Neurovascular Mechanisms of Cognitive Aging: Sex-Related Differences in the Average Progression of Arteriosclerosis, White Matter Atrophy, and Cognitive Decline.

Arterial stiffness (arteriosclerosis) has been linked to heightened risks for cognitive decline, and ultimately for Alzheimer's disease and other forms of dementia. Importantly, neurovascular outcomes generally vary according to one's biological sex. Here, capitalizing on a large sample of participants with neuroimaging and behavioral data ( N = 203, age range = 18-87 years), we aimed to provide support for a hierarchical model of neurocognitive aging, which links age-related declines in cerebrovascular health to the rate of cognitive decline via a series of intervening variables, such as white matter integrity. By applying a novel piecewise regression approach to our cross-sectional sample to support Granger-like causality inferences, we show that, on average, a precipitous decline in cerebral arterial elasticity (measured with diffuse optical imaging of the cerebral arterial pulse; pulse-DOT) temporally precedes an acceleration in the development of white matter lesions by nearly a decade, with women protected from these deleterious effects until approximately age 50, the average onset of menopause. By employing multiple-mediator path analyses while controlling for sex, we show that age may impair cognition via the sequential indirect effects of arteriosclerosis and white matter atrophy on fluid, but not crystallized, abilities. Importantly, we replicate these results using pulse pressure, an independent index of arterial health, thereby providing converging evidence for the central role of arteriosclerosis as an accelerating factor in normal and pathological aging and identifying robust sex-related differences in the progression of cerebral arteriosclerosis and white matter degradation.

Prevalence and imaging characteristics of cerebral small vessel disease in a Colombian population aged 40 years and older.

Cerebral small vessel disease is a major contributor to both brain aging and cognitive decline. This study aimed to determine the prevalence of cerebral small vessel disease in a Colombian population over 40 years of age who attended a Radiology and Diagnostic Imaging service for brain MRI between October 2018 and March 2019. This was an observational, cross-sectional and analytical study of 710 adult patients over 40 years of age who attended the Radiology and Diagnostic Imaging service for a brain MRI. The analysed data were obtained from an anonymized database of the service. We studied 710 MRI scans of patients aged between 40 and 104 years. The most frequent risk factor was hypertension (36.2%). Brain abnormalities associated with cerebral small vessel disease, such as white matter hyperintensities, were seen in 56.20% of the population, and brain atrophy was observed in 12.96%. Brain disease prevalence increased with age (23.18% for those aged 55 years, 54.49% for those aged 55-64 years, 69.8% for those aged 65-74 years and 90.53% for those older than 75 years). The prevalence of cerebral small vessel disease in our population was similar to that reported in the world literature, as were the prevalence of the evaluated cardiovascular risk factors. Additionally, we identified an association between hypertension and advanced age with cerebral small vessel disease, with white matter hyperintensities being the most characteristic finding.

MaPPeRTrac: A Massively Parallel, Portable, and Reproducible Tractography Pipeline.

Large-scale diffusion MRI tractography remains a significant challenge. Users must orchestrate a complex sequence of instructions that requires many software packages with complex dependencies and high computational costs. We developed MaPPeRTrac, an edge-centric tractography pipeline that simplifies and accelerates this process in a wide range of high-performance computing (HPC) environments. It fully automates either probabilistic or deterministic tractography, starting from a subject's magnetic resonance imaging (MRI) data, including structural and diffusion MRI images, to the edge density image (EDI) of their structural connectomes. Dependencies are containerized with Singularity (now called Apptainer) and decoupled from code to enable rapid prototyping and modification. Data derivatives are organized with the Brain Imaging Data Structure (BIDS) to ensure that they are findable, accessible, interoperable, and reusable following FAIR principles. The pipeline takes full advantage of HPC resources using the Parsl parallel programming framework, resulting in the creation of connectome datasets of unprecedented size. MaPPeRTrac is publicly available and tested on commercial and scientific hardware, so it can accelerate brain connectome research for a broader user community. MaPPeRTrac is available at: https://github.com/LLNL/mappertrac .

Yoga, aerobic and stretching exercise effects on neurocognition: Randomized controlled trial protocol.

