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The Eyes Have It-for Idiopathic Pulmonary Fibrosis: a Preliminary Observation.
No full textIntroductionThe disease origins of idiopathic pulmonary fibrosis (IPF), which occurs at higher rates in certain races/ethnicities, are not understood. The highest rates occur in white persons of European descent, particularly those with light skin, who are also susceptible to lysosomal organelle dysfunction of the skin leading to fibroproliferative disease . We had observed clinically that the vast majority of patients with IPF had light-colored eyes, suggesting a phenotypic characteristic.MethodsWe pursued this observation through a research database from the USA Veterans Administration, a population that has a high occurrence of IPF due to predominance of elderly male smokers. Using this medical records database, which included facial photos, we compared the frequency of light (blue, green, hazel) and dark (light brown, brown) eyes among white patients diagnosed with IPF compared with a control group of lung granuloma only (no other radiologic evidence of interstitial lung disease).ResultsLight eye color was significantly more prevalent in patients with IPF than in the control group with lung granuloma [114/147 (77.6%) versus 129/263 (49.0%], p ConclusionWe provide evidence that light eye color is predominant among white persons with IPF
Prospective multi-centric evaluation of upper cervical and infra-cervical sagittal compensatory alignment in patients with adult cervical deformity.
No full textPURPOSE:Reciprocal mechanisms for standing alignment have been described in thoraco-lumbar deformity but have not been studied in patients with primary cervical deformity (CD). The purpose of this study is to report upper- and infra-cervical sagittal compensatory mechanisms in patients with CD and evaluate their changes post-operatively. METHODS:Global spinal alignment was studied in a prospective database of operative CD patients. Inclusion criteria were any of the following: cervical kyphosis (CK) > 10°, cervical scoliosis > 10°, cSVA (C2-C7 Sagittal vertical axis) > 4 cm or CBVA (Chin Brow Vertical Angle) > 25°. For this study, patients who had previous fusion outside C2 to T4 segments were excluded. Patients were sub-classified by increasing severity of cervical kyphosis [CL (cervical lordosis): 10°] and cSVA (cSVA-low 0-4 cm, cSVA-mid 4-6 cm, cSVA-high > 6 cm) and were compared for pre- and 3-month post-operative regional and global sagittal alignment to determine compensatory recruitment. RESULTS:75 CD patients (mean age 61.3 years, 56% women) were included. Patients with progressively larger CK had a progressive increase in C0-C2 (CL = 34°, CK-low = 37°, CK-high = 44°, p = 0.004), C2Slope and T1Slope-CL (p < 0.05). As the cSVA increased, there was progressive increase in C2Slope, T1Slope and TS-CL (p < 0.05) and patients compensated through increasing C0-C2 (cSVA-low = 33°, cSVA-mid = 40°, cSVA-high = 43°, p = 0.007) and pelvic tilt (cSVA-low = 14.9°, cSVA-mid = 24.1°, cSVA-high = 24.9°, p = 0.02). At 3 months post-op, with significant improvement in cervical alignment, there was relaxation of C0-C2 (39°-35°, p = 0.01) which positively correlated with magnitude of deformity correction. CONCLUSIONS:Patients with cervical malalignment compensate with upper cervical hyper-lordosis, presumably for the maintenance of horizontal gaze. As cSVA increases, patients also tend to exhibit increased pelvic retroversion. Following surgical treatment, there was relaxation of upper cervical compensation
Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis.
No full textAlthough acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%-72.4%) and 44.9% (95%CI: 40.8%-49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87-4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21-4.99). There was no publication bias as evaluated by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality
Maternal vitamin D deficiency and developmental origins of health and disease (DOHaD).
No full textVitamin D is an essential nutrient that is metabolized in the body to generate an active metabolite (1,25(OH)2D) with hormone-like activity and highly diverse roles in cellular function. Vitamin D deficiency (VDD) is a prevalent but easily preventable nutritional disturbance. Emerging evidence demonstrates the importance of sufficient vitamin D concentrations during fetal life with deficiencies leading to long-term effects into adulthood. Here, we provide a detailed review and perspective of evidence for the role of maternal VDD in offspring long term health, particularly as it relates to Developmental Origins of Health and Disease (DOHaD). We focus on roles in neurobehavioral and cardiometabolic disorders in humans and highlight recent findings from zebrafish and rodent models that probe potential mechanisms linking early life VDD to later life health outcomes. Moreover, we explore evidence implicating epigenetic mechanisms as a mediator of this link. Gaps in our current understanding of how maternal VDD might result in deleterious offspring outcomes later in life are also addressed
Systems modelling as an approach for eliciting the mechanisms for hip fracture recovery among older adults in a participatory stakeholder engagement setting.
