Participant Data Research Articles

Correlation of the Transfusion Camp knowledge assessment test with clinical transfusion practice.

It is uncertain how transfusion knowledge translates to practice. The purpose of the study was to determine if higher scores on a validated Transfusion Camp knowledge assessment test were associated with transfusion order appropriateness. Eligible participants included postgraduate trainees and faculty physicians who had prescribed at least four transfusion orders in the preceding 6 months at two hospitals. Participant data and knowledge were collected using a web-based questionnaire with a validated Transfusion Camp knowledge assessment tool. The most recent 4-10 consecutive transfusion orders per prescriber were independently dually adjudicated for appropriateness based on published criteria. The primary outcome was the correlation between the score on six questions on red blood cells (RBCs), platelets (PLTs), and plasma from the validated test and the percentage order appropriateness. Generalized linear regression was conducted to determine if factors (sex, specialty, participation in Transfusion Camp, previous transfusion education, self-rated knowledge) were associated with appropriate orders. Seventy-four participants (45 trainees, 29 faculty; 31 females, 43 males) completed the test. Median score was 66.7% (interquartile range [IQR]: 50.0, 83.3) for six questions on RBCs, PLTs, and plasma transfusions. Of 546 transfusion orders adjudicated, appropriateness was 90.7% (95% confidence interval [CI]: 87.9%-93.0%). The correlation between prescriber test scores and order appropriateness was very weak (r = -.08). In multivariable analysis, female prescribers (p = .02) and beginner (vs. intermediate) self-rated knowledge (p = .01) were associated with higher transfusion appropriateness. Transfusion knowledge test scores did not correlate with order appropriateness. Factors other than knowledge are key to understanding how to improve appropriate blood use.

Program Reach and Motivational Correlates of Exercise Behavior among Program Participants with Visual Impairment

ABSTRACT Introduction Adults with visual impairments (VI) experience unique barriers to exercise. Targeted exercise programming can eliminate barriers, but little is known about who engages in such programs. This cross-sectional study a) describes program reach and motivational correlates of exercise behavior among members of specialized exercise programs offered to adults with VI; b) examines demographic, psychological, and behavioral differences according to VI severity; and c) assesses the interrelationships between motivational characteristics and exercise behavior. Methods Data for program participants were provided to researchers by the partnered organization with participant consent. A total of 118 participants also completed a post-program survey on motivational characteristics and exercise behavior. Reach was assessed with descriptive statistics. T-tests and chi-squared tests were used to analyze respondent representativeness compared to the population of program participants (demographically) and normative values (motivationally). Analysis of variance examined differences according to VI severity. Pearson’s correlations and multiple regression assessed strength and independence of relationships between motivational variables and exercise. Results Programs attracted mostly equivalent groups of individuals across gender and varying severity of VI. Survey respondents were representative of program participants but were significantly more approach motivated and less avoidance motivated than published norms, and mostly exhibited autonomous forms of motivational regulation for exercise. Differences according to VI severity were not significant. Relationships between approach motivation and exercise were no longer significant when modeled with motivational regulation for exercise. Identified regulation was the lone significant predictor of exercise in the multivariate model. Conclusion This study presents a novel understanding of the demographic and motivational reach of specialized programming for adults with VI, as well as the motivational correlates of exercise behavior among existing program participants. Motivational characteristics were related to exercise behavior in a way that was consistent with theory, such that contextualized motivational regulation demonstrated stronger associations with exercise behavior than motivational dispositions.

How bad becomes good: A neurocomputational model of affect-informed choice.

People often draw on their current affective experience to inform their decisions, yet little is known about the underlying mechanisms of this process. Understanding them has important implications for many big questions in both the affective and decision sciences. Do the same neural circuits that generate affect generate value? What differentiates people who have greater contextual flexibility in their reliance on affect? Do affective choices invoke processes that are distinct from less affective choices? To investigate these questions, we developed a neurocomputational model of affect-informed choice, in which people convert subjective affect into context-sensitive decision value through a process of weighted evidence accumulation. We then tested model predictions by recording electroencephalography and facial electromyography during a novel affective choice paradigm in a sample of racially diverse undergraduate participants (data collected in 2018-2019). In addition to validating our model, we found that generation of affective responses occurs earlier than, and is neurally distinct from, valuation of that affect. Moreover, individual differences in contextual flexibility of affective weighting correlated only with later valuation processes, not earlier affect generation processes. Our results have important theoretical implications for emotion, emotion regulation, and decision making. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Increased expression of ABO blood group antigens secretion phenotype with O blood group and age advances.

