Cardiac Rehabilitation Delivery in Low and Middle-Income Countries

Cardiovascular diseases are among the leading causes of disability in low- and middle-income countries (LMICs). Cardiac rehabilitation (CR) is an effective secondary prevention program model. In this cross-sectional study, a confidential, online surveywas administered to CR programs around the world. CR programs were identified in 55/138 (39.9%) LMICs; 47 (85.5% country response rate) countries participated and 335(53.5% program response rate) surveys were initiated. There was 1 CR spot for every66 incident ischemic heart disease patients in LMICs. CR was most often paid by patients in LMICs (n=212,65.0%). On average, programs offered 7.31.8/11 core components over 33.730.7 sessions (significantly greater in publicly-funded programs;p<.001). Lack of patient referral (3.8/5) and financial resources (3.5/5) were the greatest barriers to CR provision in LMICs. CR is only available in 40% of LMICs, but where offered is fairly consistent with CR guidelines. Governments must enact policies to reimburse CR so patients do notCardiovascular diseases are among the leading causes of disability in low- and middle-income countries (LMICs). Cardiac rehabilitation (CR) is an effective secondary prevention program model. In this cross-sectional study, a confidential, online surveywas administered to CR programs around the world. CR programs were identified in 55/138 (39.9%) LMICs; 47 (85.5% country response rate) countries participated and 335(53.5% program response rate) surveys were initiated. There was 1 CR spot for every66 incident ischemic heart disease patients in LMICs. CR was most often paid by patients in LMICs (n=212,65.0%). On average, programs offered 7.31.8/11 core components over 33.730.7 sessions (significantly greater in publicly-funded programs;p<.001). Lack of patient referral (3.8/5) and financial resources (3.5/5) were the greatest barriers to CR provision in LMICs. CR is only available in 40% of LMICs, but where offered is fairly consistent with CR guidelines. Governments must enact policies to reimburse CR so patients do not pay out-of-pocket

A Review of Cardiac Rehabilitation Delivery Around the World.

Herein, 28 publications describing cardiac rehabilitation (CR) delivery in 50 of the 113 countries globally suspected to deliver it are reviewed, to characterize the nature of services. Government funding was the main source of CR reimbursement in most countries (73%), with private and patient funding in about ¼ of cases. Myocardial infarction patients and those having revascularization were commonly served. The main professions delivering CR were physicians, nurses, and physiotherapists. Programs offered a median of 20 sessions, although this varied. Most programs offered the core components of exercise training, patient education and nutrition counselling. Alternative models were not commonly offered. Lack of human and/or financial resources as well as space constraints were reported as the major barriers to delivery. Overall, CR delivery has been characterized in less than half of the countries where it is offered. The nature of services delivered is fairly consistent with major CR guidelines and statements.non

UPAYA MENGATASI STEREOTIPE MUSIK KLASIK SEBAGAI ALAT REPRODUKSI SOSIAL KAUM ELITE (STUDI KASUS KOMUNITAS SANGGAR MUSICASA DI GAJAH MADA, JAKARTA PUSAT)