No full textIntroductionDue to an aging population, the rising prevalence and incidence of hip fractures and the associated health and economic burden present a challenge to healthcare systems worldwide. Studies have shown that a complex interplay of physiological, psychological, and social factors often affects the recovery trajectories of older adults with hip fractures, often complicating the recovery process.MethodsThis research aims to actively engage stakeholders (including doctors, physiotherapists, hip fracture patients, and caregivers) using the systems modeling methodology of Group Model Building (GMB) to elicit the factors that promote or inhibit hip fracture recovery, incorporating a feedback perspective to inform system-wide interventions. Hip fracture stakeholder engagement was facilitated through the Group Model Building approach in a two-half-day workshop of 25 stakeholders. This approach combined different techniques to develop a comprehensive qualitative whole-system view model of the factors that promote or inhibit hip fracture recovery.ResultsA conceptual, qualitative model of the dynamics of hip fracture recovery was developed that draws on stakeholders' personal experiences through a moderated interaction. Stakeholders identified four domains (i.e., expectation formation, rehabilitation, affordability/availability, and resilience building) that play a significant role in the hip fracture recovery journey..DiscussionThe insight that recovery of loss of function due to hip fracture is attributed to (a) the recognition of a gap between pre-fracture physical function and current physical function; and (b) the marshaling of psychological resilience to respond promptly to a physical functional loss via uptake of rehabilitation services is supported by findings and has several policy implications
Mathematically Quantifying Non-responsiveness of the 2021 Georgia Congressional Districting Plan
No full textTo audit political district maps for partisan gerrymandering, one may determine a baseline for the expected distribution of partisan outcomes by sampling an ensemble of maps. One approach to sampling is to use redistricting policy as a guide to precisely codify preferences between maps. Such preferences give rise to a probability distribution on the space of redistricting plans, and Metropolis-Hastings methods allow one to sample ensembles of maps from the specified distribution. Although these approaches have nice theoretical properties and have successfully detected gerrymandering in legal settings, sampling from commonly-used policy-driven distributions is often computationally difficult. As of yet, there is no algorithm that can be used off-the-shelf for checking maps under generic redistricting criteria. In this work, we mitigate the computational challenges in a Metropolized-sampling technique through a parallel tempering method combined with ReCom[11] and, for the first time, validate that such techniques are effective on these problems at the scale of statewide precinct graphs for more policy informed measures. We develop these improvements through the first case study of district plans in Georgia. Our analysis projects that any election in Georgia will reliably elect 9 Republicans and 5 Democrats under the enacted plan. This result is largely fixed even as public opinion shifts toward either party and the partisan outcome of the enacted plan does not respond to the will of the people. Only 0.12% of the ∼160K plans in our ensemble were similarly non-responsive
Risk Of Venous Thromboembolism In Patients With Celiac Disease: A Systematic Review And Meta-Analysis
No full textBackground/Purpose: Deep venous thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE), are common medical conditions resulting in significant morbidity and mortality. Chronic inflammatory state has been increasingly recognized as a risk factor for VTE as several chronic inflammatory disorders, such as rheumatoid arthritis, inflammatory bowel disease and systemic lupus erythematosus have been shown to increase the risk of VTE in large epidemiological studies. However, the data on celiac disease, a chronic inflammatory disease affecting primarily the small bowel, remain unclear due to conflicting studies. Thus, to further investigate this possible association, we conducted a systematic review and meta-analysis of cohort and case-control studies that compared the risk of VTE in patients with celiac disease versus participants without it.
