Association Between Body Mass Index, Obesity, and Clinical Outcomes Following Coronary Artery Bypass Grafting in Brazil: An Analysis of One Year of Follow-up of BYPASS Registry Patients.

OBJECTIVE: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. METHODS: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. RESULTS: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. CONCLUSION: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.

Don't SNARC me now! Intraindividual variability of cognitive phenomena - Insights from the Ironman paradigm.

Two implicit generalizations are often made from group-level studies in cognitive experimental psychology and their common statistical analysis in the general linear model: (1) Group-level phenomena are assumed to be present in every participant with variations between participants being often treated as random error in data analyses; (2) phenomena are assumed to be stable over time. In this preregistered study, we investigated the validity of these generalizations in the commonly used parity judgment task. In the proposed Ironman paradigm, the intraindividual presence and stability of three popular numerical cognition effects were tested in 10 participants on 30 days: the SNARC (Spatial-Numerical Association of Response Codes, i.e., faster left-/right-sided responses to small/large magnitude numbers, respectively; Dehaene, Bossini, & Giraux, 1993), MARC (Linguistic Markedness of Response Codes; i.e., faster left-/right-sided responses to odd/even numbers, respectively; Nuerk, Iversen, & Willmes, 2004), and Odd (i.e., faster responses to even numbers; Hines, 1990) effects. We replicated the group-level effects; however, they were reliably present in only four to five (SNARC), six (MARC) or five (Odd) of 10 participants. Fluctuations seemed unsystematic, although the SNARC effect decreased over time along with reaction times. No correlation between the SNARC and MARC effects and sleep duration, tiredness, daytime, and consumption of stimulants were detected in most participants. These results challenge the frequent generalizations from group-level phenomena to individual participants and from single sessions to typical behavior. The innovative Ironman paradigm combined with bootstrap analyses permits unique insights into the intraindividual presence and stability of cognitive phenomena.

The Healthy Context Paradox Between Bullying and Emotional Adaptation: A Moderated Mediating Effect.

Introduction: Bullying is a significant concern for young people, with studies consistently showing a link between bullying and negative emotional consequences. However, the mechanisms that underlie this association remain unclear, particularly in terms of the classroom environment. This study aimed to explore the paradoxical phenomenon between bullying victimization and emotional adaptation among junior high school students in China, using the hypothesis of the healthy context paradox. Methods: The study involved 880 students (565 girls; Mage=14.69; SD=1.407 years), and data were collected using self-reported surveys. The findings of the study, utilizing multilevel structural equation modeling (MSEM) techniques, demonstrated a cross-level moderated effect of classroom-level bullying victimization on the relationship between individual bullying victimization and emotional adaptation. Results: Specifically, the results indicated that in classrooms with higher levels of victimization, the association between individual bullying victimization and increased depressive symptoms and State&Trait anxiety was more pronounced. These findings support the "Healthy context paradox" hypothesis in the Chinese context and provide insight into the mechanisms underlying this phenomenon. Discussion: The results suggest that the classroom environment plays a crucial role in shaping the emotional consequences of bullying and that addressing classroom victimization is crucial for promoting emotional health among young people. By understanding the mechanisms that underlie the association between bullying and emotional consequences, interventions can be developed to target the underlying factors that contribute to this paradoxical phenomenon. Overall, the study provides new insights into the complex relationship between bullying and emotional health among young people, highlighting the importance of considering the classroom environment in addressing this issue.

Investigation of smoking on the antiplatelet response to clopidogrel: Unravelling the smoker's paradox.

The intricate relationship between smoking and the effects of the antiplatelet drug clopidogrel has been termed the "smoker's paradox". This paradox details the enhanced efficacy of clopidogrel in smokers compared to non-smokers. This review begins with an exploration of the proposed mechanisms of the smoker's paradox, particularly drawing attention to the induction of cytochrome P450 (CYP) isoenzymes via tobacco smoke, specifically the enzymes CYP1A2 and CYP2C19. Moreover, an investigation of the effects of genetic variability on the smoker's paradox was undertaken from both clinical and molecular perspectives, delving into the effects of ethnicity and genetic polymorphisms. The intriguing role of CYP1A2 genotypes and the response to clopidogrel in smoking and non-smoking populations was examined conferring insight into the individuality rather than universality of the smoker's paradox. CYP1A2 induction is hypothesised to elucidate the potency of smoking in exerting a counteracting effect in those taking clopidogrel who possess CYP2C19 loss of function polymorphisms. Furthermore, we assess the comparative efficacies of clopidogrel and other antiplatelet agents, namely prasugrel and ticagrelor. Studies indicated that prasugrel and ticagrelor provided a more consistent effect and further reduced platelet reactivity compared to clopidogrel within both smoking and non-smoking populations. Personalised dosing was another focus of the review considering patient comorbidities, genetic makeup, and smoking status with the objective of improving the antiplatelet response of those taking clopidogrel. In summation, this review provides insight into multiple areas of research concerning clopidogrel and the smoker's paradox taking into account proposed mechanisms, genetics, other antiplatelet agents, and personalised dosing.