As the global population ages, the prevalence of cognitive decline and dementia is expected to rise, creating a significant health and economic burden. The purpose of this trial is to rigorously test, for the first time, the efficacy of yoga training as a physical activity intervention to mitigate age-related cognitive decline and impairment. We are conducting a 6-month randomized controlled trial (RCT) of exercise among 168 middle aged and older adults to compare the efficacy of yoga vs. aerobic exercise on cognitive function, brain structure and function, cardiorespiratory fitness, and circulating inflammatory and molecular markers. Using a single-blind, three arm RCT, 168 older adults ages 55-79 will be assigned to either: a Hatha yoga group, an aerobic exercise group or a stretching-toning active control group. Participants will engage in hour long group exercise 3x/week for 6-months. A comprehensive neurocognitive test battery, brain imaging, cardiovascular fitness test, and a blood draw will take place at baseline; end of the 6-month intervention, and at 12-month follow-up. Our primary outcomes of interest are brain regions, such as hippocampal volume and prefrontal cortex, and cognitive functions, such as episodic memory, working memory and executive functions, that are typically affected by aging and Alzheimer's disease. Not only will this RCT test whether yoga is a means to mitigate age-related cognitive decline, but it may also offer an alternative to aerobic exercise, which could be particularly appealing to older adults with compromised physical functioning. ClinicalTrials.gov Identifier: NCT04323163.

Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery.

BACKGROUND: Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS: An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS: The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS: The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

Reductions in systolic blood pressure achieved by hypertensives with three isometric training sessions per week are maintained with a single session per week.

Isometric handgrip or (wall) squat exercise performed three times per week produces reductions in systolic blood pressure (SBP) in adults with hypertension. We aimed to compare these interventions and the potential to retain benefits with one exercise session per week. We compared blood pressure changes following handgrip and squat isometric training interventions with controls in a randomized controlled multicentre trial in 77 unmedicated hypertensive (SBP ≥ 130 mmHg) adults. Exercise sessions were performed in the workplace and consisted of four repetitions-three sessions per week for the first 12 weeks (phase 1), and one session per week for the subsequent 12 weeks (phase 2). Office blood pressure (BP) was measured at baseline, post-phase 1 and post-phase 2. Post-phase 1, mean reductions in SBP were significantly greater in handgrip (-11.2 mmHg, n = 28) and squat (-12.9 mmHg, n = 27) groups than in controls (-.4 mmHg; n = 22) but changes in DBP were not. There were no significant within-group changes during phase 2 but SBP was 3.8 mmHg lower in the wall squat than the handgrip group-a small magnitude but clinically important difference. While both interventions produced significant SBP reductions, the wall squat appears to be more effective in maintaining benefits with a minimal training dose. The low time investment to achieve and retain clinically significant SBP reductions-42 and 12 min, respectively-and minimal cost, particularly of the wall squat, make it a promising intervention for delivery in public health settings.

[Barriers to knowledge, treatment, and control of hypertension in Latin America: a scoping reviewBarreiras ao conhecimento, tratamento e controle da hipertensão arterial na América Latina: uma revisão de escopo]. / Barreras para el conocimiento, el tratamiento y el control de la hipertensión arterial en América Latina: una revisión de alcance.

Objective: Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods: A scoping review was conducted in accordance with the Arksey and O'Malley methodological framework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results: Eight qualitative and quantitative studies that fit the research question were included. The most frequently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adherence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions: The detected barriers affect all dimensions of adherence to treatment; among the most important barriers are decision makers who lack education and positioning with respect to care of hypertension.

Objetivo: Compilar as barreiras ao conhecimento, tratamento e controle da hipertensão arterial em pacientes da América Latina por meio de uma revisão de escopo. Métodos: Foi realizada uma revisão de escopo de acordo com a estrutura metodológica de Arksey e O'Malley e as diretrizes PRISMA para revisões sistemáticas e metanálises. Foi realizada uma busca nas bases de dados PubMed, Biblioteca Virtual em Saúde e Scopus. A seleção foi realizada de forma independente e cega no aplicativo RAYYAN QCRIâ. Por último, os resultados dos estudos selecionados foram abordados de forma narrativa. Resultados: Foram incluídos oito estudos qualitativos e quantitativos que se enquadravam na nossa questão de pesquisa. As barreiras mais frequentemente descritas são aquelas próprias do sistema que dificultam o acesso integral e equitativo a atendimento médico e medicamentos, a ausência de programas educativos e intervenções personalizadas que melhorem a adesão ao tratamento e as mudanças no estilo de vida. O fator econômico é crítico na América Latina e impede o acesso ao sistema de saúde para modificar o estilo de vida devido aos custos de transporte, consultas médicas e medicamentos. Conclusões: As barreiras detectadas afetam todas as dimensões da adesão ao tratamento, entre as quais se destaca a falta de capacitação e posicionamento dos tomadores de decisão sobre o cuidado da hipertensão.