Stereotipe dapat diartikan sebagai suatu konsep pemikiran yang klise mengenai sifat, nilai ataupun golongan tertentu berdasarkan prasangka yang tidak tepat dan bersifat subjektif. Dalam penelitian ini akan melihat upaya yang dilakukan oleh Sanggar Musicasa untuk mengurangi reproduksi sosial pada pertunjukan musik klasik. Penelitian ini bertujuan untuk mendeskripsikan habitus pada musik klasik dalam lembaga Sanggar Musicasa. Selain itu, penelitian ini akan mendeskripsikan kiat-kiat yang dilakukan oleh Sanggar Musicasa untuk mengubah reproduksi sosial pada pertunjukan musik klasik. Penelitian ini menggunakan pendekatan deskriptif kualitatif dengan metode studi kasus yang merujuk pada tujuan penelitian ini untuk secara mendalam mengetahui habitus pada Sanggar Musicasa. Teknik pengumpulan data melalui teknik observasi, dokumentasi, penelitian terdahulu, dan wawancara mendalam secara langsung maupun online (daring) kepada 6 informan dalam penelitian. Subjek penelitian berjumlah 6 orang yang terdiri dari 1 penikmat dari Sanggar Musicasa yaitu Inayah, 4 murid dari Sanggar Musicasa yaitu Darwis, Michael, Angel, dan Eveline serta 1 pendiri dari Sanggar Musicasa yaitu Joseph Kristanto. Penelitian ini berlangsung sejak Januari 2021 - Maret 2021. Penelitian ini menggunakan konsep habitus yang melihat bahwa suatu produksi budaya dapat dikonsumsi dari salah satu stratifikasi sosial. Namun dalam penelitian ini dimana musik klasik merupakan suatu produk budaya yang bernilai tinggi itu sulit untuk diubah. Hasil dari penelitian ini menunjukan bahwa habitus yang ditunjukan oleh Sanggar Musicasa ini masih melanggengkan reproduksi sosial. Hal tersebut dilihat bahwa kegiatan dan konser yang dilakukan masih belum cukup bisa dikonsumsi oleh kalangan menengah ke bawah. Maka upaya yang telah dilakukan hingga saat ini oleh Sanggar Musicasa dengan merubah konsep pertunjukan dan harga iuran yang lebih murah dari sanggar lainnya masih sulit untuk merubah reproduksi sosial yang berkembang di dalam masyarakat. Hal tersebut dikarenakan adanya salah satu pengaruh dari konsep habitus yang menjelaskan bahwa ekonomi kapital juga mempengaruhi suatu produksi budaya yang dikonsumsi oleh masyarakat. Stereotype can be interpreted as a clichéd concept of thinking about certain traits, values or groups based on inappropriate and subjective judgments. In this study, the concept of habitus is used which can be interpreted as a thought, perception scheme, and action that lasts for a long time. And this research will look at the efforts made by Sanggar Musicasa to reduce social reproduction in classical music performances. This study aims to describe the habitus of classical music in the Sanggar Musicasa institution. In addition, this study will describe the tips used by Sanggar Musicasa for social change in classical music performances. This study uses a qualitative descriptive approach with a case study method that refers to the purpose of this study to find out in depth about the habitus of the Musicasa Studio. Data collection techniques through observation, documentation, previous research, and in-depth interviews directly and online to 6 informants in the study. The subjects studied were 6 people consisting of 1 connoisseur of the Musicasa Studio, namely Inayah, 4 students from the Musicasa Studio, namely Darwis, Michael, Angel, and Eveline and 1 founder of the Musicasa Studio, Joseph Kristanto. This research took place from January 2021 - March 2021. This study uses the concept of habitus which sees that a cultural production can be consumed from one of the social stratifications. However, in this study, classical music is a cultural product that deserves to be changed. The results of this study indicate that the habitus shown by Sanggar Musicasa is still perpetuating social reproduction. It is seen that the activities and concerts carried out are still not enough to be enjoyed by the lower middle class. Therefore, the efforts that have been made to date by the Musicasa Studio by changing the concept of performances and fees that are cheaper than other studios, are still difficult to change the social reproduction that develops in society. This is due to the influence of the habitus concept which explains that the capital economy also affects a cultural production that is consumed by the community

