Vectorcardiography Predicts Heart Failure in Patients Following ST Elevation Myocardial Infarction.

BACKGROUND: Modeling outcomes, such as onset of heart failure (HF) or mortality, in patients following ST elevation myocardial infarction (STEMI) is challenging but clinically very useful. The acute insult following a myocardial infarction and chronic degeneration seen in HF involve a similar process where a loss of cardiomyocytes and abnormal remodeling lead to pump failure. This process may alter the strength and direction of the heart's net depolarization signal. We hypothesize that changes over time in unique parameters extracted using vectorcardiography (VCG) have the potential to predict outcomes in patients post-STEMI and could eventually be used as a noninvasive and cost-effective surveillance tool for characterizing the severity and progression of HF to guide evidence-based therapies. METHODS: We identified 162 patients discharged from Michigan Medicine between 2016 and 2021 with a diagnosis of acute STEMI. For each patient, a single 12-lead ECG > 1 week pre-STEMI and > 1 week post-STEMI were collected. A set of unique VCG parameters were derived by analyzing features of the QRS complex. We used LASSO regression analysis incorporating clinical variables and VCG parameters to create a predictive model for HF, mortality, or the composite at 90, 180, and 365 days post-STEMI. RESULTS: The VCG model is most predictive for HF onset at 90 days with a robust AUC. Variables from the HF model mitigating or driving risk, at a p < 0.05, were primarily parameters that assess the area swept by the depolarization vector including the 3D integral and convex hull in select spatial octants and quadrants.

Exploring the feasibility and acceptability of community paramedicine programs in achieving vaccination equity: a qualitative study.

BACKGROUND: Mobile Integrated Health-Community Paramedicine (MIH-CP) is a novel approach that may reduce the rural-urban disparity in vaccination uptake in the United States. MIH-CP providers, as physician extenders, offer clinical follow-up and wrap-around services in homes and communities, uniquely positioning them as trusted messengers and vaccine providers. This study explores stakeholder perspectives on feasibility and acceptability of community paramedicine vaccination programs. METHODS: We conducted semi-structured qualitative interviews with leaders of paramedicine agencies with MIH-CP, without MIH-CP, and state/regional leaders in Indiana. Interviews were audio recorded, transcribed verbatim, and analyzed using content analysis. RESULTS: We interviewed 24 individuals who represented EMS organizations with MIH-CP programs (MIH-CP; n = 10), EMS organizations without MIH-CP programs (non-MIH-CP; n = 9), and state/regional administrators (SRA; n = 5). Overall, the sample included professionals with an average of 19.6 years in the field (range: 1-42 years). Approximately 75% (n = 14) were male, and all identified as non-Hispanic white. MIH-CPs reported they initiated a vaccine program to reach underserved areas, operating as a health department extension. Some MIH-CPs integrated existing services, such as food banks, with vaccine clinics, while other MIH-CPs focused on providing vaccinations as standalone initiatives. Key barriers to vaccination program initiation included funding and vaccinations being a low priority for MIH-CP programs. However, participants reported support for vaccine programs, particularly as they provided an opportunity to alleviate health disparities and improve community health. MIH-CPs reported low vaccine hesitancy in the community when community paramedics administered vaccines. Non-CP agencies expressed interest in launching vaccine programs if there is clear guidance, sustainable funding, and adequate personnel. CONCLUSIONS: Our study provides important context on the feasibility and acceptability of implementing an MIH-CP program. Findings offer valuable insights into reducing health disparities seen in vaccine uptake through community paramedics, a novel and innovative approach to reduce health disparities in rural communities.

Safety Window for Effective Lesion Crossing in Patients With Chronic Thromboembolic Pulmonary Hypertension.

