Electrocardiography-based Artificial Intelligence Algorithms Aid in Prediction of Long-term Mortality After Kidney Transplantation.

BACKGROUND: Predicting long-term mortality postkidney transplantation (KT) using baseline clinical data presents significant challenges. This study aims to evaluate the predictive power of artificial intelligence (AI)-enabled analysis of preoperative electrocardiograms (ECGs) in forecasting long-term mortality following KT. METHODS: We analyzed preoperative ECGs from KT recipients at three Mayo Clinic sites (Minnesota, Florida, and Arizona) between January 1, 2006, and July 30, 2021. The study involved 6 validated AI algorithms, each trained to predict future development of atrial fibrillation, aortic stenosis, low ejection fraction, hypertrophic cardiomyopathy, amyloid heart disease, and biological age. These algorithms' outputs based on a single preoperative ECG were correlated with patient mortality data. RESULTS: Among 6504 KT recipients included in the study, 1764 (27.1%) died within a median follow-up of 5.7 y (interquartile range: 3.00-9.29 y). All AI-ECG algorithms were independently associated with long-term all-cause mortality (P < 0.001). Notably, few patients had a clinical cardiac diagnosis at the time of transplant, indicating that AI-ECG scores were predictive even in asymptomatic patients. When adjusted for multiple clinical factors such as recipient age, diabetes, and pretransplant dialysis, AI algorithms for atrial fibrillation and aortic stenosis remained independently associated with long-term mortality. These algorithms also improved the C-statistic for predicting overall (C = 0.74) and cardiac-related deaths (C = 0.751). CONCLUSIONS: The findings suggest that AI-enabled preoperative ECG analysis can be a valuable tool in predicting long-term mortality following KT and could aid in identifying patients who may benefit from enhanced cardiac monitoring because of increased risk.

Simulation of daily soft multifocal contact lenses using SimVis Gekko: from in-vitro and computational characterization to clinical validation.

Multifocal contact lenses (MCLs) are one of the solutions to correct presbyopia, but their adoption is not widespread. To address this situation, visual simulators can be used to refine the adaptation process. This study aims to obtain accurate simulations for a visual simulator (SimVis Gekko; 2EyesVision) of daily soft MCL designs from four manufacturers. In-vitro characterization of these MCLs-several powers and additions- was obtained using NIMO TR-1504. From the averaged relative power profiles across powers, phase maps were reconstructed and the Through-Focus Visual Strehl metric was calculated for each MCL design. The SimVis Gekko simulation corresponding to each MCL design was obtained computationally and bench-validated. Finally, the MCL simulations were clinically validated involving presbyopic patients. The clinical validation results show a good agreement between the SimVis Gekko simulations and the real MCLs for through-focus visual acuity (TF-VA) curves and VA at three real distances. All MCL designs showed a partial correlation higher than 0.90 and a Root Mean Square Error below 0.07 logMAR between the TF-VA of simulations and Real MCLs across subjects. The validity of the simulation approach using SimVis Gekko and in-vitro measurements was confirmed in this study, opening the possibility to accelerate the adaptation of MCLs.

Seabird guano inputs increase impacts from introduced mammals on the native plants and animals of an oceanic island.

Seabirds create fluxes of nutrients from marine to terrestrial ecosystems that influence the food webs of small islands. We investigated how guano inputs shape terrestrial food webs by comparing species of selected plant and animal species in a red-footed booby colony in Mona Island (Puerto Rico, Caribbean Sea), to sites of the island lacking guano inputs. We quantified guano deposition and its relationship to plant biomass production, fecundity and density, as well as the activity of native and introduced animal species. In general, guano inputs increased the gross primary plant productivity, size, and fecundity by twofold. Guano inputs were also associated with twofold increases in density of Anole lizards, but also to increases in the activity of introduced pigs (> 500%), goats (> 30%), and cats (> 500%), which negatively impact native species. In particular, elevated pig and cat activity within the booby colony was correlated with lower activity of endemic ground lizards and of introduced rats. Our results also suggest that severe droughts associated with climate change exacerbate the negative effects that introduced species have on vegetation and reduce the positive effects of seabird guano inputs. Our findings underscore the importance of allochthonous guano inputs in subsidizing plant productivity and native and endemic species in small oceanic islands, but also in increasing the negative impacts of introduced mammals. Management and conservation efforts should focus on the exclusion (or eradication) of introduced mammals, particularly pigs and goats, from remnant seabird colonies in Mona Island.

Effects of nanotubes on semen quality and fertility in humans: A systematic review of literature.