Barreras para el conocimiento, el tratamiento y el control de la hipertensión arterial en América Latina: una revisión de alcance

[RESUMEN]. Objetivo. Agrupar las barreras para el conocimiento, tratamiento y control de la hipertensión en pacientes de América Latina mediante una revisión de alcance. Métodos. Se realizó una revisión de alcance de acuerdo con el marco metodológico de Arksey y O'Malley y las directrices para revisiones sistemáticas y metaanálisis (PRISMA). Se efectuó una búsqueda en las bases de datos PubMed, Biblioteca Virtual de Salud y Scopus. La selección se realizó de manera independiente y en ciego en el aplicativo RAYYAN QCRI®. Por último, se abordaron los resultados de los estudios seleccionados de manera narrativa. Resultados. Se incluyeron ocho estudios cualitativos y cuantitativos que se adecuaban a nuestra pregunta de investigación. Las barreras descritas con más frecuencia son las propias del sistema que dificultan el acceso integral y equitativo a la atención médica y los medicamentos, la ausencia de programas educativos e intervenciones personalizadas que mejoren la adherencia a tratamientos y los cambios en el estilo de vida. El factor económico es crítico en América Latina e impide el acceso al sistema de salud y modificar el estilo de vida debido a los costos del transporte, las citas médicas y los medicamentos. Conclusiones. Las barreras detectadas afectan todas las dimensiones para la adherencia al tratamiento; entre ellas se destacan la falta de educación y posicionamiento de los tomadores de decisiones en la atención de la hipertensión.

[ABSTRACT]. Objective. Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods. A scoping review was conducted in accordance with the Arksey and O'Malley methodological fra- mework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results. Eight qualitative and quantitative studies that fit the research question were included. The most fre- quently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adhe- rence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions. The detected barriers affect all dimensions of adherence to treatment; among the most impor- tant barriers are decision makers who lack education and positioning with respect to care of hypertension.

[RESUMO]. Objetivo. Compilar as barreiras ao conhecimento, tratamento e controle da hipertensão arterial em pacientes da América Latina por meio de uma revisão de escopo. Métodos. Foi realizada uma revisão de escopo de acordo com a estrutura metodológica de Arksey e O’Ma- lley e as diretrizes PRISMA para revisões sistemáticas e metanálises. Foi realizada uma busca nas bases de dados PubMed, Biblioteca Virtual em Saúde e Scopus. A seleção foi realizada de forma independente e cega no aplicativo RAYYAN QCRIâ. Por último, os resultados dos estudos selecionados foram abordados de forma narrativa. Resultados. Foram incluídos oito estudos qualitativos e quantitativos que se enquadravam na nossa questão de pesquisa. As barreiras mais frequentemente descritas são aquelas próprias do sistema que dificultam o acesso integral e equitativo a atendimento médico e medicamentos, a ausência de programas educativos e intervenções personalizadas que melhorem a adesão ao tratamento e as mudanças no estilo de vida. O fator econômico é crítico na América Latina e impede o acesso ao sistema de saúde para modificar o estilo de vida devido aos custos de transporte, consultas médicas e medicamentos. Conclusões. As barreiras detectadas afetam todas as dimensões da adesão ao tratamento, entre as quais se destaca a falta de capacitação e posicionamento dos tomadores de decisão sobre o cuidado da hipertensão.

Resting-State Functional Connectivity in Relapsing-Remitting Multiple Sclerosis with Mild Disability: A Data-Driven, Whole-Brain Multivoxel Pattern Analysis Study.