Background: Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) is limited by a lack of safe and effective tools for crossing these lesions. We aim to identify a safety window for an intraluminal crossing device in this vascular bed by studying the piercing properties of pulmonary arterial vessel walls and intraluminal CTEPH lesion specimens. As a secondary objective, we also describe the histopathologic features of CTEPH lesions. Methods: Specimens were procured from 9 patients undergoing pulmonary endarterectomy. The specimens were subsampled and identified grossly as arterial wall or intraluminal CTEPH lesions. The force needed for tissue penetration was measured using a 0.38-mm (0.015-in) diameter probe in an ex vivo experimental model developed in our lab. Concurrent histology was also performed. Results: The mean force needed to penetrate the arterial wall and intraluminal CTEPH lesions was 1.75 ± 0.10 N (n = 121) and 0.30 ± 0.04 N (n = 56), respectively (P < .001). Histology confirmed the presence of intimal hyperplasia with calcium and hemosiderin deposition in the arterial wall as well as an old, organized thrombus in the lumen. Conclusions: The pulmonary arterial wall is friable and prone to perforation during instrumentation with workhorse coronary guide wires. However, the results of this study demonstrate that a much lower force is needed for the 0.38-mm (0.015-in) probe to penetrate an intraluminal CTEPH lesion compared to pulmonary arterial intima. This finding suggests the existence of a safety window for lesion-crossing devices, enabling effective balloon pulmonary angioplasty.

Behavioral and neural responses to social exclusion in women: the role of facial attractiveness and friendliness.

The behavioral and neural responses to social exclusion were examined in women randomized to four conditions, varying in levels of attractiveness and friendliness. Informed by evolutionary theory, we predicted that being socially excluded by attractive unfriendly women would be more distressing than being excluded by unattractive women, irrespective of their friendliness level. Our results contradicted most of our predictions but provide important insights into women's responses to interpersonal conflict. Accounting for rejection sensitivity, P300 event-related potential amplitudes were largest when women were excluded by unattractive unfriendly women. This may be due to an expectancy violation or an annoyance with being excluded by women low on social desirability. An examination of anger rumination rates by condition suggests the latter. Only attractive women's attractiveness ratings were lowered in the unfriendly condition, indicating they were specifically punished for their exclusionary behavior. Women were more likely to select attractive women to compete against with one exception-they selected the Black attractive opponent less often than the White attractive opponent when presented as unfriendly. Finally, consistent with studies on retaliation in relation to social exclusion, women tended to rate competitors who rejected them as being more rude, more competitive, less attractive, less nice, and less happy than non-competitors. The ubiquity of social exclusion and its pointed emotional and physiological impact on women demands more research on this topic.

Laponite-Modified Biopolymers as a Conformable Substrate for Optoelectronic Devices.

Biopolymers such as carboxymethyl cellulose and hyaluronic acid are alternative substrates for conformable organic light-emitting diodes (OLEDs). However, drawbacks such as mechanical stress susceptibility can hinder the device's performance under stretched conditions. To overcome these limitations, herein, we developed a nanocomposite based on CMC/HA (carboxymethyl cellulose/hyaluronic acid) and synthetic Laponite, intending to improve the mechanical strength without compromising the film flexibility and transparency (transmittance >80%; 380-700 nm) as substrates for conformable OLEDs. From XRD, FTIR, CP-MAS NMR, and TGA/DTG characterization techniques, it was possible to conclude the presence of Laponite randomly dispersed between the polymer chains. CMC/HA with 5% (w/w) Laponite, CMC/HA 5, presented a higher tensile strength (370.6 MPa) and comparable Young's modulus (51.0 ± 1.2 MPa) in comparison to the nanocomposites and pristine films, indicating a better candidate for the device's substrates. To produce the OLED, the multilayer structure ITO/MoO3/NPB/TCTA:Ir(ppy)3/TPBi:Ir(ppy)3/BPhen/LiF was deposited onto the CMC/HA 5 substrate. The OLEDs fabricated using CMC/HA 5 substrates showed higher luminance (12 kcd/m2) and irradiance (0.9 mW/cm2) values when compared with those based on commercial bacterial cellulose. However, the same device presented a lower efficiency (3.2 cd/A) due to a higher current density. Moreover, the OLED fabricated onto the Laponite-modified biopolymer presented reproducible behavior when submitted to continuous bending stress. Thus, CMC/HA 5 demonstrates potential as a transparent conductor substrate for biopolymer-based OLEDs with comparable performance to commercial bacterial cellulose features.

Protracted fibrinolysis resistance following cardiac surgery with cardiopulmonary bypass: A prospective observational study of clinical associations and patient outcomes.

