This study presents a workflow for identifying and characterizing patients with Heart Failure (HF) and multimorbidity utilizing data from Electronic Health Records. Multimorbidity, the co-occurrence of two or more chronic conditions, poses a significant challenge on healthcare systems. Nonetheless, understanding of patients with multimorbidity, including the most common disease interactions, risk factors, and treatment responses, remains limited, particularly for complex and heterogeneous conditions like HF. We conducted a clustering analysis of 3745 HF patients using demographics, comorbidities, laboratory values, and drug prescriptions. Our analysis revealed four distinct clusters with significant differences in multimorbidity profiles showing differential prognostic implications regarding unplanned hospital admissions. These findings underscore the considerable disease heterogeneity within HF patients and emphasize the potential for improved characterization of patient subgroups for clinical risk stratification through the use of EHR data.
Heart Failure , Multimorbidity , Humans , Comorbidity , Heart Failure/diagnosis , Heart Failure/epidemiology , Cluster Analysis , Chronic Disease
[This corrects the article DOI: 10.3389/fnut.2023.1297926.].
Immunoglobulin heavy chain amyloidosis (AH amyloidosis) is an extremely rare subtype of immunoglobulin-derived amyloidosis and there is limited literature on how to diagnose and manage this disorder. We describe a rare case of AH amyloidosis with amyloid goitre and the importance of mass spectrometry in the identification of the different types of amyloids. While additional studies are needed, several observations suggest important practical implications, including differences in clinical picture, prognosis, and pathologic diagnosis. LEARNING POINTS: Immunoglobulin heavy chain amyloidosis is an extremely rare subtype of immunoglobulin-derived amyloidosis and amyloid goitre is even rarer.There is limited literature on how to diagnose and manage this disorder.This case portrays one of these cases - one of the few existing in the literature - and reinforces the diagnostic complexity of this entity.
BACKGROUND: The benefits of physical activity (PA) and adequate sleep are well documented, and their importance strengthens with the increasing prevalence of chronic diseases and multimorbidity (MM). Interventions to promote physical activity and sleep that use commercial activity trackers may be useful non-pharmacological approaches to managing individual health; however, limited evidence exists on their use to improve physical activity in older adult patients with MM. METHODS: This study aims to measure the effects of behavioral change techniques (BCTs) delivered by a wearable device on physical activity and quality of sleep (QS) in older adult patients with MM. We designed an open-label randomized controlled trial with participants recruited through primary care and a specialist outpatient clinic. Participants must be more than 65 years old, have MM, and have access to smartphones. All eligible participants will receive PA promotion content and will be randomly assigned to wear a smartwatch. The primary outcome will be the participants' PA measurement at baseline and at six months using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). Secondary outcomes will include changes in the participants' frailty status, biometric measurements, quality of life, and biopsychosocial assessments. A sample size of 40 participants per arm was calculated to detect group differences, with 50 participants planned to recruit and randomize into each arm. DISCUSSION: This study aims to contribute to a better understanding of PA patterns and the impact of wearable-based PA interventions in patients with MM. In addition, we aim to contribute to more knowledge about the relationship between PA patterns, Patient Reported Outcomes Measures (PROMs), and healthcare resource utilization in patients with MM. To achieve this, the study will leverage a locally developed PROMs registry and assess data from participants' medical records, in order to understand the added impact of wearable data and medical information data on predicting PROMs and unplanned hospital admissions. TRIAL REGISTRATION: NCT05777291.