Association of anthropometric measures with all-cause and cause-specific mortality in US adults: revisiting the obesity paradox.

OBJECTIVE: Previous studies have shown that the obesity paradox exists in a variety of clinical settings, whereby obese individuals have lower mortality than their normal-weight counterparts. It remains unclear whether the association between obesity and mortality risk varies by anthropometric measures. The purpose of this study is to examine the association between various anthropometric measures and all-cause and cause-specific mortality in US adults. METHODS: This cohort study included data from the National Health and Nutrition Examination Survey between 2009 and 2018, with a sample size of 28,353 individuals weighted to represent 231 million US adults. Anthropometric measurements were obtained by trained technicians using standardized methods. Mortality data were collected from the date of enrollment through December 31, 2019. Weighted Cox proportional hazards models, restricted cubic spline curves, and cumulative incidence analyses were performed. RESULTS: A total of 2091 all-cause deaths, 606 cardiovascular deaths, 519 cancer deaths, and 966 other-cause deaths occurred during a median follow-up of 5.9 years. The association between body mass index (BMI) and mortality risk was inversely J-shaped, whereas the association between waist-to-height ratio (WHtR) and mortality risk was positively J-shaped. There was a progressive increase in the association between the WHtR category and mortality risk. Compared with the reference category of WHtR < 0.5, the estimated hazard ratio (HR) for all-cause mortality was 1.004 (95% confidence interval [CI] 1.001-1.006) for WHtR 0.50-0.59, 1.123 (95% CI 1.120-1.127) for WHtR 0.60-0.69, 1.591 (95% CI 1.584-1.598) for WHtR 0.70-0.79, and 2.214 (95% CI 2.200-2.228) for WHtR ≥ 0.8, respectively. Other anthropometric indices reflecting central obesity also showed that greater adiposity was associated with higher mortality. CONCLUSIONS: Anthropometric measures reflecting central obesity were independently and positively associated with mortality risk, eliminating the possibility of an obesity paradox.

Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review.

PURPOSE OF REVIEW: Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear. RECENT FINDINGS: The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.

Survival paradox between stage IIB/C and stage IIIA colon cancer: is it time to revise the American Joint Committee on Cancer TNM system?

INTRODUCTION: A survival paradox between T4N0 (Stage IIB/IIC) and Stage IIIA colon cancer exists, even after adjusting for adequate lymph node (LN) retrieval and receipt of adjuvant chemotherapy (C). We conducted a large hospital-based study to re-evaluate this survival paradox based on the newest 8th edition staging system. METHODS: The National Cancer Data Base was queried to evaluate 35,606 patients diagnosed with Stage IIB, IIC, and IIIA colon cancer between 2010 and 2017. The Kaplan-Meier method and log-rank test were used to compare unadjusted overall survival (OS). Multivariable Cox proportional hazards model was used to determine the association of stage with hazard ratios adjusted for relevant demographic and clinical variables including ≥ 12 LNs retrieved and receipt of adjuvant chemotherapy. P value < 0.05 was considered statistically significant. RESULTS: The 5-year OS for optimally treated stage IIIA colon cancer (receipt of C) was 84.3%, which was significantly higher than stage IIB/C (≥ 12 LNs retrieved + C) (72.8%; P < 0.0001). Stage was an independent predictor of OS. Among optimally treated Stage IIIA patients, T1N1 had the best survival (90.6%) while stage T4bN0 (stage IIC) had the worst (70.9%) (P < 0.0001). Compared to stage IIB, stage IIC had a 17% increased risk of overall death while stage IIIA had a 21% reduction in death (P < 0.0001). CONCLUSION: Stage IIB/C and Stage IIIA survival paradox persists even after accounting for receipt of adjuvant chemotherapy and adequate lymph node retrieval. Future iteration of the TNM system should take this paradox into consideration.

Obesity Paradox in Patients with Acute Coronary Syndrome: Is Malnutrition the Answer?