BACKGROUND: Surgery on cardiopulmonary bypass (CPB) elicits a pleiomorphic systemic host response which, when severe, requires prolonged intensive care support. Given the substantial cross-talk between inflammation, coagulation, and fibrinolysis, the aim of this hypothesis-generating observational study was to document the kinetics of fibrinolysis recovery post-CPB using ClotPro® point-of-care viscoelastometry. Tissue plasminogen activator-induced clot lysis time (TPA LT, s) was correlated with surgical risk, disease severity, organ dysfunction and intensive care length of stay (ICU LOS). RESULTS: In 52 patients following CPB, TPA LT measured on the first post-operative day (D1) correlated with surgical risk (EuroScore II, Spearman's rho .39, p < .01), time on CPB (rho = .35, p = .04), disease severity (APACHE II, rho = .52, p < .001) and organ dysfunction (SOFA, rho = .51, p < .001) scores, duration of invasive ventilation (rho = .46, p < .01), and renal function (eGFR, rho = -.65, p < .001). In a generalized linear regression model containing TPA LT, CPB run time and markers of organ function, only TPA LT was independently associated with the ICU LOS (odds ratio 1.03 [95% CI 1.01-1.05], p = .01). In a latent variables analysis, the association between TPA LT and the ICU LOS was not mediated by renal function and thus, by inference, variation in the clearance of intraoperative tranexamic acid. CONCLUSIONS: This observational hypothesis-generating study in patients undergoing cardiac surgery with cardiopulmonary bypass demonstrated an association between the severity of fibrinolysis resistance, measured on the first post-operative day, and the need for extended postoperative ICU level support. Further examination of the role of persistent fibrinolysis resistance on the clinical outcomes in this patient cohort is warranted through large-scale, well-designed clinical studies.

Correction: Carbon dots on LAPONITE® hybrid nanocomposites: solid-state emission and inter-aggregate energy transfer.

Correction for 'Carbon dots on LAPONITE® hybrid nanocomposites: solid-state emission and inter-aggregate energy transfer' by Bruno S. D. Onishi et al., Nanoscale, 2024, https://doi.org/10.1039/d3nr06336d.

Carbon dots on LAPONITE® hybrid nanocomposites: solid-state emission and inter-aggregate energy transfer.

This study delves into the photoluminescent characteristics of solid-state hybrid carbon dots/LAPONITE® (CDLP). These hybrid materials were synthesized using the hydrothermal method with a precise pH control set at 8.5. The LAPONITE® structure remains intact without structural collapse, and we detected the possible deposition of carbon dots (CDs) aggregates on the clay mineral's edges. The use of different concentrations of citric acid (10-, 6-, 2- and 1-times weight/weight of LAPONITE® mass, maintaining the 1 : 1 molar ratio with ethylenediamine) during synthesis results in different CDs concentrations in CDLP-A (low precursors concentration) and CDLP-D (high concentration) with an amorphous structure and average size around 2.8-3.0 nm. The CDLP displayed visible photoluminescence emission in aqueous and powder, which the last underwent quenching according to lifetimes and quantum yield measurements. Low-temperature measurements revealed an enhancement of the non-radiative pathways induced by aggregation. Energy transfer modelling based on Förster-Dexter suggests an approximate mean distance of 9.5 nm between clusters of CDs.

Entanglement and ingestion of microfibers by the oyster pea crab Zaops ostreum, an endosymbiont of the eastern oyster Crassostrea virginica.

The kleptoparasitic pea crab Zaops ostreum lives within the gills of bivalves, including the economically important eastern oyster Crassostrea virginica. Previous research along the east coast of central Florida has found an average of 2.3 pieces of plastic per oyster. The goals of our research were to determine if filter-feeding oysters transfer microfibers to Z. ostreum via the crab: 1) actively consuming plastic particles, or 2) passively becoming entangled in microfibers. Our results show that both occur. While only 11.6 % of Z. ostreum (total n = 122) consumed microfibers, those that did had up to 14 pieces in their soft tissues. Similarly, only 7.4 % of Z. ostreum had microfibers entangled around their appendages. Mean lengths of consumed and entangled fibers were similar, 1.9 and 2.7 mm, respectively. Additional research is needed to understand the positive and negative impacts of microfibers associated with pea crabs on both species.

Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening.