BACKGROUND: In the medical field, it is increasingly common to observe the use of nanotubes, for example, in the administration of drugs. However, nanotubes raise concerns for male fertility due to potential effects on hormone levels and sperm quality observed in animal studies. In addition, animal exposure to multi-walled carbon nanotube models found alterations in hormone levels, sperm motility, and sperm count. Limited evidence in humans suggests no adverse effects, but further research is needed. This study aimed to perform a systematic review to assess the in vitro effects of nanotubes on semen and fertility in humans. METHODS: We included all published in vitro studies about semen or sperm or male fertility and nanotubes in humans. A search was conducted in LILACS, PubMed, and SCOPUS as of May 2023. The risk of bias was assessed using the QUIN tool. RESULTS: Four studies using nanotubes on human sperm were included, nanotubes exposure appears not to affect sperm viability; however, some alterations to motility, velocity and production of reactive oxygen species were reported. Limited evidence is provided because of the small quantity of publications. CONCLUSIONS: Nanotubes appear to have no adverse effects on human sperm.

The social-cognitive clinician: On the implications of social cognitive theory for psychotherapy and assessment.

We review Bandura's contributions to cognitive-behavioural theory, research and practice. His basic research on the causal role of cognitive processes in social learning was a major factor in the emergence of cognitive-behavioural therapies in the 1970s. His investigations on observational learning and self-efficacy beliefs led to the development of guided mastery therapy, a specific cognitive-behavioural intervention for anxiety disorders. His research on self-regulatory processes provided an empirical basis for the emergence of numerous therapies targeting self-regulation. We conclude by discussing how Bandura's social cognitive theory, as well as more recent advances in social cognitive theorising, might be further applied to innovative approaches to therapeutic interventions, assessment and clinical case conceptualization.

Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial.

INTRODUCTION: The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting. METHODS: A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups. RESULTS: The use of barbed sutures decreased closure time by 6 min (30.1 vs. 36.1 min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5 mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up. CONCLUSION: Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique. LEVEL OF EVIDENCE: I.

Thoracic impedance pneumography in propofol-sedated patients undergoing percutaneous endoscopic gastrostomy (PEG) placement in gastrointestinal endoscopy: A prospective, randomized trial.

STUDY OBJECTIVE: To assess the efficacy of an ECG-based method called thoracic impedance pneumography to reduce hypoxic events in endoscopy. DESIGN: This was a single center, 1:1 randomized controlled trial. SETTING: The trial was conducted during the placement of percutaneous endoscopic gastrostomy (PEG). PATIENTS: 173 patients who underwent PEG placement were enrolled in the present trial. Indication was oncological in most patients (89%). 58% of patients were ASA class II and 42% of patients ASA class III. INTERVENTIONS: Patients were randomized in the standard monitoring group (SM) with pulse oximetry and automatic blood pressure measurement or in the intervention group with additional thoracic impedance pneumography (TIM). Sedation was performed with propofol by gastroenterologists or trained nurses. MEASUREMENTS: Hypoxic episodes defined as SpO2 < 90% for >15 s were the primary endpoint. Secondary endpoints were minimal SpO2, apnea >10s/>30s and incurred costs. MAIN RESULTS: Additional use of thoracic impedance pneumography reduced hypoxic episodes (TIM: 31% vs SM: 49%; p = 0.016; OR 0.47; NNT 5.6) and elevated minimal SpO2 per procedure (TIM: 90.0% ± 8.9; SM: 84.0% ± 17.6; p = 0.007) significantly. Apnea events >10s and > 30s were significantly more often detected in TIM (43%; 7%) compared to SM (1%; 0%; p < 0.001; p = 0.014) resulting in a time advantage of 17 s before the occurrence of hypoxic events. As a result, adjustments of oxygen flow were significantly more often necessary in SM than in TIM (p = 0.034) and assisted ventilation was less often needed in TIM (2%) compared with SM (9%; p = 0.053). Calculated costs for the additional use of thoracic impedance pneumography were 0.13$ (0.12 €/0.11 £) per procedure. CONCLUSIONS: Additional thoracic impedance pneumography reduced the quantity and extent of hypoxic events with less need of assisted ventilation. Supplemental costs per procedure were negligible. KEY WORDS: thoracic impedance pneumography, capnography, sedation, monitoring, gastrointestinal endoscopy, percutaneous endoscopic gastrostomy.

Variation in Avian Predation Pressure as a Driver for the Diversification of Periodical Cicada Broods.

AbstractPeriodical cicadas live 13 or 17 years underground as nymphs, then emerge in synchrony as adults to reproduce. Developmentally synchronized populations called broods rarely coexist, with one dominant brood locally excluding those that emerge in off years. Twelve modern 17-year cicada broods are believed to have descended from only three ancestral broods following the last glaciation. The mechanisms by which these daughter broods overcame exclusion by the ancestral brood to synchronously emerge in a different year, however, are elusive. Here, we demonstrate that temporal variation in the population density of generalist predators can allow intermittent opportunities for new broods to invade, even though a single brood remains dominant most of the time. We show that this mechanism is consistent, in terms of the type and frequency of brood replacements, with the distribution of periodical cicada broods throughout North America today. Although we investigate one particularly charismatic case study, the mechanisms involved (competitive exclusion, Allee effects, trait variation, predation, and temporal variability) are ubiquitous and could contribute to patterns of species diversity in a range of systems.