BACKGROUND: Obesity paradox has been reported in patients with cardiovascular disease, showing an inverse association between obesity as defined by body mass index (BMI) and prognosis. Nutritional status is associated with systemic inflammatory response and affects cardiovascular disease outcomes. OBJECTIVE: The authors sought to examine the influence of obesity and malnutrition on the prognosis of patients with acute coronary syndrome (ACS). METHODS: This study included consecutive patients diagnosed with ACS and underwent coronary angiogram between January 2009 and February 2023. At baseline, patients were categorized according to their BMI as follows: underweight (<18 kg/m2), normal weight (18-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (>30.0 kg/m2). We assessed the nutritional status by Prognostic Nutritional Index (PNI). Malnutrition was defined as a PNI value<38. RESULTS: Of the 21,651 patients with ACS, 582 (2.7%) deaths from any cause were observed over 28.7 months. Compared to the patient's state of normal weight, overweight and obesity were associated with a decreased risk of all-cause mortality. Malnutrition was independently associated with poor survival (HR 2.64, 95%CI 2.24-3.12, P<0.001). In malnourished patients, overweight and obesity showed a 39% and 72% reduction in the incidence of all-cause mortality, respectively. However, in nourished patients, no significant reduction in the incidence of all-cause mortality was observed (all P>0.05). CONCLUSIONS: Obesity paradox appears to occur in patients with ACS. Malnutrition may be a significant independent risk factor for prognosis in patients with ACS. The obesity paradox is influenced by the status of malnutrition.

COVID-19 mortality paradox (United States vs Africa): Mass vaccination vs early treatment.

The coronavirus disease 2019 (COVID-19) mortality rate in 55 African countries is almost 4.5 times lower than in the coronavirus disease 2019 (COVID-19) despite Africa having over 4.2 times more people. This mortality paradox is also evident when comparing Nigeria, a heavily populated, poorly vaccinated and weakly mandated country to Israel, a small, highly vaccinated and strictly mandated country. Nigeria has almost 4 times lower COVID mortality than Israel. In this Field of Vision perspective, I explain how this paradox has evolved drawing upon my academic, clinical and social experience. Since April 2020, I've developed and been using the Egyptian immune-modulatory Kelleni's protocol to manage COVID-19 patients including pediatric, geriatric, pregnant, immune-compromised and other individuals suffering from multiple comorbidities. It's unfortunate that severe acute respiratory syndrome coronavirus 2 is still evolving accompanied by more deaths. However in Africa, we've been able to live without anxiety or mandates throughout the pandemic because we trust science and adopted early treatment using safe, and effective repurposed drugs that have saved the majority of COVID-19 patients. This article represents an African and Egyptian tale of honor.

Peer Victimization and Adolescent Mental Health: School-level Victimization as a Moderator.

As a global issue, peer victimization is closely associated with adolescent mental health. Although previous research has explored the relationship between peer victimization and mental health in some contexts, the school context, particularly within the Chinese cultural context, has not received sufficient attention. Based on the Healthy Context Paradox, this study aimed to explore the moderating role of school-level victimization in the relationship between individual-level peer victimization and mental health. This study tested two hypotheses by using a multilevel design: higher individual-level and school-level peer victimization are associated with higher depressive symptoms and lower life satisfaction (Hypothesis 1); school-level victimization moderates the association between individual-level peer victimization and mental health (Hypothesis 2). Participants were 39,720 adolescents (50.41% females; Mage = 13.68, SD = 2.39) across 292 Chinese schools. They completed a set of questionnaires, including the Center for Epidemiologic Studies Depression Scale, the single-item Life Satisfaction Questionnaire, the Peer Victimization Scale, and demographics. The multilevel model indicated that both individual-level and school-level peer victimization were positively correlated with depressive symptoms and negatively correlated with life satisfaction. In schools with lower levels of victimization, there was a stronger association between individual peer victimization and adolescent mental health. A potential explanation for these results might be the victimization visibility and perceived severity in different contexts. These findings extended the discussion of the Healthy Context Paradox within the Chinese school context and provided valuable insights for developing school support strategies for victimized adolescents. School management might play a significant role in affecting the mental health of victimized adolescents.

BMI-Stratified Exploration of the 'Obesity Paradox': Heart Failure Perspectives from a Large German Insurance Database.

