Association of HIV and HCV Infection With Carotid Artery Plaque Echomorphology in the MACS/WIHS Combined Cohort Study.

BACKGROUND: HIV and hepatitis C virus (HCV) are associated with increased risk of carotid artery atherosclerotic plaque and stroke. We examined associations of HIV- and HCV-related factors with echomorphologic features of carotid artery plaque. METHODS: This cross-sectional study included participants from the MACS (Multicenter AIDS Cohort Study)/WIHS (Women's Interagency HIV Study) Combined Cohort Study who underwent high-resolution B-mode carotid artery ultrasound. Plaques were characterized from 6 areas of the right carotid artery. Poisson regression controlling for demographic and cardiometabolic risk factors determined adjusted prevalence ratios (aPRs) and 95% CIs for associations of HIV- and HCV-related factors with echomorphologic features. RESULTS: Of 2655 participants (65% women, median age 44 [interquartile range, 37-50] years), 1845 (70%) were living with HIV, 600 (23%) were living with HCV, and 425 (16%) had carotid plaque. There were 191 plaques identified in 129 (11%) women with HIV, 51 plaques in 32 (7%) women without HIV, 248 plaques in 171 (28%) men with HIV, and 139 plaques in 93 (29%) men without HIV. Adjusted analyses showed that people with HIV and current CD4+ count <200 cells/µL had a significantly higher prevalence of predominantly echolucent plaque (aPR, 1.86 [95% CI, 1.08-3.21]) than those without HIV. HCV infection alone (aPR, 1.86 [95% CI, 1.08-3.19]) and HIV-HCV coinfection (aPR, 1.75 [95% CI, 1.10-2.78]) were each associated with higher prevalence of predominantly echogenic plaque. HIV-HCV coinfection was also associated with higher prevalence of smooth surface plaque (aPR, 2.75 [95% CI, 1.03-7.32]) compared with people without HIV and HCV. CONCLUSIONS: HIV with poor immunologic control, as well as HCV infection, either alone or in the presence of HIV, were associated with different echomorphologic phenotypes of carotid artery plaque.

Explainable Machine Learning Analysis of Right Heart Failure After Left Ventricular Assist Device Implantation.

Right heart failure (RHF) remains a common and serious complication after durable left ventricular assist device (LVAD) implantation. We used explainable machine learning (ML) methods to derive novel insights into preimplant patient factors associated with RHF. Continuous-flow LVAD implantations from 2008 to 2017 in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) were included. A total of 186 preimplant patient factors were analyzed and the primary outcome was 30 days of severe RHF. A boosted decision tree ML algorithm and an explainable ML method were applied to identify the most important factors associated with RHF, nonlinear relationships and interactions, and risk inflection points. Out of 19,595 patients, 19.1% developed severe RHF at 30 days. Thirty top predictors of RHF were identified with the top five being INTERMACS profile, Model for End-stage Liver Disease score, the number of inotropic infusions, hemoglobin, and race. Many top factors exhibited nonlinear relationships with key risk inflection points such as INTERMACS profile between 2 and 3, right atrial pressure of 15 mmHg, pulmonary artery pressure index of 3, and prealbumin of 23 mg/dl. Finally, the most important variable interactions involved INTERMACS profile and the number of inotropes. These insights could help formulate patient optimization strategies prior to LVAD implantation.

Natural language processing analysis of the psychosocial stressors of mental health disorders during the pandemic.

Over the past few years, the COVID-19 pandemic has exerted various impacts on the world, notably concerning mental health. Nevertheless, the precise influence of psychosocial stressors on this mental health crisis remains largely unexplored. In this study, we employ natural language processing to examine chat text from a mental health helpline. The data was obtained from a chat helpline called Safe Hour from the "It Gets Better" project in Chile. This dataset encompass 10,986 conversations between trained professional volunteers from the foundation and platform users from 2018 to 2020. Our analysis shows a significant increase in conversations covering issues of self-image and interpersonal relations, as well as a decrease in performance themes. Also, we observe that conversations involving themes like self-image and emotional crisis played a role in explaining both suicidal behavior and depressive symptoms. However, anxious symptoms can only be explained by emotional crisis themes. These findings shed light on the intricate connections between psychosocial stressors and various mental health aspects in the context of the COVID-19 pandemic.