To ascertain the prevalence of ABH antigen secretors and non-secretors among Yemenis. In addition to explore the factors that may affect the expression of the secretion phenotype. This cross-sectional study was carried out between May and September 2022 on 215 healthy Yemeni individuals at the International Malaysian University, Ibb, Yemen. The participants were tested for blood group antigen on their blood samples using standard test tube method using the suitable ABH antisera. Saliva was collected and tested for secretion using hemagglutination inhibition test with suitable A, B, and H antisera. Before collecting the blood samples, informed consent was obtained from each participant and complete data and history questionnaire were collected by the research team. In general, 78.1% of Yemini participants were found to be secretor (80% men and 73.3% females). This percentage increased within O blood group (95%) and decreased within AB blood group (54%) individuals. Both O and AB blood groups showed statistically significant association with secretor trait. Also, it was noticed that age advance increases the expression of Se gene. In addition, the secretor state increased among Rh-negative people. The frequency of ABH secretors was 78.1% among Ibb province population in Yemen. Blood group O revealed the greatest frequency (95%), whereas blood group AB showed the lowest secretor frequency (54%). The secretor phenotype was highly expressed gradually with advance age then decline.

Comparative Study on Continuous and Discontinuous Dorling Maps

ABSTRACTThe Dorling map, a special type of thematic map, is a widely employed tool for visualizing geospatial statistical data. It transforms regions into circles with areas proportionate to statistical values while endeavoring to maintain regional spatial relationships. Notably, two types of Dorling maps emerge, distinguished by their consideration of regional continuity: continuous and discontinuous Dorling maps. However, as of yet, the discrepancies between these two types remain inconclusive. In this paper, we employ an eye‐tracking method to investigate the efficacy of Dorling maps in two common application scenarios, namely unpurposed browsing tasks and purposeful reading tasks. To this end, we administer tasks involving region search, attribute comparison/recognition/memory, conditional selection, relationship judgment, summary, and subjective evaluation. Subsequently, we perform a statistical analysis of the eye movement data of participants when they complete the above tasks in the continuous and discontinuous Dorling maps. The results indicate that the discontinuous Dorling maps are significantly better than the continuous ones in interpretation time for forward and reverse region search, selecting conditions, and judging adjacent relationships. Continuous Dorling maps significantly outperform discontinuous maps in terms of search efficiency during attribute comparison. Moreover, continuous maps significantly outperformed discontinuous maps in terms of cognitive supplementation or reprocessing of previous regions during conditional selection. This study can help users choose the right form of Dorling map visualization according to their needs.

Neutralizing antibody titers after COVID-19 vaccination

BackgroundMonitoring COVID-19 and evaluating the effectiveness of prevention and control strategies are considered critical priorities in public health. As a result, the administration of COVID-19 vaccines has been widely approved around the world. In the current study, we investigated the level of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) neutralizing antibody (NAb) among individuals who received different COVID-19 vaccines. MethodsThis cross-sectional study recorded demographical data and clinical characteristics of 168 individuals who received COVID-19 vaccines from 2021 to 2022. Vaccination data of participants, including type and times of vaccine and any complications and symptoms after vaccination, were also recorded. SARS-CoV-2 NAb level was assessed by performing an ELISA test, and all data was analyzed using SPSS version 21. The significant level was set at 0.05. ResultsThe mean age of the participants was 40.4 ± 16 years, and 109 were females. About 18.4% of participants had the underlying diseases, of which thyroid diseases were the most frequent. The mean SARS-CoV-2 NAb level was 31.6 ± 39.78 ng/ml. Sinopharm was the common vaccine in our population, and AstraZeneca represented a high level of Nab 47.18 ng/ml. Among the participants, 96 had mild to severe complications after vaccination, with the most complaining of arm pain. Significant differences of NAb levele were observed only between types of vaccine and gender (P<0.05). ConclusionDue to our findings, all employed vaccines demonstrated efficacy in generating NAb. The levels of Nab were different among genders, age groups, and different types of vaccine receivers.