Tailoring three-dimensional topological codes for biased noise

Tailored topological stabilizer codes in two dimensions have been shown to exhibit high storage threshold error rates and improved subthreshold performance under biased Pauli noise. Three-dimensional (3D) topological codes can allow for several advantages including a transversal implementation of non-Clifford logical gates, single-shot decoding strategies, parallelized decoding in the case of fracton codes as well as construction of fractal lattice codes. Motivated by this, we tailor 3D topological codes for enhanced storage performance under biased Pauli noise. We present Clifford deformations of various 3D topological codes, such that they exhibit a threshold error rate of $50\%$ under infinitely biased Pauli noise. Our examples include the 3D surface code on the cubic lattice, the 3D surface code on a checkerboard lattice that lends itself to a subsystem code with a single-shot decoder, the 3D color code, as well as fracton models such as the X-cube model, the Sierpinski model and the Haah code. We use the belief propagation with ordered statistics decoder (BP-OSD) to study threshold error rates at finite bias. We also present a rotated layout for the 3D surface code, which uses roughly half the number of physical qubits for the same code distance under appropriate boundary conditions. Imposing coprime periodic dimensions on this rotated layout leads to logical operators of weight $O(n)$ at infinite bias and a corresponding $\exp[-O(n)]$ subthreshold scaling of the logical failure rate, where $n$ is the number of physical qubits in the code. Even though this scaling is unstable due to the existence of logical representations with $O(1)$ low-rate Pauli errors, the number of such representations scales only polynomially for the Clifford-deformed code, leading to an enhanced effective distance.Comment: 51 pages, 34 figure

Quantum Machine Learning in High Energy Physics

Machine learning has been used in high energy physics since a long time, primarily at the analysis level with supervised classification. Quantum computing was postulated in the early 1980s as way to perform computations that would not be tractable with a classical computer. With the advent of noisy intermediate-scale quantum computing devices, more quantum algorithms are being developed with the aim at exploiting the capacity of the hardware for machine learning applications. An interesting question is whether there are ways to combine quantum machine learning with High Energy Physics. This paper reviews the first generation of ideas that use quantum machine learning on problems in high energy physics and provide an outlook on future applications.Comment: 25 pages, 9 figures, submitted to Machine Learning: Science and Technology, Focus on Machine Learning for Fundamental Physics collectio

Absence of Barren Plateaus in Quantum Convolutional Neural Networks

Quantum neural networks (QNNs) have generated excitement around the possibility of efficiently analyzing quantum data. But this excitement has been tempered by the existence of exponentially vanishing gradients, known as barren plateau landscapes, for many QNN architectures. Recently, Quantum Convolutional Neural Networks (QCNNs) have been proposed, involving a sequence of convolutional and pooling layers that reduce the number of qubits while preserving information about relevant data features. In this work we rigorously analyze the gradient scaling for the parameters in the QCNN architecture. We find that the variance of the gradient vanishes no faster than polynomially, implying that QCNNs do not exhibit barren plateaus. This provides an analytical guarantee for the trainability of randomly initialized QCNNs, which highlights QCNNs as being trainable under random initialization unlike many other QNN architectures. To derive our results we introduce a novel graph-based method to analyze expectation values over Haar-distributed unitaries, which will likely be useful in other contexts. Finally, we perform numerical simulations to verify our analytical results.Comment: 9 + 20 pages, 7 + 8 figures, 3 tables. Updated to published versio

Active and passive procrastination in terms of temperament and character

Background While passive procrastination is usually associated with distress and dysfunction active procrastination may be an effective coping style. To test this possibility, we examined passive and active procrastination in terms of temperament, character, and emotional intelligence (EI), as well as by a short-term longitudinal study. Methods Adult community volunteers (N = 126) self-reported twice in an online short-term longitudinal study. At baseline on active and passive procrastination, as well as on the temperament and character inventory of personality (TCI-140) and EI. At first testing, they were asked to freely describe three personal goals and to make action plans to achieve each within the next two weeks. Two weeks later they reported on progress on their personal goals (PPG). Results PPG correlated positively with active procrastination and negatively with passive procrastination. Dividing the participants into median splits on active and passive procrastination resulted in four groups: Active, Passive, Active-Passive, and Non-Procrastinators. Analysis of variance showed that active procrastinators had an advantage in temperament and character traits as well as EI. Active procrastinators were also higher than the other groups on personality profiles i.e. combinations of traits; dependable temperament and well-developed character. Conclusions Active procrastination can be an adaptive and productive coping style. It is associated with dependable temperament, well-developed character, and high emotional intelligence and predicts meeting personal goals

Cardiac Rehabilitation Models around the Globe.