Integración curricular de habilidades investigativas en enfermería: análisis de una universidad privada chilena / Curriculum integration of research skills in nursing: analysis of a Chilean private university / Integração currícula de habilidades de pesquisa em enfermagem: análise de uma universidade privada do Chile

INTRODUCCIÓN:Las universidades además de transferir conocimiento, lo generan; para lo cual deben formar estudiantes capaces de aprender de manera autónoma para aportar a la sociedad. De la producción científica de América Latina en la línea de salud, Chile produce menos del 7% del total. La formación científica permitirá que la ciudadanía encuentre solución a las problemáticas contemporáneas. OBJETIVO: Analizar el desarrollo de habilidades investigativas en el currículo de la carrera de Enfermería de una universidad privada. METODOLOGÍA: Estudio de caso intrínseco evaluativo. RESULTADOS: Los 28 programas de asignatura disciplinar analizados tienen, en los ochoprimeros semestres de la carrera, 216 tributaciones a habilidades investigativas, tributaciones identificadas en: resultados de aprendizajes, metodologías evaluativas, actividades en aula, taller y trabajo personal. Del total de tributaciones, un 72% son tributadas en el 7tmo y 8vo semestre, año donde se diseña y ejecuta la tesis de pregrado. CONCLUSIONES: La malla curricular analizada, tributa metodológicamente, en sus 10 semestres, a todas las habilidades investigativas, no obstante, no hay un desarrollo progresivo y continuo previo a la asignatura de metodología de la investigación impartida en el séptimo semestre.

INTRODUCTION: Universities, in addition to transferring knowledge, generate it; they must train students capable of learning autonomously to contribute to society. Of the scientific production of Latin America in the line of health, Chile produces less than 7% of the total. Therefore, scientific training will allow citizens to find solutions to contemporary problems.OBJECTIVE: To analyze the development of investigative skills in the nursing career curriculum of a private university. METHODOLOGY: Evaluative intrinsic case study. RESULTS: The 28 disciplinary subject programs analyzed have, in the first eight semesters of the degree, 216 taxes on investigative skills, taxes identified in learning outcomes, evaluation methodologies, classroom activities, workshops, and personal work. Of the total taxes, 72% are taxed in the 7th, and 8th semesters, the year the undergraduate thesis is designed and executed. CONCLUSIONS: The analyzed curriculum pays methodologically in its ten semesters, all investigative skills; however, there is no progressive and continuous development before the subject of research methodology taught in the seventhsemester.

INTRODUÇÃO :As universidades, além de transferir conhecimento, o geram; para o qual devem formar estudantescapazes de aprender de forma autônoma para contribuir com a sociedade. Da produção científica da América Latina na área da saúde, o Chile produz menos de 7% do total. A formação científica permitirá aos cidadãos encontrar soluções para os problemas contemporâneos.OBJETIVO: Analisar o desenvolvimento de habilidades investigativas no currículo da carreira de enfermagem de uma universidade privada. METODOLOGÍA: Estudo de caso avaliativo intrínseco. RESULTADOS: Os 28 programas disciplinares analisados têm, nos primeiros 8 semestres do curso, 216 impostos sobre habilidades investigativas, impostos identificados em: resultados de aprendizagem, metodologias de avaliação, atividades de sala de aula, oficina e trabalho pessoal. Do total de impostos, 72% são tributados no 7º e 8º semestre, ano em que o trabalho de conclusão de curso é elaborado e executado.CONCLUSÃO: O currículo analisado contempla metodologicamente, em seus 10 semestres, todas as competências investigativas, porém, não há um desenvolvimento progressivo e contínuo anterior à disciplina de metodologia de pesquisa ministrada no sétimo semestre.

Right heart failure after left ventricular assist device: From mechanisms to treatments.