Prevalence of poststroke anxiety and its associations with global cognitive impairment: An individual participant data analysis

Background and purposeAnxiety is frequent after stroke; however, little is known about its determinants. This study aims to assess the prevalence and correlates of post stroke anxiety (PSA) within 3–6 months following ischemic stroke. MethodsThree cohort studies from the STROKOG consortium were involved. Demographic and clinical data were standardized. PSA and PSD were assessed using inventories. The criteria for post-stroke cognitive impairment (PSCI) were at least one cognitive domain impaired if applicable, or a Montreal Cognitive Assessment (MoCA) score. Descriptive analyses were conducted to ascertain the prevalence of anxiety. Comparisons between anxious and non-anxious patients in the total sample were made using χ2 and t-tests. A two-step individual participant data (IPD) meta-analysis was employed to identify factors associated with PSA. Results584 patients were included. The total prevalence of PSA was 35 % (95%CI = [31.23;38.97]) and ranged from 27 % to 45 % across cohorts. In the total sample, there was a higher proportion of females in the anxiety group than the non-anxiety group (χ2 = 19.62; p < 0.001). Anxious patients had lower education, (χ2 = 6.59; p = 0.03), higher stroke severity (t = 2.77; p = 0.002), and higher rates of PSD (χ2 = 118.09; p < 0.001), and PSCI (χ2 = 23.81, p < 0.001). The analysis demonstrates that the odds of presenting with PSA is larger in patients with PSCI (OR = 1.84, 95%CI = [1.14; 2.91]). ConclusionsAnxiety is frequent after stroke, especially in females, and is associated with depression and cognitive impairment.

Effect of RAAS Inhibitors in People with COVID-19: An Independent Participant Data Meta-Analysis

Effect of RAAS Inhibitors in People with COVID-19: An Independent Participant Data Meta-Analysis

Development and validation of a prognostic model to predict relapse in adults with remitted depression in primary care: secondary analysis of pooled individual participant data from multiple studies.

Relapse of depression is common and contributes to the overall associated morbidity and burden. We lack evidence-based tools to estimate an individual's risk of relapse after treatment in primary care, which may help us more effectively target relapse prevention. The objective was to develop and validate a prognostic model to predict risk of relapse of depression in primary care. Multilevel logistic regression models were developed, using individual participant data from seven primary care-based studies (n=1244), to predict relapse of depression. The model was internally validated using bootstrapping, and generalisability was explored using internal-external cross-validation. Residual depressive symptoms (OR: 1.13 (95% CI: 1.07 to 1.20), p<0.001) and baseline depression severity (OR: 1.07 (1.04 to 1.11), p<0.001) were associated with relapse. The validated model had low discrimination (C-statistic 0.60 (0.55-0.65)) and miscalibration concerns (calibration slope 0.81 (0.31-1.31)). On secondary analysis, being in a relationship was associated with reduced risk of relapse (OR: 0.43 (0.28-0.67), p<0.001); this remained statistically significant after correction for multiple significance testing. We could not predict risk of depression relapse with sufficient accuracy in primary care data, using routinely recorded measures. Relationship status warrants further research to explore its role as a prognostic factor for relapse. Until we can accurately stratify patients according to risk of relapse, a universal approach to relapse prevention may be most beneficial, either during acute-phase treatment or post remission. Where possible, this could be guided by the presence or absence of known prognostic factors (eg, residual depressive symptoms) and targeted towards these. NCT04666662.

Cardiometabolic multimorbidity and neuropsychiatric disturbances in multiregional older adults

AbstractIntroductionTo investigate the association between cardiometabolic multimorbidity (CMM) patterns and dementia‐related neuropsychiatric symptoms (NPSs) among multiregional and ethnic seniors.MethodsFour Asian studies (discovery) and UK Biobank (validation) were included. CMM was defined as two or more of hypertension, hyperlipidemia, diabetes mellitus, stroke, and heart disease. The latent class analysis identified CMM patterns. Two‐step individual participant data (IPD) and Cox regressions explored associations between CMM and the presence and short‐term (1–2 years) incidence of four neuropsychiatric subsyndromes: psychosis, hyperactivity, affective, and apathy.ResultsA total of 2950 Asian and 40,424 UK participants were included. Metabolic multimorbidity (≥2 of hypertension, hyperlipidemia, and diabetes mellitus) was associated with the presence (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.00–1.81; and 1.93, 1.73–2.16; in the respective data set), and incidence (hazard ratio [HR] = 3.91, 1.53–10.01; and 6.94, 2.52–19.07) of affective subsyndrome. Cardio‐cerebrovascular multimorbidity (≥2 of hypertension, stroke, and heart disease) was not associated with any NPSs.DiscussionMetabolic multimorbidity may exacerbate the neuropsychiatric disturbances of possible dementia.Highlights Four Asian multiregional and ethnic studies were included as the discovery data set, with the UK Biobank being applied as the validation data set. Metabolic multimorbidity had a higher presence and short‐term incidence of affective syndromes. Cardio‐cerebrovascular multimorbidity was not associated with any neuropsychiatric symptoms.

Portfolio practices in the principal evaluation process: A qualitative case study

BackgroundThe portfolio is a vital component of the evaluation of principals and serves as a repository of evidence of achievements, skills, and capabilities. It facilitates the meticulous recording and documentation of experiences undertaken. Furthermore, the portfolio is instrumental in the refinement of conceptual ideas over time, while simultaneously offering a panoramic vista of a school's operational ethos and its alignment with professional benchmarks. ObjectiveThis study delves into the practices surrounding the principal portfolio and the formative and summative evaluation of principals by their evaluating supervisors. It aims to uncover principals’ perceptions regarding the obligatory nature of portfolios and other evaluative methodologies throughout both assessments. In light of the pivotal role that portfolios occupy in the realm of professional development and evaluation for school principals, the Abu Dhabi Education Council has mandated the compilation of principal portfolios within public schools. This mandate requires a detailed accounting of principals' proficiencies, achievements, and developmental trajectories. Markedly, this exploration stands as one of a scant number of inquiries probing the application of portfolios by school principals, with a particular focus on the context of the United Arab Emirates. It is poised to enrich the discourse on the utility of portfolios as instrumental tools for fostering leadership acumen and evaluative competency within the spheres of educator and principal preparation over the preceding two decades. The critical examination of these practices is vital for a nuanced understanding of their operational dynamics, the efficacy and challenges of e-portfolios, the array of opportunities they unveil, the identities of the involved stakeholders, and their ultimate objectives. MethodsThis study adopted a qualitative research approach to gather and analyze non-numerical data in the form of concepts, opinions, and experiences presented by principals and their supervisors within the Al-Ain School District (overseen by the Abu Dhabi Education Council). The cohort of participants comprised nine individuals endowed with extensive portfolio experience, six principals and three cluster managers. All worked in public educational institutions and were meticulously selected based on predefined criteria. This study relied on several data collection methods to obtain participants’ perspectives on their experiences with portfolio practices, including face-to-face interviews and documents from their portfolios. ResultsA thematic analysis of the participant data yielded five salient themes reflecting the experiences of the principals: (1) inconsistent expectations for portfolio evidence; (2) portfolios summoned in response to rising tensions at the summative evaluation; (3) portfolios promoting reflective practices in formative evaluation; (4) portfolios susceptible to manipulation or falsification; and (5) excessive time spent building and developing portfolios. In order to maximize the utility of portfolios, this result invites school principals to unleash the latent potential inherent in their actions by leveraging portfolios as mirrors for reflective leadership and ongoing self-assessment. ConclusionsThis research delineates both practical and theoretical ramifications for the application of professional portfolios. It elucidates the nature of evidence principals ought to incorporate within their portfolios. Furthermore, it endeavors to better inform principals of the evidence collection process, including what artifacts and documentation to gather and how to do so.

Identification of perceived sentences using deep neural networks in EEG

Objetive. Decoding speech from brain activity can enable communication for individuals with speech disorders. Deep neural networks (DNNs) have shown great potential for speech decoding applications. However, the limited availability of large datasets containing neural recordings from speech-impaired subjects poses a challenge. Leveraging data from healthy participants can mitigate this limitation and expedite the development of speech neuroprostheses while minimizing the need for patient-specific training data.Approach. In this study, we collected a substantial dataset consisting of recordings from 56 healthy participants using 64 EEG channels. Multiple neural networks were trained to classify perceived sentences in the Spanish language using subject-independent, mixed-subjects, and fine-tuning approaches. The dataset has been made publicly available to foster further research in this area.Main results. Our results demonstrate a remarkable level of accuracy in distinguishing sentence identity across 30 classes, showcasing the feasibility of training DNNs to decode sentence identity from perceived speech using EEG. Notably, the subject-independent approach rendered accuracy comparable to the mixed-subjects approach, although with higher variability among subjects. Additionally, our fine-tuning approach yielded even higher accuracy, indicating an improved capability to adapt to individual subject characteristics, which enhances performance. This suggests that DNNs have effectively learned to decode universal features of brain activity across individuals while also being adaptable to specific participant data. Furthermore, our analyses indicate that EEGNet and DeepConvNet exhibit comparable performance, outperforming ShallowConvNet for sentence identity decoding. Finally, our Grad-CAM visualization analysis identifies key areas influencing the network's predictions, offering valuable insights into the neural processes underlying language perception and comprehension.Significance. These findings advance our understanding of EEG-based speech perception decoding and hold promise for the development of speech neuroprostheses, particularly in scenarios where subjects cannot provide their own training data.

PREVALENCE AND MOLECULAR CHARACTERIZATION OF ROTAVIRUS IN MEAT CUTS, AND MEAT HANDLERS IN SELECTED ABATTOIRS IN NAIROBI, KENYA

In Kenya, food screening exercises mostly applies to bacterial and parasitic agents, with enteric viral detection neglected. This study aimed to determine the prevalence and molecular characterization of rotavirus in beef/pork cuts and beef/pork handlers in 4 selected abattoirs in Nairobi. Rotavirus was preferred because of its high prevalence rates and its ability to cause pathophysiologic infective gastroenteritis in humans. It has diverse strains characterized as P and G genotypes based on the VP7 and VP4 proteins, respectively. This cross-section study involved the collection of a total of 467, (165) beef/pork cuts and (302) handlers fecal samples. Collected samples wereprepared before rotavirus identification. Prepared meat and stool suspensions were subjected to direct RNA extraction and EIA detection respectively. All the stool suspensionsand RNA extracted meat suspensions subjected to EIA and Two step RT-PCR were all non-reactive respectively. Therefore, there was no VP4 and VP7 genotyping for characterizationpurposes on confirmed primary PCR products. Eppicollect5 was also used to collect and store the descriptive data of study participants, and the analysis conducted using Power BI statistical software application. The studys findings, indicating no human rotaviral infections in meat cuts, enhance public health by reassuring consumers, guiding regulatory policies, emphasizing the need for ongoing surveillance, directing resources to pressing concerns, supporting safe food handling campaigns, establishing baseline data for future assessments, and encouraging best practices in both formal and informal markets.

VITAMIN D STATUS AMONG FEMALE STUDENTS IN FACULTY OF MEDICINE AND HEALTH SCIENCES UNIVERSITY OF ADEN- YEMEN

Vitamin D deficiency is not only associated with rickets and osteomalacia, but with several chronic diseases, such as cancer, ischemic heart disease and type 1 and 2 diabetes mellitus. Vitamin D deficiency is prevalent across all age groups in epidemic proportions. Worldwide, an estimated one billion people suffer from vitamin D deficiency. One of the major reasons for the worldwide spread of this disorder has been deficient awareness about the importance of vitamin D, its benefits on health, and prevention of deficiency state across different populations. This study aimed to investigate the prevalence of vitamin D deficiency among female medical students regarding the importance of vitamin D and to determine its correlates among female students in Aden, Yemen. A cross-sectional study was conducted with 70 adult female students aged 19-30 years enrolled in Faculty of Medicine and Health Sciences University of Aden in the period April to October 2019. A self-administered questionnaire was used to collect information for participants data such as age, place of residence (urban or rural), skin color (pigmentation) and applying of sun protection creams. Blood samples were taken to investigate serum 25-(OH)D3 level for all participants through laboratory examination using Roche Cobas e 411 Automatic Analyzer, after recruiting their sociodemographic, health and lifestyle. Serum 25-hydroxyvitamin D levels were classified as normal (&gt;30 ng/ml), insufficiency (10-30 ng/ml) and deficiency (&lt;10 ng/ml). The data statistically analyzed using SPSS version 24. The mean age (SD) of participants 22.4 ± 2.01years. The prevalence of vitamin D deficiency among all participants was 34.3% while 65.7% had vitamin D insufficiency. low concentrations of serum vitamin D is highly prevalent among female medical students. It is advisable to increase their consumption of foods rich in vitamin D. the incidence of VDD among growing girls is concerning and necessitates preventive intervention. Importantly, health strategy plan requires considerations of more promotion of safe sun exposure practice, sufficient vitamin D supplements and vitamin D fortification of foods.

Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis.

The Liver Imaging Reporting and Data System (LI-RADS) does not consider factors extrinsic to the observation of interest, such as concurrent LR-5 observations. To evaluate whether the presence of a concurrent LR-5 observation is associated with a difference in the probability that LR-3 or LR-4 observations represent hepatocellular carcinoma (HCC) through an individual participant data (IPD) meta-analysis. Multiple databases were searched from 1/2014 to 2/2023 for studies evaluating the diagnostic accuracy of CT/MRI for HCC using LI-RADS v2014/2017/2018. The search strategy, study selection, and data collection process can be found at https://osf.io/rpg8x . Using a generalized linear mixed model (GLMM), IPD were pooled across studies and modeled simultaneously with a one-stage meta-analysis approach to estimate positive predictive value (PPV) of LR-3 and LR-4 observations without and with concurrent LR-5 for the diagnosis of HCC. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Twenty-nine studies comprising 2591 observations in 1456 patients (mean age 59years, 1083 [74%] male) were included. 587/1960 (29.9%) LR-3 observations in 1009 patients had concurrent LR-5. The PPV for LR-3 observations with concurrent LR-5 was not significantly different from the PPV without LR-5 (45.4% vs 37.1%, p = 0.63). 264/631 (41.8%) LR-4 observations in 447 patients had concurrent LR-5. The PPV for LR-4 observations with concurrent LR-5 was not significantly different from LR-4 observations without concurrent LR-5 (88.6% vs 69.5%, p = 0.08). A sensitivity analysis for low-risk of bias studies (n = 9) did not differ from the primary analysis. The presence of concurrent LR-5 was not significantly associated with differences in PPV for HCC in LR-3 or LR-4 observations, supporting the current LI-RADS paradigm, wherein the presence of synchronous LR-5 may not alter the categorization of LR-3 and LR-4 observations.

The association between adult asthma in the United States and dietary total energy intake: a retrospective cross-sectional analysis from NHANES

BackgroundEpidemiological research links asthma progression to dietary nonallergic factors, particularly high-calorie intake. However, evidence supporting the relationship with total dietary calorie consumption remains scarce.ObjectiveThis study aimed to explore the potential correlation between asthma occurrence and total dietary energy intake.MethodsA retrospective cross-sectional study of 21,354 US adults collected comprehensive participant data, including demographics, blood parameters, fatty acids, zinc, fiber intake, and asthma outcomes. Statistical analyses included interaction effects analysis, smooth curve fitting, and logistic regression.ResultsOf 21,354 participants, 14.77% self-reported asthma diagnosis. After adjusting for confounders, odds ratios (OR) for asthma decreased with higher energy intake: Q2 (OR = 0.77, 95% CI: 0.69–0.86, p < .001), Q3 (OR = 0.66, 95% CI: 0.59–0.75, p < .001), and Q4 (OR = 0.61, 95% CI: 0.53–0.69, p < .001) compared to Q1 (< 17.73 kcal/kg/day). A non-linear (L-shaped) association between energy intake and asthma was observed (p < .001), with a critical threshold around 24 kcal/kg/day, supported by subgroup and sensitivity analyses.ConclusionThis study reveals an L-shaped trend between total energy intake and asthma in US adults, with a significant threshold at approximately 24 kcal/kg/day.

Risk of short-term cardiovascular disease in relation to the mode of delivery in singleton pregnancies: a retrospective cohort study

Cardiovascular disease (CVD) is increasing in prevalence and affects up to 4% of pregnancies in otherwise healthy persons. The specific factors that drive the development of CVD in pregnant people are poorly characterised. This study aimed to determine whether the mode of delivery in singletons affects the risk of cardiovascular morbidity and mortality within one year in patients without prior CVD. We designed a retrospective cohort study utilising the Nationwide Readmissions Database (NRD) to identify singleton delivery hospitalisations in the United States from Jan 1, 2010 to Nov 30, 2018. International Classification of Disease (ICD) versions 9 and 10 codes were used to identify patients with readmission for CVD within the calendar year of index delivery. Patients aged 15-54 who underwent a singleton vaginal or caesarean delivery were included. Patients with pre-existing CVD hospitalisations before or during delivery, ectopic pregnancies, or abortive outcomes were excluded. Participant data was retrieved from the NRD database. The primary outcome was hospital readmission, defined by ICD 9 and 10 codes for fatal or non-fatal CVD in the same calendar year as delivery. Cox proportional hazard regression models were used to adjust for confounders. These included maternal age, hospital bed size, hospital type, hospital teaching status, income quartile, insurance, and year of delivery. Additional sub-analyses were performed adjusting for hypertensive disorders of pregnancy and diabetes mellitus. Of the 14,179,299 singleton deliveries, 32% (n=4,553,492) underwent a caesarean. CVD readmissions occurred in 255.2 per 100,000 (n=11,710) caesarean deliveries compared with 133.9 per 100,000 (n=12,507) vaginal deliveries (rate difference [RD], 121.4, 95% confidence interval [CI], 114.8-127.9; hazard ratio [HR] adjusted for all confounders including hypertensive disorders of pregnancy and diabetes mellitus was 1.42, 95% CI 1.35-1.50). This association was highest in the first 0-29 days following delivery (HR 1.68, 95% CI 1.59-1.78). The risk of readmission for CVD persisted for one year. These findings suggest that caesarean delivery of singletons is associated with a higher risk of cardiovascular morbidity in patients without pre-existing CVD. This risk was highest in the first month but remained elevated for one year after delivery. These findings add to the accumulating evidence that undergoing caesarean delivery may have long-standing health implications and support the extension of the post-partum surveillance period. Limitations of this study include the lack of adjustment for body mass index, race, and parity. We were also unable to determine the reason for the caesarean delivery. None.

Curriculum Innovation: A Standardized Experiential Simulation Curriculum Equips Residents to Face the Challenges of Chief Year.

A chief resident's role incorporates administrative, academic, and interpersonal responsibilities essential to managing a successful residency program. However, rising chief residents receive little formal exposure to leadership training. To (1) define leadership styles; (2) understand the effect of cultural competence on leadership styles; (3) learn effective methods to advocate as the chief resident; (4) provide effective peer feedback; (5) provide effective supervisor feedback; (6) learn effective conflict management; (7) ensure psychological safety. We developed a 1-day curriculum combining didactics and simulation activities for our program's rising chief residents. Implementation of our curricular design included a morning session focusing on small groups and didactic-based lectures on specific topics pertinent to leadership, along with a debriefing of a psychometric evaluation tool administered before the curriculum day. The simulation activity consisted of 3 group objective structured clinical examination (G-OSCE) scenarios: (1) providing a struggling junior trainee with feedback; (2) debriefing an adverse clinical outcome as the team leader; (3) navigating a challenging situation with a supervising physician. Standardized participants were surveyed for specific objectives. Learners completed precurricular and postcurricular surveys on their familiarity and preparedness for their chief year. Comparison of preintervention (n = 16) and postintervention (n = 10) data shows improvements in familiarity with leadership models (p = 0.006), cultural competence in leadership (p = 0.027), and team organizational structure (p = 0.010) with notable improvement in report of advocating for the team to 100% of participants in the postcurricular survey. In addition, although not statistically significant, familiarity with specific strategies for feedback delivery improved (p = 0.053), as did learner comfort levels with feedback delivery (comparing 51% of learners were either very or somewhat comfortable precurriculum to 90% postcurriculum). This is further supported by standardized participant data after the G-OSCEs. Although familiarity with wellness resources did improve across learners (p = 0.421), learner-reported use of wellness resources was noted to be reduced after the curricular intervention and remains a result of further interest for exploration. A 1-day leadership development curriculum combining didactics and simulation is an effective means of preparing rising chief residents to succeed in their transition to this leadership role.

Exercise training in left ventricular assist device patients: Protocol of an individual participant data meta-analysis.

Although left ventricular assist device (LVAD) implantation improves prognosis of advanced heart failure patients still suffer from impaired exercise capacity and quality of life (QoL). Exercise training may improve both; however, the available evidence about exercise training effects in LVAD patients remains inconclusive due to small and monocentric randomized controlled trials. This study aims to aggregate the individual participant data (IPD) to perform meta-analysis on the safety and efficacy of exercise training on exercise capacity and QoL over standard care in LVAD patients. Randomized controlled trials comparing exercise training and standard care (no supervised training) will be identified through database searching. Corresponding authors of eligible randomized controlled trials will be invited to share IPD. All IPD will be checked, recalculated to validate findings in initial reports, merged in a single dataset and stored in a secured encrypted database server. The merged IPD will be screened for quality, risk of bias, and heterogeneity of the included trials. Random effects meta-analyses will be conducted using one-stage and two-stage approaches, in particular with a view to subgroup analyses. Based on findings of the individual randomized trials, we expected to obtain superior effects of exercise training on submaximal exercise capacity and QoL and similar effects on maximal aerobic capacity when compared with standard care. Our study will be the first to harmonize IPD in meta-analysis to demonstrate the effects of exercise training on exercise performance and QoL over standard care in LVAD patients. CRD42023480119.

Association of Seizure Control With Cognition in People With Normal Cognition and Mild Cognitive Impairment.

Seizures are common in dementia and associated with accelerated cognitive decline. However, the impact of active vs remote seizures on cognition remains understudied. This study aimed to investigate the impact of active vs remote seizures on cognition in people with normal cognition and mild cognitive impairment (MCI). This longitudinal, multicenter cohort is based on National Alzheimer's Coordinating Center data of participants recruited from 39 Alzheimer's Disease Centers in the United States from September 2005 to December 2021. All participants with normal cognition and MCI and at least 2 visits were included. Primary outcome, that is, cognitive decline, was determined using Clinical Dementia Rating (CDR) from (1) normal-to-impaired (CDR ≥0.5) and (2) MCI-to-dementia (CDR ≥1) groups. The effect of active seizures (over the preceding 12 months), remote seizures (previous seizures but none over the preceding 12 months), and no seizures (controls) on cognition was assessed. Subgroups of chronic seizures at enrollment and new-onset seizures were further analyzed. Cox regression models assessed the risk of all-cause MCI and/or dementia. All models were adjusted for age, sex, education, race, hypertension, and diabetes. Of the 13,726 participants with normal cognition at enrollment (9,002 [66%] female; median age 71 years), 118 had active seizures and 226 had remote seizures. Of the 11,372 participants with MCI at enrollment (5,605 [49%] female; median age 73 years), 197 had active seizures and 226 had remote seizures. Active seizures were associated with 2.1 times higher risk of cognitive impairment (adjusted hazard ratio [aHR] 2.13, 95% CI 1.60-2.84, p < 0.001) in cognitively healthy adults (median years to decline: active seizures = ∼1, remote seizures = ∼3, no seizures = ∼3) and 1.6 times higher risk of dementia (aHR 1.58, 95% CI 1.24-2.01, p < 0.001) in those with MCI (median years to decline: active seizures = ∼1, remote seizures = ∼2, controls = ∼2). This risk was not observed with remote seizures. In this study, active seizures but not remote seizures were associated with earlier cognitive decline in both cognitively normal adults and those with MCI, independent of other dementia risk factors. Therefore, early identification and management of seizures may present a path to mitigation of cognitive decline in the aging epileptic population. A limitation is that causality cannot be confirmed in our observational longitudinal study.