusted mortality hazard ratios compared with normal weight males. Conversely, females in the overweight BMI range (25.0 to 29.9 kg/m2) had the lowest adjusted mortality (hazard ratio: 0.84; 95% confidence interval: 0.77 to 0.93; p = 0.0005 compared with normal weight females) with a nadir in mortality hazard just below BMI 30 kg/m2. The multivariable model supported a differential impact of BMI on mortality in males versus females (p for interaction \u3c0.0001). Conclusions: In this advanced HF cohort, an unadjusted obesity survival paradox disappeared after adjustment for confounders. Overweight and obese males had higher adjusted mortality than normal weight males, whereas a BMI in the overweight range was associated with a significant survival benefit in females

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

INTRODUCTION: Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. METHODS: Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004-2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. RESULTS: A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = -0.17; 95% confidence interval [CI] = [-0.25, -0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. CONCLUSIONS: Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings

Nanostructure Dependence of T‐Nb₂O₅ Intercalation Pseudocapacitance Probed Using Tunable Isomorphic Architectures

Intercalation pseudocapacitance has emerged as a promising energy storage mechanism that combines the energy density of intercalation materials with the power density of capacitors. Niobium pentoxide was the first material described as exhibiting intercalation pseudocapacitance. The electrochemical kinetics for charging/discharging this material are surface‐limited for a wide range of conditions despite intercalation via diffusion. Investigations of niobium pentoxide nanostructures are diverse and numerous; however, none have yet compared performance while adjusting a single architectural parameter at a time. Such a comparative approach reduces the reliance on models and the associated assumptions when seeking nanostructure–property relationships. Here, a tailored isomorphic series of niobium pentoxide nanostructures with constant pore size and precision tailored wall thickness is examined. The sweep rate at which niobium pentoxide transitions from being surface‐limited to being diffusion‐limited is shown to depend sensitively upon the nanoscale dimensions of the niobium pentoxide architecture. Subsequent experiments probing the independent effects of electrolyte concentration and film thickness unambiguously identify solid‐state lithium diffusion as the dominant diffusion constraint even in samples with just 48.5–67.0 nm thick walls. The resulting architectural dependencies from this type of investigation are critical to enable energy‐dense nanostructures that are tailored to deliver a specific power density

Rift Valley Fever Virus Infection in Golden Syrian Hamsters

Rift Valley fever virus (RVFV) is a formidable pathogen that causes severe disease and abortion in a variety of livestock species and a range of disease in humans that includes hemorrhagic fever, fulminant hepatitis, encephalitis and blindness. The natural transmission cycle involves mosquito vectors, but exposure can also occur through contact with infected fluids and tissues. The lack of approved antiviral therapies and vaccines for human use underlies the importance of small animal models for proof-of-concept efficacy studies. Several mouse and rat models of RVFV infection have been well characterized and provide useful systems for the study of certain aspects of pathogenesis, as well as antiviral drug and vaccine development. However, certain host-directed therapeutics may not act on mouse or rat pathways. Here, we describe the natural history of disease in golden Syrian hamsters challenged subcutaneously with the pathogenic ZH501 strain of RVFV. Peracute disease resulted in rapid lethality within 2 to 3 days of RVFV challenge. High titer viremia and substantial viral loads were observed in most tissues examined; however, histopathology and immunostaining for RVFV antigen were largely restricted to the liver. Acute hepatocellular necrosis associated with a strong presence of viral antigen in the hepatocytes indicates that fulminant hepatitis is the likely cause of mortality. Further studies to assess the susceptibility and disease progression following respiratory route exposure are warranted. The use of the hamsters to model RVFV infection is suitable for early stage antiviral drug and vaccine development studies

Faraday waves on a viscoelastic liquid

We investigate Faraday waves on a viscoelastic liquid. Onset measurements and a nonlinear phase diagram for the selected patterns are presented. By virtue of the elasticity of the material a surface resonance synchronous to the external drive competes with the usual subharmonic Faraday instability. Close to the bicriticality the nonlinear wave interaction gives rise to a variety of novel surface states: Localised patches of hexagons, hexagonal superlattices, coexistence of hexagons and lines. Theoretical stability calculations and qualitative resonance arguments support the experimental observations.Comment: 4 pages, 4figure