Background: Multivoxel pattern analysis (MVPA) has emerged as a powerful unbiased approach for generating seed regions of interest (ROIs) in resting-state functional connectivity (RSFC) analysis in a data-driven manner. Studies exploring RSFC in multiple sclerosis have produced diverse and often incongruent results. Objectives: The aim of the present study was to investigate RSFC differences between people with relapsing-remitting multiple sclerosis (RRMS) and healthy controls (HC). Methods: We performed a whole-brain connectome-wide MVPA in 50 RRMS patients with expanded disability status scale ≤4 and 50 age and gender-matched HCs. Results: Significant group differences were noted in RSFC in three clusters distributed in the following regions: anterior cingulate gyrus, right middle frontal gyrus, and frontal medial cortex. Whole-brain seed-to-voxel RSFC characterization of these clusters as seed ROIs revealed network-specific abnormalities, specifically in the anterior cingulate cortex and the default mode network. Conclusions: The network-wide RSFC abnormalities we report agree with the previous findings in RRMS, the cognitive and clinical implications of which are discussed herein. Impact statement This study investigated resting-state functional connectivity (RSFC) in relapsing-remitting multiple sclerosis (RRMS) people with mild disability (expanded disability status scale ≤4). Whole-brain connectome-wide multivoxel pattern analysis was used for assessing RSFC. Compared with healthy controls, we were able to identify three regions of interest for significant differences in connectivity patterns, which were then extracted as a mask for whole-brain seed-to-voxel analysis. A reduced connectivity was noted in the RRMS group, particularly in the anterior cingulate cortex and the default mode network regions, providing insights into the RSFC abnormalities in RRMS.

Adherence to pharmacological treatment in non-communicable chronic diseases in the Colombian population: Systematic review and meta-analysis / Cumplimiento del tratamiento farmacológico en enfermedades crónicas no transmisibles en la población colombiana: revisión sistemática y metaanálisis.

Introduction. Non-communicable chronic diseases represent the leading cause of death worldwide, and their prevalence is increasing due to the epidemiological transition. Despite the advances in their management, control rates are deficient, attributed to multiple factors like adherence to pharmacological treatment, one of the most significant and least studied in the Colombian population. Objective. To calculate adherence to treatment in Colombian patients with arterial hypertension, cerebrovascular disease, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and dyslipidemia between 2005 and 2022. Materials and methods. We performed a systematic literature review and a meta-analysis of studies identified through the Medline and LILACS databases to quantitatively synthesize treatment adherence percentage. Results. Fourteen studies met the inclusion criteria, and 5,658 patients were analyzed. The treatment adherence was 59%, with significant heterogeneity among the included studies (95% CI= 46- 71%; I2 = 98.8%, p< 0.001). Higher adherence rates were observed for diabetes mellitus (79%; 95% CI = 65- 90%) and dyslipidemia (70%; 95% CI = 66- 74%). Adherence to arterial hypertension treatment was 51% (95 %; CI = 31- 72%). Conclusions. This systematic review showed low adherence to recommendations regarding pharmacological management in non-communicable chronic diseases, which can have implications for long-term clinical outcomes and disease burden.

Introducción. Las enfermedades crónicas no transmisibles representan la principal causa de muerte en el mundo y su prevalencia va en aumento debido a la transición epidemiológica. A pesar de los avances en su manejo, las cifras de control son deficientes y esto se atribuye a múltiples factores, como el cumplimiento del tratamiento farmacológico, que es uno de los más representativos y menos estudiados en la población colombiana.Objetivo. Establecer la frecuencia de casos que cumplieron con el tratamiento farmacológico en pacientes colombianos con hipertensión arterial, enfermedad cerebrovascular, diabetes mellitus, asma, enfermedad pulmonar obstructiva crónica y dislipidemia, entre el 2005 y el 2022.Materiales y métodos. Se llevó a cabo una revisión sistemática de la literatura y un metaanálisis de los estudios identificados mediante las bases de datos Medline y LILACS para sintetizar cuantitativamente el porcentaje de cumplimiento del tratamiento.Resultados. Catorce estudios cumplieron los criterios de inclusión y se analizaron 5.658 pacientes. El cumplimiento del tratamiento fue del 59 %, con una heterogeneidad alta entre los estudios incluidos (IC95 % = 46-71 %; I2 = 98,8 %, p<0,001). Se obtuvo un mayor cumplimiento para la diabetes mellitus (79 %; IC95 % = 65-90 %) y la dislipidemia (70 %; IC 95 % = 66-74 %). En los pacientes con hipertensión arterial el cumplimiento fue del 51 % (IC 95 % = 31-72 %).Conclusiones. La revisión sistemática muestra un bajo cumplimiento de las recomendaciones sobre el manejo farmacológico de enfermedades crónicas no transmisibles, lo que puede repercutir en los resultados clínicos y en la carga de la enfermedad a largo plazo.