Global Neurosurgery at the 76th World Health Assembly (2023): First Neurosurgery-Driven Resolution Calls for Micronutrient Fortification to Prevent Spina Bifida.

Since 2018, a neurosurgery delegation has been actively engaged and consistently present at the World Health Assembly. Recognizing the growing impact of neurosurgical diseases, the neurosurgery delegation participated in the 76th World Health Assembly in May 2023, advocating for timely, safe, and affordable global neurosurgical care. The delegation focused on forging new collaborations, strengthening the World Health Organization-World Federation of Neurosurgical Societies official relations, and actively supporting resolutions that impact the neurosurgical patients. However, there is a long advocacy journey ahead to address unmet neurosurgical needs. Patient-centered advocacy is an inherent task of our profession and the essence of the Global Neurosurgery Bogota Declaration of 2016. The highlight of the 76th World Health Assembly was the adoption of the first neurosurgery-driven resolution calling for micronutrient fortification to prevent spina bifida and other micronutrient deficiencies. For the last 4 years, the Global Alliance for Prevention of Spina Bifida, a group spearheaded by neurosurgeons, advocated for spina bifida prevention. This Alliance collaborated with many stakeholders, notably, the Colombian government to promote the resolution: "Accelerating efforts for preventing micronutrient deficiencies and their consequences, including spina bifida and other neural tube defects, through safe and effective food fortification." This is a proud milestone for the neurosurgical profession. There are many strategies available for neurosurgeons, when working together with elected leaders, other stakeholders, and allied professionals, to implement initiatives that can prevent future cases of spina bifida and other neurological disorders and reduce the burden of neurosurgical disease.

Surface deformations of the 6 February 2023 earthquake sequence, eastern Türkiye.

Two powerful earthquakes struck Türkiye on 6 February 2023. The initial rupture was on the Dead Sea fault zone, yet maximum displacements and energy release [moment magnitude (Mw) 7.8] occurred 24 seconds later when rupture transferred to the East Anatolian fault zone (EAFZ). More than 7 hours later, a Mw 4.5 aftershock at the junction of the EAFZ with the east-west striking Çardak-Sürgü fault was followed 86 minutes later by the second large (Mw 7.5) earthquake, suggesting a causal relationship. We provide quantitative ground and aerial documentation of surface offsets and kinematics from the slipped faults, providing important data on surface deformation during large continental strike-slip earthquakes, rupture propagation mechanisms, and how slip may be transferred between complex fault systems. We also provide insight into how slip along linked fault systems accommodates global plate motions.

The Brain Health Diplomat's Toolkit: supporting brain health diplomacy leaders in Latin America and the Caribbean.

Maintaining and improving brain health, one of the most critical global challenges of this century, necessitates innovative, interdisciplinary, and collaborative strategies to address the growing challenges in Latin America and the Caribbean. This paper introduces Brain Health Diplomacy (BHD) as a pioneering approach to bridge disciplinary and geographic boundaries and mobilize resources to promote equitable brain health outcomes in the region. Our framework provides a toolkit for emerging brain health leaders, equipping them with essential concepts and practical resources to apply in their professional work and collaborations. By providing case studies, we highlight the importance of culturally sensitive, region-specific interventions to address unique needs of vulnerable populations. By encouraging dialogue, ideation, and cross-sector discussions, we aspire to develop new research, policy, and programmatic avenues. The novel BHD approach has the potential to revolutionize brain health across the region and beyond, ultimately contributing to a more equitable global cognitive health landscape.

A meta-analysis of hairy vetch as a previous cover crop for maize.