Multimorbidity , Wearable Electronic Devices , Humans , Aged , Quality of Life/psychology , Exercise/psychology , Sleep , Randomized Controlled Trials as Topic
In recent years, polymeric materials have been gaining prominence in studies of controlled release systems to obtain improvements in drug administration. These systems present several advantages compared with conventional release systems, such as constant maintenance in the blood concentration of a given drug, greater bioavailability, reduction of adverse effects, and fewer dosages required, thus providing a higher patient compliance to treatment. Given the above, the present work aimed to synthesize polymeric matrices derived from polyethylene glycol (PEG) capable of promoting the controlled release of the drug ketoconazole in order to minimize its adverse effects. PEG 4000 is a widely used polymer due to its excellent properties such as hydrophilicity, biocompatibility, and non-toxic effects. In this work, PEG 4000 and derivatives were incorporated with ketoconazole. The morphology of polymeric films was observed by AFM and showed changes on the film organization after drug incorporation. In SEM, it was possible to notice spheres that formed in some incorporated polymers. The zeta potential of PEG 4000 and its derivatives was determined and suggested that the microparticle surfaces showed a low electrostatic charge. Regarding the controlled release, all the incorporated polymers obtained a controlled release profile at pH 7.3. The release kinetics of ketoconazole in the samples of PEG 4000 and its derivatives followed first order for PEG 4000 HYDR INCORP and Higuchi for the other samples. Cytotoxicity was determined and PEG 4000 and its derivatives were not cytotoxic.
In this work, a conductive ink based on microfibrillated cellulose (MFC) and multiwalled carbon nanotubes (MWCNTs) was used to produce transducers for rapid liquid identification. The transducers are simple resistive devices that can be easily fabricated by scalable printing techniques. We monitored the electrical response due to the interaction between a given liquid with the carbon nanotube-cellulose film over time. Using principal component analysis of the electrical response, we were able to extract robust data to differentiate between the liquids. We show that the proposed liquid sensor can classify different liquids, including organic solvents (acetone, chloroform, and different alcohols) and is also able to differentiate low concentrations of glycerin in water (10-100 ppm). We have also investigated the influence of two important properties of the liquids, namely dielectric constant and vapor pressure, on the transduction of the MFC-MWCNT sensors. These results were corroborated by independent heat flow measurements (thermogravimetric analysis). The proposed MFC-MWCNT sensor platform may help paving the way to rapid, inexpensive, and robust liquid analysis and identification.
People vary both in their embrace of their society's traditions, and in their perception of hazards as salient and necessitating a response. Over evolutionary time, traditions have offered avenues for addressing hazards, plausibly resulting in linkages between orientations toward tradition and orientations toward danger. Emerging research documents connections between traditionalism and threat responsivity, including pathogen-avoidance motivations. Additionally, because hazard-mitigating behaviors can conflict with competing priorities, associations between traditionalism and pathogen avoidance may hinge on contextually contingent tradeoffs. The COVID-19 pandemic provides a real-world test of the posited relationship between traditionalism and hazard avoidance. Across 27 societies (N = 7844), we find that, in a majority of countries, individuals' endorsement of tradition positively correlates with their adherence to costly COVID-19-avoidance behaviors; accounting for some of the conflicts that arise between public health precautions and other objectives further strengthens this evidence that traditionalism is associated with greater attention to hazards.
COVID-19 , Humans , Pandemics , Motivation , Public Health
Industrial applications of nanomaterials require large-scale production methods, such as liquid phase exfoliation (LPE). Regarding this, it is imperative to characterize the obtained materials to tailor parameters such as exfoliation medium, duration, and mechanical energy source to the desired applications. This work presents results of statistical analyses of talc flakes obtained by LPE in four different media. Talc is a phyllosilicate that can be exfoliated into nanoflakes with great mechanical properties. Sodium cholate at two different concentrations (below and at the critical micelar concentration), butanone, and Triton-X100 were employed as exfoliation medium for talc. Using recent published statistical analysis methods based on atomic force microscopy images of thousands of flakes, the shape and size distribution of nanotalc obtained using the four different media are compared. This comparison highlights the strengths and weaknesses of the media tested and hopefully will facilitate the choice of the medium for applications that have specific requirements.