Background: The global rise of obesity and its association with cardiovascular risk factors (CVRF) have highlighted its connection to chronic heart failure (CHF). Paradoxically, obese CHF patients often experience better outcomes, a phenomenon known as the 'obesity paradox'. This study evaluated the 'obesity paradox' within a large cohort in Germany and explored how varying degrees of obesity affect HF outcome. Methods: Anonymized health claims data from the largest German insurer (AOK) for the years 2014-2015 were utilized to analyze 88,247 patients hospitalized for myocardial infarction. This analysis encompassed baseline characteristics, comorbidities, interventions, complications, and long-term outcomes, including overall survival, freedom from CHF, and CHF-related rehospitalization. Patients were categorized based on body mass index. Results: Obese patients encompassed 21.3% of our cohort (median age 68.69 years); they exhibited a higher prevalence of CVRF (p < 0.001) and comorbidities than non-obese patients (median age 70.69 years). Short-term outcomes revealed lower complication rates and mortality (p < 0.001) in obese compared to non-obese patients. Kaplan-Meier estimations for long-term analysis illustrated increased incidences of CHF and rehospitalization rates among the obese, yet with lower overall mortality. Multivariable Cox regression analysis indicated that obese individuals faced a higher risk of developing CHF and being rehospitalized due to CHF but demonstrated better overall survival for those classified as having low-level obesity (p < 0.001). Conclusions: This study underscores favorable short-term outcomes among obese individuals. The 'obesity paradox' was confirmed, with more frequent CHF cases and rehospitalizations in the long term, alongside better overall survival for certain degrees of obesity.

Old by obsolescence: The paradox of aging in the digital era.

Geroscience and philosophy of aging have tended to focus their analyses on the biological and chronological dimensions of aging. Namely, one ages with the passage of time and by experiencing the cellular-molecular deterioration that accompanies this process. However, our concept of aging depends decisively on the social valuations held about it. In this article, we will argue that, if we study social aging in the contemporary world, a novel phenomenon can be identified: the paradox of aging in the digital era. If the social understanding of aging today is linked to unproductivity and obsolescence; then there is a possibility that, given the pace of change of digital technologies, we become obsolete at an early chronological and biological age, and therefore, feel old at a younger age. First, we will present the social dimension of aging based on Rowe and Kahn's model of successful aging. We will also show that their notion of social aging hardly considers structural aspects and weakens their approach. Second, departing from social aging in its structural sense, we will develop the paradox of aging in the digital era. On the one hand, we will explain how the institutionalization of aging has occurred in modern societies and how it is anchored in the concepts of obsolescence and productivity. On the other hand, we will state the kind of obsolescence that digitalization produces and argue that it can make cohorts of biologically and chronologically young individuals obsolete, and thus they would be personally and socially perceived as old.

Is income catch-up related to happiness catch-up? Evidence from eight European countries.

The Easterlin paradox illuminates the counter-intuitive finding that happiness is unlikely to increase with economic growth over time. This study investigates the income-happiness relationship through the concept of ß convergence (i.e., the catch-up effect). To this end, we first employed the KPSS panel unit root tests to reveal the time-varying patterns in convergences between the happiness index and real GDP per capita. Then, we conducted analyses of contingency for the linkage between the happiness catch-up and income catch-up effects via estimation using the random coefficient logit model. The data used in this study were obtained from World Database of Happiness and World Development Indicators Database. Our results indicate that both the happiness index and real GDP per capita in selected European countries exhibited signs of catch-up with their benchmark countries over the period of 1975-2020. The average income catch-up effect (generated from group mean of all individual effects) positively impacted the social harmonization of well-being (i.e., the average happiness catch-up effect). Since economic growth is the major force driving the income catch-up effect, the positive linkage between happiness and income catch-up effects provides solid proof of the beneficial effect of economic growth on the social harmonization of well-being.

Association of Body Mass Index with Outcomes in Patients with Atrial Fibrillation: Analysis from the (JoFib) Registry.

Background: Atrial fibrillation (AF) accounts for the majority of arrhythmias affecting adults. It is associated with an increased mortality and various complications. Obesity being a major risk factor of cardiovascular and metabolic diseases including AF has always been connected to the overall burden of AF, but its role in the development of AF complications remains unclear. Our study aims to evaluate the impact of obesity on the complications of AF in Jordanian patients to establish a proper prognosis since studies regarding this topic in the Middle East are scant. Methods: This study analyzed data from the Jordanian AF study (JoFib), which enrolled Jordanians with AF. Clinical characteristics were compared among patients who developed complications and those who did not. A binary logistic regression analysis was conducted to identify factors associated with AF complications development. Results: 1857 patients were enrolled. There was no significant difference in BMI value between patients who developed complications and those who did not. Male sex, old age, hypertension, diabetes mellitus, and higher risk scores were associated with increased odds of developing complications. The oral anticoagulant use was found to be protective. Smoking had no significant effect on odds of complications. Conclusion: The study concludes that increased BMI is not significantly associated with a reduced risk of developing AF complications. Further research with longer follow-up and larger sample sizes is needed to confirm these results.