Alternative models of cardiac rehabilitation (CR) delivery, such as home or community-based programs, have been developed to overcome underutilization. However, their availability and characteristics have never been assessed globally. In this cross-sectional study, a piloted survey was administered online to CR programs globally. CR was available in 111/203 (54.7%) countries globally; data were collected in 93 (83.8% country response rate). 1082 surveys (32.1% program response rate) were initiated. Globally, 85 (76.6%) countries with CR offered supervised programs, and 51 (45.9%; or 25.1% of all countries) offered some alternative model. Thirty-eight (34.2%) countries with CR offered home-based programs, with 106 (63.9%) programs offering some form of electronic CR (eCR). Twenty-five (22.5%) countries with CR offered community-based programs. Where available, programs served a mean of 21.4% ± 22.8% of their patients in home-based programs. The median dose for home-based CR was 3 sessions (Q25-Q75 = 1.0⁻4.0) and for community-based programs was 20 (Q25⁻Q75 = 9.6⁻36.0). Seventy-eight (47.0%) respondents did not perceive they had sufficient capacity to meet demand in their home-based program, for reasons including funding and insufficient staff. Where alternative CR models are offered, capacity is insufficient half the time. Home-based CR dose is insufficient to achieve health benefits. Allocation to program model should be evidence-based

Funding sources and costs to deliver cardiac rehabilitation around the globe: Drivers and barriers

Background: Cardiac rehabilitation (CR) reach is minimal globally, primarily due to financial factors. This study characterized CR funding sources, cost to patients to participate, cost to programs to serve patients, and the drivers of these costs. Methods: In this cross-sectional study, an online survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Costs in each country were reported using purchasing power parity (PPP). Results were compared by World Bank country income classification using generalized linear mixed models. Results: 111/203 (54.68%) countries in the world offer CR, of which data were collected in 93 (83.78% country response rate; N = 1082 surveys, 32.0% program response rate). CR was most-often publicly funded (more in high-income countries [HICs]; p < .001), but in 60.20% of countries patients paid some or all of the cost. Funding source impacted capacity (p = .004), number of patients per exercise session (p < .001), personnel (p = .037), and functional capacity testing (p = .039). The median cost to serve 1 patient was $945.91PPP globally. In low and middle-income countries (LMICs), exercise equipment and stress testing were perceived as the most expensive delivery elements, with front-line personnel costs perceived as costlier in HICs (p = .003). Modifiable factors associated with higher costs included CR team composition (p = .001), stress testing (p = .002) and telemetry monitoring in HICs (p = .01), and not offering alternative models in LMICs (p = .02). Conclusions: Too many patients are paying out-of-pocket for CR, and more public funding is needed. Lower-cost delivery approaches are imperative, and include walk tests, task-shifting, and intensity monitoring via perceived exertion

PINK1 and Parkin to control mitochondria remodeling

Parkinson's disease (PD), one of the most common neurodegenerative diseases, is characterized by movement disorders and a loss of dopaminergic (DA) neurons. PD mainly occurs sporadically, but may also result from genetic mutations in several PD-linked genes. Recently, genetic studies with Drosophila mutants, parkin and PINK1, two common PD-associated genes, demonstrated that Parkin acts downstream of PINK1 in maintaining mitochondrial function and integrity. Further studies revealed that PINK1 translocates Parkin to mitochondria and regulates critical mitochondrial remodeling processes. These findings, which suggest that mitochondrial dysfunction is a prominent cause of PD pathogenesis, provide valuable insights which may aid in the development of effective treatments for PD