Overcoming the challenge of creating thick, tissue-resembling muscle constructs is paramount in the field of cultivated meat production. This study investigates the remarkable potential of random cellulose acetate nanofibers (CAN) as a transformative scaffold for muscle tissue engineering (MTE), specifically in the context of cultivated meat applications. Through a comparative analysis between random and aligned CAN, utilizing C2C12 and H9c2 myoblasts, we unveil the unparalleled capabilities of random CAN in facilitating muscle differentiation, independent of differentiation media, by exploiting the YAP/TAZ-related mechanotransduction pathway. In addition, we have successfully developed a novel process for stacking cell-loaded CAN sheets, enabling the production of a three-dimensional meat product. C2C12 and H9c2 loaded CAN sheets were stacked (up to four layers) to form a ~300-400 µm thick tissue 2 cm in length, organized in a mesh of uniaxial aligned cells. To further demonstrate the effectiveness of this methodology for cultivated meat purposes, we have generated thick and viable constructs using chicken muscle satellite cells (cSCs) and random CAN. This groundbreaking discovery offers a cost-effective and biomimetic solution for cultivating and differentiating muscle cells, forging a crucial link between tissue engineering and the pursuit of sustainable and affordable cultivated meat production.
Modified release systems depend on the selection of an appropriate agent capable of controlling the release of the drug, sustaining the therapeutic action over time, and/or releasing the drug at the level of a particular tissue or target organ. Polyethylene glycol 4000 (PEG 4000) is commonly employed in drug release formulations while polymethyl methacrylate (PMMA) is non-toxic and has a good solubility in organic solvents. This study aimed at the incorporation of ketoconazole in PMMA-g-PEG 4000 and its derivatives, thus evaluating its release profile and anti-Candida albicans and cytotoxic activities. Ketoconazole was characterized and incorporated into the copolymers. The ketoconazole incorporated in the copolymer and its derivatives showed an immediate release profile. All copolymers with ketoconazole showed activity against Candida albicans and were non-toxic to human cells in the entire concentration tested.
Candida albicans , Ketoconazole , Antifungal Agents/pharmacology , Humans , Ketoconazole/pharmacology , Polyethylene Glycols , Polymethyl Methacrylate , Solvents
Molybdenum disulfide (MoS2) is attractive for use in next-generation nanoelectronic devices and exhibits great potential for humidity sensing applications. Herein, MoS2 ink was successfully prepared via a simple exfoliation method by sonication. The structural and surface morphology of a deposited ink film was analyzed by scanning electron microscopy (SEM), Raman spectroscopy, and atomic force microscopy (AFM). The aerosol-printed MoS2 ink sensor has high sensitivity, with a conductivity increase by 6 orders of magnitude upon relative humidity increase from 10 to 95% at room temperature. The sensor also has fast response/recovery times and excellent repeatability. Possible mechanisms for the water-induced conductivity increase are discussed. An analytical model that encompasses two ionic conduction regimes, with a percolation transition to an insulating state below a low humidity threshold, describes the sensor response successfully. In conclusion, our work provides a low-cost and straightforward strategy for fabricating a high-performance humidity sensor and fundamental insights into the sensing mechanism.
Talc is a van der Waals and naturally abundant mineral with the chemical formula Mg3Si4O10(OH)2. Two-dimensional (2D) talc could be an alternative to hBN as van der Waals dielectric in 2D heterostructures. Furthermore, due to its good mechanical and frictional properties, 2D talc could be integrated into various hybrid microelectromechanical systems, or used as a functional filler in polymers. However, properties of talcas one of the main representatives of the phyllosilicate (sheet silicates) group are almost completely unexplored when ultrathin crystalline films and monolayers are considered. We investigate 2D talc flakes down to single layer thickness and reveal their efficiency for solid lubrication at the nanoscale. We demonstrate by atomic force microscopy based methods and contact angle measurements that several nanometer thick talc flakes have all properties necessary for efficient lubrication: a low adhesion, hydrophobic nature, and a low friction coefficient of 0.10 ± 0.02. Compared to the silicon-dioxide substrate, 2D talc flakes reduce friction by more than a factor of five, adhesion by around 20%, and energy dissipation by around 7%. Considering our findings, together with the natural abundance of talc, we put forward that 2D talc can be a cost-effective solid lubricant in micro- and nano-mechanical devices.