Methods: Two investigators (P.U. and K.W.) independently searched published studies indexed in MEDLINE and EMBASE from inception to September 2015 using the terms for celiac disease in conjunction with the terms "venous thromboembolism", "pulmonary embolism" and "deep venous thrombosis". A manual search of references of selected retrieved articles was also performed. The inclusion criteria were as follows: (1) cohort or case-control studies evaluating the association between celiac disease and VTE and (2) odds ratios, relative risk, hazard ratio or standardized incidence ratio with 95% confidence intervals (CI) were provided. Study eligibility was independently determined by the two aforementioned investigators. Newcastle-Ottawa scale was used to assess the quality of the included studies. RevMan 5.3 software was used for the data analysis. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. We used a random-effect model rather than a fixed-effect model in light of high likelihood of between study variance. Cochran's Q test and I2 statistics were used to determine the study's statistical heterogeneity.
Results: Out of 210 potentially relevant articles, 5 studies (4 retrospective cohort studies and 1 case-control study) were identified and included in our data analysis. The pooled risk ratio of VTE in patients with AS was 1.36 (95% CI, 1.08 to 1.72). The statistical heterogeneity of this meta-analysis was high with an I2 of 83%.
Conclusion: Our study demonstrated a statistically significant increased risk of VTE among patients with celiac disease with 36% excess risk
Ongoing Evolution of the Electricity Industry: Effects of Market Conditions and the Clean Power Plan on States
No full textThe electricity industry is evolving as changes in natural gas and coal prices, along with environmental regulations, dramatically shift the generation mix. Future trends in gas prices and costs of renewables are likely to continue moving the industry away from coal-fired generation and into lower-emitting sources such as natural gas and renewables. The U.S. Environmental Protection Agency’s Clean Power Plan (CPP) is likely to amplify these trends. The CPP rule regulates emissions from existing fossil generators and allows states to choose among an array of rate-based and mass-based goals. The analysis in this paper uses the electricity-dispatch component of the Nicholas Institute for Environmental Policy Solutions’ Dynamic Integrated Economy/Energy/Emissions Model to evaluate electricity industry trends and CPP impacts on the U.S. generation mix, emissions, and industry costs. Several coordinated approaches to the Clean Power Plan are considered, along with a range of uncoordinated “patchwork” choices by states. The model results indicate future industry trends are likely to make compliance with the Clean Power Plan relatively inexpensive; cost increases are likely to be on the order of 0.1% to 1.0%. Some external market conditions such as high gas prices could increase these costs, whereas low gas or renewables prices can achieve many of CPP goals without additional adjustments by the industry. However, policy costs can vary substantially across states, and may lead some of them to adopt a patchwork of policies that, although in their own best interests, could impose additional costs on neighboring states
Quantifying the Benefits of Balancing Area Expansion in China Southern Power Grid
No full textThe global energy sector is currently going through a transition, shifting away from the use of traditional fossil fuels into low-carbon or clean renewable energy sources (RES). While the adoption of RES into the grid continues growing, the intermittent nature of renewable supplies poses challenges to system stability and reliability. To overcome those challenges, balancing area expansion (BAE) could be a potential solution. This study quantifies the economic and environmental benefits of BAE using a case study in China Southern Power Grid (CSG). In this study, we modeled annual CSG system operation under two cases and compared the total system cost, emission, and reliability to quantify the benefits of BAE. The baseline case assumes each province within CSG operates its grid independently, while the consolidated operation case assumes the grids in all provinces are managed by one authority. We modeled the two cases using a Unit Commitment Model developed by the GRACE Lab Team, with slight modifications to match the CSG’s system better. Given its independent operation and similarities with the rest of the country, examining CSG sheds light on the prospects of expanding balancing areas on a national level
Spatiotemporal Behavior & Interactions of Neotropical Felids
No full textThe intraguild dynamics of apex and meso-carnivores contribute to the structure and resiliency of ecosystems, but temperature change and habitat loss threaten carnivores globally. This study explores the spatial and temporal behavior of four felid species (Puma concolor, Leopardus pardalis, Leopardus wiedii, and Leopardus tigrinus) in the Santa Lucia Cloud Forest Reserve (SL), near Quito, Ecuador. I used camera trap data from 2016 through 2022 to identify felid species and compare temporal trends in activity, distribution, and occupancy in relation to environmental factors. I then used the species-specific models to predict species occupancy in the unmonitored regions of the reserve. These results inform future monitoring efforts and provide insight into the extent of potential interactions among these four felids