Barreras para el conocimiento, el tratamiento y el control de la hipertensión arterial en América Latina: una revisión de alcance / Barriers to knowledge, treatment, and control of hypertension in Latin America: a scoping review / Barreiras ao conhecimento, tratamento e controle da hipertensão arterial na América Latina: uma revisão de escopo

RESUMEN Objetivo. Agrupar las barreras para el conocimiento, tratamiento y control de la hipertensión en pacientes de América Latina mediante una revisión de alcance. Métodos. Se realizó una revisión de alcance de acuerdo con el marco metodológico de Arksey y O'Malley y las directrices para revisiones sistemáticas y metaanálisis (PRISMA). Se efectuó una búsqueda en las bases de datos PubMed, Biblioteca Virtual de Salud y Scopus. La selección se realizó de manera independiente y en ciego en el aplicativo RAYYAN QCRI®. Por último, se abordaron los resultados de los estudios seleccionados de manera narrativa. Resultados. Se incluyeron ocho estudios cualitativos y cuantitativos que se adecuaban a nuestra pregunta de investigación. Las barreras descritas con más frecuencia son las propias del sistema que dificultan el acceso integral y equitativo a la atención médica y los medicamentos, la ausencia de programas educativos e intervenciones personalizadas que mejoren la adherencia a tratamientos y los cambios en el estilo de vida. El factor económico es crítico en América Latina e impide el acceso al sistema de salud y modificar el estilo de vida debido a los costos del transporte, las citas médicas y los medicamentos. Conclusiones. Las barreras detectadas afectan todas las dimensiones para la adherencia al tratamiento; entre ellas se destacan la falta de educación y posicionamiento de los tomadores de decisiones en la atención de la hipertensión.

ABSTRACT Objective. Group the barriers to knowledge, treatment, and control of hypertension in patients in Latin America through a scoping review. Methods. A scoping review was conducted in accordance with the Arksey and O'Malley methodological framework and the PRISMA guidelines for systematic reviews and meta-analyses. Searches were carried out in the PubMed, Virtual Health Library, and Scopus databases. Blind and independent selection was conducted in the RAYYAN QCRI application. Finally, the results of the selected studies were addressed narratively. Results. Eight qualitative and quantitative studies that fit the research question were included. The most frequently described barriers are systemic barriers that hinder comprehensive and equitable access to health care and medication, as well as a lack of educational programs, personalized interventions to improve adherence to treatments, and lifestyle changes. Economic factors are critical in Latin America, hindering access to the health system and changes to lifestyles due to the costs of transportation, medical appointments, and medicines. Conclusions. The detected barriers affect all dimensions of adherence to treatment; among the most important barriers are decision makers who lack education and positioning with respect to care of hypertension.

RESUMO Objetivo. Compilar as barreiras ao conhecimento, tratamento e controle da hipertensão arterial em pacientes da América Latina por meio de uma revisão de escopo. Métodos. Foi realizada uma revisão de escopo de acordo com a estrutura metodológica de Arksey e O'Malley e as diretrizes PRISMA para revisões sistemáticas e metanálises. Foi realizada uma busca nas bases de dados PubMed, Biblioteca Virtual em Saúde e Scopus. A seleção foi realizada de forma independente e cega no aplicativo RAYYAN QCRIâ. Por último, os resultados dos estudos selecionados foram abordados de forma narrativa. Resultados. Foram incluídos oito estudos qualitativos e quantitativos que se enquadravam na nossa questão de pesquisa. As barreiras mais frequentemente descritas são aquelas próprias do sistema que dificultam o acesso integral e equitativo a atendimento médico e medicamentos, a ausência de programas educativos e intervenções personalizadas que melhorem a adesão ao tratamento e as mudanças no estilo de vida. O fator econômico é crítico na América Latina e impede o acesso ao sistema de saúde para modificar o estilo de vida devido aos custos de transporte, consultas médicas e medicamentos. Conclusões. As barreiras detectadas afetam todas as dimensões da adesão ao tratamento, entre as quais se destaca a falta de capacitação e posicionamento dos tomadores de decisão sobre o cuidado da hipertensão.

Visual and satisfaction results with implantation of the trifocal Panoptix (R) intraocular lens in cataract surgery

Purpose: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens.Methods: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied.Results: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results.Conclusions: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses. (AU)

Personal and household PM2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries.