The aim of this work is to determine the varying dielectric constant of a biological nanostructured system via electrostatic force microscopy (EFM) and to show how this method is useful to study natural photonic crystals. We mapped the dielectric constant of the cross section of the posterior wing of the damselfly Chalcopteryx rutilans with nanometric resolution. We obtained structural information on its constitutive nanolayers and the absolute values of their dielectric constant. By relating the measured profile of the static dielectric constant to the profile of the refractive index in the visible range, combined with optical reflectance measurements and simulation, we were able to describe the origin of the strongly iridescent wing colors of this Amazonian rainforest damselfly. The method we demonstrate here should be useful for the study of other biological nanostructured systems.
Folds naturally appear on nanometrically thin materials, also called "2D materials", after exfoliation, eventually creating folded edges across the resulting flakes. We investigate the adhesion and flexural properties of single-layered and multilayered 2D materials upon folding in the present work. This is accomplished by measuring and modeling mechanical properties of folded edges, which allows for the experimental determination of the bending stiffness (κ) of multilayered 2D materials as a function of the number of layers (n). In the case of talc, we obtain κ â n 3 for n ≥ 5, indicating no interlayer sliding upon folding, at least in this thickness range. In contrast, tip-enhanced Raman spectroscopy measurements on edges in folded graphene flakes, 14 layers thick, show no significant strain. This indicates that layers in graphene flakes, up to 5 nm thick, can still slip to relieve stress, showing the richness of the effect in 2D systems. The obtained interlayer adhesion energy for graphene (0.25 N/m) and talc (0.62 N/m) is in good agreement with recent experimental results and theoretical predictions. The obtained value for the adhesion energy of graphene on a silicon substrate is also in agreement with previous results.
Gypsum is an Earth-abundant mineral with enormous applications in agriculture and civil engineering. Here, we show it is also an excellent height calibration standard alternative for atomic force microscopy (AFM). Using plain water as etchant, gypsum flakes readily review 0.75 nm tall terraces which are easy to image (lateral dimensions from tens to hundreds of nanometers) and robust against time in ambient conditions. Therefore, the present work demonstrates a new height standard alternative which is easily-available for all AFM microscopists around the world.
We report on an experimental investigation of serpentine, an abundant phyllosilicate, as an alternative source of two-dimensional (2D) nanomaterials. We show, through scanning probe microscopy (SPM) measurements, that natural serpentine mineral can be mechanically exfoliated down to few-layer flakes, where monolayers can be easily resolved. The parent serpentine bulk material was initially characterized via conventional techniques like XRD, XPS, FTIR and Raman spectroscopies and the results show that it is predominantly constituted by the antigorite mineral. From ab initio calculations using density functional theory, we also determine the geometry and electronic structure of antigorite, the observed structural form of serpentine. Additionally, we further characterized electrical and mechanical properties of the obtained 2D material flakes using SPM and broadband synchrotron infrared nanospectroscopy. Wavelength tuning of the serpentine vibrational resonances, assigned to in- and out-of-plane molecular vibrations, are observed and compared with the FTIR characterization of the parent bulk material. They show that there is no degradation of serpentine's structural properties during its mechanical exfoliation down to nanometer-thin sheets. Therefore, our results introduce the serpentine mineral as an attractive low-cost candidate in 2D materials applications.