INTRODUCTION: Modeling supporting recommendations for colonoscopy and stool-based colorectal cancer (CRC) screening tests assumes 100% sequential participant adherence. The impact of observed adherence on the long-term effectiveness of screening is unknown. We evaluated the effectiveness of a program of screening colonoscopy every 10 years vs annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data. METHODS: The MIcrosimulation SCreening ANalysis (MISCAN) model used observed sequential screening adherence, HSgFOBT positivity, and diagnostic colonoscopy adherence in HSgFOBT-positive individuals from the National Colonoscopy Study (single-screening colonoscopy vs ≥4 HSgFOBT sequential rounds). We compared CRC incidence and mortality over 15 years with no screening or 10 yearly screening colonoscopy vs annual HSgFOBT with 100% and differential observed adherence from the trial. RESULTS: Without screening, simulated incidence and mortality over 15 years were 20.9 (95% probability interval 15.8-26.9) and 6.9 (5.0-9.2) per 1,000 participants, respectively. In the case of 100% adherence, only screening colonoscopy was predicted to result in lower incidence; however, both tests lowered simulated mortality to a similar level (2.1 [1.6-2.9] for screening colonoscopy and 2.5 [1.8-3.4] for HSgFOBT). Observed adherence for screening colonoscopy (83.6%) was higher than observed sequential HSgFOBT adherence (73.1% first round; 49.1% by round 4), resulting in lower simulated incidence and mortality for screening colonoscopy (14.4 [10.8-18.5] and 2.9 [2.1-3.9], respectively) than HSgFOBT (20.8 [15.8-28.1] and 3.9 [2.9-5.4], respectively), despite a 91% adherence to diagnostic colonoscopy with FOBT positivity. The relative risk of CRC mortality for screening colonoscopy vs HSgFOBT was 0.75 (95% probability interval 0.68-0.80). Findings were similar in sensitivity analyses with alternative assumptions for repeat colonoscopy, test performance, risk, age, and projection horizon. DISCUSSION: Where sequential adherence to stool-based screening is suboptimal and colonoscopy is accessible and acceptable-as observed in the national colonoscopy study, microsimulation, comparative effectiveness, screening recommendations.

Thermal properties of nanofluids using hydrophilic and hydrophobic LiYF4:Yb/Er upconverting nanoparticles.

Luminescent nanoparticles have shown great potential for thermal sensing in bio-applications. Nonetheless, these materials lack water dispersibility that can be overcome by modifying their surface properties with water dispersible molecules such as cysteine. Herein, we employ LiYF4:Er3+/Yb3+ upconverting nanoparticles (UCNPs) capped with oleate or modified with cysteine dispersed in cyclohexane or in water, respectively, as thermal probes. Upconversion emission was used to sense temperature with a relative thermal sensitivity of ∼1.24% K-1 (at 300 K) and a temperature uncertainty of 0.8 K for the oleate capped and of 0.5 K for cysteine modified NPs. To study the effect of the cysteine modification in the heat transfer processes, the thermal conductivity of the nanofluids was determined, yielding 0.123(6) W m-1 K-1 for the oleate capped UCNPs dispersed in cyclohexane and 0.50(7) W m-1 K-1 for the cysteine modified UCNPs dispersed in water. Moreover, through the heating curves, the nanofluids' thermal resistances were estimated, showing that the cysteine modification partially prevents heat transfer.

Cognitive Event-Related Potentials in Young Adults With Cerebral Palsy: A Proof-of-Concept Study.

Cerebral palsy (CP) is a movement and posture disorder often accompanied by cognitive difficulties which can be assessed using event-related potentials (ERPs), an often-overlooked tool in this population. Here we describe our assessment protocol, examine its feasibility, and validate the use of single-subject ERP analyses in adolescents and young adults with CP, an analysis approach which recognizes the heterogeneity of the clinical population. This study involved a final sample of 9 adolescents/young adults with CP participating in the "MyStory" study (age range 16-29 years, Mage = 25.0 years; 6 female; Gross Motor Function Classification System level I [n = 4], II [n = 2], III [n = 1], IV [n = 1], and V [n = 1]). ERP components were elicited over medial prefrontal and central cortex (error- and correct-related negativities [ERN/CRN], error-positivity [Pe], N100, P200, N200, P300), as well as those generated over occipital cortex (P100, N170). Group and single-subject ERP statistics were computed for ERPs recorded over both areas. Using recently developed data analysis methods (independent components analysis and robust bootstrapped single-subject statistics), we measured the number of participants demonstrating significant condition differences at the timing of each ERP component of interest. We demonstrate good validity for ERPs recorded during 2 of our 3 tasks eliciting frontal activation (eg, 4 of 6 participants with usable data showed a significant single-subject medial frontal negativity condition difference in a context-switching task) and good validity for ERPs derived from a task engaging occipital regions (eg, 8 of 9 participants each showed a significant N170 face-object condition effect).