Left ventricular assist device (LVAD) therapy is a lifesaving option for patients with medical therapy-refractory advanced heart failure. Depending on the definition, 5-44% of people supported with an LVAD develop right heart failure (RHF), which is associated with worse outcomes. The mechanisms related to RHF include patient, surgical, and hemodynamic factors. Despite significant progress in understanding the roles of these factors and improvements in surgical techniques and LVAD technology, this complication is still a substantial cause of morbidity and mortality among LVAD patients. Additionally, specific medical therapies for this complication still are lacking, leaving cardiac transplantation or supportive management as the only options for LVAD patients who develop RHF. While significant effort has been made to create algorithms aimed at stratifying risk for RHF in patients undergoing LVAD implantation, the predictive value of these algorithms has been limited, especially when attempts at external validation have been undertaken. Perhaps one of the reasons for poor performance in external validation is related to differing definitions of RHF in external cohorts. Additionally, most research in this field has focused on RHF occurring in the early phase (i.e., ≤1 month) post LVAD implantation. However, there is emerging recognition of late-onset RHF (i.e., > 1 month post-surgery) as a significant cause of morbidity and mortality. Late-onset RHF, which likely has a unique physiology and pathogenic mechanisms, remains poorly characterized. In this review of the literature, we will describe the unique right ventricular physiology and changes elicited by LVADs that might cause both early- and late-onset RHF. Finally, we will analyze the currently available treatments for RHF, including mechanical circulatory support options and medical therapies.

Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices.

Over the last two decades, implantable continuous flow left ventricular assist devices (LVAD) have proven to be invaluable tools for the management of selected advanced heart failure patients, improving patient longevity and quality of life. The presence of concomitant valvular pathology, including that involving the tricuspid, mitral, and aortic valve, has important implications relating to the decision to move forward with LVAD implantation. Furthermore, the presence of concomitant valvular pathology often influences the surgical strategy for LVAD implantation. Concomitant valve repair or replacement is not uncommonly required in such circumstances, which increases surgical complexity and has demonstrated prognostic implications both short and longer term following LVAD implantation. Beyond the index operation, it is also well established that certain valvular pathologies may develop or worsen over time following LVAD support. The presence of pre-existing valvular pathology or that which develops following LVAD implant is of particular importance to the destination therapy LVAD patient population. As these patients are not expected to have the opportunity for heart transplantation in the future, optimization of LVAD support including ameliorating valvular disease is critical for the maximization of patient longevity and quality of life. As collective experience has grown over time, the ability of clinicians to effectively address concomitant valvular pathology in LVAD patients has improved in the pre-implant, implant, and post-implant phase, through both medical management and procedural optimization. Nevertheless, there remains uncertainty over many facets of concomitant valvular pathology in advanced heart failure patients, and the understanding of how to best approach these conditions in the LVAD patient population continues to evolve. Herein, we present a comprehensive review of the current state of the field relating to the pathophysiology and management of valvular disease in destination LVAD patients.

Citizens at the forefront of the constitutional debate: Voluntary citizen participation determinants and emergent content in Chile.

In the past few decades, constitution-making processes have shifted from being undertakings performed by elites and closed off from the public to ones incorporating democratic mechanisms. Little is known, however, about the determinants of voluntary public participation and how they affect the outcomes of the deliberative process in terms of content and quality. Here, we study the process of constituent involvement in the rewriting of Chile's constitution in 2016. A total of 106, 412 citizens in 8, 113 different local encounters voluntarily congregated in groups of ten or more to collectively determine what social rights should be considered for inclusion in the new constitution, deliberating and then articulating in the written word why should be included. We brought our data to statistical regression models at the municipality level, the results show that the main determinants associated with increasing citizen participation are educational level, engagement in politics, support for the government, and Internet access. In contrast, population density and the share of Evangelical Christians in the general population decrease citizen participation. Then, we further analyze the written arguments for each collectively-selected constitutional rights. The findings suggest that groups from socioeconomically developed municipalities (with higher educational levels and where the main economic activities are more distant from natural resources), on average, deliberate consistently more about themes, concepts, and ideas compared to groups from less developed municipalities. These results provide an empirical ground on the driver factors of voluntary citizen participation and on the benefits and disadvantages of deliberative democracy. Hence, results can inform the organization of new deliberative processes.