Mechanisms of Hemolysis-Associated Platelet Activation

Background Intravascular hemolysis occurs after blood transfusion, in hemolytic anemias, and in other conditions, and is associated with hypercoagulable states. Hemolysis has been shown to potently activate platelets in vitro and in vivo, and several mechanisms have been suggested to account for this, including: (i) direct activation by hemoglobin (Hb); (ii) increase in reactive oxygen species (ROS); (iii) scavenging of nitric oxide (NO) by released Hb; and (iv) release of intraerythrocytic ADP. Objective To elucidate the mechanism of hemolysis-mediated platelet activation. Methods We used flow cytometry to detect PAC-1 binding to activated platelets for in vitro experiments, and a Siemens\u27 Advia 120 hematology system to assess platelet aggregation by using platelet counts from in vivo experiments in a rodent model. Results We found that Hb did not directly activate platelets. However, ADP bound to Hb could cause platelet activation. Furthermore, platelet activation caused by shearing of red blood cells (RBCs) was reduced in the presence of apyrase, which metabolizes ADP to AMP. The use of ROS scavengers did not affect platelet activation. We also found that cell-free Hb enhanced platelet activation by abrogating the inhibitory effect of NO on platelet activation. In vivo infusions of ADP and purified (ADP-free) Hb, as well as hemolysate, resulted in platelet aggregation, as shown by decreased platelet counts. Conclusion Two primary mechanisms account for RBC hemolysis-associated platelet activation: ADP release, which activates platelets; and cell-free Hb release, which enhances platelet activation by lowering NO bioavailability

Lean Six Sigma Approach to Implement a Femur Fracture Care Pathway at “San Giovanni di Dio e Ruggi d’Aragona” University Hospital

Timeliness in the treatment of fracture of the femur, through surgery, is crucial in the elderly patient as it reduces the risk of mortality and disability. Here we propose a Lean Six Sigma (LSS) approach to reduce the preoperative length of stay for patients with femur fracture. Through the LSS, a tailored Diagnostic Therapeutic Assistance Path (DTAP) for these has been implemented and monitored over time. In particular, through the analysis, based on the application of the DMAIC cycle conducted on data extrapolated from the information system of the “San Giovanni di Dio e Ruggi d’Aragona” University Hospital of Salerno, the new DTAP was designed and implemented. After the introduction of the DTAP, a significant reduction in the average length of hospital stay was observed, with a preoperative length of stay within 48 h in 65% cases (compared to the previous 9%). In particular, the most significant reduction (over 55%) is obtained for patients aged over 65 years old. Such a result reflects not only the improvement in the care process but it is also compliant with the guidelines of the Italian Ministry of Health, as reported in the New Guarantee System for monitoring the quality of care. © 2021, Springer Nature Switzerland AG

Forward pi^0 Production and Associated Transverse Energy Flow in Deep-Inelastic Scattering at HERA

Deep-inelastic positron-proton interactions at low values of Bjorken-x down to x \approx 4.10^-5 which give rise to high transverse momentum pi^0 mesons are studied with the H1 experiment at HERA. The inclusive cross section for pi^0 mesons produced at small angles with respect to the proton remnant (the forward region) is presented as a function of the transverse momentum and energy of the pi^0 and of the four-momentum transfer Q^2 and Bjorken-x. Measurements are also presented of the transverse energy flow in events containing a forward pi^0 meson. Hadronic final state calculations based on QCD models implementing different parton evolution schemes are confronted with the data.Comment: 27 pages, 8 figures and 3 table

Direct observation and control of near-field radiative energy transfer in a natural hyperbolic material

Heat control is a key issue in nano-electronics, where new efficient energy transfer mechanisms are highly sought after. In this respect, there is indirect evidence that high-mobility hexagonal boron nitride (hBN)-encapsulated graphene exhibits hyperbolic out-of-plane radiative energy transfer when driven out-of-equilibrium. Here we directly observe radiative energy transfer due to the hyperbolic phonon polaritons modes of the hBN encapsulant in intrinsic graphene devices under large bias, using mid-infrared spectroscopy and pyrometry. By using different hBN crystals of varied crystalline quality, we engineer the energy transfer efficiency, a key asset for compact thermal management of electronic circuits.Comment: 21 pages including Supplementary Material (Main text: 10 pages, 4 figures