BACKGROUND: Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. OBJECTIVE: To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. METHODS: As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. RESULTS: The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) µg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10-5 m-1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. CONCLUSIONS: We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.

Deep learning representations to support COVID-19 diagnosis on CT slices. / Representaciones basadas en aprendizaje profundo como apoyo del diagnóstico de la COVID-19 en cortes de tomografía computarizada

INTRODUCTION: The coronavirus disease 2019 (COVID-19) has become a significant public health problem worldwide. In this context, CT-scan automatic analysis has emerged as a COVID-19 complementary diagnosis tool allowing for radiological finding characterization, patient categorization, and disease follow-up. However, this analysis depends on the radiologist's expertise, which may result in subjective evaluations. OBJECTIVE: To explore deep learning representations, trained from thoracic CT-slices, to automatically distinguish COVID-19 disease from control samples. MATERIALS AND METHODS: Two datasets were used: SARS-CoV-2 CT Scan (Set-1) and FOSCAL clinic's dataset (Set-2). The deep representations took advantage of supervised learning models previously trained on the natural image domain, which were adjusted following a transfer learning scheme. The deep classification was carried out: (a) via an end-to-end deep learning approach and (b) via random forest and support vector machine classifiers by feeding the deep representation embedding vectors into these classifiers. RESULTS: The end-to-end classification achieved an average accuracy of 92.33% (89.70% precision) for Set-1 and 96.99% (96.62% precision) for Set-2. The deep feature embedding with a support vector machine achieved an average accuracy of 91.40% (95.77% precision) and 96.00% (94.74% precision) for Set-1 and Set-2, respectively. CONCLUSION: Deep representations have achieved outstanding performance in the identification of COVID-19 cases on CT scans demonstrating good characterization of the COVID-19 radiological patterns. These representations could potentially support the COVID-19 diagnosis in clinical settings.

Introducción. La enfermedad por coronavirus (COVID-19) es actualmente el principal problema de salud pública en el mundo. En este contexto, el análisis automático de tomografías computarizadas (TC) surge como una herramienta diagnóstica complementaria que permite caracterizar hallazgos radiológicos, y categorizar y hacer el seguimiento de pacientes con COVID-19. Sin embargo, este análisis depende de la experiencia de los radiólogos, por lo que las valoraciones pueden ser subjetivas. Objetivo. Explorar representaciones de aprendizaje profundo entrenadas con cortes de TC torácica para diferenciar automáticamente entre los casos de COVID-19 y personas no infectadas. Materiales y métodos. Se usaron dos conjuntos de datos de TC: de SARS-CoV-2 CT (conjunto 1) y de la clínica FOSCAL (conjunto 2). Los modelos de aprendizaje supervisados y previamente entrenados en imágenes naturales, se ajustaron usando aprendizaje por transferencia. La clasificación se llevó a cabo mediante aprendizaje de extremo a extremo y clasificadores tales como los árboles de decisiones y las máquinas de soporte vectorial, alimentados por la representación profunda previamente aprendida. Resultados. El enfoque de extremo a extremo alcanzó una exactitud promedio de 92,33 % (89,70 % de precisión) para el conjunto 1 y de 96,99 % (96,62 % de precisión) para el conjunto-2. La máquina de soporte vectorial alcanzó una exactitud promedio de 91,40 % (precisión del 95,77 %) para el conjunto-1 y del 96,00 % (precisión del 94,74 %) para el conjunto 2. Conclusión. Las representaciones profundas lograron resultados sobresalientes al caracterizar patrones radiológicos usados en la detección de casos de COVID-19 a partir de estudios de TC y demostraron ser una potencial herramienta de apoyo del diagnóstico.

Risk factors, cardiovascular disease, and mortality in South America: a PURE substudy.