OBJECTIVES: To systematically review findings of GWAS in schizophrenia (SZ) and in bipolar disorder (BD); and to interpret findings, with a focus on identifying independent replications. METHOD: PubMed search, selection and review of all independent GWAS in SZ or BD, published since March 2011, i.e. studies using non-overlapping samples within each article, between articles, and with those of the previous review (Li et al., 2012). RESULTS: From the 22 GWAS included in this review, the genetic associations surviving standard GWAS-significance were for genetic markers in the regions of ACSL3/KCNE4, ADCY2, AMBRA1, ANK3, BRP44, DTL, FBLN1, HHAT, INTS7, LOC392301, LOC645434/NMBR, LOC729457, LRRFIP1, LSM1, MDM1, MHC, MIR2113/POU3F2, NDST3, NKAPL, ODZ4, PGBD1, RENBP, TRANK1, TSPAN18, TWIST2, UGT1A1/HJURP, WHSC1L1/FGFR1 and ZKSCAN4. All genes implicated across both reviews are discussed in terms of their function and implication in neuropsychiatry. CONCLUSION: Taking all GWAS to date into account, AMBRA1, ANK3, ARNTL, CDH13, EFHD1 (albeit with different alleles), MHC, PLXNA2 and UGT1A1 have been implicated in either disorder in at least two reportedly non-overlapping samples. Additionally, evidence for a SZ/BD common genetic basis is most strongly supported by the implication of ANK3, NDST3, and PLXNA2.
Bipolar Disorder/genetics , Genetic Predisposition to Disease/genetics , Genome-Wide Association Study , Schizophrenia/genetics , Bipolar Disorder/etiology , Genetic Markers/genetics , Humans , Polymorphism, Genetic/genetics , Schizophrenia/etiology
Hybrid organic-inorganic perovskites containing Cs are a promising new material for light-absorbing and light-emitting optoelectronics. However, the impact of environmental conditions on their optical properties is not fully understood. Here, we elucidate and quantify the influence of distinct humidity levels on the charge carrier recombination in Cs xFA1- xPb(I yBr1- y)3 perovskites. Using in situ environmental photoluminescence (PL), we temporally and spectrally resolve light emission within a loop of critical relative humidity (rH) levels. Our measurements show that exposure up to 35% rH increases the PL emission for all Cs (10-17%) and Br (17-38%) concentrations investigated here. Spectrally, samples with larger Br concentrations exhibit PL redshift at higher humidity levels, revealing water-driven halide segregation. The compositions considered present hysteresis in their PL intensity upon returning to a low-moisture environment due to partially reversible hydration of the perovskites. Our findings demonstrate that the Cs/Br ratio strongly influences both the spectral stability and extent of light emission hysteresis. We expect our method to become standard when testing the stability of emerging perovskites, including lead-free options, and to be combined with other parameters known for affecting material degradation, e.g., oxygen and temperature.
The ability to create materials with improved properties upon transformation processes applied to conventional materials is the keystone of materials science. Here, hexagonal boron nitride (h-BN), a large-band-gap insulator, is transformed into a conductive two-dimensional (2D) material- bonitrol-that is stable at ambient conditions. The process, which requires compression of at least two h-BN layers and hydroxyl ions, is characterized via scanning probe microscopy experiments and ab initio calculations. This material and its creation mechanism represent an additional strategy for the transformation of known 2D materials into artificial advanced materials with exceptional properties.
The association of organic molecules with two-dimensional (2D) materials, creating hybrid systems with mutual influences, constitutes an important testbed for both basic science self-assembly studies and perspective applications. Following this concept, in this work, we show a rich phenomenology that is involved in the interaction of thionine with graphene, leading to a hybrid material formed by well-organized self-assembled structures atop graphene. This composite system is investigated by atomic force microscopy, electric transport measurements, Raman spectroscopy, and first principles calculations, which show (1) an interesting time evolution of thionine self-assembled structures atop graphene; (2) a highly oriented final molecular assembly (in accordance with the underlying graphene surface symmetry); and (3) a strong n-type doping effect introduced in graphene by thionine. The nature of the thionine-substrate interaction is further analyzed in experiments using mica as a polar substrate. The present results may help pave the way to achieve tailored 2D material hybrid devices via properly chosen molecular self-assembly processes.