Predicting mortality risks in patients with heart failure using body mass index and weight loss at admission.

Background: The association of the combination of body mass index (BMI) and weight change at admission with prognoses in patients with heart failure (HF) is unclear. Therefore, we investigated whether body mass index (BMI) and weight changes at admission affect mortality in patients with HF. Methods: This retrospective cohort study lasted 99 months, starting in April 2014, and included 4,862 patients with HF from a Japanese real-world database. Cubic and thin-plate smoothing spline analyses were performed to investigate the association of BMI and weight changes with mortality. The percentage weight change was calculated every 6 months. The study outcome was the presence or absence of death. Results: The patients' mean age was 81.5±9.6 years, and 1,239 (25.5%) patients died. Cubic spline analysis revealed a negative correlation of BMI with mortality hazard ratio (HR) (BMI=18.5 kg/m2 and 25 kg/m2; HR=1.3 [1.2-1.4] and 0.8 [0.7-0.9], respectively). Cubic spline analysis of weight change showed that weight loss tended to increase the mortality HR (weight change rate=-6%, HR=1.1 [1.0-1.2]). Thin-plate smoothing spline analysis showed that the odds ratio (OR) negatively correlated with BMI (1-year mortality: BMI=18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.5, 1.0, and 0.7, respectively; 2-year mortality: BMI=18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.4, 0.9, and 0.7, respectively). Conclusion: A low BMI in patients with HF was associated with a higher risk of mortality. Weight loss in patients, regardless of BMI, was associated with a higher OR for mortality.

The smoker's paradox in transjugular intrahepatic portosystemic shunt procedure: A national inpatient sample analysis from 2015 to 2020.

OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate patients with chronic liver cirrhosis and portal hypertension. Smoking can adversely impact liver function and has been shown to influence liver-related outcomes. This study aimed to examine the impact of smoking on the immediate outcomes of TIPS procedure. MATERIALS AND METHOD: The study compared smokers and non-smokers who underwent TIPS procedures in the National Inpatient Sample (NIS) database from the last quarter of 2015 to 2020. Multivariable analysis was used to compare the in-hospital outcomes post-TIPS. Adjusted pre-procedural variables included sex, age, race, socioeconomic status, indications for TIPS, liver disease etiologies, comorbidities, and hospital characteristics. RESULTS: Compared to non-smokers, smokers had lower risks of in-hospital mortality (7.36% vs 9.88 %, aOR 0.662, p < 0.01), acute kidney injury (25.57% vs 33.66 %, aOR 0.68, p < 0.01), shock (0.45% vs 0.98 %, aOR 0.467, p = 0.02), and transfer out to other hospital facilities (11.35% vs 14.78 %, aOR 0.732, p < 0.01). There was no difference in hepatic encephalopathy or bleeding. Also, smokers had shorter wait from admission to operation (2.76±0.09 vs 3.17±0.09 days, p = 0.01), shorter length of stay (7.50±0.15 vs 9.89±0.21 days, p < 0.01), and lower total hospital cost (148,721± 2,740.7 vs 204,911±4,683.5 US dollars, p < 0.01). Subgroup analyses revealed consistent patterns among both current and past smokers. CONCLUSION: This study compared the immediate outcomes of smokers and non-smokers after undergoing the TIPS procedure. Interestingly, we observed a smokers' paradox, where smoker patients had better outcomes following TIPS. The underlying causes for this smoker's paradox warrant further in-depth exploration.

Pulmonary Hypertension in Women.

Pulmonary arterial hypertension (PAH) is a rare devastating disease characterized by elevated pulmonary artery pressure and increased pulmonary vascular resistance. Females have a higher incidence of PAH, which is reflected globally across registries in the United States, Europe, and Asia. However, despite female predominance, women had better outcomes compared with male patients, a finding that has been labeled the "estrogen paradox." Special considerations should be given to women with PAH regarding sexual health, contraception, family planning, and treatment before, during, and after pregnancy. Pregnant women with PAH should be referred to a pulmonary hypertension care center; a multidisciplinary team approach is recommended, and Cesarean section is the preferred mode of delivery. While pregnancy outcomes have improved over the years with PAH-specific therapy, pregnancy portends a high-risk for those with PAH. Continued research is needed to tailor PAH treatment for women.

Paradoxes in Humanbecoming Hermeneutic Sciencing.

The author explores humanbecoming hermeneutic sciencing and provides exemplars of paradoxes that are used by scholars in this mode of inquiry.