Background: The use of hairy vetch (Vicia villosa Roth.) as cover crop is increasing worldwide. Hairy vetch can contribute as a nitrogen (N) source with potential to impact subsequent high N demanding cereals such as maize (Zea mays L.). Contrasting literature results emphasize the need for a global synthesis analysis to quantify changes in maize yield after hairy vetch. Objectives: A meta-analysis was conducted to i) quantify maize yield response to hairy vetch as previous crop, ii) explore hairy vetch influence on fertilized and non-N fertilized maize yields, and iii) assess the tillage and environment factors on maize yield response to hairy vetch. Methods: The global systematic search yielded 23 publications selected by the following criteria, i) hairy vetch dry matter at the end of the season, ii) maize grain yield, and iii) experimental design with (Mzhv) and without (Mzcontrol) hairy vetch treatments. Information such as N fertilization for maize, N accumulation in hairy vetch, organic matter, and tillage before maize sowing were recorded. Hairy vetch effects (effect size) were expressed as a ratio (percentage of grain yield variation in Mzhv/Mzcontrol). Results: Under non-N fertilization (n = 9), results revealed hairy vetch had mostly a positive effect, ranging from 13 to 45% (n = 6). In contrast, N-fertilized maize (n = 20) showed a high chance of neutral effects (n = 12), moderate probability of positive yield impact (7 to 38%, n = 6), and a low likelihood of negative effects (-32 and -17%, n = 2). Notably, maize yields improved by 21-25% when the N accumulation in hairy vetch ranged from 95 to 150 kg ha-1 and N rate from 0 to 120 kg ha-1. Non-N-fertilized maize exhibited a 14% increase in response in no-till systems and a 31% increase with conventional tillage. Conclusion: This study summarizes potential benefits of hairy vetch preceding maize. Yet, the heterogeneous outcomes deserve further exploration in terms of environment and management factors.

Stability of Coumarins and Determination of the Net Iron Oxidation State of Iron-Coumarin Complexes: Implications for Examining Plant Iron Acquisition Mechanisms.

Coumarins are exuded into the soil environment by plant roots in response to iron (Fe) deficiency. Previous studies have shown that coumarins can increase the Fe solubility upon interaction with sparsely soluble Fe(III) (hydr)oxide. However, the chemical mechanisms of Fe(III) (hydr)oxide dissolution by coumarins remain unclear. The high redox instability of dissolved coumarins and the interference of coumarins in determining the Fe redox state hinder the quantitative and mechanistic investigation of coumarin-induced Fe mobilization. In this study, we investigated the oxidative stability of three coumarins that have been found in root exudates, esculetin, scopoletin, and fraxetin, over a broad pH range under oxic and anoxic conditions. Our results show that the oxidation of coumarins is irreversible under oxic conditions and that oxidative degradation rates increased with increasing pH under both oxic and anoxic conditions. However, the complexation of Fe protects coumarins from degradation in the circumneutral pH range even under oxic conditions. Furthermore, we observed that Ferrozine, which is commonly used for establishing Fe redox speciation, can facilitate the reduction of Fe(III) complexed by coumarins, even at circumneutral pH. Reduction rates increased with decreasing pH and were larger for fraxetin than for scopoletin and esculetin. Based on these observations, we optimized the Ferrozine method for determining the redox state of Fe complexed by coumarins. Understanding the stability of dissolved coumarins and using a precise analytical method to determine the redox state of Fe in the presence of coumarins are critical for investigating the mechanisms by which coumarins enhance the availability of Fe in the rhizosphere.

Rates and Mechanism of Vivianite Dissolution under Anoxic Conditions.

The iron phosphate mineral vivianite Fe(II)3(PO4)2·8H2O has emerged as a potential renewable P source. Although the importance of vivianite as a potential P sink in the global P cycle had previously been recognized, a mechanistic understanding of vivianite dissolution at the molecular level, critical to its potential application, is still elusive. The potential of vivianite as a P sink or source in natural or engineered systems is directly dependent on its dissolution kinetics under environmentally relevant conditions. To understand the thermodynamic and kinetic controls on bioavailability, the oxidation and dissolution processes of vivianite must be disentangled. In this study, we conducted controlled batch and flow-through experiments to quantitatively determine the dissolution rates and mechanisms of vivianite under anoxic conditions as a function of pH and temperature. Our results demonstrate that vivianite solubility and dissolution rates strongly decreased with increasing solution pH. Dissolution was nonstoichiometric at alkaline pH (>7). The rapid initial dissolution rate of vivianite is related to the solution saturation state, indicating a thermodynamic rather than a kinetic control. A defect-driven dissolution mechanism is proposed. Dissolution kinetics over pH 5-9 could be described with a rate law with a single rate constant and a reaction order of 0.61 with respect to {H+}: Rexp=36.0·e-1.41·pH·[1-e(0.2·ΔG/RT)]4.7 The activation energy of vivianite dissolution proved low (Ea = 20.3 kJ mol-1), suggesting hydrogen bridge dissociation as the rate-determining step.

Multiplexed vortex beam-based optical tweezers generated with spiral phase mask.

The design and implementation of a multiplexed spiral phase mask in an experimental optical tweezers setup are presented. This diffractive optical element allows the generation of multiple concentric vortex beams with independent topological charges and without amplitude modulation. The generalization of the phase mask for multiple concentric vortices is also shown. The design for a phase mask of two multiplexed vortices with different topological charges is developed. We experimentally show the transfer of angular momentum to the optically trapped microparticles by enabling nearly independent orbiting dynamics around the optical axis within each vortex. The angular velocity of the confined particles versus the optical power in the focal region is also discussed for different combinations of topological charges.

Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations.

This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.