AIMS: In a multinational South American cohort, we examined variations in CVD incidence and mortality rates between subpopulations stratified by country, by sex and by urban or rural location. We also examined the contributions of 12 modifiable risk factors to CVD development and to death. METHODS AND RESULTS: This prospective cohort study included 24 718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia. The mean follow-up was 10.3 years. The incidence of CVD and mortality rates were calculated for the overall cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and for death were examined for 12 common modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (tobacco, alcohol, diet quality, and physical activity), and others (education, household air pollution, strength, and depression). Leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). The incidence of CVD (per 1000 person-years) only modestly varied between countries, with the highest incidence in Brazil (3.86) and the lowest in Argentina (3.07). There was a greater variation in mortality rates (per 1000 person-years) between countries, with the highest in Argentina (5.98) and the lowest in Chile (4.07). Men had a higher incidence of CVD (4.48 vs. 2.60 per 1000 person-years) and a higher mortality rate (6.33 vs. 3.96 per 1000 person-years) compared with women. Deaths were higher in rural compared to urban areas. Approximately 72% of the PAF for CVD and 69% of the PAF for deaths were attributable to 12 modifiable risk factors. For CVD, largest PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), tobacco use (13.5%), low strength (5.6%), and diabetes (5.3%). For death, the largest PAFs were from tobacco use (14.4%), hypertension (12.0%), low education (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). CONCLUSIONS: Cardiovascular disease, cancer, and respiratory diseases account for over two-thirds of deaths in South America. Men have consistently higher CVD and mortality rates than women. A large proportion of CVD and premature deaths could be averted by controlling metabolic risk factors and tobacco use, which are common leading risk factors for both outcomes in the region.

Deep learning representations to support COVID-19 diagnosis on CT slices / Representaciones basadas en aprendizaje profundo como apoyo del diagnóstico de la COVID-19 en cortes de tomografía computarizada

Introduction: The coronavirus disease 2019 (COVID-19) has become a significant public health problem worldwide. In this context, CT-scan automatic analysis has emerged as a COVID-19 complementary diagnosis tool allowing for radiological finding characterization, patient categorization, and disease follow-up. However, this analysis depends on the radiologist's expertise, which may result in subjective evaluations. Objective: To explore deep learning representations, trained from thoracic CT-slices, to automatically distinguish COVID-19 disease from control samples. Materials and methods: Two datasets were used: SARS-CoV-2 CT Scan (Set-1) and FOSCAL clinic's dataset (Set-2). The deep representations took advantage of supervised learning models previously trained on the natural image domain, which were adjusted following a transfer learning scheme. The deep classification was carried out: (a) via an end-to-end deep learning approach and (b) via random forest and support vector machine classifiers by feeding the deep representation embedding vectors into these classifiers. Results: The end-to-end classification achieved an average accuracy of 92.33% (89.70% precision) for Set-1 and 96.99% (96.62% precision) for Set-2. The deep feature embedding with a support vector machine achieved an average accuracy of 91.40% (95.77% precision) and 96.00% (94.74% precision) for Set-1 and Set-2, respectively. Conclusion: Deep representations have achieved outstanding performance in the identification of COVID-19 cases on CT scans demonstrating good characterization of the COVID-19 radiological patterns. These representations could potentially support the COVID-19 diagnosis in clinical settings.

Introducción. La enfermedad por coronavirus (COVID-19) es actualmente el principal problema de salud pública en el mundo. En este contexto, el análisis automático de tomografías computarizadas (TC) surge como una herramienta diagnóstica complementaria que permite caracterizar hallazgos radiológicos, y categorizar y hacer el seguimiento de pacientes con COVID-19. Sin embargo, este análisis depende de la experiencia de los radiólogos, por lo que las valoraciones pueden ser subjetivas. Objetivo. Explorar representaciones de aprendizaje profundo entrenadas con cortes de TC torácica para diferenciar automáticamente entre los casos de COVID-19 y personas no infectadas. Materiales y métodos. Se usaron dos conjuntos de datos de TC: de SARS-CoV-2 CT (conjunto 1) y de la clínica FOSCAL (conjunto 2). Los modelos de aprendizaje supervisados y previamente entrenados en imágenes naturales, se ajustaron usando aprendizaje por transferencia. La clasificación se llevó a cabo mediante aprendizaje de extremo a extremo y clasificadores tales como los árboles de decisiones y las máquinas de soporte vectorial, alimentados por la representación profunda previamente aprendida. Resultados. El enfoque de extremo a extremo alcanzó una exactitud promedio de 92,33 % (89,70 % de precisión) para el conjunto 1 y de 96,99 % (96,62 % de precisión) para el conjunto-2. La máquina de soporte vectorial alcanzó una exactitud promedio de 91,40 % (precisión del 95,77 %) para el conjunto-1 y del 96,00 % (precisión del 94,74 %) para el conjunto 2. Conclusión. Las representaciones profundas lograron resultados sobresalientes al caracterizar patrones radiológicos usados en la detección de casos de COVID-19 a partir de estudios de TC y demostraron ser una potencial herramienta de apoyo del diagnóstico.