The History of Durable Left Ventricular Assist Devices and Comparison of Outcomes: HeartWare, HeartMate II, HeartMate 3, and the Future of Mechanical Circulatory Support.

The utilization of left ventricular assist devices (LVADs) in end-stage heart failure has doubled in the past ten years and is bound to continue to increase. Since the first of these devices was approved in 1994, the technology has changed tremendously, and so has the medical and surgical management of these patients. In this review, we discuss the history of LVADs, evaluating survival and complications over time. We also aim to discuss practical aspects of the medical and surgical management of LVAD patients and future directions for outcome improvement in this population.

Anthropogenic influence on surface changes at the Olivares glaciers; Central Chile.

We have investigated the source and role of light-absorbing impurities (LAIs) deposited on the glaciers of the Olivares catchment, in Central Chile. LAIs can considerably darken (lowered albedo) the glacier surface, enhancing their melt. We combined chemical and mineralogical laboratory analyses of surface and ice core samples with field-based spectral reflectance measurements to investigate the nature and properties of such LAIs. Using remote sensing-based albedo maps, we upscaled local information to glacier-wide coverage. We then used a model to evaluate the sensitivity of surface mass balance to a change in ice and snow albedo. The across-scale surface observations in combination with ice core analysis revealed a history of over half a century of LAIs deposition. We found traces of mining residuals in glacier surface samples. The glaciers with highest mass loss in the catchment present enhanced concentrations of surface dust particles with low reflectance properties. Our results indicate that dust particles with strong light-absorbing capacity have been mobilized from mine tailings and deposited on the nearby glacier surfaces. Large-scale assessment from satellite-based observations revealed darkening (ice albedo lowering) at most investigated glacier tongues from 1989 to 2018. Glacier melt is sensitive to ice albedo. We believe that an accelerated winter and spring snow albedo decrease, partially triggered by surface impurities, might be responsible for the above-average mass loss encountered in this catchment.

Projected increases in surface melt and ice loss for the Northern and Southern Patagonian Icefields.

The Northern Patagonian Icefield (NPI) and the Southern Patagonian Icefield (SPI) have increased their ice mass loss in recent decades. In view of the impacts of glacier shrinkage in Patagonia, an assessment of the potential future surface mass balance (SMB) of the icefields is critical. We seek to provide this assessment by modelling the SMB between 1976 and 2050 for both icefields, using regional climate model data (RegCM4.6) and a range of emission scenarios. For the NPI, reductions between 1.5 m w.e. (RCP2.6) and 1.9 m w.e. (RCP8.5) were estimated in the mean SMB during the period 2005-2050 compared to the historical period (1976-2005). For the SPI, the estimated reductions were between 1.1 m w.e. (RCP2.6) and 1.5 m w.e. (RCP8.5). Recently frontal ablation estimates suggest that mean SMB in the SPI is positively biased by 1.5 m w.e., probably due to accumulation overestimation. If it is assumed that frontal ablation rates of the recent past will continue, ice loss and sea-level rise contribution will increase. The trend towards lower SMB is mostly explained by an increase in surface melt. Positive ice loss feedbacks linked to increasing in meltwater availability are expected for calving glaciers.

Presence of Intracardiac Thrombus at the Time of Left Ventricular Assist Device Implantation Is Associated With an Increased Risk of Stroke and Death.

BACKGROUND: Heart failure predisposes to intracardiac thrombus (ICT) formation. There are limited data on the prevalence and impact of preexisting ICT on postoperative outcomes in left ventricular assist device patients. We examined the risk for stroke and death in this patient population. METHODS AND RESULTS: We retrospectively studied patients who were implanted with HeartMate (HM) II or HM3 between February 2009 and March 2019. Preoperative transthoracic echocardiograms, intraoperative transesophageal echocardiograms and operative reports were reviewed to identify ICT. There were 525 patients with a left ventricular assist device (median age 60.6 years, 81.8% male, 372 HMII and 151 HM3) included in this analysis. An ICT was identified in 44 patients (8.4%). During the follow-up, 43 patients experienced a stroke and 55 died. After multivariable adjustment, presence of ICT increased the risk for the composite of stroke or death at 6-month (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.00-3.33, P = .049). Patients with ICT were also at higher risk for stroke (HR 2.45, 95% CI 1.14-5.28, P = .021) and death (HR 2.36, 95% CI 1.17-4.79 P = .016) at 6 months of follow-up. CONCLUSIONS: The presence of ICT is an independent predictor of stroke and death at 6 months after left ventricular assist device implantation. Additional studies are needed to help risk stratify and optimize the perioperative management of this patient population.

Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure.

INTRODUCTION: Outcomes in acute decompensated heart failure (ADHF) have remained poor. Worsening renal function (WRF) is common among patients with ADHF. However, the impact of WRF on the prognosis is controversial. We hypothesized that in patients with ADHF, the achievement of concomitant decongestion would diminish the signal for harm associated with WRF. METHODS: We performed a systematic search of PubMed, EMBASE, and the Cochrane Library up to December 2019 for studies that assessed signs of decongestion in patients with WRF during ADHF admission. The primary outcome was all-cause mortality and heart transplantation. RESULTS: Thirteen studies were selected with a pooled population of 8138 patients. During the follow-up period of 60-450 days, 19.2% of patients died. Unstratified, patients with WRF versus no WRF had a higher risk for mortality (odds ratio [OR], 1.71 [95% confidence interval {CI}, 1.45-2.01]; P < 0.0001). However, patients who achieved decongestion had a similar prognosis (OR, 1.15 [95% CI, 0.89-1.49]; P = 0.30). Moreover, patients with WRF who achieved decongestion had a better prognosis compared with those without WRF or decongestion (OR, 0.63 [95% CI, 0.46-0.86]; P = 0.004). This tendency persisted for the sensitivity analyses. CONCLUSIONS: Decongestion is a powerful effect modifier that attenuates harmful associations of WRF with mortality. Future studies should not assess WRF as an endpoint without concomitant assessment of achieved volume status.

Metabolomic Profiling of Left Ventricular Diastolic Dysfunction in Women With or at Risk for HIV Infection: The Women's Interagency HIV Study.

Background People living with HIV have an increased risk of left ventricular diastolic dysfunction (LVDD) and heart failure. HIV-associated LVDD may reflect both cardiomyocyte and systemic metabolic derangements, but the underlying pathways remain unclear. Methods and Results To explore such pathways, we conducted a pilot study in the Bronx and Brooklyn sites of the WIHS (Women's Interagency HIV Study) who participated in concurrent, but separate, metabolomics and echocardiographic ancillary studies. Liquid chromatography tandem mass spectrometry-based metabolomic profiling was performed on plasma samples from 125 HIV-infected (43 with LVDD) and 35 HIV-uninfected women (9 with LVDD). Partial least squares discriminant analysis identified polar metabolites and lipids in the glycerophospholipid-metabolism and fatty-acid-oxidation pathways associated with LVDD. After multivariable adjustment, LVDD was significantly associated with higher concentrations of diacylglycerol 30:0 (odds ratio [OR], 1.60, 95% CI [1.01-2.55]); triacylglycerols 46:0 (OR 1.60 [1.04-2.48]), 48:0 (OR 1.63 [1.04-2.54]), 48:1 (OR 1.62 [1.01-2.60]), and 50:0 (OR 1.61 [1.02-2.53]); acylcarnitine C7 (OR 1.88 [1.21-2.92]), C9 (OR 1.99 [1.27-3.13]), and C16 (OR 1.80 [1.13-2.87]); as well as lower concentrations of phosphocholine (OR 0.59 [0.38-0.91]). There was no evidence of effect modification of these relationships by HIV status. Conclusions In this pilot study, women with or at risk of HIV with LVDD showed alterations in plasma metabolites in the glycerophospholipid-metabolism and fatty-acid-oxidation pathways. Although these findings require replication, they suggest that improved understanding of metabolic perturbations and their potential modification could offer new approaches to prevent cardiac dysfunction in this high-risk group.