Land Ho! Polarized light serves as a visual signal for landward orientation in displaced spiders.

An organism's ability to identify goals within their environment, orient towards those goals, and successfully navigate to them are critical to all aspects of survival. Long-jawed orb weavers (Tetragnatha elongata) occupy riparian zones and perform orientation behaviors when displaced from this habitat onto the water. Spiders prefer to move toward the closest shoreline, regardless of release location, likely to avoid predation from fish. In this study, we conducted a series of investigations to determine the mechanism by which these spiders rapidly achieve zonal recovery. Occlusion experiments indicate that spiders use visual information to identify characteristics of the riparian habitat and navigate to shelter. While environmental characteristics such as color, contrast, and the sun's position do not appear to factor into this orientation behavior, the polarization of light appears critical. We propose that the polarization of light reflecting off the water's surface acts as a water detector and the absence of such at the edges of the pond (or via experimental induction) serves as a visual reference for the closest suitable habitat.

Extending the Palette of Luminescent Primary Thermometers: Yb3+/Pr3+ Co-Doped Fluoride Phosphate Glasses.

The unique tunable properties of glasses make them versatile materials for developing numerous state-of-the-art optical technologies. To design new optical glasses with tailored properties, an extensive understanding of the intricate correlation between their chemical composition and physical properties is mandatory. By harnessing this knowledge, the full potential of vitreous matrices can be unlocked, driving advancements in the field of optical sensors. We herein demonstrate the feasibility of using fluoride phosphate glasses co-doped with trivalent praseodymium (Pr3+) and ytterbium (Yb3+) ions for temperature sensing over a broad range of temperatures. These glasses possess high chemical and thermal stability, working as luminescent primary thermometers that rely on the thermally coupled levels of Pr3+ that eliminate the need for recurring calibration procedures. The prepared glasses exhibit a relative thermal sensitivity and uncertainty at a temperature of 1.0% K-1 and 0.5 K, respectively, making them highly competitive with the existing luminescent thermometers. Our findings highlight that Pr3+-containing materials are promising for developing cost-effective and accurate temperature probes, taking advantage of the unique versatility of these vitreous matrices to design the next generation of photonic technologies.

An efficient strategy for evaluating new non-invasive screening tests for colorectal cancer: the guiding principles.

OBJECTIVE: New screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. DESIGN: A formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles. RESULTS: Twelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test's ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase III prospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IV studies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence. CONCLUSION: New non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact.

Perinatal nicotine exposure relates to stimulus-locked event-related potentials in early adolescence during an emotional go/no-go task.

Nicotine exposure is associated with negative consequences on the developing brain, both in utero and after birth. We investigated the relationship between perinatal nicotine exposure and electroencephalographic brain activity recorded during an emotional faces Go/No-Go task among adolescents. Seventy-one adolescents aged 12-15 years completed a Go/No-Go task using fearful and happy faces. Parents completed questionnaire measures of their child's temperament and self-regulation and retrospectively reported on nicotine exposure during the perinatal period. Perinatally exposed children (n = 20) showed increased and prolonged frontal event-related potential (ERP) differentiation in stimulus-locked analyses; that is, greater emotion and condition differentiation in comparison with their non-exposed peers (n = 51). However, non-exposed children showed greater late emotion differentiation recorded over posterior sites. Response-locked ERP differences were not found. ERP effects were not related to temperamental, self-regulatory, or parental education and income-related factors. This study is the first to demonstrate a relationship between perinatal nicotine exposure and ERPs in an emotional Go/No-Go task among adolescents. Findings suggest that while conflict detection remains intact for adolescents with perinatal nicotine exposure, their attentional allocation to behaviourally relevant stimuli may be magnified to beyond optimal levels, particularly when emotion is salient in information processing. Future studies can extend these findings by isolating prenatal nicotine exposure and comparing its effects to isolated postnatal exposure and clarifying the implications of the face and performance processing differences in adolescence.