Fitness Changes in Adolescent Girls Following In-School Combined Aerobic and Resistance Exercise: Interaction With Birthweight.

PURPOSE: To assess the efficacy of a supervised in-school combined resistance and aerobic training program in adolescent girls and investigate whether responses differ according to birthweight. METHODS: Participants (girls aged 13-17 y) were randomized either to an intervention replacing physical education (PE) classes with 2 × 60-minute training sessions per week (n = 58) or to a control group that continued to attend 2 × 60 minutes per week of curriculum PE (n = 41). We measured muscular fitness (handgrip, standing long jump, and sit-ups), cardiorespiratory fitness (20-m shuttle run), skinfolds, and lean body mass preintervention and postintervention and determined effect size (Hedge's g) differences between changes in these measures. We also compared changes within lower (<3000 g) and normal birthweight intervention and PE control subgroups. RESULTS: The intervention group showed greater improvements in all the fitness measures and lean body mass (g = 0.22-0.48) and lower skinfold increases (g = 0.41) than PE controls. Within the intervention group, improvements in all fitness measures were larger in lower birthweight (g = 0.53-0.94) than in normal birthweight girls (g = 0.02-0.39). CONCLUSION: Replacing curriculum PE with supervised training improved muscular and cardiorespiratory fitness and body composition outcomes in adolescent females. Our findings suggest an enhanced adaptive response to training in participants with lower birthweight which warrants further investigation.

Multinational prediction of household and personal exposure to fine particulate matter (PM2.5) in the PURE cohort study.

INTRODUCTION: Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM2.5 exposure models. METHODS: The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM2.5 kitchen concentrations (n = 2,365) and male and/or female PM2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM2.5 exposures. RESULTS: The final models explained half (R2 = 54%) of the variation in kitchen PM2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R2 = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM2.5 kitchen concentrations. Average national PM2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 µg/m3 (Chile); 55 µg/m3 (China)) and 12-fold among households primarily cooking with wood (36 µg/m3 (Chile)); 427 µg/m3 (Pakistan)). Average PM2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile). CONCLUSION: Using survey data to estimate PM2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.

Measuring and predicting personal and household Black Carbon levels from 88 communities in eight countries.

Black Carbon (BC) is an important component of household air pollution (HAP) in low- and middle- income countries (LMICs), but levels and drivers of exposure are poorly understood. As part of the Prospective Urban and Rural Epidemiological (PURE) study, we analyzed 48-hour BC measurements for 1187 individual and 2242 household samples from 88 communities in 8 LMICs (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Light absorbance (10-5 m-1) of collected PM2.5 filters, a proxy for BC concentrations, was calculated via an image-based reflectance method. Surveys of household/personal characteristics and behaviors were collected after monitoring. The geometric mean (GM) of personal and household BC measures was 2.4 (3.3) and 3.5 (3.9)·10-5 m-1, respectively. The correlation between BC and PM2.5 was r = 0.76 for personal and r = 0.82 for household measures. A gradient of increasing BC concentrations was observed for cooking fuels: BC increased 53% (95%CI: 30, 79) for coal, 142% (95%CI: 117, 169) for wood, and 190% (95%CI: 149, 238) for other biomass, compared to gas. Each hour of cooking was associated with an increase in household (5%, 95%CI: 3, 7) and personal (5%, 95%CI: 2, 8) BC; having a window in the kitchen was associated with a decrease in household (-38%, 95%CI: -45, -30) and personal (-31%, 95%CI: -44, -15) BC; and cooking on a mud stove, compared to a clean stove, was associated with an increase in household (125%, 95%CI: 96, 160) and personal (117%, 95%CI: 71, 117) BC. Male participants only had slightly lower personal BC (-0.6%, 95%CI: -1, 0.0) compared to females. In multivariate models, we were able to explain 46-60% of household BC variation and 33-54% of personal BC variation. These data and models provide new information on exposure to BC in LMICs, which can be incorporated into future exposure assessments, health research, and policy surrounding HAP and BC.

Visual and satisfaction results with implantation of the trifocal Panoptix® intraocular lens in cataract surgery.

PURPOSE: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens. METHODS: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied. RESULTS: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results. CONCLUSIONS: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses.