Large Effect Research Articles

Effectiveness of Technology-Delivered Psychosocial Interventions for Family Caregivers of Patients With Dementia: A Systematic Review, Meta-Analysis and Meta-Regression.

Family caregivers living with patients with dementia (PwD) face psychological challenges due to care burden. Technology-delivered psychosocial interventions (TPIs) have played a promising role in improving health outcomes among family caregivers living with PwD. This review aims to synthesise evidence of the effectiveness of TPIs on primary (burden and depression) and secondary outcomes (self-efficacy, stress and anxiety) for family caregivers living with PwD. Random-effects meta-analyses were performed to determine effect size. Using Cochran's Q and I2 tests, statistical heterogeneity was evaluated. Sensitivity, subgroup analyses and meta-regression were employed to explain statistical heterogeneity. Twenty-eight trials comprising 4160 family caregivers from eight countries were included. Our meta-analysis revealed that TPIs resulted in slight reduction in depression, probably resulted in a slight reduction in burden and anxiety and slight increase in self-efficacy. Subgroup differences were detected in geographical regions (Western Pacific and Southeast Asia) for burden. While there were no significant subgroup differences in other factors, TPIs with preventive function and mobile applications had a more prominent larger effect size. Meta-regression analysis showed that attrition rate was a significant moderator on depression. Results are limited by the high risk of bias of included trials, which may reduce certainty of evidence. This review suggest TPIs are recommended as an adjunct treatment for alleviating burden and depressive outcomes in healthcare institutions. PROSPERO Registration Number: PROSPERO (CRD42023387962).

Dosimetric impact of intrafraction patient motion on MLC-based 3D-conformal spatially fractionated radiation therapy treatment of large and bulky tumors.

To evaluate the dosimetric impact on spatially fractionated radiation therapy (SFRT) plan quality due to intrafraction patient motion via multi-field MLC-based method for treating large and bulky (≥8cm) unresectable tumors. For large tumors, a cone beam CT-guided 3D conformal MLC-based SFRT method was utilized with 15Gy prescription. An MLC GTV-fitting algorithm provided 1cm diameter apertures with a 2cm center-to-center distance at the isocenter. This generated a highly heterogeneous sieve-like dose distribution within an hour, enabling same-day SFRT treatment. Fifteen previously treated SFRT patients were analyzed (5 head & neck [H&N], 5 chest and lungs, and 5 abdominal and pelvis masses). For each plan, intrafraction motion errors were simulated by incrementally shifting original isocenters of each field in different x-, y-, and z-directions from 1 to 5mm. The dosimetric metrics analyzed were: peak-to-valley-dose-ratio (PVDR), percentage of GTV receiving 7.5Gy, GTV mean dose, and maximum dose to organs-at-risk (OARs). For±1,±2,±3,±4, and±5mm isocenter shifts: PVDR dropped by 3.9%, 3.8%, 4.0%, 4.1%, and 5.5% on average respectively. The GTV(V7.5) remained within 0.2%, and the GTV mean dose remained within 3.3% on average, compared to the original plans. The average PVDR drop for 5mm shifts was 4.2% for H&N cases, 10% for chest and lung, and 2.2% for abdominal and pelvis cases. OAR doses also increased. The maximum dose to the spinal cord increased by up to 17 cGy in H&N plans, mean lung dose (MLD) changed was small for chest/lung, but the bowel dose varied up to 100 cGy for abdominal and pelvis cases. Due to tumor size, location, and characteristics of MLC-based SFRT, isocenter shifts of up to±5mm in different directions had moderate effects on PVDR for H&N and pelvic tumors and a larger effect on chest tumors. The dosimetric impact on OAR doses depended on the treatment site. Site-specific patient masks, Vac-Lok bags, and proper immobilization devices similar to SBRT/SRT setups should be used to minimize these effects.

Examining ChatGPT adoption among educators in higher educational institutions using extended UTAUT model

Purpose Based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model, this study aims to explore the factors influencing educators’ acceptance and utilization of chat generative pretrained transformer (ChatGPT) in the context of higher educational institutions. This study additionally examines the moderating influence of trust on the association between intention and adoption of ChatGPT. Design/methodology/approach A structured questionnaire was disseminated to 1,214 educators following the purposive sampling method. The hypothesized relationships between the extended UTAUT model constructs and ChatGPT adoption were examined using structural equation modeling. Findings The results of this study indicate positive impact of ChatGPT adoption and its use behavior (UB) among educators. Performance expectancy, effort expectancy, hedonic motivation, facilitating conditions and habit have a positive impact on behavior intention to use this tool among educators in higher education institutions, However, the educators intend to use ChatGPT in a personal capacity and are negatively influenced by the social groups. Moreover, behavior intention to adopt ChatGPT has a larger effect on the UB due to the higher involvement of trust. Practical implications This research adds to the literature on technology adoption by emphasizing the significance of trust in the adoption of emerging technologies, such as big language models. This study’s findings have implications for ChatGPT technology developers, legislators and academics considering the implementation of ChatGPT for teaching and research. Originality/value This research investigates ChatGPT adoption among higher education educators using the UTAUT model. It emphasizes the role of trust in adoption, highlights key adoption factors and reveals a paradox: educators are personally inclined to use ChatGPT but hesitant due to negative social influence. This study's novelty lies in its focus on trust and its implications for developers, legislators and educators, offering valuable insights for integrating ChatGPT in education.

Effects of Digital Psychotherapy on Suicide: A Systematic Review and Meta-Analysis.

Previous studies reported that digital psychotherapy was a clinically beneficial intervention for suicide ideation. However, the effects of digital psychotherapy on other aspects of suicide beyond ideation remain unclear. Therefore, this study investigated the effects of digital psychotherapy on suicide and depression. Articles were identified by searching Cochrane, Google Scholar, Medline, PubMed, Web of Science, and PsycINFO in line with the PRISMA statement, yielding nine randomized controlled trials. The difference between conditions regarding suicide and depression in the effect size of the individual article was calculated using Hedges' g. Most digital psychotherapy interventions were based on cognitive behavioral therapy and delivered via apps or the web for at least six weeks. Suicide outcomes primarily focused on suicide ideation. The findings showed digital psychotherapy achieved a significantly larger effect size for suicide (g = 0.488, p < 0.001) and depression (g = 0.316, p < 0.001), compared to controls. Specifically, digital psychotherapy showed a significant effect on both suicide ideation (g = 0.478, p < 0.001) and other suicidal variables (g = 0.330, p < 0.001). These results suggest the effectiveness of digital psychotherapy in reducing suicide and depression compared to traditional face-to-face therapy. Future research should consider a wider range of outcomes and examine the long-term effectiveness of digital psychotherapy to better understand its effects on suicide prevention.

Obstructive Sleep Apnea Characterization: A Multimodal Cross-Recurrence-Based Approach for Investigating Atrial Fibrillation.

Obstructive sleep apnea (OSA) is believed to contribute significantly to atrial fibrillation (AF) development in certain patients. Recent studies indicate a rising risk of AF with increasing OSA severity. However, the commonly used apnea-hypopnea index in clinical practice may not adequately account for the potential cardiovascular risks associated with OSA. (1) Objective: to propose and explore a novel method for assessing OSA severity considering potential connection to cardiac arrhythmias. (2) Method: the approach utilizes cross-recurrence features to characterize OSA and AF by considering the relationships among oxygen desaturation, pulse arrival time, and heart-beat intervals. Multinomial logistic regression models were trained to predict four levels of OSA severity and four groups related to heart rhythm issues. The rank biserial correlation coefficient, \boldmath rrb, was used to estimate effect size for statistical analysis. The investigation was conducted using the MESA database, which includes polysomnography data from 2055 subjects. (3) Results: a derived cross-recurrence-based index showed a significant association with a higher OSA severity (\boldmath p 0.01) and the presence of AF (\boldmath p 0.01). Additionally, the proposed index had a significantly larger effect, \boldmath rrb, than the conventional apnea-hypopnea index in differentiating increasingly severe heart rhythm issue groups: 0.14 0.06, 0.33 0.10, and 0.41 0.07. (4) Significance: the proposed method holds relevance as a supplementary diagnostic tool for assessing the authentic state of sleep apnea in clinical practice.

Asymmetric Effects of Monetary Policy on Firms

AbstractThis paper documents firm‐level evidence on the asymmetric effects of monetary policy in the United States. Focusing on the 1980q3–2019q4 period, I find that monetary tightenings show larger effects on firms' employment and sales than monetary easings. In comparison, investment rate does not generate significant asymmetry in response to sign‐dependent monetary policy shocks. I interpret these findings in the context of downward nominal wage rigidity and investment irreversibility channels. Furthermore, I exploit cross‐sectional variation and show that employment of small, nondividend payer, low credit rating, and young firms displays larger contractions in response to a monetary tightening.

Effectiveness of technology-based psychosocial interventions for improving health-related outcomes of family caregivers of stroke survivors: A systematic review and meta-analysis.

To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors. A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted. Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023. Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness. The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes. Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices. It is not applicable as this is a systematic review. The protocol was registered on PROSPERO (CRD42023402871).

Stock Liquidity Sidedness and Share Repurchase

We show that stock liquidity sidedness plays a vital role in share repurchase decisions. Specifically, we investigate whether share repurchases are affected differently by upside and downside liquidity, which respectively correspond to positive and negative return days. Using a sample of U.S. publicly-listed firms over four decades, we demonstrate that upside liquidity has a larger effect on repurchase initiation, amount, and ratio. Managers of repurchasing firms are more concerned with upside liquidity because they expect their repurchase activities to propel stock prices upward rather than down. The relationship between liquidity sidedness and repurchase decisions is more pronounced for financially constrained firms but less so for firms with higher stock price informativeness. We mitigate potential endogeneity concerns by using the market and industry liquidity sidedness as instruments and exploiting the 2003 Amendment to SEC Rule 10b-18 as an exogenous shock to the information advantages of repurchasing firms. Overall, our findings underscore the importance of market microstructure in shaping corporate policies.

Sex-related variability of white matter tracts in the whole HCP cohort

Behavioral differences between men and women have been studied extensively, as have differences in brain anatomy. However, most studies have focused on differences in gray matter, while white matter has been much less studied. We conducted a comprehensive study of 77 deep white matter tracts to analyze their volumetric and microstructural variability between men and women in the full Human Connectome Project (HCP) cohort of 1065 healthy individuals aged 22–35 years. We found a significant difference in total brain volume between men and women (+ 12.6% in men), consistent with the literature. 16 tracts showed significant volumetric differences between men and women, one of which stood out due to a larger effect size: the corpus callosum genu, which was larger in women (+ 7.3% in women, p = 5.76 × 10–19). In addition, we found several differences in microstructural parameters between men and women, both using standard Diffusion Tensor Imaging (DTI) parameters and more complex microstructural parameters from the Neurite Orientation Dispersion and Density Imaging (NODDI) model, with the tracts showing the greatest differences belonging to motor (cortico-spinal tracts, cortico-cerebellar tracts) or limbic (cingulum, fornix, thalamo-temporal radiations) systems. These microstructural differences may be related to known behavioral differences between the sexes in timed motor performance, aggressiveness/impulsivity, and social cognition.

Weibull distribution as a criterion of emergency levels

In the exploitation of machinery and equipment, one of the most important parameters is the dynamic state of the object. Observing residual processes is the most popular method of assessing the dynamic state. In particular, dynamic residual processes are a carrier of diagnostic information. Measuring the vibrations and noise of working mini-mining machines provides knowledge about the dynamics of the assessed machinery. Many years of knowledge and experience have allowed for the creation of diagnostic procedures. Within most machines used in the industry, the procedures considered standard allow for an effective diagnostic assessment and optimal management of mini-mining machine exploitation. The applicability of these standards is quite wide. However, there are machines with parameters that prevent the application of said standards. Mini-mining machines used in subterranean mining are one of these machines. In the case of diagnostic assessment of continuous miners, chain conveyors, as well as other machinery used in the technological chain, the usage of assessment brackets consistent with adopted standards is incorrect. In the diagnostic assessment of these types of mini-mining machines, an analysis of long-term trends is often used. The determination of acceptable vibration levels is obtained heuristically through observations of the damage up to the state of emergency. In the article, methods of mini mining machines state assessment using models of machine degradation, using Weibull distribution, are presented. The presented method has been used in real results of vibration measurement of underground machinery used in a coal mine. The analyses showed a large effectiveness of the presented method.

In vitro model to evaluate effect of acidic pepsin on vocal fold barrier function

The pathophysiology of laryngopharyngeal reflux (LPR) and its impact on the vocal fold is not well understood, but may involve acid damage to vocal fold barrier functions. Two different components encompass vocal fold barrier function: the mucus barrier and tight junctions. Mucus retained on epithelial microprojections protects the inside of the vocal fold by neutralizing acidic damage. Tight junctions control permeability between cells.Here we developed an in vitro experimental system to evaluate acidic injury and repair of vocal fold barrier functions. We first established an in vitro model of rat vocal fold epithelium that could survive at least one week after barrier function maturation. The model enabled repeated evaluation of the course of vocal fold repair processes. Then, an injury experiment was conducted in which vocal fold cells were exposed to a 5-min treatment with acidic pepsin that injured tight junctions and cell surface microprojections.Both of them healed within one day of injury. Comparing vocal fold cells treated with acid alone with cells treated with acidic pepsin showed that acidic pepsin had a stronger effect on intercellular permeability than acid alone, whereas pepsin had little effect on microprojections.This result suggests that the proteolytic action of pepsin has a larger effect on protein-based tight junctions than on phospholipids in microprojections. This experimental system could contribute to a better understanding of vocal fold repair processes after chemical or physical injuries, as well as voice problems due to LPR pathogenesis.

Delivery mode is a larger determinant of infant gut microbiome composition at 6 weeks than exposure to peripartum antibiotics.

Background. Previous research has shown that delivery mode can shape infant gut microbiome composition. However, mothers delivering by caesarean section routinely receive prophylactic antibiotics prior to delivery, resulting in antibiotic exposure to the infant via the placenta. Previously, only a small number of studies have examined the effect of delivery mode versus antibiotic exposure on the infant gut microbiome with mixed findings.Objective. We aimed to determine the effect of delivery mode compared to antibiotic use during labour and delivery on the infant and maternal gut microbiome at 6 weeks post-partum.Methodology. Twenty-five mother-infant dyads were selected from the longitudinal Queensland Family Cohort Study. The selected dyads comprised nine vaginally delivered infants without antibiotics, seven vaginally delivered infants exposed to antibiotics and nine infants born by caesarean section with routine maternal prophylactic antibiotics. Shotgun-metagenomic sequencing of DNA from stool samples collected at 6 weeks post-partum from mother and infant was used to assess microbiome composition.Results. Caesarean section infants exhibited decreases in Bacteroidetes (ANCOM-BC q<0.0001, MaAsLin 2 q=0.041), changes to several functional pathways and altered beta diversity (R 2=0.056, P=0.029), while minimal differences due to antibiotic exposure were detected. For mothers, caesarean delivery (P=0.0007) and antibiotic use (P=0.016) decreased the evenness of the gut microbiome at 6 weeks post-partum without changing beta diversity. Several taxa in the maternal microbiome were altered in association with antibiotic use, with few differentially abundant taxa associated with delivery mode.Conclusion. For infants, delivery mode appears to have a larger effect on gut microbiome composition at 6 weeks post-partum than intrapartum antibiotic exposure. For mothers, both delivery mode and intrapartum antibiotic use have a small effect on gut microbiome composition at 6 weeks post-partum.

Simulation with a standardised patient to reduce stigma towards people with schizophrenia spectrum disorder among nursing students: A quasi-experimental study

ObjectivesThis study examined the effectiveness of simulation with a standardised patient on the perception of stigma associated with schizophrenia among undergraduate nursing students. It also assessed the reliability of the AQ-27 questionnaire in this context. MethodA quasi-experimental study without a control group was conducted on a non-probabilistic sample. The simulation programme used a standardised patient portrayed by a nurse with mental health experience. ResultsAfter simulation, statistically significant stigma improvements were found in six out of nine dimensions; anger and help obtained larger effect sizes (r = 0.392 and 0,307, respectively). Regarding gender, the intragroup analysis revealed that simulation improved stigma among women in six dimensions and among men in four dimensions, with anger and fear showing the highest effect size (r = 0.414 and 0.446, respectively).Regarding previous contact with mental illness among the study participants, the intergroup analysis did not show differences. In the intragroup analysis, simulation improved fear only in the contact group (p = 0,040, r = 0.353). In contrast, simulation changed the response in six dimensions in the no-contact group, similar to the entire group. ConclusionSimulation with a standardised patient is an effective teaching tool for reducing the stigmatisation of people with schizophrenia, thus reducing people's perception of internal causal attribution. It allows for experiencing situations that may be anticipated in clinical practice and reflectively addressing emerging aspects during simulation.

Assessment the impact of drought on vegetation carbon source/sink at a spatial scale and identify the dominant factors in the Middle Reaches of the Yellow River Basin, China

Drought poses a severe threat to terrestrial ecosystems’ carbon sequestration function, which in turn affects regional sustainable development. Understanding its impact on carbon source/sink dynamics is crucial for addressing extreme climate change challenges. This study, based on the Carnegie-Ames-Stanford approach (CASA) model and soil heterotrophic respiration equation, the Net Ecosystem Productivity (NEP) of the middle reaches of the Yellow River Basin (MRYRB) from 2001 to 2019 were estimated and utilized to characterize the vegetation carbon source/sink. Additionally, four factors, namely, average surface temperature (AST), root-zone soil moisture (RM), drought frequency (DF), and drought intensity (DI), were selected and a multiscale geographically weighted regression (MGWR) model was applied to assess the dominant factors influencing vegetation carbon source/sink dynamics at the spatial scale. The results indicated that: (1) MRYRB vegetation acted as a carbon sink, showing an increasing trend. Carbon sink was primarily located in Shaanxi’s central region, while carbon source was primarily located in Inner Mongolia and Shaanxi’s northern part. (2) Both the extent and severity of drought in the MRYRB showed a mitigating trend, presenting a spatial distribution of high-intensity low-frequency and low-intensity high-frequency. (3) AST, RM, DF, and DI had larger effects on carbon source than carbon sink. AST dominated mainly in northern Shanxi and Shaanxi, RM in central Shaanxi and Gansu, while DI and DF were concentrated in central Shaanxi and northern Shanxi.

Freeway Revolts! The Quality of Life Effects of Highways

Abstract Why do freeways affect spatial structure? We identify and quantify the local disamenity effects of freeways. Freeways cause slower growth in central neighborhoods (where local disamenities exceed regional accessibility benefits) compared with outlying neighborhoods (where access benefits exceed disamenities). A quantitative model calibrated to Chicago attributes one-third of the effect of freeways on central-city decline to reduced quality of life. Barrier effects are a major factor in the disamenity value of a freeway. Local disamenities from freeways, as opposed to their regional accessibility benefits, had large effects on the spatial structure of cities, suburbanization, and welfare.

Far-red light effects on plant photosynthesis: from short-term enhancements to long-term effects of artificial solar light

Abstract Background and Aims Long-term exposure over several days to Far-Red (FR) increases leaf expansion, while short-term exposure (minutes) may enhance the PSII operating efficiency (ϕPSII). The interaction between these responses at different time scales, and their impact on photosynthesis at whole-plant level is not well understood. Our study aimed to assess the effects of FR in an irradiance mimicking the spectrum of sunlight (referred to as artificial solar irradiance) both in the long and short-term, on whole-plant CO2 assimilation rates and in leaves at different positions in the plant. Methods Tomato (Solanum lycopersicum) plants were grown under artificial solar irradiance conditions with either a severely reduced or normal fraction of FR (SUN(FR-) vs. SUN). To elucidate the interplay between the growth light treatment and the short-term reduction of FR, we investigated this interaction at both the whole-plant and leaf level. At whole-plant level, CO2 assimilation rates were assessed under artificial solar irradiance with a normal and a reduced fraction of FR. At the leaf level, the effects of removal and presence of FR (0FR and 60FR) during transition from high to low light on CO2 assimilation rates and chlorophyll fluorescence were evaluated in upper and lower leaves. Key Results SUN(FR-) plants had lower leaf area, shorter stems, and darker leaves than SUN plants. While reducing FR during growth did not affect whole-plant photosynthesis under high light intensity, it had a negative impact at low light intensity. Short-term FR removal reduced both plant and leaf CO2 assimilation rates, but only at low light intensity and irrespective of the growth light treatment and leaf position. Interestingly, the kinetics of ϕPSII from high to low light were accelerated by 60FR, with a larger effect in lower leaves of SUN than in SUN(FR-) plants. Conclusions Growing plants with a reduced amount of FR light lowers whole-plant CO2 assimilation rates at low light intensity through reduced leaf area, despite maintaining similar leaf-level CO2 assimilation to leaves grown with a normal amount of FR. The short-term removal of FR brings about significant but marginal reductions in photosynthetic efficiency at the leaf level, regardless of the long-term growth light treatment.

Sustainable basalt fiber reinforced polyamide 6,6 composites: Effects of fiber length and fiber content on mechanical performance

The aim of this study is to explore the use of sustainable basalt fiber (BF) as compared to glass fiber and talc in injection molded engineering polyamide 6,6 (PA 6,6) plastic composite. Basalt fibers having lengths of 3 mm and 12 mm were added to PA 6,6 at 23 and 30 wt.% to fabricate the composites. The addition of basalt fiber restricts the mobility of the polymer chain in the composites, leading to its increased viscosity. Rheological results showed that the out-of-phase response to the applied stress indicated that the 3 mm basalt fiber composite could dissipate more energy, and the elastic behaviour of the composite under deformation increased with increasing basalt fiber wt.%. The fiber length had a larger effect on the mechanical properties of the composites as compared to the fiber load. The 12 mm basalt fiber composites at 23 wt.% and 30 wt.% produced higher tensile strength and modulus than the 3 mm basalt fiber composites while the 3 mm basalt fiber composite at 30 wt.% resulted in a 25 % increase in flexural strength. The experimental and the theoretical modulus predicted by the rule of mixtures showed an interaction between the matrix and the basalt fiber. Morphological analysis shows more agglomeration in composites with 3 mm fiber than the 12 mm. Glass fiber-reinforced PA 6,6 showed slightly higher performance than basalt fiber-reinforced PA 6,6. However, the basalt fiber-reinforced composites demonstrated better performance in tensile strength, flexural modulus, flexural strength, and heat deflection temperature than talc-reinforced composites.

Individualized epidemic spreading models predict epilepsy surgery outcomes: A pseudo-prospective study.

Epilepsy surgery is the treatment of choice for drug-resistant epilepsy patients, but up to 50% of patients continue to have seizures one year after the resection. In order to aid presurgical planning and predict postsurgical outcome on a patient-by-patient basis, we developed a framework of individualized computational models that combines epidemic spreading with patient-specific connectivity and epileptogeneity maps: the Epidemic Spreading Seizure and Epilepsy Surgery framework (ESSES). ESSES parameters were fitted in a retrospective study (N = 15) to reproduce invasive electroencephalography (iEEG)-recorded seizures. ESSES reproduced the iEEG-recorded seizures, and significantly better so for patients with good (seizure-free, SF) than bad (nonseizure-free, NSF) outcome. We illustrate here the clinical applicability of ESSES with a pseudo-prospective study (N = 34) with a blind setting (to the resection strategy and surgical outcome) that emulated presurgical conditions. By setting the model parameters in the retrospective study, ESSES could be applied also to patients without iEEG data. ESSES could predict the chances of good outcome after any resection by finding patient-specific model-based optimal resection strategies, which we found to be smaller for SF than NSF patients, suggesting an intrinsic difference in the network organization or presurgical evaluation results of NSF patients. The actual surgical plan overlapped more with the model-based optimal resection, and had a larger effect in decreasing modeled seizure propagation, for SF patients than for NSF patients. Overall, ESSES could correctly predict 75% of NSF and 80.8% of SF cases pseudo-prospectively. Our results show that individualised computational models may inform surgical planning by suggesting alternative resections and providing information on the likelihood of a good outcome after a proposed resection. This is the first time that such a model is validated with a fully independent cohort and without the need for iEEG recordings.

Elevated Ambient Temperature Associated With Increased Cardiovascular Disease–Risk Among Patients on Hemodialysis

IntroductionAmbient temperatures have increased due to climate change in many parts of the world. Due to loss of renal function which impacts regulation of thermoregulatory mechanisms the ability to adapt and resilient to changing conditionals is particularly concerning among individuals with kidney failure. The aim of this study is to assess the effect of heat on mortality and health care utilization among US hemodialysis patients. MethodsWe conducted a retrospective analysis 2011-2016 in contiguous United States during warmer months among eligible dialysis patients identified in the United States Renal Data system. Daily ambient temperature was estimated on a 1 km grid and assigned to ZIP-code. Case-crossover design with conditional Poisson models were used to assess the risk of developing adverse health outcomes associated with temperature exposure. ResultsOverall, exposure to high temperature is associated with elevated risk for both mortality and health care utilization among hemodialysis patients. The risk ratios for all-cause mortality and daily temperature were 1.07 (95% CI: 1.03-1.11), 1.17 (1.14-1.21) for fluid disorder-related hospital admissions, and 1.19 (1.16-1.22) for cardiovascular event-related emergency department visits, comparing 99th percentile vs. 50th percentile daily temperatures. Larger effects were observed for cumulative lagged exposure three-days prior to the outcome and for Southwest and Northwest climate regions. ConclusionHeat exposure is associated with elevated risk for CVD-related mortality and health care utilization among this vulnerable population. Furthermore, the effect appears to be potentially cumulative in the short-term, and varies geographically.

Chronic angiotensin-converting enzyme inhibition attenuates frailty and protects against atrial fibrillation in aging mice

BackgroundAging is a major risk factor for atrial fibrillation (AF); however, not all individuals age at the same rate. Frailty, which is a measure of susceptibility to adverse health outcomes, can be quantified with a frailty index (FI). ObjectiveThis study aimed to determine the effects of angiotensin-converting enzyme (ACE) inhibition on AF and atrial remodeling in aging and frail mice. MethodsAging mice were treated with the ACE inhibitor enalapril for 6 months beginning at 16.5 months of age and frailty was quantified. AF susceptibility and atrial structure and function were assessed by intracardiac electrophysiology in anesthetized mice, high-resolution optical mapping in intact atrial preparations, patch clamping in isolated atrial myocytes, and histology and molecular biology in atrial tissues. ResultsEnalapril attenuated frailty in aging mice with larger effects in females. AF susceptibility was increased in aging mice but attenuated by enalapril. AF susceptibility and duration also increased as a function of FI score. P-wave duration was increased and atrial conduction velocity was reduced in aging mice and improved after enalapril treatment. Furthermore, P-wave duration and atrial conduction velocity were strongly correlated with FI score. Atrial action potential upstroke velocity (Vmax) and Na+ current (INa) were reduced whereas atrial fibrosis was increased in aging mice. Action potential Vmax, INa, and fibrosis were improved by enalapril and also correlated with FI scores. ConclusionACE inhibition with enalapril attenuates frailty and reduces AF susceptibility in aging mice by preventing atrial electrical and structural remodeling.